“Addiction Wants You Alone, And Then It Wants You Dead”

A cage within a cage. A bridge in the rain. A red Solo cup. As I’ve spent the past two months getting to know my cousin who died at 29 last spring, these objects have gripped my mind with talismanic power.

I was sitting on the front porch of my house with my wife and kids when I got the news. My phone buzzed; it was my mom. She told me they had found Taylor. Before she got her next words out, I knew. “He overdosed,” she said.

Two months before Taylor died, Gov. Eric Holcomb issued a stay-at-home order in response to the then-burgeoning COVID-19 pandemic. At the time, Taylor was working full time at a downtown restaurant. When he wasn’t working, he could usually be found at the Irsay Family YMCA, where he lifted weights every day. The gym was his Cheers and he was Norm, but with rippling muscles instead of a beer gut.

Like many people in recovery, Taylor relied heavily on routine to stay healthy. His may not have been ideal; his YMCA habit had a worryingly compulsive aspect to it. But it worked for him. It kept him sane and alive. The stay-at-home order took a sledgehammer to his systematized life. Emma McAfee, his manager at work, recalls the shutdown hitting Taylor extremely hard. Normally something of a health nut, he began eating poorly and sleeping late. She remembers talking to him on May 10, when it briefly seemed like their restaurant might reopen. “He was so excited,” she says. They didn’t reopen. A week later, he was gone.

This is a story about my cousin, Taylor. It is also a story about how the public health response to the COVID-19 pandemic, necessary though it was, had tragic consequences for people in recovery.

***

Growing up in Bloomington, Taylor’s childhood resembled a Norman Rockwell painting. His mom, Lisa, was an elementary school teacher; his dad, Tom, worked in insurance. They lived in a two-story midcentury home backed by a wooded area where Taylor and his older sister could run and play while remaining safely within their parents’ view.

In elementary school, Taylor loved Star Wars and dinosaurs. He was outgoing and made friends easily. He could be flighty. He often lost or misplaced things. Alex, a close childhood friend, remembers when a visiting archaeology professor gave every student in their third-grade classroom a fossil. Taylor, the dinosaur enthusiast, was overjoyed. When he lost the fossil later that day, “he had a total meltdown.”

That same year, Taylor was diagnosed with attention-deficit disorder. Nevertheless, he thrived academically and athletically. As an eighth-grader, Taylor set several swimming records, catching the eye of college scouts. Early in his freshman year at Bloomington North High School, he won the Cougar Pentathlon, out-swimming the entire high school team. Around that time, some friends introduced him to mind-altering substances. Alex says Taylor embraced them with unsettling enthusiasm. “He was extreme. He was taking pills, smoking weed, drinking, doing ecstasy, acid, coke.”

Taylor overdosed at age 16. It was the first of several drug-related incidents that landed him in the hospital. But at the time, his parents weren’t ready to accept the idea that their son was an addict. At the Fairbanks treatment center, they were told that what they knew about Taylor’s drug use was likely the “tip of the iceberg.” Lisa thought they were mistaken. Other kids might be capable of hiding a secret life of drug abuse from their parents. But Taylor? “I remember thinking, No, that’s not going to be him.”

Taylor and his dog, Harper.

Meanwhile, Taylor’s life unraveled. He no longer seemed to control his own actions, his free will supplanted by a slavish obedience to drug use. His capacity for risky behavior surged alarmingly. His parents revoked his driving privileges, fearing he might hurt himself or someone else. Things reached a tipping point when Taylor robbed a Bloomington convenience store for drug money. He ended up in Branchville Correctional Facility, where he got sober the hard way. He earned an associate degree at Oakland City University while incarcerated. He tutored fellow inmates working toward their GEDs. They affectionately called him “College.”

After he was released from prison, Taylor wanted to get away from Bloomington. He moved to Indianapolis, where I’d occasionally see him riding his bike downtown. He looked well; he had the healthy glow of a college athlete. Shortly after arriving in Indy, Taylor came out as gay. According to Alex, he had been quietly out during high school, but hadn’t been eager to spread the news. I understood why. He was the first openly gay person in our extended family, which isn’t exactly known for its progressive social values.

Alex recalls that Taylor’s personality underwent a subtle but unmistakable shift after he came out. He became more confident. He wore flashier clothes. He was just generally more comfortable in his skin. “I think he found himself when he moved downtown,” she says.

He also found love, at least for a while. His partner was also in recovery, and together they helped keep one another clean. When their relationship broke off in 2018, Taylor didn’t take it well. He relapsed, and spent a few months on shaky ground. That’s when a new group of profoundly supportive friends came along and helped him regain his footing. Ryan Crossley was one of them. She met Taylor while visiting a mutual friend in Miami. They hit it off instantly and were inseparable for the next year. They went out dancing, zipped around Mass Ave on motorized scooters, and attended countless EDM concerts.

The only companion who rivaled Ryan’s importance to Taylor in the final year of his life was Harper—a rambunctious mutt he adopted in early 2019. In more than a few ways, Harper’s personality mirrored Taylor’s. She was sweet, outgoing, fiercely loyal. But when left alone, she became moody and destructive. When she learned to escape her crate, Taylor bought a second, larger cage and put her crate inside of it. A cage within a cage was the only way Taylor could keep Harper confined.

Meanwhile, in his own life, Taylor had fashioned a figurative cage-within-a-cage to contain his own destructive impulses. His inflexible routine—work, gym, dog, friends; work, gym, dog, friends—was a barricade between him and spaces that were physically and psychologically dangerous. After the stay-at-home order was issued, he was suddenly unmoored. He no longer had work, or the YMCA, or nights out with supportive friends to keep him from drifting into dangerous territory. All he had was time.

***

I have flirted with unhealthy forms of self-medication. But my fear of consequences— jail, death, social sanction—has kept me from getting pulled into the vortex of truly self-destructive behavior. In people with substance-use disorder, this instinct gets hijacked. It’s not that they want to die. But their fear of death gets blotted out by the need for the relief the drug provides. 

That’s how it seems to me, anyway. But I don’t really know what it feels like to be gripped by substance-use disorder. I have no idea what it felt like to be Taylor in those last few months. So I talked to someone who does.

Like Taylor, Spencer Medcalf started using opioids as a teenager. By age 17, he was sneaking morphine daily before school. Soon he graduated to intravenous heroin. He managed to convince himself he could maintain his habit while still living a normal life. “I wanted to be the exception,” he says. “But I always ended up with a needle in my arm in the slums of Indianapolis.”

After landing in rehab seven times, Medcalf finally got sober at age 25. Now, as a Lead Recovery Coach at IU Health, he leads a team of peer recovery coaches in emergency departments throughout Indiana. When someone arrives at the hospital after a drug-related event or overdose, a peer recovery coach is there to offer support from someone who’s been down the same dark road. 

Medcalf likens the life of an addict to driving on the highway in a torrential thunderstorm. The sound of rain pelting the car makes it hard to hear anything else. The normally effortless act of driving on a straightaway is now nearly impossible. Up ahead, there’s a bridge. As the car passes under it, the rain and noise stop. For a brief moment, everything is serene. Wouldn’t it be nice to stay under that bridge? According to Medcalf, that’s what many people with opioid addiction are trying to do. Opioids offer instant tranquility.

When the government-mandated shutdowns began, Medcalf’s team saw a surge in patients. He was disheartened, but not surprised. “Addiction is a disease of isolation,” he says. “It wants you alone, and then it wants you dead.” The forced isolation intended to curb COVID-19 inadvertently created the ideal conditions for another disease—substance-use disorder—to thrive.

The American Medical Association issued a brief earlier this year stating that during the pandemic “the nation’s opioid epidemic has grown into a much more complicated and deadly drug overdose epidemic.” Dan O’Donnell, chief of Indianapolis Emergency Medical Services, has seen this heartbreaking trend firsthand. He works in the emergency department at Eskenazi Hospital, where the number of patients coming into the ER with non-COVID complaints—like chest pain or stroke symptoms—dropped precipitously last March. But the number of overdose victims not only didn’t drop, it went up significantly.

In a study published in The Journal of Urban Health this year, O’Donnell and a team of researchers looked at EMS data in Marion County before and after the stay-at-home order was issued. When comparing the post-shutdown period to the same three months from 2019, overdose deaths increased by 100 percent. Addiction wants you alone, and then it wants you dead.

Before the pandemic, O’Donnell had spent a good portion of his career helping decrease overdose numbers in Indiana. He was part of the team that trained IMPD officers to administer the life-saving overdose drug naloxone, which is now standard in police departments statewide. He’s naturally disturbed by the recent rise in overdose deaths. It’s a thorny problem, though, because he believes the stay-at-home orders were necessary.

Would Taylor have survived had the pandemic not happened? His friends and family all unhesitatingly answer “yes.” Of course, it’s impossible to say for sure. But there’s little doubt that a disproportionate number of people with substance-use disorder have died since it began. That’s to say nothing of people who delayed important medical care or treatment because of COVID-19. If another spike in infections occurs, should the public health response be less draconian?

It’s a tricky question. So tricky that Peter Singer—the Princeton bioethics professor and philosopher best known for his groundbreaking book Animal Liberation—ran into trouble trying to answer it. In an October 2020 article titled “To Lock Down or Not to Lock Down?” Singer called for a cost-benefit analysis that took into account not only lives saved, but also years of life saved or lost. “An adequate assessment would not disregard the difference between dying at 90 and 20, 30, or 40,” he wrote.

About 95 percent of the people killed by COVID-19 have been older than 50. Substance-use disorder disproportionately kills younger people. I emailed Singer to ask if he thought public health officials should more carefully consider the impact of forced isolation on this population. He replied that it’s unlikely that much could change given the stigma around substance-use disorder. “Many people will just blame the victims for using drugs anyway,” he wrote.

Shame comes with the territory of addiction. It can become a self-perpetuating force. Society casts you as a hopeless criminal, so you use drugs to dull the shame of feeling like a hopeless criminal. Perhaps that’s why Taylor fell in love with weightlifting. Not only did he find comfort in its regimented nature; he likely relished the confidence boost. No matter what was happening in his mind, by all outward appearances he was unquestionably strong.

The extended closure of the YMCA was nothing short of devastating for Taylor. He tried to recreate the experience by working out outside, but he missed the social component of the gym. Taylor not only thrived on social interaction; his survival practically depended on it. So it was a red flag when, six weeks into the stay-at-home order, he stopped reaching out to his friends. Ryan tried to force her company on him, but was only fitfully successful. She recalls Taylor going to a clinic to get his meds in mid-April, and he told her it was far more crowded than usual. “He saw other people struggling, and I think he was just kind of like, ‘Maybe it’s OK to struggle.’”

In the final weeks of his life, falling deeper into depression, Taylor pushed away those who most wanted to help him. “He didn’t want to hang out with me,” Ryan says. “He changed a lot.” Ryan had lost a close friend in high school to a drug overdose. It was one of the most emotionally gutting experiences of her life. Had she known Taylor was in recovery when she met him, she likely would have kept her distance. “I didn’t want to lose somebody close to me again.”

Now, though, it was too late. He was her best friend.

***

When Taylor called his mom last year on Mother’s Day, they talked for nearly 15 minutes. For Lisa, it felt like a breakthrough in their relationship. “He almost never talked to me like that,” she says. In his teen years, when Taylor began to exhibit highly erratic and even illegal behavior, Lisa assumed the role of “bad cop.” She called him out on his lies. She kept tabs on his whereabouts. She even considered sleeping outside his bedroom door to keep him from sneaking out. Her tenacious surveillance was born of a maternal instinct to protect her child. But it put her at odds with Taylor, and their relationship devolved into a domestic cold war. Tensions eased over the years, but their relationship remained somewhat strained.

From the beginning, Taylor’s dad took a more diplomatic approach. Tom and Lisa’s contrasting styles created discord in their relationship. It’s no secret that marriages suffer collateral damage when a child has a severe addiction problem. But they held things together. When Taylor moved to Indy, Tom became Taylor’s primary point of contact. The two of them texted nearly every day. Tom visited Taylor weekly “just to look into his eyes.” In the months prior to the pandemic, Tom sensed that Taylor “had things more under control” than he had in years. But then the stay-at-home order happened, and his optimism turned to apprehension. “He loved going to work; he lived to work out,” he says. “All of the sudden, it was all gone.”

Ryan suspects Taylor knew that things were growing precarious for him. He even gave her his mother’s phone number, something he had refused to do previously. “I think he was worried for himself.”

The Saturday following Mother’s Day marked Tom and Lisa’s 34th anniversary. It should have been a day of celebration. But when Taylor didn’t respond to a series of text messages, his parents grew worried. When the next morning arrived and Taylor still hadn’t texted, Tom set out for Indy. He knocked on the door of Taylor’s apartment, but no one answered. He tried to go inside. Harper stood guard, refusing him entry. Taylor’s body lay lifeless behind her.

When my mom called me that morning with the news, I hung up the phone and went inside my house. Standing at the counter in my kitchen, I cried. I didn’t know Taylor deeply, but I knew how much he had overcome. After spending half his life struggling with a disease that dealt him nothing but pain, he had emerged with a shot at survival. Before the pandemic, he had been mapping out his future. He was thinking of returning to school to finish a bachelor’s degree, maybe in Florida. He had friends in Key West. Maybe Ryan would move there with him. Although he wasn’t out of the woods yet, he seemed to be at least within range of light.

Of course, I knew it was more complicated than that. Substance-use disorder is a lifelong disease. You’re never really out of the woods. But what I didn’t expect was for a public health response to a pandemic to drag Taylor deep into the black heart of the forest.

My personal grief in response to Taylor’s death was sharp, but fleeting. The grief felt by his closest friends is searing and shot through with regret. “I could see what was happening, and I felt like I could have done so much more,” Ryan says.

Justin Phillips knows how survivor’s guilt can haunt the loved ones of overdose victims. After losing her son, Aaron, to an overdose in 2013, she channeled her grief into activism, launching the nonprofit Overdose Lifeline the next year. Her organization is on a mission to reshape how we think about substance-use disorder. Even in our personal social circles, she says, “we don’t give casseroles to families of people with substance-use disorder the way we do to families of people with cancer.” But maybe we should. Maybe then we would start to see people like Taylor as individuals with a complicated but treatable illness instead of as criminals with a shameful secret. Maybe then they would begin to see themselves that way, too.

Taylor’s solo cup still hangs in his parents’ backyard.

As I was finishing this story, Mother’s Day was approaching. For my Aunt Lisa, it marked the anniversary of her final conversation with her son. For the previous 15 years, her life had been turned inside out by Taylor’s disease. “Every time I saw him walking out the door I wondered, Will this be the last time I see him alive?” she says. Only recently had she started to allow herself a sliver of hope. She was even beginning to think that she might one day have a normal mother-son relationship with him. “Unfortunately,” she says, “we never got that opportunity.”

We describe people with substance-use disorder as battling “demons” for good reason. Addiction is a cruel and insidious disease that hits you when you’re down and convinces you to take the blame. “I always wondered why his life had to be so hard,” Lisa says. “Because it was hard. He didn’t want it to be like that, but it was.”

Now, life is hard for Lisa and Tom, too. Surviving a child’s death, no matter the circumstances, is harrowing beyond words. “It’s not something you get over,” Tom says. “You just get through it.” They still live in the same house that Taylor grew up in. In the wooded area behind them, a plastic red Solo cup hangs from a string on a tree. When he was 9 years old, Taylor climbed up on a ridge and hung it there. It has remained there ever since, stubbornly refusing to yield to the elements. “We’ve had high winds and straight-line winds,” Lisa says. “But that cup still hangs there.” 

The permanence of loss is its most pitiless feature. Maybe that’s why we find comfort in unexpected places as we navigate the morass of grief. For Lisa, this plastic red cup is a source of solace. It’s a portal to a time in Taylor’s life before the demons took hold. When he was just a beautiful, adventurous boy, full of wonder and innocence. The cup was once, all those years ago, a string telephone. Somehow, it still works. “It’s where I talk to him,” Lisa says