Abstract
Psychologist and professor of sociology Charles Winick observed back in 1962 that as people get older, their drug use often abates as they assume responsibilities and lifestyles that require their time and attention and they learn to cope with the circumstances that may have led them to self-medicate in the first place. In Hurt: Chronicles of the Drug War Generation, sociologist Miriam Boeri explores the lives of people who, contrary to Winick’s prediction, began or continued to use drugs in their thirties.
Boeri draws on interviews with 38 people who were 45 to 65 years of age and who had used heroin, cocaine, and/or methamphetamine at some point in the last ten years, even if they were not currently using them. Boeri supplements these accounts with insights, experiences, and observations of her brother Harry. In particular, Boeri considers how the War on Drugs affected people’s lives, including but not only their drug use.
The War on Drugs, launched by President Richard Nixon some 45 years ago, has continued virtually unabated to the present day. Since the 1970s, U.S. drug enforcement has relied on stop-and-frisk, the militarization of the police, the arrest and incarceration of millions of people, harsh sentences, and surveillance and punishment more broadly under the guise of reducing the illegal drug trade. Hurt makes the case that the War on Drugs hinders baby boomers who have a substance use disorder from “maturing out.” Lives punctuated by periods of incarceration, drug treatment, and court and community supervision leave many people with little time to engage in social roles or social activities to replace those that had accompanied their continued drug use. Furthermore, the dismantling of social supports in favor of punitive, individualistic approaches has curtailed opportunities for people to address the trauma and circumstances that may have led them to misuse drugs in the first place.
Hurt challenges many assumptions about substance use, substance use disorders, and the people who use and sometimes misuse alcohol and other drugs. Taken individually and collectively, the accounts highlight that, like many other human behaviors and experiences, substance use, use disorders, and recovery rarely follow a linear progression, but instead are marked by changes in the type, amount, and context of drug use. Lapses and full-bore relapses are an expected part of recovery. Twelve-step programs and abstinence-only programs are of questionable value. Behaviors do change when support and buffers are available to people. Stability, particularly with regard to housing, health care (including treatment with methadone and buprenorphine), and income, allows people to pursue goals and improve their quality of life. A careful reading of the book also reveals that people use substances for many different reasons and that drug use is not always or inherently problematic and not infrequently may provide some benefit to a person.
The book is ambitious in its scope and coverage, featuring chapters examining how historical and social context, relationships, and criminal justice system involvement, as well as race, gender, and aging, figure in the lives of individuals. The firsthand accounts will sound familiar to many who have experienced or witnessed problematic use of alcohol and other drugs. They show how individuals attempt to navigate life with an alcohol or substance use disorder in the face of structural obstacles and trauma, as when Victoria delineates her systematic process for finding tricks or Elijah describes the pain of missing his mother. The influence of housing and income support (or the lack thereof), abandonment, violence, and incarceration are also documented with sometimes numbing repetition.
In the last chapter, Boeri calls for disentangling treatment from law enforcement (and, presumably, court supervision and punishment). Funding dedicated to enforcing drug laws should be reallocated to public housing, comprehensive evidence-based treatment, and other social services. Boeri includes harm reduction along with community-based initiatives and “Housing First” as examples of approaches that work. Here, too, she draws on her brother Harry’s experiences to highlight the need for “social recovery” to support people in developing or restoring their social capital and to assist them in becoming integrated into conventional society.
While an ambitious undertaking, Hurt falls short in some ways. Boeri conflates substance use and substance use disorders in places and occasionally uses reductive and stigmatizing language such as “drug users,” “heroin addict,” and “convicted felon.” She raises important subjects (e.g., how individuals internalize self-blaming rhetoric, the limits of abstinence-based approaches and the “12 steps,” the role of being an African American or a woman) but then discusses them in a skirting or superficial way. The narratives reveal many of the factors, contexts, and mechanisms that influence people’s use of drugs and overall well-being; awkward organization within and across chapters, however, makes it difficult for the reader to get a clear handle on the significance of the findings and how they connect to one another.
Criticisms of the War on Drugs and its consequences abound. Works such as Boeri’s that document the specific impact at the level of the individual are less common. Far from reducing the harms associated with problematic or chaotic drug use, the strategies of the War on Drugs are themselves a source of harm, diverting resources and undermining ties to people and social institutions that make change and self-actualization possible, even likely. This finding, which Boeri makes explicitly clear, is arguably the book’s greatest contribution.