Anatomy of a Relapse

Will My Insurance Pay for Rehab?

Sponsored Legal Stuff - This is an advertisement for Service Industries, Inc., part of a network of commonly owned substance abuse treatment service providers. Responding to this ad will connect you to one of Service Industries, Inc.’s representatives to discuss your insurance benefits and options for obtaining treatment at one of its affiliated facilities only. Service Industries, Inc. Service Industries, Inc. is unable to discuss the insurance benefits or options that may be available at any unaffiliated treatment center or business. If this advertisement appears on the same web page as a review of any particular treatment center or business, the contact information (including phone number) for that particular treatment center or business may be found at the bottom of the review.

Anatomy of a Relapse

By James Renato 09/13/18

When my father died, I hadn’t been to a meeting in over a year. I had no active knowledge of how to apply healthy coping mechanisms to a devastating situation so I just went back to what I knew: opioids and numbness.

Image: 
Man in hoodie with hands covering his face.
No need to bother snorting or smoking whatever powder my dealer claimed to be heroin; I went right back to the needle.

Two years ago I wrote a controversial feature for The Fix, "I Take Psychedelic Drugs and I’m in Recovery." It was controversial in the sense that the response from the publication’s readers — many of whom have an obviously vested interest in topics related to addiction recovery — ranged from sarcastic, hyperbolic criticism to open-minded consideration, with some even condoning the perspective I was sharing.

The reason I chose to write this honest, albeit uncomfortable “Part 2” of sorts, is to do what folks in certain recovery circles do best (when at their best): share experience, strength, and hope, so that whoever may be listening, reading, or watching may, at the very least, relate and ideally, be helped by it.

Full disclosure: My name is not James Renato. It’s a pseudonym, adopted out of respect for the principle of anonymity in a 12-step offshoot group I am a member of. It’s also, of course, meant to protect myself from facing unnecessary personal backlash merely for engaging in public discourse.

Now that I’ve successfully buried the lede, in the spirit of qualifying in the style of an Alcoholics Anonymous meeting: “here’s what it was like, what happened, and what it’s like now.”

Last April, I ended a full-blown relapse of what previously was an opioid use disorder in remission. In other words, I’d started injecting heroin again eight months earlier, for the first time in over six years.

It was the culmination of a tripartite experiment involving: firstly, a noble attempt to actively practice a program I helped form (namely, Psychedelics in Recovery [PIR]). Secondly, a misguided lack of acknowledgement that I was inviting a serious risk to my life by no longer practicing abstinence (not just from psychedelics). And lastly, a gradual ceasing of the daily commitment to personal growth in the form of meeting attendance, regular contact with a sponsor, associating with peers in recovery, and just continuing to work on improving the overall quality of my life and relationships with others.

People in recovery continue to regularly engage in their program of choice because life is unpredictable, and the myriad tools we learn are not always the same ones we rely on for every situation. One day a simple phone call can be all that’s necessary to get ourselves out of “a funk.” Another day it’s hitting four meetings, extensively praying and meditating, and taking a newcomer out for coffee because we were just laid off from a full-time job and needed to avoid the danger that can come from “feeding the poor me’s.”

In my case, when I stopped participating in my ongoing recovery process, I made an inexplicably impulsive decision to reintroduce opioids to my system. When the DEA announced that they were planning to classify kratom as Schedule 1, I purchased a kilogram from an online vendor for literally no good reason. Several weeks after I received the package of high potency kratom leaf powder (of the “super green vein” variety), I conducted a dose-response self-experiment. I have a history of progressing down the road of “continued use [of opioids] despite negative consequences” (the current best definition of addiction), and within a few months I developed a dependency and went through the entire kilo, despite attempts to reassure my partner that the amount I purchased was intended to last for years, and would only be used when absolutely necessary.

Right around the time my supply ran out, a friend who had no idea of the habitual relationship I had with kratom use told me about another mild opioid sold on the supplement market called tianeptine sulfate. Tianeptine had undergone clinical trials as an opioid-based antidepressant in the 1990s but did not progress past the second of three phases required by the Food and Drug Administration (for unknown reasons). With the drug’s unscheduled status, enterprising entrepreneurs in the unregulated supplement industry capitalized on tianeptine’s acute, short-acting antidepressive effects at low doses, but savvy opioid connoisseurs discovered the euphoric high it brought on (also short-acting) at much larger doses.

My kratom habit switched to tianeptine, in large part because of how disgusting I found the taste of the tea I made from brewing the leaf powder, and the hassle of masking the taste by encapsulating the amount I needed to take to reach the effects I preferred. In addition to the perfect storm of things perpetuating my now very active addiction, I’d even stopped attending PIR meetings, was becoming increasingly disillusioned with my graduate studies, and was now too ashamed to admit to anyone that I was seriously struggling.

Then, tragedy struck. My father, a seemingly healthy 64-year-old on the verge of retirement, suffered a sudden, fatal heart attack on a scuba diving trip in the Caribbean. I was already treading on thin ice, and this kind of event is something I’d long heard people in 12-step meetings share reservations over in their commitment to recovery. But I hadn’t been to a meeting in over a year at this point, so I had no active knowledge of how to apply healthy coping mechanisms to a devastating situation. It was a situation that countless people have gone through, relying on their recovery program to help them navigate as safely as possible, but I’d learned from the opioids I’d been relying on that if I could just figure out how to stay numb 24/7, that’s all I needed to do.

After the standard bereavement rituals of a wake, funeral, and burial at the family cemetery plot, which was actually a very supportive and comforting assemblage of close friends, loved ones, and long-lost acquaintances paying their respects, I ended up alone in a dangerous situation. I called my old dealer, whose number I still had memorized after over six years of no contact, and one night drove out to meet him just like old times. No need to bother snorting or smoking whatever powder he claimed to be heroin; I had already been well reacquainted with the too-mild results of those routes of administration, so I went right back to the needle.

I’ll spare you all the details of the familiar downward spiral and just hit on the highlights: I depleted all of my savings, misappropriated funds from an award I’d received, stole thousands of dollars from my father’s still active bank account, then my mother’s shared account, totaled my partner’s car from multiple accidents, couldn’t maintain my job, took a leave of absence from school, and wreaked a devastating emotional toll by shattering the trust of my friends and family.

Miraculously, I was not arrested, did not overdose (though I came close), and was not robbed (although certainly ripped off repeatedly). About six weeks before I was confronted about the missing money, I obtained a 15-day supply of Suboxone from a chemical dependency clinic, but I shelved it, having no intention of taking it. Towards the end of the first week of April, my partner was preparing to go out of town for the weekend, and I had just been asked by my mom if I knew anything about the empty bank accounts.

I woke up alone on April 5th, a Thursday, and began my morning ritual of taking stock of the heroin I had left, trying to negotiate with myself on how to titrate the remaining amount throughout the day. I always lost these negotiations and usually just did all of it, or the rest soon thereafter. But after I injected the last of it, I didn’t feel the slightest bit high. Instead, I wept. With only the company of my two cats (who avoided me as much as possible), I realized that I could no longer hide. I faced a crossroads: I could escalate my lies and attempt to find another hustle — knowing full well how inept I am when it comes to actual criminal behavior — or, surrender.

I remembered the Suboxone sublingual film, and without really taking any time to talk myself out of it, I tore open the package and put the film under my tongue — realizing that if I kept it in long enough to absorb the full dose, I’d be inducing opioid withdrawal. I felt incredibly lonely and remorseful, so I begged my partner to come home from work, admitting to her what she had long known but felt powerless to help me with. Then I texted my mom, hinting to her that I was in a desperate state, and needed to spend the weekend at her home or I wouldn’t be able to “see things through.”

Tears were pouring down my face in these moments, and I was wailing — one of the deepest emotional pits of despair I’ve ever found myself in. I’ve never found the concept of rock bottom useful. Instead of labeling that moment or attempting to explain it, I attribute my actions to grace.

A New Perspective on an Old Idea

I’m a wholehearted believer in the potential of psychedelics or plant medicines in recovery. I have heard first-hand tremendously powerful stories from people who have overcome their reluctance and the doubt instilled upon them by their peers, and are actively integrating the spiritual insights from their psychedelic journeys into their lives. PIR continues to meet regularly via an online meeting, twice a month, and our members gather from across whatever time zones they’re in to come together and share experience, strength, and hope with each other. We’ve formulated a list of guiding principles, meant to clarify the scope of our suggested program. I had strayed from those principles and met the predictable outcome we’re hoping to help others avoid.

There are ongoing FDA-approved clinical trials for the use of psilocybin (the active pro-drug of psilocin, a psychedelic found in several species of mushrooms) for nicotine, cocaine, and alcohol use disorder, as well as a recently approved study in Europe looking at MDMA-assisted psychotherapy for treatment of alcohol use disorder. While these trials are aimed at treatment of an acutely manifesting substance use disorder, one of the primary guidelines for PIR is that our members should have a firmly established foundation of recovery in a primary qualifying recovery fellowship, and are actively working that program as it’s suggested.

Recently, now just five months out from ending my relapse, I considered having a ceremony with iboga (the alkaloid-containing root bark of a shrub indigenous to western equatorial Africa), as I wanted to commemorate the one-year anniversary of my father’s death. After soliciting the feedback of my support network, none of whom gave me any advice, but instead offered honest and open perspective to help guide me in making a decision, I decided against it. Ultimately, the decision to commemorate the anniversary unaided came during several of my morning sitting meditations, a practice that has become vital to my ongoing recovery.

Instead, friends, family, and loved ones gathered at our house on the anniversary day, and shared memories, pictures, and videos of my father.

Please read our comment policy. - The Fix
Disqus comments
Disqus comments