Why couldn\u2019t Dana Smith stay sober?<\/p>\n
It was 1998. Dana was a 34-year-old methamphetamine and prescription pain medication addict. She\u2019d been a nurse in Statesboro, Georgia, until she was fired for stealing medication from the hospital where she worked. She was divorced with two children, ages 12 and 13.<\/p>\n
Getting fired was a wake-up call. Dana checked herself into a residential treatment center near Statesboro called John\u2019s Place, part of a state-funded network of drug treatment and mental health-care facilities in eastern Georgia. She emerged sober and determined to stay that way<\/a>.<\/p>\n \u201cMy kids were the only good thing in my life, and I was trying hard to be a good mom to them,\u201d she says. Dana kicked out the boyfriend who\u2019d introduced her to drugs (\u201che was smoking crack in the bathroom\u201d), got a job at Pizza Hut and attended outpatient support group meetings.<\/p>\n Five months after leaving John\u2019s Place, Dana began spending time with a man she met at a support group meeting. The two began using drugs together, including intravenous heroin. Dana lost her job, ran out of grocery money and stopped paying her power bill.<\/p>\n For a while, she and the kids were homeless<\/a>. Eventually the kids went to live with her ex-husband\u2019s mother while Dana detoxed again.<\/p>\n A cycle began: sobriety, regaining custody, relapse, homelessness, kids landing at a relative\u2019s house.<\/p>\n Finally Dana stopped trying to stay sober. The kids ended up with her ex-husband. Dana drifted to Florida, where she engaged in sex work to buy heroin.<\/p>\n Dana Smith loved her children. She hated being an addict. \u201cIt was horrible,\u201d she says. \u201cIt ate me up inside.\u201d<\/p>\n So why couldn\u2019t she stay sober?<\/p>\n That question\u2014about addiction\u2019s seemingly intractable power\u2014lies at the heart of America\u2019s epidemic of substance abuse, which over the past two decades has claimed more than 700,000 lives.<\/p>\n Some 40 percent to 60 percent of people treated for substance abuse relapse within a year of treatment, notes a 2014 study published in the Journal of the American Medical Association. <\/em>The reason, according to researchers: Drug dependence is a chronic illness, similar to Type 2 diabetes in its propensity for relapse<\/a> and its need for careful lifelong management.<\/p>\n For the past two years, Guideposts<\/em> has published stories from the front lines of this disease epidemic. Contributors to our Overcoming Addiction <\/em>series have told of their own addictions, the struggles of loved ones and the damage done to families, communities, faith institutions and America\u2019s economy and public health.<\/p>\n The series began in January 2018 and now concludes as a regular feature, though we will continue to run addiction-related stories on an occasional basis.<\/p>\n I was the lead editor for most of those stories. Our narrators universally expressed bafflement at the power of addiction<\/a>. Not a single one told of an instance when they or a loved one recovered from substance abuse on the first try.<\/p>\n For this final story in our series, I wanted to give readers the best currently available answer to the questions raised by Dana Smith\u2019s story and the stories of so many other people who have despaired in the face of addiction\u2019s power.<\/p>\n Why is sobriety so hard to maintain? What gives people the best chance of recovery?<\/p>\n In the two years I talked to treatment professionals, researchers, advocates, public health leaders and addicts and their families, no one explained the issue to me more clearly than Tony Kennedy, an addiction counselor<\/a> at the Harbour Light Salvation Army shelter and drug treatment center in the Downtown Eastside neighborhood of Vancouver, British Columbia, Canada. Vancouver is home to one of North America\u2019s worst drug problems. The city is also a living laboratory for experimental approaches to treatment.<\/p>\n The addicts who end up in one of Harbour Light\u2019s 60 beds are the \u201ctoughest of the toughest to treat,\u201d Tony says. \u201cSome people go through detox up to 50 times. They go through treatment eight to 10 times.\u201d<\/p>\n Many of Downtown Eastside\u2019s roughly 18,000 residents are homeless or live in single-room-occupancy hotels. Their challenges\u2014long-term unemployment and poverty, childhood abuse, addiction to multiple substances\u2014might seem too extreme to serve as examples of barriers to recovery.<\/p>\n But research shows that trauma, both extreme and everyday, is key to understanding how addiction works and why it is best thought of as a chronic disease.<\/p>\n Repeated exposure to stress, especially before birth and in childhood, can cause structural imbalances in the brain that prompt people to seek a chemical shortcut to emotional equilibrium.<\/p>\n If the shortcut is alcohol or other drugs, the chemicals in those substances cause further brain changes that erode judgment, long-term thinking and impulse control. Alcohol and drugs start out feeling like a remedy for internal distress. They end up undermining the parts of the brain that enable someone to stop using. The seeming cure becomes a self-perpetuating cause of disease as physical addiction takes hold.<\/p>\n Learning to cope with the everyday stresses of life without chemical support is one of the first goals of treatment. Counseling and 12-step programs teach people how to \u201cbe okay without having to avoid what\u2019s going on inside and having to numb yourself out,\u201d Tony says.<\/p>\n But maintaining emotional and spiritual equilibrium is not enough. People also need what Tony calls recovery capital: decent housing, job prospects<\/a>, a community that supports recovery and practical life skills.<\/p>\n Without such capital, people can emerge from treatment with good intentions but relapse when confronted by all the problems they\u2019d sought to escape with substances\u2014now magnified by the destructive effects of addiction. \u201cIn a lot of ways, society doesn\u2019t want you and you don\u2019t know how to participate in that world,\u201d Tony says.<\/p>\n Regaining emotional balance and amassing recovery capital take far longer than the standard 28 days of rehab depicted on television. Treatment at Harbour Light lasts as long as three years, with patients gradually progressing to greater independence.<\/p>\n Tony says the \u201cmiracles\u201d (his word) he has seen at Harbour Light\u2014hardcore addicts achieving recovery<\/a> after years of relapse on the streets\u2014are the product of time, diligent work and research-backed treatment standards.<\/p>\n Tony counts himself as one of the miracles. His father was an alcoholic who drove drunk, lost his job and walked out on his family when Tony was 10. Seeking relief, Tony started smoking marijuana at age 12 and had his first drink a few years later. For nearly a decade, he was an alcoholic and drug addict in Vancouver.<\/p>\n Desperate to change, he tried a 12-step support group and spent the next two years cycling between relapse and vows to sober up. At last he entered residential treatment.<\/p>\n Tony had managed to stay employed and in contact with his family during his years of addiction. He emerged from treatment with some recovery capital. But he needed ongoing help coping with stress without chemical support.<\/p>\n Graduating from residential treatment, he was told to attend daily 12-step meetings for 90 days.<\/p>\n A foundation of 12-step programs is committing oneself to a higher power<\/a>. \u201cI was an atheist,\u201d Tony says. \u201cI thought, This won\u2019t work, but I\u2019ll do what you say to show you it doesn\u2019t work.\u201d<\/p>\n It did work. \u201cI started to get better and have a little bit of hope,\u201d Tony says. \u201cWhen I started making amends to family and friends, I felt the obsession with alcohol just lift.\u201d<\/p>\n He trained as a counselor, worked for several years helping federal offenders reintegrate after they leave prison, then took a job at Harbour Light in 2010.<\/p>\n After 25 years of sobriety, Tony continues to attend 12-step meetings and practice the disciplines of prayer and service foundational to his recovery. He does not consider himself \u201ccured.\u201d Sobriety, he says, is a lifelong endeavor.<\/p>\n \u201cThe best evidence for the effectiveness of treatment is someone like me,\u201d he says. \u201cI was once in the darkness, and now I\u2019m in the light.\u201d<\/p>\n Comprehensive programs such as Harbour Light\u2019s are far less common than they should be, especially in America, where a fragmented, privately run health-care system has not developed universal standards of treatment or ways to pay for vital care.<\/p>\n Advocates and public health professionals I spoke to say efforts are under way to strengthen treatment standards and broaden access to quality care. For now, a patchwork of state-by-state regulations and a lack of long-term federal initiatives have left addicts such as Dana Smith dependent on local resources that vary in quality and affordability.<\/p>\n Thankfully, Dana found the right resources and her story\u2014which she told in our September 2019 issue<\/a>\u2014did not end on the streets of Florida.<\/p>\n Strung out and missing her kids, Dana made her way back to Georgia. Her good intentions were derailed by an abusive man she met in Statesboro, who supplied her with drugs in exchange for sex.<\/p>\n At last, in 2007, she was arrested while trying to buy drugs.<\/p>\n What broke her cycle of relapse? A comprehensive state-backed program, roughly equivalent to Tony Kennedy\u2019s Harbour Light. Dana was routed into a court-ordered, two-year drug treatment program. She underwent mandatory detox and residential treatment, followed by supportive housing and long-term attendance at 12-step support group meetings.<\/p>\n Dana witnessed substance abuse in her family growing up, was bullied at school, then endured physical and emotional abuse in multiple relationships with men. Treatment helped her cope with that trauma and the further trauma caused by her years of addiction.<\/p>\n She gained more recovery capital through counseling and by living in a supportive housing facility for homeless women struggling with substance abuse.<\/p>\n After nearly a year of treatment, she gathered enough courage to apply for a waitressing job at a local caf\u00e9. The caf\u00e9\u2019s lively crew of regulars welcomed her with open arms<\/a>\u2014more recovery capital. Several years later, Dana opened a caf\u00e9 of her own, where she now hires people in recovery.<\/p>\n \u201cJust wanted to say thank you again for doing my story in Guideposts<\/em>,\u201d Dana texted me after her story was published. \u201cI\u2019ve had several people contact me and say that it helped them.\u201d<\/p>\n I suspect Dana\u2019s story helped many more readers than just the ones who reached out to her. Recovering from addiction, as she and other contributors to our series showed, is a monumental challenge. A lifetime\u2019s work.<\/p>\n Our series showed something else too. Despite the chronic nature of addiction, recovery is possible with the right treatment, support and resources.<\/p>\n \u201cI wasn\u2019t a bad person. I was just a sick person,\u201d Dana told me. \u201cI thought I was bad. I didn\u2019t think I had my heart anymore. But it came back.\u201d<\/p>\n The goal of our series, and our ongoing coverage, is to bring that message of hope everywhere it\u2019s needed. It\u2019s a lifetime\u2019s work.<\/p>\n