The book Addicted and Convicted: Letters from a Lost Daughter, published in August, tells the story of how Elizabeth Elliot (pseudonym) lost her life in 2014 due to the failures of the United States’ addiction treatment system. Elizabeth’s cause of death—endocarditis, an infection of the heart’s inner lining for which injection drug use is a risk factor—is increasingly widespread, but would not be included in the surging numbers of overdose fatalities recorded each year.
The book was put together by her mother, Sheila Ellin (pseudonym). It combines letters, poems and other documents written by Elizabeth with her mother’s commentary. The published work has an important purpose: not only showing the damage caused by our current systems of incarceration and rehab, but also how science-based harm reduction interventions, such as medications for opioid use disorder, could have saved Elizabeth’s life.
I have known Sheila Ellin, who lives in New Jersey, for some years through harm reduction circles. I recently had the opportunity to interview her about her daughter’s story. Our interview has been edited for length and clarity.
Kenneth Anderson: Who was Elizabeth, and what happened to her?
Sheila Ellin: Elizabeth was gifted in so many areas—writing, art, music, fashion design—but she also struggled with social anxiety, depression and low self-esteem, made worse by childhood sexual abuse. She started self-medicating with several substances, and at age 19 she was arrested for possession and entered the criminal-legal system.
Elizabeth attended six 12-step rehabs, and was locked up in three county jails, the New Jersey state prison and several prison halfway houses. Elizabeth died from endocarditis at age 29.
“The 12-step model was useless to Elizabeth. In fact, it made her feel like a failure. That system, and most of the world, judged her.”
When did you first learn about Elizabeth’s drug use?
In January of Elizabeth’s junior year of high school, I found a lighter when I was cleaning her bedroom. I knew Elizabeth was strongly anti-smoking [of cigarettes], so I concluded that she was smoking marijuana. When I asked her about it, she told me she was “just experimenting,” and so that was that.
Three and a half years later, when she was 19, she called me in tears, and told me she was addicted to heroin.
What did you expect would happen when she first entered rehab?
When we arranged for Elizabeth to go to rehab the first time, after she told me she was addicted to heroin, I believed that she would spend 28 days in rehab [and that] she would have to go to AA/NA meetings, and she would no longer be able to use any drugs or alcohol. I thought after 28 days, her life would be back on track—as if her heroin use had never even happened. A minor blip.
What was the actual result of her going to rehab?
The actual result [was] that Elizabeth, and all the people around her, started viewing her as a “drug user” and college drop out.
She did meet her soulmate in her first rehab, and I am happy that she experienced true love in her shortened life. But the rehab did nothing for her.
They diagnosed her with an eating disorder and depression, but did not give her any medication, because they required a person to be abstinent from all substances before they would consider medication.
The 12-step model was useless to Elizabeth. In fact, it made her feel like a failure. She did not go to meetings after she left rehab; she did not get a sponsor. She just did not buy into the whole abstinence, 12 step-based system.
That system, and most of the world, judged her for that—they judged her a failure for her relapses, and for her not buying into what they were peddling.
How did her involvement in the criminal-legal system affect her?
Her involvement with the criminal system, obviously, affected Elizabeth in many ways, all negative. Elizabeth struggled with anger all her life, and being in prison increased her anger and resentment towards those who mistreated her in prison and out of prison. Her mental health suffered in prison, because she was separated from her baby, from her family, her friends, and everything she loved.
Upon leaving prison, Elizabeth was not eligible for assistance with housing because she had drug [convictions]. And because of her drug possession felonies, Elizabeth’s job options were limited.
“There are many things I believe could have helped Elizabeth. None of them are rehab or prison.”
How was her continuing experience in the treatment system?
The treatment system did not help Elizabeth. Elizabeth was always an “A” student, and she was an excellent student in 12-step rehab programs as well. She tried her best. She did all the work sheets; she worked the Steps. She was always optimistic—but that is because Elizabeth and I and so many others believed the culture of 12-step rehabs. We believed they would do what they said they would.
No matter how hard Elizabeth tried inside rehab, as soon as she was out, her issues led her to begin immediately self-medicating and using again. She was kicked out of two or three rehabs for “fraternization”—even though she always told the rehabs she had a sex addiction.
I think the main effect of the rehabs was to make Elizabeth feel like a failure. She wasn’t a failure; 12-step rehabs were just not a fit for Elizabeth. But they made her feel she was a failure. It was kicking her when she was down—over and over, with every relapse or arrest for possession.
We know that help with injection techniques and availability of alternatives could have reduced Elizabeth’s risk of endocarditis. What else do you think might have helped her?
There are many things I believe could have helped Elizabeth. None of them are rehab or prison. I would say harm reduction, [including] treatment with methadone or buprenorphine. Trauma-informed therapy—for her PTSD, the loss of her son [he was removed rom her care, and she was not allowed to see him], domestic violence, multiple rapes, childhood sexual abuse—evidence-based treatment such as cognitive behavioral therapy or dialectical behavioral therapy.
Something that would really have helped Elizabeth, and all people who use drugs, is reducing the stigma towards drug users. Elizabeth talked about herself as a criminal, loser, deadbeat mom, college dropout, etc. For people who are using drugs because they are struggling, stigma just makes them feel so much worse about themselves.
How has your loss affected you in the years since?
I’ve dealt with mental health issues since I was a child. Elizabeth was the light of my life. My mother died of cancer when I was 15. My mother was a wonderful person. Losing her, and then losing Elizabeth, who was the best thing by far to ever happen to me, has been a nightmare.
But almost worse than losing Elizabeth was seeing/feeling the pain that she went through and not being able to help her. It has changed me in ways too complicated to get into here, but I believe I am more compassionate, and I believe I am more open to new ideas and different ways of seeing the world.
“Harm reduction has changed the way I view the world.”
How did you come to learn about harm reduction?
I came to know about harm reduction in 2016, two years after Elizabeth’s death. I was in the Facebook group GRASP (Grief Recovery After a Substance Passing) and I made a post. An admin said my post wasn’t right for GRASP, but was perfect for their sister group Broken No More, which dealt with harm reduction, medication-assisted treatment, advocacy etc. I went to Broken No More. For several months, I read every single post, every single day.
Later that year, I attended the GRASP/Broken No More conference. The next year, the Reform conference, and the following year, the National Harm Reduction Conference.
How has harm reduction changed you?
Harm reduction has changed the way I view the world. I guess, growing up, I was relatively conservative, and I believed drugs were illegal because they were “bad.” I thought if people were arrested for possession of drugs—well, they broke the law.
After learning about harm reduction, I believe people should be able to use whatever substances they want, as long as they’re not hurting other people. I participated in advocacy groups in New York State for several years, and I spoke in Albany several times. I did not ever think I would be the type of person to have the desire or the capability to do that, but I felt very strongly, and I continue to feel very strongly about advocacy.
What would you say to other moms in the situation you experienced?
To moms in this situation, I guess what I would suggest is: One, be a support and love your child unconditionally and without judgment. Don’t believe what treatment centers tell you and don’t try “tough love” unless it’s a serious safety issue.
And two, educate yourself. The internet was not as big when Elizabeth was alive, and maybe things would’ve been different if I had learned about harm reduction and medication-assisted treatment when she was alive. Back then I read a lot of books, but most of the books were written by people in recovery through the 12 Steps, so they were pretty much useless.
“Harm reduction does not require abstinence as a condition to help a person make positive change in their life.”
What is wrong with the way the US treats people who use drugs?
Everything. Criminalization is wrong, mass incarceration is wrong, drug courts are wrong—because they punish participants by putting them in jail—stigma is wrong….
Our whole culture’s belief and fixation on 12-step rehabs, then AA/NA meetings and abstinence for the rest of your life, is just wrong—because it does not work for the majority. The $35 billion per year (several years ago) rehab industry is just not working. People need to understand that it is not working.
Another thing people need to understand is that most people who use drugs never have a problem. They just stop on their own or continue to use in a functional way. That’s something I learned through harm reduction, and most people don’t understand that. Before Elizabeth struggled, I just assumed that everyone who used heroin, crack, meth, etc., would get addicted and would have problems. No. Wrong.
What is wrong with the US treatment system?
I guess the main thing wrong is that no single treatment type will ever work for everyone. Individuals need different types of help with finding a safe place to live [with] poly-substance use, mental health issues, trauma—and everyone is different. There’s no way one type of treatment is going to work for everybody. And abstinence is not gonna happen for everyone.
If Elizabeth had lived, maybe she would’ve stopped some substances or moderated, but with all the trauma and her issues and her genetics, I do not believe she ever would’ve been abstinent, and I certainly would not have expected her to be. Substances were Elizabeth’s coping mechanisms, and I believe they work better than current psych medications for the most part.
Why is harm reduction a better way?
Harm reduction is a better way because it meets the person where they are at, without judgment. Harm reduction considers all aspects of the human condition and tries to help in any way to make a person’s life better, and reduce the harm of the substances they’re using or the behaviors they’re doing. Harm reduction does not require abstinence as a condition to help a person make positive change in their life.
Detail from the cover of Addicted and Convicted: Letters from a Lost Daughter, showing Elizabeth Elliot, courtesy of Sheila Ellin