The salmon swim upstream, some smaller than others. Some in mid-current, some on the shallower sides. When the small ones get stuck, the elders nudge them from over-hanging branches or eddies. The ones they can’t save may not thrive, and you can see them now as they are passed by the sturdier ones as they float along, lost.

Only dead fish swim downstream.

“Relapse, it’s what we do,” said one addict to another.

“I know,” came the reply, “it’s happening now.”

I just finished my second stint at Gosnold detox. The first time was a rescue mission; this time it was self imposed to get rid of the insipid chemical and to start again. Again.

The way it works is you go in and they bring to the cot room, where you are medicated and monitored until your blood alcohol level gets to zero. Before that happens you may have a night or two of crazy dreams brought on by the medications given to keep you from having a seizure. As you lie in your bed, others are brought in from time to time. You wake, look up, see another struggling. Occasionally you wake up in the middle of the night to see who else is comatose, what beds are empty, what new ones have been filled.

I woke up a few times wondering where the Christmas tree was, thinking I was home. Another time I asked someone to let the cats in. Needless to say, the cats never came in.

When you get out of the cot room, you enter the general population and hear things in group gatherings. Such as:

“I’ve got ten years.”

“I’ve got five years.”

“I’ve got one year.”

“I’ve got five minutes.”

But this story is not about me. It’s about the small ones. In the old days the drunks were put in the drunk tank. (The nickname for the cot room is spin dry.) But what tank do you put the heroin addicts in? And the opioid addicts? Where do they put the ones stuck in the branches, stuck in the eddies?

The most fascinating and perplexing thing about this recent journey to a zero blood alcohol level was the experience of hanging out with the young kids that were making what was for many one more in a series of trips to detox, and then possibly to a bed in a rehab center. These are remarkable people who have been turned to putty by pills and other substances not of their own making, but perhaps that come from some huge pharmaceutical building located in an offshore tax haven. Like San Juan, Puerto Rico, for instance.

“They cut back on my dose, I feel like puke,” he mumbled from beside me as we smoked cigarettes at the picnic table.

“Said the insurance doesn’t cover the dose.”

The dose of remedy to the drug that the big offshore tax exempt building provided, at a discount, money gained to develop new pills and to build mansions.

“They cut back on my dose, I feel like puke,” he said again.

I can’t tell you how many there are. So many join the stream daily, as others leave for a world which for some is replete with opportunity, and which for others is bereft of it. These days far too many are found floating downstream, the small ones that don’t heed the call of the nudge. It is beyond tragedy.

Detox is the front line, rehab the next step. But the streets remain the streets, the river still flows.

I’m out now, swimming upstream, near the banks for the moment, hoping to do some nudging some day. First I have to make it to mid-stream. It’s going to take awhile.

“Relapse, it’s what we do.”

Joe Keenan is a roofer, baker and musician living in West Tisbury.