Sister of Heroin

Life & Thoughts of a Heroin User's Sister

12 Steps: I am powerless over my inability to believe in them.

“I admit that I am powerless over heroin.”

Admitting this is a first step in a twelve step recovery program for heroin users.  It is the step that my brother is struggling with in rehab.

Through his attempts to get clean, my brother has told me that he believes that personal will and commitment is the key predictor of whether someone will stay clean.  In that regard, he doesn’t believe that anyone is powerless to their addiction.  It takes real power to stay off drugs, to change your life, to commit to overcoming your life’s biggest obstacle.

I don’t think he’s wrong.  Admitting powerlessness does not seem like a strength-based approach to recovery at all.  How is that inspiring or motivational?  “I’m powerless, but let me work these steps because somehow that might do something to improve my situation,” I think sarcastically.

I know that there are people that believe in the 12 steps, and there are people that have used that as their tool to live a life in recovery.  Good for them!  It’s certainly not an approach for everyone.

Months ago, in recovery between heavy heroin binges, my brother was attending several Narcotics Anonymous meetings each day in his attempts to stay clean.  I went to a few of them with him, always afraid to let him out of my sight.  They were fascinating.  I sat there listening to people’s stories of hitting rock bottom and finding hope and new lives.  It made me totally relate to the character in Fight Club who became addicted to attending group meetings as a “tourist.”  Now, were the meetings helpful?

Reminders that people get clean and stay clean are great.  Seeing hope in the eyes of those still struggling with addiction in the meetings is powerful.  Following the 12 steps?  Prescriptive.  Dated.  A bad fit for atheists.  Probably not the most effective tool.

I’ve read about some alternatives to 12 step programs that are out there, but the options seem fairly limited.  Many of them are just variations of 12 step programs tailored for atheists or Buddhists.  Very few group programs seem to deviate from the core model.  Let’s face it…the twelve step model was developed nearly a century ago.  The heroin epidemic we face now is unprecedented.  We need more and better tools to help people fight addiction with science-based, person-centered,  and strength-based approaches.  If you know of any supports like that that I can share with my brother, please comment below.  My search continues for new and better ways to think about recovery…



My brother is officially in his second week of rehab.  On Monday he was temporarily released for a court date.  After insisting that my brother waive all rights to any day passes at the rehab, the judge officially reinstated deferred adjudication.  Pending a successful three month rehab stint and a year of probation, my brother could still get out of this all without a felony.  One dares to hope.

Now that Joseph’s* rehab is in progress, he is being evaluated and reevaluated and receiving more counseling than ever before in his life.  The doctor’s first order of business was to put my brother on anti-depressants.  He certainly had seemed depressed to me when he was staying at my house.   Joseph’s depression mainly stems from the event that made him want to get clean again.

Earlier this year Joseph contacted me after months of not speaking to me and asked if he and his girlfriend Ashley* could rent a room at my house.  I was weary but I agreed provided that they would be willing to sign a lease.  They first arrived on a Saturday morning around 9 a.m. reeking of booze.  They had clearly been up all night drinking.  They slept most of the day and then left to work their night shifts waiting tables.  They came back home on Sunday around 3 a.m. and went to sleep shortly thereafter.  By 7 p.m. on Monday evening they still had not woken up.  Neither Joseph or Ashley had so much as gotten up to use the restroom, have a glass of water, or eat anything at all.  When they finally got up around 8 p.m. and headed out to their jobs, I did a quick search of their room.  The bloody cotton ball and the belt adjusted to arm’s width were all I needed to see.  I let my brother know that if he wanted to come back to stay then he would have to take a drug test.

He refused and a couple more months went by before I heard from him again.  “Will you please help me buy my prescription?” he asked by text referring to his suboxone.  I agreed to meet him at the pharmacy.  For a hug and chance to see his face, I spent $120 on his medication and another $20 buying him soda and some snacks.  “Ashley is sick so I’m going to share my medicine with her,” he told me.

Yet another couple of months later I was sitting at a bar having a sangria martini with my fiancé when I got the text message.  Joseph said that he was at the hospital and wanted to know if I would buy him some food.  I took him to dinner and he told my fiancé and I over dinner that Ashley had collapsed from pneumonia and was in the ICU.

It was another day before my brother texted me from the hospital and asked if he could come home with me.  “I’m done using,” he said, “and I just need to get out of here.”  Over the course of the next couple of weeks, while my brother suffered through his withdrawals, we occasionally went to the hospital to check on Ashley.  I always went because I could scarcely stand to let my brother out of my sight.

I learned what I think most people don’t realize about heroin. People die from heroin in other ways besides just acute overdose events.  Ashley had a heart infection caused by shooting up, most likely with a dirty and/or used needle.  She had not sought medical treatment when she started feeling ill and her lungs began swelling with liquid.  Joseph had finally taken her to the hospital when she started speaking gibberish and was too weak to walk on her own.  At the ICU, the medical staff put Ashley on a breathing tube and let us know that she may never be able to fully breathe on her own again.  A couple of weeks later, a nurse at the front desk told us that there was no longer anyone by Ashley’s name at the hospital.

My brother blamed himself for what had happened to Ashley.  Ashley had a long history of drug use.  She had even lost custody of her two children in another state.  Joseph claimed that Ashley had moved here to get clean and that he had gotten her using again.

Before Joseph was admitted to the rehab, we learned that Ashley had actually recovered (at least enough to breathe on her own) and was released from the hospital.  Contrary to what the doctors had told me, they did not attempt to detox Ashley and she was discharged with a heavy arsenal of pain killers.  Just like that, she was back in my brother’s life trying to see him.  Thankfully, Joseph got admitted to rehab without any major incidents, but I didn’t sleep for at least a week.

Joseph’s biggest challenge in rehab will be accepting that Ashley made her own decisions to use heroin.  He will also need to think long and hard about his relationship with her, and hopefully acknowledge that having her in his life is probably not the best decision for his recovery.  One of my worst fears is that he will finish rehab, go back to Ashley, and then we’ll never see him alive again.

*Names have been changed.


Recovery Ranch

The nights before my brother’s rehab admission were long and sleepless.  My brother was still maintaining his addiction schedule with prime activity hours being between 5 pm and 7 am.  Every time the door open and shut for my brother’s frequent cigarette breaks, I would wonder if he was coming back or if he’d try to make a run for it.  Ultimately he stayed and I could only hope that this meant that maybe this time would be different.

The rehab facility, located on a ranch, looked like a peaceful environment.  The rural landscape and the 70 degree temperatures made me almost want to go for a pleasant stroll.  Then I looked to the residential dorms and thought about the people housed inside.  This was anything but a peaceful place for the residents.  I was sure about that.  So many of the recovery ranch residents had to be experiencing such tremendous discomfort and unhappiness even at that very moment.  The atmosphere was clearly designed to evoke a sense a peace, but it brought me none and I’m sure that my brother felt the same way.

We had talked about his upcoming trip to rehab.

“I’ll fake it until I make it,” my brother had said to me when we talked about the 12-step programming.

My brother and I were raised under strict religious conditions as children.  Neither of us believe in God or adhere to any types of spiritual rituals, so needless to say, the 12-step program has not held much appeal to either of us as an effective method of treatment.

The bottom line was that my brother had to go to rehab to avoid having a felony heroin possession charge on his record.  As a result of the Affordable Care Act, substance abuse treatment is now covered by health insurance unlike ever before…but not for us.  Insurance companies generally will not fund court mandated rehab, they will not fund rehab for someone who has had a recent unsuccessful treatment (like my brother), and they will not fund rehab if it is not considered a medically necessary treatment.  Because my brother had not used heroin for more than sixty days and had not taken suboxone for more than thirty, there would be no detox and hence the insurance companies did not consider inpatient treatment to be medically necessary.

I say all that to get to the point that out-of-pocket rehab, with no assistance from any type of insurance coverage, is a huge expense and the non-twelve step programs are often only available at an even more premium rate.  When it came down to it, it was either pay ~$30K for three months of treatment or triple that for a non-twelve step treatment program.  Seeing as how we were already borrowing the money, it just didn’t make sense to us to pay a ridiculous rate for a non-twelve step program.  Twelve-step or not, most rehabs have a success rate around 15% so I personally could care less about which program we throw away our money on.

“Try to get something out of it,” I said to my brother as I hugged him goodbye.  He smiled and I continue to hope.

Needle with the Orange Cap

I found a needle in my house today.  My house which was once so clean feels tainted somehow.  I held the needle in my hand and uncapped it checking for blood.  No blood, but the needle had clearly been used.  The needle was in a backpack dirty with residue along with a lighter and a note from my brother’s estranged heroin user girlfriend.  “I hate to see you this way,” the note read.

It’s actually a bit more complicated than that.  My brother was recently released from jail with a chance to have no felony on his record on the condition that my family enroll him in an inpatient treatment program.  He came to live with me since I am the family member who has a career tied to substance abuse programming.

This afternoon my phone rang.  It was a call for my brother from a local agency that I had him contact months ago to get connected to their methadone clinic.  I took the phone to my brother’s room where he was sound asleep.  It was 1:00 p.m.  I woke him up and passed him the phone.  He spoke incoherently into the phone and was a bit giggly.  I hung up the phone.  “Are you fucking high?” I asked.  No coherent response.

My significant other volunteered to rouse my brother and take him to the store so I could check his room.  The search uncovered a phone message from my brother to his estranged girlfriend around 3:45 a.m. asking if she was still coming by.  This discovery was followed by the discovery of a hidden backpack and, of course, the needle.

Then came the confrontation and the denial.  The hungry look in his eyes when I presented the needle was so sickening.  He maintained that the findings were just a string of coincidences.  First he said that his girlfriend had never come and then hours later the story was that he and his girlfriend didn’t do anything when she came.  I had heard the lies and stories before.  I noticed his ADD medication laying on a windowsill untaken.  I thought about how he had asked for calamine lotion because he was itchy.  I realized that he hadn’t eaten anything all day.  So many of the symptoms were present.

Rehab intake is only days away.  Would a rehab report back to the court that my brother had to be detoxed?  Would such a report render the rehab useless in the eyes of the court?  Would we have to pay extra money out of pocket for detox services in addition to the $30K cost of the 90 day program?  Would it all be a waste yet again?

My significant other and I decided that the best course of action would be to administer a drug test.  If the test was clean, then great!  If the test was dirty, then there would be the calls to the lawyer and to family members to decide what to do next.

It was such a long five minutes. My brother, already depressed from his recent month in jail, sat slumped against a wall staring into space.  It pained me to see him that way.  Trusting in recovery is hard…wondering if your brother will forgive you for not trusting is even harder.

The test came out clean. I immediately apologized for not believing him, but the damage had been done. There is sadness in the house that can’t quite be shaken.  I guess I’ll approach it just like everything else in recovery…I’ll take things one day at a time.

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