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Sitting in her living room — books on the shelf, houseplants on the floor, coffee in a mug on the table — Pam McCaffrey recalled her plea for help and how that first 12-step meeting saved her life.

"I never, ever in my life wanted to get so high, even when I was an active user," she said, holding back tears. "And, um, these people just loved me. Total strangers."

Pam learned that day that if there was one thing she could count on, it was the support of other recovering addicts. It was an idea that took some getting used to, though — for the past 30 years Pam had spiraled through a life that left husbands, kids, close family members and many others in its choppy wake.

And during that life, she couldn't count on anyone to help her get or stay clean, least of all total strangers.

In Blount County, aside from jail there was not much of a system in place that could have done much to help Pam or the thousands of people like her.

Between 2000 and 2008, 7,491 people were charged with drug crimes in Blount County -- almost half of the charges were filed against someone who had been charged with a drug crime in the county before.

Pam was one of those repeat offenders — over the years she was in and out of jail in Blount and Knox counties many times — 19 times in Blount with her longest stay at the jail being 11 months of a two-year sentence.

And while the number of drug crimes in the county is already high — about one in four crimes is a drug offense — people in law enforcement, the judicial system and even the addicts themselves say the number of drug-related crimes is much higher.

Law enforcement officials in the county estimate the amount of crime tied to drugs — robberies, assaults, thefts, murders, etc. — accounts for 85 percent or more of all crime in the county.

Deeply entrenched in that cycle, Pam would get high, she would get arrested and go to jail, and then she would get out and get high again. For years that was her life.

At her lowest point — the day Pam says she physically died in the parking lot of Blount Memorial Hospital in Maryville — doctors and family members were there to help Pam heal. But no one was there to help her get better.

Hitting bottom

Blinking awake to the bright fluorescent lights of an unfamiliar hospital room, Pam tried to lift her arms, but couldn't.

She was restrained, lashed to a hospital bed because she kept pulling lifesaving tubes and wires off her body.

She did not remember any of it.

The day was July 15, 2007. Pam had spent the past 12 days in a coma. She would spend almost the entire month of July in the hospital.

Doctors thought she had tried to kill herself.

Pam insists she was not trying to commit suicide. Instead, she said, it was bad crack.

She still can't remember much about the day she was brought to the hospital. She remembers the acrid yellow smoke of a crack pipe flooding her lungs. She remembers not being able to breathe, not being able to move. She remembers expecting to die.

"(I was) standing on my tiptoes leaning against a car saying, 'I need help.' I really thought I was going to die," Pam said.

"I told my friend that I was visiting that I was going to die in his yard," she said. "And he told me, 'The hell you are.'

"I think he was telling me to move somewhere else," she said. "But I couldn't. I couldn't move; I couldn't breathe; I couldn't get any air."

Finally someone brought her to the emergency room and that's where things go dark.

Reaching out

Still lying in a hospital bed barely able to move, Pam found a $20 bill among the shredded clothes that had been cut from her body by emergency room doctors.

It was just enough to buy crack, but the hard part was getting someone to sneak drugs into the hospital.

There was no way she could get up and walk out, Pam was still too weak. "I would sit there and just drool," she said. "My bowel movements -- if I sneezed, I was in trouble. If I coughed, I was in trouble.

"I was not in control of my body at all."

A lack of motor and bowel control did not matter much to her coke-addicted brain, which was screaming for crack like drowning lungs scream for oxygen. So after being moved from the intensive care unit to a private room, she quickly started to use her phone.

"The first people that I tried to reach were dope dealers," she said. "It wasn't family or friends, it was dope dealers.

"When I came to and realized I had money, (crack) was the first thing that I wanted.

"And I guess only by God's grace, dope dealers don't go to hospitals to do delivery," she said. "They were like, 'You're going to have to come out.'

"So I laid there, and I'm trying to scheme on how I can get some dope."

It didn't matter who came, Pam would say anything to get to a dealer.

"I tried to manipulate anybody that came to get me up into the hood so I could spend that 20 bucks," she said. "And it didn't work."

When she was well enough to leave the hospital, Pam took no time getting drugs. A documented overdose patient with nearly two dozen drug arrests, she was picked up by a friend and dropped off in "the hood" without a second thought.

"So the time I actually left the hospital to the time that I was actually smoking crack again? Maybe this time was an hour," Pam said.

The cycle of offense

On a windy afternoon in March at the Save-A-Lot on Hall Road in Maryville, Pam found a familiar face in the parking lot.

William Harshaw, who Pam knew as "Squirmy," said he had spent time with Pam when she was an active user.

"We probably used together," he said.

"More than once, Squirmy," Pam responded. "More than once."

Out of jail for about a month, and clean for about five, Squirmy said he got into drugs because he didn't know what they were, or how they would affect him.

"My friends were using it, and my friends seemed normal," he said of his first experience with crack. "I'd never seen it used before. And the next think you know, I was hooked.

"I was gone."

Saying the legal system doesn't care about getting people clean, the indifference he sees is what Squirmy blames for the drug problem in Blount County. Even if you want help, you can't get it, he said.

"In Blount County, man, there's really nobody to help you," he said. "The only time you can really get help is if you go to jail and you really want to try to get a break, you can get them to give you some time and try to get you into a halfway house.

"Other than that, no. There ain't no help."

There are no government-run treatment facilities in Blount County. And according to Dan Caldwell, president and CEO of Cornerstone of Recovery -- a treatment facility in Alcoa -- there is very little interaction between the justice system and private treatment facilities in the county.

But even if they did work together more, there is still the issue of space. There are only five in-patient treatment facilities in East Tennessee and they all have waiting lists that stretch for months, Caldwell said. So if a person really needs help, there is a very good chance there just won't be a place for them to go.

Having been in that position, Squirmy agreed.

"They ain't got no help down here, man, they ain't got no facilities," he said.

"They just want to lock you up and let you right back out and give you all kinds of fines. And as soon as they let you out (of jail), they're going to wait for you to mess up," he said. "There's plenty of people getting locked up, but they ain't getting no help. They get right back out and do the same thing.

"That's what Blount County knows."

You have to hit bottom

Pam will tell you that in her case, treatment would not have done much good until she was ready and willing to go. Her near-death experience she said, was the bottom she had to hit before the road to her recovery could start. She has been clean now for nearly two years.

Someone seeing the events of Pam's life unfold might simply ask: How did she get there in the first place? If she knew the drugs were killing her, why didn't she just stop?

Dr. Bradley Lander, clinical director and a specialist in addiction and recovery at The Ohio State University Medical Center's Talbott Hall, says the answer lies in the way the most primitive parts of the brain work.

A newborn child knows he or she needs to eat from the moment of birth. No one has to tell it, it just knows. The reason is, Lander says, that the "reward pathways" of the brain -- which primarily run on dopamine -- regulate the most basic human needs: food, water, and reproduction.

Drugs like cocaine also produce dopamine and activate the same "reward center" of the brain, and when that happens taking the drug starts to take on the same properties as those basic, vital human needs.

"What happens over time, using these chemicals enough, is the brain makes an adaptation to the point where it believes it needs the drug the same way it needs food, water or sex," Lander said. "Once that has kicked in, then this automatically sets up a hunger -- a brand new drive -- that goes from being a want to being a true compulsion."

That adaptation — where a drug like cocaine infiltrates the brain's basic functions — is a concept many people can't grasp, he said.

"Most people don't understand what a compulsion is," he said. "They think it's an urge. A compulsion is a drive that takes over."

Once the addiction is there — that compulsion — the need to get drugs can overwhelm rational thought.

"We can tell ourselves, of course I don't need the drug, I know that," he said. "But that is a learned rational thought. Whereas this is an irrational drive state that has kicked in."

When a person is starving, their brain tells them they need food or they will die. When an addict is without drugs, the brain reacts the same way, Lander said -- the brain believes it needs the drugs to stave off death, and that causes the user to react in kind.

"If you get hungry enough, you will actually do something pretty drastic in order to eat if you feel like you're starving," Lander said. "Well, if your drug hunger gets to a certain point where you feel like you're starving, you will act out, you will do something very impulsive."

Bad choices

For Pam, those impulsive actions took everything from her -- and she will tell you that her bad situation didn't change the fact that the choices she made were her own. Four marriages fell apart, she ignored her two kids (now both in their 20s) for most of their lives, her health didn't matter, other people didn't matter, nothing mattered except the drugs.

"Some of us can go, 'OK, that was college and that was a good time and now it's time to live life,'" Pam said. "I never stopped, and if it wasn't drugs it was alcohol.

"My oldest (son), I neglected -- barely even recognized he existed for most of his life," she said. "And I'm not talking two or three years, he's 28 years old."

Mark Boxley has been writing about drug issues his entire career. Connect with him at:

— mark.boxley@thedailytimes.com

— www.twitter.com/docboxley

— www.lives-wasted.com

— www.lives-wasted.ning.com

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