Hayley drank a little in high school and most likely smoked marijuana occasionally. But there were no red flags indicating a dependency. In college, I’m sure her alcohol and marijuana use increased when not limited by the confines of parental monitoring, but didn’t most kids’? Honestly, I’m alarmed by the alcohol consumption and drinking patterns of many young adults; the excess seems to have become the norm. There weren’t any blatant incidents or indiscretions that we knew about during Hayley’s college years to cause concern. She was on course to graduate with a B.A. in Politics with ~ a 3.2 gpa. When the question of an eating disorder arose in the spring of her junior year while participating in a study abroad program in Italy, we scheduled appointments for her to see a therapist, physician, and nutritionist upon returning home in June. All three professionals concluded that she most likely did not have a diagnosable eating disorder, and was probably just under a lot of stress during the Florence experience. While in Italy, she had broken up with a serious boyfriend, hosted visits from 3 different groups of family members, and was juggling a full academic course load. It made sense.
Hayley was eventually diagnosed with a serious eating disorder (bulimia) in 2002 and went to a residential treatment center in the midwest for about 45 days. Since then, she has lived and worked here in her home town and gone through a series of jobs, financial crises, romantic relationships, friendships, and sporadic bursts of using a variety of drugs, always managing to convince us, and herself, that there was not a “problem”.
It appears that she used prescription painkillers whenever she could, and had access to a steady supply through her numerous bouts with root canals and irritable bowel syndrome, all probably resulting from her bulimia. We discovered she was using cocaine in the spring of 2003, did a “mini-intervention” with the family and her boyfriend, and to her credit, she got herself off the coke.
But the chaos in her life continued – – – and now I’m wondering if she’s always had a substance abuse issue, and/or, is there some kind of underlying mental illness – is there a dual diagnosis?
Fast Forward: A year ago, Hayley lost her last job and collected unemployment for many months. She seemed depressed and did not keep in touch very regularly. I sensed her downward spiral, but was never able to confirm or document it. Hayley is a master manipulator and a gifted salesperson. Most family members felt either helpless or were in denial about the seriousness of her mental state and life circumstances. Last June, I discovered she had been evicted from her duplex and was living in a crack house.
After many days of trying to get in contact with her, I was able to convince her to come home. She did – twice – and left both times. Each time, she made an attempt to get herself in to treatment, but couldn’t make it through the waiting period required for admission. The few hours I had with her at home, we talked and went on walks, and I tried to make her feel loved and nurtured. I was her cheerleader. She was proud of the fact that she was the only one in the crack house not shooting heroin. I pulled out every supportive slogan and statistic I could think of. Ultimately, Hayley went back to the cocoon of the crack house and the sordid living conditions there. It was a refuge of some sort, I think, where she didn’t have to deal with the realities of trying to become an independent, productive adult.
Texting has been our only mode of communication. After not seeing her for almost a month, a friend suggested that I invite her to meet me someplace neutral, which she agreed to. Due to her paranoia that I would “try something”, Hayley re-scheduled our meeting time and location many times. Finally, we met and I saw her for the first time in weeks.
We met in Safeway’s parking lot and sat in my car. It was a hot August day, but she had on a long sleeved sweater and her right hand and arm were wrapped with an Ace bandage. She looked thin and pale, but had tried to appear pulled together with a little eye make-up and freshly washed hair. She said, “I need a medical detox.” I knew what that meant, but pretended I didn’t. “Why”? I asked. She looked at me, and couldn’t say it – so I did. “You’re using heroin?” “Yes”, she answered. “How long?” I asked. “A few weeks”, she responded. I wanted to scream, “Are you fucking nuts? Why would you do this to yourself? Was this some kind of initiation rite in to the crack house?” Instead, there was silence – followed by my comment, “I knew when I saw your long sleeves.” My worst fear had been realized. It was there in front of me, yet I couldn’t believe it. Apparently, she had graduated.
“I have a bad abscess”, she said, almost proudly, as if it were a merit badge. “Wanna see it?” I didn’t. Why would I want to? But she ceremoniously unwound the bandage to reveal a red, throbbing, swollen wrist. “It’s pretty normal”, she said, “for drug users to get abscesses.”