Win Some, Lose Some.

The post is reprinted from Miserable Bliss with permission of the author. With a daughter in Social Work, I follow the misadventures of Violet, another Social Worker with a wry sense of humour and a way of putting words on paper that make you think.  This is one of those blogs.

The vast majority of my clients are addicted to something. Many of them personify, to varying degrees, what you (likely) think of when you hear the word ‘addict’ – though most people don’t recognize that ‘addict’ is still ‘human’ and thus it’s not just about the drug, even when it’s all about the drug. But if you saw them walk by, you’d probably assume correctly that they were an addict based on various indicators that are stereotypes. Stereotypes and, often, reality.

A smaller number are what I’d call “recreational users” of substance(s) – sort of like your friend who really does only smoke a bit of weed at parties and never any other time – but if they’re coming to see me they’re into something considered a bit ‘harder’ than marijuana. I deal in clean needles and crack pipes, remember. But it is completely possible for someone to recreationally use something like crack or meth. Probably more than you think, actually. (But it’s a slippery slope, indeed.)

Then there are the people who come to pick up supplies for their friends – and yes, they really are getting stuff for someone else. (And yes, I also have clients who pretend they’re picking up for a friend.. most of them eventually drop the pretense when I ask a few questions about what their ‘friend’ needs/wants.) Sometimes they’re picking up for a roommate who’s at work and can’t come to my location. Sometimes they’re picking up for a girlfriend or husband or cousin. Sometimes it’s their tenant. They often ask me for information about drugs or side effects – is the behaviour they’re seeing caused by the drug? Mental health? Personality? Is this a psychotic break or mania? I like talking to these people, generally, because they have the same goal that I do – keeping a substance user healthy and safe. They are curious about what the supplies are for and how to use them.

I have favourite clients from all of those categories. As a general rule, I like them for the same reason that I like anyone else – they’re funny, or they’re smart, or they tell a good story. Some of them might terrify me if we met in some other context. I probably shouldn’t have favourites but, really, it’s not like I treat them any differently from the people who I like a bit less. The stuff I give out is unlimited, standardized, and there really aren’t any extra perks I can give out.

The nature of addiction, particularly for those who I consider to be “hard core addicted” is that the health and general well-being of my favourites is pretty much all over the place. I can tell when someone has ramped up their drug use: they lose weight rapidly, melting in days what would take someone months to achieve; they have open sores on their body, face, hands; they lose what I’d call, for lack of a better term, a sense of pride, and they start showing up unwashed, smelling, unkempt or just plain filthy; they cavalierly tell me that they did [some action] that’s out of their normal behaviours and probably outside of society’s definition of “normal” or acceptable. Sometimes they just tell me directly that they’re using more. Sometimes I can tell by the number of supplies they take from me.

It’s hard to watch. It’s hard to see someone twice a week, for example, and watch them begin to snuff themselves out. The light disappears from their eyes and is replaced by an emptiness and a cold-focus that appears to be hunger – craving, wanting, needing. They don’t ask how I am, anymore, or comment on the t-shirt I’m wearing – they make their demands and then they’re off and running again. I need 10 needles, 5 cookers, 5 waters, 2 ties. Thanksbye. I watch them first appear embarrassed, then ashamed, then completely vacant, as their personality dissipates. I see the manicure turn to chewed nails and abscesses on the backs of their hands, arms, breasts or feet.

It would all be so much easier if people with addictions fulfilled the stereotypes – surly, mean, criminal, filthy, society’s rejects, stupid.. whatever. But my clients, as much as they fill some of those stereotypes, are also parents and students and wives and brothers. They’ve often experienced huge amounts of trauma – awful, terrible things. (They’ve also often handed out their share of awful, terrible things to other people.) They inhabit lives that are ridiculously difficult to fathom – the stress and anxieties of their daily life often boggles my mind. They are warm and sweet and funny and caring.

I watch them decline and there is nothing I can do.
This is where, I understand, people judge the work that I do. “If you didn’t give them needles, they wouldn’t do those drugs” or “You’re condoning drug use!”
People are wrong. This is where the work that I do becomes incredibly important.

I check in as best I can – I look at abscesses and refer to treatment (I have access to a physician who can usually get someone in very quickly to have an abscess drained and packed and bandaged up). I try to refer people to the social worker on my team if I think there’s a chance they’ll show up for an appointment. I ask how people are doing. Mostly, though, I am invisible to them for a bit.

The rational human being is swallowed inside the addiction. Eventually, with any luck, the human emerges again. My job is to help make sure the person that emerges is coming back to reasonable health. When asked for 4 needles, I hand out 10 or 20. When someone grabs a bunch of needles, I hand them a bunch of (sterile) water vials so they won’t use puddle water.

I caretake, a little, for people who are not overly invested in taking care of themselves for a bit.
Maybe, just maybe, it’ll prevent an infection. HIV. Hepatitis. Any number of health problems.
I mention all of this because today I saw two clients that drove the point home.

One, who I’ll call Tammy, has been away for a while, causing me some worry. It’s not like I can call someone to ask how she is or what she’s doing; I don’t know her last name, who her friends are, what her phone number is or where she lives. But today she reappeared to get some supplies and tell me about the treatment she’s starting soon. She was radiant – healthy, glowing, happy, smiling – and it was a vast change from the last time I saw her. She told me about the things she’s been doing for the past chunk of time, the improvements and changes and things she’s done to make life better.

Will she actually go to treatment? I have no idea. We both know that she needs it.. and we both know how easily she could miss that appointment and just keep doing what she’s doing. I cheer her on, tell her that I hope things go really well for her, and then I hand her my business card.

The other client is someone who has been drifting around me for a while, off and on. I’ll call her Amy. She was doing well, then not, then well again. We connected quite a bit and had some good conversations. Then a series of events transpired that knocked her off-kilter and I didn’t see her for a while. Today I saw her slinking around – avoiding my eye contact, embarrassed, and looking extremely unwell. She has escalated her use. She will likely continue to avoid me for a while. She bolted out of the place before I could decide whether or not to go over to her.

I know she has my number. Knows where to find me. Knows what I can do to help (and what I can’t do, too.) I will wait, patiently, for her to get in touch. I try to remain hopeful. I also try to remain realistic.

When I don’t see someone for a long while, I like to think they’re home with family. Healthy. The reality is that they’re more likely in jail. Sometimes dead. But sometimes they really are out of town, staying with their parents, avoiding the ‘bad influence friends’. Sometimes they’re in treatment and they come back looking better than I do on my best days.

Win some, lose some, isn’t quite accurate. Keep playing the game – the winners sometimes lose and the losers sometimes win. There is no end.