The American Ethos and Drug Addiction and Death
An odd moment occurred on MSNBC when the host of "All In with Chris Hayes" interviewed liberal New Hampshire Senator Maggie Hassan.
As Senator Hassan reviewed the wide deployment of medications used to assist in preventing drug deaths, Hayes interjected, "But drug deaths are continuing to rise." Hassan looked disconcerted briefly, then returned to her recitation of the great steps New Hampshire was taking to prevent these deaths.
The New York Times has just conducted an analysis indicating that, not only have such deaths not declined, or leveled off, but they are instead accelerating.
I have written about this topic repeatedly in recent weeks, including Reducing Drug Deaths: Heroin Injection by Appointment (May 29), Trump Won't Reduce the Ravages of Drug Addiction (March 30), and The Solution to the Opioid Crisis (March 16).
Do I think that this new attention to the carnage will improve the situation? No. Indeed, I think the Times article itself is part of—contributes to—the problem.
I have a theory, of which Maggie Hassan is but one example: We don't really care whether people become addicted, or whether they die. We only care about maintaining our cultural blinders. All of our energy goes into that purpose.
Here's proof (as I have written about in Psychology Today): The United States was the last country in the western world to adopt clean needle programs because of our AA and abstinence fixation. Ethan Nadelmann, among others, has estimated that this killed 100,000s of Americans. I happened to live in New Jersey over this period. When Governor Christine Whitman appointed an AIDS Council, it recommended such a clean needle program. Whitman rejected it, saying it "sent the wrong message" to drug users. You know, that they should care for themselves and stay alive.
The commission had done its homework, and estimated that clean needles would save the lives of 700+ addicts a year. Instead of being the first state in the union to adopt clean needles, NJ was delayed ten years, and became the last state to adopt such a program. Result: 7,000 dead heroin injectors (a couple of whom I have known).
I have another theory. And it is that public health officials and politicians can succeed if they simply do three things: Always say bad things about drugs, claim that addiction is a disease, and report that social conditions have nothing to do with addiction and that thus everyone is equally susceptible, from President Obama's daughters to young people living in the deepest misery, deprivation, and demoralization in Appalachia and American inner cities. Do those three things and you will always get ahead.
Five Reasons the Times Article Will Only Exacerbate the Problem
Among other reasons the Times article contributes to, rather than addresses, the problem is because it steps up the panic and alarm with which we approach the problem, which is the source of the drug-death epidemic in the first place.
Let me review the top five reasons for this:
1. We are so frightened of the words, the concepts, of "heroin" and "addiction" that we can't approach them rationally. My heroin injection by appointment article seeks to encourage the use of heroin injection sites around the United States. Currently, there are none in this country, while hundreds exist throughout Europe. There is currently one in Canada, but this number is expected to grow rapidly as plans for them unfold around the country. This won't happen in the United States, where our answer to drug deaths is to say, "Don't take drugs."
2. We conceive of addiction as a medical problem since we are unprepared, and unable, to address its social drivers. My article about how Trump and his commission to end the addiction epidemic are doomed to failure addresses the fact that, by isolating the epidemic from its social causes, we have no chance to fix our addiction-and-death epidemic. And we don't really want to, since addressing these root causes is too problematic and questions the American ethos. Instead of such action, we imagine that the problem is one that we can address medically.
3. By hyping the disease theory of addiction, we actually make addiction more prevalent and resilient. Claiming that addiction is a disease that people cannot avoid, which was the theme of the Today Show in which my point of view was ignored, even mocked, simply makes it more likely that people feel that they can't escape addiction's ravages, before they become addicted because it is prevalent in their communities and families, then because they imagine addiction is inescapable after they experience it. Instead, as I argue in my solution piece, we should "make clear that addiction is not a disease and therefore, that it is escapable and not a lifelong identity."
4. The medication-assisted treatment craze is leading us down the wrong path. An addiction is something that lures us in with a promise, but then leaves us high and dry. And this is the case with medication-assisted treatment. Indeed, methadone and buprenorphine are medical substitutes for heroin that lower the risk of death. However, they are not solutions to addiction. By relying more and more on medications as our answer to the opioid and multiple-drug death crises (as Hassan, New Hampshire, and most other states are), we merely avoid and delay the actions and therapies that can possibly reduce addiction per se.
5. We can't even get the cause of drug deaths straight, as proven by the Times article. The Times piece on the never-ending drug-death crisis repeatedly refers to it as being due to "overdose." As I wrote in "solution," instead:
If people were to consume pure doses of heroin or other opioids, their likelihood of accidental death is reduced to nearly naught. Yet the myth that people typically develop an inordinate, insatiable desire for a single drug—when in fact those most at risk are mixing a variety of substances in what can be considered either a chaotic pattern or an abandoned, intentionally self-destructive one—still fatally misinforms our policies.
I led off my solutions piece by indicating that we need to "Loudly advertise the dangers of drug-mixing. Spread this message widely, including in schools, along with other critical information about drugs, while teaching drug-use and life skills." This requires abandoning the idea of a drug-free America, and instead educating people to minimize negative drug-use consequences. We will never do that.
And so, we see, the Times piece's sounding the alarm bells for drug addiction and drug deaths will merely add to the snowballing of these very things.