titantoo
09-02-2005, 08:50 AM
My comeback
Heroin was killing Andrew Constantine. Desperate to survive, he signed up for radical detox. For five days he was drugged into near-unconsciousness. This is his compelling chronicle of that gruelling time - and what has happened in his life since he walked out of the clinic door
Andrew Constantine
Friday September 2, 2005
Guardian
March 1 2004 Another grey, freezing Penzance morning. My waking ritual begins with 10 dihydrocodeine tablets, 30ml, lots of steaming coffee and a spell of chain smoking cannabis as I sit staring out the window at the backs of the houses opposite. Six weeks to go before I'm evicted from here.
The codeine tablets are meant to treat an ongoing ear infection. I keep them in the cupboard for emergencies when money or heroin are short. Soon the rotting feeling in my stomach dissipates enough for me to stop being aware of it and my mind begins groping around among last night's plans for an emotional foothold of some sort; plans devised in the darkness, out of bitterness, resentment and self-pity.
March 16
Birthday number 40, and my overriding thought is: my life might be falling apart, but I don't want to die yet. There was that overdose last Christmas - met a girl at Narcotics Anonymous, she took me home, cooked me up a hit and practically killed me ... So OK doctor, what's on offer?
As far as my GP is concerned, a referral to the local drugs team is on the cards. But for residential rehab there's an eight-month waiting list. So really, the team's only immediate resort is methadone. I have big misgivings. I run a boxing club, and come September I want to start a foundation degree at college. So does this make me special? Well no, but what it does make me is desperate not to become one of those walking methadone corpses.
Whatever the theory of maintaining people on methadone, the reality is on the streets of Penzance. Under the security cameras on the corner of Causewayhead, you will always find a contingent shooting the breeze, scoring heroin; addicts and alcoholics without hope, staggering and dazed. Because it's never just the methadone is it? It's the benzos and the sleepers and the anti-depressants and the barbiturates that seem to be dispensed like confetti.
But there is this other thing I've heard about. Apparently, it's a treatment that involves being put to sleep for five days and, when you come to, you are no longer dependent on opiates. This sounds a bit too good to be true.
April 5-12
Had to get away from Penzance. My cat is traumatised by the move: still in Cornwall, new town. Sorry, Tizer. The flat really is lovely, though. My guiding idea now is to undergo this programme, "Detox 5". I see it as my final chance.
My doctor has made inquiries and sent referral forms to the clinic I've chosen, in Harrogate, north Yorkshire. We're waiting for confirmation.
For most of the five days, I'll be heavily sedated - in effect, one bunch of drugs will keep me semi-unconscious while my system (so the plan goes) gets over its dependence on another lot, opiates. I also have to find a "nominated supervisor", who will escort me to and from Harrogate, and be available during the treatment. My long-time friend and mentor Elizabeth, who came to Cornwall when she and her husband retired, has agreed to do this. To her I owe deep thanks for never giving up on me. Ever.
I've read the glossy booklet I got in the post. One picture is of a dining hall. Resembles Trusthouse Forte. The second is of a girl lying on a couch, looking kind of smug. That's good then.
How will I feel after the five days? One of the clinic coordinators told me over the phone to imagine "getting over a really really bad bout of flu - and times it by 10". Don't like the sound of that.
April 14
We have it straight from the lab. My girlfriend Nadia is pregnant. Words inadequate.
April 24
The loose ends were tied up yesterday. I am booked into the Detox 5 clinic on May 10.
Dropped my partner off at her folks' place. An argument at 4am. Afterwards the weather was beautiful driving home, roof open. I slipped into Penzance and scored. Going back to the car park, I stopped a man in the street, pushing a pram, tiny little baby in there.
"My fiancee is three weeks gone," I said. "Can I look?"
"Sure." He stopped.
And together we adopted that crouched-over, hands-on-thighs thing. A beautiful little creature. Soon, I will be a father. Sixteen days to detox.
May 9
A glorious sunny morning and I have said all my goodbyes. The landlord and his wife. My pregnant partner. My cat, my second in command at the boxing club and, finally, my dealer.
We set off in Elizabeth's long silver monstrosity of a car. Having had my last fix, all I've got now is a bottle of about 30 dihydrocodeine. Half will go overnight, to get me to sleep.
By the time we have switched from the A30 on to the M5 my vague unease has focused into a dense cold mass of anxiety.
May 10
Before setting out on the final leg, from the cottage Elizabeth keeps in Stratford to Harrogate, I have taken my last 15 dihydrocodeine.
In the car I find myself telling Elizabeth a nightmare story of a detox (involuntary) at Wormwood Scrubs prison, about eight years ago, when I woke up lying in a pool of my own vomit. Those horrifyingly intense feelings of abject despair and physical torment will stay with me for a very long time.
"How many prison detoxes have you actually been through?" Elizabeth asks. In all honesty, I reply that I have lost count.
The clinic building is one of those fairly modern brick jobbos. A nurse with a ponytail shows me to what will be my room. His badge says he is Andy.
The room itself is quite cheerful, three-star hotel sort of thing. Great effort has clearly been made. It's the bed that gives it away. There are sidebars, that and the smell of sickness and suffering that no amount of disinfectant will ever eradicate.
Andy lights a smoke, and answers some questions. No, there will be no IV drip, I will be put under heavy sedation and woken every two hours to have my blood pressure and pulse checked. I will be required to drink half a pint of something that tastes not very nice during these checks. Afterwards I will remember very little. The price, by the way, is three grand, which of course renders it out of reach for almost every addict out there. The only way I can pay for this is that I've managed to find a (sort of) sponsor.
Then the troupe arrive, dragging equipment, lots of digital displays and dangly bits to check my weight, height, blood pressure, pulse. They take blood and urine samples. The resident psychiatrist, a serious straight-talking consultant, Amal Beaini, draws us some diagrams and discusses medicating individual symptoms of my impending withdrawal.
And then it's back to my room. Elizabeth is gone. I put on my knee-length boxing shorts. They arrive with the hypodermics.
May 13
Whatever cocktail of see-you-later drugs they are pouring into me, there must be a muscle relaxant. My facial muscles are so out of it I can't even raise my eyebrows, meaning my perspective is reduced to the bottom of two white tunics, one pair of trainers and one pair of black shoes - my life has become a series of being pulled into a sitting position to be checked and re-sedated as my mind gropes around the smog.
And the smell. Always the smell of those that have suffered before me in this same bed.
May 14
I watch them drag the monitoring equipment to the room across the hall. Its occupant arrived the same day as me. I caught sight of him in the car park, climbing out of a people carrier with an older lady, possibly his mother.
Quite often I call across to him, "All right there Tom?"
Sometimes a hand rises. Just a hand. And something about the way it falls again tells how he must be feeling and though I don't know him I love him for having the spirit to raise it.
Just before the latest sedative kicks in, I set about disengaging the bed's security bars. My legs collapse and for a long time I lie on the floor, desperate to muster the energy to crawl and then stand up using the sink for support. Finally, I am in front of the mirror, staring at a three-dimensional horror mask that is my own face.
May 15
"Am I going home today?"
"Yes, today is the big one," chirps nurse Bev.
The effort required to pull my trousers on leaves me weak. All I can think is I've done it, over and over I've done it, little old me sitting there, rocking backwards and forwards in the chair, eyes streaming. Euphoria.
We are back in Elizabeth's silver monster, driving back to the Stratford cottage to recover for a while in the peace and quiet before heading home to Cornwall. The clinic has given Elizabeth a big collection of pills to administer. She has put them in a biscuit tin. On arrival, I head for bed. Come early evening, the chemically-induced euphoria begins to expire. And when it does the result is a physical nightmare involving projectiles from both main orifices at the same time.
In four words: Extremely. Severe. Withdrawal. Symptoms.
May 16
It is five o'clock in the morning. Elizabeth has spent the past two hours trying to rouse a doctor, any doctor, from his warm bed to come over and take a look at this piece of shit pulsating on the bed. I am freezing and hot and throwing up.
The collection of follow-up drugs that the clinic sent with us includes: Buscopan for cramps, and trazodone, which is a sedative/ anti-depressant. There is chlorpromazine (most people know it as Largactyl); a note written in red pen on the box says it's for sickness. There is Gaviscon, to coat the stomach, and Imodium for diarrhoea. And there is naltrexone, a blocking drug that wraps itself round the opiate receptors in the brain, rendering the question of a relapse redundant. The Buscopan is taking care of the cramps. Otherwise, we are talking - on a suffering scale of one to 10 - about a seven as opposed to an eight. So what is a 10? Unbearable.
But this is unbearable. And here is poor Elizabeth with her apron and her rubber gloves. As I quiver under the covers the sound of her cleaning away an earlier accident in the bathroom penetrates my pain and registers my shame and self-loathing.
Come mid-afternoon we decide to try the hospital. This involves me getting up, taking a bath and getting dressed, which is no mean feat. Outside the light is too much. I have to shuffle along, holding on to Elizabeth for support, using the other hand to cover my eyes. The sun is blaring and Joe Public is in shorts and sandals. I have four layers of clothing up top and I am freezing cold.
In A&E a young girl is in some distress and I feel that wretchedness I always feel in such situations when I have to reveal that I am - in effect - a self-inflicted case. He examines my stomach and gives me a jab in the arm for the sickness. For this I have to remove my layers, and in a mirror I catch sight of this pale, emaciated me. Arrogant though it is to say it, I have - under normal circs - a very fit body. Every muscle is well developed and clearly defined; fast twitch athletic as opposed to beefcake.
I am disconcerted and depressed by the rinsed-out looking old guy staring back at me.
On our return home I am sick again. By now I have concluded that there is some sort of link between me taking the assortment of pills that the clinic gave me, and me spewing my guts up.
May 17
More of the same.
May 18
The sickness and diarrhoea have passed and I feel just plain old shit. I have gone from the one extreme of being insulated against my emotions to the other of being hyper-sensitive. The smell of Elizabeth cooking a home made chicken pie sets me salivating like one of Pavlov's dogs. The first mouthful is actually painful. Just being touched is unbearable.
Already the cracks are appearing through which my addiction attempts to squeeze. One song on a 16-track CD is my current addiction (The Lighthouse Family: Lifted, remix with the vocoder). I play it overandoverandoverandover. I dispose of a six-pack of crisps in as many minutes and then want moreandmoreandmore.
Elizabeth corners me in the conservatory - my favourite hangout - and confronts me about events in my recent past: fighting in the street (banging out liberty-takers); driving my black 2-litre GTi coupe like a dickhead; shouting people down and refusing to listen at boxing club committee meetings; phoning friends at any hour asking for money.
I accept most of that. But the driving ... I think when the day dawns that I can regard the vehicle in front of me as anything but a challenge to overtake, it'll be about time to cook up the final big hit and put me out of my misery ...
May 23
The car sits loaded up on the gravel and we are bound for Cornwall and home. The previous time I visited Elizabeth's cottage I was a full-on, syringe-carrying smackhead. In fact, I was here to reduce myself from mainlining heroin to swallowing codeine tablets instead. Getting home to Penzance from that trip the first familiar face I encountered - on leaving the car park to walk to my flat - was that of my heroin dealer. I didn't know whether to punch him or score off him. Sadly I did the latter.
But hey, that was then. Now I have naltrexone in my system. Even so, I feel completely exposed and vulnerable.
May 26
As usual, since leaving the clinic I have had three hours of fitful sleep. After the anti- depressant sedative I take in the evenings, rising from the bed is a monumental effort but preferable to lying here, at the mercy of my thoughts. This particular morning I set about a bin liner full of laundry. I tackle the carpets, the dishes and the dusting and then it's down to the beach. At exactly 7.30 every morning an elderly lady appears and proceeds to cram her head into a rubber skull cap before dashing into the freezing cold sea. I am in awe of her.
It would be a distortion to say that I am enjoying my own company at the moment but I certainly prefer it to other people's. By what satanic route did I arrive at the point where I could tell my beautiful, pregnant partner: "I'm not sure if that baby is mine anyway." It happened in the street and it was loud and ugly. The effect was quite sobering. She feels rejected by me. Rejection becomes anger and anger becomes recrimination. The structure of our relationship - such as it was - has collapsed. At times we are like two strangers, trapped by proximity.
May 27
My GP looks long and hard at this resurrected vampire as I plonk myself down in his chair. Before leaving for Detox 5 I told him, "The next time you see me I will be asking for a repeat prescription of naltrexone", and here I am doing just that. I have gained more than a stone. I have colour in my cheeks too, but the real evidence of my detoxification is in my eyes. The demons have left them now. Back home, I go into the garden tool shed and punch the shit out of the maize bag hanging there for an hour or so. Afterwards, drenched in sweat, there is something missing. A sensation almost as familiar as the air I breathe, that feeling of serenity that comes from endorphins. Instead, my joints ache slightly and my stomach is churning. It is at this point that I retrieve the naltrexone box. The first paragraph of its consumer pamphlet explains: "Naltrexone hydrochloride is an opioid antagonist, which means that it blocks the effects of opioid drugs prescribed by your GP, (eg dihydrocodeine, morphine, and heroin) and the body's own opioids which occur naturally in the brain."
Side effects: difficulty sleeping, anxiety, cramps, nausea, lack of energy, joint and muscle pain, headaches, loss of appetite, diarrhoea, irritability, dizziness, reduced libido ...
I know, even before I have reached the end, that I will never take this drug again.
May 28
A fortnight out of detox. Pressure from family and friends since my decision to stop naltrexone, including a phone call this morning - this feels surreal - from a nurse at Harrogate ordering me to take it. I am torn between my revulsion at a drug that severely disagrees with me, and what I see as my responsibility to everybody, including my unborn child - who is due on Christmas day.
June 17
The back-slapping is all but behind me and now there is the business of carving out a future. A letter arrives inviting me to make an interview date at Cornwall College in Camborne, where I am hoping to go in September. I have already missed the standard Ucas entry system.
July 20
There is a problem with the baby. This morning there was a wake-up phone call from a specialist midwife. A blood test for spina bifida has come back "raised". We are given an emergency appointment for an ultrasound at Trelisk hospital. When our turn finally comes, the scan images show a perfectly formed baby. More blood to be taken tomorrow and then more days of waiting for the results. There is a brown A4 envelope on the doormat this evening. It is a letter from the college course coordinator, along with manuscripts I left for her to read when we met at interview. They cover my life as an addict, and the Detox 5 experience. She thanks me for my honesty. She would like to take this opportunity to offer me a place on the course. (Full title: "Management and Sport and Exercise Science".)
Another day
To any passing jogger I am just another driver sitting in my little black car at Long Rock beach. There is a wholesomeness about this scene: the dog walkers and, beyond, the wind and kite surfers skimming before a purple sunset. And I have no part to play in it. Dangling from my lips is a slim silver tube. In one hand is a clipper lighter and in the other a sheet of tin foil with a blob of molten heroin on it. Inside I am warm and comforted. The torture of whether to score has been wrestling with me all day. Tonight when I go to bed and switch the light off the shame will come smoking out of the darkness.
July 30
For every day I score some heroin there is a little red asterisk in my diary. There were two for the week before last, three for last week and by the end of this week I am vaulting over my dealer's back wall every other morning as the children on the estate make their way to school.
I need to get this under control before it is too late. My counsellor knows of another opiate blocker called Subutex. She will post me a pamphlet.
August 16
So doctor, the wheels have fallen off my dream wagon again. I need you to change my prescription from naltrexone to Subutex. Problem: only the local drugs team can prescribe this. A quick referral then? Minimum six-week waiting list, says my GP. By that time I will be addicted to heroin again.
We'll have to find a quicker route. Paul Wiggans runs the drug assessment and stabilisation programme based in Redruth. He has known me for many years. Based on that knowledge of my history, getting him to approve a Subutex prescription proves a simple matter of asking.
August 20
I collect my first prescription of Subutex. The white-coated pharmacist is polite. I notice that, unlike in Penzance, I haven't encountered a single other addict. Because Subutex, too, is an opiate blocker, it's likely I will have some withdrawal symptoms due to the heroin still in my system from last night. I toss the blister pack unopened into the car's console and reach for the ignition.
It has been a month since I began taking Subutex. Once a week I've come to see Paul Wiggans for a "quick chat" and a saliva drug test. This morning he has the lab results from the last four weeks. They are all negative. This comes as no surprise to me and yet it is immensely gratifying, with the autumn sun streaming through the window, to see it in black and white.
It seems too early to be openly rejoicing and yet I feel, for the very first time since my discharge from the clinic, that I am on solid ground. My emotions have a dry, healthy feel to them. After my 11 o'clock with Paul I resist a niggling urge to roll a joint in the car and make instead for the open beach.
Induction week at college has just finished. Yesterday the 15 individuals on my course introduced ourselves. I mentioned my ambition to work with young offenders in a sporting capacity. I spoke for maybe 10 minutes without mention of crime, prison, addiction. My portrait comes across as: one-dimensional do-gooder. November 11
Nadia feels slightly queasy - not unusual, but we decide to go to Trelisk hospital. The nurses quickly rig up a monitor. We are there most of the day, tense and yet reassured by the amplified sound of the little one's heart beating. A consultant decides Nadia should be admitted for observation. Just in case.
November 22
Exams. My tutor and fellow students know that Nadia is in hospital and I am moved by their interest and their kindness. Constant flitting between college, home and hospital. I am sleeping four hours a night and my weight has fallen quite dramatically.College life is good. I have a real reason to rise from my bed at 7 every grim, freezing morning. I am up to date on all my work. But as a group we have not gelled. There are a number of reasons for this, none of which are really important to me because there was never any question that I was going to get too close to anybody.
Christos is extracted from an incision in Nadia's abdomen as I stand holding her hand. His first scream is ear-splitting. Everything happening around me seems vivid and slightly out of sync, as though I am in shock.
A scan yesterday morning revealed that the amniotic fluid surrounding the baby was low. Nadia was distraught. The consultant was a grey-haired old gentleman in tweeds and half-moon glasses. His cheerful outlook priceless at that moment. I knew what was coming next, and sure enough they decided to perform the C section. After they left the room was very big. For a long time we sat holding hands. Later in the evening my mother set off from London to be here.
November 29
In class, a round of applause and I go red.
We take Christos out for the first time - to a restaurant to have dinner with Elizabeth. Almost everybody who walks past our table stops to look at him and occasionally to say how beautiful he is. By the end of it I am puffed up with pride.
Nadia and Christos were discharged on December 7. After college that day I drove to the hospital to collect them. Nadia's father and I had just moved her things from the tiny cottage in Penzance to another little place closer to mine. The idea was that this would become our home.
February 10 2005
My landlord and landlady have decided to sell their big house, which means that about a year after my arrival here I will have to say goodbye to my flat in paradise. But this time I will take with me a good reference. I walk to the beach and sit on the sand, in the exact spot I used to come to on those sleepless nights immediately after the Detox 5, when my body was still recovering from the shock and my emotions were all over the place.
The day-to-day routine that previously held my life together has now been swept away. Nothing can prepare you for nursing your own new-born little bundle. A typical day since going back to college after the Christmas break: Classes in the daytime. Boxing in the evening. Arrive home exhausted with two assignments to catch up on. Am still there with it at 2am. Three hours' sleepbefore baby wakes demanding a feed. Grab another hour's sleep before leaving for college at eight.
March 16
My 41st birthday. Nadia's mother looks after Christos and we go out for a meal.
At college there is a work placement module that requires a criminal records check. I am apprehensive about it. At what point - if ever - does a man with my background really put the past behind him?
May 23
Depression. In recent weeks this has intensified into bouts of paranoia and occasional panic in the street. My GP has prescribed anti-depressants, which sit in a drawer untouched. Taking more than Subutex does not appeal. I am glad when I receive an appointment through the post today to see a psychotherapist. I haven't a clue what psychotherapy involves.
Since my flat disappeared, I moved my possessions in early April to a little studio I managed to rent just behind the cottage. There has been a lot of friction between Nadia and me about my need to have a separate place. I love her completely and exclusively. But so much of my life has been in tiny prison cells - sometimes 24/7 for months - I need some solitude to function.
July 1
Down to Redruth for what will be my fifth session with Bill, my psychotherapist. To begin with I was sceptical but with each session I see more about why my life turned out the way it did. Sometimes I come out shaking and covered in sweat. I have more than my share of horror stories to tell. The stigma of my addiction and my criminal past cling to me and no matter how normal a person I become, I think this will always be so.
The first year of my course is over. In the college library during the days of June, only a few stragglers trying to catch up - I was one. Other students looked forward to the three-month break. I have been dreading it. College has provided structure in my life.
August
Now, Christos demands most of what I have by way of free time, and there is very little room for diary reflections about my life. Some things I can say. Towards the end of July the intermittent smog that has been my depression descended and decided to stick around for a while. There were days I could barely motivate myself to have a wash in the morning. Nothing had any meaning. One of the hardest aspects of an illness like this is that - to all outward appearances - my life contains all the ingredients of an enviable present and a bright future. That period of depression did pass.
Today
When it comes to recovering from heroin addiction I am now well into year two. I am almost unrecognisable from the character I was when I began this journal. That is not to say my life is a wheeze. It is not.
My struggle has shifted towards the matter of how, really, to be part of this small community. As a lifetime criminal I rarely spent more than a month or two in any location and as a convict I was constantly being ghosted from one jail to the next at the first sign of trouble.
I am unsure what the exact mechanics of assimilation are. My ignorance on the subject is quite profound. Father, boxing coach, fitness instructor, student, writer - I have no innate sense of public identity. If we are, in fact, merely the sum of what we think others think we are, then for the most part I am that geezer from London who pushes the pram along the cobbled streets every day.
Tentatively we have made a few friends. People to nod to in the street, shopkeepers passing the odd comment about the weather, the man from the pasty place on the corner who always asks if I am keeping out of trouble.
So I have, slowly, felt myself becoming assimilated here, as an individual and as the head of a small family. This has been difficult and at times painful. Social anxiety is the textbook name for it but in old money it amounts to caring what the neighbours think. And there it is in a nutshell. Today I care what the neighbours think, not least because that affects my family as well as me.
As each month passes, Christos becomes bigger, stronger and brighter. This might almost be a metaphor for the way I feel about myself.
· The cost of Andrew Constantine's detox was met by the Guardian in lieu of a fee for this article. Some names have been changed.
Heroin was killing Andrew Constantine. Desperate to survive, he signed up for radical detox. For five days he was drugged into near-unconsciousness. This is his compelling chronicle of that gruelling time - and what has happened in his life since he walked out of the clinic door
Andrew Constantine
Friday September 2, 2005
Guardian
March 1 2004 Another grey, freezing Penzance morning. My waking ritual begins with 10 dihydrocodeine tablets, 30ml, lots of steaming coffee and a spell of chain smoking cannabis as I sit staring out the window at the backs of the houses opposite. Six weeks to go before I'm evicted from here.
The codeine tablets are meant to treat an ongoing ear infection. I keep them in the cupboard for emergencies when money or heroin are short. Soon the rotting feeling in my stomach dissipates enough for me to stop being aware of it and my mind begins groping around among last night's plans for an emotional foothold of some sort; plans devised in the darkness, out of bitterness, resentment and self-pity.
March 16
Birthday number 40, and my overriding thought is: my life might be falling apart, but I don't want to die yet. There was that overdose last Christmas - met a girl at Narcotics Anonymous, she took me home, cooked me up a hit and practically killed me ... So OK doctor, what's on offer?
As far as my GP is concerned, a referral to the local drugs team is on the cards. But for residential rehab there's an eight-month waiting list. So really, the team's only immediate resort is methadone. I have big misgivings. I run a boxing club, and come September I want to start a foundation degree at college. So does this make me special? Well no, but what it does make me is desperate not to become one of those walking methadone corpses.
Whatever the theory of maintaining people on methadone, the reality is on the streets of Penzance. Under the security cameras on the corner of Causewayhead, you will always find a contingent shooting the breeze, scoring heroin; addicts and alcoholics without hope, staggering and dazed. Because it's never just the methadone is it? It's the benzos and the sleepers and the anti-depressants and the barbiturates that seem to be dispensed like confetti.
But there is this other thing I've heard about. Apparently, it's a treatment that involves being put to sleep for five days and, when you come to, you are no longer dependent on opiates. This sounds a bit too good to be true.
April 5-12
Had to get away from Penzance. My cat is traumatised by the move: still in Cornwall, new town. Sorry, Tizer. The flat really is lovely, though. My guiding idea now is to undergo this programme, "Detox 5". I see it as my final chance.
My doctor has made inquiries and sent referral forms to the clinic I've chosen, in Harrogate, north Yorkshire. We're waiting for confirmation.
For most of the five days, I'll be heavily sedated - in effect, one bunch of drugs will keep me semi-unconscious while my system (so the plan goes) gets over its dependence on another lot, opiates. I also have to find a "nominated supervisor", who will escort me to and from Harrogate, and be available during the treatment. My long-time friend and mentor Elizabeth, who came to Cornwall when she and her husband retired, has agreed to do this. To her I owe deep thanks for never giving up on me. Ever.
I've read the glossy booklet I got in the post. One picture is of a dining hall. Resembles Trusthouse Forte. The second is of a girl lying on a couch, looking kind of smug. That's good then.
How will I feel after the five days? One of the clinic coordinators told me over the phone to imagine "getting over a really really bad bout of flu - and times it by 10". Don't like the sound of that.
April 14
We have it straight from the lab. My girlfriend Nadia is pregnant. Words inadequate.
April 24
The loose ends were tied up yesterday. I am booked into the Detox 5 clinic on May 10.
Dropped my partner off at her folks' place. An argument at 4am. Afterwards the weather was beautiful driving home, roof open. I slipped into Penzance and scored. Going back to the car park, I stopped a man in the street, pushing a pram, tiny little baby in there.
"My fiancee is three weeks gone," I said. "Can I look?"
"Sure." He stopped.
And together we adopted that crouched-over, hands-on-thighs thing. A beautiful little creature. Soon, I will be a father. Sixteen days to detox.
May 9
A glorious sunny morning and I have said all my goodbyes. The landlord and his wife. My pregnant partner. My cat, my second in command at the boxing club and, finally, my dealer.
We set off in Elizabeth's long silver monstrosity of a car. Having had my last fix, all I've got now is a bottle of about 30 dihydrocodeine. Half will go overnight, to get me to sleep.
By the time we have switched from the A30 on to the M5 my vague unease has focused into a dense cold mass of anxiety.
May 10
Before setting out on the final leg, from the cottage Elizabeth keeps in Stratford to Harrogate, I have taken my last 15 dihydrocodeine.
In the car I find myself telling Elizabeth a nightmare story of a detox (involuntary) at Wormwood Scrubs prison, about eight years ago, when I woke up lying in a pool of my own vomit. Those horrifyingly intense feelings of abject despair and physical torment will stay with me for a very long time.
"How many prison detoxes have you actually been through?" Elizabeth asks. In all honesty, I reply that I have lost count.
The clinic building is one of those fairly modern brick jobbos. A nurse with a ponytail shows me to what will be my room. His badge says he is Andy.
The room itself is quite cheerful, three-star hotel sort of thing. Great effort has clearly been made. It's the bed that gives it away. There are sidebars, that and the smell of sickness and suffering that no amount of disinfectant will ever eradicate.
Andy lights a smoke, and answers some questions. No, there will be no IV drip, I will be put under heavy sedation and woken every two hours to have my blood pressure and pulse checked. I will be required to drink half a pint of something that tastes not very nice during these checks. Afterwards I will remember very little. The price, by the way, is three grand, which of course renders it out of reach for almost every addict out there. The only way I can pay for this is that I've managed to find a (sort of) sponsor.
Then the troupe arrive, dragging equipment, lots of digital displays and dangly bits to check my weight, height, blood pressure, pulse. They take blood and urine samples. The resident psychiatrist, a serious straight-talking consultant, Amal Beaini, draws us some diagrams and discusses medicating individual symptoms of my impending withdrawal.
And then it's back to my room. Elizabeth is gone. I put on my knee-length boxing shorts. They arrive with the hypodermics.
May 13
Whatever cocktail of see-you-later drugs they are pouring into me, there must be a muscle relaxant. My facial muscles are so out of it I can't even raise my eyebrows, meaning my perspective is reduced to the bottom of two white tunics, one pair of trainers and one pair of black shoes - my life has become a series of being pulled into a sitting position to be checked and re-sedated as my mind gropes around the smog.
And the smell. Always the smell of those that have suffered before me in this same bed.
May 14
I watch them drag the monitoring equipment to the room across the hall. Its occupant arrived the same day as me. I caught sight of him in the car park, climbing out of a people carrier with an older lady, possibly his mother.
Quite often I call across to him, "All right there Tom?"
Sometimes a hand rises. Just a hand. And something about the way it falls again tells how he must be feeling and though I don't know him I love him for having the spirit to raise it.
Just before the latest sedative kicks in, I set about disengaging the bed's security bars. My legs collapse and for a long time I lie on the floor, desperate to muster the energy to crawl and then stand up using the sink for support. Finally, I am in front of the mirror, staring at a three-dimensional horror mask that is my own face.
May 15
"Am I going home today?"
"Yes, today is the big one," chirps nurse Bev.
The effort required to pull my trousers on leaves me weak. All I can think is I've done it, over and over I've done it, little old me sitting there, rocking backwards and forwards in the chair, eyes streaming. Euphoria.
We are back in Elizabeth's silver monster, driving back to the Stratford cottage to recover for a while in the peace and quiet before heading home to Cornwall. The clinic has given Elizabeth a big collection of pills to administer. She has put them in a biscuit tin. On arrival, I head for bed. Come early evening, the chemically-induced euphoria begins to expire. And when it does the result is a physical nightmare involving projectiles from both main orifices at the same time.
In four words: Extremely. Severe. Withdrawal. Symptoms.
May 16
It is five o'clock in the morning. Elizabeth has spent the past two hours trying to rouse a doctor, any doctor, from his warm bed to come over and take a look at this piece of shit pulsating on the bed. I am freezing and hot and throwing up.
The collection of follow-up drugs that the clinic sent with us includes: Buscopan for cramps, and trazodone, which is a sedative/ anti-depressant. There is chlorpromazine (most people know it as Largactyl); a note written in red pen on the box says it's for sickness. There is Gaviscon, to coat the stomach, and Imodium for diarrhoea. And there is naltrexone, a blocking drug that wraps itself round the opiate receptors in the brain, rendering the question of a relapse redundant. The Buscopan is taking care of the cramps. Otherwise, we are talking - on a suffering scale of one to 10 - about a seven as opposed to an eight. So what is a 10? Unbearable.
But this is unbearable. And here is poor Elizabeth with her apron and her rubber gloves. As I quiver under the covers the sound of her cleaning away an earlier accident in the bathroom penetrates my pain and registers my shame and self-loathing.
Come mid-afternoon we decide to try the hospital. This involves me getting up, taking a bath and getting dressed, which is no mean feat. Outside the light is too much. I have to shuffle along, holding on to Elizabeth for support, using the other hand to cover my eyes. The sun is blaring and Joe Public is in shorts and sandals. I have four layers of clothing up top and I am freezing cold.
In A&E a young girl is in some distress and I feel that wretchedness I always feel in such situations when I have to reveal that I am - in effect - a self-inflicted case. He examines my stomach and gives me a jab in the arm for the sickness. For this I have to remove my layers, and in a mirror I catch sight of this pale, emaciated me. Arrogant though it is to say it, I have - under normal circs - a very fit body. Every muscle is well developed and clearly defined; fast twitch athletic as opposed to beefcake.
I am disconcerted and depressed by the rinsed-out looking old guy staring back at me.
On our return home I am sick again. By now I have concluded that there is some sort of link between me taking the assortment of pills that the clinic gave me, and me spewing my guts up.
May 17
More of the same.
May 18
The sickness and diarrhoea have passed and I feel just plain old shit. I have gone from the one extreme of being insulated against my emotions to the other of being hyper-sensitive. The smell of Elizabeth cooking a home made chicken pie sets me salivating like one of Pavlov's dogs. The first mouthful is actually painful. Just being touched is unbearable.
Already the cracks are appearing through which my addiction attempts to squeeze. One song on a 16-track CD is my current addiction (The Lighthouse Family: Lifted, remix with the vocoder). I play it overandoverandoverandover. I dispose of a six-pack of crisps in as many minutes and then want moreandmoreandmore.
Elizabeth corners me in the conservatory - my favourite hangout - and confronts me about events in my recent past: fighting in the street (banging out liberty-takers); driving my black 2-litre GTi coupe like a dickhead; shouting people down and refusing to listen at boxing club committee meetings; phoning friends at any hour asking for money.
I accept most of that. But the driving ... I think when the day dawns that I can regard the vehicle in front of me as anything but a challenge to overtake, it'll be about time to cook up the final big hit and put me out of my misery ...
May 23
The car sits loaded up on the gravel and we are bound for Cornwall and home. The previous time I visited Elizabeth's cottage I was a full-on, syringe-carrying smackhead. In fact, I was here to reduce myself from mainlining heroin to swallowing codeine tablets instead. Getting home to Penzance from that trip the first familiar face I encountered - on leaving the car park to walk to my flat - was that of my heroin dealer. I didn't know whether to punch him or score off him. Sadly I did the latter.
But hey, that was then. Now I have naltrexone in my system. Even so, I feel completely exposed and vulnerable.
May 26
As usual, since leaving the clinic I have had three hours of fitful sleep. After the anti- depressant sedative I take in the evenings, rising from the bed is a monumental effort but preferable to lying here, at the mercy of my thoughts. This particular morning I set about a bin liner full of laundry. I tackle the carpets, the dishes and the dusting and then it's down to the beach. At exactly 7.30 every morning an elderly lady appears and proceeds to cram her head into a rubber skull cap before dashing into the freezing cold sea. I am in awe of her.
It would be a distortion to say that I am enjoying my own company at the moment but I certainly prefer it to other people's. By what satanic route did I arrive at the point where I could tell my beautiful, pregnant partner: "I'm not sure if that baby is mine anyway." It happened in the street and it was loud and ugly. The effect was quite sobering. She feels rejected by me. Rejection becomes anger and anger becomes recrimination. The structure of our relationship - such as it was - has collapsed. At times we are like two strangers, trapped by proximity.
May 27
My GP looks long and hard at this resurrected vampire as I plonk myself down in his chair. Before leaving for Detox 5 I told him, "The next time you see me I will be asking for a repeat prescription of naltrexone", and here I am doing just that. I have gained more than a stone. I have colour in my cheeks too, but the real evidence of my detoxification is in my eyes. The demons have left them now. Back home, I go into the garden tool shed and punch the shit out of the maize bag hanging there for an hour or so. Afterwards, drenched in sweat, there is something missing. A sensation almost as familiar as the air I breathe, that feeling of serenity that comes from endorphins. Instead, my joints ache slightly and my stomach is churning. It is at this point that I retrieve the naltrexone box. The first paragraph of its consumer pamphlet explains: "Naltrexone hydrochloride is an opioid antagonist, which means that it blocks the effects of opioid drugs prescribed by your GP, (eg dihydrocodeine, morphine, and heroin) and the body's own opioids which occur naturally in the brain."
Side effects: difficulty sleeping, anxiety, cramps, nausea, lack of energy, joint and muscle pain, headaches, loss of appetite, diarrhoea, irritability, dizziness, reduced libido ...
I know, even before I have reached the end, that I will never take this drug again.
May 28
A fortnight out of detox. Pressure from family and friends since my decision to stop naltrexone, including a phone call this morning - this feels surreal - from a nurse at Harrogate ordering me to take it. I am torn between my revulsion at a drug that severely disagrees with me, and what I see as my responsibility to everybody, including my unborn child - who is due on Christmas day.
June 17
The back-slapping is all but behind me and now there is the business of carving out a future. A letter arrives inviting me to make an interview date at Cornwall College in Camborne, where I am hoping to go in September. I have already missed the standard Ucas entry system.
July 20
There is a problem with the baby. This morning there was a wake-up phone call from a specialist midwife. A blood test for spina bifida has come back "raised". We are given an emergency appointment for an ultrasound at Trelisk hospital. When our turn finally comes, the scan images show a perfectly formed baby. More blood to be taken tomorrow and then more days of waiting for the results. There is a brown A4 envelope on the doormat this evening. It is a letter from the college course coordinator, along with manuscripts I left for her to read when we met at interview. They cover my life as an addict, and the Detox 5 experience. She thanks me for my honesty. She would like to take this opportunity to offer me a place on the course. (Full title: "Management and Sport and Exercise Science".)
Another day
To any passing jogger I am just another driver sitting in my little black car at Long Rock beach. There is a wholesomeness about this scene: the dog walkers and, beyond, the wind and kite surfers skimming before a purple sunset. And I have no part to play in it. Dangling from my lips is a slim silver tube. In one hand is a clipper lighter and in the other a sheet of tin foil with a blob of molten heroin on it. Inside I am warm and comforted. The torture of whether to score has been wrestling with me all day. Tonight when I go to bed and switch the light off the shame will come smoking out of the darkness.
July 30
For every day I score some heroin there is a little red asterisk in my diary. There were two for the week before last, three for last week and by the end of this week I am vaulting over my dealer's back wall every other morning as the children on the estate make their way to school.
I need to get this under control before it is too late. My counsellor knows of another opiate blocker called Subutex. She will post me a pamphlet.
August 16
So doctor, the wheels have fallen off my dream wagon again. I need you to change my prescription from naltrexone to Subutex. Problem: only the local drugs team can prescribe this. A quick referral then? Minimum six-week waiting list, says my GP. By that time I will be addicted to heroin again.
We'll have to find a quicker route. Paul Wiggans runs the drug assessment and stabilisation programme based in Redruth. He has known me for many years. Based on that knowledge of my history, getting him to approve a Subutex prescription proves a simple matter of asking.
August 20
I collect my first prescription of Subutex. The white-coated pharmacist is polite. I notice that, unlike in Penzance, I haven't encountered a single other addict. Because Subutex, too, is an opiate blocker, it's likely I will have some withdrawal symptoms due to the heroin still in my system from last night. I toss the blister pack unopened into the car's console and reach for the ignition.
It has been a month since I began taking Subutex. Once a week I've come to see Paul Wiggans for a "quick chat" and a saliva drug test. This morning he has the lab results from the last four weeks. They are all negative. This comes as no surprise to me and yet it is immensely gratifying, with the autumn sun streaming through the window, to see it in black and white.
It seems too early to be openly rejoicing and yet I feel, for the very first time since my discharge from the clinic, that I am on solid ground. My emotions have a dry, healthy feel to them. After my 11 o'clock with Paul I resist a niggling urge to roll a joint in the car and make instead for the open beach.
Induction week at college has just finished. Yesterday the 15 individuals on my course introduced ourselves. I mentioned my ambition to work with young offenders in a sporting capacity. I spoke for maybe 10 minutes without mention of crime, prison, addiction. My portrait comes across as: one-dimensional do-gooder. November 11
Nadia feels slightly queasy - not unusual, but we decide to go to Trelisk hospital. The nurses quickly rig up a monitor. We are there most of the day, tense and yet reassured by the amplified sound of the little one's heart beating. A consultant decides Nadia should be admitted for observation. Just in case.
November 22
Exams. My tutor and fellow students know that Nadia is in hospital and I am moved by their interest and their kindness. Constant flitting between college, home and hospital. I am sleeping four hours a night and my weight has fallen quite dramatically.College life is good. I have a real reason to rise from my bed at 7 every grim, freezing morning. I am up to date on all my work. But as a group we have not gelled. There are a number of reasons for this, none of which are really important to me because there was never any question that I was going to get too close to anybody.
Christos is extracted from an incision in Nadia's abdomen as I stand holding her hand. His first scream is ear-splitting. Everything happening around me seems vivid and slightly out of sync, as though I am in shock.
A scan yesterday morning revealed that the amniotic fluid surrounding the baby was low. Nadia was distraught. The consultant was a grey-haired old gentleman in tweeds and half-moon glasses. His cheerful outlook priceless at that moment. I knew what was coming next, and sure enough they decided to perform the C section. After they left the room was very big. For a long time we sat holding hands. Later in the evening my mother set off from London to be here.
November 29
In class, a round of applause and I go red.
We take Christos out for the first time - to a restaurant to have dinner with Elizabeth. Almost everybody who walks past our table stops to look at him and occasionally to say how beautiful he is. By the end of it I am puffed up with pride.
Nadia and Christos were discharged on December 7. After college that day I drove to the hospital to collect them. Nadia's father and I had just moved her things from the tiny cottage in Penzance to another little place closer to mine. The idea was that this would become our home.
February 10 2005
My landlord and landlady have decided to sell their big house, which means that about a year after my arrival here I will have to say goodbye to my flat in paradise. But this time I will take with me a good reference. I walk to the beach and sit on the sand, in the exact spot I used to come to on those sleepless nights immediately after the Detox 5, when my body was still recovering from the shock and my emotions were all over the place.
The day-to-day routine that previously held my life together has now been swept away. Nothing can prepare you for nursing your own new-born little bundle. A typical day since going back to college after the Christmas break: Classes in the daytime. Boxing in the evening. Arrive home exhausted with two assignments to catch up on. Am still there with it at 2am. Three hours' sleepbefore baby wakes demanding a feed. Grab another hour's sleep before leaving for college at eight.
March 16
My 41st birthday. Nadia's mother looks after Christos and we go out for a meal.
At college there is a work placement module that requires a criminal records check. I am apprehensive about it. At what point - if ever - does a man with my background really put the past behind him?
May 23
Depression. In recent weeks this has intensified into bouts of paranoia and occasional panic in the street. My GP has prescribed anti-depressants, which sit in a drawer untouched. Taking more than Subutex does not appeal. I am glad when I receive an appointment through the post today to see a psychotherapist. I haven't a clue what psychotherapy involves.
Since my flat disappeared, I moved my possessions in early April to a little studio I managed to rent just behind the cottage. There has been a lot of friction between Nadia and me about my need to have a separate place. I love her completely and exclusively. But so much of my life has been in tiny prison cells - sometimes 24/7 for months - I need some solitude to function.
July 1
Down to Redruth for what will be my fifth session with Bill, my psychotherapist. To begin with I was sceptical but with each session I see more about why my life turned out the way it did. Sometimes I come out shaking and covered in sweat. I have more than my share of horror stories to tell. The stigma of my addiction and my criminal past cling to me and no matter how normal a person I become, I think this will always be so.
The first year of my course is over. In the college library during the days of June, only a few stragglers trying to catch up - I was one. Other students looked forward to the three-month break. I have been dreading it. College has provided structure in my life.
August
Now, Christos demands most of what I have by way of free time, and there is very little room for diary reflections about my life. Some things I can say. Towards the end of July the intermittent smog that has been my depression descended and decided to stick around for a while. There were days I could barely motivate myself to have a wash in the morning. Nothing had any meaning. One of the hardest aspects of an illness like this is that - to all outward appearances - my life contains all the ingredients of an enviable present and a bright future. That period of depression did pass.
Today
When it comes to recovering from heroin addiction I am now well into year two. I am almost unrecognisable from the character I was when I began this journal. That is not to say my life is a wheeze. It is not.
My struggle has shifted towards the matter of how, really, to be part of this small community. As a lifetime criminal I rarely spent more than a month or two in any location and as a convict I was constantly being ghosted from one jail to the next at the first sign of trouble.
I am unsure what the exact mechanics of assimilation are. My ignorance on the subject is quite profound. Father, boxing coach, fitness instructor, student, writer - I have no innate sense of public identity. If we are, in fact, merely the sum of what we think others think we are, then for the most part I am that geezer from London who pushes the pram along the cobbled streets every day.
Tentatively we have made a few friends. People to nod to in the street, shopkeepers passing the odd comment about the weather, the man from the pasty place on the corner who always asks if I am keeping out of trouble.
So I have, slowly, felt myself becoming assimilated here, as an individual and as the head of a small family. This has been difficult and at times painful. Social anxiety is the textbook name for it but in old money it amounts to caring what the neighbours think. And there it is in a nutshell. Today I care what the neighbours think, not least because that affects my family as well as me.
As each month passes, Christos becomes bigger, stronger and brighter. This might almost be a metaphor for the way I feel about myself.
· The cost of Andrew Constantine's detox was met by the Guardian in lieu of a fee for this article. Some names have been changed.