I call Bruce Alexander on a Friday morning. On my computer screen I can see he’s sitting comfortably in his living room somewhere on an island near Vancouver. Evergreen trees outside the windows, light coming in, but we talk about Ohio. He went to Miami University in Oxford, just a couple of hours southwest of here. He remembers it fondly, remembers, too, how he connected with the ethos of the liberal arts while he was there. That tradition of holistic and free inquiry, he says, followed him throughout his life. Although his “Rat Park” experiments are well-known (see chapter 2), he eventually reached the limit with that kind of study and was looking for something else. When his funding ran out, there was only one place he could go do research for free—the campus library. To Alexander, that felt comfortable, appropriate, and in keeping with what he had been doing before: “I read Plato. I read Saint Augustine. That’s the source. Our wisdom is cultural, I think.”1
To understand the genesis of Alexander’s more recent work, we must recognize his methodology, rooted in the tradition of the liberal arts, one that speaks to the many ways in which we must address the problem of addiction, overdose, and the war on drugs. We can’t address these problems only through data or historical analysis, through psychology, and through clinical trials. These problems, he seems to say, require a holistic approach. Scholars, policymakers, and activists must push on the horizon.
“The last few days,” he tells me, “I’ve been reading psychology papers on gambling addiction because I have to give a speech on gambling addiction.” But he’s frustrated with the work he’s encountering. “It’s too narrow. You can’t get anywhere doing what they’re doing, even though I know them, they’re good people, and they want to help. But it’s just too narrow.”
And yet where he began his own career was quite narrow—an experiment that could fit indoors, focused on rats and substance use. Rat Park, he says, “starts by saying, well, the ‘demon drug’ myth is wrong. It’s just wrong. Let’s forget it. But the fact that rats are less inclined to take opioids when they have decent housing, community housing, doesn’t really tell you anything about people. It’s just a metaphor. And then you say, well, let’s try this out on people. Well, we can’t do it with people experimentally, but we can do it with people anthropologically. We can look at where people have been taken from their natural cultural setting and put into horrible restricted housing or lives. And it has happened thousands of times. So we have thousands of natural experiments to look at with people.”
If you look at the natural experiences of human beings, he says, rather than just the experiences of rodents, the idea begins to evolve. It’s not a cage per se that harms people; it’s the larger economic, social, cultural, and historical context. “So it all follows from Rat Park,” he continues. “[That] was just a moment of clarity which said, wait a minute, these rat studies look like bullshit. Let’s change your conditions a little bit. And sure enough.”
Alexander thinks that some psychologists use the word environment in too limited a way. “Really, what’s around you is surrounded, is concentric circles, right?” he says. “There’s what’s around your house, and then there’s what’s around your community, and there’s what’s around your nation. And maybe there’s something around that and we call that God or religion.” If we want to understand who a person is and why they are the way they are, then we need to explore those circles.
Bruce Alexander is reaching for bigger ideas now, and that is why, it seems, he does not agree with much of contemporary thinking about the overdose crisis. “We’re screwing the Big Pharma companies. They deserve to be screwed; I don’t mind that at all. But it’s the exclusive narrative. We crush those guys and the problem is solved. Well, no. And that’s why I love to talk about the history, because we had the same problem in 1970. All of the same panic and all that stuff here. But of course we didn’t have fentanyl. We didn’t have Big Pharma being part of it. It’s a different problem. And yet I think the deindustrialization now is an extension of a long period of whatever you want to call it.”
I tell him about how Lisa Roberts reads the history of Appalachia as one of extraction—outsiders coming in, taking things, and leaving. And with each subsequent leaving, the people remaining in the area were just devastated. Penalizing the pharmaceutical companies will provide some temporary relief for overburdened social service, health care, and law enforcement systems, but it will not solve the larger problems facing Appalachia. As Alexander says, addiction is a political problem, wrapped up in structures that need to be transformed.
One way to begin to address this crisis is to rebuild communities, and that is apparent throughout the places hardest hit; it is apparent in the relationships described in this book. But Alexander would argue that it’s still not enough. As an example, he points me to the addiction recovery movement. It’s an important movement, he says, but the addiction recovery communities are operating within a larger, more damaged framework. You might build a thriving community in, say, Columbus with a recovery house where people can connect and find fellowship, but you’re in the state of Ohio, with mounting overdose deaths and people sleeping in the streets outside the house. The house is just an island in a rough sea.
“And as soon as you talk to somebody, you realize there’s all this hate in the air,” he says. “And you can’t just erase that stuff by building a nice house, or by funding a nice house. We’ve got to live within that world.” And to live in our world, he says, requires a kind of fortitude that can exacerbate addiction. Our modern world, with our myriad screens and devices, with the catastrophe of global warming, with the threat of mass shootings. Our world. In the United States, where life expectancy has declined for three years in a row—in part because of drug overdoses, suicides, and organ system diseases (such as heart disease and diabetes).2 And in Ohio, where five people died of suicide every day in 2018, where suicide is the leading cause of death for people ages ten to fourteen.3
“We’re not all that strong,” says Alexander. “We try to take care of our kids, and we try to do our job properly, and we try to be good citizens and recycle and all that stuff. But it’s hard to have the strength to do that when you get up and read the news, and see all the misery that falls on people who don’t deserve it for any reason. We don’t have that kind of strength. We need environmental support, and it isn’t just our house or our community. It’s these concentric circles. They’re with us all the time.”
Alexander says that things will have to change at a national level, really, a global one. “That’s where it’s going to be resolved,” he says, “if it’s going to be resolved.” He does not proffer cheap hope.
In the smallest of places, in the city of Newark, Ohio, people are trying their level best to rebuild those circles, but it is a slog. When the syringe exchange is voted down, when the board of health meeting leads to nothing, the collective energy seems drained, the movement stuttering. But Trish Perry keeps on. She’s starting to collect shoes for an event she’s organizing in May—a rally at the courthouse at which she will display a pair of shoes to represent all of the people who have overdosed in the last year as well as the nearly five hundred homeless adults and children. Her apartment is slowly filling up with shoes. When I suggest that it’s a lot to be reminded of all the time, she politely suggests that at least she has not had to deal with death like some mothers have had to. It’s a check on me, a reminder of the empathy present in Trish’s work. It is also a reminder of how much trauma all of these overdoses have inflicted, how they have broken those circles, and how much repair work we must do.
I want to believe that there are many strong people out there, strong enough to face the powerful systems that seek to dislocate and to disorient us. On the radio I hear stories of protests in Hong Kong, Bolivia, Chile, Lebanon, Ecuador, Colombia. I hear that people are putting their lives on the line for human rights, for autonomy, and for economic justice. Some of us are that strong.
After filling up plates from a taco-salad bar, about twenty people sit around a large square of folding tables. Around the tables are little signs filled with Bible scriptures. The one in front of me reads 1 Peter 5:7, which in the New International Version reads, “Cast all your anxiety on him because he cares for you.” The drop-ceilinged room is dominated by a large cross at the front, and the walls are covered with faux-hand-painted signs that read: “His mercies are new every morning” and “Grateful-Thankful-Blessed.”
It’s a Wednesday night at Vertical 196, a recently opened and much-needed drop-in day center for people who are homeless in Newark. Vertical 196 gives people a place to rest during the day, a place to wash clothes, to take showers. Tonight, the Licking County Champions Network is hosting a Bible study and discussion connected to The Refuge, the free Christian-based treatment program where Johnathon stayed briefly. Chris Gargus, a fifty-something organizer with a full head of curly white hair, welcomes everyone to “this awesome gathering of saints.” There are some announcements about free meals and some rumblings about watching out for the police, to which Chris adds, “I’m a little annoyed with the popo right now, running off our homeless people.” Heads nod around the table. Chris reads a passage from the New Testament (King James Version), John 1:17—“For the law was given by Moses, but grace and truth came by Jesus Christ.” God loves you, Chris says, no matter what, and you are deserving of that love. It’s because of God’s grace, he adds. Grace is central. “Grace is unmerited favor all the time.”
A young man sitting next to me wearing a ball cap and jeans responds to that: “If you don’t believe that, look at the people Jesus hung out with. He didn’t hang out with the rich and the people in fancy houses.” Jesus, he says, hung out with those who were struggling, those who were ostracized, those who were othered. The implication in this space being—he hung out with people like you. A man across from me responds, “That’s true!” Others just nod in agreement. But a young woman sitting to the left of Chris rolls her eyes, straightens her shirt and hair in fun as if to say, “You talking about me?! You can’t be talking about me?!”
Beth Bline, who helps Chris run these meetings, stands up and starts talking. She is full of light and energy and speaks with a twinge of an Appalachian accent. She is in a zone, infused with some spiritual energy, her faith, I think, taking hold. Her eyes are closed, she’s so moved by the message that has quickly lit up this room. Beth talks about grace, how we all need it but don’t believe we deserve it. We may need to use our spiritual imaginations, she says, to see and understand this grace. We’re all transfixed by her energy, by her joy—and for me, a guy who grew up in a rather staid Presbyterian church, there is almost too much feeling in this room. “It is no accident you all are here tonight,” she says. “You are meant to be here.” God sees something in all the people who are here, she says, and she calls people out by name, forecasting their futures. Mary, who will one day be a counselor. Steve, a preacher who will write important books.
It goes on like this for over an hour, a Bible study that zeroes in on just a few passages, close-reading them within an inch of their lives, a freewheeling, free-associating discussion. The central message is that even if you do wrong, Jesus still loves you. It’s simple. It’s nourishing. Chris says, “You wanna put your eyes on God, put your eyes on Jesus … The walk with Jesus isn’t complicated. We make it complicated.” The message must mean something to the people in this space, because no one is forced to stay—indeed, some get up and leave after they eat—but mostly, everyone stays, even the woman rolling her eyes.
One man wearing a black T-shirt waxes eloquent on his experience of twelve-step programs, how he feels alienated when he goes to meetings. It’s not for everyone, folks around the table seem to agree. Everyone needs something different. Chris brings up his own struggles and says, “God sees you the whole time. When I got ready to drink I had a decision to make, but I didn’t have Jesus in my life. I can empathize with drug use … I knew they were bad decisions, but I made them.” It’s simple, he says: “Jesus loves you. That’s what you need to know and that’s where we start. We’re trying to bring the Word to life here.”
The woman next to him giggles and rolls her eyes again. She chats with a young man sitting next to her. Chris is unfazed. He was in the military for almost two decades. When he was training as a paratrooper, he remembers standing on the edge of the payload door, wind whipping around him. He was thinking in those moments that he didn’t need God, didn’t need anything but the courage to leap. Years later, his teenage son Tyler was at the house of his best friend, Zach, who was playing with a gun, pointed it at Tyler, and pulled the trigger—the bullet hit Tyler; he was gone within minutes. Chris says in that moment he needed God. When his world was turning upside down. When the wind was whipping around him again. His son. His family. His future. That was the moment, he says, that he figured it all out. That was the moment he did something unusual. He forgave Zach. He let it go. He did the unthinkable, crossed into a place most can’t or won’t. No judgment, only hope. For him, he says, that was the moment when he knew God was really with him. Chris told me later that he knew staying angry wasn’t going to help him and it wasn’t going to help Zach; if he held on to hate, it would hold them all down forever.
After Zach’s sentencing to “indefinite probation,” a bevy of TV reporters surrounded Chris. “They were all over it, because they knew that it was a light sentence, and Channel 6 came out, and they go, ‘So, what do you think about the sentencing?’ It was right before Christmas, and you know what I told her, I said, ‘I’m not really concerned about that.’ I said, ‘This is the season of forgiveness and I’m just going to stay there.’”4
Watching Chris in action tonight, it makes sense. Chris continues his lesson despite the responses, despite the incredulity of the woman sitting next to him. He’s not here to judge anyone but to love.
It’s this lack of judgment—from a man who talks about his own struggles with addiction and the experience of losing his son—and also a persistent desire to keep people alive. Chris admits that the latter has a lot to do with his son.
The Bible study started as a way to reach out to the homeless in a way that wasn’t aggressive. Chris likes being able to minister, but it’s also about having a meal together. He thinks of this as a kind of harm reduction—meeting people where they are—and even uses the term. And it’s one of the reasons he supports syringe exchange. “At first, I was just skeptical,” he admits. “Kind of thought, ‘Well, isn’t that kind of enabling?’ But as I studied it, and looked into it and realized how fast people die from fentanyl, I’m like, ‘No. No. This is good.’”
Chris says that it’s normal for people who are actively using to come to their meetings. “I’ve had them come out of the street live. It’s pretty open for them.” But to put up barriers, that doesn’t work, he says. “I don’t care if they relapsed or not. I want them to stay. I want them to come back. Come back, man. Don’t be ashamed. A lot of guys have shame and guilt. I’m like, ‘Man, don’t be afraid. Don’t be ashamed of that.’ See, that’s what happens. The church sometimes will beat them up, and once they get beat up by the church, they’re done.” Chris adds, “Jesus always was moved by compassion. He felt empathy for people. He felt that, and I try to do the same thing, and it’s not always easy for me to do.”
In Down and Out in Paris and London, published in 1933, George Orwell immerses himself in the lives of unhoused people in and outside of London between the world wars. He writes about “tramps,” men who are not allowed to stay in a shelter more than one night, so they wander and wander on a seemingly endless circuit of despair through the English countryside. He pays close attention to the ways these people are treated and cared for or not. He describes the slumming parties of the early twentieth century; the preachers who went to poor communities, Bible and crucifix in hand, singing in the kitchens of flophouses; and the many churches that would open their doors wide to the poor and slam them shut once they were inside, preach at them, and only then let them go.5 In one instance the tramps are shut in a church that has offered the requisite tea and two slices of bread. The church leaders make them sit in the balcony. The church service is down below, all the middle-class people in the church pews, and the poor people above. The preacher launches into a sermon, and the tramps jeer and laugh and chatter away. The preacher calls the men “unsaved sinners” and directs the final moments of his sermon at them. “Even while the minister was threatening hell fire, we were rolling cigarettes, and at the last amen we clattered down the stairs with a yell, many agreeing to come back for another free tea next week.”6 Orwell found the whole scene fascinating, noting that this was charity with expectations, charity directed at a people deemed morally inferior. The men were exhausted and dumbed down from poor nutrition, their ceaseless wandering, and the complexities of poverty. But here they were, yelling and screaming, and part of it has to do with how they were being treated. Orwell’s attuned to the effect of that, to the damage such expectations can do to a person. And so the people who ordinarily are spoken to but not listened to, they scream, they curse, they claim the space they are in.
In another instance Orwell describes a clergyman who would meet homeless men under Charing Cross Bridge and distribute meal tickets.7 He said little to the men, had no expectations. Orwell concludes, “The consequence was that, for once, there was genuine gratitude.”
This Bible study here in Newark in 2019 is the latter. The table is set. They have opened a door—people get up and leave if they are bored or not interested. They comment and push back. But the effect of this lack of judgment is another kind of harm reduction.
At the end of the evening, Chris and Beth ask everyone what is on their minds, what they want them to pray for. I think it’s almost over—I’m getting a little antsy. But then the praying begins. People rise and pray. Sit and pray. Individually, collectively, everyone prays over everyone, putting their hands on them or above them, and with an energetic and empathetic voice, they pray for recovery, they pray that someone can find a home despite a felony charge, they pray for families, for safe childbirth, for rebirth, for life. Then we all stand up and hold hands in a circle and pray that the whole community will be protected and loved. And I’m humbled and ashamed that I had been so antsy, that I had wanted to leave.
Author and psychotherapist Francis Weller notes, “The work of the mature person is to carry grief in one hand and gratitude in the other and to be stretched large by them … If I carry only grief, I’ll bend toward cynicism and despair. If I have only gratitude, I’ll become saccharine and won’t develop much compassion for other people’s suffering. Grief keeps the heart fluid and soft, which helps make compassion possible.”8 Weller says that when we think of grief, we often think of it as a complete state of despair and “deadness.” But, he says, “Grief is wild; it’s a feral energy.” Grief can fuel a movement for transformation and change. That wild energy can lead people to do things in this world that they did not imagine were possible. Eric’s resilience. Trish’s resilience. Billy’s. Chris’s. It must be acknowledged that behind some of it is grief, but that somehow they each have managed to transform that grief into bold and transformative action.