Heroin Addicts: Beyond Redemption?

Maybe they’re deluding you. Maybe they’re deluding themselves. Maybe they want to believe in their hearts what they have programmed their mouths to say: that this time, this time, maybe they’re going to make it.

GEORGE JAMES, IN THE NEW YORK TIMES¹

T hroughout the better part of this century experts have proclaimed to have the answers to the heroin problem in America. Law enforcement proponents continue to believe that they can win a drug war through interdiction and incarceration, but even they have admitted that we can’t arrest our way out of the problem. There simply aren’t enough prisons, and although new prison construction became one of the fastest growing industries in America during the 1980s and 1990s, now in the twenty-first century, we are beginning to see signs that we may have overbuilt and will some day have vacancies and lost jobs in areas of the country where prison work represents the best career choice for a young person. Incarcerating heroin users is not the answer. We have seen varying levels of success in drug courts and treatment alternatives to prison, indicating that we may have been on the wrong road all along.

Treatment experts have suggested that perhaps we could provide mandatory treatment to prisoners, but thus far we have not been able to effectively deliver treatment even in prisons, where many heroin users end up. A report from the National Center on Addiction and Substance Abuse (CASA) at Columbia University released in 2010 gave a clear sense of how grim the situation is. CASA found that while 65% of inmates met criteria for addiction, only 11% of them receive it.² Prevention and education experts believe that keeping the upcoming generations of youth informed holds the key to avoiding future problems.

The current approach to the heroin problem could perhaps best be described as a piecemeal compromise that primarily focuses on interdiction and enforcement, with varying degrees of commitment to prevention, education, and treatment mixed in. But it is an uneasy compromise at best. Many feel that too much emphasis is placed on enforcement and not enough is placed on treatment. For example, in New York State, there were an estimated 507,000 addicts or abusers of illicit drugs in 2008; of these, 115,600 received treatment (37,840 in methadone or buprenorphine programs). In California, individuals dependent on or abusing illicit drugs were estimated at 795,000 in 2008; those who received treatment totaled 139,339 (28,067 in methadone or buprenorphine programs).³ While many who were not treated were those with no interest in discontinuing their use, many others report being unable to find treatment when they needed it or being unable to pay for it when they did find it. Currently, the bulk of the drug war’s budget goes to interdiction and enforcement. Why? Politics may be the reason. Big drug busts make good TV news and headlines. They give the impression that the war is being won. But if the strategy is to reduce the supply of heroin on the street, thereby driving the price higher and making it harder to obtain, why is there more cheap, pure heroin available now than ever before? The literal war that Mexico is waging on the U.S. border against its own country’s drug cartels points to how heavily armed and violent these cartels really are. Billions of dollars are at stake in their businesses. America has now begun the pattern of trying to stop the flow of drugs coming into the country, while also fighting to prevent cash and guns going back to the Mexican cartels.

We face two major dangers at this point—Afghanistan and Mexico. In the coming years we will see extremely pure levels of heroin being exported from Afghanistan. The Taliban, al-Qaeda and their couriers are responsible for some of it, but many other Afghanis produce heroin as well; it is the only source of income in much of the country.

On the Mexican border, it has already reached the point that the drug cartels are just as armed as the Mexican and U.S. military. An alarming fact: There have been 25,700 drug-related violent deaths along the Mexican border in the last four years (as of March 2010), since President Calderón declared war on the drug cartels.⁴

On the other hand, if treatment is the answer, why are so few actually treated? And of the ones who do receive treatment, why do so few succeed? For that matter, how do we define success? As perfect abstinence from all illicit drugs? As periods of abstinence? Staying on medication maintenance for a set number of years? Improvement in other areas of addicted peoples’ lives? As for education, if we were to blitz the airwaves with antidrug messages, would our children respond and grow up drug free?

It is easy to see how a can-do society like America would arrive at such a three-pronged attack strategy against the heroin problem. After all, why not use everything we have in our arsenal? Yes, we can lock up drug dealers in maximum-security prisons and at least temporarily hamper their ability to deal drugs. Yes, treatment can work, though it requires an earnest effort on the part of the addict. Yes, the prevention message is vital and does reach many young people, though one wonders why, when they turn thirteen, many who were previously scared to use drugs suddenly begin using. Part of the problem is that this three-pronged strategy, though seemingly comprehensive, is ultimately a simplistic solution to a very complex problem.

Historically, America has chosen to demonize heroin and those who use it. An article in Popular Science Monthly, published in June 1930, reported that one of every sixty people in America was a drug addict. The author, John E. Lodge, interviewed one of the leading medical experts of the time, William I. Sirovich, a medical doctor and a member of Congress. Sirovich estimated that there were two million “dope fiends” in America. He blamed the Prohibition era, stating that without liquor, these weak individuals turned to narcotic drugs to help them cope. He pointed out, accurately, that addicts could be found among the rich, poor, and middle class, among the socially respectable and those in the underworld. Their common trait, said Sirovich, was that “they all are psychopathic constitutionally inferior types. They are mostly men and women who are afraid to face the unpleasant realities of life; in other words moral cowards.” Needless to say this is a powerful indictment. Can there be any hope for such people? He went on to say, “The mental condition that causes thousands of people to turn to drugs is lack of courage or initiative. They take dope for sustenic purposes; that is to say, as a stimulant to bolster up their nerve.”⁵

It’s easy to see why addicts were generally written off as beyond redemption in the 1930s. Any hope for social reclamation such “moral cowards” ever had would almost certainly be annihilated by society’s attitudes toward them, especially if they admitted they had a problem. Sirovich’s description of what an addict faced in order to return to the mainstream of society is daunting indeed:

To return, they also have to cross four bridges—the bridge of sighs, the bridge of humiliation, the bridge of degradation, the bridge of infamy.

It’s a tough road for a “constitutionally inferior type” to walk; there are some serious tolls on each of those bridges.⁶

But you say this is a new century; that was 1930. We’ve come a long way in our perceptions about who is addicted, and our attitudes toward them have changed. Or have they? For example: Two individuals have a history of abusing heroin. One has sought treatment several times and has now been drug free for five years. The other has never admitted a problem, never been treated, and never stopped using. Assuming that neither has a criminal record, the addict who has never been treated and still uses heroin daily is eligible to receive a permit to carry a handgun. The addict with a documented history of treatment would be denied such a permit under the current gun laws in most states, even though he or she is now a functioning member of society. Who is more likely to use that gun to rob in order to obtain drugs? The difference between the two is the stigma of being branded an addict. To be an addict is to be seen as untrustworthy in our collective thinking. Why would we deny the gun permit to someone who had a problem but who put his life back together again yet be willing to arm an individual who is unstable? Because one of them admitted he had a problem and “once an addict, always an addict. You never know when he or she is going to fall off the wagon.”

Our perception of addiction as an incurable disease has not changed much, either. In 1930 Sirovich stated: “Thus medical science is almost powerless to redeem these unfortunates. The only way to combat this grievous evil is eternal vigilance on the part of the Government and, better still, the cessation of manufacture of all narcotics not required for medical or other scientific purposes.”⁷ Today we say treatment can work, but the fact is it works for relatively few, and these few are viewed skeptically, not embraced as redeemed members of our society. Mark Parrino, president of the American Association for the Treatment of Opioid Dependence, points to an analogue in Pygmy culture. In that society, drunkards and drug users are driven out of the tribe in the middle of the night, jabbed with pointed sticks, and forbidden from returning. They are beyond redemption. Do we not do this with our heroin addicts? Do we not banish them to the fringes of society? To our prisons?

Our perceptions of who is an addict, and who winds up in prison because of addiction, are tainted by decades of assumptions and judgments, like those of Sirovich, and by our cultural legacy of racism. Two studies, one by the FBI and the other by the National Institute on Drug Abuse, describe the typical cocaine user as a white male, high school graduate, living in a small city or suburb. Both studies came to the same conclusion: that African Americans make up only 12% of the nation’s drug users. Yet law enforcement focuses the vast majority of its resources and efforts on minorities. Between 1980 and 2007, there were 25.4 million adult drug arrests. While African Americans made up only 13% of the U.S. population, they accounted for one-third of these arrests. In New York State, where they account for only 20% of the arrests on drug charges,⁸ whites occupy 42.7% of the state-funded treatment slots.⁹ University of Chicago law professor Norval Morris says, “The whole law and order movement that we’ve heard so much about is, in operation, antiblack and underclass. Not in plan, not in design, not in intent, but in operation.”¹⁰

Where do we go from here? Dr. Herbert Kleber, former deputy to U.S. drug czar William Bennett during the George H. W. Bush administration, predicted that by the year 2000 we would have 1,000,000 heroin addicts. While that total was not reached until a few years later, the best estimate is now 1.2 million American heroin addicts.¹¹ Whatever the numbers, heroin use has been on the rise for years, growing with the population as a whole. How can this be? As we’ve seen, we’re expending enormous energy and vast resources to solve the drug problem in America. How can it be getting worse?

Perhaps it is time for America to really focus on the underlying societal problems that lead one to turn to heroin. It is true that men and women have been using psychotropic substances for at least as long as humankind has recorded its history, and it is perhaps arrogant to think we can ever eliminate heroin entirely from our streets. But it is possible to change our focus and begin to address the problem in new ways. It is possible to treat addicts with some dignity, to stop criminalizing our minorities, and to work toward an understanding that fear of our differences is what keeps addicts and nonaddicts apart, and maybe even what keeps us all from becoming whole.

All the facts and statistics about heroin only tell a small part of the story. The real story is a human one. If you want to get an idea of who uses heroin and why, you won’t find the answer in the National Survey on Drug Use and Health—you’ve got to go to the street.

On the street is where you’ll meet people like Robert M. whom I (Humberto Fernandez) came to know when I spent the better part of a year on the streets of New York, hanging around, watching the tide of heroin traffic, and getting to know the patterns of addicts. I met Robert in the late 1990s. Robert was a short, slightly built man in his early forties. His light brown complexion had begun to give way to a pallor that bears witness to the years he devoted to heroin. His street uniform of hooded sweatshirt, jeans, and army fatigue jacket concealed a man who once helped his mother raise four younger brothers and sisters when his father, still a young man himself, was stabbed to death on a Friday night for his week’s earnings. Robert assumed the role of protector and provider, quitting high school and taking whatever work he could find. When the pressure became too much for a teenager to bear, he turned to the comfort of heroin, until eventually that became but another pressure. Robert managed to help his family survive a life of food stamps, social workers, and public assistance before heroin got the better of him, but by then, his youngest brother had graduated high school. Robert was proud of having seen his siblings through to adulthood, but says it came none too soon, since by that time he could no longer help support anything but his own habit. His obsession with heroin and lack of education made him unemployable, forcing him to hustle anything and anybody he could to get by. For more than twenty-five years, Robert battled his addiction; in and out of methadone programs, jails, and detoxes, he never managed to maintain any kind of long-term recovery—but he did survive.

Robert was my guide to a secret world. After months of building trust, we began to learn each other’s ways. Some days he’d be sick, and I’d help. He helped me, too, protected me in a potentially dangerous environment, and made me feel safe. In short, Robert was another human being: no more, no less.

When my research was completed, I told Robert I would not be hanging around anymore, that it was time for me to go. He looked away, and when he turned to face me again, I could see that his eyes were wet. He lifted his shoulders, sighed, and said, “Well, I guess all good things end sometime.” He laughed, zipped up his green army jacket, and went back into character as if embarrassed by his moment of sentiment.

“But hey, you could still come around sometime, you know, say hello to a friend.”

“I’ll do that, Robert,” I promised.

He reached into the pocket of his jeans, pulled out some money, and separated a $10 bill from a few singles.

“Yo man, here I want you to have this.” He offered me the bill.

“No Robert, I can’t, really, but I appreciate the gesture,” I told him.

“What, come on man, you gonna insult me now? I want you to have it, a token, from me to you. Here, go on buy yourself something. I want you to have it.”

What could I do? I saw that to refuse would be ungrateful, a symbol of judgment and reproach, so I let him hand it to me.

“Thanks, Robert. I’ll see you. You take care of yourself,” I said.

“I always do, I always do.”

We shook hands and walked away. He yelled back at me, “Yo, you gonna mention me in the book?”

I turned the corner, folded the $10 bill, and put it in my wallet, tucked behind the pictures of my kids.

That was the last time I saw Robert. When I went back to try to find him, ten years later, I learned from his younger brother that Robert had passed away in 2005 from AIDS. I felt like a fraud, not a friend.

His brother was kind enough to make me a copy of his short obituary that the family ran in the Daily News, and he even gave me a wallet-size photo of Robert when he was a ten-year-old boy. His innocent smile haunts me.

Today, I still carry Robert’s $10 bill. It’s still tucked behind the pictures of my four children, but now, I’ve added another picture of a smiling young boy, and a short, almost anonymous obituary that could have been written for any one of us whose life was robbed by this drug, heroin.