Chapter 5
austin
“I see that you’ve been on a monitored dose of naltrexone. Is that correct?” Dr. Manzulla asked as I sat in his office.
Dr. Manzulla was a primary care physician, but his practice specialized in comprehensive care for people with addiction.
The office offered a complete support system, including a therapist, psychiatrist, and primary care services, all in one space.
This was my first official appointment, and today I was meeting with both the primary care physician and the therapist. The psychiatrist would be involved later, if Dr. Manzulla determined I needed more specialized care.
“Yes. I am on naltrexone and a small dose of Prozac as well.” The latter was what I dubbed my “happy pill.”
“Right. The naltrexone has been helping you with the cravings?”
“Yeah. It still helps curb the shakes and the powerful voice in my head that has me wanting to run to a bar.”
It was a joke. I was trying to punch light, but Dr. Manzulla clearly didn’t seem to find it funny. I held up my hands. “Kidding, doc.”
“And the Prozac?”
When I first started treatment, I refused the antidepressant vehemently.
I told the doctors, my therapists, and my sober buddy that I didn’t need it.
I wasn’t depressed, I was just an alcoholic.
It wasn’t until I found myself a week without a shower, sitting in a dark, cold room for the majority of the day, that I decided that I’d need something to help me, and relying on therapy alone wasn’t cutting it.
I’d made a commitment to get better for myself, and every single day, I fought my own psyche to continue fulfilling that promise.
My brain and body were exhausted. Sometimes, late at night, I cursed my body for making my brain full of rot.
It took a lot of understanding who I was and working on myself to find the positivity in everything.
“It’s still helping.”
Dr. Manzulla nodded. “Great. That’s good to hear.”
He looked over my chart a few times, frowned, and then pulled up the chair next to me.
“Everything good?”
“Yes, your vitals look great, and everything seems to be in order. There’s one thing, though, and I need you to check with the front desk. I’m pretty sure it’s because you’ve recently moved and haven’t officially started your job yet.”
“What’s that?”
“Well, you’ve just hit twenty-six and five months, so the insurance you were on, which was your mother’s, is no longer covering your visits.”
My heart sank as the doctor’s words hit me. Insurance. Of course. Racing thoughts flooded my mind, and panic set in almost instantly.
How the hell am I supposed to afford my healthcare that was vital to my sobriety without insurance?
A portion of what I earned was sent to Nova, and the rest? That was swallowed by rehab bills. I barely had anything left for myself, which was the whole reason I was here in the first place.
I racked my brain, trying to remember if I’d talked to Ledger about insurance when he asked me about working the new job. Everything had been a blur—rehab, the move, the scramble to get settled—it was hard to know what I’d discussed and what had slipped through the cracks. The panic buzzed louder.
The room suddenly felt smaller. I swallowed hard, trying to keep my voice steady as I asked, “How much would my prescriptions cost out of pocket?”
The doctor’s expression softened. “I can’t give you an exact number, but I’d recommend checking with the pharmacy.
Without insurance, it can get a bit pricey.
” The doctor gave me a sympathetic look, clearly sensing the weight of the situation.
“I know this is important,” he said gently, “and I understand how crucial it is to have these medications. We’ll do what we can to help. ”
The words were meant to reassure me, but something inside me snapped.
“I need these drugs,” I blurted out, my voice shaking.
“Without them, I-I can’t survive. I won’t be able to live normally.
” My breath hitched. “My brain . . . it’s an addict’s brain.
If I don’t have what I need to stay balanced, I’ll slip. And I can’t afford to slip.”
The room was so quiet, you could’ve heard a pin drop.
“I agree, these medications are helping you, and we’re going to get you on the right track. Let’s walk to the front desk and see what we can figure out.”
I stood up, moving on autopilot as we made our way to the front desk. The receptionist looked up, offering me a small, crooked smile that was meant to be polite, but it only made me feel worse.
She typed something into the computer, her fingers clicking across the keyboard as the doctor stood beside me, waiting.
Finally, she glanced up, her eyes hesitant. “With the three treatments and prescriptions your doctors have recommended . . . it’s going to run you about ten thousand dollars a month. Without insurance, I mean.”
Ten grand. The number hit me like a punch to the gut, and the room seemed to spin for a second.
I didn’t even know how to respond, my brain struggling to comprehend how I could ever afford that.
Every part of me wanted to crumble under the weight of it, but I stood there, trying to keep it together.
“Let’s go meet Ralph. He’ll help you sort this out.”
I nodded, hearing his words but not processing them. My feet moved me to follow the doctor, the walls around me feeling like they were closing in. There had to be some kind of resolution waiting at the end of all this.
The pit in my stomach told me otherwise.
What if there wasn’t? What if this was it—me, standing on the edge of losing everything I’d worked for because I couldn’t keep up with the costs?
I knew deep down that I couldn’t do this without my meds.
Hell, I’d fought against taking them for so long, convinced I could handle things on my own. That I didn’t need the crutch.
But they’d become a part of my routine. The small pills I’d once resented were my lifeline.
Maybe that made me weak, maybe it made me a big pussy, but I didn’t care.
I was self-aware enough to know that without them, I’d struggle.
A lot. I didn’t have it in me to go back to that dark place. Not after all the progress I’d made.
I walked down the hall, my mind racing with a mix of panic and frustration.
“I just don’t want to go downhill,” I whispered to no one in particular.
Before I knew it, Dr. Manzulla was introducing me to another guy—older, probably in his forties, wearing a plain T-shirt and jeans.
He had a calm, easygoing demeanor, and his office felt a lot more inviting than the clinical sterility of the doctor’s room.
Warm lighting filled the space, and a large, worn black leather couch sat in the corner. Without thinking, I plopped down on it.
The two of them exchanged a few words, their voices blending into the background as I stared out the window, lost in my own thoughts.
The weight of everything was hitting me all at once.
How could I possibly afford this? Therapy, prescriptions, everything that was supposed to keep me stable—it all felt like too much.
“I don’t think I can afford weekly therapy,” I muttered, more to myself than anyone else.
The door opened and closed again, and the older guy—probably the therapist—took a seat across from me. “It looks like Dr. Manzulla was able to write you a three-month supply of your medication,” he said calmly. “So you’ve got a little time to figure out a solution.”
I nodded, but the relief I was supposed to feel didn’t quite settle in. Three months. It wasn’t much time at all, but it was something.
“Yeah.” I nodded excessively. “I’ll talk to Ledger and figure out what’s going on with the insurance.”
“You know, sometimes we have to start by looking at the leaves of the tree.”
I narrowed my eyes and swung my gaze to the therapist. “The leaves?” I repeated, confused by the metaphor. This kind of talk was something I still wasn’t used to.
Ralph leaned forward slightly. “The leaves paint the picture of the tree, Austin. They’re small, individual parts, but together they make up the whole.
If you start by trying to take in the entire tree, it can feel overwhelming.
But if you focus on the leaves, one at a time, it’s a lot easier to manage. ”
I sat with that for a moment, trying to make sense of what he was saying.
He wasn’t wrong—it was easier to focus on one small thing than the whole giant mess.
The thought of everything—insurance, money, prescriptions, staying on track—felt like staring at a massive, impossible tree.
But the leaves? One conversation with Ledger, one step forward? That was manageable.
“Yeah. I can do that.”
“I think you can too. There are people in your corner to support you.”
“It doesn’t always feel like that. My mom had me young. She worked her ass off to make sure I had everything I needed, but . . . when I got older, I think she wasn’t always sure what to do next. Sometimes it felt like the only way she knew to help was to step back and hope I figured it out.”
Ralph nodded, jotting something down on his notepad.
“I still carry a lot of resentment about the first time I got out of rehab. She wasn’t there when I walked out the door.”
“Did she come the second time?”
“No. Not at first, anyway. The first time, I left a day earlier than planned, so she couldn’t have been there.
And the second time . . .” I rubbed the back of my neck.
“She stayed away for the first year. Thought giving me space was the right move. She told me later she was following advice from a friend and her therapist, that she didn’t want to smother me.
But sitting there week after week, watching other people get visits .
. . it didn’t feel like space. It felt like I’d been written off. ”
“And when she did come?”
“We talked. She apologized. Said she went too far. And I believe she meant it. But that first month—man, that’s the part that sticks. That’s the part I keep trying not to carry with me, and it still sneaks in.”
Ralph’s pen scratched against the paper.
“My goal,” I said, breaking the silence, “now that I’m out here, is to sit down with her one day and actually talk about it. You know, clear the air.”
Ralph gave a small nod of approval. “That’s good. You’re moving in the right direction.” He paused for a moment. “So, switching topics—how about dating? Seeing anyone?”
“Absolutely not.”
“Why not?”
“I don’t want to date right now,” I said, leaning against my chair. “I’m focused on my sobriety. That’s all that matters to me right now. I can’t afford distractions.”
Ralph set his notebook down and leaned forward.
“Austin, it’s been years since your divorce, according to your chart.
You’ve been on this journey for a while.
I understand your hesitancy, but you’ve spent years building the tools to keep yourself grounded.
You have to trust yourself at some point.
You won’t slip because you open yourself up to something new. ”
I let out a soft laugh, shaking my head. “Yeah, well, easier said than done.”
“True, but that doesn’t mean you can’t try.”
I gave a half-hearted shrug, still feeling uneasy about the idea. He wasn’t wrong. There had to be a point where I stopped keeping everyone at arm’s length. I simply wasn’t ready to admit it yet.
Ralph glanced at the clock and closed his notebook. “Alright, let’s wrap it up for today. We can talk more about what dating looks like once you get the insurance situation squared away.”
I nodded, standing and grabbing the prescription that had been set aside for me. “Yeah, I’ll make sure to do that.”
As I walked out of the office, Ralph’s words kept turning over in my mind.
I’d been looking at life through the lens of needing to fix the whole tree—my sobriety, my relationships—but what I really needed was to break it down, piece by piece.
I’d been so focused on getting better, staying sober, but it was time to start testing things out.
Dating, talking to my mom about how I really felt about our relationship. It didn’t have to happen all at once.
One leaf at a time.