It’s almost beyond words, trying to describe the physical transformations of a casual drug consumer who turns into a full blown addict. Physical changes are the principal markers of one’s stage of addiction. For example, one of my sex worker friends, K. has recently gained a lot of weight, signaling that she’s getting clean, while C. has become a sunken skeleton over the past six months, indicating that she has fallen deeper into her habit. Indeed, K. uses her weight gain as proof of her new sobriety. She keeps pointing out to me, while pulling at her stomach, “See Anita, look how fat I am…I’m not smoking anymore.” I congratulate her and always mention her weight gain every time I see her. The other women also notice and whisper to one other, “K. is kicking the habit, look at her legs, they aren’t twigs anymore…look, her ass is coming back…that’s the K. from 5 years ago…” Everyone agrees that with each pound gained, K. is becoming more and more beautiful (given that curvy, more voluptuous figures are celebrated here). I just ran into another friend from the streets, someone I hadn’t seen in several months, and the first thing I noticed about him was his weight gain. He looked great—and sure enough, beaming with pride he told me, “Anita, I’ve kicked the habit.” He face looked so different I hardly recognized him. It makes me so happy to see these “success” stories, even if they are temporary.
C. is a different story. I have worked with marginalized populations all my adult life and am very familiar with the hardened faces of addicts. I can usually identify one’s stage of addiction based on their physical appearance, but the majority of the time I’m exposed to addicts who already carry the physical markings of their habits. Watching C.’s downfall is the first time I have witnessed the entire process, from start to “finish”, of the physical changes someone goes through over time. It’s deeply disturbing to watch. When I first met C. more than a year ago she was plumb and quick to smile. She had bright eyes and shiny skin and hair. She had beautiful hair that she kept down, resting on her back in a thick sheet. I knew C. had a particularly sad back-story--her son had recently died as a toddler and her husband had abandoned her, leaving her to fend for herself on the streets. I don’t know anything about her past drug use, perhaps she has always been a casual user, or perhaps someone introduced her to drugs for the first time while working on the streets. C. is the only person I have ever met in Quito for whom heroin is her drug of choice. It is very difficult to find here and when the other women talk about her habit, they don’t even use the term heroin. The vast majority don’t even know what drug she uses, only that she gives herself “injections.” Most of the women have never heard of such a thing. I’ve explained to them that it sounds like C. uses heroin and finally one of the women confirmed to me that indeed, she’s a heroin addict.
I first noticed C.’s weight loss, it seemed like every time I saw her she had lost another five pounds. She wears leggings and t-shirts. At this point even her leggings are baggy. It’s not just her plummeting weight that has been disturbing. It’s how her face has changed. Her skin is pale and her eyes no longer shine. Her features are pointy, transforming her oval face into a sharp triangle. She always has her hair pulled back into a tight, lifeless pony tail. Basic hygiene is no longer a priority; her clothes are dirty and it seems like she showers less. Her personality has also changed dramatically. When she greets me she no longer smiles, she just kisses me on the cheek and walks by. In fact, I can’t remember the last time I’ve since her hang out with the other women. She’s always on the move and has a harried look on her face, as if she’s searching for something (which she is, obviously). There’s no time for small talk in her present life, she simply searches for clients and then is off to score heroin.
It is heartbreaking to witness someone’s extreme transformation—if I hadn’t been in daily contact with her over the past year, I would never recognize the C. of today from a year ago. Like I said, I’m accustomed to being around addicts, but with people who are already lost in their addictions. I recognize the hardened lines etched into people’s faces, their constant jaw-clenching, body scars, shaking and twitching, darting eyes, and lack of hygiene. Since the people I work with mostly smoke base, it’s their weight loss, yellow fingertips and jaw clenching that gives them away. The yellow tips of their thumb and forefinger are the big give-away that they smoke base (a yellow powder). Most people smoke out of their hands, rather than using a pipe. I was dumbfounded when I first learned this fact. But how, I asked. Many people don’t have access to pipes and simply start using their fingers. In fact, cops regularly stop people on the street where I work to check their fingers. I still don’t understand how they do it without burning themselves—
Perhaps the most disturbing part about C.’s physical transformation is that there’s no end in sight. I ask myself, will she continue to shrink until she no longer exists? At what point will her body simply collapse? How long can she sustain her deteriorating condition? The worst part is that we can’t do anything to help her. Despite efforts from friends who try to convince her to enter rehab, C. continues on her self-destructive path. Everyone on the streets (including myself) knows enough about addiction to know that an addict can’t be stopped until he/she wants it. We can only hope that C. hits rock bottom soon and decides to seek help. Until then, we can only stand by and watch her slowly disappear.