Update Heroin

Last May we reported on the American opioid epidemic as seen from our corner of the map (“Heroin: Too Close To Home”). It was not a pretty picture. We noted that 2015 marked an all-time high for overdose deaths in Connecticut as a whole (729) and Fairfield County in particular (102), and that roughly 90 percent of those deaths involved opioids.

The epidemic began circa 2000 with laxly prescribed opioid painkillers and accelerated with cheap, abundant Mexican heroin, which addicts turned to when their prescriptions dried up and black-market pills proved too costly to keep buying. The silver lining seemed to be that, by early 2016, news of the epidemic was exploding: What once was a series of private tragedies had suddenly become a public health crisis. Cries for help went up at town halls and churches across the land; even the presidential candidates agreed on the need for aggressive action—if not on what that action should be.

HOW ARE WE DOING?
Despite this new awareness, opioids continued taking lives at a bewildering clip. The month our story appeared, Connecticut recorded seventy-eight overdose deaths; opioids figured in all but one of them. By year’s end the grim tally was 917 overdose deaths statewide (up 25.6 percent from 2015) and 157 in Fairfield County (up 54 percent).

Greenwich, at least, fared pretty well. In 2016 only two residents died from overdoses: a forty-six-year-old man who dangerously mixed oxycodone and alprazolam (Xanax), and a twenty-four-year-old man who overdosed on a rare synthetic opioid called U-47700. A third death was narrowly averted in December, when a woman who overdosed on heroin at a house in Cos Cob was resuscitated at Greenwich Hospital.

A STRONGER HEROIN?
One disturbing trend was a sharp rise in related deaths. Fentanyl, roughly fifty times as potent as heroin, is a synthetically manufactured opioid used to alleviate severe pain in cancer patients. It’s easy to manufacture illicitly in makeshift labs. Dealers “cut” their product with fentanyl, occasionally in doses powerful enough to kill the unsuspecting users. (Some people deliberately seek out fentanyl because of its potency. The musician Prince, a chronic pain sufferer who died of a fentanyl overdose last April, appears to have been one of them.) How bad has it gotten? In 2015 fentanyl contributed to 188 overdose deaths in Connecticut; last year it contributed to 479—more than half of our state’s 917 overdose deaths.

WHAT ABOUT LEGAL DRUGS?
According to John Hamilton, a substance abuse counselor who heads the Shelton-based Recovery Network of Programs, another worrisome trend is the taking of opioids with benzodiazepines (Xanax, Klonopin and Valium, among others), a class of drugs used to treat anxiety and insomnia. This is the combo that killed the forty-six-year-old Greenwich man—one of 232 state residents to die of an opioid-benzodiazepine overdose last year. Hamilton notes that the danger is widespread but little-known. “There were 257 million opioid prescriptions written last year—about one for every adult in the United States,” he says. “But benzos are prescribed at an even higher rate.”

FEDERAL ATTENTION?
New policies, laws and treatment strategies came to the fore in 2016, attacking the problem from all sides. At the federal level, Congress approved President Obama’s request for $1 billion over two years to help states fight the epidemic—a rare instance of bipartisan accord. In March of this year, treatment advocates breathed a momentary sigh of relief when Trumpcare died in utero: The hundreds of thousands able to get treatment stood to be out of luck. But in May, a new version of the bill passed the U.S. House, which treatment advocates deemed equally devastating (though the bill awaits extensive reworking in the Senate). On top of that, the administration proposed slashing the budget of the White House drug czar by 95 percent, further undercutting candidate Trump’s promise to deal aggressively with the opioid crisis.

LOCAL LEGISLATION
Connecticut has made real advances. In 2015, new legislation allowed certified pharmacists to prescribe and dispense the overdose-reversing drug naloxone (Narcan) directly to customers. Now, for example, parents can have a Narcan kit at the ready should a son or daughter overdose. Laws passed in 2016 limited the duration of opioid prescriptions, required municipalities’ first responders to be equipped with Narcan and strengthened laws requiring prescribers to enter information into a state database that is designed to keep users from getting opioids via “doctor shopping.”

MEDICAL PROFESSIONALS
Surgeons are beginning to turn to new methods of pain control. Greenwich’s ONS now uses the injectable, non-narcotic painkiller Exparel for shoulder surgeries; the drug reduces or eliminates the need for opioids to manage post-surgical pain.

In October, a Yale School of Med-icine panel unveiled Connecticut’s strategy for fighting the opioid epidemic. Among other things, it calls for swift and widespread access to treatment—specifically to methadone and buprenorphine, drugs that help users manage their addiction and live productive lives.

This is key, because treatment remains an enormous challenge. Most people addicted to opioids go through several rehabs at a cost of tens of thousands of dollars; some insurance plans cover it, but many still do not. And up to now, state-funded treatment had a long waiting list.

THE NEW FRONTIER
As the state plan recognizes, the opioid crisis has begun yielding concrete treatment solutions to what only recently were conflicting theories. In a nutshell, treatment must last a while—a thirty-day rehab won’t suffice—and will probably require a fully rounded strategy, including medication, therapy, healthy living instruction and careful oversight. Westport House (for men) and Shana’s House (for women), both in Westport, fit the bill admirably; both have achieved very low relapse rates.

Another new option getting great results is the North Haven-based Aware Recovery Care. Its yearlong treatment program is carried out, counterintuitively, in one’s own home. Typically when people complete rehab, they fall back into a world of stress and temptation; they leave the safety of treatment for the rapids of real life. ARC’s idea is to recover while learning to navigate those rapids. Each client is assigned a team consisting of a care coordinator and two recovery advisors; and each family is assigned a marriage counselor or family therapist to work out underlying problems. “The most important part of treatment is after-care,” ARC’s clinical director, Sarah Benton, says. “We have a huge safety net.”

Matt Eacott might not be alive today but for ARC. Matt had gone from alcohol and OxyContin to snorting eighty-five bags of heroin a day. “I thought I was a lost cause,” he says. “Addiction psychiatrists gave me a 2 percent chance of success.” Though serial visits to treatment centers—fourteen all told—had value, eventually he had to come home “where all your cues and triggers are.” Relapse would ensue. But with ARC, “You’re able to have a job, have a relationship, do all the things you can’t do in a controlled environment, but you’re able to utilize the supports in real time.”

Today, he’s a counselor at ARC. “It’s a miracle. It really is. You get to the point where, if you give yourself a chance, you accumulate so many good things in your life that you’re unwilling to risk losing them.”

For the article “Heroin: Too Close To Home,” go to greenwichmag.com/heroin


AVOIDING A WORST-CASE SCENARIO

Silver Hill Hospital is working with area agencies to try to prevent opioid-related deaths by making Narcan, a fast-acting drug that reverses the effects of an opioid overdose, more available to those at risk. The hospital’s addiction psychiatrists and Ellen Brezovsky, LCSW, director of community relations, provide education and training to opioid users and their friends and families. Narcan is distributed after the sessions, which are offered in groups and on a one-to-one basis. The program is free.

“By offering free Narcan trainings and kits, we are hopeful that fewer overdose deaths will occur. Getting these kits into the hands of family members and friends is more important than ever with the increasing numbers of deaths in Connecticut and nationwide.”
– Ellen Brezovsky

 

 

Heroin: Too Close to Home

*Name has been changed for privacy

Behold Adam Dalman*, twenty-three years old, back from the land of the dead. He’s standing in the cold sunlight of a February afternoon, trim, clean-shaven, dressed in a plaid flannel shirt and khakis. You study his face for signs of his journey into heroin’s dark wood, there across the Styx and the Lake of Fire, but none are apparent; all you see, as he stretches out his hand to greet you, is a slight fragility in his otherwise perfect smile.

Adam leads me inside Westport Sober House, an immaculate Colonial near Main Street and the Saugatuck River, where he has lived since leaving prison fourteen weeks earlier. Adam’s three-year heroin addiction began in the light of euphoria, progressed to street-living and petty crime, and ended in an abyss of suicidal despair. “I know like thirty-something people who have overdosed and died,” he says, referring to young men and women he encountered in serial rehabs. “You think about those things and it’s like, ‘Holy shit.’” But nothing, not even his own near-fatal overdoses, could release him from heroin’s grip.

Adam first snorted heroin at age twenty, while sitting in a friend’s car in his native Greenwich. “An overwhelming joy would come over you,” he tells me. “A peaceful joy would take over your entire body. Something would just click, and you’d be the happiest person in the world. Picture your happiest moment, and that’s how you feel—like you’re floating on a cloud and your favorite song is playing.”

That “click” Adam describes is actually the unlocking of a powerful pleasure center deep inside the brain—the nucleus accumbens—the same place that rouses to life when stimulated by food or sex. Heroin binds to the brain’s opiate receptors, triggering a rush of dopamine exponentially greater than would eating fried oysters or making love to the Venus or Adonis of your choosing. The problem is, the nerve cells that dopamine so deliciously bathes tire from overstimulation, and then you need ever-greater dosages to chase ever-more-elusive highs. That’s just the beginning; soon you’re a lab rat pounding away at your reward lever, until the best payoff you can expect is to keep the misery of withdrawal at bay. In other words, you have catastrophically rewired your brain. “You treat heroin like an animal would treat food,” Adam says. “It becomes instinctual.”

Adam’s path to heroin use was typically incremental: alcohol at fifteen, marijuana at sixteen, cocaine and ecstasy and acid at seventeen. “That’s what it seemed everyone did,” he says. “But it was really just a Fairfield County or a Greenwich kind of thing. I found that out when I went to college. Everyone was like, ‘That’s what you were doing in high school?’ I was like, ‘You guys weren’t?’” As his drug use accelerated, his lifelong interests, namely sports, withered and dropped away. “I quit football my sophomore year [of high school] because it was too much work. It didn’t allow me to party when I wanted. I never even attempted to try out for varsity lacrosse—and lacrosse had been a passion of mine.”

While marijuana “opened the drug spectrum” for Adam, it was the prescription painkiller OxyContin that flung wide the gate to addiction. OxyContin is an opioid, or semi-synthetic drug derived from the opium poppy. So is heroin. Your family doctor prescribes one, and Mexican drug cartels smuggle the other, but the two drugs are essentially the same thing; the notable difference is that Oxy has a time-release coating and is not cut with mystery substances. Compared to the illicit drugs he’d been taking, OxyContin struck Adam as fairly innocent. “One day I went over to my buddy’s house, and he was crushing up an OxyContin pill.” Crushing the pill destroys its time-release coating and delivers the full force of the drug—oxycodone—all at once. “He said, ‘Try this, you’ll love it.’ And I loved it.”

But OxyContin and its ilk were expensive, running to a dollar a milligram, or roughly $40 to $80 a pill. As Adam built up his tolerance, he would lay out $100 for a single high. “Heroin was less than half the price and stronger,” he says. It made complete sense to switch. “But needles were still like, ‘No. That’s homeless people under the bridge.’” As his body demanded more and more heroin, the financial imperative yet again took hold, and what was once unthinkable became pragmatic. “Shooting it, you get more bang for your buck. You don’t have to use the same amount you would use snorting it.” As a bonus, the high was instant and even more intense, a glow that suffused his whole being. “At that point, I think I knew I was in a bad place.”

Heroin addicts tend to function quite well early in their illnesses. Many find that heroin heightens sensations in a relaxed sort of way, making life seem more vivid and colorful—anything but dangerous. “My parents had no idea for the longest time,” says Adam. “No one could look at me and say, “This guy’s fucked up.’”

But the turning point always comes. When Adam could cadge no more money from his parents, he began stealing from them; soon he was shoplifting and breaking into unlocked cars, for which, in the end, he was arrested several times. Heroin addicts usually fall into this destructive pattern and women sometimes add prostitution to the mix. “As you get to that everyday habitual use where you’re dope-sick and dependent on it, it really takes over your mind,” Adam explains. “It skews every thought you have. You might know that what you’re doing is bad, but the power that drug has over you—you can justify anything.”

One day, Adam’s mother made a small but con-sequential discovery—a missing check—and confronted her son. When he made the partial admission that he was “dabbling” in opiates, she decided to take action. First Adam went to intensive outpatient treatment in Stamford, “but that got in the way of my using very quickly.” A month later he crashed his mother’s car; his parents, now deeply alarmed, sent him to A Forever Recovery in Battle Creek, Michigan. Suffice it to say the recovery was not forever. His second day out, he shot up in his mother’s basement and overdosed.

Post-rehab is an exceptionally dangerous time for heroin addicts. Tolerance has plummeted and cravings lie in wait, ready to ambush: When you give in—as 90 percent do—you have to be careful to use a fraction of what you once did. If you were to resume your customary dosage, the drug would probably stop your heart from beating.

Adam injected a quarter of his old dose, one bag, thinking, “no way this will kill me.” Mrs. Dalman chanced to come down the stairs in the middle of the night, heard her son gurgling, saw the needle on the couch beside him. Adam came to on a stretcher. In the nick of time, paramedics had shot him full of Narcan, a somewhat newly available opioid “antagonist” that quickly reverses the effects of an overdose. “Any longer and I’d have been dead,” Adam tells me.

But here is something the average reader will never comprehend: Adam shrugged off the overdose as a mere speed bump on the path of his life. “Just thinking about heroin, imagining that feeling again, was enough for me to think, ‘I’ll be fine. Let me just get over this little thing here, and I’ll go back to it.’”

From here Adam’s story gathers a sad, weird momentum. There was a second failed rehab at the renowned High Watch, up in Kent; a spell sleeping on the streets of West Hartford; a second overdose, during which he stopped breathing; a brief stay at his father’s house that ended in theft; another spell of street-living, this time in Greenwich; and a third failed rehab at Turning Point in New Haven. This relapse crushed him.

“I was their golden boy,” he recalls somberly. “I was eight months sober.” He’d fooled himself into believing he could handle a drink like a normal twenty-one-year-old “and a week later, I was using heroin again.” Adam headed back to rehab, up to Mountainside in Canaan, and from there to a sober house in North Haven. So goes the heroin addict’s vicious cycle: detox to sober house to relapse—repeat, repeat, repeat.

When the last glimmer of hope faded, Adam sank into a profound depression. “I just accepted that, wow, I cannot do this, I cannot get this right. That progressed into three months of sleeping in my car, sleeping on the streets, hell-bent on killing myself, wanting to die. And that was okay. I didn’t want to deal with the pain anymore. I was back in the same loop, and it sucked. So I’d always carry a little bit of extra heroin, and I’d say, ‘All right, when the time is right, I’ll just do as much as I can, and I’ll be gone.’”


How to Talk to a Heroin Addict

LET’S SAY IT’S YOUR SON. IN HIS ADDICTION, HE CAN’T HEAR YOU. AND IF YOU COME AT HIM WITH STERN ADVICE, HE CAN’T HEAR YOU EVEN MORE

Listen
“If you tell your son what his problems are and how to solve them, you’re going to get a big shutdown,” says Alan Mathis, president and CEO of Liberation Programs, which offers clinical services for the addicted in lower Fairfield County. “IT’S CRUCIAL TO BE ABLE TO LISTEN TO YOUR SON, even though he may be doing outrageous things. YOUR JOB IS TO KEEP THE LINE OF COMMUNICATION OPEN. Recognize that there does come a point when a person using drugs doesn’t want to use them anymore.”

Do Not Enable
While it’s imperative to let your son know that you love him and you understand that his addiction is an illness, IT’S EQUALLY VITAL NOT TO ENABLE THE ADDICTION. Do you loan him money? Lie or otherwise cover up for him? Clean up his messes? Bail him out of jail? Give ultimatums that you don’t carry out? All of that is tempting, and none of it is helpful. A FIRM STANCE AGAINST ENABLING HELPS KEEP YOU FROM BEING DRAWN INTO HIS CHAOS.

Be There
“MY PARENTS CUT THE CORD, AND I’M GLAD THEY DID,” says Molly Ashcroft, twenty-eight, who kicked her crack cocaine and heroin addiction at age twenty-one. “They just were not going to allow drug use in their house” But the Ashcrofts, who had three younger children to consider, left the line of communication open in this way: “THEY WOULD ONLY PICK UP THE PHONE IF I WANTED TO GO TO TREATMENT.” Granted, Molly gave her parents repeated false hope, but when she finally hit bottom, as so many heroin addicts must do, they were there for her.

Ask Questions
Adam Dalman, twenty-three, free of heroin for a year and a half, now finds himself talking to younger versions of himself. What does he tell them? “Not ‘Hey, don’t do drugs, because you’ll wind up in jail.’ Because when you’re already using, you won’t hear that. It’s more like, ‘WHAT MAKES YOU TICK? WHAT MAKES YOU HAPPY? WHAT MAKES YOU WANT TO LIVE LIFE? DO THAT.’ Because odds are, you won’t be living life soon if you’re still getting high.”

Learn
When your child travels to the dark side of the moon, you are not going to be able to bring him back yourself. It may be a long and costly battle involving many professionals. But to understand the nightmare he is enduring is to help him. “MY MOM WAS WILLING TO LEARN, AND SHE FINALLY UNDERSTOOD,” ADAM SAYS. “BUT MOST PARENTS DON’T. They think something’s really wrong with you—you’re doing all these terrible things—but deep down you’re still that same child, that same loving and caring person that you’ve always been. It’s just all hidden by the addiction.”


THE ANATOMY OF AN EPIDEMIC
Alas, the Adam Dalmans of Fairfield County aren’t hard to find, though many do not live to tell their stories. Last year 102 residents of Fairfield County died from drug and alcohol overdoses, fifty-three of them from heroin and thirty-six more from opioids such as oxycodone, hydrocodone and fentanyl. In other words, opioids accounted for 87 percent of our fatal overdoses in 2015.

This statistic deserves special notice. Twenty years ago, there were virtually no deaths by opioid in Fairfield County or, for that matter, anywhere else in suburban or rural America. In Connecticut, the last three years have been especially bad. In 2012 there were 174 heroin-related deaths—a sharp increase from previous years—and last year there were 415. (Heroin cut with the brutally potent fentanyl, almost unheard of five years ago, now accounts for 107 of that total.) The national figure over a longer period is more disturbing still: Since 2001, heroin-related deaths have quintupled—reaching a record 10,574 in 2014, the last year for which statistics are available.

A heroin epidemic is now in terrible flower. It’s a national epidemic, to be sure, but the Northeast from New Jersey to Maine has been hit particularly hard. “It’s like an explosion,” says Captain Richard Conklin of the Stamford Police Department. “We’ve seen heroin around here forever, but this is different—there’s a huge supply and an ever-increasing demand. It’s really reaching across all demographics.”

What happened? In the sixties and seventies the drug existed only in a shadow mythology of back rooms and back alleys, an underworld to which bleak-hearted writers and musicians descended in order to bring us news of the dark side of life. Otherwise heroin was not part of our universe, certainly not out here beneath the blue suburban skies. There was a slight bulge in the heroin trade in the seventies during Vietnam. But the drug in those years was only about 8 percent pure and had to be injected; it was therefore a “dirty” drug that conjured bottom-of-the-pit visions of tying off one’s arm and shooting up—a drug that went too far for most people.

Our cultural memory has not retained the fact that heroin once enjoyed a season of middle-class respectability. In 1898 Friedrich Bayer & Co.—the aspirin people—began selling it profitably as an over-the-counter cold and cough medicine; Bayer’s ads show pretty mothers spoon-feeding it to their happy children. “There’s no danger of acquiring a habit,” the Boston Medical and Surgical Journal observed in 1900.

In the following decade, physicians discovered this common assertion to be utterly false, but were reluctant to let go of heroin: “I feel that bringing charges against heroin is almost like questioning the fidelity of a good friend,” wrote a doctor in Kentucky. Lawmakers clamped down anyway, first restricting heroin use to doctors’ prescriptions, then banning it altogether in 1923.

The one-time elixir had been driven fully underground, to the blackest of black markets.

This history is worth noting because it’s repeating itself. The heroin epidemic now in progress is floating upon a sea of prescription opioids. If this sea had never swelled, Mexico’s Sinaloa drug cartel would never have noticed a vast new market to exploit, would never have ramped up opium poppy farming, would never have bothered learning to refine opium paste into high-grade white powder for export to America. (“Only about 5 percent of the heroin in the United States comes from Afghanistan,” says Robert Lawlor of the New England High Intensity Drug Traffic Area, a law enforcement liaison agency. “The vast, vast majority of the heroin comes from Mexico, with a little bit from Colombia.”)

Many experts date the opioid epidemic to 1996, the year pharmaceutical giant Purdue Pharma (then of Norwalk, now of Stamford) launched its billion-dollar drug OxyContin. Oxy’s arrival dovetailed perfectly with the medical community’s redoubled focus on pain alleviation: “pain is the fifth vital sign” was the new mantra (though pain can’t be measured as pulse, blood pressure, body temperature and respiration can). “Optimizing analgesic use” was the new practice.

Intentions were good all around. OxyContin, for its part, delivered a large dose of the painkiller oxycodone over the course of twelve hours, allowing cancer and AIDS patients to sleep through the night. The trouble was, Purdue Pharma got greedy. It sold the drug as a nonaddictive alternative to the painkillers Vicodin and Percocet, and in a climate of total pain annihilation, family doctors across the land eagerly bought the pitch. (Percocet and Vicodin are opioids as well, but they differ from Oxy in two important respects: Both contain the pain reliever acetaminophen, which makes you sick if you take too much—though people do so anyway—and neither is time-released, meaning the dosages are smaller.) Soon doctors were writing OxyContin scripts with benevolent abandon—for backaches, headaches, sprains, sore hips—and patients who acquired a fondness for Oxy took to reporting pain that didn’t exist.

The result? People began dying. In 1999, 4,030 people in the United States died from overdosing on prescription opioid painkillers; by 2014 that number had ballooned to 18,893, making pills nearly twice the killer that heroin is. Together, opioid painkillers and heroin are driving an American overdose epidemic that costs 47,055 lives a year, easily surpassing the annual toll of motor vehicle deaths, suicides or homicides. In March of this year, an alarmed federal government issued stringent new guidelines for prescription painkillers, urging physicians to try ibuprofen first and then limit opioid prescriptions to a few pills rather than the customary thirty. (Pain doctors and the drug industry fiercely opposed the guidelines, and held up their release for months.)

“Percocet, Vicodin, OxyContin—these are heroin in a pill. But they don’t have the dirty name,” says Gary Mendell of Easton, founder of Shatterproof, a nonprofit that he hopes will evolve into an American Cancer Society for addiction, educating the public and advocating for policy change. Gary lets fly a silver bullet of a statistic: Four out of five heroin users begin their addictions, legitimately or recreationally, with prescription painkillers. “Prescription painkillers are the feeders for heroin,” he says.

Purdue Pharma, meanwhile, reaped breathtaking profits. Its annual revenues of greater than $3 billion come largely from OxyContin, though there have been hiccups along the way. In 2007, the company pleaded guilty to misleading doctors and patients about OxyContin’s risk of addiction and paid $634 million in fines and civil litigation settlements.

In 2010, the company reformulated OxyContin to make it difficult to misuse. Now, if you try to crush an Oxy, it turns into a gummy paste. But tamperproof OxyContin appears to have had a dire unintended consequence: Addicts turned in droves to heroin.


BUT IN FAIRFIELD COUNTY?
Heroin wends its way from Mexico to distribution hubs like New York by any and every means you can imagine: by tunnel, by truck, by cargo ship, by private plane, by submarine, by pleasure boat. Some traffickers catapult narcotics over the border. Mostly, heroin is trucked from Mexico to warehouses outside cities and then disbursed to cars, which go to ho-hum apartments in (for example) northern Manhattan and the Bronx. From there, heroin filters out to distant parts via the interstate highways, finding especially fertile markets in upper New England—virgin territory in the sense that scourges like meth and crack never gained traction there.

Connecticut is a direct extension of the burgeoning New York market. Small-time dealers exist discreetly in towns from Greenwich to Fairfield, but they’re much easier to find in our urban centers along the so-called I-95 and I-91 corridors—in Stamford, Bridgeport, New Haven and Hartford. That doesn’t mean it’s easy for police to flush them out, though.

“With the advent of the cell phone, drug dealing has completely changed,” Richard Conklin, the Stamford police captain, says. “It’s no longer an open-air market” in which you go to a known spot and find a dealer loitering. “Now it’s a kind of moving rendezvous.” That is, you call the number you’ve been given—it’s a network powered by word-of-mouth—then agree to meet at a gas station or a fast-food joint where the exchange is swiftly made.

Al Samaras, the founder of Westport House—actually three houses in close proximity to one another—says, “It’s extraordinarily easy to get. It’s everywhere and it’s cheap: Heroin is four dollars a bag. Four dollars a bag! [The price varies; it might be as little as four dollars or as much as twenty a bag.] I can take change out of my car and go buy heroin. Is there a dealer here in Westport? Maybe not. But there’s certainly one in Norwalk who will drive over the town line and bring it to you or meet you at the McDonald’s.”

Richard Conklin notes that suburban dealers aren’t really part of heroin’s organized food chain. “It’s not like they’re getting rich,” he says. “Many of these dealers are addicted to heroin themselves—it’s more of a subsistence-type dealing.”

Dennis Wright* is a case in point. The story of this twenty-seven-year-old from Greenwich illustrates that, in some cases, dealing heroin is a natural progression of the disease, a survival adaptation. He was fifteen when he made his first cocaine-buying trip to New York. Someone’s older brother had slipped him and his friends a business card—“Carlos, Miami and New York”—and when they called the number on it, Carlos showed up in a gold Ford Explorer to deliver the goods. Between the ages of fifteen and nineteen, Dennis took a range of drugs, from marijuana to acid, but everything changed the day he tried OxyContin. “I remember a friend of mine crushed a pill up. I snorted it, and the euphoria was incredible. I have no problem saying it: That was the greatest feeling I’d ever had up to that point. It’s a warm blanket. You don’t have a care in the world.”

After college, Dennis found that his whole Greenwich circle was snorting Oxys. “It was only a matter of time before one of my friends said, ‘I got some heroin. It does the same thing, but it costs way less.’ So at that point the table was set.”

Two years later, sitting in a parking lot across from Greenwich Police Headquarters, Dennis overdosed. His drug-mate bolted from the scene, fearing arrest. (In 2011 Connecticut passed a Good Samaritan law, granting immunity to 911 callers who have been using.) By miraculous good fortune, a passerby noticed Dennis’s car and a motionless leg dangling out an open door. Paramedics laid him on the pavement and administered Narcan. “You know most people don’t survive this,” they told him en route to Greenwich Hospital.

Dennis used heroin from ages twenty to twenty-four, while working in the business world in New York City. Toward the end, as his addiction careened out of control, he lost his job: “I went from working in the Chrysler Building to sleeping in the back of a moving truck—I was a mover by day.” Then to support his habit he turned to dealing. “This was your normal street-dealing stuff—nothing big time,” he says. “Me and a few other addicts, guys I ran with, we would buy a large amount, and we would ‘step on’ the drugs—cut them with different things, baking soda—and we would take it out to the suburbs.”

Out here, he sold to acquaintances in their early twenties, guys in college or recently graduated but still living at home. “These kids were going to use no matter what, right? And they didn’t have to deal with all the stuff we had to. They didn’t have to go into East New York, into a sketchy project building with guns on the table.” He draws a breath. “Well, that was our justification. But whatever justification we used, we brought it right to their door.”

Three years ago, Dennis had the good luck to get arrested in a sting operation in New York. “We had about ten unmarked cars cutting us off on a city block, guns drawn, the whole thing. I think at that point, I had about a hundred bags of heroin. Fortunately, they did not tap me with intent to distribute—only possession. I think these undercovers were after a little bit bigger fish than me.” He might have served five years behind bars, but the courts allowed Dennis to try to get sober—and this he did. He has since moved cross country and restarted his career. But he knows how sneaky heroin addiction can be. “I’ve seen three friends of mine pass away in the last year from heroin relapses,” he says. “There’s a constant threat of that—so to be reminded, to be humble, is the biggest thing.”


FACES OF ADDICTION
Last year, heroin claimed the lives of a twenty-six-year-old trombonist from Wilton; a fifty-three-year-old receptionist from Stamford who loved quilting, gourmet cooking and stamp collecting; a nineteen-year-old Greenwich girl soon to enter Sarah Lawrence; a twenty-two-year-old star athlete from Wilton studying finance at University of Connecticut; a fifty-one-year-old landscaper from Fairfield—the list goes on and on. Here is a middle-aged man from Weston whose obituary paints a picture, no doubt accurate, of family happiness and civic engagement. The obit reports the cause of death as a heart attack, but the actual cause, according to the list before me, provided by the state’s chief medical examiner, was cocaine and heroin intoxication. Such is drug addiction’s stigma.

Then there are those who lived.

Richard Treglia, fifty-one, a builder from Norwalk, climbs the front steps of my house with a pronounced limp and settles in at the dining room table. He’s an affable man with a lot of mileage on him. The first thing he mentions is his idyllic childhood, on the edge of Oak Hills Park Golf Club in Norwalk; the second thing he mentions is a beloved older brother’s fatal motorcycle accident in 1978. The drinking and pot smoking started then, at age thirteen, and the cocaine followed at seventeen. Clinicians know that the younger the age of first use, the likelier addiction becomes.

The addiction that nearly killed Richard did not begin until 2003, at age thirty-eight, with Percocet and OxyContin. By then Richard was married with three daughters and living in a beautiful house down in Marvin Beach on the Norwalk waterfront. “My next-door neighbor, Eric, God rest his soul, said, ‘Richard, the pills are getting hard to get—the heroin is cheaper, and we can get it all the time.’”

Richard got his in South Norwalk. The self he showed the world was a bon vivant who loved entertaining the neighborhood kids with elaborate holiday displays. All the while, he was high on heroin and drunk on vodka, which helped steady his increasingly tremulous hands. He’ll never forget the moment when, dressed as the Easter Bunny, he heard a child say to his mother, “Mommy, the bunny smells like alcohol.”

Richard overdosed three or four times that he can recall. Once he shot up at a traffic light and blacked out. “I was doing ten or twelve bags of heroin a day,” he tells me. “I would get up at four o’clock in the morning, shoot two bags of dope, then sleep until seven, get my kids off to school so my wife could sleep. Then I’d have some drinks to calm my shakes down. At the end, I would have to fill my needle the night before, because by four a.m. I’d be too dope-sick to do the process”—mixing heroin and water in a spoon, then drawing it through a cotton ball into a syringe.

During a three-month binge in 2005, Richard spent $40,000 on heroin. The money was leaking away so fast that he resorted to selling his work trucks and power equipment “just to feed my addiction.” His house went, his marriage, too. “You put this drug in you—” he begins, and shakes his head. “I lost everything.”

When Richard kicked his habit the first time, a daughter called him in rehab to say that Eric, his neighbor, was being carried out of his house, blue-lipped, dead. Richard stayed sober for seven years, until a hip operation required a powerful opiate painkiller—morphine. “I told the doc, ‘I’m a heroin addict!’ I was fighting it tooth and nail. But they gave me the morphine drip and I was off to the races, fuck everybody.”

Clean now for three years, he chooses to endure chronic pain rather than risk another operation with its requisite painkillers. “If you’re ever in the grasp of this disease, you will do anything,” he says. “That’s how powerful it is. You’ll walk over your kids, your parents. Anything.”

Molly Ashcroft, twenty-eight, was a good girl from a good Guilford family, a swimmer, a softball player, and especially a dancer; she still has the lithe dancer’s body honed from forty-hour practice weeks and national
competitions. She’s nicely put together, too, in blues and purples, with a knit scarf tucked under her long, light brown hair. “I think I was a little bit late on the party scene, going into junior year of high school, mainly because I was so dedicated to dance,” she says. “Then cocaine went through the school system like wildfire.”

Most students left it behind. Molly graduated to crack—“a whole other beast.” At age sixteen she was sneaking out to buy crack in the Fair Haven section of New Haven, known for crime, drugs and prostitution. She stole from her parents, her siblings, her beloved grandmother. She went to rehab for four months and drank on her first day out.

One day, in mild psychosis after crack had kept her up for days, a guy gave her heroin to bring her down. “That’s what began the chase of the next couple of years,” she says. “You do cocaine to get up and heroin to come down. A constant cycle you can’t break.” Rehabs came and went; promises to her parents to try to get clean evaporated as soon as she made them. She ended up homeless in Fair Haven at age twenty-one, passing bad checks, stealing, doing whatever it took to feed a ferocious crack and heroin addiction that cost, at its peak, $1,000 a day. “I was the queen of telling my parents that I wanted help—then I wouldn’t pick up the phone for three weeks or I would change my number,” Molly says, growing teary. “I wasn’t allowed home. If I were to go home, they would call the police.”

She lived at night. “That’s when the underground world comes out,” she says. Hers was a world of criminals and addicts—users with collapsed veins who had to shoot heroin into their necks or feet, often jabbing futilely for a port of entry. (Watching them, Molly would only snort the drug.) There was an aura of death and actual death. Finally, Molly herself had the sense of an ending. “I just called my dad. I called him and I said, ‘I don’t think I’m going to make it.’ He agreed to meet with me within twenty-four hours. It wasn’t right away. He was sick of jumping at every phone call.” But he did respond, perhaps saving her life. She has stayed clean since December 15, 2008, ending a half-decade nightmare.

“My family felt I would die,” Molly says. “I’d been in ten inpatient treatment settings, I’d been in tons of sober houses and gotten kicked out. I had been in detox six to ten times—I mean, I really, really, struggled for a long time. The biggest thing to let parents know is, there’s hope. They can draw that from my story, at least.”

Nicholas de Spoelberch, thirty-seven, of Darien, married with two young children, tells me his remarkable story as we sit on a bench on Main Street. “People still talk of heroin as something unthinkable, shocking, appalling, and so it was the one thing I was going to take to my grave. And I literally almost did.”

Three years ago, Nick was the dean of students at Regis High, an esteemed Catholic school on Manhattan’s Upper East Side. Partly because he’s so presentable—athletic-looking, neatly groomed, with an air of genial competence—he had little trouble scoring oxycodone prescriptions. At first, the pills were legitimately dispensed to alleviate injuries sustained in martial arts training. But they had the bonus of walling Nick off from an anxiety he’d endured since youth (discomfort in one’s own skin is a startlingly common thread in heroin addicts), and so, by degrees, his requests for medication went “from honest to fudging the truth to being so dependent that I just didn’t care.”

As doctors cut him off, Nick shopped with increasing desperation for new ones. “Finally I was so tired of lying. Call up a new doctor, go down there, put on a show.” Early in 2013 he arranged to meet a Norwalk-based heroin dealer in New Canaan. Snorting a couple of bags a week turned into snorting a couple a day. “Then the brakes totally came off,” he says. “You hate yourself for doing them, then you do more to escape that feeling. Self-hatred, escape, self-hatred, escape, faster and faster. In about five months I was shooting thirty to forty bags a day. It was like being trapped inside a nightmare—worse, to me, than dying. All your brain and body seem to think is, ‘More, more, more,’ even when it stops working.”

In the spring of 2013, St. Regis held its graduation, as usual, at the Church of Saint Ignatius Loyola on Park Avenue. Not halfway into the ceremony, Nick, sitting by the altar in his black faculty robe, abruptly got to his feet, walked past the principal, away from the hundreds in the pews, and out the side door. “I just decided, ‘I’m gonna go get high.’ I went to my office, threw down the gown, got in my car and hightailed it to Norwalk to buy thirty bags. And I went to the beach and shot heroin. I just thought, ‘I don’t want to live this life anymore. Let it end.’ But I kept waking up.”

Even so, he managed a brief respite from heroin. On July 11, 2013, Nick told his wife he was going to an AA meeting in Wilton. Somewhere along the line, he discovered a bag of heroin beneath the car seat, shot it up, and overdosed. Nine hours later a Wilton police officer banged on the window with his flashlight. “I got arrested for a felony, heroin possession as a school administrator,” he says.

“A couple of days later, everybody I had ever known in my life—my family, my wife’s family, all those kids at school who looked up to me—woke up to front page headlines everywhere. ‘Dean of students busted for heroin.’ My job was gone. My wife wouldn’t pick up the phone (I had checked myself into detox in Westport). I was a wreck. But you know, God kind of gives you what you need.” What Nick needed was ruination on a spectacular scale. “It wasn’t a pleasant experience—it was kind of like getting your skin ripped off—but I’m grateful that it happened.”

Richard Treglia, back running his business, is engaged to be married. Molly Ashcroft is the director of admissions and business development at Westport House. Nick de Spoelberch works as a substance abuse and mental health counselor in Bridgeport; his wife took him back, and now he enjoys nothing more than the company of his young family.


WHAT’S THE ANSWER?
For decades the solution to drug addiction in our midst was to lock people up. New York’s infamous Rockefeller drug laws of 1973, copied around the country, decreed that low-level drug dealers, even hapless addicts, would serve mandatory sentences of fifteen years to life. Get caught with a measly four ounces of narcotics and you’d draw a second-degree murderer’s sentence.

A climate of voter-pleasing toughness prevailed for the next forty years—a period during which judges complained with mounting bitterness about having to sentence (for instance) a Florida man to twenty-five years for selling 365 Percocet pills. Largely as a result of harsh mandatory minimums, the U.S. prison and jail population swelled from 330,000 in 1973 to about 2.4 million in 2009, with nonviolent drug offenders comprising 48 percent of that number. And yet the war on drugs—the domestic side of it—turned out to be a folly. Costly and ineffective, it was also destructive, particularly to urban minorities and their families.

The current opioid epidemic has forced a massive shift in strategy. Compassion is proving the smarter route. In February President Obama requested $1.1 billion for fiscal year 2017 to fund medication-assisted treatment for opioid addiction. In March the U.S. Senate passed the Comprehensive Addiction and Recovery Act, designed to expand access to treatment and strengthen prescription drug monitoring systems. Five states, including Connecticut, have already done the latter; these states now require doctors to consult a database of patient prescription histories, thus foiling the sort of doctor shopping that kept Nick de Spoelberch in opioids. Connecticut has also passed laws making Narcan—the drug that saved both Adam Dalman and Dennis Wright—available to anyone by prescription, so that a mom worried about her son’s heroin habit can keep a kit on hand.

Those are policy answers, and they’re important. But down in addiction’s trenches, the picture is murky. What’s a family to do when confronted with a heroin-using son or daughter? Ideally, the first step is detoxification in a hospital or rehab setting. The next step is continued treatment at a residential facility, treatment that “integrates” medication to control the physical addiction and therapy to address underlying psychological issues. The final step might be a less-supervised sober house as a sort of bridge back to independent living, or intensive outpatient treatment.

But there are caveats. “You’re going to have to get your head around the fact that this may be a long and tiresome journey,” says Alan Mathis, who heads the Norwalk-based Liberation Programs, which provides a variety of services to those battling addiction.

Mothers and fathers, so often heroin addiction’s collateral damage, drain their coffers paying lawyers’ fees and sending their addicted children to rehab. Very good Connecticut inpatient rehabs, like High Watch ($11,000 per month) or Mountainside ($30,000), are costly. Some accept insurance; many do not. There are state-funded rehabs, but they have dishearteningly long waiting lists—weeks or months. “The window of insight for someone willing to put down the needle or the straw is maybe six hours, maybe two days,” says Nick de Spoelberch. “After that, they’re gone.”

If you can afford private rehab, which one do you choose? Different rehabs espouse different treatment philosophies—twelve-step, therapeutic community, faith-based, cognitive behavioral, skills development, a smattering of each—and families are ill-equipped to sort them out.

Gary Mendell, the Shatterproof founder, describes the search for answers as “a journey through darkness.” Gary’s son Brian isn’t on any list of drug overdose deaths. Like others you’ve read about here, he progressed from marijuana to painkillers to heroin—but finally wrestled his addiction to the ground. It’s hard, though, for the non-addict to appreciate the damage these wars can do to a soul. One night in the summer of 2011, Brian told his father, as they sat out on their back porch in Easton, “Someday people will realize that I have a disease, and that I am trying my hardest.”

On October 20, 2011, thirteen months clean, Brian Mendell hanged himself. He was twenty-five years old.

Reviewing Brian’s ten-year history of substance abuse and the eight rehabs it entailed, Gary observes, “Every treatment program he went to was preaching a different thing. And very little of it was based on science.” Gary discovered that proven solutions do exist but tend to be tucked away in medical journals, far from public view. In Brian’s last inpatient rehab, for instance, he was prescribed buprenorphine—better known by the brand name Suboxone—a synthetic opioid designed to reduce cravings and thwart withdrawal. And if he were to use heroin while on Suboxone, the “reward’ would be severely diminished. It seemed to work: “He was doing the best he ever did,” Gary says. Curiously, none of the prior rehabs had mentioned Suboxone, and an outpatient program titrated Brian off the drug in his final summer. “They didn’t believe in it,” Gary says in a clipped voice.

The rehab world is still divided on the matter of “maintenance treatments” like buprenorphine and its forerunner, methadone. Since these treatments replace one opioid with another, they merely perpetuate the addiction, argue so-called abstinence proponents. Dr. Eric Collins, physician-in-chief at Silver Hill, adamantly disagrees. He says that detox without methadone or Suboxone can be dangerous, since the high probability of relapse combined with a weakened tolerance leaves users vulnerable to overdose. “People invoke a moral view: ‘It’s not good to be on an opioid’,” Collins says. “But when people stay on methadone or buprenorphine, their overdose rates are dramatically less, their risk of relapse is much smaller, and they can maintain normal, healthy lives much of the time.”

Methadone is reserved for especially chronic relapsers. While Collins acknowledges the drawbacks—it’s very hard to quit and overdose is a concern—he says “the evidence is convincing: For many people, it works.” Buprenorphine, available in the U.S. since 2003, is prescribed for less deeply impaired addicts: a pill a day keeps the craving away. Collins says, “All of us in addiction have seen patients whose lives are manageable only when they’re maintained on one of these treatments—and who never stay off heroin unless they’re on one of them.”

A drug called naltrexone offers a new medical solution, perhaps the most promising one of all. Unlike methadone and buprenorphine, it has zero opioid effect and thus is neither addictive nor abuseable. Moreover, it prevents opioids like heroin from reaching their receptors. You can’t get even a little bit high on it. Ironically, that was the problem: A total absence of opioid good-feeling disinclined people to keep taking it.

“Oral naltrexone effectively didn’t work,” Collins reports. But in 2010 the FDA approved an injectable form of naltrexone, called Vivitrol, to combat opioid addiction. One shot lasts four weeks. “For about a month, you don’t have to make the decision every day,” says Collins. “You’re blocked.”

While the research verdict on Vivitrol is not fully buttoned down yet, clinicians like what they see. Westport House’s Al Samaras says, “We’re big fans of that here. Any opiate guy who walks in the door is going to see Dr. [Joseph] Russo here in town about Vivitrol.”

Both Collins and Samaras hasten to point out that medication is only a piece of recovery. Heroin addiction’s psychological issues can be ferociously tangled, since they involve no less than the near-destruction of a life and all its relationships.


BACK TO ADAM
One morning in October of 2014, Stamford police found Adam Dalman half-asleep in the street outside a Walgreens in Stamford. He’d been walking around in a fog, addled from potent heroin, and come to rest at Walgreens for no reason that he can recall. Police arrested him for heroin possession and let him go on a promise to appear. Two days later, police responded to a report of thefts: Adam had spent the night rummaging through unlocked cars and fallen asleep on the side of the road.

When the police found him, Adam struck off on foot, losing his shoes, losing his glasses, hoping to find a place to end his life. And that was the end of the road. The police closed in and Adam lay down in surrender. “Part of me felt so relieved to be done running from everything and everyone,” he recalls. “I remember feeling an overwhelming sense of calm come over my body as they cuffed me—I was almost smiling.”

He spent a year in prison. For Adam, time behind bars forced the reckoning that all heroin addicts eventually must make: Get high or get clean? Live or die? “The longer you stay away from heroin, the more your head clears,” he says. “That’s science. A whole year away from drugs and your mind is ten times better. So when the fog cleared, I figured out I wanted to live. That’s really the biggest thing.”

He thinks for a moment. “Last Wednesday I got fitted for a suit for my sister’s wedding. I was with my mom. And when she saw me in the suit, she started to cry. She was like, ‘Wow, who would have thought? Who would have thought I’d see my son, getting ready for my daughter’s wedding?’”


Resource Guide

Some of the helpful resources in our area

HANDS-ON HELP

ADDICTION RECOVERY CENTER AT GREENWICH HOSPITAL
The hospital’s ARC has inpatient and outpatient services, as well as an eight-week Opiate Addiction Recovery Program. The program uses an “integrated” approach, combining medication and therapy. greenwichhospital.org; 203-863-4673

AWARE RECOVERY PROGRAMS
A novel statewide program of comprehensive, wrap-around drug and alcohol addiction rehab care producing recovery rates 650% above the national average. ARC provides private, personalized care for clients in the security of their own homes, an approach that research is finding to promote faster, lasting recovery. awarerecoverycare.com; 203.779.5799. All calls are strictly confidential. Most private health insurers provide full or partial reimbursements for those under the care of Aware Recovery Care.

LIBERATION PROGRAMS
Based in Norwalk with a treatment center in Stamford, Liberation Programs offers a variety of clinical services, including detox, methadone maintenance and outpatient treatment. A far less costly option than most, it accepts state-funded insurance and can also work out payments on a sliding scale. liberationprograms.org; 203-851-2077 In Greenwich, Liberation Programs sponsors an outpatient office for teens and their families called Family & Youth Options. 203-869-1349

SILVER HILL HOSPITAL
Long established as a premier psychiatric hospital, New Canaan’s Silver Hill also treats people with addictions. Last year, largely in response to the opioid epidemic, Silver Hill opened its intensive six-week Outpatient Addiction Program. For opioid users, the program typically starts with detox and daily meetings with clinical staff, and continues with group therapy. silverhillhospital.org; 800-899-4455, admissions ext. 4

ST. VINCENT’S BEHAVIORAL HEALTH SERVICES, WESTPORT CAMPUS
St. Vincent’s, which acquired Westport’s Hall-Brooke Hospital in 1998, provides detox and substance abuse treatment at its seventy-six-bed campus on Long Lots Road. It also offers outpatient psychiatric and counseling services. stvincents.org; 203-227-1251

STAMFORD HOSPITAL
The hospital offers addiction treatment as part of its Psychiatric and Behavioral Health Services department. stamfordhealth.org; 203-276-1000.

NORWALK HOSPITAL offers addiction recovery outpatient services. norwalkhospital.org; 203-852-2000

TRANSFORMATION HOUSE FOR WOMEN
Robert Curry is the founder of Turning Point for Leaders, which does interventions for corporate executives and business leaders. In February, he addressed a pressing need by founding the only sober-living house for women in Fairfield County. Transformation House, in Westport, is closely allied with Westport House, Curry says. He can be reached at 203-966-1103. Transformation House can be reached at 203-254-0791.

WESTPORT HOUSE
Westport House is three sober- living houses for young men in Westport. Al Samaras, a former health care technology executive and recovered heroin addict, founded Westport House in 2014, after observing “extraordinarily high” relapse rates in other sober houses. Westport House’s multi-pronged approach includes 24/7 staffing, clinical services, physical fitness, life skills training and, crucially in opioid cases, Vivitrol. Relapse rates are exceptionally low. westportsoberhouse.com; 888-302-6790


INFORMATION SERVICES

COMMUNITIES4ACTION
C4A provides lower Fairfield County with substance abuse education and training, and advocates for policy change. Though C4A emphasizes prevention, it’s a great place to consult if you’re wondering what to do about a loved one’s addiction and the system has you cowed. C4A is one of thirteen “regional action councils” that form the Connecticut Prevention Network, communities4action.org; 203-588-0457

NARCAN PRESCRIBERS
One bright spot in the opioid epidemic has been increased accessibility to Narcan, which reverses the effects of a heroin overdose. “We’ve seen people that looked like they were gone,” says Stamford Police Captain Richard Conklin. “It’s almost spooky how quickly they come to.” Until recently, only first responders had access to it. Doctors can now prescribe Narcan to “third parties”—like parents—and so can some pharmacists. For certified pharmacists: data.ct.gov/Health-and-Human-Services/Naloxone-Prescribing-Pharmacists/qjtc-pbhi

OPIOID TREATMENT HOTLINE
In March, Connecticut’s Department of Mental Health and Addiction Services established a hotline to connect opioid users with local walk-in assessment centers. These centers, sprinkled around the state, work with patients and insurance companies to overcome barriers to treatment. ct.gov/dmhas/walkins; 800-563-4086

SHATTERPROOF
Founded by Gary Mendell to honor his son who committed suicide after a ten-year battle with substances, Shatterproof has been instrumental in pushing for “Good Samaritan laws” that offer immunity to users who call 911, and for wider availability of Narcan. One of Shatterproof’s goals is to eradicate the stigma surrounding addiction; another is to educate the public about the science of addiction and policy changes that can save lives. shatterproof.org; 800-597-2557

*Name has been changed for privacy

Behold Adam Dalman*, twenty-three years old, back from the land of the dead. He’s standing in the cold sunlight of a February afternoon, trim, clean-shaven, dressed in a plaid flannel shirt and khakis. You study his face for signs of his journey into heroin’s dark wood, there across the Styx and the Lake of Fire, but none are apparent; all you see, as he stretches out his hand to greet you, is a slight fragility in his otherwise perfect smile.

Adam leads me inside Westport Sober House, an immaculate Colonial near Main Street and the Saugatuck River, where he has lived since leaving prison fourteen weeks earlier. Adam’s three-year heroin addiction began in the light of euphoria, progressed to street-living and petty crime, and ended in an abyss of suicidal despair. “I know like thirty-something people who have overdosed and died,” he says, referring to young men and women he encountered in serial rehabs. “You think about those things and it’s like, ‘Holy shit.’” But nothing, not even his own near-fatal overdoses, could release him from heroin’s grip.

Adam first snorted heroin at age twenty, while sitting in a friend’s car in his native Greenwich. “An overwhelming joy would come over you,” he tells me. “A peaceful joy would take over your entire body. Something would just click, and you’d be the happiest person in the world. Picture your happiest moment, and that’s how you feel—like you’re floating on a cloud and your favorite song is playing.”

That “click” Adam describes is actually the unlocking of a powerful pleasure center deep inside the brain—the nucleus accumbens—the same place that rouses to life when stimulated by food or sex. Heroin binds to the brain’s opiate receptors, triggering a rush of dopamine exponentially greater than would eating fried oysters or making love to the Venus or Adonis of your choosing. The problem is, the nerve cells that dopamine so deliciously bathes tire from overstimulation, and then you need ever-greater dosages to chase ever-more-elusive highs. That’s just the beginning; soon you’re a lab rat pounding away at your reward lever, until the best payoff you can expect is to keep the misery of withdrawal at bay. In other words, you have catastrophically rewired your brain. “You treat heroin like an animal would treat food,” Adam says. “It becomes instinctual.”

Adam’s path to heroin use was typically incremental: alcohol at fifteen, marijuana at sixteen, cocaine and ecstasy and acid at seventeen. “That’s what it seemed everyone did,” he says. “But it was really just a Fairfield County or a Greenwich kind of thing. I found that out when I went to college. Everyone was like, ‘That’s what you were doing in high school?’ I was like, ‘You guys weren’t?’” As his drug use accelerated, his lifelong interests, namely sports, withered and dropped away. “I quit football my sophomore year [of high school] because it was too much work. It didn’t allow me to party when I wanted. I never even attempted to try out for varsity lacrosse—and lacrosse had been a passion of mine.”

While marijuana “opened the drug spectrum” for Adam, it was the prescription painkiller OxyContin that flung wide the gate to addiction. OxyContin is an opioid, or semi-synthetic drug derived from the opium poppy. So is heroin. Your family doctor prescribes one, and Mexican drug cartels smuggle the other, but the two drugs are essentially the same thing; the notable difference is that Oxy has a time-release coating and is not cut with mystery substances. Compared to the illicit drugs he’d been taking, OxyContin struck Adam as fairly innocent. “One day I went over to my buddy’s house, and he was crushing up an OxyContin pill.” Crushing the pill destroys its time-release coating and delivers the full force of the drug—oxycodone—all at once. “He said, ‘Try this, you’ll love it.’ And I loved it.”

But OxyContin and its ilk were expensive, running to a dollar a milligram, or roughly $40 to $80 a pill. As Adam built up his tolerance, he would lay out $100 for a single high. “Heroin was less than half the price and stronger,” he says. It made complete sense to switch. “But needles were still like, ‘No. That’s homeless people under the bridge.’” As his body demanded more and more heroin, the financial imperative yet again took hold, and what was once unthinkable became pragmatic. “Shooting it, you get more bang for your buck. You don’t have to use the same amount you would use snorting it.” As a bonus, the high was instant and even more intense, a glow that suffused his whole being. “At that point, I think I knew I was in a bad place.”

Heroin addicts tend to function quite well early in their illnesses. Many find that heroin heightens sensations in a relaxed sort of way, making life seem more vivid and colorful—anything but dangerous. “My parents had no idea for the longest time,” says Adam. “No one could look at me and say, “This guy’s fucked up.’”

But the turning point always comes. When Adam could cadge no more money from his parents, he began stealing from them; soon he was shoplifting and breaking into unlocked cars, for which, in the end, he was arrested several times. Heroin addicts usually fall into this destructive pattern and women sometimes add prostitution to the mix. “As you get to that everyday habitual use where you’re dope-sick and dependent on it, it really takes over your mind,” Adam explains. “It skews every thought you have. You might know that what you’re doing is bad, but the power that drug has over you—you can justify anything.”

One day, Adam’s mother made a small but con-sequential discovery—a missing check—and confronted her son. When he made the partial admission that he was “dabbling” in opiates, she decided to take action. First Adam went to intensive outpatient treatment in Stamford, “but that got in the way of my using very quickly.” A month later he crashed his mother’s car; his parents, now deeply alarmed, sent him to A Forever Recovery in Battle Creek, Michigan. Suffice it to say the recovery was not forever. His second day out, he shot up in his mother’s basement and overdosed.

Post-rehab is an exceptionally dangerous time for heroin addicts. Tolerance has plummeted and cravings lie in wait, ready to ambush: When you give in—as 90 percent do—you have to be careful to use a fraction of what you once did. If you were to resume your customary dosage, the drug would probably stop your heart from beating.

Adam injected a quarter of his old dose, one bag, thinking, “no way this will kill me.” Mrs. Dalman chanced to come down the stairs in the middle of the night, heard her son gurgling, saw the needle on the couch beside him. Adam came to on a stretcher. In the nick of time, paramedics had shot him full of Narcan, a somewhat newly available opioid “antagonist” that quickly reverses the effects of an overdose. “Any longer and I’d have been dead,” Adam tells me.

But here is something the average reader will never comprehend: Adam shrugged off the overdose as a mere speed bump on the path of his life. “Just thinking about heroin, imagining that feeling again, was enough for me to think, ‘I’ll be fine. Let me just get over this little thing here, and I’ll go back to it.’”

From here Adam’s story gathers a sad, weird momentum. There was a second failed rehab at the renowned High Watch, up in Kent; a spell sleeping on the streets of West Hartford; a second overdose, during which he stopped breathing; a brief stay at his father’s house that ended in theft; another spell of street-living, this time in Greenwich; and a third failed rehab at Turning Point in New Haven. This relapse crushed him.

“I was their golden boy,” he recalls somberly. “I was eight months sober.” He’d fooled himself into believing he could handle a drink like a normal twenty-one-year-old “and a week later, I was using heroin again.” Adam headed back to rehab, up to Mountainside in Canaan, and from there to a sober house in North Haven. So goes the heroin addict’s vicious cycle: detox to sober house to relapse—repeat, repeat, repeat.

When the last glimmer of hope faded, Adam sank into a profound depression. “I just accepted that, wow, I cannot do this, I cannot get this right. That progressed into three months of sleeping in my car, sleeping on the streets, hell-bent on killing myself, wanting to die. And that was okay. I didn’t want to deal with the pain anymore. I was back in the same loop, and it sucked. So I’d always carry a little bit of extra heroin, and I’d say, ‘All right, when the time is right, I’ll just do as much as I can, and I’ll be gone.’”


How to Talk to a Heroin Addict

LET’S SAY IT’S YOUR SON. IN HIS ADDICTION, HE CAN’T HEAR YOU. AND IF YOU COME AT HIM WITH STERN ADVICE, HE CAN’T HEAR YOU EVEN MORE

Listen
“If you tell your son what his problems are and how to solve them, you’re going to get a big shutdown,” says Alan Mathis, president and CEO of Liberation Programs, which offers clinical services for the addicted in lower Fairfield County. “IT’S CRUCIAL TO BE ABLE TO LISTEN TO YOUR SON, even though he may be doing outrageous things. YOUR JOB IS TO KEEP THE LINE OF COMMUNICATION OPEN. Recognize that there does come a point when a person using drugs doesn’t want to use them anymore.”

Do Not Enable
While it’s imperative to let your son know that you love him and you understand that his addiction is an illness, IT’S EQUALLY VITAL NOT TO ENABLE THE ADDICTION. Do you loan him money? Lie or otherwise cover up for him? Clean up his messes? Bail him out of jail? Give ultimatums that you don’t carry out? All of that is tempting, and none of it is helpful. A FIRM STANCE AGAINST ENABLING HELPS KEEP YOU FROM BEING DRAWN INTO HIS CHAOS.

Be There
“MY PARENTS CUT THE CORD, AND I’M GLAD THEY DID,” says Molly Ashcroft, twenty-eight, who kicked her crack cocaine and heroin addiction at age twenty-one. “They just were not going to allow drug use in their house” But the Ashcrofts, who had three younger children to consider, left the line of communication open in this way: “THEY WOULD ONLY PICK UP THE PHONE IF I WANTED TO GO TO TREATMENT.” Granted, Molly gave her parents repeated false hope, but when she finally hit bottom, as so many heroin addicts must do, they were there for her.

Ask Questions
Adam Dalman, twenty-three, free of heroin for a year and a half, now finds himself talking to younger versions of himself. What does he tell them? “Not ‘Hey, don’t do drugs, because you’ll wind up in jail.’ Because when you’re already using, you won’t hear that. It’s more like, ‘WHAT MAKES YOU TICK? WHAT MAKES YOU HAPPY? WHAT MAKES YOU WANT TO LIVE LIFE? DO THAT.’ Because odds are, you won’t be living life soon if you’re still getting high.”

Learn
When your child travels to the dark side of the moon, you are not going to be able to bring him back yourself. It may be a long and costly battle involving many professionals. But to understand the nightmare he is enduring is to help him. “MY MOM WAS WILLING TO LEARN, AND SHE FINALLY UNDERSTOOD,” ADAM SAYS. “BUT MOST PARENTS DON’T. They think something’s really wrong with you—you’re doing all these terrible things—but deep down you’re still that same child, that same loving and caring person that you’ve always been. It’s just all hidden by the addiction.”


THE ANATOMY OF AN EPIDEMIC
Alas, the Adam Dalmans of Fairfield County aren’t hard to find, though many do not live to tell their stories. Last year 102 residents of Fairfield County died from drug and alcohol overdoses, fifty-three of them from heroin and thirty-six more from opioids such as oxycodone, hydrocodone and fentanyl. In other words, opioids accounted for 87 percent of our fatal overdoses in 2015.

This statistic deserves special notice. Twenty years ago, there were virtually no deaths by opioid in Fairfield County or, for that matter, anywhere else in suburban or rural America. In Connecticut, the last three years have been especially bad. In 2012 there were 174 heroin-related deaths—a sharp increase from previous years—and last year there were 415. (Heroin cut with the brutally potent fentanyl, almost unheard of five years ago, now accounts for 107 of that total.) The national figure over a longer period is more disturbing still: Since 2001, heroin-related deaths have quintupled—reaching a record 10,574 in 2014, the last year for which statistics are available.

A heroin epidemic is now in terrible flower. It’s a national epidemic, to be sure, but the Northeast from New Jersey to Maine has been hit particularly hard. “It’s like an explosion,” says Captain Richard Conklin of the Stamford Police Department. “We’ve seen heroin around here forever, but this is different—there’s a huge supply and an ever-increasing demand. It’s really reaching across all demographics.”

What happened? In the sixties and seventies the drug existed only in a shadow mythology of back rooms and back alleys, an underworld to which bleak-hearted writers and musicians descended in order to bring us news of the dark side of life. Otherwise heroin was not part of our universe, certainly not out here beneath the blue suburban skies. There was a slight bulge in the heroin trade in the seventies during Vietnam. But the drug in those years was only about 8 percent pure and had to be injected; it was therefore a “dirty” drug that conjured bottom-of-the-pit visions of tying off one’s arm and shooting up—a drug that went too far for most people.

Our cultural memory has not retained the fact that heroin once enjoyed a season of middle-class respectability. In 1898 Friedrich Bayer & Co.—the aspirin people—began selling it profitably as an over-the-counter cold and cough medicine; Bayer’s ads show pretty mothers spoon-feeding it to their happy children. “There’s no danger of acquiring a habit,” the Boston Medical and Surgical Journal observed in 1900.

In the following decade, physicians discovered this common assertion to be utterly false, but were reluctant to let go of heroin: “I feel that bringing charges against heroin is almost like questioning the fidelity of a good friend,” wrote a doctor in Kentucky. Lawmakers clamped down anyway, first restricting heroin use to doctors’ prescriptions, then banning it altogether in 1923.

The one-time elixir had been driven fully underground, to the blackest of black markets.

This history is worth noting because it’s repeating itself. The heroin epidemic now in progress is floating upon a sea of prescription opioids. If this sea had never swelled, Mexico’s Sinaloa drug cartel would never have noticed a vast new market to exploit, would never have ramped up opium poppy farming, would never have bothered learning to refine opium paste into high-grade white powder for export to America. (“Only about 5 percent of the heroin in the United States comes from Afghanistan,” says Robert Lawlor of the New England High Intensity Drug Traffic Area, a law enforcement liaison agency. “The vast, vast majority of the heroin comes from Mexico, with a little bit from Colombia.”)

Many experts date the opioid epidemic to 1996, the year pharmaceutical giant Purdue Pharma (then of Norwalk, now of Stamford) launched its billion-dollar drug OxyContin. Oxy’s arrival dovetailed perfectly with the medical community’s redoubled focus on pain alleviation: “pain is the fifth vital sign” was the new mantra (though pain can’t be measured as pulse, blood pressure, body temperature and respiration can). “Optimizing analgesic use” was the new practice.

Intentions were good all around. OxyContin, for its part, delivered a large dose of the painkiller oxycodone over the course of twelve hours, allowing cancer and AIDS patients to sleep through the night. The trouble was, Purdue Pharma got greedy. It sold the drug as a nonaddictive alternative to the painkillers Vicodin and Percocet, and in a climate of total pain annihilation, family doctors across the land eagerly bought the pitch. (Percocet and Vicodin are opioids as well, but they differ from Oxy in two important respects: Both contain the pain reliever acetaminophen, which makes you sick if you take too much—though people do so anyway—and neither is time-released, meaning the dosages are smaller.) Soon doctors were writing OxyContin scripts with benevolent abandon—for backaches, headaches, sprains, sore hips—and patients who acquired a fondness for Oxy took to reporting pain that didn’t exist.

The result? People began dying. In 1999, 4,030 people in the United States died from overdosing on prescription opioid painkillers; by 2014 that number had ballooned to 18,893, making pills nearly twice the killer that heroin is. Together, opioid painkillers and heroin are driving an American overdose epidemic that costs 47,055 lives a year, easily surpassing the annual toll of motor vehicle deaths, suicides or homicides. In March of this year, an alarmed federal government issued stringent new guidelines for prescription painkillers, urging physicians to try ibuprofen first and then limit opioid prescriptions to a few pills rather than the customary thirty. (Pain doctors and the drug industry fiercely opposed the guidelines, and held up their release for months.)

“Percocet, Vicodin, OxyContin—these are heroin in a pill. But they don’t have the dirty name,” says Gary Mendell of Easton, founder of Shatterproof, a nonprofit that he hopes will evolve into an American Cancer Society for addiction, educating the public and advocating for policy change. Gary lets fly a silver bullet of a statistic: Four out of five heroin users begin their addictions, legitimately or recreationally, with prescription painkillers. “Prescription painkillers are the feeders for heroin,” he says.

Purdue Pharma, meanwhile, reaped breathtaking profits. Its annual revenues of greater than $3 billion come largely from OxyContin, though there have been hiccups along the way. In 2007, the company pleaded guilty to misleading doctors and patients about OxyContin’s risk of addiction and paid $634 million in fines and civil litigation settlements.

In 2010, the company reformulated OxyContin to make it difficult to misuse. Now, if you try to crush an Oxy, it turns into a gummy paste. But tamperproof OxyContin appears to have had a dire unintended consequence: Addicts turned in droves to heroin.


BUT IN FAIRFIELD COUNTY?
Heroin wends its way from Mexico to distribution hubs like New York by any and every means you can imagine: by tunnel, by truck, by cargo ship, by private plane, by submarine, by pleasure boat. Some traffickers catapult narcotics over the border. Mostly, heroin is trucked from Mexico to warehouses outside cities and then disbursed to cars, which go to ho-hum apartments in (for example) northern Manhattan and the Bronx. From there, heroin filters out to distant parts via the interstate highways, finding especially fertile markets in upper New England—virgin territory in the sense that scourges like meth and crack never gained traction there.

Connecticut is a direct extension of the burgeoning New York market. Small-time dealers exist discreetly in towns from Greenwich to Fairfield, but they’re much easier to find in our urban centers along the so-called I-95 and I-91 corridors—in Stamford, Bridgeport, New Haven and Hartford. That doesn’t mean it’s easy for police to flush them out, though.

“With the advent of the cell phone, drug dealing has completely changed,” Richard Conklin, the Stamford police captain, says. “It’s no longer an open-air market” in which you go to a known spot and find a dealer loitering. “Now it’s a kind of moving rendezvous.” That is, you call the number you’ve been given—it’s a network powered by word-of-mouth—then agree to meet at a gas station or a fast-food joint where the exchange is swiftly made.

Al Samaras, the founder of Westport House—actually three houses in close proximity to one another—says, “It’s extraordinarily easy to get. It’s everywhere and it’s cheap: Heroin is four dollars a bag. Four dollars a bag! [The price varies; it might be as little as four dollars or as much as twenty a bag.] I can take change out of my car and go buy heroin. Is there a dealer here in Westport? Maybe not. But there’s certainly one in Norwalk who will drive over the town line and bring it to you or meet you at the McDonald’s.”

Richard Conklin notes that suburban dealers aren’t really part of heroin’s organized food chain. “It’s not like they’re getting rich,” he says. “Many of these dealers are addicted to heroin themselves—it’s more of a subsistence-type dealing.”

Dennis Wright* is a case in point. The story of this twenty-seven-year-old from Greenwich illustrates that, in some cases, dealing heroin is a natural progression of the disease, a survival adaptation. He was fifteen when he made his first cocaine-buying trip to New York. Someone’s older brother had slipped him and his friends a business card—“Carlos, Miami and New York”—and when they called the number on it, Carlos showed up in a gold Ford Explorer to deliver the goods. Between the ages of fifteen and nineteen, Dennis took a range of drugs, from marijuana to acid, but everything changed the day he tried OxyContin. “I remember a friend of mine crushed a pill up. I snorted it, and the euphoria was incredible. I have no problem saying it: That was the greatest feeling I’d ever had up to that point. It’s a warm blanket. You don’t have a care in the world.”

After college, Dennis found that his whole Greenwich circle was snorting Oxys. “It was only a matter of time before one of my friends said, ‘I got some heroin. It does the same thing, but it costs way less.’ So at that point the table was set.”

Two years later, sitting in a parking lot across from Greenwich Police Headquarters, Dennis overdosed. His drug-mate bolted from the scene, fearing arrest. (In 2011 Connecticut passed a Good Samaritan law, granting immunity to 911 callers who have been using.) By miraculous good fortune, a passerby noticed Dennis’s car and a motionless leg dangling out an open door. Paramedics laid him on the pavement and administered Narcan. “You know most people don’t survive this,” they told him en route to Greenwich Hospital.

Dennis used heroin from ages twenty to twenty-four, while working in the business world in New York City. Toward the end, as his addiction careened out of control, he lost his job: “I went from working in the Chrysler Building to sleeping in the back of a moving truck—I was a mover by day.” Then to support his habit he turned to dealing. “This was your normal street-dealing stuff—nothing big time,” he says. “Me and a few other addicts, guys I ran with, we would buy a large amount, and we would ‘step on’ the drugs—cut them with different things, baking soda—and we would take it out to the suburbs.”

Out here, he sold to acquaintances in their early twenties, guys in college or recently graduated but still living at home. “These kids were going to use no matter what, right? And they didn’t have to deal with all the stuff we had to. They didn’t have to go into East New York, into a sketchy project building with guns on the table.” He draws a breath. “Well, that was our justification. But whatever justification we used, we brought it right to their door.”

Three years ago, Dennis had the good luck to get arrested in a sting operation in New York. “We had about ten unmarked cars cutting us off on a city block, guns drawn, the whole thing. I think at that point, I had about a hundred bags of heroin. Fortunately, they did not tap me with intent to distribute—only possession. I think these undercovers were after a little bit bigger fish than me.” He might have served five years behind bars, but the courts allowed Dennis to try to get sober—and this he did. He has since moved cross country and restarted his career. But he knows how sneaky heroin addiction can be. “I’ve seen three friends of mine pass away in the last year from heroin relapses,” he says. “There’s a constant threat of that—so to be reminded, to be humble, is the biggest thing.”


FACES OF ADDICTION
Last year, heroin claimed the lives of a twenty-six-year-old trombonist from Wilton; a fifty-three-year-old receptionist from Stamford who loved quilting, gourmet cooking and stamp collecting; a nineteen-year-old Greenwich girl soon to enter Sarah Lawrence; a twenty-two-year-old star athlete from Wilton studying finance at University of Connecticut; a fifty-one-year-old landscaper from Fairfield—the list goes on and on. Here is a middle-aged man from Weston whose obituary paints a picture, no doubt accurate, of family happiness and civic engagement. The obit reports the cause of death as a heart attack, but the actual cause, according to the list before me, provided by the state’s chief medical examiner, was cocaine and heroin intoxication. Such is drug addiction’s stigma.

Then there are those who lived.

Richard Treglia, fifty-one, a builder from Norwalk, climbs the front steps of my house with a pronounced limp and settles in at the dining room table. He’s an affable man with a lot of mileage on him. The first thing he mentions is his idyllic childhood, on the edge of Oak Hills Park Golf Club in Norwalk; the second thing he mentions is a beloved older brother’s fatal motorcycle accident in 1978. The drinking and pot smoking started then, at age thirteen, and the cocaine followed at seventeen. Clinicians know that the younger the age of first use, the likelier addiction becomes.

The addiction that nearly killed Richard did not begin until 2003, at age thirty-eight, with Percocet and OxyContin. By then Richard was married with three daughters and living in a beautiful house down in Marvin Beach on the Norwalk waterfront. “My next-door neighbor, Eric, God rest his soul, said, ‘Richard, the pills are getting hard to get—the heroin is cheaper, and we can get it all the time.’”

Richard got his in South Norwalk. The self he showed the world was a bon vivant who loved entertaining the neighborhood kids with elaborate holiday displays. All the while, he was high on heroin and drunk on vodka, which helped steady his increasingly tremulous hands. He’ll never forget the moment when, dressed as the Easter Bunny, he heard a child say to his mother, “Mommy, the bunny smells like alcohol.”

Richard overdosed three or four times that he can recall. Once he shot up at a traffic light and blacked out. “I was doing ten or twelve bags of heroin a day,” he tells me. “I would get up at four o’clock in the morning, shoot two bags of dope, then sleep until seven, get my kids off to school so my wife could sleep. Then I’d have some drinks to calm my shakes down. At the end, I would have to fill my needle the night before, because by four a.m. I’d be too dope-sick to do the process”—mixing heroin and water in a spoon, then drawing it through a cotton ball into a syringe.

During a three-month binge in 2005, Richard spent $40,000 on heroin. The money was leaking away so fast that he resorted to selling his work trucks and power equipment “just to feed my addiction.” His house went, his marriage, too. “You put this drug in you—” he begins, and shakes his head. “I lost everything.”

When Richard kicked his habit the first time, a daughter called him in rehab to say that Eric, his neighbor, was being carried out of his house, blue-lipped, dead. Richard stayed sober for seven years, until a hip operation required a powerful opiate painkiller—morphine. “I told the doc, ‘I’m a heroin addict!’ I was fighting it tooth and nail. But they gave me the morphine drip and I was off to the races, fuck everybody.”

Clean now for three years, he chooses to endure chronic pain rather than risk another operation with its requisite painkillers. “If you’re ever in the grasp of this disease, you will do anything,” he says. “That’s how powerful it is. You’ll walk over your kids, your parents. Anything.”

Molly Ashcroft, twenty-eight, was a good girl from a good Guilford family, a swimmer, a softball player, and especially a dancer; she still has the lithe dancer’s body honed from forty-hour practice weeks and national
competitions. She’s nicely put together, too, in blues and purples, with a knit scarf tucked under her long, light brown hair. “I think I was a little bit late on the party scene, going into junior year of high school, mainly because I was so dedicated to dance,” she says. “Then cocaine went through the school system like wildfire.”

Most students left it behind. Molly graduated to crack—“a whole other beast.” At age sixteen she was sneaking out to buy crack in the Fair Haven section of New Haven, known for crime, drugs and prostitution. She stole from her parents, her siblings, her beloved grandmother. She went to rehab for four months and drank on her first day out.

One day, in mild psychosis after crack had kept her up for days, a guy gave her heroin to bring her down. “That’s what began the chase of the next couple of years,” she says. “You do cocaine to get up and heroin to come down. A constant cycle you can’t break.” Rehabs came and went; promises to her parents to try to get clean evaporated as soon as she made them. She ended up homeless in Fair Haven at age twenty-one, passing bad checks, stealing, doing whatever it took to feed a ferocious crack and heroin addiction that cost, at its peak, $1,000 a day. “I was the queen of telling my parents that I wanted help—then I wouldn’t pick up the phone for three weeks or I would change my number,” Molly says, growing teary. “I wasn’t allowed home. If I were to go home, they would call the police.”

She lived at night. “That’s when the underground world comes out,” she says. Hers was a world of criminals and addicts—users with collapsed veins who had to shoot heroin into their necks or feet, often jabbing futilely for a port of entry. (Watching them, Molly would only snort the drug.) There was an aura of death and actual death. Finally, Molly herself had the sense of an ending. “I just called my dad. I called him and I said, ‘I don’t think I’m going to make it.’ He agreed to meet with me within twenty-four hours. It wasn’t right away. He was sick of jumping at every phone call.” But he did respond, perhaps saving her life. She has stayed clean since December 15, 2008, ending a half-decade nightmare.

“My family felt I would die,” Molly says. “I’d been in ten inpatient treatment settings, I’d been in tons of sober houses and gotten kicked out. I had been in detox six to ten times—I mean, I really, really, struggled for a long time. The biggest thing to let parents know is, there’s hope. They can draw that from my story, at least.”

Nicholas de Spoelberch, thirty-seven, of Darien, married with two young children, tells me his remarkable story as we sit on a bench on Main Street. “People still talk of heroin as something unthinkable, shocking, appalling, and so it was the one thing I was going to take to my grave. And I literally almost did.”

Three years ago, Nick was the dean of students at Regis High, an esteemed Catholic school on Manhattan’s Upper East Side. Partly because he’s so presentable—athletic-looking, neatly groomed, with an air of genial competence—he had little trouble scoring oxycodone prescriptions. At first, the pills were legitimately dispensed to alleviate injuries sustained in martial arts training. But they had the bonus of walling Nick off from an anxiety he’d endured since youth (discomfort in one’s own skin is a startlingly common thread in heroin addicts), and so, by degrees, his requests for medication went “from honest to fudging the truth to being so dependent that I just didn’t care.”

As doctors cut him off, Nick shopped with increasing desperation for new ones. “Finally I was so tired of lying. Call up a new doctor, go down there, put on a show.” Early in 2013 he arranged to meet a Norwalk-based heroin dealer in New Canaan. Snorting a couple of bags a week turned into snorting a couple a day. “Then the brakes totally came off,” he says. “You hate yourself for doing them, then you do more to escape that feeling. Self-hatred, escape, self-hatred, escape, faster and faster. In about five months I was shooting thirty to forty bags a day. It was like being trapped inside a nightmare—worse, to me, than dying. All your brain and body seem to think is, ‘More, more, more,’ even when it stops working.”

In the spring of 2013, St. Regis held its graduation, as usual, at the Church of Saint Ignatius Loyola on Park Avenue. Not halfway into the ceremony, Nick, sitting by the altar in his black faculty robe, abruptly got to his feet, walked past the principal, away from the hundreds in the pews, and out the side door. “I just decided, ‘I’m gonna go get high.’ I went to my office, threw down the gown, got in my car and hightailed it to Norwalk to buy thirty bags. And I went to the beach and shot heroin. I just thought, ‘I don’t want to live this life anymore. Let it end.’ But I kept waking up.”

Even so, he managed a brief respite from heroin. On July 11, 2013, Nick told his wife he was going to an AA meeting in Wilton. Somewhere along the line, he discovered a bag of heroin beneath the car seat, shot it up, and overdosed. Nine hours later a Wilton police officer banged on the window with his flashlight. “I got arrested for a felony, heroin possession as a school administrator,” he says.

“A couple of days later, everybody I had ever known in my life—my family, my wife’s family, all those kids at school who looked up to me—woke up to front page headlines everywhere. ‘Dean of students busted for heroin.’ My job was gone. My wife wouldn’t pick up the phone (I had checked myself into detox in Westport). I was a wreck. But you know, God kind of gives you what you need.” What Nick needed was ruination on a spectacular scale. “It wasn’t a pleasant experience—it was kind of like getting your skin ripped off—but I’m grateful that it happened.”

Richard Treglia, back running his business, is engaged to be married. Molly Ashcroft is the director of admissions and business development at Westport House. Nick de Spoelberch works as a substance abuse and mental health counselor in Bridgeport; his wife took him back, and now he enjoys nothing more than the company of his young family.


WHAT’S THE ANSWER?
For decades the solution to drug addiction in our midst was to lock people up. New York’s infamous Rockefeller drug laws of 1973, copied around the country, decreed that low-level drug dealers, even hapless addicts, would serve mandatory sentences of fifteen years to life. Get caught with a measly four ounces of narcotics and you’d draw a second-degree murderer’s sentence.

A climate of voter-pleasing toughness prevailed for the next forty years—a period during which judges complained with mounting bitterness about having to sentence (for instance) a Florida man to twenty-five years for selling 365 Percocet pills. Largely as a result of harsh mandatory minimums, the U.S. prison and jail population swelled from 330,000 in 1973 to about 2.4 million in 2009, with nonviolent drug offenders comprising 48 percent of that number. And yet the war on drugs—the domestic side of it—turned out to be a folly. Costly and ineffective, it was also destructive, particularly to urban minorities and their families.

The current opioid epidemic has forced a massive shift in strategy. Compassion is proving the smarter route. In February President Obama requested $1.1 billion for fiscal year 2017 to fund medication-assisted treatment for opioid addiction. In March the U.S. Senate passed the Comprehensive Addiction and Recovery Act, designed to expand access to treatment and strengthen prescription drug monitoring systems. Five states, including Connecticut, have already done the latter; these states now require doctors to consult a database of patient prescription histories, thus foiling the sort of doctor shopping that kept Nick de Spoelberch in opioids. Connecticut has also passed laws making Narcan—the drug that saved both Adam Dalman and Dennis Wright—available to anyone by prescription, so that a mom worried about her son’s heroin habit can keep a kit on hand.

Those are policy answers, and they’re important. But down in addiction’s trenches, the picture is murky. What’s a family to do when confronted with a heroin-using son or daughter? Ideally, the first step is detoxification in a hospital or rehab setting. The next step is continued treatment at a residential facility, treatment that “integrates” medication to control the physical addiction and therapy to address underlying psychological issues. The final step might be a less-supervised sober house as a sort of bridge back to independent living, or intensive outpatient treatment.

But there are caveats. “You’re going to have to get your head around the fact that this may be a long and tiresome journey,” says Alan Mathis, who heads the Norwalk-based Liberation Programs, which provides a variety of services to those battling addiction.

Mothers and fathers, so often heroin addiction’s collateral damage, drain their coffers paying lawyers’ fees and sending their addicted children to rehab. Very good Connecticut inpatient rehabs, like High Watch ($11,000 per month) or Mountainside ($30,000), are costly. Some accept insurance; many do not. There are state-funded rehabs, but they have dishearteningly long waiting lists—weeks or months. “The window of insight for someone willing to put down the needle or the straw is maybe six hours, maybe two days,” says Nick de Spoelberch. “After that, they’re gone.”

If you can afford private rehab, which one do you choose? Different rehabs espouse different treatment philosophies—twelve-step, therapeutic community, faith-based, cognitive behavioral, skills development, a smattering of each—and families are ill-equipped to sort them out.

Gary Mendell, the Shatterproof founder, describes the search for answers as “a journey through darkness.” Gary’s son Brian isn’t on any list of drug overdose deaths. Like others you’ve read about here, he progressed from marijuana to painkillers to heroin—but finally wrestled his addiction to the ground. It’s hard, though, for the non-addict to appreciate the damage these wars can do to a soul. One night in the summer of 2011, Brian told his father, as they sat out on their back porch in Easton, “Someday people will realize that I have a disease, and that I am trying my hardest.”

On October 20, 2011, thirteen months clean, Brian Mendell hanged himself. He was twenty-five years old.

Reviewing Brian’s ten-year history of substance abuse and the eight rehabs it entailed, Gary observes, “Every treatment program he went to was preaching a different thing. And very little of it was based on science.” Gary discovered that proven solutions do exist but tend to be tucked away in medical journals, far from public view. In Brian’s last inpatient rehab, for instance, he was prescribed buprenorphine—better known by the brand name Suboxone—a synthetic opioid designed to reduce cravings and thwart withdrawal. And if he were to use heroin while on Suboxone, the “reward’ would be severely diminished. It seemed to work: “He was doing the best he ever did,” Gary says. Curiously, none of the prior rehabs had mentioned Suboxone, and an outpatient program titrated Brian off the drug in his final summer. “They didn’t believe in it,” Gary says in a clipped voice.

The rehab world is still divided on the matter of “maintenance treatments” like buprenorphine and its forerunner, methadone. Since these treatments replace one opioid with another, they merely perpetuate the addiction, argue so-called abstinence proponents. Dr. Eric Collins, physician-in-chief at Silver Hill, adamantly disagrees. He says that detox without methadone or Suboxone can be dangerous, since the high probability of relapse combined with a weakened tolerance leaves users vulnerable to overdose. “People invoke a moral view: ‘It’s not good to be on an opioid’,” Collins says. “But when people stay on methadone or buprenorphine, their overdose rates are dramatically less, their risk of relapse is much smaller, and they can maintain normal, healthy lives much of the time.”

Methadone is reserved for especially chronic relapsers. While Collins acknowledges the drawbacks—it’s very hard to quit and overdose is a concern—he says “the evidence is convincing: For many people, it works.” Buprenorphine, available in the U.S. since 2003, is prescribed for less deeply impaired addicts: a pill a day keeps the craving away. Collins says, “All of us in addiction have seen patients whose lives are manageable only when they’re maintained on one of these treatments—and who never stay off heroin unless they’re on one of them.”

A drug called naltrexone offers a new medical solution, perhaps the most promising one of all. Unlike methadone and buprenorphine, it has zero opioid effect and thus is neither addictive nor abuseable. Moreover, it prevents opioids like heroin from reaching their receptors. You can’t get even a little bit high on it. Ironically, that was the problem: A total absence of opioid good-feeling disinclined people to keep taking it.

“Oral naltrexone effectively didn’t work,” Collins reports. But in 2010 the FDA approved an injectable form of naltrexone, called Vivitrol, to combat opioid addiction. One shot lasts four weeks. “For about a month, you don’t have to make the decision every day,” says Collins. “You’re blocked.”

While the research verdict on Vivitrol is not fully buttoned down yet, clinicians like what they see. Westport House’s Al Samaras says, “We’re big fans of that here. Any opiate guy who walks in the door is going to see Dr. [Joseph] Russo here in town about Vivitrol.”

Both Collins and Samaras hasten to point out that medication is only a piece of recovery. Heroin addiction’s psychological issues can be ferociously tangled, since they involve no less than the near-destruction of a life and all its relationships.


BACK TO ADAM
One morning in October of 2014, Stamford police found Adam Dalman half-asleep in the street outside a Walgreens in Stamford. He’d been walking around in a fog, addled from potent heroin, and come to rest at Walgreens for no reason that he can recall. Police arrested him for heroin possession and let him go on a promise to appear. Two days later, police responded to a report of thefts: Adam had spent the night rummaging through unlocked cars and fallen asleep on the side of the road.

When the police found him, Adam struck off on foot, losing his shoes, losing his glasses, hoping to find a place to end his life. And that was the end of the road. The police closed in and Adam lay down in surrender. “Part of me felt so relieved to be done running from everything and everyone,” he recalls. “I remember feeling an overwhelming sense of calm come over my body as they cuffed me—I was almost smiling.”

He spent a year in prison. For Adam, time behind bars forced the reckoning that all heroin addicts eventually must make: Get high or get clean? Live or die? “The longer you stay away from heroin, the more your head clears,” he says. “That’s science. A whole year away from drugs and your mind is ten times better. So when the fog cleared, I figured out I wanted to live. That’s really the biggest thing.”

He thinks for a moment. “Last Wednesday I got fitted for a suit for my sister’s wedding. I was with my mom. And when she saw me in the suit, she started to cry. She was like, ‘Wow, who would have thought? Who would have thought I’d see my son, getting ready for my daughter’s wedding?’”


Resource Guide

Some of the helpful resources in our area

HANDS-ON HELP

ADDICTION RECOVERY CENTER AT GREENWICH HOSPITAL
The hospital’s ARC has inpatient and outpatient services, as well as an eight-week Opiate Addiction Recovery Program. The program uses an “integrated” approach, combining medication and therapy. greenwichhospital.org; 203-863-4673

AWARE RECOVERY PROGRAMS
A novel statewide program of comprehensive, wrap-around drug and alcohol addiction rehab care producing recovery rates 650% above the national average. ARC provides private, personalized care for clients in the security of their own homes, an approach that research is finding to promote faster, lasting recovery. awarerecoverycare.com; 203.779.5799. All calls are strictly confidential. Most private health insurers provide full or partial reimbursements for those under the care of Aware Recovery Care.

LIBERATION PROGRAMS
Based in Norwalk with a treatment center in Stamford, Liberation Programs offers a variety of clinical services, including detox, methadone maintenance and outpatient treatment. A far less costly option than most, it accepts state-funded insurance and can also work out payments on a sliding scale. liberationprograms.org; 203-851-2077 In Greenwich, Liberation Programs sponsors an outpatient office for teens and their families called Family & Youth Options. 203-869-1349

SILVER HILL HOSPITAL
Long established as a premier psychiatric hospital, New Canaan’s Silver Hill also treats people with addictions. Last year, largely in response to the opioid epidemic, Silver Hill opened its intensive six-week Outpatient Addiction Program. For opioid users, the program typically starts with detox and daily meetings with clinical staff, and continues with group therapy. silverhillhospital.org800-899-4455, admissions ext. 4

ST. VINCENT’S BEHAVIORAL HEALTH SERVICES, WESTPORT CAMPUS
St. Vincent’s, which acquired Westport’s Hall-Brooke Hospital in 1998, provides detox and substance abuse treatment at its seventy-six-bed campus on Long Lots Road. It also offers outpatient psychiatric and counseling services. stvincents.org; 203-227-1251

STAMFORD HOSPITAL
The hospital offers addiction treatment as part of its Psychiatric and Behavioral Health Services department. stamfordhealth.org; 203-276-1000.

NORWALK HOSPITAL offers addiction recovery outpatient services. norwalkhospital.org; 203-852-2000

TRANSFORMATION HOUSE FOR WOMEN
Robert Curry is the founder of Turning Point for Leaders, which does interventions for corporate executives and business leaders. In February, he addressed a pressing need by founding the only sober-living house for women in Fairfield County. Transformation House, in Westport, is closely allied with Westport House, Curry says. He can be reached at 203-966-1103. Transformation House can be reached at 203-254-0791.

WESTPORT HOUSE
Westport House is three sober- living houses for young men in Westport. Al Samaras, a former health care technology executive and recovered heroin addict, founded Westport House in 2014, after observing “extraordinarily high” relapse rates in other sober houses. Westport House’s multi-pronged approach includes 24/7 staffing, clinical services, physical fitness, life skills training and, crucially in opioid cases, Vivitrol. Relapse rates are exceptionally low. westportsoberhouse.com; 888-302-6790


INFORMATION SERVICES

COMMUNITIES4ACTION
C4A provides lower Fairfield County with substance abuse education and training, and advocates for policy change. Though C4A emphasizes prevention, it’s a great place to consult if you’re wondering what to do about a loved one’s addiction and the system has you cowed. C4A is one of thirteen “regional action councils” that form the Connecticut Prevention Network, communities4action.org; 203-588-0457

NARCAN PRESCRIBERS
One bright spot in the opioid epidemic has been increased accessibility to Narcan, which reverses the effects of a heroin overdose. “We’ve seen people that looked like they were gone,” says Stamford Police Captain Richard Conklin. “It’s almost spooky how quickly they come to.” Until recently, only first responders had access to it. Doctors can now prescribe Narcan to “third parties”—like parents—and so can some pharmacists. For certified pharmacists: data.ct.gov/Health-and-Human-Services/Naloxone-Prescribing-Pharmacists/qjtc-pbhi

OPIOID TREATMENT HOTLINE
In March, Connecticut’s Department of Mental Health and Addiction Services established a hotline to connect opioid users with local walk-in assessment centers. These centers, sprinkled around the state, work with patients and insurance companies to overcome barriers to treatment. ct.gov/dmhas/walkins800-563-4086

SHATTERPROOF
Founded by Gary Mendell to honor his son who committed suicide after a ten-year battle with substances, Shatterproof has been instrumental in pushing for “Good Samaritan laws” that offer immunity to users who call 911, and for wider availability of Narcan. One of Shatterproof’s goals is to eradicate the stigma surrounding addiction; another is to educate the public about the science of addiction and policy changes that can save lives. shatterproof.org; 800-597-2557