NICOLE Kapulsky didn't do the 12 steps.
She doesn't go to Narcotics Anonymous meetings and tell other recovering addicts about how she trekked into North Philly's Badlands - 5-foot-nothing, alone, petrified - to buy dope.
Or about the worst day of her life, when her ex-husband showed up at her parents' house with police and took her children away. Or when her family turned their backs on her and she was calling rehab centers every hour to check for an open bed - only to relapse after she'd finally detoxed.
She didn't suddenly find God and realize that surrendering to a higher power was the only way to get clean.
"I did it my way," said Kapulsky, 35, who was introduced to heroin in 2009, after an ugly divorce, but who has been drug-free for nearly 19 months.
And, importantly, her doctor's way.
In January 2011, after being away from her three sons for Christmas and New Year's, Kapulsky decided that she needed to kick heroin for good. She'd seen it kill her friends. It had to stop.
"By the time I was done, I had no savings, no jewelry. I had nothing," she said. "I couldn't take any more of not being with my kids. It was heartbreaking for me. My kids were my whole life. That's when I googled it. I made an appointment and went in."
The appointment was with Dr. Richard DiMonte, an addiction-treatment specialist in Media. He uses a non-narcotic that has helped Kapulsky and hundreds of his patients reclaim their lives from prescription painkillers and heroin.
It's called Vivitrol, a monthly injection of naltrexone that binds to human opioid receptors and blocks the drugs' euphoric effects, so addicts can't get high even if they want to. Kapulsky said it also stopped her drug cravings. She doesn't even think about heroin anymore, unlike in 2010, when she relapsed after methadone treatment.
'It saved me'
Doctors and researchers hate the term "miracle drug." But Kapulsky says that's the best way to describe her experience.
My family trusts me. There's no question of whether I'm clean or not. They know that I am because I go and I get my shot every 28 days, and they know that you can't do drugs when you're on the shot. You just can't do it," she said. "It saved me. I'm not the strongest person in the world, believe me. If I wasn't on Vivitrol, I probably would have relapsed."
Vivitrol was approved in October 2010 by the Food and Drug Administration for the treatment of opioid dependence. Experts say it could be a game-changer in combating the increasing abuse of oxycodone and other prescription painkillers, which doctors and law-enforcement officials say is helping to create a new category of heroin addicts.
"We have a prescription-drug problem, and it's just getting out of control," DiMonte said. "Most of the heroin use nowadays is because people can't afford the prescription pills they're buying, so they convert over to heroin, which is cheaper."
In 2010, about 12 million Americans reported that they'd used prescription painkillers for nonmedical purposes in the past year, according to the Centers for Disease Control and Prevention. Between 1998 and 2008, the reported abuse of prescription painkillers more than quadrupled, from 2.2 percent to 9.8 percent, among people 12 and older who entered substance-abuse treatment.
"It's really taken off over the last five years. I couldn't even begin to tell you how bad," said a veteran officer in the Philadelphia police Narcotics Field Unit, who asked that his name not be printed because he works undercover. "It's much easier to get started on the pills because the doctors are writing prescriptions. Nobody thinks anything of it.
"It's a very wide range of addict," he said. "It doesn't just attack the poor or a certain neighborhood; it's all over the place."
This summer, opiate abuse was back in the news after the death of Eagles coach Andy Reid's 29-year-old son, Garrett. He started with OxyContin as a freshman at Brigham Young University in 2002 and later began using heroin. His cause of death has not been disclosed, but Reid has said his son "lost the battle" he'd been fighting.
"These are not drugs secretly transported into the country by boat or airplane. The drugs are here," Thomas Perricone, chief of the narcotics and dangerous- drugs section of the U.S. Attorney's Office in Philadelphia, said of prescription painkillers. "We are seeing very organized rings where networks recruit 'patients' and sometimes transport them in groups to corrupt doctors' offices."
'Weapons in the arsenal'
Vivitrol has shown promising results so far, experts say.
Instead of replacing one narcotic with another - such as methadone or Suboxone, both of which have the potential for abuse and are sold on the street alongside heroin - a monthly injection of Vivitrol forces addicts to remain clean. That enables them to participate in a support program, or, in Kapulsky's case, one-on-one therapy, and to tackle the root causes of their addiction, which often involve mental illness.
Alkermes, the company that manufactures Vivitrol, doesn't disclose patient data, but it says net sales of Vivitrol have increased for 12 consecutive quarters. Some doctors are using Suboxone and other medicines to taper their patients off heroin or painkillers, then switching them to Vivitrol. It could be a winning formula, recent research shows.
"These are just weapons in the arsenal, tools to help the patient. But if the underlying cause is still there, the likelihood of success diminishes considerably," said Dr. Hani Zaki, director of psychology at Eagleville Hospital in Montgomery County, which treats substance abusers.
Zaki said the nature of addiction is still widely misunderstood. Recovery isn't a matter of days or weeks or months, he said, "it's always years." Very few addicts can do a quick detoxification then go on with their life without the risk of relapse.
"The willpower and 'just say no' thing are really very naive. There are physical changes in the brain when you become addicted," Zaki said. "The brain needs time to recover. Just finishing detoxification doesn't mean that the patient is out of the danger zone."
For Kapulsky, who now lives in Boothwyn, Delaware County, Vivitrol serves as a safety net while she pieces her life back together after she was blindsided by heroin addiction in 2009. She has regained joint custody of her children, reconnected with her sister and helps care for her 1-year-old niece. She goes to therapy once, sometimes twice, a week, and plans to take college courses to become a drug-and-alcohol counselor.
She's happy now, and quick with a smile.
But Kapulsky said she knows four people who died from heroin this summer alone, including a close friend. She's trying to spread the word that Vivitrol is available - and covered by many insurance plans - for people who want to get clean and stay clean.
"It's horrible. I've never seen anything like this in my life, how many people are addicted to opiates," Kapulsky said. "It's everywhere, and nobody's immune to it. People don't want to believe that addiction is a disease. But it is a disease, and you know what? It's curable."
Contact William Bender at firstname.lastname@example.org or 215-854-5255. Follow him on Twitter @wbender99.