Episode 2

Aspenridge at NAATP Denver

Today Cortland Mathers-Suter from Aspenridge Recovery joins me at the 2018 National Association of Addiction Treatment Providers conference. Cortland shares with me how he has separated Aspenridge from other Treatment centers and how he plans to continue to do so. Cortland also shares his valuable insight on the Treatment industry and what he believes are the next steps to take.

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Full Episode Description:

Timmy's Story: The Insanity,

The Despair & The Willingness

The story of Timmy, one of the very first inpatients at Northpoint Recovery (in fact, and make of this what you will, he was number 13), would make the perfect case study for both those who are addiction professionals, and those who are seeking recovery from substance abuse for themselves. To call it multifaceted would be an understatement, and his story is featured in No Way But North's second podcast, entitled "Timmy's Willingness." The various themes which recur throughout his moving and, ultimately, inspiring story will be recognized by addiction treatment specialists and felt by many addicts, whether in recovery or not.

The quote below from Timmy's story is one that will surely resonate with many of those suffering from addiction, especially that of substance abuse:

"I couldn't handle this, or keep going. It got to the point where I didn't know if wanted to die, but I didn't want to live like this anymore."

For Timmy, one of those themes was the development of a co-occurring disorder - alcoholism (mixed with serious levels of drug abuse) and then depression, and how the pairing of these conditions drastically affected his adolescent and young adult life.

Co-Occurring Disorders: Alcohol Abuse & Depression

Co-occurring disorders, formerly known as a dual disorder or dual diagnosis, are defined as the presence of both a mental health disorder, such as depression or bipolar disorder, and a substance-abuse disorder. The National Center for Biotechnology Information reports that 64% of diagnosed alcoholics actually meet all the criteria for a diagnosis of depression.

What exacerbates this issue for the sufferer is that both are causal factors in the emergence of the other, and, without the necessary treatment, will only make each disorder worse. In Timmy's case, his co-occurring disorder resulted in a number of suicide attempts - fortunately, unsuccessful.

The abuse of substances, such as alcohol, prescription medications or illegal drugs, by an individual is often the very first clear sign that a pre-existing disorder, such as depression, anxiety or PTSD, had existed well before they ever began to drink or use uncontrollably.

It is not just adults who can be affected either. Various studies have shown that depressed children are more likely to endure alcohol abuse issues as they grow older, and teenagers are twice as likely to do the same if they have suffered a bout of major depression.

Timmy's Early Experiences with Substances

Using his own words, it's there that we shall see how Timmy's co-occurring disorder began to manifest itself. From a very early age, Timmy, either consciously or subconsciously, sought ways to make himself feel happier.

"I am not exactly sure what led up to it, I am not even sure what age it was. One of the first times that I remember using substance to feel different, I was in grade school. I had asthma, and all the kids would be sent to the Principal's Office to use their inhaler before gym class. I must have been, I don't' know, 5th grade, 4th grade.

And we'd all stand there with our albuterol, 10 to 15 of us, and we kind of, you know, shaky-float all the way to gym class. Probably, a little earlier, sneaking dimetapp, because I liked the taste of it. I would get into the cupboard and just take little tugs out of the bottle. I don't know if I was conscious of it, but all I knew was that I liked the taste."

As we shall see, Timmy's spiral into substance abuse and addiction was a gradual process, as it is for most addicts. Furthermore, the perils and pitfalls of prescription medication for Timmy will become all too apparent, somewhat poignant with the U.S. currently enduring the opioid crisis.

From those early experiences with albuterol and dimetapp, Timmy's progression towards addiction was possibly further fuelled by a family move to Boise, Idaho, leaving him feeling somewhat isolated, without friends, and trying to find where he could fit in.

"I kind of gravitated to the people that were antisocial, antistablisment, the skater kids, the punker kids, and that's where I kind of fit in. Almost right of the bat, I started smoking cigarettes… then smoking weed.

"Oh, I made a new friend, Mom and Dad. I'm going to go and stay the night, and eat popcorn, watch movies. Yeah, you can even call his parents." So they called his parents. "Yes, they are going to be in the basement watching some movies." Meanwhile, we are eating mushrooms, smoking weed, and drinking alcohol.

Factors Associated with Concurrent Alcohol Abuse & Depression

So why does alcoholism and depression co-occur in individuals so regularly? The answer is twofold: firstly, that, as previously mentioned, one can actually be a causal factor of developing the other, and secondly, the presence of environmental and genetic factors.

As a causal factor, both alcoholism and clinically-diagnosed depression are associated with a double risk of developing the other. In other words, they are considered a likely predictor of the other as a future disorder. It really is a self-perpetuating cycle, as in the following examples of the possible development of such a co-occurring disorder:

  • Prolonged substance abuse will actually restructure how the brain functions, resulting in memory loss, confusion, mood swings, impulsive behavior, poor decision-making, and general mental instability. All of these in themselves will make the individual vulnerable to depression.
  • Self-medicating with substances to deal with depression can have the converse effect, as the individual is then more likely to be drawn into addiction, which will then worsen the existing depression.
  • Lastly, prolonged substance abuse will undoubtedly lead to financial problems, work-related issues, strained relationships with partners, family members and friends, legal issues, and the obvious problems with health. As is profoundly clear in Timmy's story, any one of these will damage a person's self-esteem and confidence, which can then transform into clinical depression.

Environmental and genetic factors include:

  • Stress and/or trauma: A deeply traumatic event, and the stress associated with that, or environmental stress on its own, such as death, divorce, or abuse (be it physical, emotional and/or sexual), leaves the individual far more open to addiction and mental disorders.
  • Heredity: A predisposition to both addiction and mental disorders can be part of an individual's genetic makeup.
  • Neurology: A deficiency of neurotransmitters enabling emotional stability in the brain can result in both addiction and mental disorders.
  • Brain development: If the individual is abusing substances whilst their brain is still developing, such as during their adolescent years, there is a greatly increased chance of a mental disorder developing.

Timmy' Adolescent Years of Substance Abuse

"Between 13 and 15, it was "Ok, let's try everything." Eventually, got to the cocaine, mixed with everything else I was doing, and eventually, at 16, I was introduced to speedballs. Now, Holy Moley! It's funny that I can laugh about that now. But that was my introduction to needles, a whole different ball-game, and the people that you're dealing with. I mean, a 16-year old playing doctor, and resuscitating, hopping in the back of cars with guys that don't even speak English, and coughing up balloons. Then, you hop in your car and drive off. Then they start delivering to your house."

As a teenager regularly doing speedballs on top of everything else, you would expect serious problems with Timmy's high school education. Timmy was actually kicked out of his Boise high school, but that only proved to be a good move for him.

"I started going to Mountain Cove, an alternative school that used to be in town. It was a much easier schedule to handle. There were three classes, they were only an hour and a half long, or you could take extra periods. You could take one in the afternoon, one in the morning, and you got to 5 of them. I went to summer school, and got paid by the state, and got school credit, and actually graduated early.

I was also working full time, which was how I afforded my drugs. I was a go-getter, I guess. Had ambition, but my ambitions were getting the hell out of my parent's house and being able to do this full time, more than I was. I look back and I don't know how the hell I did it."

But did it, he did. However, both personal and professional success can be a catalyst for many things, and, in Timmy's case, it was the catalyst for living life as he wanted, to earn money, to party, to meet women, and to do as many drugs as he could handle, with his addiction taking center stage:

"I started drinking very heavily, which of course it wasn't from the start. It was progressive and I, at 23, started working at a massive restaurant in town, and started off as a prep cook, and I was 19 then, but, by the time I was 23, I was the executive chef.

So I was the youngest chef ever for this company, and we did four and a half million dollars in food sales a year, and so I had a lot of money. I was young, I was partying, I had the awesome jeep, the BMW, and I had nothing to show other than that, you know, for what I was making, and it was just a party.

I guess it was fun, during the whole shabang. I mean - the women. When you are young, and you have a full head of hair, you've got two cars, you've got plenty of money to spend, I had a townhouse, [even] my cats had their own room - it was great."

The High-Functioning Addict & The Inevitable Downfall

The average person-on-the-street has a very general view of the life of an addict - one of despair, of being wasted the whole time, usually jobless (or soon will be), and living in something close to squalor. However, addicts are a broad demographic indeed, from all walks of life, from different financial situations, and different backgrounds. You simply can't lump them all into one shoebox of thinking.

A prime example of this is the high-functioning addict - an addict, yes, but a high-achieving one, who works hard before playing hard, and is able to maintain both a family and social life by simply hiding their addiction in plain sight.

Their impending and inevitable downfall, regardless of how far they actually fall, results primarily from their high-functioning abilities. It is more often the case that high-functioning addicts are simply so good at hiding the addiction that the people closest to them (family, friends, and colleagues) do not become aware of the scale of the problem until it is, sadly, too late.

However, high-functioning addicts do display a number of tell-tale signs, and these can include:

  • Mental health: The development of mental health issues, such as depression, anxiety or psychotic symptoms.
  • Physical health: The development of physical health issues, such as mild, short-term conditions or even more serious ones.
  • Social relationships: Because many high-functioning addicts experience periods of loneliness and isolation, even within social settings, the obvious relationship strains will become more common. Additionally, they will develop new social relationships with other substance users.
  • Financial: Eventually, the money spent on their addiction becomes apparent to family and friends.
  • Career: Their work performance and attendance will begin to decline, as their addiction finally begins to destroy their proof of being successful and "normal."
  • Legal: Substance abuse often involves the use of illegal drugs, leading to legal issues. The abuse of certain legal substances, ie. alcohol or prescription medications, can also result in legal problems, eg. DUI, failure to pay debts, etc.

A Best Friend's Grave & An Assault Rifle

With the extremely high level of Timmy's substance abuse, there is little doubt that he falls into the high-functioning bracket. It was, for him, simply a case of when his downfall would come, not if.

"Eventually, of course, that catches up. It gets to the point when you're so wasted at noon, and being belligerent. Eventually, they got to let you go, because you're not gonna go on your own, and turn down the money and your lifestyle, your identity. It was my identity that I became. So after 8 years, I got the talk. "Tim, we're going to need to part ways. Because I feel that if you don't leave of your own accord, you won't leave. So, we're going to have to let you go."

The loss of what Timmy considered to be his identity would result in his first stay within a mental hospital, placed on a 72-hour hold because he was deemed to be a threat to his own safety and the safety of others.

"I am drunk, of course, going through these old photos, and just as depressed as all hell. I hadn't had this kind of depression in a really long time, and you know my identity was gone. I was lost in the ex-girlfriend's house, and not making the money anymore. A real blow to who I was.

A lot of friends passed away at that time and I was looking at the picture of my best friend. His name was Ryan, and he committed suicide when we were both 20. He overdosed himself in a park. He was in a lot of legal trouble. He knew he couldn't stop, but he didn't know how. We don't know these programs exist out there. I didn't know. And I am looking at photos and I decide I'm going to go and blow my brains out on Ryan's grave.

So, I grab my SKS, which is an assault rifle, and go up to his grave. I guess the cops have come by and people were worried about me. My ex-girlfriend called the cops because there was blood somewhere. I must've had cut myself doing God-knows-what. She knew that my gun was missing. So now the cops were wanting to check it out."

An unexpected phone call from his friend Dan persuaded him to walk away from the grave.

"By the time I was back to the house to drop off my gun, no one was there. So I dropped off my gun, and Dan and I went to a park to keep drinking. Now, I'm actually in a better mood, and then the cops finally somehow tracked us down and they pick me up. They were like "We're just going to take you and get you checked out."

So I go to one of the hospitals here, and this is the first time I got put on a 72-hour hold. A 72-hour hold where you are deemed to be a harm to yourself or to someone else. Then you got 72 hours to bullshit your way out of a mental hospital."

Throughout the course of his active addiction, Timmy was to make several more suicide attempts and cries for help, resulting in being placed on a 72-hour hold. After each of those mandatory 3-day commitals, he walked away each time, enabling him to continue his self-destructive path.

"I was getting spasms, abdominal pains, and so I had someone take me to the hospital. I figured they were just going to hook me up to banana bags, fluids, the usual deal, and set me on my way. I can't hold down liquor, so I start going through withdrawals, and that's what I'm telling the ER doc, who is looking at me like I'm an asshole. They got to get tired of people like me.

He says, "We've done some blood work. We have to admit you. You have ketoacidosis [which is usually linked to diabetes] and pancreatitis, but the ketoacidosis is going to kill you if we don't admit you." So they admit me. The pain is so great that they hook me up to an IV of dilaudid. Who would have seen it coming that the last go-around would be the dilaudid? Just that feeling of the heroin all over again."

Timmy, who had once done speedballs regularly, but had successfully put down the needles by drastically increasing his alcohol consumption, had an opioid-induced high once more - this time, prescribed in a hospital.

Timmy' First 28 Days at Northpoint Recovery

"My friend Maria, I guess, had called around and had gotten referred to Northpoint. "Call this number." She left the message, and within 5 or 10 minutes she got a call back. So I wake up in this familiar place, but it's a new place. It's a rehab facility. I guess Northpoint had only been up and running for about 3 weeks.

I was lucky 13, that went through the whole 28 days. I could tell that these people thought like me, and a few of the techs had the same sick humour that I did, and I had a sneaking suspicion that these people were addicts. Recovering addicts. I am an addict first, no matter. I realize this place is a little bit different.

These people know from experience, I could tell. If people could see I got that smile again for a good reason. It was just so special. Anyways, I made it out of there. I went through the program. I went to Sober Living. I was clean, finally clean, and someone was using in there.

They were using my old drug of choice, you know, my heroin. How dare he? Here I am, clean. How can people do this? Eventually, you know, I moved out of the sober house and I get my own little apartment, which I still live in today. It's a nice little nest, basement apartment downtown.

Within two weeks, I pick up that half gallon. I made it about four and a half months. So I got a taste, and I also called this girl that I met in rehab. I was in love with her. She was gorgeous, she was younger than me, but I think she just - she didn't like me that way. So, here I am, I'm back on the needles."

Recovery, Romance & Relapse

Recovery is an experience to be shared as much as possible, with medical staff, counselors, techs, and fellow recovering addicts. However, there is one kind of relationship that can be highly dangerous to an addict's recovery - the romantic one.

Addicts are vulnerable people in the early days of recovery, be it physically, mentally or spiritually. There are simply not equipped on an emotional level to deal with new romantic relationships, especially, as in Timmy's case, with someone else in recovery themselves.

Those emotional feelings that accompany this new-found closeness with someone are exceptionally close to the highs the addict experienced with their drug of choice. During sex, the brain responds chemically in similar ways to the use of substances. Replacing one addictive behavior for another is not the kind of recovery that will last, and, as Timmy's experience with his co-addict and sometime-girlfriend clearly demonstrates, the usual result is relapse, and a resounding relapse at that.

The dangers of romance within an early recovery include:

  • A return to old coping mechanisms and thinking
  • Fragile self-esteem
  • Addiction replacement
  • Distraction from your recovery, and
  • The consequences of the relationship ending

Bath Salt & Full-On Hallucinations

Now back using illegal drugs like heroin and meth, Timmy found himself in a situation he couldn't deal with - but a situation that would eventually drive him back to Northpoint:

"I come back to my house, and the gal has biker fricking guys there. It's like a party. Now, it's a meth shooting gallery, slash bath salt [a dangerous meth substitute, the active ingredient being mephedrone]. She ends up leaving. I just keep getting bath salt. Isn't the progression insane? Bath salt. I'm putting this, what people call bath salt, in my vein and I don't like it.

Eventually, I'm sitting on my couch, and people start coming in to my house, people are almost body-to-body. There is just so many people and I don't know even know them. Part of me is thinking, "I don't even know if this is actually happening." I get up and I start asking them one by one, "Are you real?" They say, "No, I'm not real." Ok, I ain't got to worry about that person.

There is a knock on the door, and so I open the door and it's a cop. He wants to talk about my neighbor's bumper. The cop and I walk to the other side of my car, and he is like, "What's this?" I go, "I don't know. I thought someone had hit my car." That kind of a thing. I have liability, even though I haven't paid my insurance in forever. I had better things to spend it on. Bath salt now. Why did I have to cut myself off from the dilaudid guy?"

What is Mephedrone?

Mephedrone is a designer drug and a powerful synthetic stimulant, similar to amphetamines like ecstasy and speed, and is often sold as a methamphetamine substitute. However, and this is where part of its danger lies, the user has no guarantee that what they're using is pure mephedrone, as it is invariably contaminated with other chemicals. It has the slang names of bath salt, meow meow, drone and white magic.

The primary effects and dangers of mephedrone include:

  • Euphoria and heightened alertness
  • Anxiety
  • Paranoia
  • Overstimulation of the heart, body circulation and nervous system, resulting in fits and/or hallucinations
  • Death by adverse physical reaction or overdose

Mephedrone is a fine powder, and is usually snorted like cocaine, or it is wrapped in paper and "bombed" - swallowed. It can also be found in capsule form, smoked and even, as in Timmy's case, injected. Mixing the drug with alcohol will increase the likelihood of the above dangers, including death. Lastly, mephedrone is highly addictive in itself, and will result in the user experiencing cravings and taking increased quantities of the drug.

At Last, The Willingness To Do It Differently

"Anyways, I am walking to the liquor store, and something says, "What the fuck are you doing now? Where is this going to go now? Turn around, and make this phone call." So, I called someone that I knew from the program, and they pick me up and took me to a meeting. I had an appointment to go back into Northpoint, face Claudette [my first counselor], because she was still there.

Man, she let me have it! "What are you going to do different this time?" and I'm like, "I don't know what I'm going to do different this time. All I know is I'm frightened." It's weird. I've been at different lows, but this one was so different. It was just the fear of everything, and how I felt of being the cuck, being the pin cushion, and being the guy putting this Chinese chemical bullshit that people call bath salt, that crap, in my body, and having those full-on hallucinations.

And then here is Claudette. "What are you going to do different?" [My new counselor, Mike] would always tell me, "You have a lot more recovery than a lot of people in here, where this is their first go."

He would talk to me about the willingness, and I think that was the issue. The willingness to just take the direction, and actually do it. I always knew what I should do, but I wouldn't do it. I think we all intuitively, even someone just trying this for the first time, know what they need to do."

Timmy's clean date is April 1st, 2016. As he says, "Now, I'm 35 years old, and I'm learning how to live. I guess you are never too young, never too old. Sometimes, you're just right."

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