by Paul Elam

Created on: March 28, 2009

Amy sat across from me in one of the two Queen Anns. She looked vacantly at the floor and her shoulders slumped downward, as if ready to collapse under the weight of a hard life. She used a pale finger to absently toy with a strand of hair that hung by her cheek and was silent save the sound of her breathing. She was the third of four assessments I would do that day. Clients came in waves in residential treatment and that day I was surfing.

I had read her intake notes, a page of dispassionate scrawls from the admissions nurse, and was already writing the psychosocial in my head before I asked her any questions.

22 year old white female, complaint of cocaine dependence. Patient admits to alcohol and poly-substance abuse since age 11. Began using intranasal powder cocaine 3 years ago and has been using I.V. intermittently for the past six months in amounts averaging from 1-2 grams daily while binging.

I didn't need the chart to tell me she had likely been supporting her habit with dancing or hooking or both. It came with the territory.

She was a pretty girl. Even with the dark bags under her eyes that looked like bruises against her wan skin, and the track marks in the soft tissue at the bend of each arm, she had a beauty that softened the ravages of her addiction.

She shivered, but remained silent. I went to a linen closet and got her a blanket. She wrapped herself in it without speaking.

I would get past the preliminaries with her as quickly as possible. Like all addicts, she had a story that went past her drug use. That story was my job. The rest, the drugs she used, how much and when and for how long was just the requirements for documentation; an insurance matter. But it was something that had to be attended to.

I wish I could tell you that my work is like breaking a great and mystical code; that it requires a combination of high intellect and finely honed skills. I can't though. One look at her and most people would have a pretty good idea what the story was. Something, somewhere in her life had caused her enough pain, enough trauma, that she would stick needles in her arm to keep from thinking about it. Something, likely someone, had robbed her of enough self worth that she could smile while crawling naked on a dirty floor, scraping up the money for her habit from a crowd of drunken lechers. The only trick was getting her to talk about it.

I would do that. I had my ways. But I still had no assurances it would help. Addictions have no memory. They move forward

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