Why We Couldn't Save Nicole

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Excerpt: School Project Awareness Video

Joseph Duda, whose sister Nicole died of a heroin overdose, interviewed several health professionals for a school project to help raise awareness of the realities of addiction.

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We learned about a whole range of treatment measures: detoxification; individual, group and family therapy; residential treatment; 12-step programs. And of course, medication. Like many (perhaps most) families of addicts, we were completely bewildered. I realize now that drug addiction and the problems in treatment have been old news for decades. But when it happened to us, it was news to us. We had little way of evaluating what we learned or figuring out what we didn't know.

Treatment options exist if families know how to navigate the system, says Mady Chalk, director of the Center for Policy Analysis and Research at the Treatment Research Institute in Philadelphia. "Families need to know the right questions to ask," she says, "and someone needs to help them figure it out." We talked to agencies, crisis hotlines and counseling centers, but we often got conflicting information, confusing us even more.

Relapsing

As days and then weeks passed, Nicole seesawed between wanting to resume a normal life and craving heroin. Having moved back with us temporarily, she talked about living drug-free, getting another job and returning to college in Frederick County. She smiled; She said she missed my cooking. Her friend Meagan came over, and we ate ice cream and joked about the old days in middle school. In those moments I recognized the laughing, affectionate daughter I'd taken to dance classes for 15 years.

But other days the grim hand of addiction reached out and grabbed Nicole, and she would hitch a ride with someone and head for Baltimore. She would tell us she had a court date (she'd been charged with speeding, drug possession, driving with a suspended license), or she was just going to the movies. When we called to check on her, we couldn't always locate her. Our hunts for her frequently lasted all night.

This is a normal pattern for most addicts; those who have successfully gotten clean say it took them several attempts over months or years. "They've been using and they keep using, because it gives them something, and they don't want to give that up," says Yngvild Olsen, a Harford County internist certified in addiction medicine and the medical director and acting deputy health officer for the county Health Department. "Yet they hate the life."

Three weeks after that pre-Thanksgiving confession, we got Nicole a spot at the local health department's drug treatment program. She began attending sessions two to three times a week, paying a fee ($20 a session) based on her meager income from a job at a restaurant. Most of the treatment was group therapy; there were also family sessions, which included us. We could see that the clinic was swollen with desperate clients, and the overworked staff members were clearly doing the best they could.

But Nicole's seesawing continued. She would disappear and call from an unknown location, saying she was fine. We wanted to believe her, despite the wobble in her voice, but we couldn't. When we asked the police to help find her, they said that because she was older than 18 she wasn't considered a runaway, but they would keep watch for her if she had a warrant from a missed court date. Many were sympathetic, but we mainly hunted on our own.

All this was made more difficult by the shame and fear surrounding addiction. I couldn't help but wonder if everyone I told would look at me as though I were an addict myself, or simply devoid of any moral character, and not as a frightened mother. Experts describe addiction as a chronic, relapsing disease, "like someone with diabetes that ends up with out-of-control blood sugar that may have been self-inflicted from not following his diet," in the words of Wilson Compton, director of the division of Epidemiology, Services and Prevention Research at the National Institute on Drug Abuse.

But when your kid falls off the wagon, don't expect the same attitude the diabetic gets. People tend to see addiction as an immoral choice, a character flaw. And even though treatment has been shown to reduce drug use by 40 to 60 percent, many people view it as a revolving door for addicts who thumb their noses at sober living. The media spotlight on celebrities who drop in and out of rehab doesn't help.

Since the public hasn't bought the disease model, Gimbel says, politicians aren't willing to invest more public dollars in treatment. "Politically speaking, it's more expedient to combat the drug problem by hiring more police and building more prisons," he says. "The public thinks we can arrest our way out of this problem."

Hoping for Detox

Over the next few months, Nicole continued the cycle of trying to quit and relapsing. When the pains of withdrawal became severe, she visited our local hospital emergency room. Each time, we hoped that she'd be whisked into detox, a three-day hospital stay during which doctors can prescribe medications, such as methadone, to ease withdrawal symptoms and replacement therapy for the addictive substance.

The problem is, most hospitals and local treatment programs don't offer detox. And few hospital ERs have addiction experts. "Detox is viewed separately from the treatment system," Chalk explains, and Nicole never got that kind of medical help.