On May 12, 2015, two Newark, NJ police officers rang our doorbell. The officers came to tell us that our 25-year-old son Alex had died. “Heroin,” they said, “probably yesterday morning.” We had many horrible days during Alex’s years of psychological pain and addiction, but that day is most seared in my memory.
The overdose crisis is called “an epidemic.” The metaphor is reasonable. Researchers in the American Journal of Public Health found that more than one in eight Americans had their lives disrupted by a drug overdose death. In the last twelve months, nearly 110,000 Americans died of an overdose. I’ve heard President Biden’s Drug Czar Rahul Gupta liken these deaths to a 737 crashing into the Potomac every single day. Whatever the actual number, the death and misery from overdose are huge. And the outrage is much lower than we might expect for such a high body count.
For the first time in years, I have reason to hope. I’ve spent the years since 2015 writing about addiction and loss. When Alex died, I was a sociology professor at Rutgers University. I’d spent much of my career researching patterns of inequality by sex and race. My sociological training helped spur me on a quest to better understand the damage the overdose crisis had wreaked on my family, and society more generally.
I write to let people know what it feels like to ride the carousel from hell that is addiction. I write to warn. If it happened to my family, it could happen to anyone. Look at your child and imagine him, or her, injecting heroin, or ingesting fentanyl. It’s hard to imagine. Until it isn’t.
After Alex died, I resolved to turn grievance into action. I found writing to be therapeutic, although the grievance never went away. I researched theories and treatments for opioid use and the growing number of overdose deaths. We know a lot more than we did 10 or 20 years ago. We know that most people who use addictive drugs don’t become addicted. We know that current treatments are mostly failures. We also know that addiction is most often a consequence of self-medication. But we know much less about why drugs destroy some lives but not others. Until we analyze that “why” question we’ll stumble along with piecemeal interventions that work at cross purposes.
Weaving together the personal and the sociological, I learned about the broader set of factors involved in mental health and substance use disorders. Instead of focusing on individual-level choices and brain diseases, I look to the larger social context in which individual-level actions occur.
The two usual—and generally ineffective—solutions to the problem of addiction are 12-step programs (AA, NA) and criminalization (drug courts, locking up users). But people and their problems are more complex than those approaches recognize. 12-step programs work for some, but there are many more for whom they do not. Fortunately, 12-step approaches are no longer the only game in town. The smartest way forward is to explore multiple paths to recovery, almost nonexistent during Alex’s active addiction days. And, despite the growing recognition that the War on Drugs has failed, politicians chasing tough-on-crime headlines will never admit it. Relying on incarceration will lead only to more dead Americans, especially young Americans.
Health activists have fought for, and begun to popularize, strategies that prioritize health care over criminal justice approaches. It is called harm reduction. Although many Americans misunderstand it, its practices have been around for years. Seat belt laws, helmets, designated drivers, and anti-smoking efforts are examples, as was wearing masks during Covid. During the HIV/AIDS epidemic distributing syringes decreased deaths. Nowadays, fentanyl test strips, Good Samaritan Laws, and overdose prevention sites have proven to reduce overdose deaths. These strategies make the most sense if we think of people who suffer with addiction in the same light as those who struggle with diabetes or lung cancer.
How can we facilitate recovery? How can we prevent deaths? Incarceration doesn’t work. Tough love doesn’t work.
Here are proposed solutions:
- We need to meet substance users where they are, providing health care that sustains life until they’re ready to stop or reduce using. This would entail reforming ineffective treatment systems, introducing proven medications for substance use disorder.
- It would also require low barrier access to safe use supply. Narcan should be ubiquitous so that more overdoses can be reversed wherever they occur.
- And looking more broadly, we should also decriminalize and regulate drugs; ensure all Americans have insurance, lengthy enough to support recovery and in parity with that available for physical illnesses; and guarantee housing for anyone in need. One can’t succeed in recovery without a place to live.
We need to turn away from failure. We need to try a different way. We must recognize that substance users who fall into addiction are human beings. They are us.
I imagine a world steeped in compassionate, paradigm-shifting harm reduction. Alex might have survived if we had lived in that world. If only.
Understanding the larger, systemic picture is key to understanding how to fix the problem, and the constructive roles that and private partnerships can play in developing solutions. Then we can really hope again.
About the Author: Patricia A. Roos is the author of: Surviving Alex: A Mother’s Story of Love, Loss, and Addiction (patroos.com), published May 17, 2024 by Rutgers University Press.
