Overdose is the leading cause of injury death for people 18-64 in America, and in most cases, opioids are to blame. What's being done in the Centennial State to fight this growing public health problem?
No one ever thinks he’s going to become addicted to drugs: You know better, or you’ve got too much going for you. Especially in Colorado, celebrated as the land of the happy and healthy, it’s easy to assume we’re immune from problems with drug abuse, which seems more applicable to the lifestyles of international celebrities (such as Prince, who died of a fentanyl overdose last April) or unsavory happenings elsewhere.
Thinking this way keeps the uncomfortable truth at a distance: Drug overdose is now the leading cause of injury death for Americans ages 25 to 64, and the primary culprit is a class of drugs called opioids. The category includes prescription painkillers (synthetics such as Vicodin, OxyContin, Percocet, and fentanyl) and illegal heroin (which is naturally derived from the opium in poppy seeds). In the last 15 years, opioid-related fatalities have quadrupled nationwide, and Colorado is a microcosm of that unsettling reality. It’s the only state the Substance Abuse and Mental Health Services Administration ranks as a top consumer of alcohol, marijuana, cocaine, and opioids for nonmedical purposes. And all but one of the state’s counties have seen a rise in deaths by overdose in the past decade. In Denver County alone, 123 people died from overdoses between January and October 2016; about two-thirds of them had opioids in their systems at their times of death.
What’s driving the epidemic? From the overprescription of pain pills to limited treatment capacity at clinics to easy access to heroin on the streets, the contributing factors are many. But one thing is for sure: “We can no longer say this is [just] a problem for people who are poor and people who are minorities and people who don’t have moral strength,” says Thea Wessel, an addictions counselor and president of the Colorado Association of Addictions Professionals. “This is affecting everyone in some capacity.”
This past July, Congress passed the Comprehensive Addiction and Recovery Act, which calls for $181 million for new research and treatment programs. (The Centennial State’s portion will be awarded in 2017, following an extensive application process.) Coloradans, too, are collaborating on innovative solutions. We talked to the state’s public health specialists, counselors, pharmacists, doctors, scientists, and recovering addicts for a glimpse inside opioid addiction and a look at how they’re working together to curb the problem.
Inside the Addiction: I, Robot
A Columbine survivor turns his turbulent journey with pain-numbing meds into a career helping other addicts recover their health and their lives.
—Photo by Morgan Rachel Levy
It’s a familiar story to many Americans: On April 20, 1999, two students entered Littleton’s Columbine High School and killed 12 teenagers and one teacher. That day, Austin Eubanks, a junior, was in the library when he was shot in the right hand and left knee—an event that precipitated Eubanks’ long battle with prescription drugs.
Over the weeks that followed, Eubanks’ physical discomfort and mental shock required serious medication; doctors gave him a month’s supply each of Percocet and Vicodin (for pain) and Klonopin (a benzodiazepine, for sleep) with the option for refills. “With the combination of those drugs, you can turn yourself into a robot,” he says. “You don’t have to feel anything.”
After graduating from high school and foregoing college, Eubanks built a career in advertising and adopted a lifestyle of hard drinking and late nights. Drugs marked the rhythm of his daily routine: Adderall would kick-start his mornings and fuel his days; OxyContin kept him “functional”; and Xanax provided a knockout punch at night. Seven years passed before Eubanks’ then wife and parents forced him to enter a 30-day residential treatment program.
During that first rehab stint, Eubanks realized his pill-popping habit might be a bigger deal than he’d let himself believe. “I’d been holding on to this false core belief that because of what happened to me, I needed those drugs to function,” he says. “But in treatment, I saw people who were abusing cocaine and heroin, and I thought, Their stories sound really familiar.” Still, Eubanks relapsed almost immediately once he returned to the real world. At the height of his addiction, he was swallowing more than 400 milligrams of OxyContin and 90-plus milligrams of Adderall per day. (For perspective: A doctor would likely prescribe about five milligrams of Oxy to an adult with a broken arm.) He would go through three other rehab programs before he became sober on April 2, 2011, almost 12 years after that shattering day at Columbine.
Today, Eubanks helps other addicts find paths to recovery as the chief operations officer at the Foundry Treatment Center, a private facility in Steamboat Springs that opened in 2015 to combat the increase in overdoses. “We approach recovery from a place of empowerment,” he says. “We’re empowering clients to have lives that are so great they can’t imagine going back to addiction.”
Accelerated heart rate. Trouble breathing. Death. The physiological effects of a drug overdose—an event in which you’ve taken more of a substance than your body can metabolize or, in the case of prescription drugs, more than the prescribed amount at one time—can be traced to a change in brain chemistry. Here, Ryan Bachtell, associate professor of neuroscience at the University of Colorado Boulder, walks us through the effects opioids have on parts of the central nervous system.
THIS IS YOUR BRAIN
1. Mesolimbic system: This network regulates your senses of pleasure and pain. Whenever you have an enjoyable experience, like eating your favorite food or having sex, neurons in the midbrain release a chemical neurotransmitter called dopamine. This chemical then binds to receptors (proteins found throughout the body, including in the brain and spine), signaling to other areas of the brain that you’re enjoying yourself—and telling them to file that detail away for future use.
2. Prefrontal cortex (PFC): The PFC deals with integral cognitive processes such as critical thinking and risk perception; the PFC also controls a part of the brain stem that responds to stress and panic.
3. Brain stem: This part of your brain is responsible for basic functions such as sleep, respiration, and heart rate.
*Coloring shows functional activity in the brain. Cool colors indicate that the brain is calm, and warm colors indicate hyperactivity.
THIS IS YOUR BRAIN ON DRUGS
Mesolimbic system: The structures of prescription opioids and heroin imitate those of specific natural neurotransmitters, meaning they can bind to the same receptors and trick neurons into sending excessive amounts of dopamine (two to 10 times more than normal) through the brain’s reward circuit. Since the brain doesn’t naturally process that much of the feel-good chemical at once, it registers drug use as the best possible experience, creating an incentive to use again and again.
Prefrontal cortex: This region isn’t fully formed until age 25 or 26. Until that age, people can have a harder time assessing the danger level of a particular act (say, injecting heroin). And no matter your age, opioids reduce PFC activity, leaving you more likely to make risky decisions.
Brain stem: Heroin and many commonly abused prescription opioids are depressants, so they’ll slow your breathing and your heart rate.
THIS IS YOUR BRAIN ADDICTED TO DRUGS
Mesolimbic system: The more opioids you use, the more your tolerance will grow, and the more dopamine your reward circuit will need to reach the same artificially elevated level of pleasure you’re craving. Only a higher (or stronger) dosage can send ever-larger amounts of dopamine through your system, trapping you in a cycle of hard drug use.
Prefrontal cortex: Habitual drug use damages this region—sometimes so badly that you pursue dangerous activities (like shooting up just one more time) instead of alerting you that your decision could have fatal consequences.
Brain stem: As dependency increases, your body will try to offset the drugs’ effects. For instance, your brain stem will tell your lungs to work more quickly right before you inject heroin because it knows the drugs will cause them to slow. But there’s only so much your respiratory system can do. Once you’re oxygen-deprived, your entire brain begins to falter, and you’ve overdosed.
—iStock Photos (3)
Needling At Us
As many as four in five addicts’ first habit-forming drug is a prescription opioid, thanks to easy initial access and the possibility of accidental dependency. About one-third of Coloradans have admitted to using pain medications prescribed for someone else, while 25 percent of us have used pills for something other than what our doctor instructed. But how do users get hooked on illegal heroin, which is often injected intravenously?
> Heroin produces a similar high to prescription opioids at a much lower price—and the street drug tends to be easier to obtain long-term.
> According to the Drug Enforcement Administration, dealers are starting to lace heroin with fentanyl—the fast-acting prescription opioid—to create a stronger, more euphoric high.
> Following the legalization of marijuana in Colorado, Mexican drug cartels have pushed more heroin into the state to compensate for their losses in black-market revenue, say law enforcement agents.
> The withdrawal symptoms (vomiting, muscle spasms, and insomnia, to name a few) are so aggressive that many heroin addicts refer to their drug use as “staying well” instead of getting high.
7: The number of Colorado counties whose residents are at the highest risk for opioid abuse and overdose, from urban (Denver, Boulder) to suburban (Adams, Arapahoe) to rural (Jefferson, El Paso, Pueblo) –Colorado Department of Human Services
Are doctors and dentists giving out too many painkillers?
If you’ve had your wisdom teeth removed, you might have gone home from surgery with a prescription for 20 Vicodin or Percocet. Yes, your gums might have been sore, but did you really need so many opioids for minor surgery? Probably not, says Robert Valuck, a professor at the Skaggs School of Pharmacy at the University of Colorado Anschutz Medical Campus and the coordinator of the Colorado Consortium for Prescription Drug Abuse Prevention. In fact, a 2016 study at the Dartmouth-Hitchcock Medical Center in New Hampshire found that patients undergoing outpatient procedures needed, on average, only 43 percent of their prescribed opioids. The extra pills, he says, are part of the addiction problem: Most prescription drug addicts initially get hooked on meds given to them by someone who hasn’t disposed of unused pain pills.
It’s a trend that began almost three decades ago. As Valuck tells it, the mid-’80s saw a push within the medical profession to better relieve pain. Providers began to identify pain as the “fifth vital sign,” and painkiller prescriptions surged. Then, in the mid-’90s, insurance companies started handing out care assessments to patients, who would rank how well their pain had been treated. If a practice received high scores, its providers would collect more reimbursements—an incentive to prescribe stronger or more medication. The U.S. Department of Health and Human Services now manages these assessments, though they continue to reward practices’ pain-treatment scores—which still affect reimbursements.
Today, the Colorado Medical Society partners with its accredited hospitals to offer popular continuing education courses on best practices in opioid prescription. Still, Valuck says attempting an about-face in the way meds are prescribed is like spinning an ocean liner 180 degrees: “It’s very hard to do because it’s a gigantic ship, and many forces continue to push it the way it’s going.”
The Why Factors
Here’s a grim reality check: According to the Substance Abuse and Mental Health Services Administration, Colorado is the only state ranked as a top consumer of alcohol, marijuana, cocaine, and opioids for nonmedical purposes. Sure, genetics, age, and life experiences all influence who turns to drugs—and who becomes addicted—but what’s behind our propensity for mind-altering substances?
The MJ Effect
Before the legalization of marijuana, recreational users might have smoked weed before they hit the bar. Now, the thinking goes, they tend to use harder substances for a pre-game high. “You don’t want to smoke weed [before going out] because you smoke weed every morning,” says Rob Archuleta, who battled meth addiction for 11 years and founded Addict2Athlete, a Pueblo-based organization that combines CrossFit workouts with 12-step programs to provide addicts with a natural high.
Coloradans’ love of extreme athletics often results in painful strains, tears, and breaks; it’s logical that doctors might prescribe opioids for relief. The problem is predicting and measuring each patient’s pain threshold so as not to overprescribe narcotics when perhaps over-the-counter meds would do.
Going It Alone
The Rocky Mountain region’s frontier mentality of rugged independence might be a reason some Coloradans resist treatment and remain in cycles of self-abuse. “There’s a lot of good about that [mindset],” says Shannon Breitzman, former branch chief of the Colorado Department of Public Health and Environment’s violence and injury prevention division, “but it’s not so good when people feel like they can’t ask for help, especially with problems around emotional health or substance abuse.”
800: Coloradans who die every year from prescription painkiller overdose –Colorado Consortium for Prescription Drug Abuse Prevention
—iStock Photos (3)
Inside the Addiction: Downward Spiral
How a cycle of suffering led to a cycle of addiction for one Pueblo woman.
—Photo by Morgan Rachel Levy
When she was 11 years old, Kristy Rhodes was molested and raped by her mother’s boyfriend. A year later, she was raped a second time, by a classmate in the locker room after school. Before she was a teenager, Rhodes had turned to marijuana and booze as a way to cope with the trauma of her assaults.
Attempts to get back on track were met with new challenges. At 15, she quit weed and alcohol to focus on school. Then she got pregnant. By 22, she had divorced her abusive husband, whom she’d married in high school; a year later, her father—and biggest supporter—died. After each setback, Rhodes floundered; unaware of wellness and counseling resources in Pueblo, where she lived, she chose drugs as a coping mechanism.
By April 2013, Rhodes, then 27, had progressed from pot to pills to heroin. She had accrued several drug-related charges, and recognizing that she was a danger to her three kids, she sent them to live with her mother. She remembers staying in a hotel not 10 blocks away from her mother’s house and feeling powerless to choose seeing her children over getting high on heroin. It wasn’t until Rhodes’ six-year-old daughter texted her a picture she’d drawn of Jesus on the cross that Rhodes saw her struggles clearly. She broke down sobbing. “Once I felt that God forgave me,” she says, “I was able to forgive me.” That night, she prayed for a way out of her addiction. The next day, she was arrested for violating probation on a drug distribution charge and committing a robbery a month earlier.
Although she faced up to 22 years in prison, the judge sentenced her to five years of probation. His goodwill wasn’t misplaced: This past July, Rhodes got off probation two years early. In April, she’ll be four years clean after intensive outpatient rehabilitation and treatment at the Colorado Mental Health Institute at Pueblo. “I have a decent job; I have a vehicle in my own name that I’m making payments on,” says Rhodes, who works as an administrative assistant at a car company and volunteers with a faith-based after-school program to help guide the next generation away from the mistakes she made. “I’m actually a productive member of society. It’s sometimes just so crazy to look around and know where I could be.”
The Other Side
Addictions counselor Thea Wessel has made it her mission to understand how addicts think—and to help them shift their mindsets. Wessel, who runs a private practice and also works with inmates in such places as Denver County Jail and ADX Florence (the supermax prison), shares what she wants all of us to know about the growing population she serves.
What is the biggest misconception about addiction?
People reference the moral theory: “It’s your problem; you should just be able to stop.” But when I hear my clients’ stories, I don’t know if I’d be different [than them]. We’re all playing the [same] game, but it impacts us differently because we have different gear to handle it.
Give us some best practices in addiction therapy: What’s different about what you do?
This is an area where counselors think they don’t have to be specifically trained. But if you don’t understand what the drugs do to the body—the biochemistry and how it alters the brain—then you have limited ability to help someone find recovery because you’re missing a huge piece of the puzzle. I worked with a woman whose father died of a heroin overdose, and she was using [partial opioid] Suboxone because it isn’t heroin. I told her, “Opioids are made in a lab, but they have the same molecular structure as heroin, which is an opiate.” She’s eight years sober now. You have to create enough discomfort in the person that they’ll want to change.
Why is counseling an important part of the recovery process for addicts?
A lot of people who are addicted experienced some sort of trauma. There’s something about their lives that makes them not want to feel again, and the trauma gives them a reason to not engage with the world. What they don’t understand is that you can’t selectively numb; if you’re numb to disappointment, fear, and shame, you’re also numb to joy, happiness, and relief. Addiction treatment is not trauma treatment, but we can help people understand how they’ve become isolated and disconnected.
Why do you do this job?
Recovery is possible, and people do heal. We’re starting to change the dialogue. When my clients look at me and say, “Thea, you make me think”—I walk away knowing that I’m doing my job to the best of my ability.
The Way Forward
A sampling of programs and initiatives Coloradans have introduced to start reversing the drug overdose trend.
—Courtesy of Safe Rx
Initiative: Safe Rx
Location: Fort Collins
Premise: Dr. Sean Serell, an anesthesiologist, invented a prescription vial that uses a four-digit combination lock to prevent kids and teenagers from accessing their parents’ medications.
Initiative: Safe Disposal
Location: 25 locations throughout the state
Premise: These permanent “take-back” sites allow anyone to anonymously drop off prescription drugs, which can wreak havoc on the environment—including the water supply and aquatic and plant life—if flushed. The collected medications are incinerated.
Initiative: Prescription Drug Monitoring Program
Premise: Colorado pharmacists are required to upload patients’ prescriptions for controlled substances into a database so providers can determine when someone is “doctor shopping” to collect more pain pills. (Strangely, providers are not required to check the information before prescribing more meds.) This spring, pilot programs will help state officials figure out whether the program can be better integrated into providers’ workflow and help identify the sources of the state’s overdose problem. colorado.gov/pacific/dora/pdmp
Initiative: No Wrong Door
Location: Routt County
Premise: This nascent program allows addicts to turn themselves in to police without threat of arrest and ask for help getting treatment. Plus, any law enforcement official who comes across an addict using can give that person the option of treatment instead of jail time.
Initiative: Celebrating Lost Loved Ones
Premise: A manager at Broomfield-based GIS mapping company Esri lost his brother to a prescription drug overdose. In commemoration, in 2016 he launched an editable online story map, on which visitors can share the stories of loved ones lost to overdose.
Initiative: Communities That Care
Location: 30 towns throughout the state
Premise: Staffers from the Colorado Department of Public Health and Environment are working to implement evidence-based programs that will curb substance abuse and related issues in communities across the state. Programs cater to communities’ specific needs.
Premise: This three-year-old collaboration between legislators, pharmacists, educators, and public health officials is a state-level strategic plan that addresses the problem of prescription drug abuse through different working groups (such as Provider Education, Public Awareness, and
Safe Disposal) designed to address the problem from multiple angles. Its experts have consulted on many of the other initiatives above.
Getting Your (Medical) Fix
The case for medication-assisted treatment—and why it’s easier said than done.
MAT center locations across the state of Colorado; Shutterstock
For addicts, getting sober can be a two-pronged challenge: Not only are they dealing with the physical and mental symptoms of withdrawal—nausea, vomiting, uncontrolled shaking—but they also need to face any underlying trauma that compelled them to turn to substance abuse in the first place.
While some facilities advocate a complete abstinence method, most research points to medication-assisted treatment (MAT)—which includes both medicine (often a substance that’s like a drug addict’s version of a nicotine patch) and behavioral therapy—as the most effective method to combat addiction.
But finding a MAT center isn’t easy. Methadone—a medication commonly used in MAT—has a high risk of chemical dependency and is controlled very tightly by the Drug Enforcement Administration, making MAT clinics subject to heavy regulation (which translates into high operating costs). “You’d need to have over 100 clients for it to become cost-effective from a business standpoint,” says Marc Condojani, a licensed social worker and director of community treatment and recovery programs for the Colorado Department of Human Services. “In a rural community, there might be 25 people who need MAT, so having a methadone clinic there might be challenging.” Plus, few Colorado doctors are trained in MAT, likely because addiction medicine isn’t a lucrative specialty, says clinical pharmacy specialist Sunny Linnebur of the University of Colorado Hospital.
Currently, addiction treatment is considered an essential service under the Affordable Care Act, so Medicaid covers the patient’s cost of methadone and other MAT drugs like Vivitrol and Suboxone. Plus, in September, Colorado received a $950,000 grant from the U.S. Department of Health and Human Services toward the expansion of treatment options. Condojani says the state could use those funds in rural regions to create satellite medication units within existing health-care clinics that are associated with larger methadone clinics in more urban areas. These smaller sites would have fewer regulations, making it easier to get them up and running. Rural clients would still have to travel to receive counseling, but at least they could get their medications locally. “There are funding mechanisms in place to support it, but it’s [about] building the capacity and the workforce and many other continuing demands,” Condojani says. “We’re starting to make some headway with providers—not just in the behavioral health system but in primary health as well. That’s encouraging.”
We visited the Foundry Treatment Center’s residential program for drug and alcohol addicts in Steamboat Springs to find out what starting a zero-tolerance (i.e., cold-turkey) long-term recovery plan is like.
The following is a composite of patients’ experiences based on the author’s interviews and observations from her time embedded at the Foundry. Names are withheld to protect privacy. Individual experiences may differ.
FRIDAY, 9:03 a.m. En route. Hillsides and alpine lakes whip by, but you can’t focus on anything beyond your last high, which is fading into a painfully intense exhaustion. Your emotions bounce between resentment and anxiety about what’s to come over the next 90 days.
12:13 p.m. Detox. Buried in a strip-mall-like complex a few miles from the treatment center’s main residential ranch, the detox facility doesn’t scream rehab—but it becomes your prison during withdrawal. You shake. You vomit. You sweat through your clothes. You stare at the ceiling in the middle of the night, willing sleep but fighting chills and nausea atop soaked sheets. You wonder if you’ll ever feel like yourself again.
MONDAY, 12:45 p.m. Transfer. Down the road from the detox center, the 48-acre ranch where you’ll spend the next couple of months looks much like all the others along Highway 131. Surrounded by horse pastures and rolling hills, you’ll share sleeping quarters and a bathroom with at least one other recovering addict, and you realize that you won’t have the luxury of feeling sorry for yourself in private.
3:05 p.m. Education group. Addicts gather to share and discuss resources that can help in recovery. Some share blankets and banter like veterans who’ve done this before; you perch on a cushion and try not to touch anyone else as talk turns to social media. Older addicts don’t really relate to the topic, but the twentysomethings lament the constant stream of joyful Instagram posts that illuminates inadequacies in their own lives.
4:15 p.m. Meditation. Finding Zen has never been your thing, but here you are on a serene hillside, trying, per staff instructions, to isolate each of your senses on a guided meditation walk. Some participants grumble about the pungent whiffs that come with a working ranch. You find the earthy scent comforting and silently breathe it in.
TUESDAY, 7:35 a.m. Medication. A staffer watches you swallow your personal smorgasbord of pills—a “detox pack” of 30 vitamins and minerals, folic acid, and an antidepressant. It’s a bit time-consuming and makes you feel vaguely like a child, but the supplements are already helping you feel better than you have in years.
8:32 a.m. Morning opener. Today’s reading and discussion address a specific element of recovery: “Cleaning your side of the street.” It’s a common AA mantra that reminds you to worry about your own response during confrontations instead of the other person’s. It’s easy advice to digest—at least here, in this safe living room.
9:45 a.m. Wellness activity. The group gets shuttled to the Steamboat Movement Fest, where you nervously shrug off an invite to try your hand at some West African drumming. You’re four days in, and the last thing you want is to look ridiculous, especially without something to dull the embarrassment. Next, it’s African dance, and an instructor’s words ring in your ears: “When you are in a group, you’re never alone,” she says. “You may think you are, but you’re not. Just remember that this isn’t about perfection.” It’s a slow start, but eventually, you begin to feel the rhythm.
How to use a drug to prevent death by overdose.
One of the most effective tools to reverse an opioid overdose is naloxone, a medication that breaks the connection between the opioid and the receptor to which it attaches. (Note: You can’t get high off of naloxone, and it isn’t harmful if accidentally used.) Before 2013, only drug users could receive a naloxone prescription in Colorado—not the family and friends who’d be able to inject it in the case of an overdose. Now, thanks to expanded legislation, anyone can get the life-saving drug.
But naloxone isn’t useful unless you know when to administer it. With that in mind, the Colorado Naloxone for Life Initiative launched in late 2016 by sending naloxone to police officers and EMTs in the 17 counties with the highest drug overdose rates and offering 10 public trainings on administering the drug.
Lisa Raville, executive director of Denver’s Harm Reduction Action Center, advises friends and families to keep an eye on anyone who has engaged in the following risky behaviors. And, she says, if your loved one is exhibiting any of the signs of overdose listed below and you have access to naloxone, use it right away.
♦Started using after a long period of sobriety
♦Mixed alcohol with other drugs
♦Been using alone
SIGNS OF OVERDOSE:
♦Unresponsiveness (check by shaking or slapping)
♦Difficulty breathing or slow, shallow breathing
♦Foaming at the mouth
♦Excessive sweating or no sweating
Call 911 before following naloxone instructions.
Inside the Addiction: A Mother’s Story
Denver resident Valerie Medina’s 22-year-old identical twin sons, Daniel and Donovan, started using heroin when they were 17. They’re sober now. Here, Medina shares her journey as a parent of two addicts.
—Photo by Morgan Rachel Levy
My sons’ addictions started after they were prescribed Percocet for shoulder surgeries. They crushed up the pills and smoked them. Eventually, they could no longer afford pills on the street, so that’s when they got into heroin, which they bought from a dealer. They smoked it; they never injected. Even in their demented world, there were boundaries that scared them.
They grew up in Westminster in a nice area; it’s not like we were living in poverty. My parents were co-parenting with me, always providing everything I wasn’t able to (their dad was in prison for 10.5 years for criminally negligent manslaughter). A year before their father was getting out, he began writing to me, telling me how sorry he was. He wanted to be in the boys’ lives. For six months, he worked really hard on proving he was this good guy, and I married him. Two years later, though, I thought he was having an affair: He wasn’t coming home and wouldn’t answer my calls. Turns out, he was on heroin.
My sons weren’t exposed to their dad for most of their lives, but some of their behaviors mimic their father’s so closely. Part of that addiction component has to be genetic.
I denied some of the signs—well, really, every single sign. I would find these foil wrappers and think it was just teenage experimentation. After I went through a divorce, I finally could focus on them and nothing else, and it became too much for me to ignore. Once I figured out what was really going on, I blamed myself. I was a teen mom, so I already had that stigma, and I would think, Maybe I wasn’t a stable enough parent. But it really doesn’t matter who you are. There are district attorneys’ children who have become addicts.
I once told the boys that I didn’t think this would be a lifelong battle, and one of them said, “Heroin is an ugly mistress who will pop up when you least expect her.” So I would like to believe they’ll always be sober, but I’m not naïve. Right now, they’re in the right place. It makes me sad to think that they will struggle with everyday challenges. They’ll have to figure out how to cope. It’s a strange thing, addiction. As I’ve told people, I’ve never done heroin, but I’ve been abused by it.