LAURENS, Iowa - Methamphetamine has claimed every tooth in Dennis Patten's head, which is why his face is caving into his jaw and why just about everything south of his neck is falling apart.
The squat Patten is a 28-year veteran of the Iowa drug wars, 25 of them spent as an addict, and the last three as an uncertain just-say-no convert torn by occasional gnawing cravings for the drugs that have crippled him.
"I can't honestly say that if you dumped some (meth) right here," he said, tapping a couple of fingers on a table in front of him, "that I'd turn it down."
Like Patten, Iowa is struggling with meth.
In Iowa as well as the Midwest, it's not clear that anyone is winning the drug war. In 2006, the Midwest had six of the nation's top 10 states in the number of meth lab incidents, according to the U.S. Drug Enforcement Administration.
It's not even clear that the drug-clean Patten, who weighs 387 pounds, down from 450, can say he's winning. As a result of prolonged drug abuse, he suffers from congestive heart failure, diabetes, emphysema and short-term memory loss. At 44, he's already had two strokes. Doctors would like to perform a gastric bypass operation to get another 150 pounds off him, but they aren't sure Patten's heart could handle the stress. His breathing is labored and difficult, which is why Patten carries a small oxygen cylinder with a clear plastic nose hose that wraps around his head and clips to his nostrils.
"If I run into someone who's used (drugs), I get cravings," Patten said, silently acknowledging that, as drug counselors point out, 9 out of 10 meth addicts fall back into meth abuse.
The battle against illegal drugs is often measured in terms of numbers - grams, ounces and pounds, street sale value, state and federal dollars available for drug investigations, arrests and convictions.
But numbers alone often obscure the struggle that is ongoing for police agencies battling the gopher hole-type challenge of illegal drugs and addicts who are trying to recover from years of addiction and the often heavy physical toll on their bodies. Addiction produces its own set of numbers, such as rising health-care costs and higher rates of burglaries and domestic abuse.
Bob Cooper has intimate knowledge of the gently warped farmland and back roads of this region of northwest Iowa because he skillfully used them to manufacture and sell meth and, by hiding in cornfields, repeatedly eluding capture by authorities who spent years chasing him.
Meth "became a way of life," said Cooper, who can still methodically explain his production method. He pocketed a thousand dollars a week making the stuff.
"They were on my heels. They never could catch me," said Cooper, barely hiding his satisfaction.
The law caught up with Cooper in late 2000. He was convicted of manufacturing and selling meth and spent 42 months in prison. Now 32, Cooper is trying to put his life back together in Laurens.
Cooper's younger brother Bill has not been so fortunate. Bill Cooper is 31 and started taking meth when he was 19.
Today he suffers from high blood pressure. He passes blood and is seeing a nephrologist. His wife Amy, 27, was on meth for one year. Family or job trouble or emotional stress did not lead to their drug use, they said. They just did it.
"I think the drug problem is getting worse. They're afraid to admit it. It's everywhere," Bill Cooper said.
There has been a big drop in homemade meth lab incidents and that, said Gary Kendell, director of the Governor's Office of Drug Control Policy, has reduced the threat to the environment and to children exposed to labs.
"But we still have a real problem," Kendell said, pointing to a rising number of adults treated for substance abuse - other than alcohol - up 36 percent since 2000.
Patten's war is more personal. He says there's not much more doctors can do for him. He can't do a lot of physical work because it puts too much strain on his heart.
Patten says he's available to anyone who wants advice, but the phone doesn't ring often.
His wife added, "It's usually someone asking if this is a good price for an 8-ball," a common street term for an eighth of an ounce of cocaine.