Guinevere Gets Sober

Recovery news, reviews and stories, by Jennifer Matesa.

Tag: methadone (page 1 of 2)

Community Is Expensive, Drugs Are Cheap

One magazine I sometimes read is More, whose content is designed to help women in midlife. This month they’ve got a long feature on how women with migraines are being deluged with painkillers.

The drugs are “transforming” the migraines from episodic to chronic daily headaches. I’d thought this was my own private anomaly. (This view is part of growing up in an alcoholic family: everything is “personal,” we don’t have anything in common with anyone else, and we Don’t Talk About It.) I’m sometimes forced to take triptans every day for weeks, and this is not good for me but I do it anyway. It’s a common problem for women.

The piece mentions a review of medical-insurance claims published in 2009 that found “almost 20 percent of the opioids prescribed in this country are dispensed to relieve the pain of migraines and headaches.”

But the source wasn’t cited. So I did a little checking and turned up the study, which appeared in the journal Pain (144:20-27). Psychiatrists at Washington University School of Medicine in St. Louis examined insurance claims for opioid painkillers, since self-reports of opioid use are pretty unreliable (we forget; we lie; etc.). They were looking at people who were “chronic” painkiller users (with more than 180 days of opioid use—which means I was a “chronic” user way back in 1999); “acute” users (less than 10 days), and non-users. Some startling results:

  • Chronic users made up only .65 percent—a tiny sector of the total population, but they used almost half of all the painkillers appearing in the claims
  • They had significantly more physical and psychiatric problems than people in the other two groups
  • Women made up more than 63 percent of the chronic users, and they used more of the medical services, especially as they got older
  • More than one-third of all the chronic users—and many more women than men—had mental health disorders.
  • Opioid abuse was twice as common among women than men, while men had twice the rate of alcohol problems.

Classic: We don’t have to drink, because we have our drugs! I can’t tell you how many women I’ve known who had this experience. I think of it as professionalizing our addictions. Being a drunk is low-class—Hurstwood crashed in the Bowery flophouse. But popping those pristine purple pills (which is the way I always remember OxyContin—like little amethysts) is moving it uptown.

And what do the drugs do for us emotionally? Do the scientists ever ask about the kinds of pain the drugs numb out?

Questions for a future interview.

The researchers are calling for pain programs to offer treatment not just for the “physical disease state” but also for the emotional problems that go with the appearance of chronic pain.

The way I hear this is, in order not just to cover up the symptoms but actually to heal, people in pain need other people to listen to us. We need community.

But healing the emotional problems is expensive. It’s a lot cheaper to give out drugs, even Prada drugs like OxyContin. Methadone and oxycodone (both of which I’ve taken; methadone is strong and cheap, I remember my shock when I bought 90 pills for five bucks) are a lot less expensive than the kind of help people might need to really heal. A study in the journal Headache (2010;50(7):1175-1193) last year found that in just six years between 1997 and 2003, U.S. methadone sales shot up by 824 percent, and oxycodone sales rose 660 percent. And this investigative story published in Salon and picked up by AlterNet the other day reported that the DEA has for the past 10 years been rubber-stamping gargantuan increases in production of opioid painkillers despite evidence of massive diversion from Florida to Maine and into the Ohio valley.

Insurers no longer want to pay for long-term treatments that involve patients talking to actual people (this story is trending in the New York Times today; there have been others talking about how psychiatrists only have time to give out drugs and can’t afford to listen to their clients).

It’s expensive to pay a real person.

From an interview with Gabor Maté that I’m going to run later on (stay tuned):

G: Do you think addicts can truly recover? You’re a proponent of harm-reduction for a certain percentage of addicts.

GM: The answer is absolutely yes. Precisely because we’re not isolated human beings. It very much depends on a supportive context. And if you talk to people who have made it, what was the one quality that was always there for them? Community.

The best solution is to build more community. Connection heals.

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Every Detox Fail You? Try the Thai Buddhist Detox

Thamkrabok Thai Buddhist monastery, where addicts and alcoholics get sober according to Buddhist teachings.

For those in search of them, there are detox and recovery choices other than the 12 steps and drug-maintenance. For example, the Beeb is reporting results from a UK nonprofit that show that 95 percent addicts who go to a Thai Buddhist monastery stay clean after treatment.

East-West Detox, a Berkshire nonprofit organization (or “charity” in British-speak), helps British people who want addiction treatment to go to Thamkrabok, a monastery about two hours’ drive north of Bangkok. After the charity’s National Health Service (NHS) funding was cut in 2007, they commissioned Queen’s University in Belfast and London’s Brunel University to study its effectiveness over the following three years.

The report, released recently, states that 95 percent of those who receive the four-week Thamkrabok treatment stay drug-free, compared with 38 percent of NHS patients in UK detox centers, and recommends the NHS reinstate funding, though the Berkshire NHS trust says it currently has no plans to do so.

Thamkrabok’s treatment involves drinking a secret herbal formula and then sticking a finger down the throat and forcing yourself to vomit. Addicts in treatment receive other herbal remedies—to help, for example, with sleep—and they’re taught to meditate, chant, and contribute to the work of the monastery. Those receiving treatment are asked to make a solemn vow, called a “sajja,” stating that they “really want to stop using drugs/alcohol” and that they’re attending of their own volition.

The Thamkrabok website itself says it “does not offer miracle cures” and cautions readers to take any success-rate claims with a grain of salt. However, it makes this claim for itself:

What can be said, without any doubt, is that ALL ex-addicts who keep their SAJJA—with honesty and integrity—remain 100 percent drug free.

One of the BBC pieces tells the story of Sarah, a former heroin addict and mother of a young child, who had been prescribed methadone and Subutex (buprenorphine) to help wean her off heroin, but she “just found herself stuck on them.” Since coming back from Thamkrabok in 2004, she has remained free of her addiction.

I also follow a blog by Paul Garrigan, an Irishman who got sober from alcoholism in 2006 at Thamkrabok. Check out his blog for more information about this Buddhist-oriented way of staying sober.

How To Detox From OxyContin And Other Opiates

OxyContin

OxyContin tabs in a candy-colored rainbow.

Dunno why, but I seem to have paid short shrift to sharing detox experience on this blog. Which is weird, because I’ve got so many stories about opiate detox and recovery.

Received an inquiry recently about how to detox.

What do you know about getting off of OxyContin?—the length of time it takes, how safe it is, and what could the consequences be of going off too quickly. Do you have any idea?

Yes, I have some idea. Thanks so much for asking.

First I must say that none of this is medical advice or a substitute for it. If you want medical advice, please consult a doctor.

From one addict to another. About the length of time it takes to get off OxyContin—this depends on a few factors:

  • The level of Oxy you’re taking. (It could be any other drug. Not to put too fine a point on it: with the exception of methadone, Suboxone and tramadol, an opiate is an opiate. Heroin is Oxy is morphine is Vicodin is dilaudid. Even fentanyl is pretty similar, though it’s fat-soluble. They’re all short-acting full-agonists—though their dosage equivalencies differ.) If you’re taking maybe up to 120mg of oxycodone, chances are you could taper just using Oxy, following some rules for tapering that are few but non-negotiable. If you’re on a level that’s a lot higher than that, you might need some help. However, only you can tell, right? You know your own limits. I’ve known people who have detoxed cold-turkey off 600-800mg Oxy.
  • The reasons you started taking pharma-grade painkillers in the first place. If you have pain, you’ll need to work on figuring out other ways of managing it. Many non-opiate treatments exist that may help, depending on the circumstances. It may take time, consultation with professionals, patience, and a process of trial and error.
  • Whether you’re taking the drug “as prescribed” (i.e., swallowing it whole), or “not as prescribed” (i.e., chewing/snorting/shooting). OxyContin is also a bit difficult to taper from because you can’t split them. So another factor is the strength of dose you have available to you. One of the cardinal rules of a taper is: swallow whole, on schedule. If you can’t take your proper dose of Oxy on time and swallow it whole (I mean what addict can?), then you may need the help of a reliable detox doctor. (Operative word here: reliable. How I chose my doctor: I called the most reputable rehab in town and asked if I could please pay them to run my outpatient detox. When they said No, I asked for the name of someone else who might do it. Then I called my primary care physician and asked for her top referral. When they turned out to be one and the same person, I knew I had my guy.)

Let me also mention that the person who asked today’s question apparently got the idea from this blog that Suboxone treatment was Not Good. I’d like to correct this impression: Suboxone can be a very effective tool if it’s used properly. I myself got off an enormous level of opioids using Suboxone and Subutex. The danger comes when vulnerable, fearful detoxing addicts are encouraged to stay on enormous doses indefinitely rather than to use it as they often want to use it—as a tool to claim their right to lower their chemical load.

Using Suboxone or another drug as a detox tool doesn’t necessarily mean we’ll be “substituting one drug for another.” I mean, in a sense we are, but only for a short period, and under a doctor’s guidance. This can mean all the difference between addiction and recovery. … When I was detoxing with Suboxone, I did not write the taper schedule, my doctor did. I had to visit him every week, and later every other week; I paid him $80 a crack, aside from what I paid the pharmacy for the weekly prescriptions, and it was worth every penny to get free. I keep the receipts for my detox doctor’s visits in the drawer of my nightstand. The equivalent of my parents burning their mortgage (which they did, literally).

The reason I chose to taper off drugs using Suboxone is that I was on such an enormous level—more than 100mcg/hr of fentanyl. I was prescribed one patch every two days, and because I did not always take them as prescribed, I used a bit more than that. Fentanyl is a crazy-strong drug, it’s what they give you when you go in for surgery, and this level is roughly equivalent to 400-600mg morphine or oxycodone per day. Somehow my lizard-brain knew it was going to be impossible for me to taper off that level of fentanyl, or get enough of another drug to equal that level so that I could taper. And anyhow, I’d never been able to taper off a full-agonist—a drug that plugs into the receptors and stimulates them fully, like heroin, oxycodone or morphine.

Read Dr. Scanlan’s interview about Suboxone: it has a long half-life, which means it doesn’t create as much of a buzz as the short-acting drugs like oxycodone. As long as you keep tapering, and you have a doctor willing to help you keep the taper short, you can get free with Suboxone.

How safe is detox?—Opiate detox is not life-threatening. In contrast to alcohol withdrawal and detox from benzodiazepines (Valium, Xanax, etc.), both of which can cause life-threatening seizures if done too quickly, detox from short-acting opiates can be done safely at home. A “cold-turkey” detox happens in two phases:

  • Acute detox, which lasts 10-14 days or so (depending on level of use), in which the body excretes the drug and, in doing so, experiences signs of active withdrawal such as runny nose and eyes, sneezing, goosebumps, shivering, loose bowels, and restless legs and arms (kicking). All this means the body is healing.
  • Post-acute withdrawal syndrome (PAWS), which lasts an indefinite period (depending on level of use and how well we take care of ourselves), in which the body’s opiate receptors heal and the body learns to produce endorphins again. Most people find exercise and good nutrition help a great deal, as does some kind of support plan.

I can hear some folks out there thinking, “I think I’m endorphin-deficient.” I love hearing people register this claim. I used to believe this about myself before I got on drugs like fentanyl. Then, after I got on drugs like fentanyl (and morphine, and OxyContin, and whatnot), I used to believe that I’d MADE my body permanently endorphin deficient, so I should just stay on the drugs forever. Addiction lizard-brain. … Today I lift weights and cycle 30 miles and play tennis. I do all this having been diagnosed with two painful neurological disorders. I’m not bragging here, I’m just saying: I’m NOT endorphin deficient. If I can get off this stuff, I think anyone can.

The consequences of going off “too quickly”?—There is no “too quickly,” imo. If one is addicted, the only dangers are not quickly enough, or not at all. However, if your level of use is high, and you have kids and a job and still want to function during detox (as I did), it might be worth it to slow the detox down. I’ve always compared detox to learning how to land a plane. Not that I’ve ever landed a plane. But I imagined being in the pilot’s seat, and taking direction from the tower (higher power/physician/recovery community, etc.), and telling the tower I needed either to make a quick-and-dirty landing or a long slow smooth landing.

You can do either one safely. The first takes a lot less time, but it might be a rougher ride. The second is much smoother, but there’s more time to worry about whether you’re gonna crash. Which is why it’s helpful to get support, not only from a doctor but also from a community of people who have been through similar stuff.

Detoxing was one of the best decisions I ever made. It was the start of a new life.

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Suboxone: Amazing Detox Tool, Monster Maintenance Drug.

An Expert Talks About Suboxone: Dr. Steven Scanlan of Palm Beach Outpatient Detox

Steven Scanlan M.D.

Steven Scanlan M.D., medical director of Palm Beach Outpatient Detox

Steven Scanlan, M.D. is board-certified in psychiatry and addiction medicine. In his practice, Palm Beach Outpatient Detox (PBOD), on the Florida coast, he has detoxed more than a thousand patients off many drugs, including alcohol, benzodiazepines (Valium, Xanax, etc.), and sleep aids. But his specialty is opiate detox.

Scanlan has been practicing as medical director of PBOD for about two years. His practice, he said, is located in an area where more than two-thirds of all oxycodone prescriptions in the nation are issued—the south Florida coast that has become notorious for its “pill mills.”

Scanlan said 70 percent of his patients come to him addicted to oxycodone at levels of about 300 to 600mg per day. About 20 percent also come in with alcohol problems. “The rest use Vicodin and Ultram,” and a few come in addicted to Fentanyl, he said.

And then there are the increasing numbers who come to him desperate to get off Suboxonea drug that combines buprenorphine, a synthetic partial-agonist opioid, with another drug to prevent abuse. Suboxone (commonly known as “Sub” by people with addiction) is used in opiate detox and maintenance, it’s known and “prison-heroin,” and it’s now commonly sold on the street.

Scanlan says he has seen Suboxone work brilliantly as a detox tool and dangerously as a maintenance drug.

I first heard Scanlan speak on a podcast that’s now defunct. Two reasons I was eager to talk to him:

1. Scanlan chose addiction medicine as a result of his own recovery from opiate addiction. He understands addiction from personal and professional experience. While training to become an anesthesiologist Scanlan became addicted to Fentanyl, a strong opioid used in surgical procedures and for severe pain. After trying many times to quit on his own, he found a physician who helped him detox over two weeks using Subutex—plain buprenorphine—and other medications to ease the detox symptoms. He joined a recovery program, then decided he was well equipped to help others suffering from the same problem. Many of his physician colleagues didn’t like working with addicted patients, but he found he did. In his practice, he doesn’t just dole out drugs; he gives patients 24/7 followup until they’re physically comfortable and involved in some kind of support program.

2. I wanted to hear his clear-cut ideas about detoxing off opiates. He only does detox. He never does maintenance. Unlike so many other scientists, who believe people addicted to opioids can never stay off them, he believes we can get free.

“Believe me—it’s much more lucrative to do maintenance, to keep patients on Suboxone,” he said, adding that it’s even more profitable than, for example, doing Botox injections. Hundreds of practitioners—some of them with no experience with addiction—prescribe Suboxone as a maintenance drug, keeping patients on it for years at high levels and charging exorbitant cash fees. But for the vast majority of addicted people, Scanlan does not believe drug-maintenance is appropriate—or even safe. Buprenorphine is such a new drug, he says, and its long-term effects have not been adequately observed and researched.

He has said that Suboxone may curb cravings for other opiates and allow people to stop stealing and get their lives in order. But the problem is that, after three months or so, patients have terrible difficulties quitting Suboxone because of its sheer strength in binding to opiate receptors, its long half-life, and the fact that it’s a partial-agonist binding to receptors built for full agonists. And despite what the media tell us, there are many people who don’t want to spend a lifetime on high doses of Suboxone.

You know what? When I was detoxing off fentanyl in 2008, I felt so good on Suboxone that I thought about staying on it. Then something happened. I no longer felt so good. My feelings dulled. I no longer wanted food or sex. I realized my body was adapting to the drug—or trying to. Fortunately my outpatient detox doctor had no more slots for Suboxone maintenance patients, so I tapered off as quickly as I could. If my doctor had been operating under the new Comprehensive Addiction and Recovery Act, he may have had a slot for me, and I might have gotten trapped on Suboxone as so many others have.

Scanlan said most people, including physicians, do not comprehend the strength and effects of buprenorphine. “Everything changes in the body when you’re on opiates long-term—the way the body regulates pain, the way it regulates hormone production, sleep, emotions—everything,” he said. And buprenorphine, he repeats, is an opiate. Its effects are not just physical: as a psychiatrist, Scanlan has noticed in his practice that at long-term doses of just 2mg, Suboxone can block almost all of a person’s emotions.

In addition, buprenorphine’s half-life is 37 hours, which means it takes the body more than a day to excrete half the dose. When dosed once a day, the body doesn’t have time to catch up, so the drug builds up in the system—a phenomenon called “bioaccumulation” that Rachel Carson documented in the buildup of toxins among wildlife in her book Silent Spring. A patient dosing with buprenorphine at 8mg is not only getting 8mg—he’s getting the 8mg, plus the amount not yet metabolized from the day before (4mg). And 8mg is a low-end maintenance dose. In the U.S., patients are commonly dosed at 16mg or 24mg per day.

“There’s definitely a risk to going on Suboxone long-term—anything over three months,” he said. “It would be easier to detox patients if they were coming in at a year’s time at one milligram, or a half-milligram, which is where they should be. But they’re always coming in at 16 milligrams. Or 4 milligrams for four years but really they’ve been at 8 milligrams and they’ve lowered it just before they’ve come to see me. I have to get them to tell me what they’ve REALLY been taking.”

Scanlan is the only professional I’ve ever heard who can explain why the body reacts so differently to Suboxone than to full-agonist drugs like heroin, Vicodin and methadone. Read on…

Suboxone tablets

Suboxone 8mg tablets

G: Educate me about buprenorphine.

Scanlan: It’s the most amazing detox medication I’ve ever seen. But for maintenance—it’s harder to get off than methadone. Suboxone is 25-45 times as potent as morphine. It’s the king of the hill in terms of opiates—it displaces every other opiate off the receptors, except for Fentanyl. [Maintenance physicians] use way too much of it. When you build up to a serum level, it’s SO POTENT.

Americans should look at European countries’ use of buprenorphine. They’ve had it much longer than we have. They use lower doses; they have as much maintenance as we do. In Scandinavia, what do you think the number-one most-abused drug is?—buprenorphine. Simple facts: they’ve had it longer, and it’s the most abused drug. That’s what I’d like people to know about.

Buprenorphine is now the 41st most prescribed drug in the U.S. Five years ago, it was the 196th most prescribed. [Update, April 2016: Suboxone is now the 16th most prescribed drug in the U.S.] So you can see what a money machine it’s becoming. … The research to get Suboxone approved [by the FDA] was funded in conjunction with the NIH. Until the NIH is run by someone in recovery from addiction, this propaganda will continue. [National Institute on Drug Abuse Director] Nora Volkow is great, she’s smart, I’ve met her, but she doesn’t have a clue.

G: Why don’t you prescribe Suboxone as a maintenance drug?

S: I wasn’t against maintenance when I detoxed. But I’ve seen a lot since then. And I had a detox physician who told me, “Do NOT stay on this drug for more than three weeks, or else you’ll be dealing with a whole different problem.”

Buprenorphine is a partial-agonist opiate. It binds to the receptor and only activates it partway. Opiates are meant to bind to the receptors and activate them fully. But if you put something completely foreign in the body like a partial agonist, the body says, “What is this?” and it tries to reach homeostasis. It struggles to understand it as a full agonist, and it can’t. There is nothing in nature that is a partial agonist, and our opiate receptors are not designed to operate with partial-agonists. Buprenorphine definitely does something unnatural to the body.

I’m not against maintenance for a certain percentage of the population. I have a friend who runs a methadone clinic, and I think there’s a percentage of patients who need to be on maintenance for the rest of their lives. Perhaps five percent of the [addicted] population. If you want to do maintenance, though, you want to do methadone. Methadone at least has been used for a lot longer, and we understand it better.

G: How do you conduct detox?

S: To detox patients off long-term Suboxone, I use clonidine [a blood-pressure medication] and Librium [a benzodiazepine] because it’s more water-soluble. And I use Darvon, a weak opiate. Its half-life is short. … The Librium is the last to go. And they complain of disturbed sleep. I don’t use Seroquel because it can be abused. I use what acts on the antihistamine and melatonin receptors—the only two receptors they haven’t messed up yet. … It can take five months to get someone off long-term Suboxone.

For a Fentanyl detox, I give them Subutex. Fentanyl detox is the most brutal detox but it has the quickest recovery of the receptors because Fentanyl has such a short half-life.

I tell them to exercise. Studies show that 12 minutes of exercise per day with a heart rate of greater than 120 beats per minute restores the natural endorphin system in half the time. The people who do that, their sleep architecture returns to normal in half the time of people who don’t exercise. Twelve minutes. And of course you can do more.

G: And you urge them to join a recovery program?

S: They need some kind of support system. Let me tell you—everyone who’s stayed off Suboxone, they’ve been in AA or NA. Thirty-day inpatient programs have an average rate of 5 percent sober after one year. But from what I’ve seen in my practice, anyone who does an honest fifth step in AA or NA stays sober—the numbers are greater than 50 percent. And anyone who can do an honest ninth step and make amends, the number shoots up to over 90 percent.

Everyone who comes to me, I get them off opiates. One-quarter of the people I treat are sober at six months, and ninety percent of those are actively involved in some program. They’re not just going to meetings or involved in community service—they’re actively seeking some kind of spiritual growth. It all comes down to whether people want to do the work.

G: What about people who are afraid of becoming depressed after detoxing from long-term use?

I ask them, Was there ever a time you were sober? Did you have a bout of depression before then? If not, then it’s probably substance-induced. You have to take a thorough history. The statistics say: of all people who get clean, 15 percent have mental illness. Maybe a bit higher than the general population.

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Related posts:

How To Detox From OxyContin and Other Opiates

Reader Questions: Addiction, Chronic Pain, and Drug Maintenance

Have questions, or want to see someone interviewed here? Email me at guinevere (at) guineveregetssober (dot) com.

Sober Life: Eminem’s Sober Interview with Rolling Stone

Standing in Whole Foods’ checkout line last night, and there was Eminem on the cover of Rolling Stone, nose peeking out from his (shady) hoodie.

Eminem Rolling Stone 2010

I shelled out. Eminem is currently the music industry’s bestselling and most visible recovering addict. From the glimpses I got waiting to buy my pork chops, I could see that his recovery from addiction was the first subject discussed and the subject most referred to throughout the interview. That, and his kids, and his work.

So I thought I’d share a few tidbits with you guys, in case you’re interested. Because I know you’re interested. Lots of you land here looking for “Eminem sobriety” or “does Eminem go to meetings.”

(For those who may not be familiar with Eminem: birth-name Marshall Mathers, 38; he is a hip-hop artist who grew up and still lives in Detroit; in December 2007 he was hospitalized for an overdose of methadone and the sleep-aid Ambien which nearly killed him. One relapse after that, and he committed to recovery. Also the title of his most recent album, Recovery is expected to be the bestselling album of 2010.)

Ambien is addictive. On his Ambien use:

Toward the end, I don’t think the shit ever put me to sleep for more than two hours. It’s very similar to what I’ve read about Michael [Jackson]. I don’t know exactly what he was doing, but I read that he kept getting up in the middle of the night, asking for more. That’s what I was doing—two, three times a night, I would get up and take more.

On the shooting death of his good friend, Detroit rapper Proof, and how addiction made him self-absorbed in his grief:

I remember days I spent just taking fucking pills and crying. One day, I couldn’t get out of bed. I didn’t even want to get up to use the bathroom. I wasn’t the only person grieving—he left a wife and kids. But I was very much in my own grief. I was so high at his funeral. It disgusts me to say it, but I felt like it was about me. I hate myself for even thinking that. It was selfish.

On getting high on methadone—a drug that most physicians and even many addiction specialists don’t believe can make you wasted:

I remember I got the methadone from somebody I’d gone to looking for Vicodin. This person said, “These are just like Vicodin, and they’re easier on your liver.” … I remember taking one in the car on the way home, and thinking, “Oh, this is great.” Just that rush.

Eminem’s just like a lot of us who committed to recovery to be here for others:

I knew I had to change my life. But addiction is a fucking tricky thing. I think I relapsed within … three weeks? And within a month it had ramped right back to where it was before. That’s what really freaked me out. That’s when I knew: either get help, or I am going to die. As a father, I want to be here for things. I don’t want to miss anything else.

Eminem apparently does not go to meetings. He wanted to attend meetings but people inevitably recognized him and wanted things from him, which made it difficult for him to be open in the group. On anonymity:

I tried some meetings—a couple of churches and things. It tended not to do me much good. People tried to be cool, but I got asked for autographs a couple of times. It made me shut down. I called a rehab counselor who’d helped me the first time. Now I see him once a week.

It’s well known that Elton John acts as his sponsor:

I speak to Elton [John]. He’s like my sponsor. He usually calls me once a week to check on me, just to make sure I’m on the up-and-up. He was actually one of the first people I called when I wanted to get clean. He was hipping me to things, like, “You’re going to see nature that you never noticed before.” Shit you’d normally think was corny but that you haven’t seen in so long that you just go, “Wow! Look at that fucking rainbow!” Or even little things—trees, the color of leaves. I fucking love leaves now, man. I feel like I’ve been neglecting leaves for a long time.

And this is where I put the magazine down to take a breath, because I enjoyed this guy’s unpretentious poetry so much and I was starting to love his process. There’s no one right way to get sober. But there are some essential ingredients: honesty, open-mindedness, and willingness to do whatever is needed. Especially willingness.

It seems Elton John, sober for 20 years, regularly reaches out to other celebrities with drug problems. Eminem has made it clear that he rang up Elton John for help because he knew Sir Elton would be able to understand the mental distortions that extreme fame exerts on a person, and he wasn’t able to get that in an ordinary meeting. Which is too bad—because when you get right down to it, in Orwell’s words, none of us addicts is “more equal” than any other. Maybe some people might think this choice in itself is grandiose and ego-driven. But I respect it: I see him recognizing the real limitations that he’s presented with, and then seeking help where he can, so that he can save his life and continue to do what he needs to do … stay sober, take care of his kids, and do his work. Each of us has to do this—get help in the way that best fits our life.

“There’s a lot more awareness of addiction these days,” my husband said this morning when I told him about this heretofore homophobic hip-hop singer calling on a flamboyantly gay star. “Imagine who might have been saved in the past if there had been more awareness. I mean, who was looking out for Janis Joplin, Jimi Hendrix, Jim Morrison? And so many others.

And here he is on some of the cleanup. On working sober, and the time lost on his CV:

I don’t know, man. I feel like I took a lot of time off. Not doing shit for those four or five years, how lazy I got—it’s time to get back to doing what I love. I feel like I’ve got a lot of gas in the tank. I just want to make up for letting people down.

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