Ilse Pauw is a holder of the Carter fellowship for mental health journalism from the Carter Center in Atlanta. This is part of her series of articles.
Sam (35) remembers the day her addiction started. While travelling on a school bus at the age of 13, she got horribly drunk on cough mixture and alcohol. Little did she know that this would be the start of a 20-year downward spiral of abuse and self-destruction.
She continued to drink episodically during her school years. By the age of 16 she was also smoking cigarettes and marijuana and taking speed.
For Sam, drugging was not so much about seeking pleasure as it was about escaping her unhappy family life. Her father was an alcoholic who abused Sam and her brother physically during his drunken rages.
"I don't think anyone believes the severity of the pain I felt due to the abuse. Drugs and alcohol helped me to numb that pain," says Sam. "My brother and I responded differently. He withdrew. I, on the other hand, provoked my father. I was the one who deserved the beatings because I acted out. It became a vicious cycle: I would rebel and then suffer the consequences, I would hate my parents and myself even further, and this would trigger more destructive behaviour in myself."
When she was 14, her father witnessed her first kiss. "He was furious. He called me a whore (amongst other things) and then wouldn't speak to me for a week. This fed into the addictive side of me, into the lower self-worth: being cheap and loose and nasty and revolting."
Her mother never intervened. Sam experienced her as distant, cold, detached and over-controlling.
"She was very scared of losing control. She controlled everything - us, her feelings, the household. She was compulsive about neatness and wouldn't express her core emotions. It was probably a reaction to her mother's addiction to tablets and to my father who was often way out of control.
"We were never allowed to take any medication. No matter how sick we were, we were not easily taken to the doctor and still had to go to school. I remember feeling confused and very resentful about that. I always felt she didn't love me and that she had no compassion."
Struggle with life
"I was in an emotional rage and wrapped up in a wild struggle with life, my family and myself. I had unleashed a little addict within me without realising what was happening and without any coping skills to deal with it. But I do remember feeling out of control and knowing something wasn't 'normal'; I just didn't know what it was or how to deal with myself."
When she was 16, Sam told her mother how she felt and asked to be taken to a psychologist. Her mother refused, saying that something had to be really wrong to warrant such a visit. She also said that she was worried about what others might think and said that a family of their social standing did not need psychiatric help.
Soon after this discussion, Sam started smoking marijuana. She felt that this calmed her and seemed to be a solution to all her problems.
At school, she became one of the "bad girls" and was the risk-taker in this group. Her grades dropped, she often missed school, and lied to her parents and teachers about her whereabouts and her substance use.
"I felt proud that I could get away with things, even taking wine to school. I attended a catholic school run by old nuns who never noticed that I got drunk. I managed to fly under the radar and did just well enough to pass.
"That is where the real manipulation in the addict's personality starts weaving its way inside your life. You start pushing more and more boundaries, you learn how to wheel and deal."
Sam moved out of home after matric and had even greater freedom to go partying and stay out late. During this time, she was involved in several relationships and experimented with LSD and cocaine. An abusive relationship forced her to move back home.
"Because I hated my father so much, this was the very last place I wanted to be. The first opportunity I had, I latched onto this 40-year-old man who lived in a mansion and drove expensive cars. The lifestyle appealed to me and it was my ticket out of home. It was also my introduction to freebase cocaine. One hit on the pipe and I was addicted."
Sam smoked cocaine all day, every day. She never left her boyfriend’s house for six months. Her family became concerned when she continued to miss family appointments and when her behaviour became increasingly unpredictable and impulsive. They were scared that she was going to die.
Her aunt eventually managed to gain access to the house and convinced her to leave.
"The drugs were so strong and powerful that when my mother came to fetch me, I opened the car door at 120 km/hour and was prepared to jump. It was easier for me to jump than to leave the drugs behind."
She spent two weeks in a treatment centre but returned to her boyfriend straight afterwards.
"I became so thin and drugged up that one of the guys who lived in his house asked my parents to fetch me. He was worried that I might die in the crack house – it became too risky for them."
At her parents' house, her health improved and she started a small business. But she never considered quitting everything and continued to use marijuana, alcohol and occasionally other drugs. She believed that she was in control as long as she avoided crack or cocaine.
Things changed for the worse when she met a drug dealer and moved to Amsterdam where she went back to using cocaine and party drugs.
"He was very wealthy and I was attracted to the lifestyle, the VIP club lists and jetsetting. I didn't realise what I was getting myself into - it all seemed like fun and games and I thought that all young adults aspired to this lifestyle. I had a false sense of popularity and it was great having a crowd of people around me. Now I know they were only after the drugs.
"I still believed I was in control as long as I never took something hectic. But then I decided to try heroin. That is when I found my euphoria. It felt peaceful, calm, warm, fab. That ultimately became my drug of choice for almost 10 years. I sometimes used heroin on its own, sometimes I mixed it with cocaine."
Fooling men and myself
On her return to South Africa, her drug use continued and she became involved in several relationships.
"I was attracted to glamorous, powerful, wealthy men. I lived a luxurious life and didn't have to work. To cut to the chase: I was whoring myself actually. I didn't see myself that way though.
"They were all strong men who had control, which I didn't have myself. I allowed them to control me so that I didn't have to take responsibility for my own life and actions. I said to myself: I'm okay because I'm involved with a successful man.
"I was a chameleon. I camouflaged myself into the personality I had to become in order to hide the extent of my addiction. I would decide how much I would let them in. With one boyfriend I could get away with just snorting cocaine and would hide heroin. With another I could only smoke marijuana and had to hide heroin and cocaine."
"The lifestyle I led made my drugging okay. You see, addiction is a 'yet' disease. I'm not an addict because:
I've never stolen from my parents - yet
I've never been found with a needle stuck in my arm - yet
I've never ended up as a street worker in Green Point - yet
I've never been destitute - yet
I'm not a junkie - yet
"Problem is, addiction is a progressive disease, no matter what your background is and where you come from. I still classified myself as a classy addict. It is human nature to compare yourself with the worst: 'I'm not that bad, therefore I can carry on drugging'. I allowed my denial to convince me that it was still okay to use and to minimise the extent of my addiction. It doesn't matter what your drug of choice is, it is about losing control over your life."
Down and out
Sam refers to her addiction as a "vicious cycle of destruction into hell". The cycle included several bad experiences such as witnessing someone die of a drug overdose, shooting at someone, driving while psychotic and crashing cars, and becoming involved in drug smuggling.
Her physical health deteriorated during those years: she became emaciated and dehydrated, would go days without sleep, neglected her hygiene and developed several ailments. She describes herself as being a ghost in her own body.
"Heroin makes you delusional. I felt invincible and powerful and cool, and because it dilates your pupils, you think you look beautiful, just magnificent."
Sam gradually became so dependent on heroin that she couldn't get out of bed without having a hit. At the height of her addiction, she experienced tactile hallucinations of insects crawling under her skin and would scratch herself until she bled. She would then pour peroxide onto her wounds in order to disinfect them.
She met her husband six years ago. In a bid to make him fall in love with her, she went onto what she calls her "maintenance programme". This meant that she scaled down her drug-taking to the extent that she could continue with it, but at a level that allowed her to hide it sufficiently.
"Although he was already a recovering alcoholic at the time, he was ignorant about drugs and didn't have a clue what the signs were. He knew that I smoked marijuana but I hid the other drugs from him. When I used heroin, I told him that I had been taking Myprodol; when I used coke, I said it was Bioplus. I was a good little actress and got away with it."
She fell pregnant a year into the relationship and gave up all drugs except marijuana. Two months after her daughter was born, she was back to using cocaine and heroin.
A year later, things had deteriorated to the extent that she could no longer fool her husband.
"He forced me to go for rehab but it didn't work. I wasn't there for myself; I was there for everyone else. If you're not ready to change, you are not ready to hear. I bribed people on the outside to give me urine so that I could pass the urine tests. I think I even still used drugs inside.
"I refused to accept that I was powerless over my addiction, that I couldn't control it. I still believed that if I only smoked dope, I would be okay. I wouldn't accept that dope was my gateway drug. I wasn't prepared to surrender to the fact that I had a serious problem. Surrendering to my powerlessness would've meant that I was weak."
She was angry and resentful and blamed her husband and family for blowing things out of proportion, as she perceived it, and for being too controlling. The treatment centre recommended long-term treatment but she didn't go, neither did she get a Narcotics Anonymous (NA) sponsor nor go to meetings.
Relapse and recovery
Her relapse started with marijuana and alcohol. She was back on cocaine and heroin not long thereafter.
"I managed to justify my drug taking once again. I was a good-enough mother because my child had food, I didn't hurt her and there were enough people looking after her. The problem is that I was emotionally unavailable. There was no connection between us. I didn't know my child at all. I couldn't look after myself; I could definitely not look after her."
Sam became very distracted, stopped working and eventually struggled to function at all. Her life had become unmanageable.
Her mother called a social worker and threatened to have Sam committed to a state institution for a year if she didn't go for treatment. Her husband said that he would emigrate and take their child with him if she didn't go for help.
"Their threats scared me. I didn't want to be locked up and I didn't want to lose my child. I also knew that I couldn't face life with all its responsibilities on my own.
"I spent a month in an in-patient treatment centre. I hated it at first. But I knew that things had got so bad and desperate that something had to change. When things get so bad, you have one of three destinations to choose from: jail, institutions and the mortuary. I was told that I was already on the brink of death. I had too much of an ego to die - I didn't want my daughter to know that her mother died of an overdose, so I chose to fight to live.
"Treatment was very painful. I was in a dark hole but gradually saw a speck of light. That light grows bigger and brighter in rehab. I had to learn to accept that I'm an addict, that I have a disease and am powerless. I learnt that it isn't a weakness to accept it but rather a strength."
Sam entered a secondary care treatment programme afterwards and was an out patient for a year. She is still in therapy and has become an active member of NA.
It has been more than two years since she was at her lowest point. Now she studies psychology and hopes to become an addiction counsellor. She plays an active role in her child's life and is a member of the school's PTA.
Challenge of staying clean
"I have a lot of shame and guilt about what I got up to during those years. I also hurt many people. My marriage suffered - there was a lot of pain, resentment, anger, and many hurtful things were said and done. We've worked through them. We've come so far, so there is hope for my family and the future.
"My husband has been my rock and gave me the strength to start believing in myself. He had the faith in my potential to recover; he never gave up. Even when he threatened to leave the country he said that he knew that I would get my act together one day and find them.
"My daughter is my best teacher, my gift, my miracle child. Every day I look into her eyes, I realise what an amazing gift life is and how grateful I am that I was given the 100th opportunity to live.
"I still crave and would love to be able to have the odd joint on social occasions. But I've had to come to terms with where I'm at and understand that it is no longer an option for me. Now I have a choice, whereas in the past I had none - I had to use in order to survive. That was my dysfunctional thinking and the extent of my physical dependence. Today I choose not to use because I know the negative consequences far outweigh the positive consequences.
"It is sometimes difficult to face obstacles because I no longer have a crutch. But pain is the only way in which I grow. I now see problems as lessons. I don't want to be numb anymore. It is a gift to become aware and conscious.
"Recovery is about starting a new life, on all levels, including people you associate with. I surround myself with winners, with people who enhance my strengths and don't judge me and who enrich my life. I now have a new motto that I live by:
'Don't muck around with the turkeys, soar with the eagles'."
- Ilse Pauw, Health24 writer and clinical psychologist
Phone the South African Depression and Anxiety Group's toll-free substance abuse helpline: 0800 12 13 14 or SMS 32312.
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