part0023

Her long, straggly brown hair framed her pale, pockmarked face, but her eyes were piercing and unrelentless as 52-year-old Dana bluntly stated, “I’ve been doing crack for twenty-two years, and it’s a habit now. It is a hard and bad habit to break.„ Dr. Grant sat quietly and listened.

Clearly, the intensity of her drug use had transformed her identity and her life. With pressured speech, Dana stated, “That is just what I do … I am just an addict. This is the only thing I know how to do right now and do it right.„ For Dana, her need to get high often superseded all her other needs. “This is pretty well all I do, just finding drugs, running around every day doing that. I will do whatever I can to get drugs,„ she stated flatly. At least Dana was honest about the intensity of her cravings and how her drug use dominated her life, reflected Dr. Grant. But she remained at a loss about how to help Dana.

The next time Dana came to the clinic, Dr. Grant viewed her name with some degree of dread, yet it was mixed with delight – at least Dana had returned. So Dr. Grant tried to sit still and just listen to Dana. Her goal was to engage Dana, not judge her. But it was evident that Dana’s isolation due to her drug use contributed to feelings of loneliness.

With an outpouring of uncharacteristic emotion, Dana blurted, “It’s scary! Especially if you’re by yourself and there’s nobody around and you don’t know what to do. I am alone, lost, scared, frustrated. I feel like I am in a dark hole and I am never coming up.„ Dana’s eyes were wet with her tears, and her face revealed her deep anguish. “It’s not put me in a good place. It put me on the street, and I’m doing stuff I wouldn’t normally do if I was not using drugs.„

Dr. Grant was overwhelmed by Dana’s flood of emotion – this was the first time she had openly revealed the rawness of her feelings. Dana’s profound sense of vulnerability, fear and hopelessness were palpable. But Dr. Grant remained at a loss about how to help Dana.

For Dana, using drugs was both a way to escape from the harsh realities of her daily life on the street and to numb her physical and psychological pain. She frankly stated her grim reality: “You feel like you’re flying. Like you’re in a whole different world. You don’t care. You have no feelings. Everything just kind of escapes.„ Dana paused for a moment, then continued, “but you’re kind of lost. But still it is a band-aid to stop the pain.„ Although Dana had suffered intense physical, social and emotional consequences because of her drug use, she continued to use. How could Dr. Grant help her change this disastrous lifestyle – how could she help Dana?

Over many visits in the months that followed, slowly and with caution, Dana began to reveal her story. “For years I hid from people and didn’t answer my phone, didn’t answer my door because I was so paranoid. I was just really crazy. I was going insane in my head, ’cause of the drugs. That was how I lived my life. That is still how I live my life, and now I got no home! The stress of it all is getting to me. And you know, stress can play a huge role on your overall health. And it’s pretty stressful, this life.„ Dana’s face sunk into her chest.

Over time, as Dana began to trust Dr. Grant, she shared her many losses. They had been devastating and isolating. “I’ve lost a lot of friends, lost my job, lost my house … I’ve lost so much,„ she said. Her voice barely revealed her pain, yet her story expressed her internal anguish. The tragic and violent death of Dana’s daughter had precipitated decades of drug use: “I lost a little girl when she was ten. And I’ve been using ever since.„ The gravity of that trauma and the multitude of losses she had suffered were so overwhelming and painful for Dana that she had been unable to talk about it with her health care providers. “I just tell them I don’t want to talk about it. Which I don’t. It’s a part of my past,„ she solemnly expressed.

The desperation to get high overcame Dana’s shame at having to participate in the sex trade. She reluctantly shared with Dr. Grant, “I do it sometimes, but I don’t want to say much about that. There’s not really much I can say about it … I do it, and I don’t really enjoy doing it.„ When Dana had nowhere to sleep, she was often forced to do sexual favors for people in exchange for a roof over her head or use drugs all night to simply stay warm. As Dana explained to Dr. Grant, “Either I had to make money to pay somebody to sleep in their place, or I had to have sex so I could do drugs to stay awake because it’s so damn cold outside you have to stay high to stay warm. Man it’s a bitch!„ While Dana’s effect was flat, her body language revealed her frustration and pain with how her life had unfolded.

After several visits over many months, Dana quietly shared with Dr. Grant, “I had to figure you out first. I wasn’t able to trust you at first. And I had to trust you before I could open up to you. I knew I could trust you when you said to me, ‘Dana, I have all the time you need; I’ll just sit here and listen. You tell me what you can.’ If I couldn’t trust you, then I was saying nothing to you!„

With this tenuous bond of trust established, Dana cautiously considered and then accepted Dr. Grant’s suggestion of subsidized housing. It got Dana off the streets – although it was not a perfect solution, it was the first step.

“I AM JUST AN ADDICT – CAN I TRUST YOU? – CAN YOU TRUST ME?„ 61

Since being housed, Dana had not needed to work the streets. “And if I go out and do that, I choose to … I rarely do that anymore. I haven’t worked the street in over a year. I’m over it.„

Dana continued, “I’m more settled now. If I want to use, I know that I can take it home and I know that I can lock my door and the door only opens if I open it.„

For Dana, violence was less common in her life, as she didn’t have to rely on sex work. Having housing, a significant change in her distal context, had altered her life. “Violence was an everyday thing,„ she said. Sighing with relief, she added, “but not so much now because now I can just go to my room and shut the door.„ Her home provided protection from violence and alleviated the need for drugs to numb her pain.

Her pain was not yet over, but perhaps subsiding. Dr. Grant would remain at Dana’s side, encouraging each step towards her recovery; ever cognizant that at any moment the process could falter for a multitude of reasons. None the less, Dr. Grant would remain stalwart in her commitment to Dana. Dr. Grant’s first goal had been to engage Dana in the relationship – to ascertain her trust – now her long-term goal was to maintain the trust they had worked so hard to establish.