PITTSFIELD — Nearly eight years drug-free, Amy Borden dismisses the notion that addiction is a choice.
"Until you're there," she said, "you can't say it's a choice."
"Yes, it was a choice that I picked up, but there was all this stuff in my life that led me to that because I couldn't deal with it myself."
Addiction, Borden said, is a disease.
"People do not go and rob their families and steal from their children and commit crimes as a choice."
Borden, 42, began abusing pain killers in early 2000, while trying to cope with stress associated with a divorce.
"I have depression and I felt like my life was over with the divorce, becoming a single mother," she said. "I had a suicide attempt and then found the painkillers and it just masked the pain."
Borden said she mostly indulged in opiate-based painkillers including Percocet and Vicodin.
"I figured out a way to start calling in my prescriptions," she said. "I pretended to be a nurse at the doctor's office."
"Addicts are very smart people. It was very easy back then. I did it for close to a year."
When those avenues dried up, Borden said she was able to get the drugs she needed from family members.
She was asked once by someone close to her who doesn't have an addiction issue why she couldn't just stop.
"It's not that easy," she said. "Unless you're there, you can't understand the physical pain and the emotional pain from stopping."
According to the National Institute on Drug Abuse, heroin and other opiates bind to molecules on cells in the brain called opioid receptors. Many of those receptors are in the areas of the brain that perceive pain and reward and in areas of the brain stem that monitor blood pressure and breathing.
Continued use creates a physical dependance and a reduction or sudden stoppage of use can lead to severe withdrawal symptoms as the body tries to adapt.
The physical effects of opiate withdrawal — including pain, nausea, sweats, cramping, anxiety and vomiting — are well-documented. Less well-known, perhaps, are the emotional effects.
In her case, Borden said, those effects included shame, embarrassment and guilt "from all the hurt that I caused."
The physical effects fade over time and can be treated medically. But the emotional fallout may linger and fester for a long time without counseling and addressing whatever personal issues may have triggered the drug use in the first place.
"When you're taking something to get away from yourself and you stop, everything's still there, no matter what it is you're trying to run away from," Borden said.
Drug abuse stigma
The social stigma of drug abuse is a barrier for many who may otherwise seek help curbing their addictions.
Borden said the reactions from people when they learn she's in recovery from addiction run the gamut from supportive to stand-offish to "kind of disgusted."
Staff from the Brien Center, where Borden has received treatment and counseling and where she now works as a site supervisor, said the World Health Organization lists substance abuse disorders as the most stigmatized diseases worldwide, ahead of leprosy and HIV.
Removing the stigma of addiction that keeps many from seeking treatment has become enough of a concern to prompt Gov. Charlie Baker to launch the "State Without StigMA," a multimedia campaign to eliminate the "shame and secrecy" surrounding the opioid epidemic.
That stigma still looms large for "Frank," a 35-year-old Army veteran whose most recent round of recovery treatment began at the Brien Center on Oct. 4, 2012.
Frank (not his real name) said he'd made about seven prior attempts to get clean, but only his most recent attempt has stuck.
He said a lack of support and after-care following short-term medical detox left him susceptible to relapse.
Frank said the stigma of addiction not only prevents some from seeking treatment or being honest with family and loved ones, it also creates barriers to taking positive steps like applying for work.
Frank said it's often difficult to explain to prospective employers about gaps in work history due to incarceration, treatment or other addiction-related issues, or why you might not be available at certain times during the week if that time is taken up by treatment or counseling.
Even with beginning his third year of sobriety, Frank is reluctant to speak openly about his addiction and recovery.
"It's still a very hard truth to share with anybody," he said.
"My experience is very relatable," he said. "But, I'm always afraid of that stigma."
Fear of that stigma prevents many from seeking help and drives others to commit crimes in order to support the habit they're unable to break on their own.
That, in turn, leads to many cases of arrest and incarceration, which does not necessarily solve addiction issues and in some cases may exacerbate the problem after release.
"I know people who went to jail and it was the check they needed," Borden said. "But, for a lot of people, you're making connections, you're finding out new tricks" to get drugs.
"It always comes down to the person themselves. You can go to jail 50 times and, until you're ready to get clean, you'll go another 50," said Borden.
During her jail stay, Borden said she was unable to participate in a lot of the addiction counseling offered because she was only sentenced to 60 days.
Borden said it was also difficult to have open and productive conversations with her fellow inmates about their shared struggles, because most of them weren't ready to be honest about their addiction.
"When you're in jail, everybody's innocent," she said. "It's hard to have a meaningful conversation when you're in jail."
$1 versus $7
Sending addicts to jail rather than into treatment may actually be financially counter-productive, according to the Brien Center.
The center estimates that every $1 spent on treatment saves $7 in incarceration costs, lost wages and lost taxes, among other factors.
Another effect of addiction, Borden said, is a loss of time, whether it's due to incarceration, hospitalization or just avoiding social and familial contact.
"My son is 22. I used for a lot of his growing up time. There's a lot I missed out on as a mother," Borden said. "I remember sitting in jail for his middle school graduation."
For Borden, her recovery didn't begin right away or even after her first crisis, she said.
"I hit bottom numerous times," she said. "Until I started to really work on myself, that's when the change really happened."
That work included being honest with her care providers and addressing other addictive issues like shopping.
"It was like that instant gratification," Borden said of her shopping addiction. "My electric would be [shut] off, but for that hour I was shopping, I felt good."
Borden said she's been receiving services through the Brien Center for about 13 or 14 years, after her family suggested seeking treatment there.
"I was sick of still living like that, still having secrets," she said. "I think it was the first time I could speak about stuff and not feel judged."
Dr. Jennifer Michaels, medical director of the Brien Center and attending psychiatrist at Berkshire Medical Center, said Borden's success is not unique among those who enter treatment.
Michaels said that a review of the Brien Center's treatment program for opioid use disorders revealed that at the time treatment is initiated, 36 percent of patients have open criminal justice cases, all drug-related. At the end of one year of treatment, none of the patients had committed new crimes.
When people receive adequate treatment, they are far less likely to commit crimes or to be arrested as they might be without it, Michaels said.
Michaels reports that prior to initiating treatment for opioid addiction at the Brien Center about 31 percent of patients are employed or enrolled in school. After one year of treatment at the Brien Center, almost 90 percent are employed or in school, she said.
The biggest indicator that treatment is working, Michaels said, is that after a year in treatment, almost 90 percent of people have remained opioid-free.
"That's what we consider success," Michaels said.
All the way
It's hard to be halfway in recovery, Borden said.
"You can be clean, but to me, recovery is when you take the time to really work on yourself and find out what your purpose is. ... Life goes on when you're clean. Recovery is changing who you are."
Borden celebrates eight years of being drug-free in February and said despite stressors in her life during that time, including the death of a loved one and being the victim of an armed home invasion, she has not fallen back into old habits.
"It just isn't an option anymore," she said.
"There was nothing good about using, because I just hurt so many people," Borden said. "I can actually say that I really like myself today."