“Something startling is happening to middle-aged white Americans. Unlike every other age group, unlike every other racial and ethnic group, unlike their counterparts in other rich countries, death rates in this group have been rising, not falling,” a recent article began.
Two Princeton economists, Angus Deaton and Anne Case. Analyzing health and mortality data from the Centers for Disease Control and Prevention and from other sources, broke the news. They also concluded that rising annual death rates among this group are being driven by an epidemic of suicides and afflictions stemming from substance abuse, alcoholic liver disease and overdoses of heroin and prescription opioids,
The analysis by Deaton and Case may offer the most rigorous evidence to date of both the causes and implications of a development that has been puzzling demographers in recent years: the declining health and fortunes of poorly educated American whites. In middle age, they are dying at such a high rate that they are increasing the death rate for the entire age group.
This is just one of many developments reported on Christopher Caldwell’s report last spring titled “American Carnage. The new landscape of opium addiction.”
Caldwell’s report is available on line and is replete with interesting data including the following:
- In state after state, voters have chosen to liberalize drug laws regarding marijuana. It is true that we cannot arrest our way out of a drug problem. But we cannot medicate and counsel our way out of it, either, and that is what we have been trying to do for almost a decade.
- Calling addiction a “disease” fails to capture what is special and dangerous about the way drugs bind with people’s minds. Almost every known disease is something people wish to be rid of. Addiction is different. Addicts resist known cures—even to the point of death. If you do not reckon with why addicts go to such lengths to continue suffering, you are unlikely to figure out how to treat them.
- If you take too much heroin, your breathing slows until you die. Unfortunately, the drug sets an addictive trap that is sinister and subtle. It provides a euphoria—a feeling of contentment, simplification, and release. Users quickly develop a tolerance, requiring higher and higher amounts to get the same effect. The dosage required to attain the feeling the user originally experienced rises until it is higher than the dosage that will kill him.
- Today, more than a third of Americans are prescribed painkillers every year.
- The best way for a society to avoid the dangers of addictive and dangerous drugs is to severely restrict access to them. That is why, in the twentieth century, powerful opiates and opioids (an opioid is a synthetic drug that mimics opium) were largely taboo—confined to patients with serious cancers, and often to end-of-life care. But two decades ago, a combination of libertarian attitudes about drugs and a massive corporate marketing effort combined to instruct millions of vulnerable people about the blessed relief opioids could bring.
- Fentanyl is an opioid invented in 1959. In its usual form, Fentanyl is about fifty times as strong as street heroin. China manufactures a good deal of the fentanyl that comes to the U.S.
- Those in heroin’s grip often say: “There are only two kinds of people—the ones I get money from and the ones I give money to.”
- Addicts wake up “sick,” which is the word they use for the tremulous, damp, and terrifying experience of withdrawal. They need to “make money,” which is their expression for doing something illegal. Some neighborhood bodegas—the addicts know which ones—will pay 50 cents on the dollar for anything stolen from CVS. That is why razor blades, printer cartridges, and other expensive portable items are now kept under lock and key where you shop.
- The population of addicts is like the population of deer. It is highest in rustic places with access to urban supplies. Missouri’s heroin problem is worst in the rural counties near St. Louis. New Hampshire’s is worst in the small cities and towns an hour or so away from the drug markets of Massachusetts: Lawrence, Lowell, and Boston.
- The implicit accusation is that only now that whites are involved have racist authorities been roused to act. This is false in two ways. First, authorities have not been roused to act. Second, when they do, they will have epidemiological, and not just tribal, grounds for doing so.
- Bill Clinton alluded to the Case-Deaton study often during his wife’s presidential campaign. He would say that poor white people are “dying of a broken heart.” Heroin has become a symbol of both working-class depravity and ruling-class neglect—an explosive combination in today’s political climate.
- Paul LePage, Maine’s governor, speaking of drug dealers has said, “These guys come from Connecticut and New York. They come up here, they sell their heroin, they go back home. Half the time they impregnate a young white girl before they leave.
- The culture of addiction treatment that prevails today is marked by an extraordinary level of political correctness. Several of the addiction professionals interviewed for this article sent instructions on how to write about it in a caring way. These people are mostly generous, hard-working, and devoted. They are also political.
- A cliché among empathetic therapists, eager to describe addiction as a standard-issue disease, is that “no one ever decides to become an addict.” But that is not exactly true. Something like an addiction to addiction plays a role in all addiction. In an empty world, people have a need to need. Addiction supplies it.
- The founders of Alcoholics Anonymous thought there was something satanic about addiction. The mightiest sentence in the book of Alcoholics Anonymous is this: “Remember that we deal with alcohol—cunning, baffling, powerful!”
- That makes addiction a special problem. The addict is unlikely ever to take seriously the counsel of someone who has not heard the call of that netherworld. That is why Twelve Step programs and peer-to-peer counseling have been an indispensable element in dragging people out of addiction. They have authority. They are, to use the street expression, “legit.”
As we contemplate the minds of the sellers and consumers of drugs, we are inclined to say the money invested in a wall between the United States and Mexico would be better invested in local communities supporting 12 Step programs, mental health treatment and faith-based institutions.