After Drugs and Dark Times, Helping Others to Stand Back Up

From the New York Times, December 19, 2011

This is the fifth part in the series “Lives Restored – Managing Severe Mental Illness”, by Benedict Carey, last in a series of profiles about people who are functioning normally despite severe mental illness and have chosen to speak out about their struggles.

Part One – Rescuing Others – Expert on Mental Illness Reveals Her Own Fight, New York Times, June 23, 2011
Part Two – Living with Voices – Learning to Cope With a Mind’s Taunting Voices, New York Times, August 7, 2011
Part Three – A High-Profile Executive Job as Defense Against Mental Ills, The New York Times, October 23, 2011
Part Four – Finding Purpose After Living With Delusion, The New York Times, November 25, 2011

The taste of cocaine and the slow-motion sensation of breaking the law were all too familiar, but the thrill was long gone.

Antonio Lambert, 41, has a combined diagnosis that is among the scariest in psychiatry.

Antonio Lambert was not a young hoodlum anymore but a family man with a career, and here he was last fall, high as any street user, sneaking into his workplace at 9 o’clock at night, looking for — what, exactly? He didn’t really know.

He left the building with a few cellphones (which he threw away) and a feeling that he was slipping, falling back down into a hole. He walked in the darkness, walked with no place to go, and then he began to do what he has taught others in similar circumstances to do: turn, face the problem, and stand back up.

“I started talking to myself, out loud; that’s one of my coping strategies, and one reason I relapsed is I had forgotten to use those,” said Mr. Lambert, 41, a mental health educator who has a combined diagnosis — mood disorder with drug addiction — that is among the scariest in psychiatry.

He texted a friend, someone who knew his history and could help talk him back down. And he checked himself into a hospital. “I know when it’s time to reach out for help.”

The mental health care system has long made use of former patients as counselors and the practice has been controversial, in part because doctors and caseworkers have questioned their effectiveness. But recent research suggests that peer support can reduce costs, and in 2007, federal health officials ruled that states could bill for the services under Medicaid — if the state had a system in place to train and certify peer providers.

In the years since, “peer support has just exploded; I have been in this field for 25 years, and I have never seen anything happen so quickly,” said Larry Davidson, a mental health researcher at Yale. “Peers are living, breathing proof that recovery is possible, that it is real.”

Exhibit A is Mr. Lambert, a self-taught ex-convict who is becoming a prominent peer trainer, giving classes in Delaware and across the country. He is one of a small number of people who have chosen to describe publicly how difficult it is to manage such a severe dual diagnosis, including the sudden setbacks that often come with it.

“He is an extreme example of how much difference passion and commitment can make, given where he’s come from,” said Steve Harrington, the chief executive of the National Association of Peer Specialists, a group devoted to promoting peer support in mental health care.

Mr. Lambert, who has climbed out of a deep hole with the help of religious faith, medication and his own forms of self-expression, puts it this way: “There are a lot of people dealing with mental illness, drugs, abandonment, abuse, and they don’t think there’s a way out. I didn’t. I didn’t.”

Bean Bean in Spider City

His grandmother was the first person to call him Bean Bean, and the boy was so skinny that he couldn’t shake it.

He couldn’t avoid the older toughs in the Brighton section of Portsmouth, Va., either, and he spent some of his school-age years taking beatings. That was Brighton back in the day, and at least those fights taught survival skills. Not everything did: He remembers being sexually abused at age 6, by an older boy in the neighborhood — brutally.

He had no one to tell, even if he had known what to say. His mother and father were split, living blocks apart, each a fixture in the neighborhood’s social swirl of house parties, moonshine “shot shops,” card games and other attractions. His mother, called Chucky, was often out, sometimes leaving the boy at a friend’s house for “a few hours” that turned into an entire weekend. For much of that time, he waited on the porch.

He idolized his father, a truck driver and warehouse worker who lived nearby but spent his free time out, too, drinking and playing cards.

“During that time I was an alcoholic, but I would go out and try to find him when I heard he was out,” said his father, Edward Lambert, in a recent interview at his house in Brighton. He gave up drinking years ago for God, and father and son would eventually become close.

But not before the son began to stand his ground on the street, earning a name as an up-and-coming gangster by age 12, a regular presence at Palmer’s Corner, home base for the heavies, the alpha males of Brighton — Spider City, as they called it. He was soon into drugs, first as a courier and then as local muscle, armed and very dangerous. He began using more and more cocaine, crack usually, and soon acquired another trait.

“We regarded craziness as an esteemed quality, something to be admired, like white people admire courage,” Nathan McCall wrote in “Makes Me Wanna Holler,” his 1994 memoir of growing up in Portsmouth. “In fact, to our way of thinking, craziness and courage were one and the same.”

The skinny boy grew big, strong and crazy enough that he would ride around on his bike with a sawed-off shotgun on the handlebars, pull up to a group of dealers and throw an empty bag on the ground in front of them, with these instructions: Fill it up. Now.

“I would shoot the gun off in the air to show I was serious, then just take the drugs and move on to the next pack of dealers, and lay them all down,” he said. He was a junior in high school.

No one who was there has forgotten it. “It got to be where people, dealers especially, they would watch the street for Bean Bean in the same way they would watch for the police,” said Henry Maurice Hunt, a stepbrother and fellow gunslinger from back then who still lives in the neighborhood. “If they saw Bean come onto the street, they were gone.”

It couldn’t last, and it didn’t. He survived several gunfights, taking a bullet behind the ear in one (it is still lodged there), and in another being ambushed from behind and hit in the legs, arms and pelvis; those bullets were all removed without lasting damage, except for prominent scars. But the police were onto him now, and by 1991, at the age of 21, he was in prison, sentenced to 22 years for malicious wounding with a firearm and other charges, according to Portsmouth court records.

He was not a model prisoner at first. He incited a protest at one institution, after which guards confined him to a “segregation” cell, away from other prisoners, for nearly two years. He began to read in there, the Encyclopaedia Britannica, then Robert Ludlum, James Clavell, Sun Tzu, anything he could find.

That curiosity nourished a deepening ambition that one day in 2002 turned to conviction. “This young thug I knew from the neighborhood comes in, first day of a life sentence, and he puts his hands up and says, ‘Hey, man, I’m here!’ — like he’s coming into a house party,” Mr. Lambert said. “That did it. I knew I had to get out and find a life, something. I didn’t know what, or how.”

Living by Your Story

He got a lifeline, is how, and it came just in time and from an unexpected source.

It was June 2003, and Mr. Lambert was out of prison (having earned time for good behavior) and living in Virginia Beach, close to home but not too close. Married with daughters now, he was becoming particularly skilled at installing and finishing floors. His life looked to be taking some shape, if not yet direction.

But the work hours were long, money was very tight, and a spat with his wife opened up a well of resentment and despair that seemed to have no bottom. In prison, he remembered, a doctor gave him a diagnosis of depression and prescribed medication. But the pills did nothing for him, and he decided it was bunk; he could handle himself fine.

Down he went, back to the streets of Brighton, crashing at friends’ apartments and feeling lost, moody and desperate for his medication of choice. The gunmetal taste of cocaine was irresistible, and at least it broke the fall. But his mood would return darker, and he would have to get high again.

That is how it almost always goes with a dual diagnosis of addiction and a mood disorder, doctors say: Each problem inflames the other, in a cycle that is extremely difficult to break.

Yet break it he soon did, leaving two ounces of cocaine and his pistol in his stepbrother’s house one morning and walking out. It was about 6 o’clock, and he was drifting toward the George Washington Highway, feeling in some ways more hopeless than he had behind bars — when his cellphone buzzed. It was his mother now living in California, and she had just seen something on late-night television: an advertisement for Teen Challenge USA, a Christian-based recovery program.

She gave him a phone number. He wrote it down, sat on the stoop of a boarded-up house and thought about it for a long time, and then dialed. The man on the other end listened and offered to waive the fee if the young man pledged himself to God. He made the commitment that morning and has been a regular churchgoer since.

He completed the program, in Greensboro, N.C., and soon found a job at a warehouse there, beginning as a temporary worker and advancing to assistant distribution manager. He was living clean, the family was intact and according to his medical records, a local therapist put him on lithium, a standard treatment for severe mood swings.

It was a friend from church who told him about peer-support work, showing him an ad for peer specialists at a local mental health clinic, Envisions of Life, and he jumped at the chance, taking a pay cut in exchange for a caseload. “He had the worst cases; he had to go into these high gang areas, places no one else would go,” said Sue Bethune, his boss at the time, who is now a mental health consultant in Greensboro. “He really opened the door for the program to be able to send people in there.”

The work was exhausting, it put him dangerously close to cocaine dealers (hence the later relapse, which resulted in misdemeanor charges), and relations at home were again badly strained. He began to set his sights higher: on training peers. In 2007, he attended a training talk by Mr. Harrington, the chief executive and founder of the national peer association.

“He was asking all these questions that reflected a lot of thought,” Dr. Harrington, now a postdoctoral fellow at Boston University, said in an interview. “When I heard more of his story, I told him, ‘Look, you can do what I do.’ ”

They stayed in touch, and soon Mr. Harrington called to say he had scheduled Mr. Lambert to give a keynote speech at an event in Michigan. He boarded a plane in Greensboro, unsure of what he was getting into. “I didn’t even know what ‘keynote’ meant,” he said. “I thought I might have to sing.”

The story told itself, and people in the audience who feared for a loved one with similar problems wanted to hear more. Parents from all walks of life, doctors, clergy members and co-workers have pulled him aside to see if he could talk to a wayward son, or a daughter into drugs. He joined Dr. Harrington to form a company, Recover Resources, which sells peer support manuals, DVDs and other educational materials. A training session in June, hosted by the Delaware Psychiatric Center and run by Mr. Lambert, was life-changing for at least two of the attendees.

One was a Navy veteran from nearby Newark, Del., who had also struggled with substance abuse and a psychiatric diagnosis. “I knew from the first smoke break that this was someone important for me,” said the veteran, Justin Thompson, 28, who has since completed his peer certification under Mr. Lambert and now works as a peer specialist. The two have become close friends. “I just related to him right away, his passion, his story, the positive energy he brings — all of it.”

Another was June Benson, a single mother of three who had had her own run-ins with the law and drug use. The two felt an instant connection and began to talk regularly by phone. (Mr. Lambert was going through a separation at the time and is in regular touch with his own children.) “He told me everything; those were some expensive phone bills,” said Ms. Benson. “But to come out of all that and be the man he is now, it’s just a miracle.”

He soon contracted with Delaware Psychiatric to provide peer services at the hospital and began speaking with Horizon House/Delaware, a clinic in Wilmington, to set up a peer specialist college. Mr. Lambert and Ms. Benson moved in together in July and are engaged to be married.

“You got to understand, for me, right now, what I been through, it’s sometimes hard to believe it’s all real,” Mr. Lambert said. “But I know my own mental illness and my addiction are real; I feel like they’re out there right now, doing push-ups, getting ready to take me down again. That’s why I got to have my own system for staying strong.”

The Day to Day

That system is based on a close monitoring of his moods, which respond only partly to the medication. It includes self-talk, often in the car or between appointments (“If this car ends up in the wrong part of town, you’ll be flat on your face”); and performance of mime, which he has done with a troupe and individually, often in churches, complete with makeup, flowing robes and gospel accompaniment.

But when Mr. Lambert feels his mind capsizing fast, he has to have company, usually Ms. Benson’s or Mr. Thompson’s.

He feels he needs a peer himself, someone with a history who knows what it looks like — from the inside — to be struggling mentally, deep in trouble, and feeling dead out of options. Someone who can be an advocate, a companion, who can share his or her own story: who can simply be there, if that’s what it takes.

Mental health researchers have tested the effect of peers in a variety of settings over the past decade. When they are “specialized” — that is, their history is similar to that of their clients, the way Mr. Lambert and others teach it — peers tend to reduce the rate of psychiatric hospitalizations and, where appropriate, increase the use of programs like Alcoholics Anonymous.

Not, in the end, that it’s about the money. In his travels as a trainer and a peer, Mr. Lambert has read clients’ poems, accompanied them shopping, and sometimes sat and watched an episode of their favorite soap opera. And he has taken on Mr. Thompson as a protégé, a peer trainer in training.

For both, it means being on call, for their students and for each other. On a recent Saturday morning, Mr. Lambert was home alone, watching college football, when he felt a pulse of that same darkness and exhaustion that led to his last relapse. “I call it the monster,” he said. “I was lying there on the couch, and after a while, the college football was watching me.”

He called Mr. Thompson, who hurried over with a pair of fishing poles. The two of them fished that afternoon. They fished and had a smoke and talked about nothing much, and neither could say exactly when it happened but it did. The monster was gone.