MARSHALL — When Leslie Roettgen fled from Marshall to Columbia in 2004 to escape her methamphetamine addiction and receive treatment, the drug followed her.
"It's the devil in my head," she told the Missourian at the time. "Meth is the hardest drug I've ever had to get off of."
The Child Welfare Information Gateway within the Department of Health and Human Services has compiled a list of various resources about meth and its affects.
Six years later, the Missourian made several phone calls to contact Leslie and follow up on her story. Sometimes, the story we hope to tell is not the one we find.
"Leslie?" her sister, Lisa Cravens, said in a phone interview. "Leslie's dead."
After staying clean for several years, Leslie relapsed into meth and prescription drug abuse, and died in the summer of 2009 at Arrow Rock State Park of an overdose of methadone, a prescription drug used to treat heroin addiction.
"She had no prescription for methadone, so that means someone gave her the methadone tablets," said Saline County Coroner William Harlow, who performed her autopsy. "Whoever gave them to her is a murderer."
Leslie's struggle with meth is not unusual in Marshall, where Saline County Sheriff Wally George has watched use of the drug swell in the county over his 31-year tenure.
"You take a bite of that meth one time, it's going to bite back and never let go," he said with a furrowed brow. "There's not enough law enforcement out there to win this."
When George considers the Saline County Jail, he sees the problem writ large: 45 to 48 of the facility's 64 beds are occupied on average.
"If we could just wave the magic wand and let methamphetamine disappear, we'd be down two-thirds," he said. "It stems from meth."
For George, the toll of methamphetamine in Saline County is personal.
"I arrested my own son — he was 37 years old," George said. "Word comes to my office that my son had a meth lab in his house."
First, George was shocked. Then he doubted. And then he remembered his obligations.
"I told my boys when they told me that, 'Here's the deal: You guys got enough probable cause for a search warrant, I want you to go do your (probable cause) with the prosecutor and get the search warrant,'" George said. "'I want you to nail (him) just like anybody else if that's true information.'"
To George's dismay, it was.
"The night before we took him down to prison, my wife and I went out to the jail that evening," he said. "I was out there late with him that night before and he was scared to death. ... It's really hard for me to put into words the perspective that I got out of that. It made me look at these meth people a hell of a lot different."
Leslie Roettgen didn't want to be one of them anymore when she fled Marshall in 2004. She wanted to tear herself away from the meth cooks and users that made up her social circle, according to the Missourian story published about her in 2004. She went to live at Oxford House, a halfway house in Columbia for recovering female addicts. She was also receiving drug treatment therapy at the McCambridge Center.
David Veanes, program director of Linn Creek Outpatient Clinic, a branch of Columbia's Family Counseling Center of Missouri, said one's peers can make the difference between a user and non-user.
"The majority of our clients ... are mostly influenced by those around them," Veanes said. "The biggest influence is who they're hanging around with and what circles they run in."
But despite her efforts to remove herself from them, old friends and demons found Leslie again after treatment. When her nephew Cody Roettgen thinks about her, his eyes glisten.
The grip of addiction
The woman behind the half tinted window at the Saline County Jail is barely visible. There is authority in her voice when it crackles from the intercom in the ceiling, and two access-controlled electronic doors unfasten with a clank, echoing like a pulse across the cold sea of concrete.
Beyond them is a small room sealed off with glass where a young man in an orange jumpsuit sits, alone, hands folded on the table. His name is Cody Roettgen, 21; he is Leslie's nephew and the only member of her family contacted who was willing to talk about what happened to her.
Cody was convicted in late 2008 of possession of a controlled substance, according to Missouri CaseNet, but was being held for a probation violation.
"I lived with (Leslie) when I turned about 17, that's about when I started using, too," he said. "She used to take care of us because my mom and dad, they had an addiction, too. She was pretty much the one who raised us: me, my sister, and my brothers."
Like Cody, Leslie was not immune to the influences around her, and she began using meth.
"It took her awhile. She stayed clean for two years at least," he said of Leslie's struggle to overcome methamphetamine addiction. "She totally changed. She tried to get us all to go to church, she invited us over. We all thought she was done using."
But a couple years later, he said, she ran into an old friend.
"He was using meth," he said. "She did, too. That was her favorite thing to do."
She returned to abusing prescription drugs like Vicodin and Percocet before addiction got the last word on lot No. 4 at the Arrow Rock campsite.
"She believed in God," Cody said. "She believed in taking care of her kids. She loved her kids. She'd give you the shirt off her back."
When the Missourian wrote about Leslie in 2004, she had already lost her children. The Department of Family Services took them during her first year of meth use because she had become such an absent parent.
Cody has seen these wounds in Marshall. He knows its dark side intimately.
"Marshall is tough," he said. "We've all tried to get away. There's a lot of addicts here. It's pretty much what this town is about ... drugs."
According to a 2006 report by the National Center on Substance Abuse and Child Welfare, 50 percent of meth users relapse, 36 percent of those within the first six months of treatment.
"That does happen," Veanes said. "We bring those clients back if they need help."
The report also said treatment completion rates among the estimated 1.4 million annual methamphetamine users in the U.S. appear to be similar if not lower than users of drugs like heroin and cocaine.
And unlike medicinal treatment for heroin, treatments for methamphetamine addiction are extremely limited, and only behavioral therapies have shown to be effective, according to a research report by the National Institute on Drug Abuse.
The report also showed that, in light of recent research correlating methamphetamine use to psychiatric disorders, many meth patients need mental health treatment, as well.
Among their problems are depression, bipolar disorder and anxiety, Veanes said, many of which stem from the stress meth use has brought upon their lives.
"Two of the biggest areas the meth addict has trouble in is family issues and the legal system," he said. "They know they're getting clean and sober to change their life, but that doesn't change the legal issues they are currently dealing with."
In treating these disorders, Veanes said, antidepressants and antipsychotics are sometimes administered.
Overcoming meth addiction alone, in Veanes' experience, doesn't happen.
"You can't do it by yourself, that's impossible," he said. "You have to get some kind of help ... have them call a treatment center, get their families involved."
But support through treatment therapy is only half the battle. The real life and death struggle begins after a patient leaves treatment and is on his or her own.
Those without a positive support network on the outside are more likely to use again, Veanes said.
"It will definitely make it more difficult to stay clean and sober," he said. "No doubt about that."
Imagine being so high you grind your teeth to dust to cope with quiet and resort to scratching craters through your skin to reach the itch in your veins.
These are some of the grim signatures of methamphetamine use George notices when he compares the mug shots of an addict who has been arrested several times in only a few years.
"It looks like they've aged 15 to 20 years," he said. "(Meth) deforms the face and deforms the teeth."
Their dental problems are so serious and painful that meth patients often have difficulty concentrating during treatment, Veanes said. The injuries are the result of saliva reduction and teeth grinding that occurs during meth use.
"Teeth is one of the problems we deal with here," he said. "They come in with a lot of broken teeth."
Deeper in the body, meth causes structural damage to regions of the brain that control memory and motor coordination.
According to the report, these effects might be related to how long methamphetamine remains in the user's body. When smoked, methamphetamine can produce an 8- to 24-hour high, remaining in the brain longer and damaging blood vessels and dopamine transporters as a result.
In comparison, smoking cocaine only produces a 20- to 30-minute high. And after one hour, 50 percent of the drug has already left the body.
Some research suggests this damage is reversible by abstaining from meth use, and that the success of healing is determined by the length of abstinence. But if someone has been recently using, Veanes said, they have noticeable cognitive difficulty reading, functioning and remembering.
"You see that about the first three to five days in treatment," he said.
Psychotic symptoms like audio and visual hallucinations, violent behavior, confusion and paranoia are also trademarks of methamphetamine. Veanes said one of his patients, before admitting himself into treatment, believed the police were coming to arrest him and climbed a tree so they would not find him when searching his home. But the police never came.
"Part of the psychological effect is paranoia. I don't usually see it that intense with other patients," Veanes said. "A lot of the paranoia has to do with law enforcement. Every time (meth addicts) hear a siren, they think it's for them."
And addiction does not know social-economic boundaries.
"You hear the, 'The first time I used it I was hooked' kind of thing," Veanes said. "I've seen it across the board from various social-economic levels, any kind of job. People who own their own business and get caught up in the meth use."
While Missouri is not a leader in meth consumption, numbers suggest it is a leader in production and manufacture.
Of the 7,438 national meth labs, dump sites, chemicals and glassware seized a decade ago by the U.S. Drug Enforcement Administration, Missouri had 439 incidents. Today, that number is 1,099, the highest in the nation, according to the Missouri State Highway Patrol.
George attributes Missouri's high number of meth lab incidents to the state's small town law enforcement. Missouri's major cities — Kansas City and St. Louis — are on the ears of the state, but everywhere in between are towns much like Marshall, with small-town people, politics and gossip.
"No disrespect to the big city boys, but we know our people one on one, and we pretty much know what's going on," George said. "I think that's why we got these numbers, because we're taking care of labs out here."
While some might view those figures to the credit of local and state law enforcement, others see it as an indication of the seriousness of the problem they face.
Veanes thinks the problem is increasing in Linn. "I've seen over the years that we have an influx of patients who are addicted to meth," he said.
Harlow said he hopes someone is prosecuted and convicted for Leslie's death and that the outcome resonates in Saline County.
"We have a strong problem in our county with people giving drugs, prescription drugs to other people," Harlow said. "Meth is rampant in mid-Missouri, and nobody wants to address that. ... (Meth has) got to be stopped, but it's tough to find the resources out here in little mid-Missouri."
George said meth is a mistake people cannot afford to make.
"Education, education, education," he said. "That's the only way we're going to win this problem over."
Jeff Kramer, principal of Marshall High School, says the district provides comprehensive drug, alcohol, and tobacco prevention programs from kindergarten through twelfth grade, many of which are incorporated into the curriculum.
"I think the school district, like many other districts, sees the use of drugs and alcohol in our students as an issue," he said. "We address it."
Through the Drug Abuse Resistance Education program, courses in health, social studies and science explain the effects of drugs, alcohol and tobacco on the body, he said. The schools also mark a "red-ribbon week" that highlights drug prevention. Guest speakers come and talk about staying in school, staying away from drugs, preventing pregnancy and avoiding sexually transmitted diseases.
"I think we've taken an all-inclusive stance trying to address the various issues," Kramer said.
But Leslie Roettgen's life path took her away from school, into early parenthood and nearly every kind of trouble a person can have. When George talks about her and the destruction meth has wrought in her family, he's matter of fact about the details: Leslie's arrests for drugs and alcohol, Cody Roettgen's troubles.
But he likes Cody; thinks he's a good kid.
"We arrest these folks, who in my opinion are not bad folks. And I swear within six months they're back again," George said. "It's just a wicked drug, a monster that won't let go of the body."