The Interventionist: Working On The Front Lines Of The Drug War, One Addict At A Time

At the local coffee shop where I get my daily caffeine fix, I began noticing another “regular” — a woman always sitting at the same table, dressed in the same sleek black exercise suit every day, tilting her whole body at a sharp angle towards her small keyboard, fingers arched and delicately typing, as if she were playing a harpsichord. Next to her on another chair sat a chihuahua, eyes tranquilly shut, curled up in a ball smaller than a loaf of bread. Every day, customers walked through the coffee shop door and eyed the chihuahua, sometimes stopping to pet its baseball-sized head. A conversation would strike up with the sleekly dressed woman. The woman had a confident air. She spoke loudly. She did not seem to care that the inflections of her voice carried across the shop to other coffee drinkers absorbed in their newspapers or navigating the internet. Decked in her black spandex uniform, looking as if she had just come from the gym, she was 50-ish, shiny-skinned, shiny-eyed, and shiny-haired, her pixie-style Peter Pan haircut stopping suddenly at the nape of her neck, the brown strands of her hair smartly highlighted with golden strands. She looked the model of health. Whenever she rose to get a sugar packet, the chihuahua quickly awoke, stood up at attention like a miniature body guard, aligned the bulging orbits of its eyes with every movement of her body, and waited until she returned to her chair to resume typing. The loaf-sized pet would then curl up in a ball and close its eyes again.

I was lured like other customers into this sweet vignette of human-canine bonding. I greeted the woman and petted the dog’s tiny head. “Her name is Lucy,” said the woman. After a long pause, she added, “She has been with me for many years, through all the ups and down.” Having watched the woman’s fingers rise and fall over her keyboard for weeks, as if she were playing a sonata, I had to ask what she was writing.

“It’s the story of my life as a drug addict and an alcoholic, and what I am doing now.” I feigned calm. This description was said with the ease of someone who might say, “I am writing about my trip to Paris.” I realized that she had shared this short storyline with a host of coffee drinkers before me. The wireless office she had created out of the coffee shop was where she was reconstructing the story of twenty-five years of alcoholism, drug addiction and recovery — much of it, I would learn, stretched over her career as a registered nurse.

I was looking at the face of middle-class addiction. Her name was Joani Gammill.

In today’s world of addiction rehabilitation, Gammill has become a media celebrity. Less than a decade after nearly dying from an overdose, she has gained a national following as an addiction expert and interventionist. Her television appearances — with the chihuahua at her side — have made the iconic duo familiar enough so that they are frequently stopped at airport terminals by television fans.

But Gammill’s rise to fame came at terrible cost. In 2004, she nearly died. She had been getting high daily from a cocktail of three prescription drugs. Then she overdosed. She went to the emergency room in her home town of Annapolis, Maryland and survived. Shortly thereafter her life took a completely new turn through an intervention televised live on the Dr. Phil Show. One evening just before that intervention, at midnight, Gammill recalls being “stoned out of my mind on tons of amphetamines.” She was worried about her two-year-son and his possible autism. She decided to write an email to Dr. Phil to ask if her addiction could be affecting her infant son’s health. “I had never searched online for any help and I had never seen Dr. Phil’s show,” Gammill told me. The email response she received from the self-help guru read “like my bio,” she recalled. “It said: ‘Joani, looking for middle class moms addicted to prescription drugs.’”

Dr. Phil was asking if Gammill wanted to appear on his show to discuss her problem and seek solutions. Gammill declined. Then a second request came. She declined a second time. On a third request, she changed her mind. “I told them I didn’t want to be on the show, that I just wanted help with my son,” she said. But then, she recalled, “a little voice inside of me… said maybe my prayers are being answered in ways that I never imagined. I thought, ‘You know what, you have nothing to lose.’ I think my higher power or maybe my parents in heaven set up it.”

Gammill boarded a plane for Los Angeles. She was now scheduled to appear on national television as a mom and a professional who was destroying her life through untreated addiction. Anxious about the upcoming show and craving a high, she located syringes before her scheduled appearance and got high on amphetamines so that “I could be articulate,” she recalled. A video clip from the program, archived on Gammill’s current website, shows Dr. Phil warning Gammill that she would die if she did not quit her drug habit. Gammill, suddenly agitated, throws her cup of water over her shoulder. During the tense exchange, Dr. Phil proposed that Gammill begin a three-month rehab and detoxification program in Hunt, Texas immediately.

“Dr. Phil told it to me straight,” Gammill said. “Talking to him was like being in a ring with a pit bull. But he told me what I needed to hear. I listened, I went to rehab, and I got well. It really fell out of the sky,” she said. “It was the strangest thing that’s ever happened to me really.” Gammill left the studio and flew to La Hacienda Alcohol and Drug Treatment Center in Hunt, Texas. She left behind her husband, her six-year-old daughter, and her three-year-old son.

By the end of three months of rehab, Gammill had undergone a “spiritual awakening.” Her trajectory from recovered addict to high-profile interventionist was just beginning. Families from around the country now contacted her requesting help with a sick family member. Gammill flew directly to their homes to act as mediator to help persuade the addict to begin rehab.

Gammill also became a regular guest on the Dr. Phil Show, encouraging addicts who participated in the televised programs to act on the same life-saving message she had received there. Wherever she traveled, Lucy, the chihuahua, traveled with her as a registered medical “service dog.” During Gammill’s appearances on the Dr. Phil Show, Lucy’s photo provided a backdrop to the large studio screen. The pair made an indelible image. When fans in airports recognized them, it was often Lucy who caught their attention — her brown head peeking out of a purse-sized pouch at Gammill’s side.

Gammill has a deceptively laid-back manner for a crusader on a mid-life mission. Still, she depends on four cups of coffee a day to keep her in high gear, and can hop on planes up to three times a week, zigzagging across the country’s five time zones to do her work in rehab centers and private homes. In her improvised WiFi office in the coffee shop, she was finalizing the draft of her book The Interventionist, a narrative combining personal memoir with stories of her clients. Gammill has also videographed her clients to capture their loneliness and terror, as well as their remarkable transformations. One story detailed the life of a 24-year-old crack cocaine addict who lived for two years in an 18th-century church graveyard and the steps she took to regain her life. To support her habit, she worked as a prostitute for downtown lawyers and construction workers. “When I took her into an urgent care facility, the doctor saw her physical state and impetigo all over her skin and said, ‘I’ve done two tours in Iraq, and I never saw anything this bad,’” Gammill said. “She had a fractured family life.” Her client became drug-free.

From the moment I met Gammill — so squeaky clean in appearance, so professional in demeanor — I could not help but wonder what made her inner demons different from anyone who didn’t resort to drugs for escape. Were successful middle-class professionals were who addicts different from other addicts? And what were the odds she and others like her would stay sober?

“My mother was a pillhead, my father was an alcohol,” Gammill told me. As a child growing up in Arizona, Gammill remembers her “emotionally distant father,” a law firm administrator who “always ate his dinner upstairs.” With both parents fixated on their addictions, Gammill fended for herself. At age 10, she was invited to the house of a pedophile neighbor. He sexually abused her for the next three years. It was “a very surreal time,” she told me. “Predators always find children starved for love.” When Gammill was fifteen she began experimenting with drugs and alcohol.

The demons that pave the path to addiction take many forms. They include child and adult sexual abuse, trauma-induced or organic brain chemical imbalances, the absence of spiritual values or a religious matrix, the alienation or neglect of family or friends, and the mysterious interplay of genes.

“Addiction is always a multifaceted malfunctioning of health,” Gammill writes. “When addiction plays out in a person’s life, it is threefold in its pathology: biological, psychological, and social. The biological involves the physical body, brain chemistry, and the genetics influencing it. The psychological has to do with elements such as family dynamics, emotional turmoil, and negative thinking. And the social aspect is related to how factors such as socioeconomic status, culture, poverty, technology, and religion can influence health.”

As a result, potential addicts fall prey easily to what Gammill, and fellow interventionist David Lee, call a “sense of disconnectedness.”

“For me and for all addicts, there is always this sense of detachment,” Gammill said. She admits that the work of the interventionist is to create a kind of instant intimacy with family members and addicts to successfully bring the addict to a state of self-awareness, but that these relationships are ultimately short-lived affairs. “For addicts, there is always the problem of intimacy,” she said, including herself in the description. “For addicts, intimacy is the final frontier.”

David Lee, another nationally prominent addict-turned-interventionist, concurs. On his website, Lee describes the addict as “the loneliest person in a crowded room.” Lee recounts spending fifteen years as an addict – repeatedly overdosing, stealing money from his family, and getting arrested. “Every single moment of my life I was asking, ‘What can make me feel better?’” Addicted to “avoiding uncomfortable feelings, things, and situations, and to seeking pleasure, through drugs, sex, whatever,” Lee said he eventually derailed mentally. At a hotel one night, he entered a meth-induced psychotic state. He believed his television was “speaking” to him. He hallucinated that drug dealers were going to kill his family. Holding a hotel clerk at knifepoint, he was arrested again. His family finally intervened. He was on the way to recovery.

In the epilogue to her book, Gammill notes that when bad biology, bad psychology, and bad social influences collide, “addiction comes to life in all its ugly destruction.” She adds: “I had the genes from my parents, psychological trauma from my childhood, and, among other social issues, access to drugs on my job.”

Current medical research confirms the three-part model. “For every addict, one part or another of the equation may weigh more heavily, but it is usually some combination of all three,” Gammill said. “Bill Watson, one of the founders of Alcoholics Anonymous in the 1930s, documented alcoholism as being threefold – involving body, mind and spirit – in a way strikingly akin to the modern bio-psycho-social model.”

In her own case, Gammill’s addictions grew about the time she became a young registered nurse. She had easy access to medications. She began popping patients’ pills. She went clean for six years after that. But in her thirties her secret on-the-job habit resumed. Her father died in a crash, drunk at the wheel of his car. Her mother died from popping pills. “I was working in a drug and alcohol rehab center for the two and a half years before my overdose,” Gammill recalled. “I was very, very sick. Statistically, we addicts can limp along for years.” Along the way, Gammill tried a dozen out-patient rehab treatments on her own. All failed.

When she became engaged, Gammill attempted to go clean again. She relapsed following a spinal fusion operation requiring pain killers. The pain medications gave her the chemical lift she craved, and she was hooked. After marriage and the birth of two children, Gammill’s drug overload was actually killing her. She had recently purchased Lucy the chihuahua – an “impulse buy.” And Lucy was now licking the blood that dripped from Gammill’s arms when she shot up.

“I overdosed on adderall when I was 46,” Gammill told me. “I was taking three prescription drugs a day. In the mornings I’d shoot up with the opiate buprenorphine. This made me euphoric. But I’d get sleepy on that, so by midday I’d take adderall, an amphetamine, by mouth to wake up. In the evenings, to counteract the adderall, I’d pop the tranquilizer klonopin.”

Gammill knew her drugs well. On the day she overdosed, pain coursed through her chest and arm. “I was on coronary artery overload,” she said. “I should have stopped what I was doing and called 911.” Instead she went to pick up her daughter Mary at the local elementary school. Gammill felt disoriented in the school parking lot. “That day I did not find my daughter. My daughter found me.” Gammill was placed in the coronary intensive care unit at the hospital and diagnosed with ischemia, a restricting of blood vessels that was preventing oxygen flow to her heart. Gammill survived.

Recovery lay ahead. “There was no single moment of catharsis,” Gammill recalled. But three watershed experiences played a critical role: her parents’ deaths from addiction, her overdose, and now the real threat of death. “I did not want to die and leave my children,” she said. Still, the fear of imminent death was not enough. More drugs followed. Then came Dr. Phil’s email. And rehab.

In the quiet of Texan hill country, Gammill looked out on a world where the Northern Star shined brilliantly at night and lizards crossed trails on the edge of the Guadalupe River. Here Gammill found a new interior landscape. After a tough detox, daily counseling sessions with addiction specialists, and AA-style meetings with other addicts, Gammill healed. “I was given another chance,” she said. “I wanted to give back to others what was given to me. I am counting on another thirty years.”

For Gammill, the addict’s best chance of success begins with intervention followed by faithful attendance “for life” at Alcoholics Anonymous (AA) or Narcotics Anonymous (NA) meetings. Individuals confronting other addictive behaviors — gambling, pornographic and sexual networking, overeating, bulimia, all called “process addictions” – should also attend their own AA-style meetings or join AA and NA groups, she said. “Clinical studies show that if you start AA meetings the day after you are discharged from treatment, you have up to a 50 percent chance of continued sobriety,” Gammill said. “You have established a supportive community. For me personally there is nothing more moving than holding hands at the end of an AA meeting, and saying the Lord’s Prayer.”

Gammill attributes AA’s phenomenal success in part to the fact that its roots are firmly planted in what have turned out to be facts confirmed by modern medicine. “But just as we have come a long way, we need to keep recovery and its meetings firmly planted in a solution that has worked for millions of people – the Twelve Steps.” Getting support from family members, friends, or work associates, as well having as a “sober buddy,” also play a part in maintaining sobriety, she noted.

Substance addiction is treacherously difficult to reverse, Gammill admits, and there is no “cure.” Prevention and abstinence are key. “You have a better chance recovering from cancer than you might from addiction,” Gammill notes. Overall recovery from addiction may be as low as 20 percent. But new clinical research shows that that figure could jump to as high as 40 percent if treatment is ongoing.

Since her own intervention, Gammill has assisted over 200 addicts. More than ten have participated in interventions with Dr. Phil. Three have died. Her clients cut across America’s cultural and religious divides. They include Bible-belt Christians, Hasidic Jews, Irish Catholics, Muslim immigrants, college students, and most recently, anorexics and bulimics.

The stories Gammill shares are testaments to grit and courage. “I am changed by my clients,” Gammill noted. “My spirituality is other people. My gift is to be able to see the person without the addiction, without the drunkenness or the chaos.”

Gammill confesses to struggling with institutionalized religion, but acknowledges its power in her interventions. “I have to admit that I have some trouble with organized religion, so when I began working with a fundamentalist Christian family to help their child I wasn’t sure how it was going to go,” Gammill told me. She was changed “by all the caring they showed.” A Hasidic family proved “incredibly loving” as the whole family wept together, Gammill recalled.

When an Iranian immigrant mother called Gammill for help, there were different challenges. Her son was attending an American college. “We discussed her son and what we could do. Then she began yelling at me, asking me why my government wasn’t doing more to stop drugs. I wasn’t about to address that problem,” Gammill said. But the mother’s question was apt. Public policy advocates have also asked it, arguing that the government’s “war on drugs” has been ineffective. Critics of current government policy advocate a policy shift towards prevention and treatment rather than crop eradication, military intervention, and domestic law enforcement. According to one advocacy group, treatment has proven to be between seven and twenty-three times more cost-effective than its policy alternatives. Gammill’s method of intervention is arguably more effective than methods endorsed by the U.S. government.

Gammill also recently intervened on behalf of a 26-year-old anorexic-bulimic. “She was 70 pounds,” Gammill said. “She took 14 laxatives a day, ate almost no food, and her kidneys were not functioning.” Her client entered a six-month treatment program to be cured.

“Addiction is everywhere, and whatever group we’re talking about, active chemical addiction trumps love, trumps food, trumps everything,” Gammill said. Addiction’s epidemic proportions make it one of the most common diseases in the United States. By one estimate, over nine million Americans need drug treatment, making addiction more prevalent than coronary heart disease and stroke, and as prevalent as cancer.

Distinct from other social groups, middle-class addicts are triggered by specific social stressors and typically use a different range of drugs. “I’ve worked with heroine and crack cocaine kids, but at least 90 percent of the drugs I’m seeing with my clients are prescription drugs – drugs from the FDA rather than the [neighbor]‘hood,’” said Gammill, whose clients are predominantly middle-class. Treatment varies enormously by class. America’s most prestigious treatment centers ask a staggering $30,000 or more per month for care. “This is a lot of money, but a patient gets the best of professional care on a day-to-day basis,” Gammill said. By contrast, addicts without financial means may receive one state-funded lifetime assessment and rehab treatment in the state of Maryland, she noted.

Gammill added that research is finally destigmatizing addiction’s biological roots. Time senior science writer Michael Lemonick, a former addict, has written: “Investigators have begun to figure out exactly what goes wrong in the brain of an addict – which neurotransmitting chemicals are out of balance and what areas of the brain are affected.” Addicts appear to have less dopamine and seratonin, key neurotransmitters involved in the brain’s reward system, causing them to resort to chemical stimulants that create the same sensations non-addicts have easily at their disposal.

Gammill’s mission is to help trigger behavioral changes in her clients that give them a fighting chance at overriding the chemical imbalances and cognitive misfirings of their brains. Just as the problem of addiction involves a mind-body, or brain-body, connection, so does the solution. But even as treatment methods improve, addiction will never go away, notes Nora Volkaw, director of the National Institute on Drug Abuse: “The use of drugs has been recorded since the beginning of civilization. Humans in my view will always want to experiment with things to make them feel good” – even when those feel-good sensations lead to illness or death.

Gammill remains undeterred. “I do whatever comes my way, whatever the higher power puts my way… It somehow makes my parents’ death not so in vain. Addiction can be found in every culture, and in the end it has to be said that the disease — and the love that cures us of the disease — transcend culture.”

Gammill quickly acknowledges the many people along the way who helped her on her path to recovery, including strangers. When Gammill relapsed five years ago, she returned to Texas for what she called “a tune-up.” On her flight home, she was seized by self-doubt and panic. She wondered if she could go on. At a stopover airport, she asked to be taken to a hospital. Trying to get a hit of Valium before being released, her request was declined.

She took a cab back to the airport. Her dark-skinned driver looked Middle Eastern. Gammill felt uneasy, as she wrote later in a blog. But the two struck up a conversation as the Northern Star shone brightly outside the cab window — the star she had gazed upon while recovering at La Hacienda. Gammill learned he was from Iran. “I asked him if it has been difficult for him since 9/11, a Middle Eastern man living in the United States. ‘No,’ he said. ‘I think people sense the goodness in others, and I am accepted here.’” The driver asked why Gammill was coming from a hospital to the airport in the middle of the night. Gammill told her story and cried. “I am sorry you are in pain,” said the driver, handing a tissue over the seat.

“Then the briefest of moments changed everything for me on this strangest of nights,” Gammill recalled. At the airport, as the driver lifted Gammill’s bags from the cab, he took her hands in his. “He gently said, almost in a whisper, ‘I sense goodness in you.’” Gammill avoided his gaze, trying to stop her tears. “He lifted my chin, looked me right in the eyes, and repeated, ‘I sense goodness in you… Go home and live your life as God intended you to, live your life in God’s grace.’”

The cab driver drove off. The two waved as the taxi faded into the night. “Lightness of being is how I felt after my encounter with the man from Iran,” Gammill wrote. “I never knew his name. He was not a fanatical bomber. He was a peaceful, generous man… And I was at peace. I had the courage to return home and give recovery another chance. I was no longer afraid.”

Through the kindness of a stranger, under the healing rays of a star, Gammill received another life-saving intervention. Her gratitude runs deep: “Thank you, whoever, and wherever, you are.”

Gammill’s book The Interventionist is now available through Hazelden Press.

Washingtonian Magazine/Backlogged