They call her Nicky.

Her real name is Nicole, but everyone calls her Nicky. I want to tell you her story. She comes from New Jersey, but the family also has a Palm Beach estate where they spend a fair amount of time. Her family brought her to my office, and in that first appointment I spoke with all of them together to gather as much background as possible. She was 24, the baby of the family, with a brother named Vinnie and sister named Sasha. Nicky and her sister Sasha took after their mother; they were all beautiful, with dark hair, light eyes, and tan skin, but Nicky had a more striking exotic appearance that was unique among the three of them. The family is Italian, very wealthy, with the father owning several large car dealerships and car washes all over the place in Jersey. Nicky’s siblings Vinnie and Sasha both work for their father. He runs dealerships while she manages human resources. And then, there is Nicky. Nicky had her share of issues, but not everything was her fault. She came from a home where her mother stayed home with the kids, doing everything for them, while her father worked a lot and wasn’t home much. When he was home, he was drinking wine. Her mom also drank wine. Nicky had few memories of either parent without a wine glass in hand. They were alcoholics, but wine was where it began and ended for them, and it didn’t seem to be an obvious source of family strife. Her brother Vinnie was a bit of a partier, drinking more than he should and smoking marijuana, but he showed up at work everyday and did a great job running his assigned dealerships and making big profits for the family business. Her sister Sasha was an exercise fanatic; she worked out every day, and was in great shape. And then, there was Nicky.  

Now, you’re reading a story written by a psychiatrist who works with a lot of patients with addiction, so you probably know where this is going, but I’d like you to go on the ride anyway. Based on information I gathered from speaking with her parents and siblings, and of course Nicky herself, I learned that Nicky was an extremely precocious kid, both physically and in mind set and attitude. The journey that brought her to where she was now seemed to begin when she was 10 years old. Nicky at 10 was already obsessed with herself. She was into internet porn and pay-for-play live camera peep shows. She was fascinated by those and the people in them, and even thought the live camera show was something she could set up and operate for herself. She never even considered the thought that her very young age should stand in the way of her doing something she wanted to do, so she didn’t let it. She was also very preoccupied with social media, always posting inappropriate pictures and cyber-courting older men with provocative messages. She would get tons of likes and messages and friend requests, and she revelled in the attention, needing it as the very oxygen she breathed. Her mother showed me pictures of Nicky circa age 10, and I was somewhat disturbed by what I saw. The 10 year old in the picture was striking. Nicky certainly didn’t look 10….she looked closer to 15 or 16. Her hair was the blackest black, her green eyes were impossibly bright, and her skin was tanned. She had the kind of looks that could cause unwanted attention for any female, much less one that was only 10 years old. But then again, I knew that the attention she got was not unwanted…it was by design. 

As Nicky got older, her behavior and habits only got more concerning. In a picture taken of her at age 12, she absolutely looked over 18. As a result, she was able to buy cigarettes, so at 12 she started smoking on a daily basis. She was also drinking on weekends, courtesy of the creepy dude that worked at the liquor store….he wanted her and she knew it, so she did whatever with him, and in return, he let her buy booze and beer. In doing so, he also reinforced her notion that she could use her looks to get things in life that she wanted, a tactic that would serve her purposes well and often in the coming years. 

By 13, she expanded her repertoire by picking up marijuana and drinking more frequently, almost on a daily basis. She had no use for her very expensive private Catholic school. There is no question in my mind that she had undiagnosed attention deficit disorder. When she went to classes, she could not sit still. She was always hyper. At 13, she had a habit of smoking in the school bathrooms because she said it helped her to calm down. She was always getting in trouble, always acting out in her classes. Her parents were constantly getting called to school because she was impulsive, talking out of turn, always causing trouble, disturbing her classmates, and acting sexually provocative. 

At ages 14 and 15, she was still skipping classes to hang out with the wrong crowd, drinking every day and smoking marijuana. She was honing the art of how to exploit her own sexuality for her benefit and became even more impulsive, especially with spending money. She was spoiled, and had several of her father’s credit cards. She put these to good use, ordering thousands of dollars of merchandise online, whatever her heart desired. As she maxed out all of the cards, her father would pay them down and she would be back in the saddle again. 

By 16, she graduated to having sex on a regular basis. I’m not certain, but I strongly suspect that she was turning tricks for money. I hate to say these things of a 16 year old, but she was dressing far too provocatively; a lot like a prostitute, and she was acted like a prostitute, hitching her hip, smiling and waving at men in cars. What came to mind was, ‘if it looks like a duck and walks like a duck….’ Anyway, at this point, she would easily pass for 21, so her weekends and many weeknights as well were spent smoking marijuana and getting drunk in a dark and nasty local bar. One night, another bar fly introduced her to cocaine, and taught her how to line it up and snort it. And suprise suprise, she liked it. 

Her 17th year looked a lot like the one before, just with more of everything. She was now smoking cigarettes and marijuana every day, drinking every day, and snorting cocaine on weekends. She wasn’t hiding things as well at this point, and was barely passing her classes at school. But private schools are in business to make money, and evidently they were fine with keeping her barely passing….as long as daddy wrote them a check each semester. 

Once again, Nicky’s 18th year was a lot like the one before, with regular abuse of alcohol, marijuana, and cocaine. The big news was that Nicky somehow managed to graduate from high school, despite almost never going to class in her senior year. It was a Catholic school, so I guess her graduating could’ve been considered a miracle. More likely her father made a substantial “donation” for Nicky to walk across that stage to get her diploma. After graduating, she decided she wanted a change, so she moved into her family’s Palm Beach house. She supposedly had decided that she was going to get her act together and take some college courses at a nearby university. At least that’s what she told her father. Apparently she was convincing, and he gave his blessing, along with one of his credit cards and his first support check for $4,000.00. They had made a deal that he would send her that check every month, as long as she was getting her crap together. It was a pretty sweet offer, especially since she’d also have his credit card. That meant that his monthly check for $4 grand was pretty much gravy. A lot of gravy. And when she arrived at the Palm Beach house, guess what awaited in the driveway. A brand new car! She was spoiled, but that wasn’t really her fault. It was just the way her folks rolled. And surprise suprise, she liked it. 

She had time and money on her hands and wasn’t really working to get her life together, though she gave her father glowing narratives on how well she was doing. In reality, she had found a source for cocaine and marijuana and was still drinking all the time. She started dating a guy of like mind and similar habits and he introduced her to his friends. At a party shortly thereafter, somebody gave her some 10mg oxycodone tablets, Percocet, aka percs and told her to take two, so she did. And surprise suprise, she liked it. 

In no time, she was taking 4 to 5 percs a day, then after a month, 8 to 10 a day. She was spending a lot of cash buying as many as she could from the original guy that gave them to her as well as other drug-using acquaintances. One day while driving high, she wrecked her new BMW and was taken by ambulance to the hospital. She wasn’t seriously injured, but she complained of pain and flirted with the ER doc and managed to get a scrip for 60 percs. That lasted her all of about 5 days. Now she had an opiate habit, she was totally addicted to the percs. But then it became impossible to get scrips because Florida shut down pill-peddling docs and adopted super strict opiate guidelines. Nicky was out of choices. She talked to her friends and various contacts and hooked up with another opiate addict that was in the same boat. Unfortunately, his solution to his inability to supply his opiate pill addiction was to do heroin. **Please see the comment on this subject at the end of this blog.** 

Now back to Nicky. She was then officially introduced to heroin….how to buy it, the amount it takes to get high, its price, how to snort it, how to cook it, how to load a syringe and shoot it, the whole nine yards. And suprise suprise, she liked it. 

Nicky had only been in Florida for about four months. Her father had replaced the car she had wrecked and had it delivered. She wasn’t working or going to school, but she was drinking, smoking cigarettes and marijuana like a chimney and doing coke everyday. She was also thoroughly hooked on heroin, buying and using at least 10 bags a day. And her appetite for heroin was only growing with each passing week. 

It wasn’t long before her father’s $4,000 a month wasn’t sufficient to cover the cost of her booze at the bars, her 2 packs of cigarettes a day, marijuana, cocaine, and the newest addition, heroin. After only two months of using the heroin, she was doing tricks on the street to get more money, because the cost of her various addictions exceeded the $4,000 check her father sent every month. But that didn’t stop her. She just used more. And the more she used, the more she wanted to use, then the more she needed to use. She was up to 15 to 20 bags a day now. So, she was having to prostitute on the side even more frequently to get the money to support her ever-growing habits. She had also had a drug using friend move in with her in exchange for $750 a month, which she always used promptly after getting it. Then one Friday night after finishing with her “clients,” Nicky pointed her car toward home. It was about 3am, and the roads were quiet; traffic was mostly drunks recently kicked out of the bars. And wouldn’t you know it? Boom! Crash! She wrecked the car. She gave a story centering on a drunk guy and it was all his fault, not hers, yada yada. Thankfully, she wasn’t injured. But the car was toast.

She took a cab home and joined her roommate in snorting some heroin. She felt kind of wired, so she may have used a little more than usual. That little more was evidently too much, and she overdosed for the first time. Thankfully, her roommate was there and called 911. At the hospital, she was treated terribly. It was basically like ‘hey, you’re an addict and you overdosed. It’s your fault, so get out of our ER’ and she was discharged very quickly. Unfortunately, the overdose didn’t stop her. She didn’t even consider stepping down on, or getting off of anything she was using.

Nicky said her life at that time was a drug induced blur, reduced to a cycle of drinking, hooking, snorting, smoking, repeat. Before long, she had overdosed twice more and totalled her second and third new cars sent by her father. For the life of me, I cannot understand his thought process, what he was thinking when he kept sending new vehicles to Nicky like lambs to the slaughter.   

So, now, we are into this odyssey for about 14 months or so, these episodes of using, prostituting, crashing her car, overdosing. She was losing weight and started looking a little haggard, worse for wear. Still, she brought guys home from her hangout bar and they paid $300 to $500 for the pleasure. There was one guy that hung out at the bar named Jimmy, and she’d forged just a friendship with him, no business involved. He really had a front row seat to Nicky’s decline and truly wanted to help her. He knew of my practice vis a vis his friend that was a patient, and he begged her to see me. He was pleased when after only a couple of days she agreed. 

He brought her into my office and he said “Doc, please, you’ve got to help get her off all this stuff.” After learning that “this stuff” was alcohol, marijuana, cocaine and heroin, I knew we were going to have an uphill battle, but Nicky was willing to try, and Jimmy was willing to help. I explained that we had to detox her, because she had a $300 a day heroin habit, which was most likely laced with fentanyl. I continued to explain that she had to be off of the heroin for 24 hours before we could start the detox drug, buprenorphine. I could see that both of them were about to freak out, but I assured them that I would give him several prescriptions to dose her with. My plan was to basically knock her out to get her to sleep for most or all of those 24 hours. I gave him scrips for clonidine 0.1mg to give every 3-4 hours, quetiapine 50mg every 4 hours, mirtazapine 30mg every 12 hours, phenergan 25mg every four hours so she doesn’t throw up all these meds, and lorazepam to throw in there every hour if she’s not sleeping and for withdrawl symptoms. I figured the whole combo would knock out a moose, so she should be okay. I gave him my cell number and asked him to call me every four hours and whenever with any questions. I told him to make sure she hydrates and eats, and that I want her zonked out so that she won’t run and use. That was my concern. I explained that the first 24 hours would be the hardest, but that once that’s over, you take the buprenorphine and everything starts to improve. But I also again explained and reiterated not to take the buprenorphine until after the 24 hours. That if it’s taken sooner, it will throw you into an immediate and horrifying withdrawl. Everybody seemed to understand so I sent them to her house to start the process with Jimmy taking care of her. 

Nicky made it through the 24 hours, and she got on the buprenorphine.  She took one, then a couple hours later, another; then three to four hours later, she took a third; then three hours later, a fourth. And tah-daaaaah! She was completely clean of heroin. She still wasn’t happy, but I think that also coming off of cocaine, marijuana and alcohol at the same time was giving her a hard time. She continued with the buprenorphine the next day and the day after. On that third day, I saw her in the office. She had just barely started to clear cognitively, and that chaotic thinking, erratic behavior, and impulsiveness, it was starting to simmer down a bit, and she was just beginning to get real. She said that she didn’t want to be addicted to the buprenorphine. I always worry when newly detoxed patients want to go off the buprenorphine, because it may be a sign that they want to use, and they don’t want the buprenorphine to block the opiate so they can’t get high. I explained that it is not like heroin at all in terms of addiction potential. And I said that her life had been so unsettled since the age of 10, but especially in the last few years or so, her life was total chaos, fueled by drugs, heroin, cocaine, heavy alcohol use and marijuana. I told her she should just stay on the buprenorphine for a little while to stabilize her behavior and get into a healthy, clean and sober daily routine. Her neurotransmitters needed a vacation off of dope, and she would need time to see what life looks like when she isn’t gorked out of her mind, going without sleep for days on end. I told her that once we got her into a ritualized life where her behavior was more routine, then I would consider getting her off the buprenorphine. I convinced her to stay on it. I don’t do this with everyone. For people who only relapse for say a month, I would give them a week detox and they’d be fine. Maybe, if they got regular cravings over the next 10 days, I’d have them take a little of it here and there if needed. But with someone who has lived a chaotic lifestyle for nearly their whole lives and had been living a very heavily drug-addicted and dependant lifestyle for the past few years, there is no way I’d take them off right after detox. So, I followed Nicky for the next two or three months, and Jimmy was her strength and support; I don’t know that she could’ve come that far without him. She came for one visit in a month, then a second visit, but just before her third visit, Jimmy told me she was out and using again. She was back to the whole enchilada- heroin and coke and weed and booze and prostitution to help pay for them. Four months later, Jimmy brought her back in, just out of the big blue sky. We went through the whole detox shebang all over again. Unfortunately, this is not unusual. I got her back on the buprenorphine,16mg twice a day.  Again, I told her she had to stay on it to block the cravings and stabilize her lifestyle after the detox. 

On this second run, she followed up for six months, but then relapsed again, went out drinking, and that lead her back to the marijuana, heroin, coke, and prostitution. She was snorting heroin and she ended up overdosing. She was in the hospital for like five days, on a respirator for three of them, because she had aspiration pneumonia, which happens when you’re so gorked out that you puke up stomach contents and then inhale them into your lungs. It’s an easy way to die. She came back to my office about three weeks after she was discharged. She grudgingly said that the hospital stay was sort of beneficial because she obviously wasn’t doing any drugs while in there, but she also added that the doctors had told her that she had major lung damage and needed to quit smoking if she wanted to live to reach normal life expectancy. 

I think that this was the first time where Nicky saw that her behavior, her extreme drug and alcohol abuse, had serious physical consequences and repercussions. I told her point blank that if she wanted a life, it would have to be a clean and sober one. To this she just nodded. She went back on the buprenorphine once again; this time she would stay on it for two years. She started to build a normal life, and she wound up taking a job at a local dealership here owned by a friend of her father’s. She was actually very intelligent, very capable, and she did a good job for him, though she complained about the pay. I told her to keep the job regardless, at least for a couple of years while she was still settling her clean and sober life. At this point, she did not smoke, drink, take any illicit drugs, or prostitute. She kept the dealership job for two years, almost to the day. I started tapering her off of the buprenorphine, and at that point, I put her on something called modafinil for her attention deficit disorder and as a pre-emptive strike against the fatigue she would likely experience when I stopped the buprenorphine. As it turned out, she got so fatigued that she could not drag herself out of bed. Once on 200mg of the modafinil each day, her focus and energy improved a great deal. She was much more alert and active on the modafinil. 

Nicky moved back to New Jersey a while back, but I still see her in Facetime visits every month. She takes the modafinil everyday. She followed her brother and sister’s cue and now she’s working in one of her father’s car dealerships, and she’s training to become a manager. All in all, she seems to be doing well. She’s not dating because she thinks it’s too risky to go to the bars and such. She says she spends time with her “crazy, loud, obnoxious Italian family” her words, not mine. She eats a healthy diet, and goes to spin classes with her sister Sasha. She learned that she enjoys yoga, and practices it often. This is the part where I’d like to say that Nicky lives happily ever after, but unfortunately, I can’t right now. For the past several months, Nicky has told me that she goes through the motions of life, but she cannot enjoy life anymore. She said that after doing so many drugs, and so much of them, that she can’t be happy. Nothing lifts her spirits. I’ve tried antidepressants, and nothing seems to work. She feels like her life while drinking and drugging was so crazy, so chaotic, that now her sober life is so boring, monotonous, and mundane. And I can imagine that that’s true. She wasn’t just addicted to the drugs and alcohol, she was also addicted to the life and lifestyle that came along with them. In addition to our monthly Facetime visits, she also has a therapist she sees in New Jersey, but so far there has been no resolution to her problem with her boring life. After watching her struggle so hard to get clean and sober, it’s such a bummer when she tells me how she doesn’t enjoy life now. It’s kind of like when you were a kid and you could hardly wait to finish the whole box of cereal so you could get the prize they promised on the front of the box, only to find that they didn’t put one in your box….you got gypped. That’s how I feel about Nicky. She got gypped, and that sucks. But, she takes care of herself and keeps to her routine, dull as it may be to her. I’ll keep following her, and I think that with time, she’ll find a new normal and new happiness. That’s what I hope for Nicky. 

For more patient stories, check out my book, Tales from the Couch. It’s available in the office and on Amazon.com. 

**Comment from above

As most people know, this country is in the grip of an opiate crisis. Staggering numbers of people are dying of opiate overdose every day. Very often it’s from heroin, often laced with fentanyl. People that were addicted to pills found they couldn’t get pills anymore, so they started doing heroin. Please, if you are addicted to opiate pills, do not turn to heroin to replace the pills. And if you’re hooked on heroin, stop. Go to detox and get off of opiates entirely. I detox people all the time, and I assure you that with the medications I utilize, it is far safer and easier to do than you think.