Why We Couldn't Save Nicole

Finding Treatment for Addiction Was Harder Than We Thought

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.
By Jacqueline M. Duda
Special to The Washington Post
Tuesday, October 7, 2008; Page HE01

We're a hardy family, used to weathering all manner of surprises as we've seen four kids through various stages of toddlerhood, childhood and adolescence. So when our fun-loving 22-year-old, Nicole, shocked us by admitting a heroin addiction and asked for our help in overcoming it, my husband and I froze only an instant. Then we leapt into action, firmly believing that with the aid of 21st-century medical treatment, we could help her reclaim her life.

Surely, we thought, college-educated suburbanites like us could locate professional help: drug counselors, doctors, therapists specializing in addiction. Surely detoxification centers would treat desperate addicts and work out a payment plan. Surely we could check her into some kind of residential treatment program with a minimum of delay.

We were wrong.

The next several months of trying to get her affordable treatment were like entering some unknown circle of hell. Then the world as we knew it came crashing down when two policemen showed up -- two years ago yesterday -- to tell us that Nicole had been found dead of an accidental overdose.

We're still adjusting to life in a reconfigured family that bumps along like a wagon missing a wheel. Meanwhile, we continue to probe the gaps in the addiction treatment system to share what we learn in hopes of helping others avoid tragedy.

The Nightmare Begins

The phone rang at 4 a.m. on the day before Thanksgiving 2005. Nicole, living in Savage, always came home for holidays, but that's not why she was calling that night. She was experiencing raging withdrawal symptoms -- vomiting and muscle tremors -- and fear and physical pain forced her to reveal her addiction.

Our first response was to leave our suburban enclave outside Frederick and take Nicole to the nearest emergency room, assuming staff there would admit her directly into some kind of treatment. How naive. Instead, an ER doctor gave her a clonidine patch and said it would take the edge off her cravings. Then he released her.

He handed us a single sheet of paper listing dozens of drug treatment facilities in Baltimore. A sentence at the top advised us to call the clinics every day, be polite and not burn any bridges. That puzzled me, at first. Weeks later, with no progress toward finding help for Nicole, I understood the admonition better.

During this initial foray into the drug-treatment world, we trolled the Internet night and day. We Googled "heroin addiction" and thumbed through phone books. It wasn't that there was no information; the information overwhelmed us, without providing answers. We called one place after another. But when private clinics learned that Nicole had no insurance and had been determined ineligible for Medicaid, most simply said "sorry" and hung up; and at $15,000 to $25,000 for a 28-day residential stay, they were out of middle-class reach.

The public, government-funded centers were stuffed to the gills, often with patients from prison-related programs. As one counselor told us, an addict can get in faster if he commits a crime than if he just asks for help. "There is a false sense in the public that treatment is one phone call away," says Mike Gimbel, former director of substance abuse education and prevention at Baltimore's Sheppard Pratt Health System, now president of his own consulting firm. "It's a crisis, because people believe they can get help, and it's not there."

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