I had said that I wasn't planning on posting anything more from my 'book' writings on here, but after having a handful of friends telling me they wanted to see my writing on here as I go along (if it even becomes a book, see last blog entry)....I have decided to go ahead and put it on here. Who knows, maybe you guys can help give me feedback and direction with it...see something I'm missing at the moment. I'm really unhappy with this particular piece not flowing well and sounding boring, but here it is nonetheless.
I had no idea what I was in for with my new role as 'substance abuse counselor.' I must sound like a broken record, but I can't emphasize this enough. How could I comprehend a title I knew little about to begin with?
Waking up at 4:00am to start my day was an arduous adjustment, in and of itself....especially since I had always been a night owl. Thus began the period of my life of chronic sleep deprivation and mass consumption of coffee (my own growing addiction). While I appeared calm and collect on the outside, I became more guarded, vigilant on the inside of my mind.....with everything that had to do with the job. Just the thought of having to travel around 5am in the dead calm of morning with random strangers brushing past me on the sidewalks, or the possibility of being confronted by a dangerous criminal on the sparsely filled train car was enough to raise my anxiety level. It took me months to get to a comfort level of fearlessness on my commute. Even still, I exercised acute awareness and precaution as I walked down desolate streets.
Six days a week, this feeling spilled over into my work hours. Unarming a security system in order to walk through the door to my workplace was standard operating procedure, a mere tip of the proverbial iceberg. Constant alert was necessary. I imagine it's somewhat akin to what it must be like to live on the streets. You can never truly relax, because if you do....that's all she wrote. Street smarts (aka 'common sense') is absolutely essential. More about this later.
As I said, the first two weeks were spent at the downtown office. I became acquainted with two other fellow colleagues, who would be joining me at the new clinic we would be 'opening' together. M. (the office manager) and A. (the nurse) had worked together at another methadone clinic that had been shut down due to financial reasons, so in essence I was the only one who was totally new to this experience. I instantly took a liking to M. the moment I met her, a kind woman with a warm personality. She was instrumental in helping me through the most stressful and scariest of times, a pseudo-counselor in her own way.
First things first....building up an existing caseload of clientele that had transferred from the clinic where M. and A. had worked, in addition to juggling and learning the ropes of daily operations. I was literally learning everything from scratch. M. and I became engrossed in learning how to use the computer program, as there were 40-50 clients whose information we would need to put into the system. We tried to coordinate the transition as smoothly as possible. This entailed knowing ahead of time when to expect a particular client to come in to be 'dosed' and/or receive their 'pickups' in work lingo.
A client's frequency in coming to the clinic was dependent on different factors, according to length of treatment and 'proof' of consistent sobriety.
New clients require the most intensive level for obvious reasons: they are at highest risk of continuing drug use and need constant monitoring, guidance, support, and behavior modification. A majority of addicts get high for years. The longer they have been addicted, the longer the recovery process. One must have a minimum of at least one year of heroin dependence to be considered for methadone treatment, though as I have mentioned a large percentage have been doing it for years. Trying to help someone get clean and change their overall well-being can be as exhausting as parenting a young child or teenager. Every client is different. There is no 'one size fits all' treatment approach. Try telling the clients this when they don't get what they want though!
Due to the highly addictive properties of heroin, many addicts choose methadone as a supportive 'tool' as a part of their overall recovery process. By this, I mean they cannot stop using heroin cold turkey (whether for mental or physiological reasons) without medication to ease them into sobriety. The only somewhat close analogy I can make to this is what the nicotine patch does for a smoker. For some people, quitting is impossible without the assistance of a patch to gradually decrease the amount of nicotine absorbed in the body. The same can be true for heroin addicts. Cravings and withdrawal symptoms can be downright intolerable without medication to make the transition more comfortable.
While methadone can be effective if utilized properly, it is still a narcotic that is tightly regulated by the DEA and in turn, the clinic staff that oversees methadone related procedures. It entails just about every aspect of the job....bringing in new clients, collecting urine specimens, and strict guidelines on how much methadone a client is allowed to have in his/her possession outside the confines of the clinic. Safety is also a top priority, methadone kept under lock and key by the nurse. As the counselor, I only had access to the security code at the front door. The nurse only had access to the nursing station security alarm, for obvious safety measures.
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