WHY WE COULDN'T SAVE NICOLE

Finding Treatment for Addiction Was Harder Than We Thought

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."

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.

Even if she had, we now know that we would have faced another race
after the three-day program to find follow-up clinical treatment
without interrupting her care. Timing is crucial: Every once in a
while, such as after a successful detox, addicts reach a point where
they actually want help, Gimbel says: "It's a little window, hours,
maybe days if you're lucky." But Chalk says that only about 25
percent of addicts who undergo detox make it into treatment within 30 days.

Nicole wanted to stay close to home, so I didn't look hard in
Baltimore. Months after she died, I found that a few hospitals there
offer detox, though they're overburdened and she might not have been
able to get in. Still, I agonize every day over my belated discovery
and wonder why the emergency room didn't have a resource book or some
automatic way of telling people like us where the detox units were.

In May 2006, after months on a waiting list for a bed, Nicole got
into the Joseph S. Massie Unit of the Allegany County Health
Department in Cumberland, Md. She stayed 30 days. My husband and I
visited every Sunday and Wednesday while friends watched our younger
children. I split myself into two people: one, the mom baking cookies
for the elementary school reading party; the other, a worried parent
driving more than 100 miles each way to visit her eldest at a treatment clinic.

It was the only time during these months that we relaxed a little bit
and felt she was safe. By the third week of treatment, I said to my
husband, "I'm starting to see the sparkle back in her eyes."

Nicole was released from Massie on a Friday. The following Monday,
she called us from the road: Instead of staying at the halfway house
where she was assigned after Massie, she had gone to live in Ocean
City. She said, "You know I love the ocean, Mom." She said she had a
job. Our hearts sank.

Losing the Fight

Over time, Nicole told us that she had been doing heroin for about
two years, starting at Baltimore dance clubs and parties. It was part
of the fun, she said; she didn't think she'd get hooked. Again, she
was not unusual. Rather than getting caught up in the whys, Gimbel
says, he wants people to understand that the most pressing need is to
find treatment. "Saying 'All they need is some willpower,' like we
used to with tobacco, doesn't work," he says. The drugs tell them
what to do 24 hours a day, and conniving, manipulative behavior
replaces their old personality. When the drug urges were great,
Nicole could always figure out a way to get them.

And that is what happened.

On Oct. 6, 2006, I was at my youngest child's elementary school
helping the teacher. The holiday season was approaching again, and we
expected Nicole to come home as usual. After school, the younger
girls and I picked up their brother, Joe, from cross-country
practice. Then we got the "visit." Two Frederick County police
officers showed up as I was preparing dinner. I left it burning on
the stove after they told us the words no parent ever wants to hear.

Nicole had been dead two days when she was found, after an all-day
party at the beach. She had alcohol, cocaine and methadone in her
system; the combination of depressants proved lethal. She'd been out
of Massie less than four months.

Families who know our experience come out of hiding to seek advice. I
see the same exhaustion and worry on their faces. I wince when I
overhear a crime drama on television refer to addicts as "crack hos"
or "junkies." I'm a parent advocate member of the National Council on
Alcoholism and Drug Dependence, Maryland Chapter. Each time I speak
at a drug treatment conference or interact with an addict in
recovery, I can't help but see Nicole and think: We can do better.