Flags representing the Native American tribes of the Upper Midwest hang on the aluminum-sided walls of the cafeteria-recreation room of this treatment center. Patients’ chatter, the din of Coke machines, and the clinking of industrial flatware is jumbled on the high ceiling. Greenish bright white sodium vapor lights shine down on our Malt-O-Meal, toast, and frosted cinnamon cake. The coffee is decaffeinated, so I drink Cherry Zero Coke to get my morning buzz. “Sisseton Wahpeton Oyate,” “Oglala Lakotah Nation,” and several other tribal names encircle embroidered emblems on the flags.
Native Americans typically occupy a double-digit percentage of the beds here. Substance abuse affects their population disproportionately, in part because the payments they receive enable them to live outside the bandage of middle class wage earning. One man here said whole-blooded Natives of Manhattan tribes can receive over $10,000 per month. Coupled with persisting beliefs in non-evidence-based healthcare, and laws that allow them exclusive rights to gambling markets, the freedom Native Americans have in some places created a perfect storm of generational alcohol and drug abuse. Men here speak openly about their fathers and grandfathers giving them permission to drink at early ages — 12 or even younger. “I don’t care what you drink or when you drink it,” a guy about my age recalled his grandfather telling him as a kid. “So long as you don’t do them illegal drugs.”
For those who become addicted at early ages, the predictable progression of their disease lands them in treatment before they’ve had a chance to gain something in life that is painful to lose. Without the threat of divorce, job loss, or a child custody battle, these younger patients often find each other as enabling partners in crime. Recently I’ve been watching this pattern unfold.
It takes place in the form of sitting around at night, discussing the glory days of their substance use. Alcohol has a set price, is legal, and easy to find anywhere, so it tends not to be a discussion topic. It’s just not that interesting. But one evening I strategically sat near a few early 20-something guys in the TV room to eavesdrop on their conversation. As others quietly ate popcorn and watched scifi (in a future post, I’ll explore why addicts are so universally interested in scifi), this group spoke of the regional illegal drug marketplace with the same enthusiasm and tacit jargon of sports enthusiasts. So and so knew a guy who could hook them up with an Eight Ball for a good price. Better weed is found here, not there, as long as you don’t buy it from so and so. The Heroin from this or that place is cut with some nasty-ass shit — and so forth. Having never had contact with this marketplace that is hidden in plain sight, I found the topic fascinating. Clearly, our efforts to keep these drugs out of the U.S. is fruitless. I liken the so-called war on drugs to a concept in biology and medice. Whenever we put downward pressure on a population, the most intelligent and fastest to adapt survive, making that population ever stronger and more difficult to control.
One such survival mechanism caught my attention that evening, because it is a simple scam that enables heroin users to keep using — at the government’s expense. Addicts seek treatment for their problem at publicly-funded clinics. Some of them are held for a medically-supervised detox, then released with a prescription for a suboxone, a synthetic opiate that in theory allows the doctor to slowly and carefully titrate down the addict’s dose, so they don’t go into painful withdrawals. In a supervised setting, treatment with suboxone and subutex (a step-down drug from suboxone) can be effective. But addicts who receive it on an outpatient basis have figured out that they can sell the pills on the street for $15-40 each. They then can use that cash to fund their primary addiction. In essence, the very program intended to help them recover is helping them die sooner.
Earlier this year, I learned how addicts sell their food stamps for cash, essentially using yet another government program against themselves. This whole underworld is mired in a cycle of hopelessness that represents a greater cost to society than any of us can imagine.
Recovery is counterintuitive, so a next-generation war on drugs will also have to be counterintuitive if our country is ever to make headway away from this problem.
Recommended reading: The Spirituality of Imperfection, by Ernest Kurtz and Katherine Ketcham
Editor’s Note: The following post was handwritten by Kirk Klocke at Keystone Treatment Center in Canton, S.D. and transcribed, edited, and published by Cassie Rodenberg, an independent journalist in New York City who covers addiction, poverty, and other dark things happening in rough urban neighborhoods. Ms. Rodenberg publishes “The White Noise,” a Scientific American blog that focuses on the scientific, medical and social implications of addiction. Follow her: @cassierodenberg