John Makohen
Arise Recovery Coaching in NYC

Without prior knowledge, preparation, or forethought, these 3 events instigated cataclysmic change.

Recovery snuck up on me. 

1 – A taste of recovery

Before I escaped back to the nomadic life of trekking New York City’s streets for dope and coke, I tasted the sweetness of living life in recovery. 

I also had a puny plan for recovery, but it worked for 6 years until a table saw ripped through my hand. 

Like all events, the accident could’ve gone two ways. I could have reached out for support from the recovery community or said fuck it and start getting high. 

I was not so wise and blinded by hubris. I refused to lean into the recovery community. I would go it alone.  At the time, recovery meant distraction and exhaustive. I substituted work for dope. 

My injury forced me to sit quietly with myself. I had not yet learned how to be my best friend, so the demons of my past mixed with the old familiar scene of morphine being worked into my vein created intense cravings.

I never picked up the phone, so my ego defeated me.

Several weeks after the surgeries to repair my hand, I stepped onto the road of active use. First alcohol and marijuana, then Vicodin and cocaine, eventually methadone pills, but we all know what happens when the pills run out. It’s inevitable the pills WILL run out, but heroin is always a phone call away. Once I released the dope into my veins, I couldn’t rear back on the reigns. I was off to the races. 

In a little more than a year, I was back on the streets of New York City drinking methadone to chase the dope-sickness away and whoring, boosting, or begging for my next fix.

But 

A seed was planted

No matter how hopeless and desperate life became, I knew I could live without heroin or other drugs. I did in county jail, prison, during parole, and for 3 years without supervision. And that shit meant something. It planted the seed that recovery is possible. The seed created hope for something better. It didn’t matter how faint the glimmer was. It was there. 

Download a FREE workbook to identify your high-risk situations and triggers that will blindside your recovery goals by creating the urge to use heroin or other drugs.

2 – Harm reduction

I returned to the streets of NYC to get on a methadone maintenance treatment program.

Not to get sober, but to hold off the demon dope-sickness. If you hustled, you could get on methadone maintenance within 24 hours.

One morning I set out to get on a program, so I landed at LESC. I made it to the assessment by 8:00 AM. It took about 3 hours to complete the biopsychosocial.

It took brutal honesty, but it was easy because I felt safe, not judged. I could say anything I wanted and not worry about a condescending look or lecture.

After the assessment, I was given an appointment card to provide blood and urine samples. If I returned by 9:00 AM the next morning with the card signed, I could get medicated. Without a guarantee to make money, dope-sickness loomed over me, si I got the blood work done and was medicated 24 hours later. 

During my 6 year retreat from street junky life, needle exchange programs sprouted throughout the city, so using clean kits and new sterile syringes each time I fixed was guaranteed.

Another new element began to pop-up in various locations throughout Manhattan. Not only did several needle exchange programs offer the use of the restroom to inject heroin or drugs safely, but drop-in centers and other community organizations also began to provide safe, monitored spaces for drug injection.

Safe injection sites didn’t only offer safety and reduce harm, but these organizations worked to shatter stigma, especially self-stigma and shame.

3. Shattering stigma

Do you know what it is like to use a public restroom to shoot up a speedball? 

When I was in getting high, I didn’t think it bothered me, but it did.

The stigma and shame crippled me. 

It didn’t matter how quick I fixed. I had to remove layers of clothes, work up the shot, bounce of the walls from the coke, and wait for the dope to wash over me with the courage to walk out the fucking door.  It’s humiliating walking facing a crowd of angry tourists holding their insides in, especially when the cocaine psychosis is riding at full peak. It sucked. My paranoia mixed with my homeless chic convinced me everyone knew what the fuck I was doing in the toilet.

My appearance concerned me. I did my best to fit in with the masses, but some things don’t wash off. I told myself stigma didn’t bother me. Ha, I also believed I looked good weighing 119 pounds, face sunken in, and eyes pinned.

It’s frustrating trying to warm up your vein so it will pop with people pounding on the restroom door.

Knock, knock, knock -“Hurry up, junky,” someone chants. Another voice chimes in with, “There’s nothing worse than a homeless junky using the toilet before you.” “Fix-up somewhere else, dirtbag!”

Forever grateful for all those who fight to reduce the harm we are blind too!

I’m grateful for those who took it upon themselves to offer us homeless New Yorkers safe places to shoot heroin and other drugs. Their efforts helped me overcome self-stigma and shame. It was a game-changer knowing there was a safe place to go, to not be judged, and where people on the other side of the door cared for my wellbeing.

Workers monitored the time spent in the bathroom, not because other kids need to fix-up, but to make sure you were breathing, safe, alive. 

I always had clean kits and sterile syringes when I used the drop-ins toilets to fix.

The most crucial benefit of safe injection sites was knowing I didn’t have to walk out of the restroom into a sea of judgmental faces looking back at me in anger. 

A safe place to shoot drugs started to break down the wall of self-consciousness, self-hate, and to have conversations with recovery advocates not pushing in-patient treatment down my throat.

It made all the difference in the world for me to exit a restroom and see peers hanging around, smiling, chatting, staying warm while waiting to fix. These people fed us, gave us toiletries, laundry services, Hep C testing… We wanted to show up and escape the reality of life on the streets. 

You might fear safe injection sites, but it’s unwarranted fear. Recovery sneaks up on you in safe injection sites.

I have shot dope in many places, literally wherever I wanted, a public toilet, a park bench, on a set of church steps, subway cars, hospitals, while walking down the street and most of these times, I was alone with no one to help me in the event of an overdose.

A safe-injection site means you, your son, daughter, or loved one will stay alive in the event of an accidental overdose.

Having a chance to find recovery another day is proof enough to claim safe-injection sites work.

Harm reduction works. 

It screams you’re worthy of love, support, and dignity. 

The folks who work harm reduction for little to no pay go to work each day and fight society’s ignorance, stigma, and fear of addiction. 

Harm reduction saved my life. It kept me alive long enough for the seed of recovery planted long ago to grow.

Embrace harm reduction today. 

Recovery sneaks up on you.

This week I spent a fantastic week with my recovery community at THE National Recovery Conference: MPRC 2019. During his closing, recovery historian and advocate William White, spoke about recovery sneaking up on you. When he said this, my ears perked up. It is true. The last monkey wrench diverting my plan of dying with a needle in my arm, on the streets of New York City was recovery – getting in my way.

I’ve been working on a memoir for quite some time. Every time I think I’m on THE final edit, I found a significant part missing.

How I Got Sober?

I found it’s easy to recollect all the stories from my past, but I could never put my finger on when the change happened. On the day I said fuck it, I don’t want to get high today.

I’ve journaled hour after hour reflecting on how I got sober. I have recently found that no matter how amazing my life has become, recovery was never my intended outcome.

When I got on methadone, I didn’t try to facilitate healing. Methadone meant survival. Like all with heroin use disorders, I feared and hated dope-sickness.

Even though I know the sickness comes in the morning, I can’t save a wake-up. I can’t rest knowing I have a 5 bag shot sitting around. Methadone kept me from being scared to wake up.

But recovery, hell I don’t know – it just happened.

After many months of journaling, self-reflection, and meditation, I can say it was many small changes that sparked one significant change. And then to paraphrase William White, the momentum kicked-in and great shit started happening.

In part, my previous taste of engaging with others from the recovery community helped.

Ultimately,  the efforts, support, and compassion of volunteers advocating for harm reduction shattered my self-stigma and shame.

I started defeating my self-limiting beliefs, disputing negative self-talk, and stopped spending all of my time with street junkies seeking the best dope in NYC 5 boroughs.

It was a gradual process.

Instead of spending all of my time hustling to shoot drugs, I only did one big speedball at the end of the day. My toxicology reports from my PG (methadone program) tell the story:

• Toxicity levels decreased,
• Questionable toxicology reports ended,
• Engaging individual briefs became the norm.

One morning, my counselor told me, during a session that I had not screened positive for any illicit drugs in 3 weeks. I laughed and didn’t believe him.

*Sidenote: In recovery, you WILL learn how to take a compliment.

He went on to tell me how excited he was to see I had broken my previous 7-day record by 14 days and counting. He let me see the screen of recent toxicology reports, and I couldn’t remember the last time I shot drugs. As soon as I left, I celebrated the best way I knew how, I copped a bundle of dope, a gram of coke, and got gone.

However, a new seed was planted, and the time between my shots of heroin and cocaine grew further apart, and now I can say through the help of so many others I have had a system for recovery for 8 years.

Today I understand recovery is a process and not a destination, and I am enjoying the ride.

Yes, indeed, Mr. William White, recovery WILL sneak up on you, especially with multiple pathways guiding the way.

What is your plan for recovery today?

You are in recovery when you say you are.
Many times you don’t know when your change was initiated.
It might have been a passing thought.
A night when you felt death was knocking at your door.
Maybe when you were watching a loved one dying, pleading for the Narcan to work, hoping one more blast will be enough to work magic and reverse the accidental overdose. Ugh, 3 hits of Narcan in each nostril and still no breath. Hopefully, the fourth time is the one.

It might have happened one night when you begged your higher power to let you find the money to cop a bundle of dope, take the sickness away, and you promised to stop in the morning.

Or maybe you are like me, and recovery just snuck up on you and bit you in the ass. You didn’t want it, but now you have it, and you’re not going to let it go.
Only you know when your changes started to take place.

Recovery sneaks up on you

Recovery sneaks up on you when you stop forcing yourself to conform to what others believe recovery means and start living life in alignment with your definition of recovery.

Recovery sneaks up on you when you stop listening to what others feel is best for you and start leaning into those who want to help you get what you desire and deserve.

Recovery sneaks up on you when you start reducing the harm and consequences of your substance use.

Recovery sneaks up on you when you start learning to love, trust and value yourself and others. When you shatter how stigma, especially self-stigma block your path to happiness and fulfillment.

Arise recovery coaching in NYC wants to guide your path into a life (of your definition) of long-term recovery.

What makes Arise recovery coaching in NYC different from traditional treatment is:

• You’re in recovery when you say you are.
• Arise Recovery Coaching is an outcome-based coaching system.
• You decide the outcomes you wish to achieve, and we will navigate you towards those goals.
• I will hold you accountable to your goals.
• Support and advocate for your process of change.
• Your uniqueness and individuality will be your guiding light in recovery.

I look forward to the chance to speak with you about reducing harm from your substance use, what recovery means to you, and how we can work together and find a place of happiness and fulfillment for you to live in and grow.

What is Harm Reduction?

Harm reduction meets the “addict” where they are at.  It’s an attempt to reduce the harm of a substance use disorder or other behavior which creates a risk to a person’s life and public health.  Advocates of harm reduction understand and accept a person’s readiness to change. Due to this acceptance, harm reduction reduces the likelihood of possible adverse outcomes to the individual and public health.

Opposition to harm reduction feels that in this acceptance a message of approval of the behavior is sent to these same individuals.  Of course, there are always pro and cons to any theory, but opposition to harm reduction creates fear and perpetuates stigma.

Those who oppose harm reduction still exhibit fear and are ignorant of individual pathways in recovery. These organizations believe that “forced total abstinence” is the only way in which a person will heal from a substance use disorder.

In their attempt to discredit harm reduction practices the International Task Force on Strategic Drug Policy states;

“We oppose so-called ‘harm reduction’ strategies as endpoints that promote the false notion that there are safe or responsible ways to use drugs. That is, strategies in which the primary goal is to enable drug users to maintain addictive, destructive, and compulsive behavior by misleading users about some drug risks while ignoring others.”

Statements like these cause more harm and risk to the lives of those persons caught in the maelstrom of the current opioid epidemic.

Harm reduction and The Opioid Epidemic

Needle Exchange

Syringe exchange is a program which distributes new hypodermic instruments and other paraphernalia an injection drug user employs to prepare and inject illicit drugs. The program works by exchanging new syringes for used syringes. In addition to syringes, exchange programs distribute caps used to mix the shot, cotton, tourniquets, alcohol swabs, and sharps containers to carry used needles in until returned to the program safely. These portable easy to carry sharps containers keep an IV drug user, or other persons searching in a bag, safe from accidental needle punctures.

Needle exchange programs can be traced back to 1983 when a pharmacy in the Netherlands began distributing sterile syringes to illicit drug users. The plan was executed due to an outbreak of Hepatitis-B. 

In 1998 in a press release, Donna Shalala, Secretary of Health and Human Services for the Clinton Administration, stated:

“A meticulous scientific review has now proven that needle exchange programs can reduce the transmission of HIV and save lives without losing ground in the battle against illegal drugs.” 

In a weekly report published on, December 11, 2015, the CDC released findings of research concluding that not only do syringe exchange programs remove HIV, HCV, and Hep C contaminated syringes form a community the programs also have established a gateway for services for substance abuse treatment and other social services.

The research concludes that needle exchange not only reduces risk and harm of injecting illicit substances, but also provides a safe haven to educate and motivate persons struggling with substance abuse disorders about the benefits of recovery, wellness, and personal health.

Methadone Maintenance Treatment Programs (MMTP)

MMTP is a Drug replacement therapy which reduces risk by providing a less harmful, longer-lasting opiate for those who have severe opiate use disorders. In MMTP, Methadone is prescribed, administered, and regulated by medical staff (licensed nurses). When a program is responsible for distributing methadone, structure and stability start to replace the unhealthy chaos associated with opiate addiction.

Ultimately, the goal of harm reduction is abstinence while respecting the individual’s readiness to change. The road to recovery I followed was through MMTP. I wasn’t planning on getting sober when I first came to the program. My goal was not to wake up, dope-sick and broke on the streets. My addiction to dope and the needle never let me hold onto a shot for the morning. But methadone allowed me not to fear waking up because my dose lasted throughout the day and night.

Christopher Morris/Corbis via Getty Images
Insite

Insite in Vancouver B.C Canada, a safe injection site has not only created a safe place for heroin users to use heroin but a place where the message for recovery is talked about openly without coercion or force.

Safe injection sites

In my opinion, safe injection sites are the ultimate form of harm reduction. The most controversial, too. Recently safe havens to inject illicit substances is creating a public outcry. Opposition to new harm reduction policy and procedures is typical.

A safe injection site provides clean supplies and equipment, along with medical assistance, and education about how to safely use and discard of injection equipment. Besides these fundamentals, safe injection houses provide information convening medical and mental health and substance abuse treatment.

More importantly, employees are available to establish caring relationships with participants using the services provided by the site.  The workers employed by safe injection sites are accessible to engage participants in conversations concerning recovery and change. Frequently these conversations have more impact because the setting is non-confrontational.

Not only do workers provide safety information they are available to assist in the event of an accidental overdose.

here is an example of how Insite a safe-injection site in Vancouver immediately responds to another’s readiness for change.

One morning at Insite,  Tim Gauthier, Insite’s clinic coordinator spotted a man slumped up against the facility’s doorway. Instinct urged him to check for an accidental overdose, but the man was alive. When he was awake he asked for information about detox. Tim Gauthier states in an interview, “That’s very typical, that’s usually how those things play out,”

Insite meets the people of Vancouver with heroin use disorders where they are at and when the interest and readiness for change peeks, the person is referred to Onsite which is located on the second floor of the facility. Onsite has beds for detox and long-term recovery stairs available.

Before I chose to work a program of recovery, I was able to find the security of several organizations which offered a safe place for me to fix. I welcomed the freedom to use a restroom which was safe, clean, and free from public scrutiny.

Not only did the facility allow free use of the restroom, but they monitored the amount of time spent behind the door. Every 5 minutes, a worker would knock on the door if I did not reply, the worker was coming in armed with Narcan.

The workers made it a point to befriend each newcomer to the organization. Eventually, the facility became a place to enjoy a cup of coffee, use the internet, charge my phone, and engage in friendly conversations. I started to crave spending time discussing sociology and philosophy with social workers at the facility. Our discussions covered healthcare, HepC, and HIV testing, Prep, needle exchange, diet and nutrition, and life in general. 

Safe injection sites will save lives, increase safety to public health, and properly discard of medical waste. More importantly, these sites will provide social services in the form of empathy and care for the well-being of those persons who feel devastated and without hope.

Why Harm Reduction Works Key Takeaways

Let’s recap how harm reduction worked in my life:

Needle Exchange- provided me with sterile syringes, clean kits, education and information about HIV/AIDS, Hep B and C, overdose, social services, and most importantly accepted my readiness to change.

Methadone Maintenance (MMTP)– allowed me to follow my own path along the road to recovery without ridicule, contempt, or pressure. As I matured in my medicated assisted treatment (MAT) program, I learned that I could live life without heroin. Heroin, and more importantly the needle. Methadone helped me rewrite my definition.

Safe Injection Houses– I’ve never been in a state-run facility, but I’ve had the opportunity to take part in organizations which allowed me to use the bathroom to work up. There was always someone keeping watch on a clock outside the door, to prevent an accidental overdose. Every 4 minutes the person would call out and expect a reply immediately or else the staff would be coming in NARCAN in hand. Clean syringes and kits were readily available.

How do you feel about harm reduction now?

I am just one of the thousands who are living and breathing free from chemical dependency and trauma of our past.

I’ve outlined my personal case study of how Harm Reduction worked in my life. I’m alive and well, due to the individuals who’ve accepted to reduce harm first and treat me with respect.  

Staff at the facilities I chose to become a part of, spoke to me with respect, dignity, and care. I was treated equally. They looked past the dirt ground into my hands, uncleanliness, and repulsive smell. They didn’t stare at the bruises on my arms, the bags under my eyes and sunken-in cheeks upon my face, or my cynical toothless grin.

I wasn’t just some homeless street junky kid.  I was another human being struggling to live one more day, and that is all that mattered to them.

Instead of pressuring me into change, I was embraced for who I was at a time in my life when I couldn’t find on an ounce of love for myself.

Meeting me where I was at sparked a friendship. Over time this connection helped me connect with who I was,  what I believed, and remembered of myself without heroin.

Discussions with staff and volunteers rarely covered my plans for change. However, hearing and seeing their stories of triumph over heroin and other drugs helped me realize that I had a choice. I could choose a futile painful life or embrace change.

Harm reduction worked for me. It’s working right now in someone else’s struggle to find the road to recovery.

Now that you have a better understanding of harm reduction how can your recovery coaching clients benefit from you meeting them where they are at without pressure, attitude, and ultimatums.

Start reducing harm, so you can build long-lasting relationships which create the readiness for change.

Stay informed about how you can use harm reduction in your recovery coaching business by signing up for our newsletter. 

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