Treatment Advocates at Odds vs Proponents of Force

Treatment Advocates at Odds vs Proponents of Force
Posted by FoM on February 21, 2000 at 07:48:33 PT
By Richard Chacón and John Donnelly, Globe Staff
Source: Boston Globe
With a knock on his apartment door, Jorge felt salvation was at hand. A friend appeared bearing gifts: two $10 bags of heroin.After the friend left the Boston apartment, Jorge put four small white rocks onto a spoon, dissolving the drug in a quarter-teaspoon of water. With his needle, he drew in the liquid heroin. And then he picked up a belt and wrapped it around his right arm.
With his left hand, he took the loaded needle and gently pricked the soft underside of his arm until he found one of his shriveled veins. He emptied the narcotic into his blood. The belt fell, unfurling like a snake at his feet."I'd thank God for this," said Jorge, after a long silence during a cold afternoon earlier this month. "But I don't know if it's him I should thank. Should I thank God to bring me something evil? I can't thank God. Should I thank the devil?"Such is the power of drugs that users embrace the devil on the wings of a high. For a high, they would risk custody of their children, sell their daughters' bodies, and steal from the mother who gives them refuge.Drug culture has existed as long as human civilization. In 21st-century America, despite falling crime rates and reports that indicate a leveling off of first-time drug use among the young, there are still 5.7 million known drug addicts.If it seems that the drug problem has been receding, that is largely percepton. The drug problem has simply shifted away from the sleek, white-collar culture of recreational cocaine users in the mid-1980s to today's legion of hard-core addicts in the underclass, where addiction compounds endemic poverty, despair, and violence.In just two years, from 1995 to 1997, the number of Americans with severe drug addictions jumped 23 percent. This group cost American society $110 billion a year, a figure compiled by federal researchers that accounts for drug-related diseases, traffic accidents, and lost productivity on the job.Now, Congress is considering a Clinton administration plan that would open a new, and some say, perilous front in the drug war in hopes of making drugs less available to Jorge and other addicts -- a $1.6 billion, two-year package that relies heavily on military force to attack the source of coca and opium poppies in Colombia, which produces 85 percent of America's cocaine and 65 percent of its heroin.Last week Congress began holding hearings on an ambitious proposal to give Colombia 30 UH-60 Blackhawk helicopters to deploy drug-suppression troops into remote areas of that country and state-of-the-art APS 145 radar to interdict drug shipments leaving the region.Colombians who live around coca and poppy fields warn that even if US-backed forces poison hundreds of thousands of acres and burn drug labs to the jungle floor the demand for drugs from the United States will ensure that the $500-billion-a-year global industry finds a new foothold elsewhere along the Andean spine.Social workers and addicts contend that the best way to attack demand is by devoting more money to treatment, just as President Nixon did on June 17, 1971, when he declared drug abuse "public enemy No. 1 in the United States." He earmarked two-thirds of new antidrug funding to treatment. Since the early 1980s, however, treatment has accounted for less than a third of federal funds.The Clinton administration's drug budget remains at that level, with the vast majority of the money aimed at stopping the supply of drugs and only a small portion going to help wean people like Jorge off them. Barry R. McCaffrey, White House drug czar and a former general who commanded the infantry division that led the "left hook" attack on Iraqi forces in Operation Desert Storm, contends that a robust effort to knock out drugs at the source will help save the lives of American youths.But the nation's first drug czar believes antidrug missions in Colombia will do little to change balance of the drug war. "We have a phenomenally large border, and as long as demand is there, and as long as people in other countries have economic situations that make trafficking attractive, you are going to have drug trafficking," said Jerome H. Jaffe, whom Nixon hired to head his drug-fighting efforts. "That is something that is an absolute reality. To do anything, you have to bring down demand."And fighting demand means fighting drug use on a person-by-person basis. Antidrug work is a tedious daily campaign of encouragement, tough love, and therapy that is different for every addict. A year in recovery does it for some, a decade for others. For still others, it never works. The drugs win.If you step into Brianne Fitzgerald's size-81/2 red-and-black Arche boots for a few days, the first thing that you'll realize is that her patient list of drug addicts is made up of people in great pain who are crying out for help -- and have been for years, sometimes decades.The 51-year-old Fitzgerald is a nurse, a South Boston resident who lived for years in the western suburbs, a divorced mother of four children, including three sons who play fullback on three different football teams (Boston College, Northeastern University, and the New York Giants) and a daughter who trains for marathons in her off hours on the hills of San Francisco. They comprise a determined family, but perhaps none more determined than Brianne.She grew up in Newton, the oldest of eight children. Her father was an alcoholic. He worked as a bookkeeper for Texaco. Her mother held jobs as a nurse and fashion model. "I became a caretaker very early on," Fitzgerald said dryly.She married at 21 and almost immediately began having children, eventually settling into a comfortable life in Wellesley. But she wanted something more, and at 33, she answered a newspaper ad for a job in a "clinic."It turned out to be an inner-city methadone clinic for heroin addicts. She got the position. Soon she was spending her mornings pouring methadone into cups for a line of addicts whose last names began with the letters A to L and her late afternoons preparing dinner for six in the suburbs."The first thing I did before going to work was take off my diamond ring," she said, her hands still ringless.Over the years, spanning a divorce and a move into the city, she stuck with her work with addicts, attracted by the stark difference from her early upbringing, lured by "living on the edge a little bit," and buffeted by the knowledge that she could make a difference in some people's lives. Not all. But some.One day recently, she drove her 1998 blue Toyota Corolla to East Boston to see a patient. Fitzgerald works for Neighborhood Health Plan, an HMO that has made the determination that the most effective -- and cost-efficient -- care for high-risk patients is to send nurse practitioners on home visits.On Meridian Street in East Boston, Fitzgerald parked and walked up a flight of stairs in an apartment building to visit Diane Amaral, 42, a recovering heroin and cocaine addict, who had lost custody of her four children years ago because of her addiction.As Fitzgerald carried her heavy black Bottega Venetta bag over her shoulder and a Zip-lock bag containing four homemade double chocolate chip cookies in her hand, Amaral started shouting from above."I'm just cracking up in here!" she said, as Fitzgerald walked into her apartment, closed the door, and handed over the cookies. Amaral ignored her. "I'm beat up," she said, pacing in her kitchen. "I'm tired. Maybe I should just die. At least I would die straight.""Do you want to go to the hospital?" Fitzgerald asked. "No! No! I just want something for my pain."Amaral's hands hurt so much that she was sleeping only a few hours a night. She was not sure why they hurt but the pain was unbearable. "I will try to help you," Fitzgerald said.Amaral shouted for another 10 minutes and put her face in her hands. "My head, my head," she said, weeping.Fitzgerald had to leave. She set up an appointment for Amaral at Lemuel Shattuck Hospital in Jamaica Plain; perhaps a doctor would prescribe something for her pain. As Fitzgerald left, Amaral ran after her, mumbling apologies, and handed her a small present, a honeysuckle mist-scented drawer sachet from Victoria's Secret. "Thank you, Brianne, thank you," Amaral said in a whisper.In her car, Fitzgerald looked weary. "Where do you begin?" she asked. "You'd think I'd be burned out, too. I grew up in an alcoholic family, so I'm no stranger to helping addicts. I learned the hard way in this job, though. When you work harder than the addicts, you get real disappointed because then they don't get clean."Her mobile phone rang. It was a former patient, an ex-heroin junkie named Walter Applegate. They set a lunch date at a deli on Dorchester Street in South Boston.Moments after she arrived, Applegate walked in, the picture of health. Baby blue eyes. A barrel chest that filled his sweatshirt. "I lift weights four times a week," he said. "I weighed 105 pounds when I was doing heroin. Now I'm 190."By his estimate, he was in and out of 70 treatment centers during the 15 years he was an addict, and six of those years were spent in prison. Now a plumber, he said he finally got sober on Labor Day 1995. "It was the consequences," he said. "I just didn't like losing my home, my boy, my family." He hasn't seen his 15-year-old son in years."When I was using, it came down to seeing my son or getting high. I would rather get high," he said matter-of-factly, his strong hands gripping a steak sandwich. "I know as long as I stay sober, I'm going to see him again. I know I can be a good father."He kept shifting in his seat as he spoke, eyes darting around the restaurant. He seemed on edge. "You OK?" Fitzgerald asked. "Yeah, yeah, yeah," he said.She wasn't so sure. How could she be? Over time, she has learned not to trust quick assurances.Fitzgerald visited Jorge the next morning. He wasn't hiding his pain. He was in withdrawal from heroin, chills running through his body as he lay under covers in his bed."I'm dying, man," he said, his eyes vacant."What do you want to do?" she asked, bending her 5-foot-10 frame and sitting down next to him."I'm tired of using drugs. I want to go into treatment. I tried calling all day yesterday and I couldn't get through."Fitzgerald made several calls and found a place for him in a detox center. The two made arrangements for her to drive him there in the morning."How bad do you want to get clean?" she said."I do, I do, Brianne.""You better be here," she said. "I'm counting on you."Several hours after she left was when Jorge's friend appeared with his gift of heroin. Jorge, 37, who asked to be identified only by his first name, injected half of the heroin into his veins that afternoon. "I need some tough, tough love," he said, lighting up a half-smoked Newport 100s cigarette.He used the last bit of heroin at 7:30 the next morning, an hour before Fitzgerald arrived. "When you're sick and going into detox, you need something for the day you go," he said in her car, explaining why he got high. "Because you get really cranky and frustrated if you don't have it."He said he hoped to stay in treatment for at least several weeks. "My opinion is you need longer treatment," Fitzgerald told him. Jorge said he wasn't sure he could do that. He said he needed to help support his mother.P> "Don't start to set up roadblocks, Jorge," she said.They hugged each other goodbye at the center. "I pray to God I'll do good," he said.Fitzgerald turned reflective as she drove away. "I don't envision myself doing this forever. I need a backup plan," she said. "We all need a backup plan."Most of her frustrations were related to her patients; Amaral, for instance, was calling her daily in despair. And, more importantly, she has seen them time and again relapse into their addictions, even when all signs pointed toward recovery. This is her never-ending war on drugs.But the national priorities in the drug war also have had an impact on her, especially with the emphasis on locking up addicts. Nearly 1.6 million drug addicts were arrested nationwide in 1997 for a variety of crimes. That is up from 1 million in 1991. At the same time, only 37 percent of hard-core addicts received treatment in 1997."The money we are spending fighting this war on drugs is a joke. It's a bottomless pit," she said. "I liken it to the Vietnam War: We're doing it for years, and the casualties keep on mounting. We put them in jail. That's how we kill them."Fitzgerald also believes the Colombian effort won't work. "People just laugh at it," she said. Even if it did result in driving up prices and reducing supply, she said it wouldn't drive down the number of hard-core addicts."If the price rose, the crime rate would rise. And somebody would make a cheaper drug. The answer has to start locally," she said.Most of her patients have been in and out jail. She saw two in the course of two days: Lee Boone, 47, of Charlestown, who injected heroin into his groin so frequently that his veins collapsed and he lost his right leg; and Billy Ketchum, 45, who used drugs for 30 years, once working as a "lieutenant" in a Colombian drug ring where he could earn $15,000 for four days of work."I must have shot up a million dollars worth of heroin," said Ketchum, who now lives in a faith-based home for recovering addicts in Dorchester.He closed his eyes and said with feeling: "I used heroin as my lover, there was no other. James Brown said he sold his wife for a $5 bag. Well, I sold my life for a $2 bag."Boone was overjoyed to see Fitzgerald, who in recent years visited him in an active drug house, a risk that she shudders at today."Saint Brianne!" he exclaimed and motioned for her to sit in his living room. He has been off heroin for five months, receiving a daily dose of methadone in a clinic, a substitute addiction but one that has allowed him to function on a much higher level."I've got something to show you," he said.Boone pulled out his wallet, and as his eyes welled up, he held up an automatic teller card."I ... have ... a ... bank ... account," he said slowly as two streams of tears fell from his chin."Lee," she said, moving toward him, "look at you!"It was a sudden, tender moment of joy. And a fleeting one.Later, Fitzgerald picked up Iayania Norwood, 23, a recovering addict who first used crack cocaine with a family member, and the two of them went to visit another patient, Cassander Johnson, 36.Johnson had been refusing to attend a group therapy session with other recovering addicts, and Fitzgerald feared she might relapse."It makes me very nervous," she said."I'm not going to go. I'm OK. I just get bored," Johnson said. Her friend Norwood challenged her: "The liquor store's right up the corner. You're going to go there, aren't you?""It's right up the corner in fact," Johnson said, smiling. "If I take a drink, I take a drink. I suffer the consequences. So what?"Fitzgerald grew angry: "Last time you took a drink, what happened? One of these times, Cassander, I'm not going to be there to pick up the pieces. You're playing with fire. You won't stay sober."Fitzgerald put her head in hands. Now her eyes filled with tears. Johnson wouldn't budge, and Fitzgerald said she would tell people in Johnson's halfway house about her fears of a relapse.Johnson yelled at her: "Why do that? I'm not even going to talk to you now!"Fitzgerald and Norwood left. "This is what I hate about my job," she said.Fitzgerald needed a break. She went to dinner that night with her Wellesley girlfriends. "We were talking about waxing eyebrows, menopause, all the girlfriend things," she said. "It was nice. I got an escape, and they live vicariously when I tell them my stories."The following week, she learned she was wrong about Cassander Johnson. She didn't relapse that weekend. Diane Amaral, meanwhile, finally agreed to go to a hospital, where doctors are monitoring the effects of different medications.As for Jorge, he remains in treatment. Two days after arriving at the detox center, he sat in an empty cafeteria, which was set for lunch with Lay's chips and Swiss creme sandwiches on white plates. On the wall was an old window shade, on which was written "The Twelve Steps," the famous recovery process.Step No. 9 urges, in part, to "make direct amends to people" whom you have harmed. Jorge said he must make amends to his mother, because he once stole her gold necklace, gold rings, and a bracelet in order to buy drugs.Then he remembered another incident, on the Boston Common, nearly 20 years ago."I snatched a pocketbook from a lady," he said, scratching a several-day growth of beard. "My friend grabbed her and threw her to the ground. And I stomped her on the chest. I left my footprint on her. I really hurt her. She finally let go of the pocketbook. We ran right into police on horseback and were arrested."But at court, the lady said she didn't want to press charges. I was shocked. I said to her, 'I'm very sorry. I have a drug problem.' ""She said to me, 'Get help.' "Jorge shook his head. "It takes a long time."Fitzgerald walked in, plopping her Bottega bag next to Jorge."You going to stay in treatment?" she asked."Of course I'm going to stay, Brianne," he said."Better," she said.Globe reporter John Donnelly can be reached at: j_donnelly globe.comWHAT DO YOU THINK?  Do you think the mainstream media has ignored the problems of drug abuse as most addicts have moved from middle-class "recreational" users to lower-income abusers of hard drugs? The War at Home:Published: February 22, 2000 © Copyright 1999 Globe Newspaper Related Article in Series:Rhetoric, Budget Priorities are an Uneven Match All Drugs are Leaving The Country Coca
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