When the investigator arrived, Mr. Smith was there. It made him nervous. He was already rattled, dealing with a job change and a custody battle, and did not want to contemplate losing Dr. Clark. “I’d be tossed right back out onto the street to buy drugs,” he said.

Addiction is a tenacious disease with tentacles — family problems, legal problems, financial problems — that do not disappear with sobriety. Recovery has its zigs and zags, which many of the patients interviewed experienced this summer and fall.

Angela Scotchel, overwhelmed by anxiety about her future, constantly craved and sometimes gave in to her desire for Xanax. She also heard the siren call of opiates even as she set out to engage in life-affirming pursuits like lifting weights, working for her parents, dating.

“This one dealer called me today and said he got some fire in,” she wrote in an email, referring to high-potency heroin. “I can’t get it out of my head. I’m not gonna act on it, though. Just threw me off. I needed to tell someone about it.”

Ms. Rogers rode a roller coaster of life changes. She broke up with her partner of 21 years and got involved with another man. She found a job as a cashier and lost it because of unreliable babysitters. She placed her late sister’s children in a therapeutic foster home. She reluctantly moved back to Steubenville for lower-priced housing. She became pregnant with her fourth child.

Dr. Clark, meanwhile, prepared himself for the possibility that he could lose his license. He aggressively recruited other doctors, figuring he could manage the clinic. He watched the movie “Lincoln” twice; it helped him “deal with ‘the negativity.’ ”

“I figure if Lincoln could fight for the rights of slaves during a time when many people thought this was practically criminal,” he wrote in an email, “the least I can do is continue to fight for the rights of a few people suffering from the disease and stigma of addiction in my little part of the world.”