America’s Drug Problem Isn’t An Opioid Epidemic, It’s A Misery Epidemic

It’s not as brave a stance as it once was to challenge traditional thinking on the current epidemic of drug abuse. By traditional thinking, I refer to the War on Drugs and its moral implications: the conflation of the stigmas of wrongness and illegality in drugs, a punitive system designed to deter potential drug users and traffickers through tough laws, and the vagueries surrounding the nature of addiction: is it genetic? Is it treatable? Do drugs contain “chemical hooks” that will make you an addict after your first try?

Tradition continues to prevail despite the fact that research presenting serious challenges to this line of thinking has been coming in for years. Two famous examples have stood out in popular journalism: heroin recovery in returning Vietnam vets, and Dr. Bruce Alexander’s “crack rats.” As Johann Hari relates in TED 2015, 20% of Vietnam soldiers were users of heroin during deployment, yet 95% of them quit cold turkey upon returning home. The question: If addiction resided in the hook of a chemical, why didn’t more vets become junkies?

Likewise, Dr. Bruce Alexander arranged two experiments involving rats. In the first, rats were placed in an empty cage with a bottle of regular water and a bottle of water laced with cocaine or heroin. The rats drank of the drug water until they overdosed and died. In a later experiment, the same two bottles of water were introduced into a large enclosure called “Rat Park” that was essentially rat heaven: tunnels and toys to play with, loads of cheese, other rats to socialize and have sex with, and so on. In this experiment the rats don’t go near the drug water: The question: what if the nature of addiction isn’t in the chemical hook, but in the cage?

America is in the middle of an opioid epidemic. Trump ran on it as a part of his campaign platform. I believe that concerns over the opioid epidemic played significantly into the coveted electoral votes of the rust belt going red. This controversial viral photo of heroin-addicted parents was taken in Ohio. The thinking of the Trump administration is traditional, taking as its modus operandi the “hard on crime” approach we see so often in conservativism. He has praised Pence for raising mandatory minimums for drug offenses in Indiana, promoted “stop and frisk” as an acceptable police practice in cities, and his administration, under Sessions, supports a punitive approach to drug abuse that treats it as a criminal justice epidemic and not a public health crisis.

We all understand at some level that ethics and laws are not always aligned: an extreme example is that atrocities committed by despots like Hitler or Stalin are “legal.” An analogy closer to home is Prohibition: alcohol did not come to be seen as wrong because it was illegal, nor was it made illegal because it was wrong. Alcohol was illegalized because it is bad for you, at a time when America was experiencing an epidemic of cirrhosis. Still our judgement of alcohol has not wavered: alcohol itself is not “wrong” in popular thought, it is only wrong for some people. The stigma of drug use is accordingly flexible: inner cities take a beating while drug use among CEOs seems to be a “quirk” of wealth. We don’t hear objection to Sherlock Holmes’ legal cocaine addiction despite the resurgence of popular interest in Conan Doyle’s classic stories.

The burning question of drug abuse that doesn’t seem to be able to penetrate traditional thinking is this: what is it that the addict gets from a drug that is absent in daily life? As author of In the Realm of Hungry Ghosts Dr. Gabor Maté says, if you want to understand addiction you have to understand not what is wrong about it, but what is “right” about it:

“What is the person getting from the addiction? What are they getting that otherwise they don’t have? What addicts get is relief from pain, what they get is a sense of peace, a sense of control, a sense of calmness, very, very temporarily. And the question is, why are these qualities missing from their lives? What happened to them? If you look at drugs like heroin, like morphine, like codeine, if you look at cocaine, if you look at alcohol, these are all painkillers.”

Dr. Gabor Maté, TEDxRio 2015

The insight is this: people do not do drugs because they are addicts, they are addicts because they are miserable.

drug overdose 2015

Here are the CDC’s most recent statistics on drug overdoses in the United States. The hot spot is clearly the rust belt with two other stand-out states that will come to be important for us: New Mexico and Maine. Louisiana, Oklahoma, and Michigan are also warm.2012 prescription painkiller audit

We’re not strangers to this map either, from a National Prescription Audit available on the FDA’s website. It’s been known for years that a significant part of the epidemic began with the legal overprescription of opioid pain medication. The availability of pain medication is certainly a factor to the crisis, but there are missing pieces.

If what I said about drug use is true, that people do drugs not because they are innately addicts but because they are emotionally susceptible to the chemical self-“treatment” of emotional pain, suffering, stress, anxiety, and so on, we might expect to see this represented statistically. And we do.

2016 well being index gallup

Every year Gallup partners with Healthways to release a national index of well-being. This index is a measure of Americans’ perceptions of their lives as a result of five interrelated elements: sense of purpose, social relationships, financial security, relationship to community, and physical health. The most miserable states in the union by this index, represented as the lightest shade of green, map directly onto regions hardest-hit by the opioid epidemic. When these five elements break down, people become susceptible to chemical self-“treatment.”

We can go further. What are the real causes of misery, we may ask? For Maté they are socio-economic, tied to the stresses of poverty and abuse that characterize lower classes. The Realm of Hungry Ghosts calls these ACE’s — adverse childhood experiences. A male child with six ACE’s has a 4,600% increase in risk of developing an addiction later in life.

2015 all ages poverty

Here are the U.S Census Bureau’s most recent statistics on poverty as they appear on the US Census website. Below I’ve mapped 2014 statistics for child abuse using data published by the ACF (Administration for Children & Families, a subsidiary of the US Department of Health & Human Services). Some pieces fall into place: New Mexico, which is low in painkiller prescription and moderate in well-being, lights up on both maps. Maine, which is moderate on both well-being and painkiller prescription, lights up in child abuse. Massachusetts, bright red on the overdose map but silent on others, emerges as a national leader in rates of child abuse.

Victims per 1,000 children.png

You can’t make this up. I’m not doctoring the numbers or selecting choice obscure statistics from websites you’ve never heard of that happen to bend in my favor. These are reliable statistics direct from government departments and polling companies charged with routinely collecting them. We come to realize that we aren’t looking at maps of a drug abuse epidemic: instead we see an epidemic of untreated human suffering, brokenness, and trauma.

Perhaps this is why the Bible is not much in the business of treating addiction. Jesus doesn’t cure addicts or treat alcohol abusers, Paul doesn’t walk anyone through the 12 steps. No matter how hard they try I can never shake the feeling that Christian rehabilitation materials with the best of intentions have to bend over backwards to try and derive the “truth of addiction” out of decontextualized Bible verses. These teachings inevitably come out of scant asides on drunkenness (if I had a dollar for every time I had heard “do not get drunk on wine…”) or from generic teachings on “freedom in Christ.”

As a close Christian friend studying psychology often tells me, if drug addiction were anything like the way it is understood in the church, the serpent might have had better success in tempting Adam and Eve by putting a crack den in the garden of Eden. We know better than that now: even had they tasted of the “fruit of the crack den” Adam and Eve would behave more like the rats in Dr. Alexander’s Rat Park who tasted the drug-laced water once and never returned.

The Bible is very much, on the other hand, in the business of healing brokenness, which as we can see now is the root of all addiction not just to drugs but also, as Maté says, addictions to sex, work, and even shopping. Last week I wrote about affirming genuine humanness by listening to the gut feelings behind compassion and pity; splagchnon and splagchnizomai. Jesus is one with the suffering of the addict. He may not have been an addict himself, but in Matthew 11 he says that he lives daily with the accusation of being one:

The Son of Man came eating and drinking, and they say, ‘Look at him! A glutton and a drunkard, a friend of tax collectors and sinners!’ Yet wisdom is justified by her deeds.

Matthew 11:19 (ESV)

Just as the humanness in the Samaritan connects with the humanness in the beaten man in Luke 10, so here the humanness in Jesus connects with the humanness of the “sinners” at his dinner table. At the expense of his own reputation he breaks bread with them to minister to the psychology of their brokenness, and therefore addiction. Punitive abstinence-only systems don’t work for drug addiction any more than they do for the Christian purity movement. The Bible’s goal is not to heal addiction, it is to heal the brokenness that we all, in our own ways, try to medicate through addiction.

The rust belt and the Bible belt don’t need me to slap them over the head with a “liberal bible” to set their heads straight. They need the welcoming embrace of life-affirming genuine humanness, of real Christian love and tenderness. To be like Jesus we need triple doses of humility and compassion, and the open-mindedness and courage to pursue progressive solutions to the problems of our age.

“And here is where I’m humbled. I’m humbled by my feebleness in helping this person. Humbled that I had the arrogance to believe I’d seen and heard it all. You can never see and hear it all because, for all their sordid similarities, each story in the Downtown Eastside unfolded in the particular existence of a unique human being. Each one needs to be heard, witnessed, and acknowledged anew, every time it’s told. And I’m especially humbled because I dared to imagine that Serena was less than the complex and luminous person she is. Who am I to judge her for being driven to the belief that only through drugs will she find respite from her torments? Spiritual teachings of all traditions enjoin us to see the divine in each other. Namaste, the Sanskrit holy greeting, means, “The divine in me salutes the divine in you.” The divine? It’s so hard for us even to see the human. What have I to offer this young Native woman whose three decades of life bear the compressed torment of generations? An antidepressant capsule every morning, to be dispensed with her methadone, and half an hour of my time once or twice a month.”

Gabor Maté, In the Realm of Hungry Ghosts

Pictured is Michelangelo’s “The Fall and Expulsion from Garden of Eden” (1509-1510) as it appears on the ceiling of the Sistine Chapel.

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