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He got off Mass. and Cass. Now, he’s working to beat the odds and stay sober.

Josh Kiv­lehan shopped for work clothes at South Bay Plaza in Boston.Erin Clark/Globe Staff

Josh Kivlehan will gladly show you the damage addiction can inflict. He will pull up his track pants to reveal a mangled calf, a reminder of the time he took heroin for what was supposed to be the last time. In the woods outside a Danvers detox facility, one last hit before getting sober, he overdosed, losing consciousness in an awkward position that put pressure on the extremity for 9½ hours, an injury that almost cost him the leg.

By the time he was found on a wet early spring day in 2018, Kivlehan was hypothermic, his kidneys were failing, and his leg, where the circulation had been cut off for hours, was a throbbing mess.

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The health complications from that overdose put him in a coma for more than three months. But the experience did not slow down his opioid habit. Wheeled back into his room after one surgery on his leg, he called a drug dealer to deliver him fentanyl. He overdosed in his hospital room. Nurses brought him back to life with Narcan.

“Getting clean is easy,” the 28-year-old reflected. “I’ve gotten clean a million times.”

Staying sober, however, is another matter. But he’s giving it another shot. His mutilated leg provides an immediate reminder of what his addiction can do, what it’s already done.

“For a long time my purpose was to get high every day,” said Kivlehan. “Once you stop, it’s like, ‘What do I do now?’ I can go to work, but after work, now what? It was a constant chase, [but] it still made me forget about whatever void wasn’t being filled.”

Josh Kiv­lehan cleaned up a site while working in Billerica.Erin Clark/Globe Staff

So long as he stays sober, Kivlehan is beating intimidating odds. According to one recent study, only one in seven adults with prior substance use disorders stayed sober over a year-long period, a stark statistic that helps explain the stubborn persistence of the city’s opioid crisis and offers a reminder that the city and state push to clear the bedraggled tent city and hundreds of dispossessed souls from the neighborhood known as Mass. and Cass addressed only the problems you can see. The much harder and enduring crisis is the one that lies within each addicted person’s will and heart. Social services can help in a big way, but success is up to them, one day of sobriety at a time.

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It is a story as old as addiction and it is so very hard. Kivlehan’s drug problems stretch back years. His father, who struggled with his own addiction problems, was not involved in his childhood. Kivlehan first met him when he was 21, visiting the prison where his dad was locked up for bank robberies. His father asked if he could sneak drugs into the facility for him. Kivlehan didn’t know whether to hit his father or hug him.

Kivlehan got high for the first time when he was 12, a one-night blitz of alcohol, marijuana, crack cocaine, and benzodiazepines. He was at his friend’s house in Lowell and his buddy had parents who were drug addicts and didn’t much care who else used, regardless of age.

From there, it was three years of adolescent angst-ridden partying. He mostly smoked weed and drank booze. At 15, he was introduced to powder cocaine at a party, when some girls invited him to blow lines off a CD case in a car. Coke became his weekend recreation. He got the drug through a neighbor who was addicted to heroin. One day his order was bungled: his guy failed to procure a bag of cocaine, but did deliver two bags of heroin in its place.

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Kivlehan insisted he could try it, just this once. After all, he wanted to get high. He did a line, went home and nodded out in a computer chair. When he came to at 8 the next morning he went straight back to his neighbor’s house: he wanted more of that stuff. Within a few months, he’d started injecting the drug into his veins instead of snorting it because he knew he could get more banged up that way.

“It went downhill from there.”

In the years that followed, Kivlehan, who split his youth between Lowell and Wilmington, was sent to prison or jail a handful of times. All his crimes were drug-related, he said, mostly illicit things he did to score: a handful of breaking-and-enterings, some larcenies, uttering false checks, and, of course, possession of hard drugs. Six-and-a-half years of his adulthood were spent behind bars, and left him with a record so long he can’t remember everything that’s on it.

He estimates his number of overdoses to be about 25. Overdosing feels to him like simply blacking out, as if someone conked you on the back of the head with a club. He hates the chemical taste of Narcan, the drug that can bring you back.

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Kivlehan once overdosed three times off one bag of fentanyl in the same day. He made three separate trips to the same hospital, and during the third trip, the hospital staff wanted to civilly commit him because they thought he was trying to kill himself.

“I was like, ‘No, I’m just trying to get high,’ ” he said, delivering the story’s kicker as if it’s a punch line to a joke.

On the streets, some talk about sobriety as if it’s a far-flung locale they hope to return to some day, just not today. Others are more frank: they don’t like the way suboxone or methadone makes them feel and staying off heroin or fentanyl without those medications feels impossible, so they’ll continue to scratch out their existences at Mass. and Cass day by day, with no plan beyond how to make the next score.

Kiv­lehan walked to South Bay Plaza to go shopping for work clothes.Erin Clark/Globe Staff

For those who make the choice to get sober, they have to want it, say those who use hard drugs on the streets every day. As clichéd as that sounds, those who live this life are adamant: no amount of therapy, mental health services, or job programming can save a person who just wants to get high.

This last time, Kivlehan decided he wanted sobriety after witnessing someone stabbed over a lighter, then a woman attacked with a 2-by-4. He was done, sick of living with a one-track mind that fixated him on scrounging for drugs or money for drugs. He had no time for anything else, which meant, at times, forgoing sex. He found himself in situations thinking, “OK so you do have 20 dollars for me? No? Then see you later.”

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He has a 6-year-old son, but addiction made it impossible to be a good dad, or even to think about his boy. “When I’m out on the Ave. getting high, he’s the last (expletive) thing on my mind.”

He hadn’t showered or changed clothes, which were blood-stained, in weeks. His feet were blackened with dirt and blistered. He slept in his Ford Ranger, or wherever he passed out on the sidewalks. He didn’t eat much at the time; he ate what he could steal from local stores. It was a hot day in June and he was sweating. He shot up “to get off ‘E,’ ” as in an empty gas tank, and told outreach workers he wanted to go to detox. He got lucky, he said, and landed a spot. His date of sobriety is June 20.

“I finally had that epiphany: I don’t even want to do this,” he said of the life drugs had given him.

A carpenter by trade, Kivlehan is back at work, in a job he secured thanks to a high school friend. On a recent sunny fall morning, he was at a construction site more than 25 miles and a world away from the chaos of Mass. and Cass. He’s thankful to have a boss who understands his disease, he says, and knows he works hard. At the end of a foliage-flecked dead end in a suburban neighborhood filled with lawns and single family homes in Billerica, he helped prep a carport for demolition and then threw the scrap wood into a large dumpster.

He is unwavering in his insistence that he is off the see-saw of addiction for good. His life is busy and structured. He has a regimented day-to-day of construction work; in his “free” time there are group sessions focused on recovery, personal one-on-one therapy, meetings with his parole officer, a curfew for the halfway house he’s staying at. He gets his methadone dose every day at about 6 a.m., before his work day starts.

“Keep on keeping on,” he said during a smoke break at the Billerica job site. “Some days are harder than others. But it’s not like using is ever a good idea.”

Kivlehan has gone sober before, only to relapse. Is he tempted to dip a toe back in his old life? He shakes his head. What about Mass. and Cass, where he still sometimes goes for his methadone dose? Doesn’t bother him, he insists, even when he stops to chat with his old friends while they’re shooting heroin. They usually apologize because they know he’s sober. He finds helping other people maintain their sobriety to be useful to his own recovery, particularly if they are contemplating relapsing — “talking them off the ledge,” he calls it.

He finds he actually likes his life when he’s sober.

Kivlehan (left) and Aaron Duval carried weights during their workout at The Phoenix gym in Boston.Erin Clark / Globe Staff

Kivlehan knows rock bottom, but also speaks to his motivation to leave the life of Mass. and Cass behind: his son. Nowadays, he calls him every night and spends time on the weekends with him, which usually means youth hockey or flag football games followed by lunch.

“If you feel like there’s nobody out there that gives a [expletive] if you’re alive or dead, then what’s the point?” he said during the summer. He has been sober for 165 days.

“I know my son might’' be that someone who cares. “I think he’s the reason I keep trying.”


Danny McDonald can be reached at daniel.mcdonald@globe.com. Follow him on Twitter @Danny__McDonald.