The call woke Kevin Schultz at 6:15 a.m. on May 6.
It was a sheriff’s deputy. He’d picked up Schultz’s 17-year-old adopted daughter Vanessa during a traffic stop near Nine Mile Falls. She had been riding with an older man known to be a “heavy meth user.”
Kevin and his wife, Rochelle, rushed to meet the deputy and see Vanessa. She had run away three weeks earlier – just before Easter. It was not the first time.
As they drove, they called emergency mental health evaluators. They needed an evaluation, and fast. Otherwise they wouldn’t be able to take Vanessa directly to the hospital. But the evaluators were busy.
So Kevin and Rochelle met the deputy and Vanessa in the parking lot of Spokane’s Juvenile Court. She looked skinny and had sores all over her face.
Vanessa went to Kevin and hugged him. On the drive back to their home, they swung through McDonald’s and bought Vanessa an Egg McMuffin and coffee. Once home she took a 40-minute shower. Then she asked Kevin and Rochelle what was going to happen.
They told her she’d go to the hospital and most likely back into inpatient drug rehab where she had stayed earlier this year for 62 days.
Vanessa’s time at Daybreak Youth Services had been her second visit to a rehabilitation facility. Prior to Daybreak, she’d attended Tamarack Center for mental health treatment; she’d been committed to Providence Sacred Heart Medical Center’s child psychiatric unit seven times, the first when she was 12 years old; she’d bitten her adopted mother and hit her; she’d been arrested.
After listening to Rochelle and Kevin, she hugged them and retreated to her room to take a nap. On her bed was an unopened Easter card from her grandmother with a $5 bill tucked inside.
Kevin called that morning a “big gut punch,” one he’s still trying to reconcile with his love and hope for Vanessa.
“She came up and squeezed me hard, I mean gave me a big hug and was crying,” Kevin said. “I don’t think she was faking that.
“She really does have that little girl that still wants to be part of this family. It’s still in there.”
By 9:30 a.m., she’d pushed out the screen in her bedroom window, took the $5 and fled.
The Schultzes haven’t seen Vanessa since.
A stigmatized condition
Vanessa is among 21 million Americans living with addiction.
For most, what support there is began in one of two places: jail or the hospital.
“It’s the rough equivalent of not offering care for diabetes until someone has lost their eyesight or their fingers or toes,” said Dr. Thomas McLellan, psychologist, addiction researcher and the former deputy director of the Office of National Drug Control Policy under President Obama’s administration. “It’s a stupid way to have a treatment system.”
Addiction has traditionally been stigmatized – a moral failing or a lack of discipline. However, emerging research is finding that addiction is a chronic illness that is not widely understood by the general public or the medical establishment. Emblematic of that, McLellan said less than 10 percent of American medical schools offer courses on addiction.
Meanwhile, roughly 50 percent of a person’s vulnerability to addiction is inherited, according to a 2009 National Institutes of Health study.
A more holistic approach from which addicts could benefit is wraparound care, a combination of medication, behavioral therapies, social supports and monitoring. As it is, only 2.2 million people received any kind of treatment in 2015.
An added difficulty? The various organizations offering wraparound services aren’t uniformly connected, and don’t necessarily communicate. And while many treatment centers and public health agencies have adapted to, and adopted, new treatment methods, many aspects of care lag, McLellan said.
“The conception that this must be treated like a chronic illness is still pretty new,” McLellan said. “So, services haven’t caught up. I think that’s fair to say. Anywhere.”
About a month before she was released from Daybreak, Vanessa sat in a basement room with 10 other teenage girls making dreamcatchers. She wove yellow leather up and over the metal hoops. The exercise is part ceremony. Dreamcatchers are traditionally given to newborns.
It’s also a test in patience and focus.
Vanessa is spirited, oscillating between manic outbursts and more contemplative moods. As she built her dreamcatcher, she talked to a girl sitting next to her.
“The first day I got here, I had a dream a giant meth pipe was chasing me,” she said.
She paused, then added, “It was bad.”
Clint Ralph walked throughout the basement room. His hair was gray and thinning. When asked how long he’s worked at Daybreak, he paused. Twenty-six years at Daybreak, 22 years sober. Sometimes he gets those two confused.
To the 10 girls in the room, he’s not Clint, or Mr. Ralph. He’s Grandpa.
“I look at these girls and they need help,” he said. “Like, who are they? They are our kids.”
Providing that help takes patience and skill. Most addicts are dealing with a combination of mental illness, trauma or post-traumatic stress disorder.
That evening in the basement, those overlapping forces started to show in Vanessa’s behavior.
Still working on her dreamcatcher, her focus drifted. She joked with another girl about sex and then about stabbing someone with a sewing needle. Miming the act of popping an eyeball out of a skull, they laughed. Slowly one-upping each other.
Ralph noticed and returned to them.
“Ladies,” he said, “Really, I’m going to start being unhappy if you don’t stop using the B-word.”
In his 26 years, Ralph has worked with a lot of children. Those experiences have convinced him of one thing: “Our society needs to help them,” he said. “And I’ve seen it happen in 26 years. I’ve seen a lot of girls come back.”
A flawed approach
Vanessa started using drugs when she was 14, maybe 15, years old.
“These men that I was with always just, like, handed it to me,” she said. “I didn’t really have to ask for it, and I wasn’t asking for it.”
Soon she was spending weeks away from home, bouncing from house to house, using and selling drugs. It came naturally to her, she said.
“It appealed to me. The kind of thuggish life really appealed to me,” she said during an interview at Daybreak.
Although she went in and out of the hospital and treatment centers, her life crashed about a month before she was admitted to Daybreak. She was dating an older man and followed him to Seattle. They got in a fight. He sliced her foot open. Not wanting to go to the hospital and knowing no one in Seattle, she took the Amtrak back to Spokane.
“I was walking around downtown with three bags of clothes,” she said. “Like, where do I go? What do I do?”
She ended up back at Kevin and Rochelle’s home. But the compulsion was too strong, and within days she was back on the streets, using again.
She remembers one day particularly well. She was walking downtown, near the Plaza. She hadn’t eaten or slept in four days. Her face was white, except for red sores.
“People were looking at me like I was crazy, like I was a complete tweaker,” she said.
She was admitted to Sacred Heart’s child psychiatric center, where she detoxed. Several weeks later, a judge ordered her to Daybreak.
At Daybreak, Vanessa talked dismissively about some of the other girls in treatment. She said they weren’t serious. For her, this time was going to be different. She said she knows the importance of getting it right.
“I’m here to get sober and have a better life,” she said.
After being released from Daybreak and running away from home, she declined further interviews.
Vanessa, unlike many of the other Daybreak patients, had a supportive and intact family waiting for her when she was released. The 17-year-old high school dropout passed her GED test easily. Her parents are teachers. Her biological mother is now involved and supportive, communicating frequently with Kevin and Rochelle.
But despite that support and Vanessa’s own stated intentions, she knew the path forward wasn’t easy. She worried about avoiding her old friends, friends she’d met in “the life.” Although she didn’t have access to the internet in treatment, Facebook messages from people she doesn’t or shouldn’t want to talk to were awaiting her, she said.
‘To prosper you and not to harm you’
On the day of her release, Vanessa confidently climbed the steps up and out of the Daybreak basement.
Reaching the top, she paused in front of a featureless metal door and waited for a staff member to unlock it. And then she stepped through and into the arms of her father.
“Hey monkey, how you doing?” Kevin said, hugging her. It was late February and Vanessa was leaving after 62 days of intensive inpatient addiction treatment.
Weeks later, Vanessa would run away from home. Again.
She would become a number, one of the roughly 40 to 60 percent of addicts who relapse after some sort of addiction treatment.
But before all of that, she hugged her adoptive father in the weak sunlight of a late February afternoon.
As Kevin signed forms, Vanessa checked her makeup in the half-dome of the lobby’s ceiling-mounted security mirror. Blond, tall and athletic, she was a ballerina with a child’s dream of dancing professionally. Then a microfracture in her hip ended those aspirations.
Her adoptive mother, Rochelle, arrived while Vanessa preened in the mirror.
“You see my coin?”
Vanessa handed a small, golden coin to Rochelle. An inscription read “Powerless to control the wind – able to adjust the sails.”
“How cool is that? I was hoping you’d get that one,” Rochelle said.
The family scheduled an appointment with an outpatient counselor for the next week. They were given the prescription drug Seroquel – an emotion regulator.
They gathered Vanessa’s few belongings, and the Daybreak staff and counselors watched as Vanessa stepped out the door.
Poised between the tight control of Daybreak and the reality of being on the cusp of adulthood, she began to get nervous. She described her upcoming freedom as “a double edged sword.”
Among the few possessions she carried out of the center – books her parents sent her, a blanket, makeup, a journal – there was a sign with white, hand-painted lettering set against a pink background. Vanessa made it in preparation for her release. On it she wrote her favorite Bible verse from Jeremiah 29:11:
“For I know the plans I have for you, declares the Lord, plans to prosper you and not to harm you, plans to give you hope and a future.”
Searching for care
Sitting in her Garland-area home, Windy Durham cried recounting the day she lost her children. Durham gave birth to Vanessa at 21 years old – her fourth child. She was in an abusive relationship, and she was an addict. The state placed her children in foster care, and when she failed to change her life, severed her parental rights.
She’s now been clean for six years, she said.
Durham acknowledged she was not fit at the time to be a good mother. But she feels that no one cared about the underlying issues.
“I needed someone to care,” she said. “No one took an interest in healing our family. (It was) all about this notion that they were protecting the kids by taking them from this addict mom.”
But she is grateful to Kevin and Rochelle . The three have had a good relationship ever since Vanessa and Durham reconnected three years ago. Because she suffered from addiction and mental illness herself, she can empathize with Vanessa.
So when Daybreak released Vanessa this year, Durham could see that she wasn’t ready.
“I hate to say that I had my doubts, but at the same time I know somebody in true recovery,” Durham said. “I know when somebody is truly just fed up and doesn’t want to go down that road anymore. It wasn’t her. She made light of the situation. She cracked jokes about it.”
Released too soon
Rochelle also doesn’t think Vanessa was ready to be released. She blames part of that on inadequate insurance coverage.
“She’s not (cured). That’s an ongoing kind of thing that she will be struggling with,” she said.
A month after being released from Daybreak, things were already starting to fray. She missed appointments with her outpatient counselors and spent long days in her room and online.
“Probably she would have been a lot stronger. More established,” Rochelle said. “And I think they could have put a lot more things into place. That last week, everything was rushed.”
Vanessa’s stay at Daybreak, which costs about $380 per day, was first paid for by Blue Cross of Idaho. However, about two weeks before she was released, Vanessa reached the limit of what Blue Cross would pay, Rochelle said. Because she was adopted, Medicaid covered more days. But Rochelle believes the treatment stay was cut short.
Annette Klinefelter, the executive director of Daybreak, said it’s unfortunate and common for private insurers to cut short residential treatment.
“It’s like the only time for a parent that you would choose for your child to be on Medicaid. It’s terrible,” she said. “It’s terrible. It’s terrible.”
Insurance companies have doctors on staff who review the medical files of the patients. They don’t meet the patients in person or speak to them. Instead, they base extended care decisions on the information kept in files.
“A lot of private insurance companies use different kinds of criteria to determine whether or not a girl is ready to leave treatment and kind of disregard the counselors’ clinical expertise as far as what’s best for this young lady’s recovery,” said Lisa Brooks, the primary counselor at Daybreak.
On average, private insurers will deny care to one Daybreak client a month, Brooks said. Sometimes the Daybreak counselors have as little as two days to prepare the girl for release.
“I have been on the phone with a doctor in another state saying that a young woman who is IV using and homeless does not meet criteria for treatment,” Brooks said.
Daybreak does provide scholarships, but those usually only buy patients a day or two more of treatment. And for many, as was the case for Vanessa, they aren’t ready for release.
Dr. Robert Small, a psychiatrist and a behavioral health medical director for Premera Blue Cross, said the company bases its decisions on the needs of clients. He reviews addiction cases and said his primary concern when doing so is making sure patients are receiving quality and appropriate care.
Additionally, he said, they do make the criteria used to evaluate clients available to treatment centers upon request.
“We are not looking to deny things,” he said. “We’re just looking again to make sure the person is where they need to be and getting the treatment they really need.”
And for cases where Premera denies extended coverage, there is an appeals process, he said. Small, who’s worked as a psychiatrist for more than 35 years, said, in his line of work, addiction has long been viewed as a “brain-based disorder.” The public conception of addiction is just now catching up with the science, he said.
“They will be in and out of treatment,” he said of addicts. “I don’t look at that as a problem. It’s part of the natural course of the disease.”
Rochelle thinks the insurance issue is just one manifestation of a larger problem. Addiction treatment isn’t consistent, and the education around how to support and help addicts is hit and miss, she said.
And, at a time when more and more Americans are addicted and dying, it’s important that addicts have intelligent, comprehensive and steady support. Last year, 115 people in Spokane County died from a methamphetamine overdose, while 64 people died from overdoses involving at least one opioid.
“Yeah, it’s crazy how easy they can get a hold of it now,” Rochelle said. “It’s like it’s in the water.”
A ‘baffling” girl
Just shy of two months after Vanessa left Daybreak, Kevin stood in the basement of his Spokane Valley home flipping through photos of her as a child. The walls are adorned with photos of their three adopted children.
“There have been a lot of Nerf wars that have taken place here,” Kevin said of the room.
“There she is a little stouter, back in the early days,” Kevin said, pointing at a photo.
He kept flipping through the photos, stopping at one where Vanessa, as a toddler, sits on the floor next to her brother. Rochelle looked on.
“This is five days after they arrived,” he said.
Rochelle nodded and added, “Yeah, look at the dazed look they’ve got right there.”
Rochelle and Kevin adopted Vanessa and her brother when the two were infants. They knew raising the two children wouldn’t be easy. Their biological mother was an active drug user. Their biological father was abusive and in and out of jail.
Still, the two teachers – both who have master’s degrees – didn’t expect it to be this difficult.
“The worse off your kid is, the more you learn, which is backward,” Rochelle said. “You want to try to catch it before it gets to this point.”
Kevin , an avid bicyclist, bought her a custom baby-blue beach cruiser. Vanessa pawned it to buy drugs.
“This is a girl who has baffled us,” Rochelle said. “She has baffled the professionals. She has baffled the teachers. She is not your typical situation. You’re dealing with someone with a very high IQ who is extremely talented. Who is more than capable of doing anything, and she’s also extremely stubborn.”
Those experiences hang heavy and unspoken while the two shuffle through stacks of photos.
Rochelle and Kevin aren’t actively looking for Vanessa, though once, immediately after she left in April, Kevin said he tracked her cellphone to a rundown house on the lower South Hill. He idled there for a while, looking for her. He didn’t see her and even if he had, he’s not sure what he would or could have done.
Vanessa is almost 18, said Rochelle. She worries what will happen if Vanessa doesn’t make drastic changes.
“Either she’s going to end up in jail or in the morgue,” Rochelle said. “One or the other. I mean, we’re not naive.”
A public health concern
On the morning of her final day at Daybreak, Vanessa sat in front of a semicircle of 30 other girls. She passed her small sobriety coin around. Each girl held it briefly, saying a few words for Vanessa. Imparting her with strength, bravery, integrity and other attributes. Each affirmation is ended with an intonation, “Love and care.”
Vanessa cried as they spoke. About halfway through the circle one girl broke the format and spoke to the darker reality of release.
“Stay sober as long as you can,” she said. “If you mess up, I hope you realize you can come back here, and it’s OK to come back here.”
There is an effective and proven way to treat addiction, said McLellan, the addiction researcher. It’s the way addicted doctors and pilots have been treated for decades.
Pilots and doctors spend roughly 30 days in high-quality inpatient care, then are released to mandatory outpatient care and monitored for five years.
Recovery rates hover around 80 percent.
“Americans can be forgiven … for being cynical about ever doing anything about drug abuse,” McLellan said. “The kind (of drug) changes, but the rate hardly has changed at all since they’ve been keeping records. So, people think it’s an intractable problem. They think we just have to live with it.”
But McLellan points to a model for hope: tobacco. Cigarettes posed the “worst drug problem the U.S. has ever had” and the one most “aggressively marketed.”
At the peak, 54 percent of U.S. adults were smokers. In 2016, that number had dropped to 19 percent.
“We didn’t turn it over to the Department of Justice,” McClellan said, “We treated it as a public health problem.”
The idea of modeling drug addiction treatment after the cigarette fight is slowly taking hold. But for many like Vanessa and her family, it’s not happening fast enough.
“It is not intractable. We simply have not thought about it the right way,” McClellan said.
“And we’ve had an insurance system that has been unwilling and unable to provide the care that’s really necessary,” he said.
The brief return
On Mother’s Day, Kevin sat in a Spokane Valley coffee shop.
It had been one week since the deputy found Vanessa and called. One week since she returned to the embrace of her parents. And one week since she kicked her way back out of their lives through her bedroom window.
Kevin points to a black leather couch in one corner. That’s where Vanessa would spend hours writing poetry and short stories. She’d ride the blue beach cruiser – the one she would eventually pawn – and hole up in the coffee shop for half a day.
Normally spry and upbeat, on that day Kevin looks tired and worn -down. His eyes are watery. He wonders what can be done. So many treatments, so many trips to the hospital and juvenile detention center.
“I’m a little perplexed (at) how ineffectual the services really are,” he said.
And then, acknowledging the difficulty of the whole undertaking, he said, “not to disparage it, you know, I don’t know what they could do. I guess that’s the other thing.”
He paused. And then continued: “I mean, but whatever we’re doing doesn’t seem to be working.”