Aleesher and the Last First Time.

Hail,

Rather than write about my own feelings (because believe me, everyone who wants to know has heard about it), I am going write about someone else's. Because otherwise I might as well just lie around the house wearing a teeshirt that says "I wish someone would do something about how whiny and boring I am". Anyway, rather than point out the individual excellent and often stop-and-stare beautifully written posts of Foilwoman, Cupcakegrrrl and g_pi I will just refer people again to these blogs, and continue to lobby for them to be included in the late secondary school English Literature syllabus. And read everyone else's stuff too.

Moving right along - and strong language alert for what follows - I saw Aleesher today. Aleesher is probably one of the Ten, one of the five percent of my clients who cause me ninety five percent of my work. And she's not violent, and her drug problem isn't that bad anymore, and she doesn't have any overt, classifiable mental illness.

But she's one of the ones I worry about. Twenty one years old. Married now, mother of one. Slim, blonde, pneumatic lipped, relatively fashionably attired. She looks - I don't know.

This will sound odd, and uncharitable, but her face - there is something wrong about it. Nothing obvious, but her ears are close and high. She has large brown eyes with an upward slant, at rest her face has a slightly odd expression, there is something that suggests to me some damage, some genetic lesion. A Barbie-doll deformity, something that makes you wonder about a touch of fetal alcohol syndrome.

And the thing is, there is something wrong, something cognitive. It's always hard to tell in someone you see for only half an hour every month or so, but there is stuff she doesn't get. A few years ago, when things were worse, she had to check into one of the homeless shelters. A crisis care centre, inadequately staffed, with about two hundred people, one hundred and eighty men (most straight out of prison) and twenty women. It is one of the worse homeless shelters in Mordor, everyone injects, rapes and assaults and the like are common.

It was a hot day and Aleesher turned up in a tiny yellow bikini. This was what she wore around the house, and she'd come there via the shops. The social worker (now working for us) describes how she shoved a size twenty two fisherman's jumper and a pair of gargantuan track-suit pants on her and bundled her off to the Salvation Army to get some acceptable clothers - all the while trying, and failing, to explain to Aleesher why a yellow bikini and sandals was not going to work to her advantage.

"But you said" said Aleesher, "that a woman should be able to dress how she liked and not get hassled."

"Yes I did" said Michelle, "and I stand by it. But there's only one of me saying that, and there's one hundred and eighty men there who reckon different, and youre not staying at my place tonight."

And there's other things. Her husband takes her up north every weekend to visit relatives, she doesn't know exactly where, even though they've been going every few weeks for a year. That kind of stuff.

Anyway, things have got better for Aleesher, due more to my wife's care than to mine. Of course, being a young blonde with puffy lips and some mild cognitive impairment, she has been snapped up in the marriage market and has a husband whom she describes as "very strong but not really supportive", and child number two would normally not be far away. She got cancer a few months ago - cervical, she thinks, she's not sure, she just had surgery, more treatment Monday - and she's always tired and the baby boy takes after his dad, big and strong, a real handful. And Brad works all the time and she can't give him sex and that's another strain.

This is why I try to make sure the patients before her finish early and the ones after her are okay with waiting a bit. Aleesher takes time.

And today she was talking about heroin. She'd used again. She was angry, she'd had a big fight with her sister, walked out and there'd been a friend from the old days, and she'd scored, just fifty dollars worth. And her chest'd been tightened up with rage and frustration, that black churning in your stomach and tears in her eyes, and she'd used. Stuck the needle in, and that'd fuck her sister and fuck her mum and fuck everyone she was angry at. Fuck herself.

And of course, afterwards the guilt. Because we've got her on twice weekly random urines and the next one was tomorrow, and it came up. I called her in.

"The thing is," she said "I hate it."

I nodded.

"Why do I keep doing it when I hate it?"

I paused. Aleesher wasn't the kind of person to deal with the neurochemicals explanation.

"A lot of people say what you're saying," I said. "Using it and hating it. It's hard to stop when you want to. That's why you sometimes need help."

She nodded. "I saw a tv programme on it the other week. About the first time. Did you see it?"

I shook my head.

"It said that the first time you use heroin it's like nothing else. It's the best. And it is. And so I keep saying 'one more time like the first time and then I'll quit'. And every time I stick the needle in I'm hoping it'll be like the first time, and it never is." Her hands - slim, tanned, cheap engagement ring, scarred from tens of missed veins - were clenched in tight white fists on her lap.

"It never fucking is. And instead it keeps getting worse, more and more shit, so you end up chasing something that gets further and further away. And no matter what you do you never get that that first time again... do you?"

"I don't think you do. From what I've read, you don't."

She stared at me. "Does it ever come back?"

I tried to think of what people had told me, what I'd read, what I should tell her. Limits of knowledge versus things I should say, that kind of thing.

"No," I said. "No it doesn't. It's gone forever. You've had your first shot and you can't ever have it again. It never ever ever comes back."

And I don't know if it's true, and it's probably not true in the way that "the atomic weight of sodium is 22.990 grams" is true, but it's what I've heard and what I suspect to be the case, and the first shock of pure heroin to young neurons - there's probably nothing like it.

Certainly, with her on fifteen mg of buprenorphine and surrounded by what continues to be fairly shit heroin and an on again off again habit low-grade that she can't really afford ... nothing like it.

What I am told is the problem with heroin, the pathology of it, is not so much the early days, when it is all about pleasure, it's later, when it becomes a form of pain relief. You start out and it's usually that things are things in your normal life are okay, certainly livable, but with heroin they are great.

Then you fast forward to a few years later and things are different. Life without heroin is unbearable, shivering and shaking and too painful to endure... and sometimes (and not for everyone, this is only what I have been told) all the heroin does is makes you feel normal again. Pain relief that causes you more pain.

When things get like this people come to the Drug and Alcohol Service, and take our toxic addictive medications and endure our preaching and our humiliating limitations on where they can go and what they can do and how long they must stand in front of the chemist before opening their mouth to prove they have done what they are supposed to.

Don't get on smack. I'm warning you.

Anyway, Aleesher and I spoke about this. About how this whole thing of chasing what she couldn't get, and what she could do instead. And we put her dose up (the one that wrecks her sleep, and screws up her teeth, and gives her those headaches, and will one day make her fat) and I spoke to her about the sleeping tablets she'd been given by her GP, using one a night now, had to be careful with them, said I wanted her to see Isobel, our hypomanic social worker, twice a week for the next month. Just because of the cancer and the stress and the using and all that. And someone else can just be found to look after Brad Junior. And we'll do the blood tests to find out why you're tired, various viruses and anaemias and so on, but I don't reckon it's anything we don't already know.

Anyway. There is an analogy that can be drawn here, not in terms of the shivering and shaking, but in terms of other first times that we always remember and that hit us hard. I don't mean sex, I mean love, and I know the analogy is a fairly fragile one. There is no buprenorphine for love, there are no dealers on the streets and no-one cuts love with other emotions. And first love is intense, changes the structure of your mind, gives you that whole can't breathe, heart pounding stuff - but later love is different, stronger and something you can live with. Love doesnt get worse and worse each time, chasing after something you can't have.

Well, there it is. I don't think it's an analogy that can really be used to anyone's advantage, but there it is. For people like (most of) us, who haven't used, it's the closest thing we can imagine to someone like Aleesher's first time.

Thanks for listening,
John