Building Connections: Inflammation by Ilana Jael
New City Players is always down for trying new things that serve our mission of creating community through transformative theatre and our vision of helping South Florida become a more empathetic and thoughtful community. And, as we approach the early stages of preparing for our upcoming production of Water By The Spoonful, a play that explores the complex issue of addiction through its portrayal of a group of recovering addicts struggling to rebuild their lives, we’re excited to expand our horizons by utilizing The Build blog to explore this issue in even more depth.
We’re not a hundred percent sure what that will look like, but we plan to include interviews with experts on the topic, interviews with the cast and crew of the production (some of whom have their own personal connections to its charged subject matter), interviews with community members, and informative pieces about the nature of addiction and of recovery.
Oddly enough, I’m also strangely well-qualified to be your theatrical guide to this complex terrain, between my undergraduate degree in psychology, my mad-writer’s fascination with the darker aspects of human nature, and the fact that my actual full-time job these days is as a content writer for Reco Intensive, a local addiction treatment center, which means I’ve absorbed quite a lot of the discourse on the current state of addiction in America.
I’ve also been graciously granted permission to use some of my on-the-job time developing content that will be of interest both to the Reco community and to whoever else New City Players can reach to spread important, enlightening, and inspiring information about this charged and complex topic.
This means that some of what I’m working on will be viewable on their site as well, and that I’ll be referencing some of my past articles throughout as they become relevant to the topic at hand.
A slightly more official intro post is in the works, but in the lead up to that, I was inspired to write a pure-inspiration overview that also serves as a surprisingly appropriate companion piece to Fire Is Light, the short play of mine that received its world premiere at NCP’s inaugural Labfest.
Fire is Light, from NCPLab Festival 2022.
The piece explored one couple’s reaction to the murder of George Floyd and the charged protests and riots that ensued afterward. In reflecting on the issues that I addressed in the play, its central metaphor, and my personal involvement in the Black Lives Matter movement, I ended up on a bit of an odyssey as I attempted to articulate the complex relationship between the interlinked American epidemics of COVID-19, substance abuse, and systemic racism.
It’s a bit of a wild ride, long read, and bleak start, but I think it serves as a decent introduction to the scope of our country’s current addiction crisis, and I swear I plan on going in a more hopeful direction from here as I move from articulating the problem to exploring individual perspectives and potential solutions.
After all, the name I landed on for this series was “Building Connections,” and I believe that being aware of the connections between individual symptomatology and a larger landscape of ideological and cultural disarray can be an important way to build understanding, which in turn can serve as a pathway towards empathy—our ultimate goal. So, if all of these big words haven’t already scared you off… well, hope you enjoy!!
—
It’s hard to ignore a fire.
That, anyhow, is the principle that inspired one of my most frequently used “Ilanaisms,” which are themselves a collection of unusual turns of phrase that have somehow made their way into my lexicon.
Basically: because of my honestly pretty significant issues with attention deficit disorder, I seem only to be able to work up the mental energy to finish most tasks when it gets to the point that not doing the task creates the risk of an imminent negative consequence. The flaming task must be finished and “put out” immediately, or else the hypothetical fire could very well spread into a cascade of missed deadlines and endless guilt.
However, I, along with the rest of the world, was reminded quite viscerally of how attention-grabbing fire actually is in late May of 2020. When, after a Black man named George Floyd was brutally murdered by a White policeman, the news was overtaken by images of his city burning — when everyone in the country could see the smoke. Suddenly, something had broken the spell of our collective terror of the coronavirus as sister protests began to erupt across the country, as an entire nation rose up in righteous rage.
Acquiescing to my mother’s fear that matters might get violent, I attend only a small protest in John Prince Park on that first weekend after it happened rather than a larger event downtown, but I sure as hell wasn’t going to be staying home. I won’t try to deny that my eagerness to join in the outcry was perhaps in part a rebound effect from having spent the previous two and half months mostly in quarantine, but it was less an eagerness to have something besides cat pictures and angsty poems to put on my Instagram feed than an eagerness to make myself useful, damn it. It was just an instinct, to rise up to meet this uprising, instinct like it is to put any fire out.
Most of us have brought signs, someone has brought water, and someone else has brought speakers, which they use to play Martin Luther King’s famous “I Have A Dream” speech. I wondered how many times I had heard it, through the years, and how many times I had failed to grasp its gravity or take it as the call to action it was. I wondered how many times that I, preoccupied by my own mental health bullshit, had simply failed to process that other people who had done nothing to invite their oppression were still fighting for their basic human rights. I wondered if I had ever really heard it at all.
–
It’s telling that the word we use to describe the act of setting something on fire is the same word we use to describe the body’s response to cellular injury, which is one of the chief drivers of the coronavirus’s excruciating symptoms and devastating effects: inflammation.
But these days, there’s another type of burning that I often hear referenced in conversations about American response to the coronavirus: the phenomenon of our collective burnout. I’m as guilty as anyone else of a slow slide towards greater passivity as my will to keep panicking wanes, though I did at least try to limit my outings to mostly professionally justifiable ones during the worst of Omnicron’s latest surge.
During my research for a play that attempts to get to the heart of the pandemic’s tragedy, I developed a habit I still haven’t quite shaken of glancing now and then at firsthand COVID accounts reported on Reddit. And though Omicron does seem to be causing, yes, milder illness than the Delta or OG COVID variants, I’ve also become aware that there seems to be some public misunderstanding about what is referred to as “mild,” with what is referred to as mild in a clinical sense usually only meaning “less likely to result in hospitalization or death.”
While the severity of symptoms varies widely among individuals, and some will indeed experience only colloquially mild illness, Omicron is not a fundamentally different disease than COVID classic: it still has the potential to incapacitate, disable, and to kill, if at significantly lower rates than its predecessors.
Of course, as with previous variants, deaths and hospitalizations of the unvaccinated far outnumber those of vaccinated folk, though vaccinated members of vulnerable populations are still at significant risk from any variant of the virus, a fact that should never be discounted when discussing it.
In another one of my morbid curiosity Reddit haunts, r/nursing, excruciating dispatches from the front lines reveal the physical and emotional toll of providing labor-intensive care for patients that often only prolongs the inevitable. Of tending to countless ICU patients hooked up to machines, eating through tubes, breathing through tubes, with tubes placed to collect their excrement. The horror of patients who are intubated and pregnant, women on life support whose infants are desperately ripped from their wombs and who will likely die before ever meeting their babies. The terror of patients starving and gasping for air, or struggling to speak as they desperately attempt to utter last words to their loved ones before they are intubated.
One detailed account of the death of an unvaccinated man in his fifties struggles to capture the actual agony of his and his family’s experience:
“Every single breath was a fight for survival, a panicked drowning victim frantically swimming with futility, unable to reach the surface of the water. We could hear him grunting with effort for every breath . . . one son could only handle it for about 30 seconds before he hung up, overwhelmed with the stark cold reality of mortality staring him in the face. Seeing the patient, not only dying, but dying by prolonged suffocating, was horrific. We gave several large doses of morphine to provide what comfort we could, and slow the breathing down a little. We took off the pressure mask, and placed a high powered nasal cannula at its highest settings.
The family could really see his face now, and their voices changed to utter terrified agony. The sound of gasping grunting breathing was no longer muffled by the pressure mask. No words were going to come out of his mouth. Only the haunting sounds of a dying man.
Omicron’s danger, too, is exacerbated by the fact that it is so much more transmissible than its counterparts, which means that the sheer number of patients sickened led to an unfathomable burden for hospitals even if those patients were, on average, getting somewhat less sick.
In one recent article, a nurse likens her working conditions to those that she might expect to see during war-times.
“We are full to the brim. We have people in beds in rooms that we never thought we would make patient rooms,” an anonymous nurse reflects.
“We have units that are shut down from outbreaks . . . we have delayed surgeries because there’s no intensive care unit nurse to receive these patients. Sometimes there’s a bed, but there’s no nurse for that bed.”
Yet what unsettled me about this as opposed to previous surges is that, before, it at least seemed as if there was more of a sense of public alarm about all this: more cancellations, more media attention, more amping up of precautions. This time? A few plans shifted by responsible friends and a few theatre schedules altered in accordance, but no, say, large scale lockdowns or quarantines
Whether this is because of the powers that be downplaying Omicron’s danger for fear of collapsing the economy or because of our collective exasperation with the whole deal, it now seems that many of us have lost sight of the human lives that are actually at stake in our decision to keep a safe distance and to exercise proper precautions.
Another nurse on the forums mentioned wishing that all of us on the outside could see the suffering that was going on in the trenches of the ICU, and I agree that there seems to be a curious lack of respect for the gravity of the disease building in the public consciousness. In other words: that it’s like some of us have forgotten there’s a fire raging simply because we can’t ourselves smell the smoke.
—
If one American dies of a drug overdose, you might reasonably conclude that there was probably something wrong with them.
If 100,00 Americans die of drug overdoses, a death rate twice as high as it is in the closest comparable countries, the reasonable conclusion may instead be that there is something wrong with America.
Between my overly sheltered suburban dwellings and my borderline antisocial lifestyle, I don’t tend to come across many people with addiction. I do, however, as alluded to earlier, have a full time job writing about it, which has only deepened my honestly pre-existing obsession with the human drive to self-destruct.
But it wasn’t until I was assigned a piece about Dopesick, a recent Hulu series that explored the roots and impact of the opioid epidemic, that I truly began to develop an understanding of the scope and urgency of this crisis in particular. That, and the recently released 100,000 figure, which burst into headlines and burned itself into me with a searing sobriety that I can scarcely fathom.
In the end, I did far more background research than I was required to and came up with an article of over-double-minimum length, shocked by how closely the fictional portrayal echoed so many victims’ horrible truths. In brief: wealthy mega-corporation Purdue Pharma aggressively marketed stronger and stronger opioid painkillers to patients suffering from forms of pain for which such powerful pharmaceuticals were probably unnecessary.
However, these opioid drugs were so addictive that patients were compelled to keep taking them long after their initial injuries had healed. And, when their prescriptions ran out and they were sent into excruciating withdrawals, many of them turned to an even stronger illegal opiate that could satisfy their cravings: heroin.
I was quickly drawn in by the darkly compelling nature of the narrative that emerged, and all the more so because of its central irony: the exacerbation of so many people’s pain by a drug that was meant to ease their suffering.
Because opioids do—at least when you first take them—ameliorate pain pretty effectively. They do this, basically, by blocking the body’s pain signals from getting through to the brain where they can be felt. But, if taken in high enough quantities, other critical communication between the brain and the body starts to break down as well, causing all sorts of nasty physical side effects.
For instance, death by opioid overdose is usually death by respiratory depression; death that comes when our bodily functions have become so slowed that we lose the ability to make ourselves breathe.
—
On the second weekend of protests after George Floyd’s murder, I again join the fray, this time at a large march downtown. I am sure that some more in-the-know people than I had an idea where exactly we were going when we headed out, but my only plan was to follow.
So, I followed. I followed even as hordes of police surrounded our hundreds-strong crowd on all sides, followed even as we came head to head with their tank. I surrender to the steps, feeling something primal in the huge mass of us, wondering if this was the way it might have felt to trek together across continents in some caveman caravan.
I was carrying a sign that someone had left behind at the first park protest. On one side was written “End Police Brutality,” and on the other “Say Their Names,” and then a list of Black victims of police violence.
I remember making a point of always angling the “police brutality” side towards the cops, these newfound enemies of mine, and remember a father explaining the meaning of the other side to his young daughter. She wasn’t the only child in attendance.
“Why didn’t you take me to protests when I was a kid?” I ask my mother.
“We took you to museums,” she said, as if the two things were at all comparable, as if studying history was an activity on the same moral plane as making it.
We trek through upscale neighborhoods, we cross bridges, we traverse parks. We even shut down the damn highways, some people getting out of their cars stopped in the ensuing traffic to raise their fists in solidarity, or honking as we walked by.
By the time we were through, we had walked, on sheer adrenaline, for over eight miles in the punishing Florida heat. We’d stopped, too, every now and then, to kneel down in solemn remembrance, once for the full eight minutes and forty six seconds that it was originally reported that Chauvin’s knee remained on George Floyd’s neck. Later, it came out that the actual time, at nine minutes and twenty nine seconds, was even longer.
“That’s a long ass time,” I remember someone murmuring, and others echoed the sentiment.
It was, so long that I found myself having to switch knees just to bear it, my body wearying under its own weight. I wondered, briefly, how it would feel to suffocate, pinned in public to hot pavement, such a knee baring down against my neck.
–
Another of the most tragic aspects of the opioid epidemic is just how preventable many opioid overdose deaths are. Yes, the drug is an incredibly addictive one, so stopping people from using opioids tends to be a good deal harder: but there are measures that could stop opioid addiction from being as deadly as it is that do not hinge on complete abstinence.
Referred to as “harm reduction” techniques, such measures include providing addicts with materials that could make drug use safer: clean syringes to reduce the spread of HIV, strips to test drugs for the presence of potentially fatal contaminants, and overdose-reversing drugs like Narcan.
Opponents of these measures worry that they might “encourage” people to use drugs. Yet it seems rather intuitively obvious to me that anyone who would be discouraged from drug use because that drug use was “unsafe” probably wouldn’t be using hard drugs in the first place, and the statistics show that these practices do in fact save lives.
In fact, rather than encourage drug use, they seem to do the reverse, with users who were helped by syringe exchange programs becoming five times more likely to enter drug treatment than those who were not and three times more likely to get sober.
But that truth seems almost beside the point, especially when it comes to the issue of overdose, because would even the mere possibility of “encouraging” dangerous behavior be enough to write off the basic humanity of an entire, massive, group of people? Is anything? Should the fact that someone is struggling with an addiction really mean that they don’t deserve to live?
Because imagine. Just, for a second. Imagine that someone is overdosing in front of you, losing their life in front of you, choking and gasping for air. Imagine watching the life go out of them, their heart stop, face go blue.
Imagine, now, that they are one of your closest loved ones, and now imagine that, because of someone’s misguided prejudice, there is absolutely nothing you can do. Imagine the coldness of this calculus: denying a life preserver to someone drowning, denying water to a burning man.
—
On the third weekend post-Floyd, I am one of many who shows up for another planned peaceful march, this one a trek from Wellington’s Okeeheelee Park to the intersection of Forest Hill Blvd and 441, where we were set to gather for a rally with the family of Cory Jones, a Black man killed by the police in Palm Beach Gardens in 2015.
But things quickly take a turn towards the crazy as I hear over a megaphone a cop designating our gathering as an unlawful assembly and threatening to arrest us and to use nonlethal weapons on us if we did not turn back.
At this point, many did turn back, fled, heeding the warning. But plenty pressed forward, and I once more, followed, which some might ascribe to a sense of duty but I wonder if more accurately could be put down to a complete disregard for my own well-being and a lack of basic common sense.
When we reach the police barricade that stops us from pressing on any further, somebody calls the allies to the front, so I soon found myself only a few feet from a long line of heavily armed policemen and women in full riot gear.
Though we had been entirely peaceful, we had, apparently strayed too far off the sidewalk and into the roadway, creating an unacceptable impediment to traffic. To which the powers that be responded by blocking off the entire roadway for what was to end up being a full ten hours, speaking of a lack of common sense.
Stopped from continuing our trek but unwilling to surrender to the interruption and go home, we find that there is nothing to do but wait, to wait at first in terror. They are adamant, though, about letting us go forward. And so it was decided: we would just stay put until they did.
The chanting continues, of slogans like “why are you in riot gear? We don’t see a riot here,” and a new one to suit the occasion:
“Are we tired? No!”
I was tired, having only slept around four hours the night before (typical crazy writer stuff), but I joined in the chant anyhow; I was going to stay this thing through. But as it became clear that the officers did not intend to follow through on their threats, the tension of our close call gradually lifts, and our mood becomes lighter, even jovial.
Music is played, from the electric slide to hopeful anthems like We Are The World and One Day to the cheeky theme song from Cops. A few people speak, one young woman of color about her cousin who had been a victim of a police shooting, and another about being forced by a shopping mall security guard to lift up her shirt in public because he wrongly suspected her of stealing.
“How old were you?” someone asks.
“I was 13,” she yells back.
There are many failed negotiations, failed attempts to come to any sort of understanding. At one point, too, we try asking the cops to kneel with us, but they would not. Then, someone says, “If you’re not a racist, put your hands up. “
Despite the fact that there were a few cops of color in the line-up, nobody moved, forbidden as they were to show even this much humanity from their place as arbiters of the corrupt institution they stood for.
It’s around 2 or 3 in the morning, when our group has become far smaller, that the cops finally agree to let the Wellington residents proceed in groups of five as the rest of us headed back to our cars.
At a later commissioner meeting, a speaker compared the incident to what had happened in Lafayette Park with Trump’s toxic photo op. While this night hadn’t been quite so awful as all that, as no force was ultimately used against us and the only person who got in legal trouble was a passing motorist who’d honked to show their support (which, seriously), I suppose that it had been quite awful enough.
But was I tired? Not really. By three the next afternoon, I was right back out on a corner only a few blocks from where the incident had taken place, and would venture back out time and time again.
—
Though opiates are the most immediately dangerous drug currently on the lamb, with over 60 percent of fatal overdoses tied to the super-potent synthetic opioid fentanyl, they are not, by any stretch of the imagination, the only thing that America is addicted to.
Both benzodiazepine addiction and methamphetamine addiction have been described as worrisome counterparts to the opioid epidemic that are often wrongly overshadowed by it, and, heck, let’s not forget that the 21 percent increase in excessive alcohol use observed during the pandemic is expected to eventually lead to 8,000 additional deaths!
In fact, many opioid overdoses could be more accurately described as polydrug overdoses, with benzodiazepines also found in the systems of 30 percent of those who perish. The effects of these drugs are not only cumulative but synergistic, and alcohol, another depressant, is frequently involved in these fatalities as well.
The fact that the brutal and deceptive marketing tactics aggressively deployed by the Sackler family had a hand in creating the opioid crisis is relatively well-known at this point. But a similar story of aggressive marketing and unnecessary overprescribing is beginning to emerge as a factor in benzodiazepine misuse as well, and don’t even get me started on the way that advertising for legal drugs like alcohol and tobacco have affected their hold on our collective psyche.
As one article about the theory scholar David T. Courtwright sets forth in his book The Age of Addiction: How Bad Habits Became Big Business describes it:
Capitalism is great at making people want things they don’t need.
And of course this is what we should expect from a system that runs on production and consumption. Companies make and sell products and those products have to be consumed by as many people as possible — that’s what makes the whole thing work.
So it’s not surprising that businesses do everything they can to convince people to buy whatever they’re selling. But what happens when marketing becomes active manipulation? More precisely, what happens when companies use science and technology not only to refine our pleasures but to engineer addictive behaviors?
Courtwright describes the phenomenon as “limbic capitalism,” because of the way in which these instilled desires take over the emotional areas of the brain, a phenomenon that he relates to attention-hijacking iPhone apps and hyper-processed junk food as well as to actual addictive drugs.
Which brings us, in a sense, to yet another epidemic that is plaguing our American plains: the obesity epidemic. Foods designed to encourage maximum consumption rather than to nourish our bodies have been shown to act on our brain’s reward system similarly to the way that addictive drugs do, driving a similar cycle of craving, compulsion, and even withdrawal.
Overeating, over time, naturally leads to obesity, a condition that drives systemic inflammatory processes. Tragically enough, these processes not only increase the risk of various chronic diseases and of fatal complications from the coronavirus, but they actually negatively impact the metabolism in a way that makes weight gain easier and weight loss harder, creating a nigh inescapable vicious cycle.
To explain this part a little more: bodily inflammation, is, basically, a distress signal. Think of how the quickest way to cause a public uproar is to yell “fire;” or how, if abandoned on an island, you’d be wont to send up a flare.
In acute inflammation, as messenger proteins called cytokines are sent to alert the body that it needs to repair the area, it starts to become painful and swollen, red and hot. This pain also serves as a warning to us, a cry for us to seek help, perhaps, or an edict to cause no further damage until we can be made once again whole.
Though inflammation can be damaging or even fatal if the reaction gets out of hand, in a healthy person, it is also necessary, and a sign that the healing process is underway. But acute inflammation has a chronic counterpart, and it’s one that you may not even feel happening. To quote this medical definition:
Inflammation is a “Goldilocks” condition – too little and our bodies can be overwhelmed by infection or fail to heal; too much and it can cause crippling health problems of its own . . . With chronic inflammation, the process does not stop and, instead of attacking a foreign invader and protecting us from disease, the inflammation now attacks the body itself….
Chronic inflammation, by contrast, comes on slowly and can last for months or even years. It is persistent inflammation that tries to rectify a problem, such as an autoimmune disease or ongoing exposure to environmental or lifestyle irritants such as pollution or smoking. Acute inflammation, if not resolved, can turn into chronic inflammation.
The mechanics of the response can be similar as for an emergency, but as the injury or infection cannot be resolved, the distress signals continue. The consequences of this persistent inflammation are one or more of a raft of health conditions. Inflammation becomes the problem and not the solution.
—
When things next get real on the protest scene, it’s at one of the handful of events I attended to protest the wrongful death of Jade Kothe, a young Black woman who had died of a heroin overdose in part because of the negligence of the police officers who had been called to come to her aid.
We had walked to the Palm Beach County Sheriff’s Office, there to demand as loudly as we could that the cops release body cam footage of the incident. In what seemed like the blink of an eye, they’re out of the gates and snatching four of my fellow protestors, two of them people of color, in what seemed like a deliberate effort to grab them rather than some of those who were rowdier and whiter. There’s running, panic, then, a frenzied ride to the jailhouse where our comrades will now be headed to wait for their release as others make the appropriate phone calls to inquire about their whereabouts.
On the way, we stop at a gas station, where I impulsively buy a pack of cigarettes. A sporadic social smoker, I’d only really been bumming them here and there while out at the protests, which, during the height of COVID-times, were some of the only times I was leaving the house.
But it was a long night ahead of us, and I correctly figured that people would be wanting them. I give away more of the pack than I inhale, not only to the other protestors but to other people who were being released from the jail in the meantime. Others help these lost souls to make phone calls or arrange rides, something that some of my fellow protesters actually may have been there doing anyway as part of a mutual aid group.
The only new releases I remember are those who had been there for drug-related offenses; I saw nobody who scared me, or who seemed as if they had deserved to be locked up. One man, upon seeing us, was so moved that anyone was there for him that he actually burst into tears.
Illana Jael
We were friendly to these visitors, sharing small talk, snacks, and smoke. I remember striking up a conversation with one boy around my age, who asked me whether I used drugs myself.
“I used to do cocaine,” I admit, truthfully.
At that point, it had probably been at least a year since my last hit, the last time I’d seen a few college friends who’d been the only people I’d ever used with. But that didn’t seem to matter then. What struck me was even this hint of symmetry between us, the fact that I had committed a crime, for which, had I not been privileged in ways too plentiful to fathom, I could’ve gotten locked away.
The destructive impact of harsh drug criminalization is another question that haunts discourse about American addiction. Many have argued that the practice harms desperate people who are in need of help rather than punishment, adding to the stigma that surrounds their disease and making it far more difficult for them to reintegrate into society and to rebuild their lives.
“If you wanted to design a system that would make addiction worse, you would design that system,” scholar Dr. Gabor Mate describes.
When the protestors from our group finally are released, at some insane hour of the morning, they speak of the degradation they felt, the horrendous dehumanizing circumstances inside, efforts to break their spirits by separating them. One of them had even had her mask taken away and was left unprotected because the slogan on it was anti-police.
It’s an even smaller group who returns the next week for another protest after the collective trauma of the arrests. But again, I refuse to stay away, and some new comrades had made their way up from Fort Lauderdale for the occasion as well.
One of them came carrying an Antifa flag, which I end up holding one side of for a few blocks. Am I an enemy of the state yet? I wonder, watching the much-maligned symbol of rebellion waving in the wind. Am I some kind of anarcho-communist now?
I wasn’t sure, and I’m still not sure exactly where I fall when it comes to any sort of formal ideological classification, but I do have the definite sense that the overwhelming ethos of capitalism is inherently linked to whatever disease is driving our country towards decay.
Or, as I attempted to express the idea in my recent Dopesick piece:
“Because, yes, it all sort of comes down to the system, doesn’t it? The system that allows, in the words of one Dopesick character, people like the Sacklers to “buy their way out of trouble” while “Black kids selling weed go to jail for decades.” Our nightmarish landscape of toxic capitalism normalizes large-scale selfishness and corporate domination at the expense of basic human compassion, leaving too many people without safety nets and thus with no escape from their circumstances besides the one that pharmaceuticals can provide.
Perhaps America has a painkiller problem because America has a pain problem, and that because our individualistic, dog-eat-dog culture uniquely fosters alienation. The pressure of toxic positivity and every man for himself pushes us to suppress all evidence of our pain, rather than to come to terms with it or to help each other to heal. Wounds then fester until we are forced to numb ourselves into oblivion, falling prey to the seeming quick-fix of a drug that eventually transforms us into black holes of want.”
Or, as Sam Quinones puts in his book Dreamland:
“And—this is my bigger point—what we are seeing is the end result of 35 years of exalting the free market, exalting the private sector, exalting the consumer and the individual, despising government, despising the public sector, despising the community assets that the public sector can and should provide. The end result of that is heroin—a drug that turns people into narcissistic, self-absorbed, intensely individualistic hyper-consumers. That is the point.”
Along with its insane rates of overdose deaths, the US is also the worst among its comparable countries in terms of COVID deaths, and many of these same factors seem to be at fault: widespread economic insecurity and no financial safety nets to fall back on, lack of compassion for one another as expressed in our willingness to spread disease and to forgo vaccination, our relentless intolerance of discomfort as opposed to quick fixes, and our need to believe that everything’s A-OK.
Writer Ibram X. Kendi has spoken of the “conjoined twins” of capitalism and racism, and I am starting to conceptualize some sort of three headed monster with addiction added to the fray. A beast that, in criminalizing and moralizing addiction, punishes us for the very desires that it instills in us, making us hungry and then striking those who dare to eat.
To think on how all three might align in fatal synergy: Americans of color have always borne the brunt of the government’s War On Drugs. In a phenomenon described in depth by Michelle Alexander in her book The New Jim Crow, Black men were disproportionately targeted by law enforcement for minor offenses like drug crimes, and received disproportionately harsh sentences in turn.
This, and the punishing restrictions and social stigma heaped on felons after their release, effectively created a permanent “underclass” of Black men, much as Jim Crow laws did in eras past. In another vicious cycle, a criminal history makes it harder to find a legitimate way to make a living, and so criminal action frequently becomes inescapable as an only way to make ends meet.
The impact that this has on Black identity is devastating, turning the community against itself and rippling down through generations through its effect on families. What does it do to one’s psyche, after all, if following in your father’s footsteps were to mean becoming imprisoned in his chains?
–
For about as long as the Black Lives Matter movement was manifesting in frequent physical protests, I kept joining in. I’ve been honestly pretty bad at engaging in other forms of activism, which I blame at least in part on my attention deficit delirium, in always feeling as if I’m a step behind on everything, of not having the mental fortitude to even begin to figure out what to do or where to start or how to be. This sounds like an excuse, and it probably is an excuse, but I will offer it up anyway because that is all I have: an excuse.
I could, though, make myself show up to the protests, which, by virtue of happening at a specific time and requiring only physical presence and in the moment enthusiasm, suited my inability to plan anything just fine. If, I figured, I had the wherewithal to do nothing else, I could at least put my body behind the movement, step in time with the rhythm of revolt.
And, for a time, during the height of the pre-vaccine pandemic, an age that seemed as if it had lost all order and all consistency, protesting even became something of an odd emotional touchstone. Eventually, I lose count of how many events I attend, how many miles I march. I march on Juneteenth and on the fourth of July, in sweltering heat and in the rain in spite of flood advisories. I march in honor of Vanessa Guillen, a soldier slaughtered by one of her comrades and whose murderer was inadequately prosecuted, and ride as passenger in a caravan in her honor.
I march the weekend after Breonna Taylor’s killers are not indicted for murder, stand strong with sign opposite a gaggle of Trump supporters after the shooting of Jacob Blake. At too many vigils, I sit, somber and silent, mourning the loss of people I never knew.
Mourning, then, maybe justice itself.
And no, for the record; I never did engage in anything more violent or disruptive than shouting when I was told to stay silent or standing where I was not told to stand. I never, for instance, threw a brick at a window, or set anything on fire.
But I’m not sure what would’ve happened if somebody had handed me a match.
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Mostly, I just smoke other people’s cigarettes.
Besides my surreal night at the jailhouse, it had been at least a good two years since I’d bought my own pack of the devils, having only swiped one a few months back from my uncle’s stash to take to a party for similar social reasons.
I’d had a pack-keeping phase in undergrad where I smoked pretty regularly because I’d fallen in with a crowd who had, and smoked even more sporadically now and again on nights out while in my MFA program, but never had any problem putting the things back down again when I left those particular social groups.
Thus, predictably, it’s again the fact that I’d started spending more time with a friend who lights up more or less once an hour that I’d felt sure enough I’d want a cigarette at some point during our next hang out and guilty enough about potentially asking to bum one too many that I’d gone ahead and decided I needed a supply.
Perhaps, then, the habit actually is contagious; not in the way that COVID is, leapfrogging from lung to lung at lightning pace, but more in the way of some slow-growing cancer, the one that you might not notice until the mass, already metastasized, has too much momentum to be stopped.
Cigarettes, by the by, cause even more deaths than opioids, at 480,000 per year, which is more, actually, than HIV, substance abuse, motor vehicle injuries, and gun deaths combined— if you don’t believe me, here’s the CDC.
“Are you going to set something on fire?” I remember once asking the friend in question, eager for the excuse to follow suit and answered by a “yes” and an amused laugh.
I know this, the extent to which it is poison, the extent to which they are addictive, the fire I am playing with with every lighter’s flick. Yet I smoke, still, if, at least for now, only every now and then. I smoke, maybe, in part, because some part of me still thinks it’s kind of cool to smoke, which may be because there have, over the years, been untold millions of dollars of marketing money put into making me think that it’s cool to smoke.
Or it could be, because, now, I’ve started to associate my periods of smoking with the times that I’ve had cool friends and those ever-fleeting periods of un-loneliness, or maybe some part of me still thinks it’s kind of cool to self-destruct, or kind of wants to self-destruct, maybe a little curious to see if anyone cares.
But all that probably comes second to the fact that I just like cigarettes, the smoke, the stimulation, the oral fixation briefly satisfied by something mercifully calorie-free. I am that base, sometimes, that enslaved to my sensations, that lacking in something like simple sense.
Whatever the source of my desire, it is now one that I feel I must castigate myself for rather than any powers that be. By some stroke of sanity, though, I’ve still not touched the pack outside of those strange shared theatre-side moments, like I never bought any cocaine to do alone.
The cocaine that the prescription stimulant medication that I’m on these days sort of does the same thing as, in a less intense and more controlled fashion, to the extent that the way I feel if I take a dose higher than I’m accustomed to can remind me so viscerally of the way I felt when I was like, high-high, that something about it almost smells the same.
Prescription stimulants, by the by, still come with the risk of causing or exacerbating all kinds of physical problems if taken for a long enough period of time and in large enough quantities, but so what if I’m prone to fucking with my dosages whenever I have too many assignments that are on fire, because it isn’t like I really wanted to live that long anyway, right?
Right?
So, even if I can say, offhand: “I don’t know many people with addiction” and have it feel relatively true, when I look at it all a little more closely… umm, let’s see. There are the obvious cases, like the ex that I’m still close friends with who spent our days together guzzling gin at all hours and never quite managed to kick the habit, or even like the aforementioned friend and their dependence on cigarettes.
But what about all the other friends I have who need a mind-altering medication just to function, or who have struggled with over-eating, or under-eating, or every dysfunctional in-between? What about the uncle whose youthful hard partying days are one of the reasons for his present poor health but who still ends his each and every day with an average of three vodka martinis, what about my daily-benzo-before-bed mother?
And yeah, sure. What about me? No, I don’t suppose there’s ever been any one substance that I felt as if I were truly physically dependent on. But while I don’t generally experience any “withdrawal” symptoms worse than exhaustion when I skip a day of my stimulants, I do need to take them the majority of the time if I want to maintain compliance with capitalist standards of productivity, the irony of which is honestly a little unfathomable given my specific line of work.
Then there’s the fact that while I’m quite capable of forgoing alcohol on any singular occasion and have never—quite—been in the habit of drinking daily, I’ll pretty dependably be one of the first ones in line at the bar at any social event where ordering an adult beverage seems acceptable and probably one of the last to close my tab.
Though, then again, I’m far from the only person I know who probably wouldn’t say that they had a drinking problem but would balk at the idea of giving up alcohol for good. Though, then again, who among us can’t get through life without something to dull the pain of it, at least every now and then?
And while both addiction and racism at their worst tend to be unignorable in their intensity, they can also be so insidious for reasons that are almost opposite, because they hit less like an atom bomb then like a barely symptomatic infection, a low-grade fever that doesn’t seem worth missing work.
If an innocent man is murdered in broad daylight by an officer sworn to protect him and the whole thing’s all caught on camera, then, yes, it’s clearly time to start a riot. If you can’t make it through the day unless you’re shooting up heroin, then, yes, you should probably find a rehab with a bed.
But what about the still-very-existent slow smolder of everyday racism, that, just to focus on the issue of violent over-policing, is spelled out here in a simple graph and some plain statistics? And what if you’re still totally fine…. except for the Xanax you need to keep on sleeping, the cigarettes you’d get sick if you stopped smoking, or the wine that you can’t stop drinking until you’ve gone a glass too far? If you’re at-least-kind-of-addicted to a drug that isn’t ruining your life… then do you just let it keep killing you, a little at a time?
We like to think of addiction as an all or nothing idea, and of “addicts” as a discrete social category; but the boundaries are not nearly that simple. Even clinically, substance use disorder can be classified as mild, moderate, or severe, with some experts conceptualizing addiction as more of a spectrum than a “disease.”
While the majority of us will never experience the nigh-inescapable inferno of a full-blown substance use disorder, won’t burn bridges or lose jobs for an addiction’s sake, I think that most of us can at least be said to have continued using some drug or engaging in some behavior even “despite negative consequences,” whether that means a few extra pounds from an unshakable sweet tooth or surrendering to a daily nightcap or hourly cigarette.
So all I’m asking. I guess. Is for you to give anyone in your life who may need it a little grace. Is for you to, once more, take a second and imagine with me. To imagine what it would be like in that inferno. And to maybe try to understand why someone’s priorities might fall more in line with just taking in whatever air surrounds them than with goals as lofty as “recovery” or “rational choice.” That there might be some smoke that you just have to keep inhaling, if there’s no way you can see to stop the flames.
After all, inflammation, at its root, is only a symptom, a signal, not a disease in and of itself. Inflammation is the body’s way of saying “something is broken”—and in some sense, perhaps addiction is the soul’s. As the writer Jiddu Krishnamurti once said: “it is no measure of health to be well adjusted to a profoundly sick society.” And I think that this one’s as infected as it gets.
The Forum: Addiction & Recovery Pt. 1
March 28, 7pm, Cyth & Co.
A free community conversation around addiction, recovery, harm reduction, sobriety, the opioid crisis, and what we can do about it.
Our Water by the Spoonful blog series is sponsored in part by Reco Intensive. To learn more about Reco Intensive, a Delray Beach addiction treatment center whose holistic and compassionate approach aligns with NCP’s vision of helping South Florida to become a more empathetic and thoughtful community, you can check out this post where it’s cross-posted on their blog here.