by David Sheff
Studies have shown that cues dramatically change an addict's vital signs. They don't have to be as obvious as a needle. A cue can be anything from the smell of a chemical reminiscent of meth burning in a pipe to "the people, places, and things" associated with the drug to, for some addicts, payday, a street corner, a song, or a sound—subtle and hidden from everyone but the addict. Many meth addicts associate the drug with sex. As the high school Casanova in the pilot of Six Feet Under put it, meth "just makes everything burn a little bit brighter, and it makes sex totally primal." Though most heavy users eventually are unable to have sex, arousal—anything from pornography to a sexual situation—can remain a powerful trigger. "Trying to interrupt drug use at that stage is like trying to get in front of a train," Dr. Rawson said. However, Dr. Shoptaw at UCLA has worked on specific therapies designed to help gay addicts who associate meth with sex to reframe their responses to arousal. The idea is that any behavior, including behaviors that seem automatic or compulsive, can become conscious and can then be interrupted. A user can be taught to stop the moving train and call an AA sponsor or drug counselor, attend a recovery meeting, work out in a gym, or other constructive choices. Once again, time in treatment—time measured in many months if not years—is usually required for dramatic change. In the process, the user's brain is probably regenerating, and dopamine levels may be normalizing. A cycle of abstinence replaces a cycle of addiction.
Recent clinical trials have shown that meth addicts respond to the Skinnerian approach of rewarding clean (that is, drug-free) urine specimens with small cash payments or vouchers for anything from immunizations for an addict's child to a pass to an ice-skating rink to a certificate good for the repair of a broken lawnmower. In a UCLA study, these contingency management strategies, when added to a cognitive and behavioral therapy program, produced two to three times as much abstinence as the cognitive and behavioral therapy programs alone.
Medications may help, too. There is currently no methadone for meth users. Nor are there medications to neutralize meth in case of overdose, counteract most symptoms, treat its neurotoxicity, or interrupt the high—all of which would be useful at different stages of treatment. Part of the reason may be that there hasn't been as much research into methamphetamine as into heroin and cocaine, which have long been pervasive on the East Coast, particularly from New York to Washington. Meth hasn't been directly in the faces of policymakers who allot research money, though this has been changing as meth creeps eastward. Another factor may be the molecular structure of heroin compared to methamphetamine. "Methamphetamine is dirtier," a researcher explained. Whatever the reason, because of the unique level of harm this drug causes, even compared to heroin and cocaine, plus the dismal record of current treatments, clinicians are desperate for medications that would help up the odds for addicts, whether they would replace dopamine, help heal the nerve damage, or treat or manage symptoms. However, the top researchers in the field admit that their efforts warrant little optimism. At the beginning of a trial of a medication that could help with withdrawal, the doctor in charge admitted, "Success for me? Modest effect in a minority of patients. My expectations are nil to minimum, so I'll be really happy with minimum." And he was working on one of the more promising drugs.
Since depression is prominent in the early stages of withdrawal, some researchers maintain that antidepressants would help. However, preliminary tests of Prozac, Zoloft, and other SSRIs suggest that those drugs have little effect. Researchers are currently investigating other antidepressants, including bupropion (Wellbutrin), which interacts with specific subsystems of serotonin and dopamine transmitters and receptors, and a drug called ondansetron. Numerous other trials are planned. Researchers throughout North America told me about dozens of drugs that might help. One is levodopa (L-dopa), which has been used to counteract the degeneration of Parkinson's. It essentially replaces missing dopamine, though the effect seems to diminish over time. When tested with cocaine addicts, the drug made no difference. However, researchers conducting a trial posit that the drug may have a stronger effect on meth addicts, because their dopamine levels are nearly zero, compared to slight reductions in cocaine users.
Even if medications turn out to aid in meth withdrawal or at other stages of recovery, researcher Gantt Galloway is convinced that they will never play more than a peripheral role. "There's never going to be a drug that will make you check the peephole before you answer the door, so if it's your dealer you won't answer it," he says. "And even if you do perfect detox and great pharmacotherapy and you get somebody's brain precisely where it was before they started using meth, then the clock starts rolling forward again. It's Groundhog Day. You have to intercede at that point, using behavioral and cognitive therapies to teach people an alternative way to live their lives."
Nic checks in with me from time to time. He attends AA meetings each evening with a band of Hazelden patients. He describes their outings with his typical dry humor. "We're a sight walking through the city," he says, "a gang of grateful misfits."
I return to my own meetings. Al-Anon gatherings are no cureall, but once again it's comforting, though always so sad, hearing others' stories. After one lunchtime meeting, at which I briefly speak—I shakily begin, "My son is in rehab again"—a woman approaches and timidly hands me a pamphlet called "3 Views of Al-Anon." "It helps me," she says.
At home, I read it. From "Letter from an Addict" in the pamphlet: "Don't accept my promises. I'll promise anything to get off the hook. But the nature of my illness prevents me from keeping my promises, even though I mean them at the time ... Don't believe everything I tell you; it may be a lie. Denial of reality is a symptom of my illness. Moreover, I'm likely to lose respect for those I can fool too easily. Don't let me take advantage of you or exploit you in any way. Love cannot exist for long without the dimension of justice."
With Nic in recovery again, Karen and I get books for children about addiction from the library and read them to Daisy and Jasper. We do our best to encourage the kids to talk about their feelings—to get them out. We meet with their teachers to discuss how they're doing. So far, we're told that they seem all right.
In December, Hazelden's New York inpatient program closes its doors. The organization, which continues to run an outpatient program in Manhattan, blames the economy—it can't fill the brown-stone's three dozen beds with paying customers. Nic is wary of the Bay Area, which he associates with meth, and chooses, helped in his decision by his counselor, to move to Los Angeles to live near Vicki.
Herbert House, a sober-living house in Culver City, is actually a cluster of bougainvillea- and rose-draped bungalows, whitewashed and cheerful, with small porches with loveseats and rocking chairs, all facing a central brick courtyard with palms, picnic tables, and garden furniture—sort of a Melrose Place for addicts.
Nic settles in and likes it there. He makes good friends with other patients, and he becomes especially close with the director of the program, a compassionate man named Jace who has dedicated his life to helping addicts and alcoholics. Herbert House has strict rules and requires chores, and residents must attend nightly meetings. Nic also participates in a nearby outpatient program, meets with a new psychiatrist, and works with another AA sponsor, Randy, a man with whom Nic goes on long bike rides along the Pacific Coast Highway. Randy has intense blue eyes; he has been sober for more than fifteen years. Nic says that Randy inspires him, "shows me how good life can be."
On the phone he sounds like the old Nic, Nic in his right mind. It is almost impossible to reconcile this Nic with the person he was on drugs. I think, by trial and error and persistence, helped by the months at Hazelden, the support of those at Herbert House, the outpatient sessions, AA, Randy, and his friends in recovery, Nic has constructed a comprehensive program that, according to what I have learned from the researchers, reflects the one that should be available for all meth addicts.
Nic's AA friends help him find a technician job at Promises, another renowned drug and a
lcohol rehabilitation program, this one based in Malibu. He drives patients to meetings and doctors' appointments, dispenses medication, and assists counselors in a wide range of other duties. It is fulfilling work. He has something to offer—he can help others even as the work helps him.
In July, Nic turns twenty-one. To celebrate, I visit him in Los Angeles. It is a warm summer afternoon when I pick him up in front of Herbert House. Nic leaps into the car. We hug. He appears whole again. Twenty-one is a milestone in everyone's life, and it is a milestone for parents when their children turn twenty-one. For me, it feels like another miracle.
It takes a while before Karen says she is ready to see him. In addition, we haven't allowed him to see Daisy and Jasper yet. We don't want them to get hurt again. We all are still torn apart by the warring between our fear and our love. We want to protect Daisy and Jasper, and yet they love him and he loves them. Once again we wonder: how do we know when we can trust him?
Finally, near the end of summer, Karen and the kids come along with me when I drive down the coast on an assignment in LA. The family is reunited on the beach, where Nic, Jasper, and Daisy make sand castles and play in the surf. After that, we come to see him on a series of weekends. We visit him at work and he introduces us to his colleagues, who clearly adore him and whom he seems to adore back. He takes us to another beach, a secluded spot near Malibu that is reached after a hike down a steep trail. Another time we hike through a canyon with his mother and stepfather's dogs, Payson and Andrew. (Nic is dog-sitting them.) We walk up a trail until we reach a lookout from where we can see all the way from Hollywood to the ocean. We rent cruisers and he meets up with us on his racing bike and together we ride down the Venice boardwalk, stopping to watch graffiti artists and weightlifters. As always, we go to museums and galleries—a Royal Art Lodge show at MOCA, and at Angles Gallery in Santa Monica an exhibition of thousands of photographs by Nick Taggart of his wife and collaborator, Laura Cooper, taken just before she woke up every morning for thirteen years. We usually eat dinner at the same restaurants, a Korean barbecue or tiny sushi bar where loud reggae music plays. We spend most of our time on the beach, but, as always, we see movies. Nic has seen The Triplets of Belleville, but he goes again because he wants Jasper and Daisy to see it. After the film, together Jasper and Nic sing, with an Indian accent, exactly as in the pre-movie commercial.
Nic begins, "Is the movie sold out, my husband?"
Jasper: "Chitra, my queen, I've used Fandango."
Nic: "My happiness is a golden poem."
Jasper: "I'll get the popcorn."
Nic calls frequently. We have a close telephone relationship. Sometimes we just yak about nothing, sometimes about his recovery. We always talk about movies and books. Especially movies. We cannot wait to talk after one of us sees a new release by one of our favorite directors, whether Spike Jonze, David O. Russell, Todd Solondz, the Coen Brothers, P. T. Anderson, Wes Anderson, Pedro Almodóvar, or Robert Altman, as well as anything written by Charlie Kaufman. I recommend films for him to rent—Rivers and Tides—or he recommends them for Karen and me—François Ozon's 8 Women and his current favorite, Fassbinder's Die Bitteren Tränen der Petra von Kant. "Have you read Anthony Lane on the new Star Wars?" Nic asks one day. He reads aloud: " 'Also, while we're here [on Yoda], what's with the screwy syntax? Deepest mind in the galaxy, apparently, and you still express yourself like a day-tripper with a dog-eared phrase book. "I hope right you are." A fucking break give me.' "
Sometimes he reports successes that for other people are no big deal but to him are Herculean. Little things: he has a bank account and secured a credit card. He is saving some money. He buys a fifth-hand four-hundred-dollar Mazda and, later, a new bike. He moves into an apartment, renting a room from Randy's sponsor, an extremely kind, silver-haired and bearded man who walks with a cane. Ted has been in recovery for thirty years and has helped many young addicts.
Yet some days are excruciating for Nic. I hear it in his voice. He is lonely. He has Randy and good friends, but he would like someone special in his life. He becomes overwhelmed with worry about the future. His moods swing, and he craves drugs. He describes these ups and downs to me sometimes with stoic determination, other times holding back tears. "Sometimes all I can think of is using," he says. "Sometimes it's too difficult. I feel as if I just can't do it. But I call Randy. It really does help if you do what they tell you."
In September, Nic celebrates his year of sobriety. As much as a child's birthday is important to a parent, as much as twenty-one meant to me, a year in recovery means more.
In fits and starts, Nic tells us about a new romance with a girl, Z., but then one day he calls and is near tears. She has broken off the relationship. Earlier, Nic would have called a dealer or one of his druggie friends or scrounged a joint or beer. Now he calls Randy.
"Get over here, Nic," Randy says. "We're going on a bike ride."
They ride for three hours—up Temescal Canyon. Twice. Afterward, Nic calls and sounds elated. "I'm going to be all right."
It is a month later. Nic stops returning my calls. Something is wrong.
In our last conversation, he admitted that he was still reeling from the heartbreaking split. He said, "I can't stop thinking about her."
It is the morning of the third day since then. After French toast, Daisy and Jasper play in their room for a while and then, though it's drizzling, head outside. By the time I corral them, we're running late. They shower and dress, and I remind them to brush their teeth. Daisy asks if she can use an acoustic toothbrush.
"Acoustic toothbrush?"
"A regular one. Not the electric."
Daisy takes her brushing seriously now that her braces are off. There's a retainer to contend with, though. "I can't stop fiddling with it with my tongue," she says.
"Try not to," I say.
"It's too tempting."
The kids race through the house, collecting homework and cleats, stuffing them into their backpacks. Karen takes on Daisy's tangled braids, and then heads out to drive them to school. When they're gone, I am left to fall apart. Again.
How do I know that something is wrong? It's not only that he hasn't called me back. Is it a parent's intuition? Were there warning signs that slowly seeped up into my consciousness? Were there clues in what he said that I detected on a subliminal level? Or was it the laconic pauses between his words?
Where is he? I will not accept the most likely answer: that he has relapsed.
He has been doing well. It's not perfect, but he has a coterie of supportive friends and a good job. He is biking and writing. He attends AA meetings, including some at Herbert House, where he sees Jace and his friends. With Randy, possibly his closest friend ever, he is devotedly working the twelve steps of self-evaluation, atonement, and what he has described as "new character building." Overall, he seems enthusiastic about his life. I know that sometimes he is lonely, but who isn't? Sometimes he is down, but who isn't? Sometimes he feels overwhelmed, but who doesn't?
And yet he must have relapsed. What else could explain his disappearance? Am I being paranoid? I have reason to be hypervigilant, alert for any sign that something could be wrong, but I must allow him to move on and have a life. Maybe he has a new girlfriend. Maybe he's just down and needs some time without being in touch; there have been times when I needed to withdraw from my parents.
I call Vicki, who reassures me that she saw him a day or two ago and he was fine.
Still, I ask her to go to Nic's apartment to check.
When she calls back in an hour, she says that his roommate hasn't seen him, his bed hasn't been slept in. We call Promises and a coworker says that he has not shown up in two days. We call his friends, who have not heard from him. Yesterday one had a date to meet Nic for lunch and a bike ride, but he never arrived. I call the police to see if there has been an accident. Once again. I call hospital emergency rooms. His mother drives to the Santa Monica police station and files a missing person report.
He is:
Male.
Caucasian.
Twenty-one.
His baby-blond hair settled into a coppery brown. He has teardrop-shaped green-brown eyes and sun-bronzed olive skin. He has an easy smile. He is just over six feet tall, thin with the muscular upper arms and chest of a swimmer and the strong thighs and calves of a cyclist. When not in bike shorts and shirt, these days he normally wears an outfit of T-shirt, jeans, Converse. He has a strawberry birthmark on his right shoulder.
I try to keep it together—to appear all right—in front of Jasper and Daisy.
Karen and I don't want to tell them about Nic until we know more. We don't want to worry them more. They are only seven and nine years old. What will we say? "Your brother has vanished. Again. He may have relapsed. Again. We don't know."
But we will have to say something soon. We can't for much longer conceal the anguish and hysteria that is, again, taking over our home. It takes a prodigious effort to go through the motions of ordinary days with my constricting stomach, racing heart, and the inescapable, high-definition CSI video clips playing inside my skull: the grimmest, most sordid scenes of the worst things that happen to children on the streets at night.
