Recently Donald Trump announced a national emergency for the opioid crisis. Regardless of why he did it or what actual effect in terms of policy this pronouncement will have, what it has done, for the good, is raise awareness that this is indeed a serious problem in the U.S.
The New York Times has an interesting webpage that allows you to test your predictions about rates of death from various unpleasant and untimely ways of dying, like AIDS, gun deaths, drug overdoses, and car accidents. There are a number of interesting takeaways from these charts. Of course, the rise in drug overdoses from 1990 to today is the most startling and frightening: an increase of 500 %, more than car accidents and gun deaths combined. Another interesting tidbit is that 60% of gun deaths are suicides but we will deal with that another day. Today I want to focus on drugs, which have long interested me for a variety of reasons.
The Sociology of Drug Use
The first reason that drugs are of interest to the sociologist, especially one with my particular interests, is that they represent an attempt by the user to change or escape from the “reality” of the drug user’s everyday life. As all of us sociologists know, “reality” is constructed within the minds of members of a shared society and culture, with many variations of perception, but is ultimately anchored in established institutions and shared social processes that give it a substance that far outweighs the power of any individual variation on this reality.
What is it about certain people (and not others) that makes them want to create an alternative, temporary reality for themselves or, alternatively, to escape from their reality?
As a sociologist, I am much more interested in any consistency we can see across groups that use drugs, rather in any individual particularity of a single drug user.
The second reason I am interested in drugs is because of their peculiar status in our society as an instrument of “crime.” The “vice” squad goes after drug-users and dealers. Have you ever thought about that terminology? Quite religious. Definitions of “vice” range from the mild “imperfection” to the scary “depravity.” Generally, vices are things you are not supposed to do. However, while over-eating, smoking, gambling, and procrastinating by watching Netflix are all things that could be considered a vice, you won’t be charged with a crime for doing so. However, drug and alcohol use and prostitution could land you in jail. Go figure.
Leaving aside the interesting topic of how and why prostitution is prosecuted under the law, let’s talk about drugs. And we will have to get even more specific than that, as different drugs are used for different reasons and with different effects. Today I want to talk about opioids… another day we can talk about the equally fascinating topics of stimulants like cocaine or everyday, accepted drugs like marijuana and alcohol.
Opioid Abuse and Overdose
I am particularly fascinated by heroin and painkiller use, and, while I have sown my share of wild oats in my time, I am hard pressed to imagine why on earth anyone could use these things recreationally, knowing all the risks and costs that I think most people do know when they try them.
However, perhaps here the classical sociological thinkers can be of use here. Let’s run through their ideas and see if they can shed any light on the American opioid epidemic.
Firstly, who is dying from these drugs? Apparently every group except the college educated. From 2010-2015, death rates by overdose only rose 4% for the college-educated as compared to 23% for those without a high school diploma. While whites in poverty, and increasingly women, who are prescribed prescription drugs in larger quantities, have seen the steepest increases in overdoses, overall, interestingly, income level does not make much difference in rising rates of heroin and opioid overdoses. Recently we have seen a drop-off in prescription painkiller deaths, while heroin deaths have continued to rise, perhaps indicating that awareness of the problem is having an effect on the over-prescribing of painkillers. So as we can see, a large part of the problem is the availability of the drugs. Unfortunately, stemming the flow of drugs like heroin and fentanyl is a much more complicated project, and ultimately, one for law enforcement.
I am interested in the underlying sociological reasons that so many people have recently felt the need to escape from their reality. So, let’s focus on the broad patterns here, and see if our classical sociologists, from their view from far in the past, can help us understand what is going on.
Opioid drugs work the same as endorphins, the natural chemicals our brain releases when our body experiences stress or pain (and also during orgasm) which reduces feelings of pain and makes us feel pleasure and even euphoria. Research has shown that people who have experienced trauma, especially in their childhood, are especially susceptible to dependents on opioids. However, what is it about the past 10 years that we have seen such a widespread increase? Has there been some kind of collective trauma that is leading more and more people in the United States to this sort of relief?
Well, looking a little more closely at the data, we see that it is white people in the United States that overwhelmingly are falling victim to this opioid epidemic. While part of the reason for that is that doctors are much more likely to prescribe painkillers to white people, especially women, and not for the best reasons, I think there is something else going on among this demographic that is leading to such a surge in addiction and overdoses. Let’s think about what other phenomenon has been happening with this particular demographic. Right, you guessed it, Trumpism and the rise of the Alt-right.
Classical Sociological Theory
I think both Karl Marx and Max Weber can be useful to us here. Marx believed that under capitalism, the worker, or proletariat, suffered from false consciousness, which he defined as believing something that is not in your own interest, or believing an ideology. Ideology is another Marxist concept, is a set of ideas that presents itself as an innocent, disinterested idea, but really serves to mask and maintain the interests of particular group to the disadvantage of another. An example of ideology that I like students to consider is the belief that the United States is a meritocracy, that is, that it is merit (brains and hard work) which propels some to be wealthy and successful and condemns others to a life of struggle and poverty. While people of color in the U.S. have long known this idea to be in fact an ideology, this unfortunately reality is just now hitting home for white Americans. G. William Domhoff’s excellent website shows us that the single most important factor in becoming rich in the United States is not, in fact, brains or hard work, but that your parents were rich, and that social mobility in the U.S. is actually lower than many other what me might consider more socialist nations, like Sweden, etc.
Since the 2008 crash, incomes have risen for the top 20% and even more for the top 1% but have remained stagnant or have decreased for the majority of Americans. Added to that is the increased job insecurity, and rising health, education, and housing costs. On top of this, until very recently, the minimum wage salary in most states has remained close to what it was in the mid-nineties, so that, even with a full-time job, a minimum wage worker would not make enough to rent a two bedroom home in any of the 50 states.
So, here we have an ideology that doesn’t match up with the facts, and who does the belief in this ideology ultimately benefit? Marx would point to our nation’s 1% and perhaps also to the top 20%. Not only do they not have to worry about large-scale political organization or rebellion of the lower classes if the lower classes believe it is their own fault that they are poor, but, and here comes Weber, the upperclasses can sleep easy with a clear conscience, believing that they deserve an easier and more satisfying life than 80% of the rest of the nation. For them, it is not that the economy is stacked in their favor, but rather, that they are smarter and work harder than the millions of home health aides, hospital orderlies, truck drivers, and waitresses that make up the rest of the country. Weber understood societies to be stratified by status groups based on consumption patterns, rather than the classes united by their common place in the production process, as Marx believed. For Weber, status groups distinguish themselves not necessarily by occupation or the ownership of the means of production, but rather, by an idea of a proper life-style, and their understanding of the respect they deserve from others in the society. This includes, importantly, a feeling of superiority towards those not belonging to the group and keeping a social distance from them.
Well, this feeling of superiority has been sorely tested for the white American lower-middle class; not only can they not feel superior to non-whites in the US, but American power and influence abroad has significantly diminished mainly due to a sluggish economic performance compared to nations such as China and Germany which have experienced strong, steady growth in recent decades. However, I believe it is the internal conflicts, mainly racial, that have attracted the emotional energy produced by the new, unstable economic order. This has happened for a couple of reasons, two of the most prominent being Barack Obama’s presidency and what is perceived as a “liberal” bias in the media and in universities. The historically marginalized populations of African-Americans, women, gay and trangender have made well-publicized gains in recent years, and I believe it is this contrast to the state that many whites find themselves in, particularly the non-college educated, that has sparked both the energetic rise of the Alt-right, as well as the epidemic of despair evidenced by the opioid epidemic.
In particular, the status group of white men have largely been left out, or indeed, pointed to as the enemy, of the social progress that these marginalized groups have enjoyed in recent years. The belief in the fairness of the American system, regarded with a healthy dose of skepticism by non-whites for many years, has plummeted among this group, along with a clear sense of a role in the family and the workforce, and an optimistic vision of the future. This loss of identity and hope among a large swath of the population, due, I believe to economic forces, primarily the corporate stranglehold on the political system, has manifested itself in alternatively outbursts of anger against scapegoats (muslims, immigrants, the liberal media) and the quiet suicides of drug overdoses.
Hate to leave this post on such a low note, and luckily I don’t have to. The astonishing rise of Bernie Sanders, who squarely and openly points the finger at the corporate oligarchy and their outsize influence on our laws, shows that many, middle, lower, even upper-class people, recognize that the problems in the U.S. have to do with corporate power and economics. However, as much as I would like to see in Bernie (and full disclosure, I campaigned for Bernie and still keep a blue Bernie sign in my living room window) Marx’s vision of a fraction of the enlightened bourgeoisie leading the proletarians to economic and social victory, I believe that what is going on in the current crisis is not merely economic.
There needs to be a conversation about the fact that not everyone in the United States is a progressive cosmopolitan atheist, and that’s OK. Those on the left are also guilty of intolerance, a lack of understanding or even the recognition that there is something to understand, about a way of life in the U.S., small town or rural, traditional, conservative, religious, that has just as much of a right to exist as the cosmopolitans. Progressives also care about status, and much social media energy is expended on moral posturing on the left that is strangely reminiscent of evangelical Christians to me. Status for some progressives is about moral superiority, as it has been for adherents of many religions in the past, but evangelical Christianity (and high-minded leftism) stands out as particularly susceptible to this, I believe.
This loss of hope is a problem for us all, and let’s hope that the opioid epidemic opens our eyes to the suffering of others, however different they may be. While I believe the correct response to the opioid epidemic should be mainly economic and political, part of that needs to include a softening of stance on the left as well, seeing those on the other side of the political divide not as enemies, but as a sort-of-annoying relative who, however different, you still need to tolerate and talk to over the dinner table about four times a year.
What do you think about the many and varied arguments in the blog? Respond with comments if you wish!