A Glimpse of America's Other Pandemic
The scandal of our failure to take addiction seriously
I just had my hair cut. The woman who previously cut my hair had left the shop, perhaps connected to the fact that her son was wrestling with addictions and she had to care for her granddaughter. The new person, as she trimmed my locks, told me that her first husband had died of an overdose, and her second had died of alcoholism.
That’s a bit of a glimpse into the toll of the pandemic in working class America: two women in Yamhill County, Oregon, entangled only by my hair, whose lives were both shattered by substance use disorder.
This is the pandemic we don’t focus on enough – the pandemic of “deaths of despair” from drugs, alcohol and suicide. This is the pandemic that predated the coronavirus and that will persist long after we’ve adjusted to Covid-19.
The numbers are staggering, and they’re going up. Some 107,000 Americans a year are now dying annually from drug overdoses and poisonings, and the C.D.C. just put out new figures estimating that alcohol in America was claiming 140,000 lives a year even before the coronavirus pandemic – and the numbers are almost certainly higher now. Meanwhile, some 46,000 Americans commit suicide each year. Collectively, that’s almost 300,000 lives a year. We’re losing Americans to deaths of despair at a more rapid pace than we lost Americans to conflict during either the Civil War or World War II.
This is a national failure. Government has failed. The health care system has failed. The media has failed to adequately cover the issue.
I’ve been writing most of my Substacks lately about Ukraine, and it’s the kind of story I care about deeply. If I were still at The New York Times, I’d be in Ukraine now. Perhaps close to 10,000 civilians have died there, and there are risks of nuclear escalation. So it deserves the attention it’s getting, and bravo to President Biden for urgently providing tens of billions of dollars in military assistance to Ukraine – but note that in the same period, 40,000 Americans have died from addiction and suicide here in the United States, receiving much less attention.
We tend to measure addiction with the metric of overdose deaths, but that’s inadequate (just as combat deaths don’t measure the toll of war). The two women who cut my hair didn’t die from addiction and weren’t themselves even drug users, yet their lives have still been shattered by substance use disorder.
When I was running for governor and giving my stump speech, I often mentioned a line from my last book with Sheryl WuDunn, “Tightrope,” that more than a quarter of the kids on my old No. 6 school bus have died from drugs, alcohol and suicide. Afterward, people would come by and chat – and so often, someone would come over and, in a whisper, recount how a brother or cousin or child was addicted and homeless. I’ll never forget the pain in their eyes.
Across America, so many households quietly suffer and worry because of loved ones dealing with substance abuse (in this respect, it’s a bit like domestic violence, which also is hard to talk about and as a result also doesn’t get adequately covered or addressed). We have to work harder to tackle substance abuse.
Is this difficult? Of course. Is it impossible? No.
We have lots of models that work, albeit imperfectly. Baltimore handed out Narcan to prevent overdose deaths, and that saved lives. Canada pioneered safe injection sites, and that did the same. I’ve written in “Tightrope” about Women in Recovery, a terrific program in Tulsa that has a 90-plus percent success rate with moms struggling with addiction (while saving Oklahoma $84 million). Here in Oregon, programs like Lines for Life, Provoking Hope and Relief Nurseries make a real difference in addressing addiction and cycles of despair. Helping people get through high school and into job training and good careers helps as well, by ensuring that people feel less need to self-medicate.
It should be a scandal that only 20 percent of those who need addiction treatment get it, even though treatment pays for itself many times over. Here in Oregon, the number of treatment beds has been declining even as demand has increased. Portugal has reduced the number of heroin users in that country by two-thirds, largely by making treatment very simple and easy; we must do the same.
Oregon Recovers, an advocacy organization, notes that my state of Oregon has a website that helps consumers find the nearest liquor store. Yet if someone wants lifesaving treatment for alcoholism or addiction, they have to jump through hoops and still may not get it. What does that say about our priorities?
One problem is that meth these days has no medication assisted treatment the way opioids do, even as today’s meth appears to be particularly dangerous, addictive and damaging; I’m afraid that in the war on meth, it’s meth that is winning. But researchers have leads. Some think that psilocybin (magic mushrooms) can help. Work with virtual reality is promising. But the entire field of treatment is getting appallingly few resources.
Right after getting my hair cut from the woman who has lost two husbands to substance use disorder, I caught up on a friend who is pregnant but has been using heroin, fentanyl and meth during her pregnancy. I think about that unborn baby and the struggles it will face because of our collective complacency.
There’s a lot of talk about addiction as a failure of personal responsibility. Fair enough. But if we have that conversation, we also have to talk about our collective failure of responsibility that allows so many people to suffer and die, while undermining the future of our entire country. It won’t be easy, but we can do better.
As you know, a significant part of the battle is just getting people to acknowledge that addiction isn't a choice and the people who have addiction problems don't deserve the hardships that addiction has caused. We could fix a lot of problems if only there were some way to dial up our collective empathy meter.
Substance abuse disorders are a subset of mental health disorders. We don't treat schizophrenics any better than we do addicts. It's all scandalous. But unless there's money to be made, investors aren't interested and the indigent mentally ill have no money. Unless government taxes the rich, neither do we.