By Alexa Epitropoulos | aepitropoulos@alextimes.com

A little more than a decade ago, Heidi Christiansen was leading what most would consider an ideal life in her hometown of New Orleans.

Christiansen, then in her early forties, was focused on raising her young son and transporting him to and from school and baseball games. She had a career, a home and lived in close proximity to her father.

Read Part 6: How the city is contending with justice in the midst of an opioid crisis

But she was also dealing with an ever-growing problem. Following three knee surgeries, Christiansen was taking oxycodone and Roxicodone, potent, habit-forming opioids, six times a day.

Life, though, was going on as usual for Christiansen – to the point where she stopped taking the medications she was prescribed when she wasn’t feeling pain. Three days later, she found herself in the emergency room.

“I was so sick I could barely raise my head,” Christiansen said. “As usual, they went through the list to narrow down what it is that you’re there for. ‘Have you eaten anything different? Have you taken any medications?’” “I said, ‘Well, no, but I’ve stopped taking a medication,’” she recalled. “They said, ‘You are now an addict. Welcome to the world of addiction.’”

Christiansen was given methadone, an opioid used both to treat pain and slowly wean opioid users off of other drugs. For her, though, being prescribed methadone only added
depth to her dependency.

“It does prevent you from going down the heroin route, it does allow you to be a productive member of society,” Christiansen said.

“But if you ever do not have it, the withdrawal and the pain from that is worse than you can probably imagine.

People will do anything as an addict to not feel it.” Christiansen, who is
now in recovery as a resident at transitional housing nonprofit Friends of Guest House in Alexandria, is quick to point out her story is not an uncommon one – and national statistics reflect that. About 2 million people in the U.S. had a substance use disorder involving prescription pain relievers in 2015, according to the American Society of Addiction Medicine, and of the 52,404 lethal drug overdoses in 2015, more than 38
percent — 20,101 — were related to prescription pain pills.

Opioid addictions are on the upswing in nearly every population, with women a particularly hard-hit demographic.

Women are more likely to have chronic pain, be prescribed pain pills and use them for a longer time period than men, according to the Centers for Disease Control & Prevention.
Though men are still more likely to die from opioid overdoses than women, women have experienced staggering increases in opioid-related deaths. Between 1999 and 2010, there
was a 400 percent increase in opioid overdose deaths by women, as compared to a 265 percent increase among men, according to the CDC.

The descent into prescription opioid abuse is often gradual and it can lead to dangerous, if not deadly, consequences.

Descent into addiction

Emma Tyrrell, a resident at Friends of Guest House since Oct. 20, was raised by her grandmother and mother in the Washington D.C. area. She began looking for an outlet from a dysfunctional upbringing at a young age.

She was introduced to drugs in her adolescence, starting with marijuana at age 15 and PCP at 16. She was 17 when a boyfriend introduced her to cocaine and, by 18, she was smoking crack cocaine daily.

“It was an escape – it felt good,” Tyrrell said.

Her drug abuse was interspersed with incarceration, which started with time in juvenile

prison at age 18. She went to prison as an adult for the first time when she was 20 for writing bad checks. When she was released from prison, the same problems she had always faced were still waiting for her.

“When I came home, I was really angry. Me and my mom never got along. She suffered from mental illness, so when I came back there, I couldn’t deal with it,” Tyrrell said. “I started using again because it’s all I knew.”

She had both of her sons, now 21 and 18, while she was in prison. And while that was difficult, Tyrrell said it also kept her sober for periods of time.

“It was hard for me, but, at the same time, I was grateful because I knew if I was out there, I probably would’ve been using.”

Throughout the following decades, Tyrrell was in and out of jail, serving time for charges like theft, which she would use to support her drug addiction. It wasn’t until a surgery at the age of 43, though, that she was introduced to opioids, including Percocet and Dilaudid.

That opened the door for Tyrrell, who soon transitioned from prescription pills to heroin. Her addiction, she said, only worsened from there.

“I’ve lost a lot of friends who have overdosed … I used heroin for a long time, for about three years, and it just got worse and worse and worse,” Tyrrell said.

“Heroin you have to have because you get sick [without it]. It’s the worst feeling I’ve ever felt in my life.”

Christiansen followed a similar path to heroin abuse.

‘Equal opportunity destroyer’

Christiansen had been on prescription pills for six years before being introduced to heroin at age 47.

It started when she moved from Louisiana to the D.C. area to help care for a family friend. Suddenly, her pipeline to prescription pills evaporated. She was subsequently introduced to heroin, which led to her injecting heroin intravenously several times a day.

“The heroin dealer doesn’t say, ‘Oh, you’ve had 90 this month, you can’t have any more,’ like a doctor does,” Christiansen said. “There is no management of it.”

At one point, Christiansen overdosed and was revived by a fellow user.

“Heroin is such a powerful drug that, instead of saying, ‘I never want to do this again,’ the first thing that comes out of your mouth is, ‘Let’s get some more of that,’” she said. “I don’t know a drug in the world that can put you out and that, when you wake up, you want to get more or when people around you find out that it put you out, they want to go get it.”

Christiansen’s heroin abuse also led to crime that fed her habit.

“It’s not so much that addiction leads you to these criminal behaviors, but the fear of being ill leads you to these criminal behaviors because no opioid addict wants to withdraw – no one willingly does that to themselves,” she said.

“Once you’ve exhausted your own resources in obtaining whatever opiates that you’re currently on, whether it be pain pills or heroin, you’re going to go outside and begin criminal behaviors.”

Christiansen went down that route – and, though she’d only had traffic infractions on her record before the abuse began, she soon was sentenced to 17 months for her third possession charge, grand larcenies and probation violations.

It’s a turn of events Christiansen couldn’t have imagined just a few years earlier.

“Addiction has no concern for where you come from or what you do or what means you may have come from,” Christiansen said. “Addiction is an equal opportunity destroyer.”

Road to recovery

Tyrrell and Christiansen are both in the midst of the first stage of Friends of Guest House’s rehabilitation plan: a 6-month residential program.

The nonprofit, which has focused on rehabilitating nonviolent female offenders since 1974, offers an 18-month program, which includes a year of aftercare, to its participants. Though the nonprofit is not limited to helping those who were incarcerated for drug-related crimes, many program participants have come from a background of addiction, according to Friends of Guest House Executive Director Kari Galloway.

“We only work with nonviolent offenders, so the majority of people may have a drug crime or possession or distribution or something related to that,” Galloway said. “The majority have some kind of addiction and a lot of crimes are tied to money for that addiction.”

Friends of Guest House and Galloway are focused on digging deep with residents and finding the root cause of their drug abuse. That’s a major reason for the success of the program. While about 70 percent of released offenders in the U.S. reoffend, fewer than 10 percent of Friends of Guest House’s graduates reoffend, according to the nonprofit’s own estimations.

“People have this perception that anyone that engages in the practice of taking drugs is using it as a recreational pursuit. We all have choices, right? That’s not been my experience at all,” Galloway said.

“The majority of the people we see here … This is not recreation, this is medication for trauma, abuse, neglect, despair, mental health issues, depression, bipolar disorder, schizophrenia,” Galloway continued. “We’ve got untreated mental health issues, we’ve got untreated trauma and people are doing what people do – they medicate so they don’t feel the pain.”

Galloway has seen many similar stories to Christiansen’s and Tyrrell’s over the years.

“I can tell you a lot of people who have switched to heroin have started on prescription drugs and, when the prescription ran out and they were already addicted, because we’re talking about addictive personalities and people who have a low threshold for pain and different things, they were already hooked,” Galloway said. “It was cheaper and easier for them to get heroin on the streets than to continue on opioids that they were getting prescribed.”

Once an opioid or heroin user comes out of jail, they’re at an even higher risk.

“The population is hugely at risk if they’ve had an opioid problem in the past and they’ve been abstinent in jail or prison and they come out. The tendency is to dose at the same rate as maybe you did when you went in, but your body can’t handle it,” Galloway said.

A support network like Friends of Guest House – one of the only programs in the commonwealth that offers an all-encompassing residential and aftercare program for former offenders – can make a difference, according to Galloway, Tyrrell and Christiansen.

“It’s not rocket science – it’s about getting real about stuff and actually asking people, ‘Why do you keep trying to kill yourself like that?’ That’s basically what’s happening. They’re trying to kill themselves,” Galloway said.

“In some cases, they’re succeeding because there are things out there that they don’t know,” Galloway said. “And they don’t care because they’re so desperate for relief from their pain and anxiety that they’re willing to take the risk – and that’s so tragic.”

Breakthrough

Emma Tyrrell was serving two years in prison in Prince William County when she realized that something had to change.

“I had time to really do something … When I was in there, I was thinking, ‘What do I need to do? I can’t get out and go back into the situations I was in because if I do, I know I’m going to get high,’” Tyrrell said.

A fellow inmate told her about Friends of Guest House and the idea stuck with her. She wasn’t committed by a court to go through the program, and that was significant for her – it’s a decision she made herself.

“For me to want to do something and not be forced to do it is a big change for me,” she said. “I don’t have to be here, but I choose to be here and that’s the big difference. I’ve always been made to do something – and when I’m made to do it, I don’t do it.”

Tyrrell’s breakthrough moment had a lot to do with her sons, as well as the point she was at in life.

“I’m not young anymore. I’m older now. I have to grow up. I have kids that need me and I can’t be selfish anymore,” Tyrrell said. “I was tired.”

Since her October arrival at Friends of Guest House, Tyrrell has been working toward recovery. She has a job, attends Narcotics Anonymous meetings and meets with a psychiatrist.

She wants to volunteer, particularly with helping the homeless. She’s also seeing her sons, who live in nearby Fairfax County, on a frequent basis.

“My passion is to show my kids I can do it and honestly, I feel that I deserve it now,” Tyrrell said. “… I deserve it to myself to be the woman which I know I can be.”

When she looks toward the future, she hopes to be independent.

“I would like to continue to work, to have a career – not just a job. I want my own place; something with my name on it … I’ve been so dependent on men. I’ve never had a car in my name. I’ve never had a house in my name. I’ve always depended on somebody else. It’s time for me to be independent and I want a home – I don’t care if it’s just a one bedroom or a studio. I want it to be mine,” Tyrrell said.

She also wants to see her sons live their dreams.

“I want them to become great men. My oldest son made mistakes, but he’s a good boy and when he comes home, he’s going to culinary school. He loves to cook,” Tyrrell said. “My younger son, they’re trying to recruit him. Who knows? He might be a famous basketball or football player.”

“They have dreams, but their main dream is for their mom to get better and for us all to be together,” Tyrrell said.

As for Christiansen, she’s also looking forward to rebuilding relationships with family, including her father and her son, who is now 22.

“It’s a process – the shame and guilt of your addiction and your behaviors during your addiction, oftentimes, without help, will prevent you from rebuilding your life and keep
you in a cycle of addiction,” Christiansen said. “You are so ashamed of yourself and you feel so worthless that, without a program of support, I have very little hope that anyone will succeed.”

When she thinks about her relationship with her son, she reflects on a talk she had with him almost a decade ago.

“I can’t imagine what it must have been like for my son. I can recall having a conversation with him at one point. He was 15. I said, ‘You know I love you — no matter what anybody tells you – I love you more than drugs, right?’” Christiansen recalled. “He said,
‘Mom, I know you love me more than you love drugs – what I don’t know is do you hate you more than you love me?’”

Christiansen is delving deep into what made her abuse drugs – and finding out ways to move forward.

“You have to start all over again. Things you learned in life, you have to relearn. Some things you learned you have to unlearn. It’s very scary,” Christiansen said. “You have to be very brave to face yourself … to give yourself permission to let go.”

Christiansen has an additional motivation to stay sober: In February, she’ll welcome her first grandchild.

“I want to graduate from this program and go to aftercare. I want to be a good
grandmother and be an active part of my grandchild and my son’s life again,” she said. “I want to be a supportive and loving daughter to my father in his elder years. I want to pursue my writing. I’ve always been a writer. That’s cathartic for me. And I want to try to get published.”

She wants those at the crossroads of breakthrough and recovery to remember something.

“You’re not alone – you’re not the only one that’s ever gone through this. Reach out and grab somebody’s hand,” Christiansen said. “… There are people who will, with a phone call, sit with you and help you through this. Don’t be scared. Don’t be afraid. You’re filled with hopeless[ness] at that point, but reaching out will give you that hope.”