Cracked: Putting Broken Lives Together Again - Drew Pinsky, Todd Gold (2004)
“DID YOU KNOW Katherine gave me a good-bye hug?” I say, in a tone meant to convey surprise. Seated in the conference room with the unit’s treatment team, I’m sharing the unexpected gesture from the cell-phone fiend with my long-suffering colleagues. Almost everyone on the team—Finley, Alexi, the unit’s two chemical dependency counselors, the family program rep, the nutritionist, and our utilization and review nurse—smiles in surprise at the story.
“The wicked witch of the east?” says Gail, a counselor in her mid-fifties who has years of sobriety under her belt.
The treatment team meets weekly to update each patient’s progress. We also use the time to let off steam. Everything said in the room stays there.
“Her husband came out to take her to Sober Living back east,” I say.
“Were they flying commercial?” asks Debra, the other counselor, grinning. “Or did he bring her broom?”
“He’s in therapy, too. And the fact that she leaves with a positive attitude about treatment is an important prognostic sign,” Finley says. “Drew, did you check in on Maria?”
Maria is a returning heroin addict. Admitted a week earlier, she’s going through the motions just as she’s done numerous times before.
“Yes,” I say. “She can’t sleep.”
“She wants meds all the time,” interjects Alexi.
“Has anyone gotten a whiff of her?” says Gail, the utilization nurse. “Pee-yew.”
“I don’t care what she says, she’s sleeping,” says Debra. “She’s a liar. Her whole life is a lie.”
“Insurance?” asks Finley.
“Covered,” says Gail.
“What about Amber?” asks Finley, opening a new chart.
“I don’t know,” says Alexi. “She has some good moments, but she’s having flashbacks. And she’s still at the window.”
“Has anyone met her husband?” says Pat. “That guy comes in here and gets her and everyone else worked up.”
“Still?” I ask.
“Shoot him,” says Alexi.
“Drew, he talks about you like you’re best friends,” says Pat.
“With friends like that…” I respond. “She’s far enough in her withdrawal that she should be settling down.”
“Let’s try reducing her meds. I’ll reduce the dose, but make the intervals more frequent.”
“I’d like add something,” says Debbie, the nutritionist. “She has an eating disorder. She’s eating about thirty percent of her tray, and she’s put on six pounds since admission.”
“Six pounds?” I say. “That doesn’t sound right.” I glance through her med sheet to see if any of her medications could be causing fluid retention. “I’m concerned. If she keeps gaining weight, she may start to preoccupy about it and trigger purging.”
“Aside from her husband, what’s the family situation?” asks Finley.
“Supposedly she contacted her mother,” Alexi says. “But I don’t know if there’s going to be any involvement.”
“She’s going to groups,” says Gail. “She’s labile and has trouble tracking, but she attends. She’s started to participate.”
“Obstacles to recovery?” Finley asks, getting to the bottom of his checklist.
“That husband of hers,” Alexi says.
“Poor family support,” Pat adds.
“Limited financial resources,” Gail says.
The negatives pile up, but I don’t want to hear them.
“If we can just get her adequately enrolled and connected,” I say. “I don’t know why, but I see something in her.”
“I like her, too,” Alexi says. “As sick as she is, there’s something about her that’s likable.”
“Agreed,” Pat says.
Alexi looks at me. “But—”
Finley closes Amber’s chart and selects the next one in the pile. Everyone in the room moves on, except for me. I continue to think about Amber, wondering what it’s going to take for her to get it. I review everything I know about her, and ask myself if I’m doing everything I can to help.
Later I receive a call that disturbs me, both as a parent and as a doctor, because I’ve been consulted on situations just like it more times than I care to remember. I hear the concern in the man’s voice. It’s a tone I’ve heard countless times from other parents.
“It’s my son, Barry,” he says. “He’s eighteen.”
“What’s wrong?” I ask.
“Somebody slipped him something. Or gave him something.”
“What’s happening right now?”
“He’s psychotic. He’s locked in the bathroom. He thinks everyone is trying to kill him. His muscles are rigid. He goes in and out of it.”
“Do you have any idea what he took?”
“Has he been depressed or had any other psychiatric symptoms lately?”
I hear a click on the phone line. His wife has picked up an extension.
“He’s had a couple panic attacks,” she says. “From the stress of school.”
I don’t buy that.
“Do you know if he does any drugs? Is he into the club scene or that sort of thing?”
“Yes, he’s smoked pot,” says his mother. “What kid these days doesn’t? But he doesn’t do it that often. And he seems to be fine with it. As far as the clubs, sure, he’s very social and has lots of friends. Barry’s a great kid. He’s a B-plus student at the University of Colorado.”
What does one thing have to do with another? Nothing. I get scared thinking of how many parents I speak to who only know their children by their SAT scores.
“He’s also locked in your bathroom, lying on the floor and scared that you want to kill him.”
His father clears his throat.
“Barry’s younger brother said that Barry was supposed to be taking Ecstasy. He thought someone must’ve given him something else.”
“Maybe, but I don’t think so,” I say. “From your description, it sounds like something I’ve seen before from Ecstasy. Severe psychotic reactions can be precipitated by this drug. In addition, there can be something called the posthallucinogenic perceptual disorder, where people can feel like they’re locked into the effects of the drug, unable to escape. At some point they then start to feel panicky, then paranoid, and eventually their moods hit the skids. Often the mood problems persist.”
“Oh my God,” says his mother.
“I don’t want to overwhelm you with information,” I continue, “but I bet you there’s a marijuana problem here as well.”
“So what do we do?” asks his father.
“I’d bring him here to the hospital immediately,” I say.
The biggest problem with Ecstasy is the lack of information surrounding the drug and its side effects. Even first-time users who have a great experience usually report intense depression the next day. They get a great big high, and then an equally significant low. They go from one extreme to the other. Often the depression lingers.
If you’ve seen anyone the day after using X, you know why they’re referred to as E-tards. They’re listless, moody, scattered. They’re being one hundred percent accurate when they say they’re burned out. After one large hit or about twenty regular doses, users suffer mood changes. Barry’s reaction was atypical, but I have seen people present like this, suddenly psychotic, often with muscle stiffness, like Parkinsonism. The more common syndrome is a social person who gradually isolates, then develops panic and agoraphobia, followed by a quick and persistent plummet of mood.
Young people who hear me speak about the realities of X often get angry. They squirm at the sight of a CAT scan showing the lesions just a couple of exposures leave on the brain. They ask, “Why hasn’t anyone told us this before?”
Then, because at eighteen or twenty years old you think you’re impervious to everything, someone will invariably ask how many times they can use X before suffering side effects. We don’t know for sure, but in my experience the potentially lifelong effects usually start after fifteen to twenty times. But there’s no definitive answer. Anyone doing X is playing Russian roulette. They’re not only tempting fate, they’re fooling with bad science.
By chance, a few hours later, we admit a good example of this. Chloe is eighteen years old. She has black hair with purple highlights, a couple of tattoos on her arms, and a piercing under her lower lip. Despite the adornments, she appears younger and more innocent than I imagine she really is.
I rarely see people her age who aren’t scared about what’s happening to them, though amazingly they manage to avoid their fears until they come to treatment and start getting better. Then every hangnail is a crisis. Chloe’s no exception. Three days earlier, she explains, she took GHB. She hasn’t come down yet. She still feels racy. She has prickly sensations up and down her arms and legs. She can’t sleep. I also notice that she’s mildly paranoid, and her speech is somewhat garbled. She has trouble maintaining a linear thought. She moves constantly. Even sitting still, her leg is jumping up and down.
“How’d you get going on GHB?” I ask; it’s unusual to see someone using that drug alone.
“I really wasn’t doing it that often,” she says. “Maybe three or four times a week. I did it at night to get myself in a better mood before going out.”
That figures. GHB is a party drug. It’s like having a few beers before hitting the scene. But it sneaks up slowly on users. They start craving the subtle euphoria.
“Were you also doing X?” I ask.
“A few times,” she says. “Last year in high school.”
“Once? Three times? More? How many times did you use it?”
“I don’t know. Four or five times over the past couple years.”
“Could it be more than four or five times?” I ask, knowing it’s more likely at least ten to fifteen.
“I don’t know, “she says. “Maybe. I can’t remember.”
“How was it the first time you took it?”
“Great. I had a great time.”
“How’d you feel the next day?”
“Let me give you some facts,” I say, looking directly into her eyes She makes strong contact in return—a good sign. “With X, that depression can be permanent. Sometimes it can be fifteen hits or one big one. You never know. It leaves you with a groggy, sluggish, depressed feeling that never goes away. You might be on the verge.”
I can see her fear surface in her eyes as she fights back tears. I take her hand and give it a comforting squeeze.
Chloe follows the pattern of a number of young GHB users. Over the next two days, she comes back to earth. She doesn’t have much detox experience to endure, though she receives a small amount of medication to deal with the paranoia, agitation, and hyperexcitability. Then she wakes up two days later feeling so much better that she wants to leave. In one of our last talks, she resists the idea that GHB is addictive.
“I’ve never been addicted to anything,” she argues.
“I think you should go to meetings,” I say.
“But it’s not a problem,” she says.
Actually, most GHB users don’t crave the drug after a few weeks off it, and indeed often grow afraid of it. But the residual effects can linger for months, in the form of crankiness, irritability, and generally manic behavior. Inevitably they start using again, and that itself can open them up to treatment. Looking at her bag all packed, I put Chloe in this category.
“How about your parents?” I ask.
“They’re divorced,” she says.
“Do either of them have any problems with drugs or alcohol?”
“My mom likes to smoke a little pot now and then. She likes it for sex. My dad’s an alcoholic.”
She’s dealing with that same thing. She just doesn’t know it. She hasn’t gotten her wake-up call yet. There’s not much I can do. She’s up and out of here, though before she leaves, I warn her that there will likely come a time when she’ll need to face facts. I don’t want her to be blind to them.
“You may not be ready to look at this now,” I say. “But you inherited a biology from your dad that set you up for this. You are an addict. I know you don’t think of yourself that way. I know you don’t feel like you have a problem. So you may have to try this on your own. But please, do both of us a favor and remember this conversation, before too much shit rains down on you. It’ll save you more problems.”
“Thanks, Dr. Drew—uh, Dr. Pinsky.”
“Good-bye, Chloe. Good luck.”
Not long after that call I remember that I haven’t yet seen Barry, the teenage X casualty. If his parents had followed my advice, they would have brought him right here to the hospital. Hadn’t he been paralyzed on the bathroom floor? Didn’t he believe that his family wanted to kill him. Aren’t either of those reasons to seek help?
My guess was that Barry was suffering from more than an allergic reaction. From their description, I’d bet he would spend two or three days cooling off in the locked unit. Once his psychosis had settled down, he would be brought onto our unit, where we would continue to require medication while he went through withdrawal, from marijuana, I suspect. Then we’d get him into groups so he could start learning to make connections that would help him manage the feelings that had originally ignited his addiction back when he first started smoking pot.
They hadn’t mentioned a pot addiction, but I bet Barry had smoked pot daily for the past three or four years. When pot starts losing its effect, addicts like Barry try smoking more, or trade up to better pot or hash. When that doesn’t work, they head toward stimulants like speed. Barry had probably done X as often as twice a weekend for six months without any problems until that fateful night. After that, the situation was more dire.
His is a common story. Right now one in five chemical dependency admissions is for marijuana addiction. That’s twenty percent. This isn’t the casual smoker lighting up once a month. Pot addicts generally have a family history of alcoholism, which they swear they will never touch. They smoke pot instead. The majority of them tell the same story of getting started. Their first time was no big deal. The second was okay. The third was magical. They develop an intimate relationship with their pot. They can’t imagine life before this wonderfully soothing herb. I will ask a roomful of pot addicts who remembers the first time they smoked, and no one will raise their hand. If I alter the question slightly by asking who remembers the first time they got high, every single hand shoots up. A pot addict can recall the exact day twenty years later.
But at some point this amazing experience loses its power to sway and seduce. The love affair goes stale. The addict is left depressed and irritable by this biological betrayal, and also confused and panicked. Think about it. If you’ve managed your moods for twenty years by smoking pot and then suddenly it stops working, what do you do? Start smoking more, smoking better—even though all of that actually accelerates the decline into depression, anxiety, and panic.
Most pot addicts try GHB, LSD, Ecstasy, and mushrooms. This is where Barry was at, I am sure. They are chasing that high, that soothing sensation that sheltered them from real feelings. Eventually the typical pot addict graduates to speed. Amphetamines seem to work best when it comes to lifting them from the depression caused by chronic marijuana use, and from there it’s all bad news.
I want the latest on Barry, and soon enough curiosity gets the better of me. I call Alexi, who has wisely saved the father’s callback number for me. I make the call from my den at home. As the telephone rings, I figure the couple must have taken their son someplace else, which is fine with me. I merely want to follow up, find out if Barry is doing better, and answer any questions they might have. Treatment can be as confusing as any medical procedure.
The father answers; he sounds as if I caught him a little off guard, but his tone is friendly and open. He thanks me for checking in, even cracks a joke about how these days you can wait six hours or more in an emergency room for a doctor to see you and yet here I am actually calling a patient at home.
That’s my cue. Much to my surprise, I remind him, his son never became a patient. “What happened?” I ask.
“He improved some and we took him to the emergency room,” he says. “They gave him a shot—”
“They probably sedated the hell out of him,” I interrupt.
“But he seemed pretty good,” the father continues. “We sent him back up to school yesterday.”
“We really appreciated the way you talked to us when I called. It helped us get a handle on Barry’s situation. Then we talked about it at a family meeting. I agree with his brother, who said someone probably slipped Barry something he didn’t expect. As for Ecstasy, we explained the facts to him just as you described them to us. We told him that that drug is a time bomb.”
“Good,” I say.
“Just to be safe, I said, ‘Son, you have to be careful nowadays. You don’t know what you’re getting with these designer drugs. You can’t tell. There’s no regulation. If you have to do something, stick to your bong.’” He pauses. “Dr. Pinsky, I grew up in the seventies. Things were different then. Safer. Don’t you agree?”
No, I don’t. I couldn’t disagree more. The father’s attitude is so disturbing I don’t have a response. Not a polite response, anyway. I could read him the riot act. They’re convinced they have a handle on the situation, when in reality they’re in such denial that their lack of response could end up leading to much more serious problems for their son. Barry might have already suffered brain injury as a result of his drug use. And he could be on the verge of a bigger break.
I end the call politely, wishing him good luck, and then I spend the rest of the night stewing in a quiet rage and disgust.
But the truth is, I have more trouble getting through to parents than their children. A speaking engagement I did at a private L.A. high school is typical. Midway through the presentation, a group of parents took exception to me for suggesting that their children drank, smoked pot, and took X. These parents wanted information, but they thought it was merely preventive. All I could think was, Wait a minute, here are the facts: Forty percent of high schoolers drink regularly; over fifty percent are using illicit drugs, and one in ten twelfth graders has used Ecstasy. If some of those aren’t your kids, whose are they?
I understood their reaction. The world is a frightening place, and parents don’t want to think of their kids experimenting with sex and drugs. But they do, and it’s negligent and irresponsible to deny it. As I told those angry parents, I don’t tell anyone what to do. I present information that will help you and your children make good, hopefully healthy choices. You have to talk to your kids. You also have to know what you’re talking about. I want people to understand the facts when someone is developing momentum in their use of drugs or alcohol. If that happens, I won’t get as many calls from parents asking what to do because their kid is passed out on the bathroom floor.
“Let me give you an example,” I told those L.A. parents. And then I told them the cautionary tale of Barry. “This boy could have been anyone’s kid…”