Many people have asked what helped with my recovery. Here are more details outlining what was helpful for me. It’s important not to take this as a template for anyone else. What I did was specifically tailored to me given the complexity of my life and the independent work I did to learn what was important to me.
When I relapsed I was in a second career because my nursing license was indefinitely suspended. I was working in Christian ministry as a pastoral intern for a homeless and addiction ministry and I was a second year graduate student in seminary. I had strong religious convictions and as a result viewed addiction as an issue of sin/morality. Over the 2 year period I was injecting opioids (heroin and fentanyl) I immersed myself in church, prayer, and seeking guidance from spiritual leaders in the church. Over time I realized that no one knew what to do when their star student at a prestigious seminary said, “I can’t stop shooting heroin and I don’t know what to do.” Ultimately, they did nothing. Trish and I went to 4 different churches and begged for help, we were outcast from the fellowship because I was in “rebellion against god and living in sin.”
We were foster parents of a 1 year old and had newborn twins at the time. Over the 2 years we worked closely with the foster care social worker (who was in recovery) and as long as we were trying to get in recovery she supported us. As soon as I realized I was dependent and addicted I started seeking help. I desperately wanted to be in recovery, however this was the second time I fell into deep addiction and it was during the current fentanyl era. I found it extraordinarily difficult to stop, much harder than the first time. I was using 4-6 times a day, getting sick more often, and overdosing with frequency and I couldn’t figure out why.
I knew I wanted to be a nurse again and for this to happen I could not be on buprenorphine or methadone. I had to choose a path of abstinence. At the time I also believed those medications were just trading one drug for another and I’d still be “sinning” based on my religious convictions and theological underpinnings. Over an 18 month period I went into inpatient treatment 16 times. I started using within 3 hours of discharge on 15 of those 16 admissions. After #14 I decided I would try naltrexone to “self detox,” so I locked myself in a hotel room with 2 trusted friends, used 20 bags of heroin and took a 50mg naltrexone tablet. I spent 3 days experiencing vomiting, intense diarrhea and hallucinations. As soon as I was lucid I left and used again. It was a horrible experience.
After about 2 more weeks of using we found an addiction medicine physician who I convinced to administer the Vivitrol injection. I lied and said I had been absintent, primarily because I was so desperate and wanted to be in recovery so badly I was willing to do anything. However, after 1 day of intense withdrawal I resumed using 4 times a day and continued to for over a month. I mixed injecting with benzodiazepines to try to buffer the symptoms.
Over this time period and after 2 years of being abandoned by the church I was spending a considerable amount of time trying to understand and figure out what I believed about god. I questioned all of the theology that undergirded my life at that point. So much of it was wonderful in theory, but practically it was useless and destructive. So, I decided to abandon my faith.
I went to see my addiction doc and told her I was continuing to use and she strongly recommended inpatient treatment. I was terrified to go away for a 16th time. Trish was at the breaking point, our marriage was becoming unstable, the kids were exhibiting signs of being taxed by daddy always going in the hospital, and financially we were bankrupt from drug money, insurance premiums, co-pays, me not working, and doctor visits. All three of us had a deep conversation and I went into treatment for the 16th time in 18 months.
When I called admissions the coordinator refused to let me come in. She said I’ve been there too may times and clearly don’t want to do the work. I remember my heart sinking and strongly considering suicide. I wasn’t sure what to do. I couldn’t stop using, I’m so bad that the treatment centers won’t even let me in, I was putting my family at risk of losing our son, and I couldn’t live with the shell of the woman Trish had become because of my addiction. But then Trish sent me a text saying, “you need to get it together and get better. You are the most tenacious man I have ever met. Please get help.” Her support alleviated all of the worthlessness I felt long enough for me to feel empowered to do something. I drove to the treatment center and told them I refused to leave until they agree to admit me. The CEO eventually came down and met with me and they agreed to admit me as long as I agreed to a special program for habitual offenders. So that’s what I did.
Given my recent thread about treatment centers you might be curious why I’d subject myself to the same experience. First, my thoughts about treatment are retrospective after several years of critically thinking about what went wrong and looking at treatment through a different lens. When I went in I was desperate and suicidal. Second, the staff at this treatment center were genuine, kind, and compassionate. They met me at the door with a smile and said they were happy to see me again. They carried my bags when I was in withdrawal. They sat with me all night long when insomnia was at its peak talking about life. The humanity they displayed was something I needed and it played a huge part in saving my life. The staff I am identifying here are the techs. They are peers in recovery who make the centers run. They are the ones you spend most of the time with. They run most of the groups. They made an unbearable situation bearable.
I committed to 1 year of investing myself into a 12-step program. I decided to abandon Christianity and try AA. It was very difficult for me to grasp the spiritual aspect of the program given the trauma I experienced with the church. There were too many parallels between AA and Christianity and my disconnection from the church was too proximal. Remember, I recently finished a bachelors degree in bible and was a second year seminary student; meticulously dissecting theological beliefs was the norm for me. One of AAs strong points is its belief requirements are incredibly malleable in order to be applicable to the widest audience. However, for someone like me who came from a staunch, confessional, reformed, Presbyterian background the looseness of AA was almost impossible for me to comprehend practically. Ultimately, working a 12-step program is what solidified my atheism. I spent the first year listening to AA beyond belief and finding great comfort there, but ultimately the amount of effort I needed to exert in order to circumvent the religious aspects of the 12 steps were counterproductive; so I created my own recovery support network, which largely came from the Twitter community.
After discharge I had employment immediately and I enrolled in my state’s nurse monitoring program. Now, I need to be very clear about the role of the nursing program. What gives me the drive to sustain my recovery aren't the programmatic aspects; rather, it’s the hope that I’ll be able to be a nurse again. Nothing that I do as part of the monitoring program supports my recovery. In fact, it threatens my sustained recovery. I write about this often. I am mandated to 3 12 step meetings a week and required to actively participate in the program,. In addition, the procedural aspects of random drug screens are dehumanizing and traumatic because I am a rape survivor. I have expressed this in writing 27 times via monthly progress reports to my case manager and the only responses I’ve received are, “sorry AA isn’t working for you yet” and “try to take some steps toward wellness (re: abuse history) and when you’re in triggering situations try not to dissociate and practicing mindfulness would be empowering to you.” What keeps me in recovery is looking forward to being a nurse, not the threat of consequences from drug screens and certainly not being mandated to 12 step meetings. This is important.
Also worth noting that I have identified several areas in my life that increased my vulnerability to developing an opioid use disorder and trauma is the main common denominator. Past sexual trauma and vicarious trauma acquired from 15 years working in intense emergency medicine environment took its toll. I find it disgustingly fascinating that part of my recovery plan is to regularly re-traumatize myself by placing me in an environment where I predictably experience flashbacks. The exact reasons I used drugs in the first place were to suppress the feelings I now am mandated to re-experience in order to prove I am "sober."
The most important thing that got me in recovery are my family. My wife who was essentially a stay at home mom for 3 toddlers while I was away in treatment. She paid the bills, my insurance premiums, co-pays, managed the house, worked full time as a social worker in the child welfare system, interacted with our son's social worker and adoption agency, and loved on me infinitely. They are the reason we recovered and the driving force behind why we stay recovered.
Other things worth mentioning:
Just because I had some positive interactions in treatment doesn’t mean treatment was necessary or worked. As I’ve outlined, there were many other things at play outside of treatment.
If I was not white I wouldn’t be in recovery and I would’ve lost my son. The privilege I benefited from by being white needs to be acknowledged. The basic fact that I entered treatment 16 times in 18 months defines privilege. We need to talk about this.
Another key ingredient for me was advocacy. I watched ‘The Anonymous People” documentary after my last inpatient stay and it had a profound impact on me. It gave me the green light to be public about my recovery. Being transparent and open has empowered me in ways I’ve never dreamed were possible. I went from living in shame, trying to hide aspects of my life to being in control of my story and empowered. I’m grateful for the recovery movement pioneers.
Being a paramedic and a nurse in recovery has its own unique subtleties. Healthcare professionals rarely speak openly about their struggle with addiction and, more importantly, their recovery. This is why we started the Health Professionals in Recovery podcast and why I am committed to pushing for a recovery movement in medicine. We need it for ourselves and our patients.
What sustains my recovery is having a drive and purpose in life. I am always working towards goals, fabricating ways to accomplish those goals, and my goals are designed to make the world a better place in some small way. Recovery is about purpose and passion. Until I figured out what I wanted my life to be about, there was no hope of stopping drug use. Now that I have purpose, direction, passion, and support, I don’t need or desire drugs. But that’s just me.