How Resilience Helped Me Transform My Life After a Brain Injury
An Everyday Health senior editor shares details of her family's history of mental illness, and how she overcame drug addiction after a traumatic brain injury.
When the phone rang, I wanted to ignore it, but I knew he would only keep calling. It was one of my relatives, no doubt panicked about not having anywhere to go after getting out of a crisis unit — his fourth visit since being diagnosed with schizophrenia in late 2018.
I probably sound heartless, but the truth is I’m simply at a loss for how to help. One of the last times this happened, I paid to put him up in a hotel for a couple nights and flew from New York City to Orlando, Florida, to be by his side. But, once I saw that he was struggling — we’re talking crippling delusions and paranoia that prevented him from trusting me to help with basic things like getting an ID card — I knew he still required hospitalization and monitoring. I had to involuntarily commit him. He got himself committed this last time after an attempted suicide: He overdosed on a bottle of antipsychotic medication.
Since he was a teenager, this relative has struggled with alcohol and substance abuse problems, and a mental illness that went undiagnosed for far too long. Schizophrenia, a chronic brain disorder in which a person has difficulty interpreting reality, can involve symptoms including delusions, hallucinations, trouble focusing, and poor executive function skills, which are mental processes that enable a person to plan, organize, and self-regulate.
The phone continued to vibrate on my bathroom counter. Not knowing what else to do, I picked up.
“Can you send me some money so I can check into a motel for a few nights?” he said, ignoring any pleasantries.
“You don’t have any form of ID to check into a motel,” I said, using logic as my first line of defense.
“Well if you just send me the money, I can figure something out.”
The conversation continued in the same circular fashion until finally I suggested he go to a homeless shelter.
“You’re going to leave me on the street to starve?” he said, in an attempt to tug at my heartstrings. Why wouldn’t he? I’ve fallen for this tactic before.
“No, I said go to a homeless shelter. I spoke to your nurse this morning, and they gave you a cab voucher to take to one of two shelters in the area. Go there for a bed, and they will help you get an ID.”
“So you’re giving up on your own family?” He paused. I hope he knew that the answer to that question was "no." I just didn’t know how else to help him until he was willing to accept that he had a problem, a difficult task for a person struggling with such a severe and debilitating condition. “This is the last time I’m speaking to you,” he said, and hung up the phone.
I placed the phone on the bathroom sink and resumed flossing my teeth, wondering what it must be like to be homeless — how sad and scared someone must feel to be on the streets without the security of a home. I squinted at my reflection in the mirror. I couldn’t fully relate to him — I do not have schizophrenia — but I certainly knew what it felt like to be homeless and to battle a brain disease rife with faulty thoughts and beliefs. It’s easy to forget that 18 years ago, I was a crackhead living on the streets of Chicago. I was a liar, a cheat, and a thief whose sole objective was to see how much I could take from other people — mostly drugs and alcohol, but also money and time.
My relative is still struggling on his unique path. As for me, the only remnants of my rebellious, drug-induced past are a couple of tattoos beginning to fade on my skin. I am nothing like the person I was. Recovery is an ongoing process that started with a willingness to change and continues with completely changing the ways in which I think and act. And that’s why it’s so hard to see my relative cope with mental illness, however distinct it is from my situation.
The Differences and Similarities Between Addiction and Schizophrenia
I know from personal experience that at their root, alcoholism and addiction are diseases of the mind. For example, my mind told me I was worthless, not good enough, that other people hated me — thoughts that I had wrestled with since early adolescence. As my suspicion and self-doubt grew, I turned to alcohol and drugs to quell my thoughts and feelings, despite sometimes-severe consequences.
In fact, drug addiction has become accepted in the scientific community as a brain disease, according to the National Institute on Drug Abuse. Initially drug use is a voluntary behavior. But in some people with an addictive personality, drug use becomes compulsive. Brain circuitry changes when a person lapses into addiction by subverting the rewards center of the brain and decreases motivation to perform everyday activities. Drug addiction is also shown to weaken regions of the brain involved in executive function.
But as Ken Duckworth, MD, medical director of the National Alliance on Mental Illness, notes, “Nothing's more complicated than the human brain.” Despite scientists’ knowledge of these changes, they still don’t know how the minds of people with drug addiction work, he says.
The same is true of schizophrenia. According to the National Institute of Mental Health, scientists believe that an imbalance in the neurotransmitters dopamine, glutamate, and serotonin contribute to schizophrenia.
Both conditions involve deficits in executive function and, according to research, the two conditions may even be linked. It’s been widely recognized that severe mental illness, such as schizophrenia, is a risk factor for substance abuse. And according to a study published April 2018 in Schizophrenia Research, genetic susceptibility to schizophrenia may make people vulnerable to substance abuse, possibly even before they experience psychotic symptoms. Substance use, in turn, can exacerbate symptoms of psychosis to form a vicious cycle that is difficult to break.
“There are parallels to all of these things,” says Frederick Charles Nucifora Jr., DO, PhD, an assistant professor of psychiatry and behavioral sciences at Johns Hopkins University in Baltimore. “But they are very different illnesses.”
Over many years of continuous treatment, I have learned that I have faulty thinking that needs regular checking to ensure that I stay on the right path. But, unlike my relative who struggles with severe deficits with his cognitive abilities, I was capable of seizing the willingness to change.
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How Feelings of Inadequacy and Insecurity Led Me to Become a Drug Addict
I likely had the makings of a trainwreck from an early age. I was a rambunctious child who didn’t like following directions and never felt comfortable in social situations. I was a loner who took to scowling at people and judging them to make myself feel good. When that stopped working, I hid in humor, dying my hair bleach blonde and acting like a ditz.
My disposition, coupled with childhood trauma, which studies — like one published in August 2016 in the Journal of the American Academy of Child and Adolescent Psychiatry — have linked to later substance abuse, was a recipe for disaster. My feelings of inadequacy abated in my early teens, when a friend in high school introduced me to drugs and alcohol. But I was prone to getting in trouble, and after a series of disciplinary problems — school suspensions, staying out past curfew, and getting fired from jobs — my mom sent me to live with her cousin in Weston, Connecticut, a small town about 60 miles Northeast of New York City, where I could focus on school and my passion for acting.
In Connecticut, life seemed better, easier. I developed a core group of friends and was active in theater, securing a part in the school’s upcoming musical, Pippin. Although I still imbibed on occasion, it was in the background of everything else that was going on in my life and did not interfere with my school or home life.
Then, two months after my 16th birthday, a car going 40 mph hit me head-on and turned my world upside down. I don’t remember anything of the day, but according to my friends, I didn’t see the '95 Ford Bronco XLT as I was crossing the street to join them at a neighborhood coffee shop. My friend Adley called out my name to warn me. Yet when I turned to look, I froze like a deer in headlights.
After lying unconscious at the scene, I was rushed by EMTs to Bridgeport Hospital for emergency surgery to fix my broken body. My spleen ruptured and needed to be taken out. Swelling in my brain required the insertion of an intracranial pressure monitoring device in my skull. Doctors mended my broken bones as best as they could, and my parents flew up from Florida and sat by my side for two weeks, as I lay comatose in a hospital bed.
After I woke, doctors referred me to Gaylord Rehabilitation Center in Wallingford, Connecticut, for intense rehabilitation, where I learned how to walk, read, and write again. I don’t remember much of the first month or two after the accident because of severe brain deficits from the traumatic brain injury (TBI), but I do recall one thing doctors regularly said to me: “You can’t drink or do drugs for at least a year, or you could have seizures.”
I didn’t think that was going to be a problem, but according to my records, my neuropsychologist noted that I was at increased risk of alcohol abuse due to a previous history of substance use and the location of the brain injury. The computerized tomography (CT) scan of my brain showed contusions or bruises in the left cerebral hemisphere of my brain, the right frontal lobe, and the basal ganglia in the center of the brain. The frontal lobes are a part of the brain directly behind the forehead that’s concerned with behavior, memory, judgment, impulse control, and sexual and social behavior. According to research published December 2019 in StatPearls, damage to this part of the brain can affect components of self-regulation like attention, impulsivity, and inhibition.
Upon discharge from rehab, I returned to my parents in Florida, but my recovery didn’t follow. I was uninsurable due to preexisting conditions from the car accident, and knew of no support for young people with a brain injury. I didn’t think I needed support, anyway. I just wanted everything to go back to the way it was before the accident. I tried to pretend like nothing happened, but I walked with a limp due to a broken femur bone and part of my hair was shaved off. It didn’t help that I had difficulty concentrating and my short-term memory was shot.
One summer day, a month or so after discharge from the rehab, I was sitting in a friend’s backyard sipping a Coca-Cola while everyone around me was drinking beer. Someone lit up a joint and started passing it around. The person to my right tried to pass it over me to someone else when I held up a hand. “Maybe I can take just one hit,” I said. I was so uncomfortable and thought that it would help me to achieve some semblance of normalcy.
None of my friends seemed particularly fazed by my request either, so I didn’t think it was a big deal. I pinched the joint between my fingers and sat back in my chair. After a moment of hesitation, I took a drag off the joint, long and full like I used to do. My throat and lungs burned, making me cough and gag. I looked around for a reaction from my friends, who all sat glassy-eyed, staring off in their own world. I passed the joint to the next person and chugged my soda to quell the burning in my throat. I felt light-headed and sat back in the chair, closing my eyes. It was a horrible experience, and any sane person would have avoided the substance after that reaction. But in me, the drug became an itch that I scratched until I was a full-fledged alcoholic and drug addict, which didn’t take long.
Within months, I was drinking alcohol and smoking pot around the clock. In my mind, intoxication helped me to become all of the things I believed I was not — smart, beautiful, social. Oblivion gave me respite from the gnawing thoughts of self-loathing. I’d wake up in the morning, and instead of going to school, I'd meet some friends in the neighborhood to drink and use drugs. School was too hard anyway. I couldn’t follow along with the lesson plans and was unable to understand basic mathematical computations or scientific theories. I labeled myself as dumb, unaware of the fact that my deficits were a result of the TBI.
This continued for the next two years, and my life got smaller and smaller as friendships dropped off. When pot stopped providing me with the desired result, I turned to different drugs for a high. I became a blackout drinker, hanging out with seedier and seedier individuals, and waking up in strange places — like my car or a random guy’s house — on a regular basis. I ended up in the hospital because of an overdose of pills, knocked my two front teeth out in a blackout, and was arrested for shoplifting and possession.
My family sent me to rehab twice, and I had brief stints in a halfway house and a mental institution. Then, in April 2001, at age 18, I was out of money and friends or family who were willing to help me. With no other options or concern for my well-being, I lived out of my light blue Mitsubishi Mirage on the streets of Chicago with a woman I met in the mental institution. Together we smoked crack every day and hustled guys in bars at night for money to fuel our drug addiction. Being underage to legally drink, I was kicked out of a lot of the bars we entered. But I remained persistent. Through some of her connections, Erica (not her real name), my car-mate, was able to get us motel rooms for a night or two. But much like food, showers were a rare occurrence.
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Hitting Rock Bottom Before Reaching Out for Help
Then after a month of living in fear, filth, and insecurity, I realized that I needed help. It was the middle of the night and my car was parked outside of an apartment complex where Erica was visiting a friend. I don’t know how we got there or if I was the one driving the car. It didn’t matter. I was awake and in dire need of drugs or alcohol. I scrounged around on the floor of my car, using the flickering of a lighter so I could see. I picked up anything that looked like a piece of crack and attempted to smoke it: fingernails, lint, whatever I could find. After several failed attempts to capture the much-sought-after feeling of oblivion, I started to cry.
Erica returned to the car empty-handed, and we drove to a nearby Jewel-Osco grocery store to park in the far end of the lot and try to sleep. But we couldn’t. Withdrawal set in. My skin was crawling and my heart raced. Although I gulped in air, I didn’t feel like I was breathing.
When a person develops a physical and emotional dependence to a drug, the number of dopamine receptors in the brain is reduced, which can lead to a loss of self-control and depressive symptoms, according to the Hazelden Betty Ford Foundation. And when you cut off the source of stimulation, the body begins to try to adjust for the chemical imbalance, causing anxiety, panic, loss of focus, fatigue, irritability, cravings, and lack of initiative, the foundation notes. These uncomfortable symptoms drive many people in recovery to get high again. But I didn’t want to get high again. Erica and I writhed around in our seats, and squinted to avoid the morning sun coming up over the bushes near the car.
Defeated, I picked up the phone and called a woman I met months prior in a meeting of Alcoholics Anonymous (AA), to ask for help.
The woman, Susie, invited me to her house that day. I wanted to go, but didn’t have gas in my car or money to get some. I stepped out of the car and started pacing next to the driver’s side window. The hope of getting out of my situation filled me with relief. But I didn’t know how to get there.
I decided to call a friend I knew from a halfway house. “Hi Jared, this woman in AA wants me to come to her house, but what do I do about Erica?” I said.
“Just kick her out,” he said.
“I barely have any gas in my car — ”
“If you drive to my record store, I’ll give you some money for gas,” he said.
Resolute, I hung up the phone and got back in the car to talk to Erica.
“Erica, I need to get help,” I started.
“Okay, I can drive you to a rehab,” she said.
“But this is my car,” I said.
“But what am I supposed to do?”
I shrugged, not having an answer or an interest in her question. Fatigue enveloped me. My body was pining for sleep or more drugs.
“You’re going to throw me out on the streets,” she said, her voice reaching a hysterical pitch.
Again, I did not respond.
We were both silent for a few minutes, staring blankly at the dusty gray dashboard.
“Can I at least call someone to pick me up?” Erica finally said.
I handed her the phone and stepped out of the car to smoke a cigarette. When I returned, Erica asked if I could drive her to a nearby motel where she could wait for someone to pick her up. I agreed.
We were silent the whole way there and as she stepped out of my car she looked back and said, “You better hope I never see you again,” and slammed the door.
That was the last time I saw her.
I started driving to my friend's job for the gas money I needed to get to Susie’s house. But then, perhaps only a few miles from my destination, my car went dead. I was on a downhill slope at the time, and rolled into a strip mall. My car quietly slid into a space in front of Dunkin’ Donuts. I picked up the phone to tell my friend what happened, but the phone died in the middle of the conversation. I grabbed the phone and charger, and walked into a pizza place in the strip mall to use one of their outlets. When the workers behind the counter saw me with sunken cheeks, greasy hair, and dirty clothes, they kicked me out. I went back to my car and instantly fell asleep.
Sometime later, I awoke as a white Honda Civic pulled into the parking spot next to me. A young man stepped out of the driver’s side and peered into my open window.
“Are you Amy?”
I nodded, unsure if I was in a dream.
“Jared sent me to give you some money.”
I perked up.
“Do you want a cup of coffee?” he said, gesturing to the Dunkin' Donuts.
I stepped out of the car and went into the coffee shop with the man. Back outside, I slurped down my coffee Coolatta, the sugar helping to keep the cravings at bay. The man handed me a few Marlboro red cigarettes for the road and a $5 bill for gas.
“I don’t want to give you any more, because I don’t want you to use it to score drugs,” he said.
A valid point, and I couldn’t blame him for being leery.
Despite my natural instincts to take the money and run, I used it to purchase a small amount of gas from a station across the street from the strip mall. The guy watched me do this. I kept an eye on him, too, focusing on his white shirt in the rearview mirror as I got back on the road and headed north to Susie’s house, Janis Joplin blasting on my car radio.
Susie greeted me at her front door an hour and a half later. She hugged me, then handed me a towel to shower. Once I was in clean clothes, she took me out for a meal at a nearby restaurant. Then she told me I could spend the night at her house. The following day, she brought me to an AA meeting, where I surrendered. I didn’t know how to stop drinking and using, but I needed to or else I was going to die. For once in my life, I was afraid of that.
Getting Sober and Building a New Life
Sobriety did not come easily to me. For the first few months, I tried to convince myself that I was too young to be an alcoholic and drug addict, and I regularly fought the urge to put a couple of bucks in my car to drive to a dealer for just one more hit. The support of my newfound friends in AA helped me stay away from the drugs and alcohol one day at a time.
I do not believe that AA is the answer for everyone struggling with a drug or alcohol problem. Research suggests that medication-assisted therapy (MAT), which combines behavioral therapy and medication, is helpful for individuals with opioid addiction. For example, one past study found that deaths from opioid overdoses fell when the health department of Baltimore expanded its use of two forms of MAT treatment, methadone and buprenorphine. And a longitudinal study published in May 2018 in the Journal of Substance Abuse Treatment found that 12-step programs like AA were no different than alternative support groups, like Women for Sobriety, LifeRing, and SMART, in terms of their benefits for people struggling with alcohol use disorder. The research showed that total abstinence led to the best odds of success regardless of the type of support program.
There’s also a spiritual aspect of the AA program, which can be off-putting to some people in recovery. But AA was the option presented to me, so I ran with it. And it has served me well. I’ve learned to take certain tools of the program while leaving out others that may not be right for me.
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A month into sobriety, I befriended a woman who became my sponsor, and she took me through the 12 steps outlined in the Big Book of AA. These steps — admitting there was a power greater than myself, taking personal inventory of the wrongs I did others and making amends to those people, and helping other alcoholics and addicts — taught me to change my actions and my thinking around every facet of my life. Up until that point, it seemed my thinking was faulty and my sole response to anything, good or bad, was to get drunk or high. If I was wont to blame others for all of my troubles, I learned how to look at myself and take action to change situations that bothered me. I also learned to forgive others, which in turn helped me forgive myself and build self-esteem.
And I regularly attended meetings to cultivate a support system and to be there to help others. The women and men in the AA rooms became my friends, and we would often socialize with one another outside of meetings, going to movies and concerts. We still do. Although I no longer have the craving for alcohol or drugs and can comfortably hang around others who are drinking alcohol, I know my limits at parties and when I’m out with friends who are drinking, and leave when I need to. I’ve seen enough people relapse and die over the years to know that it is best for me to stay sober.
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My Hope for People Who Are Struggling
Over the past 18 years, I’ve had my struggles: the death of family members and friends, job loss, and failed relationships. At times I have thought of a drink or a drug, something to numb the pain, but through using the tools and principles I picked up in AA, I’ve learned to be resilient and to let go of fear, disappointment, and anger. I’m able to show up for the people I care about and help others who are struggling with alcoholism and substance abuse. Today I am a wife and a mother, and a respectable member of my community. I’ve secured a position at a well-regarded health publication where people seek out my help and trust my judgment. Not too shabby for a former junkie.
I still struggle with some mental tasks because of my brain injury, but I know today that I can work on these things with doctors and neuropsychologists.
Along with regular attendance at AA meetings, I attend brain injury support groups to hear about how others deal with their issues, and together we help one another heal. I’m grateful for the experiences I’ve had because they helped shape the person I am today. In fact, a study published in July 2018 in the Journal of Substance Abuse Treatment found that gratitude could help a person maintain abstinence from alcohol use disorder post treatment. Staying sober is a process that I work at every day.
As I look back on my past and the life that I am creating for myself today, I can only hope that my family member finds the help he needs.
My relative’s continued recovery will potentially be marked by relapses, but is dependent on his ability to live life with symptoms, which can be done with the assistance of psychologists and psychiatrists, and medication. “Living a life that they’re content with is recovery for people,” Dr. Duckworth said, adding that social and family support are also important for a person’s recovery.
“The feeling of aloneness is very bad for recovery,” says Duckworth, “The feeling of community and connection — similar to AA meetings — is helpful."
As of this writing, this person is in a state hospital after admitting himself into a facility for treatment. I am relieved and overjoyed. He is safe, and he made the decision to ask for help. He has reached out to me a few times to talk and my other family members and I were able to visit him over the holidays. I am proud of him for asking for the help that he needs and will continue to stand beside him as an advocate, a family member, and a friend.
A lot of people have helped me build resilience on my journey, and I want this person to know that people are here to help him, too, and I’m not going anywhere.
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