ROANOKE, Va. (AP) - For nearly a decade, Maddie Ross was addicted to alcohol and opiates.
The first half of her 20s was a blur of rehabilitation facilities, mental hospitals and homelessness fueled by prescription painkillers, alcohol and heroin.
Until Dexter.
The plump baby boy with dark eyes, a smattering of brown hair and a heartwarming smile is Ross’ only child. His first birthday is this month.
Ross, 28, is a graduate of Bethany Hall - a residential treatment center located in a three-story brick home in Roanoke’s Old Southwest neighborhood. The women in Bethany Hall battle addiction with their greatest motivators and most vulnerable dependents: their babies.
For more than 45 years, the facility has served as a residential treatment facility for women, particularly those who are pregnant or postpartum. It is one of three such drug and alcohol treatment facilities in Virginia and about 150 across the country.
As the opioid epidemic grows in Virginia, so does the number of pregnant women addicted to prescription painkillers and heroin.
Concerned that their drug use might harm their unborn children, these pregnant women enter treatment either by choice or court order.
“I think it really did take Dexter coming into my life to really let me see the world in perspective, because I used to tell myself I was probably going to die by 27 and I had in my head the only way that wouldn’t happen was if I had a child,” Ross said. “When I was 26, I got pregnant.”
Parenting gives them a reason to live.
Treating the whole person
Ross checked into Bethany Hall on her birthday.
The Franklin County native celebrated turning 27 with lists of rules to follow, someone searching through her belongings and an overwhelming feeling of uncertainty.
Days earlier, Ross had threatened to kill herself. She had been staying at Trust House, an Elm Avenue homeless shelter, for three weeks, trying to detoxify from drugs and alcohol, when she relapsed.
Drug use is not permitted at the homeless shelter, and its leadership gave her two options: Go to Bethany Hall or back out on the street.
Ross didn’t like either so she threatened to kill herself, which for a person with a diagnosed history of mental illness secured her a ride straight to Carilion Roanoke Memorial Hospital. From there, she was transferred to Carilion St. Albans Hospital - an inpatient mental health treatment center.
When she was discharged at about 32 weeks pregnant, Ross voluntarily entered Bethany Hall.
Having been to six other rehabilitation facilities, she didn’t know what to expect.
“I’ve been to so many rehabs and so many psych wards and everything that I am somewhat institutionalized in a way, because that’s what I run back to whenever I’m feeling nervous or like the world is going to crash in on me,” she said.
Signing up for the residential treatment program comes with rules. Participants aren’t allowed cigarettes, caffeine or sugar. Use or possession of drugs and alcohol are dischargeable offenses.
Residents undergo four hours of emotionally draining group therapy Monday through Friday in addition to less frequent individual therapy sessions.
Life follows a regimented day-to-day, week-to-week schedule.
“The whole therapeutic community principles, it’s almost like how in the military they break you and build you back up,” Ross said. “But they don’t break you here, they just try to flip your brain and have you see (addiction) a different way.”
The women aren’t allowed to leave the premises without permission.
They’re trained to speak a formal language called “proper response.” ’’Thanks” or “thank you” becomes “thanks on top of that” and each person is encouraged to “pull up” their peers by calling out their negative or risky behaviors.
Treatment typically lasts for four to six months and usually is funded through Medicaid, private donations and funds from partner organizations such as United Way of Roanoke Valley or from clients themselves, said Ali Hamed-Moore, ARCH Services’ executive director. ARCH includes Bethany Hall, Trust House and Choices Recovery Center.
“The mission of Bethany Hall is to help women who are struggling with the ravages of substance abuse to get life skills and treatment to become functioning members of the community,” she said.
Treatment happens in a phased approach and varies for each person. Most women give birth during their stay.
At Bethany Hall, women learn self-care tips, parenting skills, coping mechanisms and strategies to better cope with grief.
“It’s a very intensive experience,” Hamed-Moore said. “They’re sorting through all of the things that brought them to treatment, and having arrived at this place in their life where they need long term residential treatment certainly, they come pretty broken.”
Many women at Bethany Hall don’t choose to be there. Some come from prison. Others, arrive when their children are taken into the custody of the Department of Social Services. Some check in at their family’s urging.
Not everyone completes the program. Some run away. Some quit. Some break the rules and are forced out.
“What I say to them and what I say to many clients that I’ve worked with is ’I hope you love yourself enough to do the work because you deserve to get better,’” Hamed-Moore said.
Most Bethany Hall clients are addicted to opiates, a growing crisis across Virginia.
Last year, 1,133 Virginians died from opioid overdoses, more than the number of people who died in vehicle wrecks, according to the Virginia Department of Health. The death toll has been rapidly climbing for years, but last year showed a 40 percent jump in fatal overdoses from 2015.
More than 6,300 people have died from opioid overdoses since the state began tracking the deaths a decade ago.
The number of infants exposed in utero also is spiking. In 2016, 1,334 children were exposed in utero, up 21 percent from 1,099 children the previous year.
“Everyone is experiencing this sort of influx into all of our systems,” Hamed-Moore said. “The hospitals are experiencing it. The police department is feeling the effects. The demand for treatment has increased. The courts and probation and parole (offices) are feeling the effects of the opiate crisis. It’s put a pretty heavy toll on all of our systems.”
Relapse part of recovery
Ross sipped her first alcoholic drink at age 3 or 4 - a child-sized slurp of her father’s beer.
She first smoked pot at 16. By then, she was an experienced drinker. This was also around the same time when she started dating her first serious boyfriend and started cutting herself after years of depression.
At age 18, her mother, Kathi, was diagnosed with breast cancer. Ross struggled to cope. She started stealing her mother’s pain pills and patches. The chemotherapy addled Kathi’s brain, so she didn’t notice.
By the end of her time at Community High School of Arts and Academics in Roanoke, Ross was dependent on alcohol and opiates.
She felt sick without alcohol. Most mornings, she woke up vomiting or with the shakes.
Ross thought she had the flu, and spent an inordinate amount of time in the school nurse’s office. She finally figured it out. She was hooked.
Not long after, Ross moved to a halfway house in North Carolina with the hope of escaping her old life and her substance use. It was there that Ross tried heroin for the first time, she said. At first she snorted it, but then she turned to a needle.
Ross had dated Dexter’s father for about a month when she found out she was pregnant.
Ross was clean at the time of Dexter’s conception. At that point, she had been clean for about three months and remained drug-free through the first trimester of her pregnancy.
Then she relapsed.
“When you’re an addict, it doesn’t take much,” Ross said. “You start back up where you stopped off, and it just started getting worse and worse.”
Relapse is part of recovery, said Dr. Jennifer Wells, an assistant professor of psychiatry at the Virginia Tech Carilion School of Medicine. Recovering addicts rarely avoid relapse, she said.
“Telling someone to stop using drugs does not work,” she said. “We know that. And it’s most clearly pointed out by if a pregnant woman cannot stop using drugs, trust me, no one can.”
Wells, an obstetrician and psychiatrist, compared drug addiction to depression. People with depression can’t stop being sad just because someone tells a funny joke or asks them to smile. Depression and addiction both have to do with brain chemistry, she said.
Addicts can’t easily stop using drugs because the chemistry in their brains makes them crave the substances, she said.
“Every pregnant woman is ashamed of what she’s doing,” Wells said. “And if she can’t stop, she just can’t. It’s not feasible.”
“That is the power of the chemical drive in your brain. The processes that drive addiction are much stronger than someone’s willpower.”
At 11 months, Dexter is growing normally and is a happy, healthy baby.
Ross was terrified something might be wrong with her son because of the pills and alcohol she consumed during her pregnancy.
“I think he’s just a miracle, period,” she said.
For decades, researchers have studied the effects of alcohol, nicotine and drugs on the unborn. Substance use during pregnancy can lead to babies being born with learning disabilities, delays in both mental and physical development and neonatal abstinence syndrome, which can lead to opiate withdrawal.
There’s no formula for how a mother’s drug or alcohol use might affect her baby because circumstances differ on a case-to-case basis. Various factors such as the amount of drugs, alcohol or nicotine consumed and at what stage of pregnancy it occurs can all play a role in a child’s development.
Wells sees about 40 pregnant or postpartum patients struggling with substance use disorder. Those patients include women from Bethany Hall.
Sometimes new patients come to her 12 weeks pregnant, and sometimes they show up 36 weeks pregnant. The sooner she can get them into treatment, the better.
She treats most of her patients, with the exception of the women from Bethany Hall, with buprenorphine - an opiate used to treat opioid addiction that is safe for use by pregnant women.
The patients on buprenorphine, also known as Suboxone, attend weekly medication-assisted treatment groups where they build life skills and talk about how they’re doing.
Her treatment follows a model of harm reduction because the medication alters the chemical drive in a person’s brain that makes them prioritize drugs above all else.
Wells said she frequently sees a spike in relapses after her patients give birth, but the treatment helps them get back on track quickly. Otherwise, those women probably would keep using day in and day out, she said.
“My ladies have the most success while pregnant,” Wells said. “That drive to protect their fetus is huge. They say to me all the time, ’I care more about my baby than I do about myself.’”
“He’s like my miracle”
Ross doesn’t count the days of her sobriety.
She did before, but the pressure was too much and caused her to relapse.
Now she simply focuses on the day-to-day. After graduating from Bethany Hall in October, Ross moved into her mother’s home in south Roanoke.
Over the winter, the cold, dark days combined with her chronic depression brought down her mood. She left the house less and missed some Narcotics Anonymous meetings.
Her mother’s cancer went into remission in 2009. Kathi still suffers from advanced rheumatoid arthritis.
The mother-daughter duo balances each other.
Kathi helps when her daughter feels overwhelmed taking care of of Dexter, especially on days when Ross’ depression worsens. Ross helps when Kathi’s joint pain flares.
Occasionally, Ross has nightmares where she wakes up and feels like she’s used drugs. Guilt settles over her conscience.
She stays in touch with some Bethany Hall friends through Facebook. But some, such as her “little sister” Kyla Donoho, have dropped out of her life.
Donoho, 23, graduated in December, about two months after her “big sister.”
Her first experience with drugs came at age 18 when she smoked crack cocaine with a longtime addict.
Eventually, her mother left Donoho with her grandmother, with whom she lived, first in Florida, then in Roanoke.
She never wants to do the same thing to her baby boy Miahn.
“I cannot see myself picking up anything again,” she said. “I can’t. I look at him all the time and I just tell him ’I’m never leaving, buddy.’”
She wasn’t always as attached to her son.
Back at Bethany Hall just a few days after Miahn’s birth, Donoho woke up and felt like she wanted to die. She cried constantly. She felt nothing when she looked at her son.
Donoho was diagnosed with postpartum depression and prescribed lithium for her bipolar disorder. Now, she feels mentally balanced, and she’s focused on Miahn.
“Now, he’s amazing,” she said. “I want to wake him up when he’s asleep, but I know I’ve got to let him sleep. I just love him.”
Donoho smoked crack the first four months of her pregnancy, growing more nervous as her delivery date neared. She worried Miahn might be disfigured because of her drug use.
He was born July 25 - a healthy 5-pound, 13-ounce baby. Donoho’s boyfriend, Tim Carter, with whom she now lives, was too scared to cut the umbilical cord.
Miahn’s heart, lungs, vision, hearing and everything else is all normal, Donoho said, calling him a marvel.
She constantly holds, tickles and cuddles Miahn. Her glances at her child convey pure adoration.
“He’s the reason I’m here, too,” she said. “He gave me a gift and now I’m going to be able to keep it because he’s here. He’s like my miracle.”
Calling for compassion
Graduation ceremonies at Bethany Hall are typically short affairs.
Many graduates and their families and friends are at a loss for words. Happy tears flow freely.
Often, the graduates are amazed they made it to this point.
Every graduate gets a fancy coin, a diploma and a reading of William Ernest Henley’s “Invictus.”
The reading ends with, “I am the master of my fate, I am the captain of my soul.”
Pregnant women face an additional hurdle in overcoming substance use disorder. Stigma looms nearly as large as the addiction itself.
Opiates are difficult to quit. That’s the nature of the drug. But many pregnant addicts fear seeking help because they worry their behavior will be judged.
“Pregnant women who have used during their pregnancy have an incredible amount of shame and guilt about it, and we don’t want to shame them or make them feel guilty,” Hamed-Moore said. “We want them to know that treatment is available.”
Trish White has felt the stigma firsthand.
White, the founder of Choices Recovery Center in Roanoke, said she drank alcohol and consumed drugs daily for more than 20 years. She has been in recovery for more than 24 years.
“When they asked us in kindergarten, ’What do you want to be when you grow up?’ I was not saying, ’an alcoholic,’” she said. “That’s not at all what I had in mind. I had a lot of other dreams and goals in mind and the disease of addiction really interfered with that. And you are powerless.”
White began drinking at age 14 and was an alcoholic before she graduated high school.
At age 25, White was the driver in a car crash that killed her 16-month-old daughter, Amanda.
Almost a decade later, after the birth of two daughters, White started attending 12-step meetings. She was on the road to recovery.
“It’s one thing to be an alcoholic addict father, not very well looked upon, but when you’re an alcoholic addict mother, society as a whole is not kind,” she said.
White founded Choices - a peer-to-peer recovery support program - in 2015. Her nonprofit organization helps build a support network for recovering addicts coming out of places like Trust House and Bethany Hall.
By sharing her story, White hopes to build sympathy and understanding for recovering addicts, especially when society can be cruel and judgmental to addicted parents.
Addiction is a disease, she said. Young mothers don’t choose this disease, it chooses them and consumes them. That doesn’t mean they love their children any less, she said.
“There is a wall between them and those kids and it’s called the disease of addiction,” White said. “They cannot help that. People need to be more compassionate and they need to be more open-minded.”
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