QUINCY, Ill. -- Tears streamed down Maria Buchanan's face and dripped into the pile of crack cocaine in her lap.
She'd finally hit bottom.
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Her addiction spanned two decades, numerous jobs, significant others and jail stays. Buchanan, 49, previously had tried to clear her mind and quit using drugs, but she caved to feelings of worthlessness and self-doubt.
She hadn't known strength. She'd only known using.
When she believed life hit her hard, she hit the crack harder.
"I didn't know how to express myself," Buchanan said. "I was just existing. I wasn't living."
Last July, Buchanan sought addiction treatment. The National Institute on Drug Abuse estimated in 2011 that 21.6 million Americans needed help for a problem related to drugs or alcohol, but only about 2.3 million received treatment at a special facility.
Locally, Great River Recovery Resources in Quincy admits yearly between 400 and 600 clients like Buchanan to its residential program. The outpatient programs serve another 1,200 to 1,400 people per year.
Eleven months later, Buchanan is living the life her addiction always prevented.
For the first since time she started using, she's kept a job, maintained healthy relationships and has her own home. She smiles more than she has in 20 years, even if she avoids it because the drug use damaged her teeth. When she thinks to, she pushes her lips shut.
However, that shred of self-consciousness can't hide her newfound glow or the progress she's made since she asked for help on July 4.
"I'm in early recovery, but I have determination," she said. "I don't want to be miserable any more."
Still, happiness comes at a cost.
Paulette Sackett, marketing specialist for Recovery Resources, said payment often poses a barrier to treatment. While Recovery Resources creates personalized plans based on budgetary and treatment needs, Sackett said less than 5 percent of clients receive insurance coverage. The cost of residential care varies based on income. Clients may pay as little as $120 or as much as $1,350 per day for services, and most stay 28 to 30 days.
Sackett says once the care for mental health and substance use disorders becomes an essential health benefit through the Affordable Care Act, all insurance providers will be required to provide a consistent level of coverage for addiction services.
Sackett hopes upcoming changes with the Affordable Care Act may change how Recovery Resources treats patients. She said illnesses such as cancer and diabetes are often addressed in the early stages. Treating patients like Buchanan should be handled in a similar way.
"What we're hoping as access to care improves is that we'll see less acute cases but a more broad spectrum," Sackett said. "Just like you see in other health care arenas where they push preventive care."
Gale Westerhoff, a criminal justice addiction specialist and Buchanan's primary counselor, said patients shouldn't consider cost as a barrier to sobriety. Patients face multiple barriers when attempting to control an addiction -- none of which can be addressed while stoned or drunk.
"You can't do any of it until you stop using," Westerhoff said.
Tully Douglas, a residential technician at Recovery Resources, believes there are two types of clear-minded addicts and alcoholics. Many dry up their addictions without changing their lifestyles. They stop using, but become miserable, frustrated and easily enraged.
Others, like Buchanan, want more than to merely dry up. They reach for the 12 steps to recovery, based on the Big Book of Alcoholics Anonymous, just as easily as they once reached for harmful substances. They form relationships with their counselors and others in their group therapy session.
Buchanan hadn't always known such determination. She'd been to Recovery Resources before, but hadn't embraced the program. Often addicts end up at facilities holding family ultimatums or court orders. Douglas said those may motivate an addict or alcoholic to participate but not to succeed.
When Buchanan called Recovery Resources on July 4, she spoke with a counselor who'd seen her fail in the past. She promised to work harder.
This time, she felt like her life depended on it.
Douglas explained that each addict and alcoholic needs to hit their own bottom.
"A person will not change until they get to that point where they are no longer willing to pay the consequences," he said.
Douglas should know. He made a phone call asking for help up from his bottom seven years ago.
Today, he wears a collared, button-down shirt and sits behind a desk at Recovery Resources. It's a slower life than the drugs and alcohol that once put him in a jumpsuit behind bars. Still he knows he's not much different from the addicts and alcoholics across from him.
He counsels alcoholics so dependent they shake from their craving. They drink their first drink each morning through a straw until the alcohol calms their nerves and they can go about drinking through the day.
For many, it's no longer about the high. It's maintenance.
Each day, he stifles the overbearing voice of his own alcoholism. Working at Recovery Resources reminds him what returning to drinking can do to him.
"In all reality, I try to help people here," Douglas said. "But in all reality, they probably help me as much as I do them."
Douglas realizes he has strings of people in his life who helped pull him up from his bottom. He cited family members, nurses, other addicts and fellow staff members who never gave up on him. But each day, he makes the decision to stay dry.
Buchanan credits her private sessions with Westerhoff and the bonds she formed with her group members with her success. Westerhoff quickly disagreed, saying Buchanan did all the work on her own; Recovery Resources just gave her tools to make it possible.
"If you put an obstacle in front of Maria before, she'd just give up," Westerhoff said. "Now she doesn't ever, ever do that. She just faces it head on."
Buchanan began her treatment as a shy, reserved individual without much to say. Using had damaged her short-term memory, and she took detailed notes just to remember what others talked about during meetings. Now, her memory and her confidence have returned.
"She'll speak up now," Westerhoff said. "She knows she's got something to say and something good to say."
Before treatment, Buchanan considered herself a homebody. Socializing wasn't something she enjoyed or ever pursued. What she wanted more than anything was love, but she kept looking for it in the wrong places.
Today, she revels in the love of strangers, the gift of a clear mind and the hope that nothing will ever change her newfound freedom.
"Me using, that was my comfort zone," Buchanan said. "Today, I thank God I don't have the urge.