The Dwindling: Dealing With The Aftermath of Loss From Substance Abuse

By Gayle Saks 01/07/16

As a substance abuse counselor, there is always the possibility of receiving devastating news about someone in my care. 

Gayle Saks

When I began my job as a substance abuse counselor in an all-male residential program, the group of men were a pretty hardened bunch. Their flesh peaked out from under tattooed murals on their arms, legs, chests and backs. They were pumped up with six-pack abs and chiseled, muscular arms that they teasingly showed off every once in a while. (Not for the faint of heart, even for this middle-aged woman.) The majority of them had spent short bids (and some long) in prison where they toughened up, losing some of their vulnerability along the way to seemingly make it easier to get through their sentences.

Since I started my job, just six months ago, almost every resident who has completed the six-month program has relapsed within a few weeks, even days. There have been four deaths, several overdoses, one which led to a two-month hospital stay. Some manage to hang on for a little while before their relapse leads them right back to where they started, like a piece on a board game—detox, then waiting for a bed in yet another residential program, a seemingly never-ending cycle.

When I started there were mini-reunions of friends who had shared needles on the streets and alleys, guys who had served time together, others who had detoxed and been in endless amounts of programs together.  

I love it when a new guy comes through the door to discover old friends sitting in the kitchen or watching TV in the living room. They greet each other in the way that men do, those quick hugs with double fist thumps on the back. In conversation, they begin to unravel and recount their recent setbacks, catch up on mutual friends, and launch into the sad but familiar, "Did you hear about so-and-so? He overdosed last week." Woven into these catch ups is a flash of excitement: "Fuck, I'm so pumped to see you, dude."

They have become numb to the frequent deaths of their friends and acquaintances. Most of the time they learn about these deaths on Facebook, seeing in their feeds "RIP" with a familiar face and name. They've told me endlessly that Facebook is their version of the obituaries. They have also told me that they can tell when a friend is high by the time of day they are posting. "What the fuck was he doing posting random shit at three in the morning?"

There are certain deaths that hit them harder than others. You can tell by the length of their pauses, the moment of processing. I attended my first funeral with a bunch of these core guys, the warriors on the front lines. This one was a really hard death for them. They hovered in the background vaping and smoking until the priest started speaking the generic, scripted words in front of him. The guys inched forward, taking it all in, watching his mother and father weeping. After this very brief eulogy, insultingly brief in my opinion, they shuffled back to the cars that they came in as they contemplated the dwindling of the friends that made up their shared history.

I am not being hyperbolic when I say that when I pull up and park my car in front of the residence, I brace myself in preparation, in case someone has relapsed or died since the day before. I wait for my coworker who has been the house manager for 10 years to say “close the door” before telling me, like he has had to do several times, that so-and-so is dead. He has been through these deaths more times than he can count, and even though he isn’t exactly indifferent when he has to deliver news like this, he says it fast, so that he can push the words out and away from himself.   

Last month, the news of one death made my knees buckle and my stomach lurch. I ran out of the residence and wandered around the local neighborhood, sobbing. This particular man had a huge impact on everyone he knew. He was the house version of a class clown but was more welcoming and helpful than most others in the house. To make matters worse, I had had lunch with him less than 24 hours before he died.

I had to break the news to some of his friends. They cursed him for not reaching out for help. Their anger shifted to laughter at some of their memories of him. In between all of these emotions was the realization that another one of their mainstays was gone.  

The stream of new guys coming into the house are often novices at this life. They are younger and needier and look to me and my other female coworker as mother figures. They aren't tattooed or pumped up. Yes, they’ve experienced some deaths, but they haven’t yet cycled through this process endless amounts of times. They haven’t yet formed the strong bonds that their predecessors have.  

Chances are very good that this could be the beginning of a long road for them. Because those before them are dying off, they don’t have mentors to tell them not to make the same mistakes they did. They are not there to warn them that the potency of the new heroin on the street will kill them. The dead are cautionary tales in and of themselves, some bound to become urban legend. Their surviving friends are few and far between.  

It takes a tremendous amount of courage to walk through our doors. The men are often terrified and full of shame. Most are full of hope and vow that there will never be another relapse. If they are lucky they find sponsors with years and years of clean time under their belts who are patient and hopeful and kind. And I, in my role as counselor, hope to do whatever I possibly can to convince them that they CAN live a life of promise, that their dreams are their's to fulfill.

Gayle Saks has written about everything from her mother’s double-suicide, online dating, a failed colonoscopy, to her work with male, female and juvenile inmates, with deep honesty, candor and humor. A piece about her best friend’s addiction to crystal meth was chosen as an Editor’s Pick on, the sister site of

She has recently begun to speak publicly about her mother’s experiences as a Holocaust Survivor, as her role as a second generation survivor and how the torch is now being passed to her teenage daughter to keep that legacy alive.

Saks grew up on Long Island, New York,  and lives in the Greater Boston area with her husband, daughter, two cats and a dog or as her husband says, “Too many beating hearts.”

She blogs at and you can follow her page on Facebook


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Gayle Saks has written extensively about her work as a substance abuse counselor from the unique perspective of someone who is not in recovery herself. Her blog, My Life In The Middle Ages, was voted one of the Top 20 Recovery Blogs for 2016 by AfterParty Magazine. She has written on the subject for The Fix, HuffPost, mindbodygreen and Thought Catalog. She has also written about being the daughter of a Holocaust survivor and the eventual suicide of her mother. Her pieces on the subject have appeared in kveller where she is a regular contributor, The Jewish Journal, and MammaMia. Saks grew up on Long Island, New York, and lives in the Greater Boston area with her husband, daughter, two cats and two dogs or as her husband says, “Too many beating hearts.” Follow Gayle on Twitter.