America’s Opiate Epidemic

Rev. Sheri Heller, LCSW

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The lovely brightly colored poppy flower, known by Sumerians as the flower of joy, is the source of a tragic opioid addiction epidemic in the United States. To a great degree, this jarring reality is an outcome of prevailing neoliberal economic policies and the overriding supremacy of the profit margin.

This economic landscape has contributed to the collapse of fundamental traditions and community-based values, along with a broken infrastructure, unaffordable healthcare, the lack of subsidized housing, the dismantling of social services and vast economic disparity, along with dramatic spikes in unemployment and poverty. Furthermore, the blight of lockdown measures due to covid-19 and the resultant trauma of isolation and loneliness has exacerbated depression, anxiety, domestic violence and child abuse. The result is collective fear and despair. Consequently, addiction and suicide are dramatically on the rise.

In fact, according to a Centers for Disease Control and Prevention (CDC) report the number of overdose deaths in the US from synthetic opioids surged 72 percent from 2014 to 2015. CDC data reveals that heroin overdose deaths in the US have reached epidemic proportions, rising 5,000 since 2014, surpassing 30,000 for the first time in recent history.

Although the opioid crisis is clearly much too complicated and nuanced to attribute to any single factor, America’s pharmaceutical industry has certainly played an instrumental role in fueling the addiction crisis. Originally painkillers such as oxycontin were fraudulently introduced by companies like Purdue and Johnson and Johnson as non-addictive. Purdue’s production of oxycontin and its aggressive marketing has proffered billions of dollars in revenue. Since Johnson and Johnson has a patent for a unique strain of opium poppy, they are a leading supplier for Purdue. Disseminated by the healthcare community through medical prescriptions, opioid misuse or addiction is initiated. When these addictive painkillers become too expensive to purchase, folks turn to heroin or even worse, synthetic opioids like fentanyl and tramadol.

Colossal military spending as opposed to financing public health concerns further exacerbates the struggles facing Americans.

This litany of unfortunate repercussions has all contributed to the ubiquitous reliance on opiates. It has become increasingly more challenging for Americans to live healthy, dignified lives. We are in a state of crisis.

Alcohol and drug abuse along with intimacy disorders (process addictions) were an integral part of my life as a survivor of complex trauma. My path of recovery coincided with being offered a job fresh out of graduate school at a comprehensive day treatment program for addiction. It was there I discovered my professional niche.

It’s no surprise when I recall the 1980’s and early ‘90’s in the public sector of addiction treatment and mental health facilities in NYC, I’m reminded of how the folks I rendered treatment to were markedly different than the folks I currently treat in private practice. Back then crack cocaine and heroin were the culprits. The clients I worked with in the public sector were disenfranchised and underserved. Many were mandated through the prison system and child welfare. The majority of my clients tested positive for AIDS. Alternatively, the provision of psychotherapy in a private practice level of care requires a modicum of remission from addictive disorders, gainful employment and sufficient housing. It also requires financial solvency and the possible utilization of outpatient mental health insurance benefits.

Yet collective moral judgements about addiction are as prevalent today as they were when I started out in the field, irrespective of demographics. The major difference, however, is that prior to the inception of managed care (Clinton), resources and healthcare were far more abundant for indigent addicts. The men and women I treated were afforded the opportunity to receive full disability benefits while undergoing a comprehensive, hospital-based five-day a week, morning to late afternoon program, inclusive of group, individual therapy, detox, vocational counseling, creative arts therapy and psychiatric services. This sort of cultural milieu was a critical component in neutralizing the toxic shame that fuels addiction and further alienates and isolates the addict. It afforded the kind of quality care that is no longer available to those who are impoverished or even lower middle class.

The absence of quality comprehensive treatment and services further marginalizes and dehumanizes addicts. Rejected and on the fringe, the addict plummets into a state of self-hate and condemnation. The label of social deviant is embodied as one’s identity. This leads to ascribing to a cultural underground where addiction is normalized and glorified. The conventional landscape of psychiatric care is viewed as part of the establishment that ostracized the addict in the first place. This us-them dichotomy makes it more challenging for addicts to trust those who are seen as part of the system. The internalization of stigma exacerbates the alienation of the addict, accordingly hindering the impulse to reach out for help.

Although it is but one element in a chaotic ocean of complexity, the acquisition of a basic understanding of addiction as a mental illness (DSM V, NIDA, APA) could certainly assist with diffusing the censure and blame that impedes the provision of treatment.

Suffice it to say, people don’t get hooked on opioids by popping a single pill, albeit folks who require pain management due to medical conditions can easily become hooked, especially if homeopathic and non-addictive means are not prescribed by healthcare providers. Nevertheless, it is always important to make the distinction between pain-related dependence and addiction.

Addiction is a three-fold disease of mind, body and spirit. Addictive agents, be it opioids, sex, food or gambling, are merely catalysts. A combination of biochemical and genetic predispositions, along with systemic environmental and familial influences influence the inception of an addictive disorder. Comorbidity also plays a big role. The psychological and spiritual need to fill one’s emptiness or regulate a limbic system steeped in fight, flight, freeze reactions also contribute to developing a dependency on a mood-altering substance.

From a psychological perspective, addictions are conceptualized as attachment disorders. This connotes an absence of primal bonding, which results in a desperate, persistent need for attachment and love. In the absence of primal bonding, the child is driven to derive wholeness, cohesion, connection, power, and love through a compulsive attachment to self-will. Hence, a mystified idealized false self forms, shielding the relationally traumatized child from the reality of toxic shame. This false self-system buffers the child from the terror of abandonment panic while offering the illusion of wholeness. Ultimately isolation, separateness, and an inability to experience oneness results, and the primal need for connection, and the agony of its deprivation, lead psychologically to the emergence of the addict.

This trajectory suggests that the link between trauma and addiction is undeniable. Indeed, in the three decades, I’ve treated addicts in detox and outpatient settings, intense flooding, dissociation, and flashbacks due to severe complex trauma was evidenced. Intertwined with acute and protracted withdrawal symptoms, the addict’s body speaks of unprocessed traumatic abuse through chronic hyper-arousal as well as through difficulties sleeping, feeding, and overall disruptions with biological functions. States of dysphoria; confusion, agitation, emptiness, and utter aloneness, further amplify the disregulation of the body. Establishing a modicum of sobriety, ego strength, and sustaining networks of support are critical pre-requisites to approaching extensive trauma work.

On a metaphysical level addictions are a misguided search for self-love and spiritual fulfillment. Founder of analytical depth psychology Carl Jung described alcoholism to A.A. co-founder Bill W as a spiritual disease, which has at its base a drive for wholeness. Jung related that it is our alienation from who we are that is the source of our brokenness.

Being that primal bonding reminds us of our sacredness, its absence fosters the belief that we are disconnected from our divinity. The mood-altering substance affords a momentary ecstatic experience of transcendent bonding which subconsciously harks back to the primal bonding that was absent with the mother. Hence, the object of addiction becomes God as it offers the temporary ‘fix’ of wholeness.

As Gandhi conveyed, to a starving man God is a piece of bread. For the addict driven by an insatiable craving and the urgency to seek relief from tremendous shame and intrapsychic fragmentation brought about by the absence of primal bonding and complex trauma, God is a mood-altering substance.

Lastly, we certainly can’t adequately address the ravages of the opioid epidemic without acknowledging trafficking. After all, the drug trade is a multi-billion dollar operation, third in commodity value after oil and the arms trade.

In examining the Taliban Opium Eradication Program in 2000 (with the support of the United Nations), which destabilized the multibillion-dollar worldwide trade in heroin, we are led to question how the U.S. led invasion of Afghanistan in October 2001 restored the heroin trade. If the Taliban isn’t transporting 90% of the world's heroin from Afghanistan it stands to reason that the U.S.- NATO occupation forces that are ‘guarding’ the poppy farms are complicit with CIA drug trafficking. Indeed, the laundering of drug money can be traced back to covert CIA operations (with George Bush Sr. at the helm as CIA director) in Afghanistan in 1979, in support of the Mujahideen rebels. The Iran Contra Scandal and the Golden Triangle during the Vietnam war are also evidence of CIA involvement in drug trafficking.

Like death and taxes, for reasons ranging from the psychological to the economic, addiction is an inevitable fact of life. However, a humane approach that systemically examines etiology on biological, social, and psychological levels and is supported by legislation and funding for treatment could certainly make a huge difference. This would entail an emphasis on child welfare laws that protect children from systemic abuse, housing, healthcare, daycare, shelter, and disability benefits for addicts who require intensive treatment. Vocational and educational services to facilitate marketable skill development and job placement and transitional services for forensic populations could also potentially lead to stabilization.

Of course, educating doctors about the ASAM criteria and ensuring stringent monitoring of prescriptions could certainly help restrict opiate use. Given that a study found primary care clinicians write 45% of all opioid prescriptions in the United States, guidelines to limit opioids as a first approach to managing most chronic pain is certainly warranted.

Unfortunately, I am not optimistic that the lucrative benefits of drug trafficking will take precedence over necessary reforms geared towards mitigating drug use and boosting the availability of addiction treatment. Along the same lines, the movement of Transhumanist philosophy suggests a trajectory towards greater isolation and further deterioration of our basic humanity, ironically by becoming through genetic modification, ‘better’ humans. This trend causes me concern about the already rapidly decaying values of family, work, community, and charity.

Driven by greed, ecological collapse, and the omnipresent threat of nuclear war and pandemic starvation, people are desperate and lost. Basic municipal services are lacking and a profit-driven corrupt healthcare system ensures that medical treatment is substandard. Fear and impotence have taken root. This climate of impoverishment makes the lure of addiction appealing. It seems to me we may just have to crash and burn before the possibility of real recovery (or perhaps revolutionary reforms) will occur.

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As a survivor (and thriver) of complex trauma and a seasoned therapist specializing in treating complex trauma, narcissistic abuse syndrome and addictions, I am intent on creating content that affords informative insight, hope and healing from psychological disorders. I aim for my creative content to assist readers with tapping into the resiliency of the human condition while recognizing the countless challenges of being human.

New York City, NY
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