The Heroin Addiction Epidemic in the United States
Heroin use has gotten rural, and whiter after authorities leaned hard to cut down on prescription opiates making their way to the streets. In no place has this rung more true than Ulster County.
Woodstock, NY has a history it can’t escape. Forty-seven years after the last tab of brown acid was consumed in Bethel, this sleepy upstate town (and its neighbors) have a different drug casting a shadow on the mountains: heroin is here. It never really left, but in the last four years a perfect storm created a radical increase in the number of users, addicts, ODs and deaths from the drug. The problem is not centered or worse in Woodstock, it just happens to be the town with a legendary name. It’s also where I live.
There are 20 towns in Ulster County extending from New Paltz to Marbletown, Kingston, Ulster and Saugerties. In total, less than 200,000 people live here. Many are part-timers who come up from New York City on weekends to enjoy the unspoiled mountains, recreation and laid-back atmosphere.
To the casual visitor the area looks like most hamlets on the Hudson River between Manhattan and Albany. Land stretches out far and wide. The businesses tend to be small sole proprietorships. Antique shops, art galleries, restaurants and tourist-friendly destinations abound. Once, these communities thrived when corporations like IBM employed white-collar professionals. That changed in the 1990s when IBM left, and no significant employer came in to take its place.
The economy of Ulster County is precarious. The main businesses—colleges, ski areas, hotels, restaurants and bars—have strong seasonal fluctuations. During snowy winters, some mountain towns thrive. In the summer, the population swells with tourists. But by this time in March every year, everyone who can, leaves for warmer shores. The rest of us tough it out one grim, gray day at a time, keeping our fires burning and praying the pipes don’t freeze. These are normal day-to-day issues of life in the rural northeast.
The opportunities for young people are different in areas like this than they are in an urban environment. There are few companies offering jobs that pay a living wage. Most people are working at more than one occupation, and tend to have a small business of their own as well. This is not the cause of addiction. The stress of financial insecurity on families and individuals is another story. There is a sense of scarcity in these parts, more palpable than any other place I have lived. Particularly in winter months, it gets bleak. Restaurants close down until spring, and many stores are not open on the slower days of the week. While the national story of economic growth blares on a monthly basis, evidence of such growth is not visible in these communities.
Heroin has become a significant problem in all of New York’s upstate counties. Statistics from NIDA show heroin use has gotten rural, and whiter. The stereotype of heroin as an inner city problem for people of color has been flipped on its head. The average American heroin addict is 25-years-old, white, and living in a suburban or rural locale. Further evidence of this phenomenon comes from hospitals, treatment centers and morgues in Ulster County. The incidence of overdose, hospitalization or death from heroin use has increased 12-fold from 2011. Data on heroin overdoses and deaths lag behind the current year. With this in mind, I interviewed doctors, treatment centers, law enforcement, the district attorney’s office, the fire department and the county medical examiner. I spoke to some people who requested anonymity, and others who did not. The goal was an attempt to understand the rapid spread of heroin addiction in this county and what is being done to address the problem.
Ulster County District Attorney Holley Carnright said, “You can be a 50-year-old accountant or 14 and in the 10th grade…” Heroin addiction knows no socioeconomic or demographic borders. Then there are recent sobering statistics: in Ulster County, 70% of drug arrests were for heroin or opiates, up from 30% in 2012.
Nationally, heroin use has about doubled since 2007, going from 373,000 to 669,000 users in 2012, according to SAMHSA. Heroin overdose deaths have spiked in the northeast, increasing 211% from 2010 to 2012, according to the Centers for Disease Control and Prevention.
There’s a sad irony noted by police, addiction specialists and users. Authorities leaned hard to cut down on prescription opiates making their way to the streets. Interconnected databases allowed pharmacies to see any controlled substance scripts written in the state of New York. Pharmacists partnered with local police, and violators with forged scripts were arrested. Physicians were informed if their patients were obtaining medication from multiple sources. The tactics worked so well that drugs like OxyContin and Vicodin became harder to source and their prices skyrocketed. At the same time, a flood of cheap heroin hit the same streets. Some addicts made the jump from prescription drugs to heroin, based on cost and availability. It’s a scene that’s played out in the war against drugs time and time again.
While that explanation makes some rational sense, it doesn’t address the “why” that surrounds addiction. Heroin has always been available in these parts according to sources in law enforcement. It became more available when criminal entrepreneurs from other cities realized they could increase their profits significantly by making a day-trip north. Mere availability doesn’t explain the large number of addicts who are on the streets first thing in the morning in order to get their doses sorted for the day.
Asking questions about heroin addiction provides no neat answers. Statistics that measure death and overdose come from public institutions, and only tell a small part of the story. No one I spoke with attempted to minimize or deny the scope and effect of heroin addiction in the county. Everyone is aware of the problem, coming to actionable conclusions about fixing it is a different proposition.
The individuals spoken to for this story all have a slightly different perspective on the problem. Law enforcement has a job, which includes arresting drug dealers. But even the most senior undercover narcotics detective I spoke with understands that it’s impossible to police addiction out of existence. First responders in this county are armed with Narcan, and the drug is credited for saving two lives the very first day it went into use. Even so, someone who overdoses and is revived by Narcan cannot be forced to go to treatment. Some who are brought back from the brink, come to angry that their high was ruined, the last thing the user recalls is that he/she was okay.
Drug court has been active here since the late 1990s. Nonviolent drug offenders, who are addicts, are offered comprehensive treatment and a structured program of accountability. Drug court offers an option to incarceration, but also requires a serious level of commitment. Those who fail will go to jail. It’s a strong incentive, but some addicts prefer prison to random drug tests, participation in treatment and following the rules required to stay in the program. These tend to be addicts who do not believe they can ever stop using. Clearly drug courts are moving in the right direction, treating addicts as human beings who are capable of making better choices when they are supported and encouraged. It is also far less costly to treat addicts rather than locking them in jail cells.
The Waiting Game
There are several treatment facilities in Ulster County. The one thing they have in common is that they all have waiting lists. The same goes for physicians who prescribe Suboxone for outpatient detoxification. It’s clear that a large number of people who need and want help to end their addictions are not able to access care. I spoke with one young woman who described a close friend who is an active addict and goes to work every day. He is desperate for help, but can’t afford private treatment and is on a waitlist for a publicly funded option.
Funding Additional Education and Treatment
In talking with law enforcement, I inquired about the endgame for the cash and property confiscated in the many drug raids that occur here. I wondered if those funds could be put towards education and additional treatment centers. While some of the money eventually returns to the county and, in theory, goes to treatment and education, the timeframe is lengthy. On top of that, every entity involved, from local to regional and federal gets a piece of the revenue.
Another interesting fact was mentioned by the DA’s office—some school boards and parents resist drug education programs. While that may sound counterintuitive, one must remember that the county is extremely liberal. Some parents associate these programs with the failed War on Drugs. Additionally, drug awareness seminars were traditionally delivered by law enforcement. A police presence sends a far different message than one coming from a recovering addict. While it may sound like an ideal plan to bring in such individuals, the continued stigma of drug addiction and the reaction of certain parents and board members makes this too difficult a task to accomplish.
Inside a Treatment Center
The Bridge Back To Life Center (BBTLC) is a key recovery hub in Kingston. Its director, Al Nace, agrees that opiate addiction is an equal opportunist without geographic or economic boundaries. The age range of clients at his center runs the gamut, from adolescents to 65-year-olds. There’s a mix of people from all walks of life. There are lawyers, health-care professionals and teachers side-by-side with young mothers, people struggling with dual diagnosis (mental health and addiction) and those currently unemployed. They’re all at BBTLC to put their lives back together. The treatment facility has several campus locations, including a hospital for detox, day programs, and after-work evening programs for those fortunate enough to have kept their day jobs.
While BBTLC assists those struggling with heroin, it treats other addictions as well. Alcohol, tranquilizers, sleeping pills—it doesn’t matter what a person used, only that he/she wants to get better and resume a life of purpose. Nace knows that you can’t take an addictive substance out of a client’s life, and leave the empty space there. It has to be filled, or the client will inevitably return to using their drug of choice.
To that end, he created an art program (which in the beginning, he supplied the brushes, paint and canvases for). Last year, a show of client’s work attracted hundreds of interested citizens. There is a boxing gym about a mile away that clients are encouraged to participate in and an annual bike race/fundraiser that is open to all. Nace is genuinely dedicated to his clients. Right now, Bridge Back has a waiting list of approximately 30 people who desperately want help. In order to allow one of those individuals in, someone has to leave the program, either by graduating, dropping out or being administratively discharged. Bridge Back is a rigorous program. If a client is not participating in group, or tests positive for an illicit substance, they will be counseled. Nace has a deep understanding of the arc of recovery from addiction. Although he has to make hard choices every day, he knows that setbacks are part of the course. This is kept top-of-mind when a client who is struggling is confronted and potentially given another chance to succeed.
Compared to the gourmet meals and equine therapy available in Southern California treatment centers, Bridge Back is bare bones. The low, unassuming brick building is clean but sparse. There are large white boards in group-therapy rooms for teaching and sharing purposes, and plenty of space for seating. The facility accepts clients with private insurance as well as those on Medicaid. As I left our meeting, I noticed a young girl trudging through the snow. I offered her a ride, knowing it would be a several mile walk in any direction to town. She looked like a teenager, but let me know she had three children who had been removed by Child Protective Services as a result of her drug use. She was on her way to meet with her probation officer. Even so, she was clear eyed and upbeat. She intends to regain custody of her children. Bridge Back To Life offers the kind of intensive structure, therapy and education that are helping her to navigate the journey.
Hard Times In Ulster County
BBTLC assists average citizens of these upstate communities. The struggle of Ulster County residents reflects hard economic times. While total employment here grew 1.7% in 2012, it lags behind national numbers. According to a study by SUNY New Paltz, in Ulster County, approximately 13% of all residents, 15% of families with young children, and 47% of single-mother families with young children fell below the poverty line. In the village of Ellenville, 70.6% of all single mother families live in poverty. These figures provide a vivid picture of strife, and illustrate why a portion of the population might feel helpless and hopeless. That said, if poverty in itself was the root of addiction, the Depression of the 1930s should have produced a generation of addicts, but it didn’t.
To describe Ulster County residents as salt-of-the-earth types is an accurate assessment. The American ideal of rugged individualism is alive, well, and tested regularly in these cities. A large number of the self-employed work with their hands and on the land. There are carpenters, excavators, tree surgeons, farmers, loggers and handymen. That is in addition to the many artists, writers, musicians, and craftspeople who have historically been attracted to the area. Local critics say that elected officials haven’t done enough to bring corporate investment to the area. At the same time, the demands for resources corporations require can be contrary to the needs of the people. A recent proposal to bring a Nestle water bottling facility to the region was nixed, based on the million gallons of water per day required to run the plant. Such are the tensions of a county in transition.
How does city development relate to heroin addiction? There are high correlations between poverty, trauma, stress and addiction. All of these factors collide in an area where 14% of residents receive federal aid and the unemployment rate languishes at 9% compared to federal figures of 5.6%. In the face of few employment opportunities, some can’t imagine a brighter future for themselves. A bleak outlook lends itself to the desire to self soothe. According to the National Council on Drug Abuse, lack of money is not a singular cause of drug use. The relationship is complicated. Poverty comes with a litany of factors; low-status, low-skilled jobs, unstable family and personal relationships, low educational achievements, high arrest rates, high incidence of undiagnosed mental illness, poor health, and high death rates. These are remarkably similar to the factors surrounding drug abuse.
Unemployment has been strongly correlated to drug use. According to the Substance Abuse and Mental Health Services Administration (SAMHSA) 18.2% of unemployed adults in 2013 were current drug users compared to the 9.1% of those who were employed full time and 13.7% of those who were employed part time. A person in an impoverished situation may abuse drugs or alcohol as a way to cope with a dangerous environment, to deal with financial stress or cope with physical or emotional abuse.
Opiate addiction has raised its black flag across New York State. From larger cities like Albany and Buffalo to the tiny towns in Ulster County. There is no safe haven. “It’s no longer the back alley bum,” says Renee Hustins, a school bus driver who knows four people who’ve lost children to heroin. ”It’s your neighbors’ kids. It’s the grocery-store worker. It’s crazy.”
According to Vancouver Professor Bruce Alexander, the phenomenon of addiction is neither a disease of the brain nor a moral failing. He posits that addiction is, in fact, an adaptation to the environment. It may not be the sole factor, but one that has been largely overlooked. Alexander’s writing in The Globalization of Addiction points to some key issues; that humans have been separated from their ties to family, culture and spirituality. Further, he notes that the unending pressure and competition of modern life have disassociated us in a manner that leaves a void demanding to be filled.
Addiction, obsessive consumption of food, worldly goods, and power are all evidence of this adaptive behavior. He points to history, where addiction in certain societies was rare for centuries. Dramatic changes in circumstance, such as the collapse of a civilization or tribal unity is when the symptoms of addiction arise.
In Alexander’s view, the deep need for “social, cultural, and spiritual wholeness” is the space that addiction fills. His premise that addiction is more a social ill than an individual disorder is controversial. However, after studying statistics, economic trends and poverty levels in Ulster County, Professor Alexander’s theories might just be the missing link.
This article was first published on The Fix. Permission to re-publish was granted by the author.