Newsday.comMany on Long Island learn of heroin's tight grip

BY ANDREW STRICKLER and MELANIE LEFKOWITZ

Across Long Island, thousands of people, some barely in their teens, are learning that heroin addiction is a monster not easily conquered. The drug holds its users in a tight grasp and won't let go without a mammoth struggle.

Between 2004 and 2008, at least 1,068 people in Nassau and Suffolk counties died from opiate overdoses. Since the beginning of the year, authorities in both counties have continued to identify overdose deaths. Beyond the deaths, more than 10,000 people went into rehab for opiate addictions last year alone.

Heroin and its highly addictive cousins - painkillers like Vicodin and OxyContin, often found right in the medicine cabinet - are creating havoc across Long Island. Experts say their power is often only broken after the addict hits "rock bottom" - a place of extreme desperation, a psychological point beyond which the person chooses not to go.

Heroin's powerful grip on addicts is all too familiar to Geraldine Celli. She lives in a split-level home in Massapequa that has all the clutter one would expect with any young family.

A Pocahontas doll is underfoot on the stairs; a toy-filled playpen dominates the center of the master bedroom. In the kids' room, a visitor must navigate around a crib and child-sized bed to see a photo collage of a dark-haired mother clutching her children.

Having raised her own two kids, Celli is now the primary caregiver for two granddaughters: Gianna, a gaptoothed 6-year-old with a passion for Barbie, and 20-month-old Veronica. A third grandchild is being raised by family friends. They are the children of Celli's daughter, Tara Amber Vitone. Her six-year battle with addiction ended in February when she died from a lethal combination of heroin and other drugs. She was 24 years old.

"It's not like I'm complaining, because I love my grandchildren, but I'm 54 years old," Celli said one day last week, holding Gianna on one knee. Celli, with the assistance of her elderly mother, now spends much of her time keeping up with the girls, picking out clothes and fixing them meals. "I don't have much time to do things for myself," she said. "It's really hard."

The overdose death a year ago of Natalie Ciappa, 18, of Massapequa, has galvanized public attention and spurred efforts to educate the public about the signs and dangers of heroin use. These efforts have merged with growing fears of parents to create something of a movement on Long Island. A community meeting in Smithtown in March attracted a crowd estimated at 1,000. Nassau County District Attorney Kathleen Rice has called heroin use in the county an "epidemic."



Thomas MacGilvray, Suffolk County's director of community mental hygiene services, said he has seen more interest in the issue in the past year than he has in his entire career. Hundreds have attended educational programs in Nassau County, said Jamie Bogenshutz, director of the YES Community Counseling Center and head of the Nassau Alliance for Addictive Services.

"This is the first time ever that the communities all came together to say, 'We have a problem.' So that's a very good thing," Bogenshutz said. "There's a perception that because you live in a particular community that looks a certain way that these types of things just don't happen. When in fact, it happens just as frequently. It just gets hidden better."



While addiction specialists agree that prevention education is the best weapon against substance abuse, that lesson has come too late for many who are trapped in addiction. For them, the path to long-term recovery is fraught with hurdles that go beyond heroin's powerful physical dependency.

For some addicts who do want to get clean, the first stop is often a bed at Nassau University Medical Center's drug detox unit, one of only three hospital-based facilities in Long Island.

The 20-bed unit is now at a consistent 98 percent to 100 percent capacity, according to administrators. Well over half of its patients are heroin addicts, and most of them are under age 29.

"The younger population is incredibly challenging," says Dr. Constantine Ioannou, vice chairman of NUMC's department of psychiatry. Part of that challenge, he said, is that addicts usually must hit "rock bottom" before he or she is truly motivated to get and stay clean. Long Island's affluence often shields many young addicts from just that.

"A majority of our 20-year-olds have not hit a bottom, because their bottom has been cushioned by the family," he said. "So they're not homeless, they're not living in parks, and as such their motivation levels are quite different."



Back and forth from using to rehab

During her battle, Vitone's personal rock bottom was elusive. She bounced between rehab and outpatient programs, only to return to heroin and alcohol. A stint in a methadone program was short-lived. Only during her pregnancies, her family said, was she able to stay clean for any significant period. All the while she lived only for the moment, and for drugs.

Celli remembers a daughter not defined by her addiction, one with a charismatic personality, bright and social. But her troubles were never far away. Seated at her dining room table, which is covered in photos and Vitone's letters, Celli recalled a conversation with her daughter last year in which she told her about a recent overdose.

"She was in the hospital for a couple of days and she almost didn't make it . . . and I didn't even know it," Celli said. "And I said, 'You have these little children, you want to see them grow up, you don't want to die.' She started to cry. She didn't want to be that way."

Experts watching heroin abuse on Long Island say the sheer amount of the drug - often combined with other substances - pushes addicts closer to deadly reactions such as Vitone's. It also means withdrawal symptoms - nausea, pain, insomnia, diarrhea - are particularly intense. Fear of that pain pushes many to keep going back, even in the face of overdoses, arrests, and family disintegration. Many addicts find that cycle nearly impossible to break.

"Ten bags a day is like the average. It's like M&Ms. It's just horrific," said Dr. Asmara Ejaz, an addiction specialist who oversees NUMC's detox and rehab program.

"Some 18- or 19-year-olds are using 30 to 40 bags of heroin a day. It's mind-boggling but that's the kind of hard-core addict we're seeing here," she said. Repeated relapses and overdoses are more the rule than the exception.

Ejaz recalls a male patient, 20 or 21 years old, who survived nine overdoses, the most recent in a CVS bathroom minutes after purchasing a box of syringes. "He couldn't wait to get high. If no one had found him so quickly, he'd be dead," she said.

Ejaz estimates that just 30 percent of those who complete NUMC's detox and rehab program remain clean after a year. Many addicts face associated medical problems, financial issues, and legal problems that discourage them from committing to treatment and sticking with it.

Detox and an inpatient program is "only a first step," Ejaz said. "A lot of time they go back to their neighborhoods, their dealers, their friends who are getting high. It becomes a vicious cycle."

For Tara Vitone, her cycle of addiction began when she was 17 and met the man who would later be Gianna's father. When she became pregnant in 2003, she stopped using and cared for Gianna for about six months. But she returned to using heroin.



Her insurance ran out

Vitone was unable to stay clean during a second pregnancy, said her brother Anthony Vitone, 26, of Massapequa. The baby, Lorenzo, was born healthy in 2004 and is now in the care of a family friend. During those years, Tara Vitone lived with a series of boyfriends who used drugs and supported her habit. She was an intermittent presence in her children's lives, her brother said, often appearing for special occasions and then disappearing again.

Money also played a role in Vitone's relapses. After one stay in an inpatient program, her daughter was forced to leave when her insurance coverage ran out, Celli said.

"There are places . . . you can go for six weeks and it's a nice place and they have a lot of people helping you," Celli said. "But you have to pay sometimes twenty or thirty thousand for that, and that was it, I didn't have that."

Vitone became pregnant again in early 2007 and had Veronica on Halloween. As with previous pregnancies, once the baby was born she quickly returned to using, her family said.

Anthony Vitone speaks bitterly about his sister's inability to break her addiction. At times it fell to him to call 911 after she collapsed from an overdose.

"I would say I just have resentment," he said. "She just could never stop what she was doing to take care of things that were important, like her kids. She could still be a good sister to me, but you have to be a parent first and foremost."

The confident words in letters and cards Vitone wrote during her last trip to rehab, at Seafield Center in Westhampton Beach, belie the danger she was in. In a card decorated with starfish, dated Feb. 15, 2008, she wrote, "Clean and sober since Feb. 7, 2008. This Is the New Me!" Six days later, she asked her mother in a letter to send her love to Gianna. "[W]hen I come home I'm coming home for good to be her mom again," she wrote.

Vitone left the facility voluntarily after about three weeks. Her family said they believe she remained clean for a time, but soon began drinking, which had triggered previous relapses.

A year later, on Feb. 7, 2009, Vitone left a relative's house in Lindenhurst for the evening. The next afternoon, a male acquaintance called 911 from a Copiague home. Paramedics found her unconscious and were unable to revive her, her family said.

The county medical examiner concluded Vitone died from an accidental overdose of heroin, cocaine, and chlordiazepoxide, a prescribed sedative. A host of prescribed drugs, such as medications for asthma, were also found in her system. Celli said she believes these drugs clouded her daughter's judgment and contributed to her taking heroin on her last day.

Mom becomes activist

In a story in last Sunday's Newsday, Linda Diorio of Farmingdale spoke about the death of her son, Erik, 19, who also could not shake heroin's grip. Diorio is now an activist, speaking to parents about what to do if they suspect their child has a drug problem.

Diorio's efforts to save her son were a roller-coaster ride. An effort to get him into NUMC's detox unit over the Memorial Day weekend in 2008 failed when he was told he could not be admitted because he wasn't in active withdrawal. But he was admitted into the hospital for a five-day stay.

"It didn't last," Linda Diorio said. "He was using again shortly thereafter."

Then, last June, when her son agreed again to try rehab, Diorio called a treatment facility where he'd gone earlier in the year only to learn she'd have to pay a $10,000 fee upfront. In the few days she needed to work out the financial end, her son changed his mind.

Erik died on the night of July 11, 2008. She declined to disclose the precise details of her son's death, saying only that "he died from the effects of heroin."

A year later, Linda Diorio still isn't sure what more she could have done. "We had our fair share of arguments, but when he wanted help, he came to us. He knew where to go," she said. "They aren't bad kids, our children. They stray."

She finds comfort in visiting Erik's grave, where she sees other cemetery regulars. Some bring folding chairs. "I talk to him," she said of her son. "That's the closest you can get."

Celli looks for similar comforts.

Along with a stack of her daughter's prescriptions and a list of the jewelry found with her body, Celli keeps her two cell phones. After her daughter's death, Celli says she called one of the numbers just to hear her daughter's voice.

"I left her a message, isn't that crazy?" she said.

Copyright © 2009, Newsday Inc.