They are functioning heroin addicts -- people who hold down jobs, pay the bills and fool their families.
For some, addiction is genetic; they're wired this way. For others, chronic pain and lack of legal opioids landed them here. Or experimentation got them hooked and changed everything.
What addicts have in common, according to experts, is a disease that has more to do with their brains than the substances they use. About 85% of people can take a pain pill, for example, and never crave it again.
This is a story about the others, those traveling the dangerous road of functional addiction. What works for them now, experts explain, can easily and lethally be derailed.
Hanging in the balance are people you may never imagine: peers, co-workers and neighbors. Loved ones, bosses and teachers. Respected members of your community who, for the benefit of everyone's understanding, want to be heard.
After CNN gave voice last fall to addicts on skid row
, the sorts we think of when we picture "heroin addict," I set out to tell this overlooked part of the heroin story.
Being a functioning addict hinges on heroin use staying hush-hush, so we agreed to change the names of those willing to open up.
'All smiles and happiness at work'
Loving and successful parents, good schools, a great upbringing in the Midwest: Todd can't point to anything that drove him to drugs. He was a typical suburban high school student who dabbled in weed. Then, at 15, he popped a Percocet his mother left lying around while she was recovering from surgery.
"The feeling in my head was, 'I want to feel like this for the rest of my life,' " Todd says. "It was the perfect drug for me."
The 11 years since have been a dance with opioid addiction, even as he graduated from college and embarked on a successful career in corporate management. Now 26, he has gone stretches where he's been sober, but the pull is strong and keeps yanking him back.
He's done heroin for periods of time and says it's "fantastic," but shooting up isn't his style. His preference, assuming he can find them, is to buy more expensive opioids. For a long time, OxyContin was his drug of choice; now he prefers Opana and, if he can't get that, Subutex.
He makes good money, which means he can afford his $350- to $600-a-week habit.
He's figured out how much to take so he doesn't feel the pains of withdrawal, which is now his goal -- rather than getting a full-on high. His sweet spot: 60 milligrams of Opana.
"I don't know how to describe withdrawal. It's like the worst flu you've ever had in your life -- and then multiply that by 1,000," he says. "There's a scraping inside your brain. You're willing to do anything to feel better."
To avoid that hell, Todd often lives a lie. He's "all smiles and happiness at work," he says, and he spins tales to guard his secret. He might say he's in one city when he's really in another. That quick trip he says he's taking to McDonald's could be to meet his dealer at Burger King. When he's used heroin, he's explained the bruises on his arm by telling people he has diabetes or an infectious disease. He once told a pharmacist he was a science teacher in need of syringes for experiments. He's invented the deaths of family members to get days off.
But death is very much a reality in his life.
His last serious girlfriend also used drugs and died from an overdose. Over the past six years, he's lost seven people he cares about to addiction.
He'd like to find love, build a relationship and have a family but says, "It would be dishonest, and I never want to hurt anybody. That's the biggest problem."
He knows that he has a lot to live for, but he often forgets that and struggles to imagine a future. And because he can't stray far from his dealer, a dream he does have remains on hold indefinitely.
"I've always wanted to see the world," he says. "I've never been outside the country because I can't leave. I'm f***ing chained where I'm at. It's a f***ing prison."
The sign of an addict
The sensation Todd had the first time he popped a Percocet, that feeling he wanted to hold onto for the rest of his life, was the giveaway. He, like 10% or 15% of people, has the disease of addiction, explains Dr. Stuart Gitlow, past president of the American Society of Addiction Medicine
What offers no special high for most people or may even make them feel queasy became Todd's aspiration. And part of the problem, says Gitlow, is that "you don't know in advance what person you're going to be."
Todd may be functioning now, but Gitlow warns that tolerances and doses often change. As an addictive disease progresses, it is also influenced by life events and stressors. What happens if Todd loses his job someday or can't afford his preferred pills?
"They all start out functioning," he says. "The bulk of people taking heroin are probably functioning. It's only in the end stage that they're nodding off in an alley and have a pretty good shot of dying."
What Todd needs, Gitlow says, is help from a doctor who is certified in addiction medicine and can treat his disease. The vast majority, or 80%, of those who seek appropriate treatment and adhere to their treatment recommendations do well, he says.
Not a unique story
It didn't start with a pill for Lisa. Her first addiction took hold at 12, when she began cutting herself.
Carving into her flesh released dopamine in her brain, giving her a high, she says. The first time she did it, she never anticipated a rush. She was overwhelmed emotionally and simply acting out. But cutting became her way to self-medicate because it offered her solace, easing the emotional pain of living in a household full of screaming.
Now, at 23, Lisa opts for heroin. And because of it and other opioids she's used, "I hurt myself a lot less."
The difference now is that she, like Todd, no longer seeks a high. When she shoots up each morning, she insists, "I just do enough to stay well" through the day and not feel physical pain.
She works hard, always has. She excelled in her college-prep private school, where she was dubbed "gifted and talented," she says. She takes her job as a store manager seriously and enjoys a supportive marriage. No one at work knows that her day begins with