Heroin's hold: How Iowans struggle - and sometimes succeed - in overcoming opioid addiction
One addicted mother learned to find hope
Abby grew up in Dubuque. The 24-year-old came from a stable, loving and supportive middle-class family. She did well in school. She’s artistic.
And she’s been addicted to heroin for six years.
Her slow decent into the depths of drug dependence and deceit can be traced back to when she was in middle school.
Heroin's hold in Iowa
Back then she was popular with a tight-knit group of girlfriends. But those girls quickly turned on her when she confided in them one day that she had fooled around with a boy.
That event took a hit on her self-esteem.
“So I became friends with kids that seemed more understanding and less judgmental,” she said. “These kids were also a little rougher around the edges.”
Abby started sneaking out at night and smoking pot. When she was 14, she started dating a guy who was four years older than she was and who was emotionally abusive.
“He was a pot dealer,” she said. “With him, I experimented with all sorts of drugs.”
She mixed cocaine with Xanax, she tried hallucinogenic mushrooms and acid, she smoked crack.
“I tried just about everything except meth and Ecstasy,” she said.
And she tried heroin for the first time when she was 17 years old.
“I didn’t know who I was as a person — or if I did, I couldn’t deal with,” Abby said. “I didn’t really like myself. I looked for a drug that could take everything away. Heroin was that drug.”
Heroin’s hold on Eastern Iowa has grown significantly in the past six years.
Linn County law enforcement responded to nine reported heroin-related deaths and non-fatal overdoses in 2009, but that number ballooned to more than 61 non-fatal overdoses and 21 deaths by 2015.
The epidemic is not unique to Eastern Iowa. Between 2002 and 2013, the rate of heroin-related overdose deaths nearly quadrupled, according to the Centers for Disease Control and Prevention.
Heroin killed more than 8,200 people in 2013 and 10,500 in 2014. What’s more, the number of opioids prescribed and sold in the United States has quadrupled since 1999, according to the CDC.
More than 40 people die every day from overdoses involving prescription opioids.
Drug overdoses increasing across U.S.
These numbers are alarming enough that the White House proposed $1.1 billion in new funding to address the problems stemming from prescription opioids and heroin in 2016.
But overcoming an opioid addiction is no easy task — withdrawal is painful, long-term residential treatment has waiting-lists miles long and medication-assisted treatment still is controversial.
From pills to needles
Abby’s path to sobriety has been dark and difficult — marked with overdoses, relapses and lies. The drug has had a tight grip on her life and has not easily let go.
She wasn’t immediately hooked after her that initial time she tried heroin. Instead, she was using OxyContin — another opioid — her senior year of high school. But it was an expensive habit, she said — one pill cost her about $60.
Overdoses in Linn County: 2016
About: Data made available by the Linn County Medical Examiner's Office
“By the time I graduated high school, I was doing a high milligram pill, 80 milligrams, at least five days a week and I would take a couple a day,” she said.
She graduated but decided to forgo college, despite having the grades to get in and the push from her parents to apply. “I just wanted to have a good time, and I didn’t consider my future,” she said.
She got a job at a restaurant and moved from OxyContin to heroin, a less-expensive alternative to the painkiller, once the pharmaceutical company that manufactured OxyContin created a “crush-proof” version intended to curtail abuse.
Paying for her addiction was not easy, and Abby did things she’s not proud of it to keep the drugs in good supply. She stole from family members and pawned her mom’s jewelry. She traded sex for drugs.
When she was 18 she started dating Ben, who became her longtime boyfriend, and the couple would get high together. The two moved in together and their heroin habit grew.
Ben eventually pressured her to go to rehab after he found out that she was trading sex for drugs. She entered a 14-day program at Horizons Substance Abuse in Waterloo but didn’t stay for more than a week.
Ben left her, so having lost her job and her boyfriend, Abby moved back home with her parents. But her drug use was getting even more out of control.
One night while hanging out with some friends — including Ben, whose life she was trying to find a way back into — she used a needle for the first time.
Heroin has a bitter taste, Abby explained, so when she would sniff it sometimes she’d get sick and throw up. That wasn’t the case when she used a needle. “A warm feeling just takes over,” she said. “It feels like someone puts a warm blanket over you. You can feel it running through your veins.”
Abby and Ben got back together around Thanksgiving 2011, and pretty soon after she found out she was pregnant.
'That's why people don't stop'
Abby’s tried to get clean on several occasions over the years — but it never seemed to stick. The first time was right before she found out she was pregnant.
She had become physically dependent on heroin and was living in a basement on a mattress with Ben.
“I woke up one day and thought, what am I doing?” she said. “I can’t even take care of myself.”
But getting clean meant she would have to go through withdrawal. It’s a painful process — she couldn’t sleep, she couldn’t eat, she couldn’t go to the bathroom.
“You just feel sick all over,” she said. “You’d have cold sweats and hot flashed at the same time. ... I also had restless leg syndrome. I wanted to stretch so badly. I wanted someone to take my bones out of my body, stretch them like an accordion and then put them back in. That’s why people don’t stop. It was hell.”
Overdoses in Johnson County
Data made available by the Johnson County Medical Examiner Department
Her older sister told her to get rid of the baby — it was a “drug baby” she told Abby, and Abby didn’t know what she was doing with her life, how could she raise a child?
But Abby was excited.
“Elliott kept me alive. He kept me from going back,” she said.
Abby and Ben both got clean and got jobs. She paid off some of her debt. Her parents bought her a house. And in August 2012 she gave birth to Elliott.
Then Ben started using again.
Getting off the roller coaster
The next three and a half years were a roller coaster. Abby and Ben alternated trying to get clean, often not at the same time.
“If one of us was falling down, we were both falling down,” she said.
At one point Ben left — he moved to Colorado — and Abby, who was clean and “on the righteous path,” had a friend struggling with heroin addiction move in with her. It didn’t take long for Abby to fall back into old patterns.
In spring 2014, Abby overdosed. Elliott was in the other room. The Department of Human Services got involved and she had to move back in with her parents to keep Elliott.
“My parents couldn’t fully understand. They’d ask, ‘Why can’t you do this for your son?’ It’s unexplainable to someone who has never dealt with this. It’s sometimes unexplainable to myself,” she said.
"If one of us was falling down, we were both falling down."
By May 2015, her family held an intervention. That time she went to Country Oaks, a rehabilitation facility in Davenport. She had to go through withdrawal a second time.
“I lost my mind,” she said.
She came up with excuses to get out of treatment. Another individual at Country Oaks used to sell heroin, and Abby told her parents he was trying to sell her drugs — a lie.
The cycle continued — she spent all her money on heroin, she traded sex for heroin, she lied to her parents about seeing Ben — who was back from Colorado — she lied to Ben about how she got the heroin, she saw friends overdose and die from the same drug she was doing.
Opioids kill dozens of Iowans every year
“I was so physically dependent that if I didn’t do it every 12 hours, I would get sick,” she said. “I needed it to feel normal but I didn’t know what normal was — without heroin all I felt was sickness and pain.”
Her parents convinced her to try Suboxone — a type of Buprenorphine, which is a medication that can be prescribed to treat opioid dependency. But she’d hide the Suboxone and buy drugs instead.
On March 21 of this year she finally came clean to her counselor at Mercy Medical Center Dubuque’s medication-assisted treatment program, which combine behavioral therapy and medications to treat substance abuse.
“I realized how bad it had become,” she said. “I was broke. I was doing things that were very demeaning to myself...I was spending $150 a day to feel normal. I didn’t have the energy to play with Elliott.”
There’s a brightly colored painting hanging on Abby’s refrigerator these days. She made it during her first week at ASAC’s Heart of Iowa, a three-month residential program for women and their children.
It shows a woman screaming with the words shame, anger, confusion and envy written in each of the page’s four corners.
“When I first came here — I wanted to run away,” Abby said. “I wanted heroin after being on a two-and-a-half-year using-spree. My brain had rewired itself to need it to feel normal. I felt so shameful for all of my past.”
She was overwhelmed, and jealous that other people could live normal lives with such ease and that so many people her age had graduated from college while she was still struggling to get her life together.
“I felt trapped in my own mind,” she said.
The first 30 days of treatment were difficult for Abby. She struggled with Elliott — they had never spent this much time together — and her mind would flash back to her years in Dubuque and getting high.
She very seriously contemplated leaving the program. She’d drop Elliott off with her parents, buy three bags of heroin from her dealer and then overdose by the Mississippi River.
She wrote about those thoughts during one of her daily group exercises: The women had to write two stories — one that detailed what their lives would look like if they continued to use and a second that described what recovery looked like.
In her first story, Abby knew what she’d write to Elliott before killing herself. She’d explain to him that her sister could provide a better, more stable life. She’d say that she loved him with all her heart. She’d tell him to grow up to be a strong, good man.
When she read that aloud to group members, and visualized the scenario, she choked up.
But her second story gave her hope. That hope is important. It was the first time she’s felt it in years. And it’s what’s pushing her to stay strong and get clean.
In it, she and Ben complete residential treatment. They get jobs and move into ASAC’s transitional housing to live as a family. In a few years’ time, they move to Portland, Ore. — away from Dubuque, their drug dealers and their past.
Abby completes college and gets a job as an animator. She and Ben get involved with Narcotics Anonymous and build clean memories as family.
“Reading that one out loud, it gave me things to hope for,” she said.
Something finally clicked once she hit the 30-day mark.
“It hit me — I can get better,” she said. “I don’t want to die. I don’t want Elliott to grow up and be messed up. I don’t want to break my son.”
Elliott, now 3, is chatty and energetic. He builds forts with couch cushions and loves dinosaurs. But Abby knows her addiction has impacted him.
“He’d say, ‘Mama, open your eyes.’ When we lived with my parents and I wouldn’t come home, he’d ask where I was. I know that he felt neglected,” she recalled. “He saw me carried out on a stretcher.”
And while both Ben and Abby have tried to get clean before, Abby thinks this will be the time it sticks. Ben entered the residential program at ASAC’s main campus shortly after she came to Heart of Iowa.
She talks to him on the phone every night, and takes Elliott to visit him on Thursdays. Their relationship always has been tumultuous, she said, but she’s happy they’re working through things as a family.
Once done with their residential programs, the two plan to move into transitional housing together. Abby wants to transfer college credits she earned during one of her clean periods over to Kirkwood Community College and get a job as a server. She wants to find Elliott a good preschool and be a family.
“I want to feel like I’m strong enough to be happy again — I do feel like that,” she said. “I haven’t felt like that in a long time.”
She’s also working to repair relationships with her family members and has become a leader of sorts at Heart of Iowa — she just got the OK to start a morning running group and helps some of the women buy healthier foods during weekly Hy-Vee visits.
There are still times her thoughts drift and she has a desire to get high again. But those are fleeting, and she reminds herself that she’ll ruin all the work she’s done these past few months.
“I still have hard times,” she said. “The memories of when I used — of what I’ve done. But I have hope. I feel healthy.
“You are as sick as the secrets you keep. I don’t want my secrets to kill me.”
The Gazette rarely publishes articles in its local news report that do not include the full name of a principal subject. A person’s full name is among the details that add authenticity and credibility.
In the case of “Abby’s Story,” we made an exception. We did not take this decision lightly.
This story was written after more than six hours of in-person interviews by Gazette reporter Chelsea Keenan with Abby, Abby’s mother and officials at the Heart of Iowa, the Area Substance Abuse Council’s residential program for women and children. That’s in addition to some 17 hours Abby and her family spent with Gazette photographer Rebecca F. Miller. Where relevant, other details were verified by Iowa court records.
Because of these extraordinary steps, and Abby’s agreement to allow broad and deep access to her life, The Gazette agreed with her request not to publish her last name.
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