In late November 2017, C.J. goes to an “addiction awareness” rally outside the Licking County Courthouse wearing his big smile, a blue Think Tank shirt, and his beloved Cleveland Browns ball cap. He hands out the first issue of Justice, the Think Tank’s newsletter, with a headline that reads “We Want Real Treatment for Meth Addiction Recovery.” C.J.’s life is improving. He has a car. He has regular visitations with his son and a steady maintenance job. One popular American narrative is that poor people are lazy, that they’re not trying hard enough. But C.J. is full of “try hard” and then some. He says he wishes he could tell his story to people running for office. He’d tell them “straight up” that when he got out of prison, he couldn’t get a job. That’s when he went back to using. It’s that simple. “If you don’t have hope, you lose all will,” he says.
C.J.’s friends in the Think Tank say that he’s a born organizer. He’s not afraid to speak to anyone—he just walks right up to passersby and shares his story, starts building connections. Allen Schwartz told me once that the Think Tank is about helping people like C.J. find a community and a place where they won’t be judged. “If that’s all we do,” he said, “then we will have done something.”
They already have done something. Now C.J. is committed to sharing his story and the Think Tank is providing a platform. A reporter from ABC 6 News hears C.J. speak up at the rally and asks him for an interview.1 He tells her about how he was treated when he went to a hospital seeking help for his meth addiction. He tells her this is an addiction crisis, not an opioid crisis. He tells her that he’s fighting for all who are suffering.
But that fight is a day-to-day thing, and for people in recovery it’s about rebuilding and reimagining the world, about finding a supportive community to help them through adversity, and about tapping into their own resiliencies. For the working poor, this process is doubly difficult because the smallest things can throw them off course. Out of the blue, C.J. gets a bill from the parole board for “unpaid fees.” The bill is for $640. He’s not sure how he’s going to pay for it, and he spirals. Despite all the good things that have been happening for him, he’s depressed, he’s lonely, he’s frustrated.
“I feel like I’m doing everything right,” he says as we sit down in a booth at a Bob Evans, “and now this.”
C.J. and I are meeting up before going to a church meeting about “opioid addiction.” Allen texted me beforehand and asked if he could join us. We order coffee and burgers just as Allen arrives and gets straight to the point—he wants to help C.J. with those “unpaid fees.” He wants to figure out how they can handle this problem together. In this moment of crisis, C.J.’s community encircles him.
In the addiction research community, what is happening here, some might say, is part of a model of addiction recovery called recovery-oriented systems of care (ROSC).2 It’s an approach to addressing addiction that seeks to move beyond pathologizing someone as an “addict,” forever marred by that designation. This begins with prevention and, hopefully, ends with holistic continued care that focuses on building people up so they attain and sustain long-term recovery.
Michael T. Flaherty, a Pittsburgh-based clinical psychologist and consultant in ROSC, says that recovery-focused care should be about building on strengths, increasing “recovery capital.” This can mean using less or abstaining, but it can also mean finding better housing, employment, education, emotional and family health, physical health, better relationships, ways to serve others, and, in general, a meaningful life.3 By increasing one person’s “recovery capital,” he points out, the entire community grows. And as this resilience grows, the ability to address an addiction crisis grows. Bruce K. Alexander supports this model when he writes, “Although personal strength and courage are absolutely necessary, the way out is not simply suppressing an addictive habit with iron will-power, for this often precipitates other kinds of social problems or different addictions, which can be worse … The best way out of addiction is overcoming dislocation by finding a secure place in a real community.”4
Finding your way into a stable and supportive community is very often the key to recovery. But it’s a challenge to build such recovery capital in a place that has its own social and economic challenges—and Newark, like many places, has them. And yet it can be a matter of life and death. Princeton economists Angus Deaton and Anne Case have noted the increasing death rates for working-class whites across the nation, so-called deaths of despair—deaths by drugs, alcohol, and suicide that are the result of economic and social issues that create a perfect storm of disconnection.5 The numbers are especially high in Ohio. This crisis is hitting poor and working-class people the hardest because they feel the economic struggle the most. They feel despair, hardship, suffering, sorrow, hopelessness.
Despite those challenges, people like C.J. are becoming resilient. C.J. is being embraced by his community, and he’s building a new one.
“There’s no cookbook,” Flaherty says. “It’s highly individualistic. It’s understanding the illness first as an illness, and then accepting that there’s some way you can get over it, and then meeting others you connect to, so it strengthens your sense of self-esteem.”
Then he adds, in a turn of phrase that resonates, “It’s a positive moving.”
In C.J.’s life there is certainly a positive moving.
It’s 8:30 p.m. in November, and Newark’s assistant fire chief, David Decker, sits at his desk doing paperwork. Suddenly, a red light flashes in the hallway; a voice comes over the intercom indicating an EMT run. A possible drug overdose. Within seconds, Decker is in his department-issued SUV, racing through downtown Newark, passing the courthouse, lights flashing and siren wailing as he careens over the train tracks and down Main Street.
He’s the first to arrive at the house. When he enters, he finds a woman lying motionless on the floor, anxious kids circled around her. Spotting the woman’s partner in the house, Decker shouts to him: “Can you get these kids upstairs? They don’t need to see this.”
Decker deftly administers Narcan, and soon the woman comes to. An EMT transports her to the nearby hospital.
Decker returns to the firehouse and sits back down at his desk. Soon enough, the red light blinks again. It’s the same address. The same emergency. He races back over. This time it is the woman’s partner—the man he’d just seen.
There is, Decker says, nothing irregular about tonight.
“In my first fifteen or twenty years of service, I bet I didn’t administer Narcan no more than a dozen times,” says Decker, who is now in his twenty-ninth year as a firefighter. “In the last two and a half or three years we’ve probably given one hundred doses of Narcan on runs I’ve been on.”
Decker takes a holistic view of the problems facing his city. The addiction crisis, he says, is largely a poverty problem.
Decker doesn’t need a study to tell him about what he sees every day. Addiction, he says, can start with a dead car battery. It’s that simple. “A guy’s car breaks down. He can’t make it to work. They terminate him,” he explains. “So now he starts into stealing. Which leads to drug abuse. Which leads to kids being removed. So on and so forth.”
What he’s describing, really, are daily problems and the inability to address them or cope with them, especially for people with limited means. And then a person adapting to those problems—addiction as a learned behavior.
And then, he says, because it’s mainly the poor who are overdosing, no one seems to care.
“Do you see any rich politician’s kids dying of a heroin overdose?” he asks.
While some politicians have dealt with personal tragedy of their own, research confirms that the overdose crisis has indeed hit low-income communities harder than well-off ones. For example, a 2017 report from researchers at The Ohio State University’s Swank Institute found that “an Ohio county’s unemployment rate in 2010 is positively correlated with overdose deaths in 2015 … Counties with a higher poverty rate have a higher overdose rate.”6
Decker’s firehouse services some economically challenged neighborhoods, so it’s not hard to find the source of his perspective.7 This also happens to be the part of town where Decker grew up.
Decker’s clean-cut look, flat tone, and no-nonsense demeanor is almost cliché first responder, but beneath that exterior lies a man who cares deeply, and who finds himself frustrated often. He struggles to understand why people judge people who use drugs, why people would call for a limit on the use of naloxone or become frustrated by repeated calls to the same house for the same person.
“Some of the patients that we bring up are remorseful. Even tearful and ashamed,” Decker says. “I’m guessing all these people didn’t have a longing to become addicted to anything.”
In many ways, the overdose crisis is magnifying deeper issues for nonusers as well. In Newark, as elsewhere, there’s a growing sense that the pressures of being a first responder are causing mental stress and post-traumatic syndrome. And county social services, especially the foster care system, are struggling to keep up. For his own part, Decker and his wife decided to foster a child. One less kid, they figured, left bouncing around a congested foster care system.
“We talked about how overwhelmed the system was because of the drug crisis,” Decker says. His own intervention in his foster child’s life has convinced Decker that what’s really needed to address the addiction crisis is better support for social service agencies and for struggling families.
Invoking almost the exact same metaphor that Kim Kehl invoked, Decker opines, “Let’s say you’re drowning in the deep end of a swimming pool and someone throws you a bucket and says, ‘Start emptying that pool out.’ Now, you’re doing all you can just to keep your head above water. You don’t have an arm free to fill up the bucket so we can get this pool empty.”
It’s a moral issue, Decker says. People need to be decent to one another. “We have a responsibility to do the right thing,” he continues. “If you’re arrested and tried for a crime, a jury of your peers will ask, ‘Did he do the right thing or the wrong thing?’ And I think that runs through everything in life.”
Our conversation is interrupted once more when an enormous flat-screen panel, situated in the middle of the fire station’s common area, starts blinking red. He calmly but swiftly throws his jacket over his shoulders and heads for the SUV.
There’s no shortage of people like Decker who are trying. People who are trying to help and to build stronger systems of care, so to speak. This community is overwhelmed by people who want to help, not just the usual suspects. The guerrilla warriors of this community—counselors, judges, community organizers, probation officers, firefighters, and a host of grassroots mothers and fathers and people in recovery packing naloxone and a prayer. Local agencies are being joined in the struggle by people who are looking for new ways to address the problem. Groups like the Think Tank and OhioCAN (Change Addiction Now), the organization Trish Perry affiliates with—as well as groups like the Licking County Champions Network, the Crossroads Crusaders, and John’s Helping Hands—directly and indirectly support parents and friends and people who use drugs themselves. The health department has created an online Narcan training system. And the county’s addiction task force brings people from law enforcement to the health department to the same table every couple of months. And yet, they’ll all agree, it doesn’t seem like enough.
Early January 2018. The temperature on the corner bank’s electronic display reads single digits. Eric is waiting in front of the First Presbyterian Church on North Third Street in downtown Newark with his five-year-old granddaughter, Kortni. She’s bouncing around wearing a pink-and-purple winter coat pulled tight, her pink backpack bobbing up and down. Eric’s wearing only a black beanie and a thin coat. It’s not enough for this cold. He tells me he’s been in some pain as of late and winces as we climb the stairs to a second-floor meeting room. He has an enlarged prostate and he’s been off work for a couple of weeks. He’s just glad there’s nothing cancerous this time.
For over three years, Eric has been running a group here for people on judicial release. They meet every Tuesday evening in this old meeting room with its peeling white paint, brown carpet, and circle of dilapidated folding chairs. He doesn’t get paid for this work. Just like he doesn’t get paid for being a part of his Wednesday-night recovery group or going to the Budget Inn to talk with people who are struggling or helping young men fresh out of jail find work. He does this because he believes in it, and because, I’m starting to learn, his hopefulness is unbounded.
But it’s a hope rooted in reality and in work—it’s central to any lecture he gives to a person struggling with addiction. It’s also central to what he does. Eric gave his own one-year Narcotics Anonymous coin to C.J., rather than giving him a shiny new one. He had had the coin for a long time, and it carried more value, more weight. When he worked nights stripping, waxing, and buffing grocery store floors, Eric used it to scrape out particularly hard spots. He would get down on his hands and knees and go at the spots. Eric gave C.J. a coin that was weathered but strong.
The group is sanctioned by Licking County’s adult probation office, and its members gather to help one another overcome obstacles, “to get real,” Eric says. If people complete the eighteen-month program, come to the meetings, and do the right things, they can get time off of their probation. This is no easy task, because most participants have substance use disorders. It’s not an addiction recovery meeting, Eric says, but he admits that the ethos of recovery shapes the group.
There’s a small crowd tonight, so Eric can take some time with each person who has shown up, check in with them, dispense advice—both practical and spiritual. Speaking with a calm toughness that is all him, he counsels them to be patient.
“We all work real hard to clear the system—to just go back and get high again?” Eric asks.
One woman talks about how she contacted an old friend on social media and then he just showed up at her workplace with dope. She quickly sent him packing.
She didn’t need that right now, she says.
“You’ve got your role models, your people. Be patient.”
His bifocals slip down his nose as he talks.
Eric listens, he connects people to resources, he shares. There’s not much to it. Except, there is. He’s here and he’s supportive. He’s providing another check-in, another layer of support. All this while he’s dealing with his own struggles, serving as the crisis manager in his own family.
After about an hour Eric dismisses the group. He stands up and walks through the door, Kortni following. I shut off the light, and we trudge down the stairs. He grabs a hidden key and locks the door for the night. It’s colder—a breeze has picked up and sends small flecks of snow into our faces.
Eric needs a ride home, so I offer and we cross the street to my truck. Kortni is lagging behind and he turns, reaching out his hand. “Come on.”
Kortni hops up into my truck, and Eric winces as he sits down.
We drive up past the courthouse and down West Main Street to his apartment. He’s quiet, tired. He has no business being out on this cold January night. But he is here. Weathered. Strong.