Photo by Matthew T Rader on Unsplash

John Doe, age 26, born on 3/16/94, died alone on 11/15/19. He was not surrounded by family or friends. He died in agony and pain. He struggled until the end to be the person that others wanted him to be, what society told him he had to be, and in the end, he determined that he could never be that person. He did not leave a note, who would read it anyway? To him, no one cared. He was all alone.

Although I have changed the name, the information is real. Another person lost. By now, I should be desensitized to it but the truth is that it never gets easier; it gets harder. It always gets harder. Every one of these deaths is preventable and every death stabs you in the chest with the realization that we, as a society, failed the person lost. This weight is especially difficult for those of us that have been able to find a way to treat or stop our substance use. Many of us find our way to service or social work after we treat our substance abuse, and this can send us to reach out for those still using or keep us close to the front lines with those who need our help the most.

As I pitched this piece to Beth Weise, she shared her personal experience with the love and loss caused by addiction. She shared with me, during my time in treatment, my cousin also entered into treatment. We became close, as happens with people who use and have used substances, you relate to each other, and even if the words are never spoken out loud, you know things about each other that no one else will ever know about you because they have never been through what you have been through. We built new hobbies together and explored new things to fill our time now that we were no longer using substances. She was quite younger than I was but mature beyond her years. I always told her I’d wished I could have found treatment at her age because I felt like she had so much life ahead of her and I had lost most of mine to using and was facing many more barriers to reintegrating into society than she was. But then one day she relapsed, and she didn’t survive. Her death was tragic, it was unnecessary, and it rocked me to my core. She was so young, so much life left, so many dreams she had yet to reach for. Why her? Why was it not me? Why did I get to survive, and she didn’t? Who makes these decisions? And who is going to understand how guilty I feel for not being able to save her? Even now, years later, these are still the feelings I have every time I find out we lost another person to an opioid overdose.

Within the substance using community, death happens on many levels, and many times before the permanency of the final time. Death, however, happens in phases as a person’s life is eroded and changed into something unrecognizable. Something so different from what they used to know as themselves that the road back doesn’t even look possible anymore. Long before a person dies physically, they have died emotionally, spiritually and, often, socially. In some instances, their family and friends have considered them dead long before the person actually loses their battle with substance abuse, either as a way of coping or out of anger and trauma for the situation with their loved one.

“People who use drugs aren’t natural-born liars, they live in a world where they have to constantly lie to survive (for employment, housing, companionship). They aren’t naturally unreliable, they live in a world where drug use almost necessarily devolves into chaos from criminalization. They are naturally prone to homelessness, joblessness, untreated mental health, they live in a world…. That the system makes it nearly impossible for connection in meaningful ways, between the media vilifying people who use drugs, the state incarcerating people and turning them into permanent second class citizens, the health care system (mental and physical) abandoning them and families being erroneously told that the best thing they can do is disconnect from their loved ones, often when their loved ones need that connection the most.”

-Christopher Abert, Southwest Recovery Alliance

When people discuss those who are using drugs, typically it is someone who they view as being able to reenter society. However, I want you to consider as you read this, those who society has already written off. The people who have been pushed completely to the margins of our lives and the edges of society. The place where they are no longer seen as people anymore. You know the ones that cause you to turn up your music at the traffic light rather than hear their plea for money or the ones hiding in the shadows of an alley or park hoping to just get some peace and quiet before they are run off and forced to try and find another place to hide from the world.

During the last ten years, something has stood out to me when a person overdoses or dies by suicide, it is the people who mourn them or lack thereof. Who comments on their death? Who misses them? I am sure that at some point, they had someone who loved them, however at the end of their life, there was seemingly no one who mourned them. Did drug use devalue that person so much that their loss meant nothing?

It has been said that substance use is a progressive and fatal disease. From my experience, it happens in three stages; emotionally, spiritually, and socially. For some it is quick, but for many, it is a lengthy process. It can happen in any order, or not at all, but I suspect that through substance use, many people experience at least some of these.

Emotional death

Often, people who turn to substances, do so in an attempt to address emotional pain or trauma. With a lack of information or resources necessary for them to cope or treat the emotional pain or trauma, they are experiencing, at least substances can provide temporary relief from actually feeling the pain inside. The flip side of this is that substances destroy a person emotionally. Over time, the ability to have healthy emotions slip away and the person is only left with the most primitive of emotions, such as anger. They might not even know why they are angry, so they use even more drugs to cope with this feeling. This might be the first stage in a person slipping away or the first sign that they don’t see a way out of their substance use. I often hear families say that their loved one “isn’t the same as they used to be” or “they are always angry”. To me, this is the tell-tale sign that substance use is getting the best of them.

When a person is under the influence of substances, they have no emotions and when they are searching for substances their emotions are raging. There is no in-between and there is nothing being done to address the underlying pain that started the cycle to begin with, so it just gets shoved down deeper and deeper to continue to hurt them again another day.

Spiritual death

Faith and drug use do not go hand in hand. In fact, faith tends to fall apart in the face of substance abuse. I have heard people many times say that a person just “needs to have faith that they will get better” regarding their alcoholism or substance use. But how do you have faith when you have faith in nothing? Even the ones that do have faith are sometimes found to be angry at faith. How can one have faith in something that dealt them such a difficult road with substance use? The only thing that I had faith in when I was in the midst of using was that I could make myself feel better with more substances.

At the very core, society cannot stand people who use drugs. There is a strong disdain rooted in a moralistic failure by the person who uses substances. Moreover, we live in a society where prevention and treatment are driven by race and financial resources instead of need and compassion.

Let’s be honest, when you look at someone who is seen as a ‘drug user’ you look at them in disgust. They are a vile blemish on our community. This stigma can prevent them from reaching out and asking for help and can live with them even after they get treatment as they remember how they are seen by society.

This spiritual death experienced by the person who uses drugs is really their loss of hope. Why should they even try? That is the message received by so many people who use drugs from society with the current approach and mindsets.

Through the work that I do, I develop relationships with a vast array of people. People who have been pushed to the margins of society. My people are the ones that you generally cross the street when you see them coming. The people who are panhandling at the exit-ramp. I could go on but you get the picture. These are the folks that I identify the most with because they are authentic. We share a common experience. I know what it is like to stand in their shoes and they know that I care about them. Often, the only thing that they have is themselves so there is an authenticity that you do not often find with people if we just give these people a chance. The other thing is that a majority of the people that I work with go by a nickname. Sometimes it is due to a physical feature and other times it is simply a name given to them by friends or associates. Subconsciously, this is another way that people are erased from society while they are still a part of it.

We called him Red.

I had gotten to know Red from my time working with the needle exchange. Red did not have much but he was known to everyone in the neighborhood, and not always for the best of reasons. Red, through an injury at work to his ankles, had been prescribed opiates. The prescription grew to a dependence that morphed into an addiction. By the time I came to know him, I mostly saw the opioid and methamphetamine version of who he was. He would share with me how he longed for something better. He hated the person that be had become and he hated the drugs that changed him but didn’t know how to go back. This was the part of him many people didn’t get to know about him, the part of him they never gave a chance.

Red tried countless times to get straight. Depending on the day of the week, Red could be found at the exchange. He was always apologetic for his behavior and he never wanted to offend anyone. I knew his behavior was a survival mechanism that he used to mask the hatred he had for himself and his use. There came a point, however, that his behavior was too problematic. He would fight with other clients and there was a rare occasion when the dope man came to the needle exchange to collect a debt. Eventually, his temper and erratic behavior from meth required that he no longer come around the needle exchange. This is always difficult. This means no access to safe supplies, it means further isolation from people who can help him, in some cases, this is a death sentence.

We would still see Red in the neighborhood. One day he sent us a message that he was ready to go to treatment. We made the arrangements and away he went. He was really doing it. The neighborhood was quiet while he was gone. It was noticeable that he was not there. After his inpatient treatment, he returned to the neighborhood one last time to say his farewells. Again, he wanted to make sure that we were not mad at him. I remember what I told him that day. “Red, leave this neighborhood and don’t look back. This place will kill you.” He responded with, “I will Aaron, I promise, I will.” I hoped he was right.

He kept his promise for a while but eventually, he came back to the neighborhood. He had relapsed and started using opioids and meth again. Each time that I would see him, he apologized to me. Again, not wanting me to be mad or disappointed in him. This apologetic action has always stuck with me. It breaks my heart. People aren’t expected to apologize if their blood pressure goes up again after a period of control or if they reinjure their knee after an ACL surgery, so why do we place so much judgment on people who use substances that they feel like a failure or disappointment when they have a relapse when we know that relapse is likely to happen without prolonged treatment and support? I was not mad at him or disappointed.

The day arrived that we all dread when a couple of my needle exchange clients came to me and said that Red was dead in a vacant building. No one wanted to call the police out of fear for obvious reasons so Red had been in the vacant building a majority of the day. A co-worker and I ran down the street to the building. As I rounded the back of the building, there was trash and shrubbery that was overgrown in the backyard. There were no lights, no gas, and no water. This was not home. And it was definitely not a place that anyone should have to die at. As I entered the building, at the far end of the darkroom laid two mattresses on the floor. Over the edge of one of those mattresses, I saw his feet. There was no question, he was gone. I did not look him in the face, I did not want to remember him like that. No one should have to find someone like that and no one should have to remember someone like that.

What stood out to me was the way that he had died. Alone. Through his use, he had alienated himself from everyone. Everyone who loved him and everyone he loved. Although I know that he had family and people he called friends, his life were pushed to the point where he was shooting dope alone in a vacant building with no electricity, heat, or water. These are not conditions anyone should be pushed to endure.

In the room where we found him, we also found Narcan, the drug that could have reversed his drug overdose. The drug that could have saved his life. Alas, that was what his addiction looked like, having no one there who would or could save his life.

Red will never get another chance to seek treatment. His death is permanent, it is forever, and it was preventable. Resource access is so vital for people who use drugs to be safe and stay alive. The only way treatment fails 100% of the time is after a person dies. If Red had been at an overdose prevention site, he would still be alive. If my cousin had been at an overdose prevention site, she would still be alive. Meeting people who use drugs where they are at and providing them with the means to be safe shows them that they matter. It tells them they are people and they are cared about. It gives back hope and provides the social network that society takes away from them when they are using it.

Substance use causes a lot of pain and suffering. No one suffers more than the person who is living through it. Often while families are the most sympathetic, society seemingly assumes that the life of a person who uses drugs is just one big party and doesn’t care about them. Unless you have been on the perpetual hunt for substances to try and avoid being sick or stop the shakes, then you will never truly understand that there is really no party to be had.

Beth Weise

Beth Weise is up and coming doctoral student in the Neuroscience Interdisciplinary Program. Her interests have long focused on work to curb the opioid epidemic. Through outreach volunteering beginning during my undergraduate degree at the University of Missouri — St Louis and lab work during my time at Washington University in St. Louis, she developed a well-rounded understanding of the problems faced by individuals suffering from opioid use disorders and the mechanistic underpinnings of opioid and cannabinoid pharmacology via bench research. She focuses her efforts on the investigation of opioid/cannabinoid interactions using cannabinoids as a viable strategy to help individuals cease their opioid use to facilitate an end to the opioid epidemic.

I am a psychotherapist who writes about mental health, addiction, recovery and the impact of substance use from personal experience. Views are my own.

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