Social Trust and the Heroin Epidemic

Since I first moved to southwestern Ohio five years ago, the heroin epidemic has gotten worse. As the Washington Post reported last week, some counties in Ohio have had to resort to temporary “mobile morgues” due to the high number of overdose-related deaths.  

In my working-class town, it is hard to miss the daily signs of this epidemic. There are the sirens, the police cars, the billboards soliciting information about dealers, and the “Go Fund Me” pages shared on Facebook to raise money for funeral expenses. There are the people who walk the streets “looking like death” as my neighbor put it—their bodies gaunt and ghost-like, hollowed out. Recently, I found a needle in the street close to where I park our family minivan.  

On my kitchen table is a vase with a large white rose and a cluster of smaller pink ones, a memento from a funeral I attended a few weeks ago. The woman, age 29, died of an overdose and left behind a four-year-old daughter, who on the day of the funeral went twirling about from family member to family member, her long blonde curls whipping in the wind at the gravesite, too young to really comprehend her loss.

In the span of two weeks in our small town, there were three funeral processions winding their way up cemetery hill, the culprit of each an opioid overdose. Lynn, 25, and a recovering addict herself, estimates that she has been to at least one heroin-related funeral per month in the past year.

The credit union around the corner—the one that I walk to regularly with my sons who love to beg the tellers for lollipops while I make a deposit—was robbed twice by the same suspect in the course of a week. Talk is that it was a man looking for drug money. 

To hear people talk, drugs have transformed the community from a town in which no one locked their doors to one in which you can no longer trust your neighbor.

Lynn feels that the world is getting worse, that her generation is all but hopeless, that the government doesn’t care about addicts dying on the streets and perhaps is even to blame for dropping fentanyl in heroin as a form of population control. As she talks, a dark portrait emerges. She shares this pessimistic worldview with some other young adults in her town, like the young man who posted on Facebook, “What’s this world coming to?!” with the hashtag #littlefaithleft.  

I was with Lynn on inauguration day as she sat in her grandma’s garage watching Fox News, and I’ve wondered since if the harsh realities she sees in her community made her more amenable to Donald Trump and what many media reports described as his “dark” tone. As Christopher Caldwell points out in his recent First Things piece, “American Carnage,”

A willingness to at least talk about opioid deaths (among other taboo subjects) surely helped Donald Trump win last November’s election. In his inaugural address, President Trump referred to the drug epidemic (among other problems) as ‘carnage.’ Those who call the word an irresponsible exaggeration are wrong.

In the case of the heroin epidemic, the “carnage” is literal, resulting in death, but it is also social, as in the loss of trust. The heroin epidemic is most severe among poor and working-class whites, and this same demographic has significantly lower levels of social trust than their college-educated counterparts. The heroin epidemic is surely not the only or even the main cause of this trust gap, but I wonder if it is not part of the story.

Perhaps it is little surprise that amid this backdrop of low social trust and dark realities, this demographic of young adults is struggling to form stable relationships and families. As I reported in my last post, “Casual Sex and the Crisis of Trust,” 71 percent of the non-college-educated young adults my husband and I interviewed in southwestern Ohio described some form of “trust issues” in a romantic relationship. And as Lynn told me, she wants to believe that love exists, but she says that “having a loving family is not guaranteed.” You never know if your spouse will “be gone tomorrow.” Of her experiences with heroin and the way it has robbed those closest to her, she says, “I was already an agnostic person about everything, and now I’m even more so. I feel like I’m questioning everything.”

To be sure, the crisis of trust is partly the legacy of the sexual and divorce revolutions, not just the drug revolution. But there seems to be a relationship that goes both ways between social distrust and family breakdown, with trauma in the family contributing to low levels of social trust, and low levels of social trust making it more difficult to form stably attached families. Beating the heroin epidemic could help to strengthen families, both because of the spillover effects of stronger social trust and because it would help individual families struggling with addiction. Likewise, a thriving marriage ecosystem could help alleviate the heroin epidemic in the long run, if it is true that trauma makes a person more susceptible to addiction.  

This is where Christopher Caldwell’s otherwise fascinating analysis fell somewhat flat for me. “Moral condemnation,” he writes, “is an incomplete response to the addict. But it has its place, because it does the addict the compliment of assuming he has a conscience, a set of thought processes.” He sees “the deeper problem” of the heroin epidemic as the cultural renunciation of “our allegiance to anything that forbids or commands.” But in small towns across America, the stigma against users is already strong. To paraphrase what one longtime resident once told me, towns are divided by those who go to church, and those who use drugs. And, for recovering addicts like Lynn, that is part of the problem. Others judge her with phrases like “once an addict, always an addict” and for her to break back into the social fabric of her town, to regain trust, even the trust of family members, is difficult.

Lynn would agree that she needs tough love and accountability, but she also stresses the need for grace and for genuine second (and third and fourth) chances. Mostly, she wants people to start noticing the crisis in a way that allows them to begin to understand the “roots” of addiction, the reasons an addict does what she does. She wants people to stop simply blaming the addict and instead start seeing the addict’s need for healing and community. Sermonizing does little to actually stop the problem if the failed attempts of programs like D.A.R.E.—“Just say no!”—are any indicator.

The other day, as she sat in the passenger seat of my minivan, which was somewhere in the middle of the funeral procession, Lynn grew angry as she watched cars whizzing past. “Don’t they know that it is a sign of respect to stop and honor the dead?” she demanded, adding that in the Kentucky town she once lived, people know better. “Not many respectable people left in the world,” she sighed.

The cry I hear from young adults like Lynn is for their struggle to be noticed, affirmed, and honored. As Caldwell says, we must pay the addict “the compliment of assuming he has a conscience,” and we must “reckon with why addicts go to such lengths to continue suffering.” To do so will require something different than moral condemnation. It will require stopping—stopping to listen, learn, and strategize solutions together—instead of whizzing by an inconvenient crisis.