A 12-Step Program to Opioid Justice

It was evening and we were in a windowless room in a Massachusetts jail. We had just finished a class--on job interview skills--and, with only a few minutes remaining, the women began voicing their shared fear. Upon their release, would someone really hire them? Beneath that concern lurked another one: Would they be able to avoid the seductively anesthetizing drugs that put them in jail in the first place?

Their disquiet was reasonable. Everyone with me around that grey plastic table, along with the vast majority of other prisoners in the jail, was addicted to opioids. On the cinderblock wall, a laminated sign read: "We take stock of all the suffering we have experienced and caused as addicts."

Those drugs, including OxyContin and fentanyl, have killed hundreds of thousands of Americans, while entangling untold numbers of others in addiction.

Thousands of lawsuits are making their way through the court system in an effort to force some kind of repayment from the corporations that manufactured, distributed, and dispensed billions of doses of prescription opioids. Those drugs, including OxyContin and fentanyl, have killed hundreds of thousands of Americans, while entangling untold numbers of others in addiction (and, often, in illegal activities like larceny to pay for the drugs they then craved). The pharmaceutical companies involved have, unsurprisingly, been eager to deny their culpability, which has led to a vast blame game that's routine in our republic of finger pointing.

When a surge of opioid addiction transformed my small New England hometown, I began to write about what was happening and follow local efforts to combat the scourge. This, in turn, led me to that jail, first as a writer on assignment and eventually to the front of that ad-hoc classroom. At the same time, over the course of two years, I interviewed dozens of people in recovery. What I learned was that, nestled within this crisis (if you knew where to look), people were taking responsibility for what had happened to them and doing so in a transformative way. They had discovered that blaming others--even the worst of those drug companies--was a quick path to the bottom, while taking responsibility turns out to be a race to the top.

The "Scum of the Earth"

On a sunny fall morning, I pulled off Route 2 in central Massachusetts and into the parking lot of what used to be the Wachusett Village Inn. It still looks like a picturesque country hotel, but today it's a detox facility and recovery center. I'm here to meet the friend of a friend. When she greets me at the front atrium, I notice that she has a lanyard around her neck with an ID indicating that she's on staff. Years ago, though, Anna Du Puis could have been a patient here. Before she got sober, she went through detox for opioid addiction so many times she lost count.

"I'm a story of perseverance," she assures me--and, when she says it, she seems to glow with energy.

It's only recently that Anna has had this full-time job helping others who are, as she once was, in early recovery. Before that she sold insurance, telling no one she had been an addict and regularly hearing coworkers and others dismiss addiction as a choice and treatment as a waste of taxpayer dollars.

Thought about a certain way, the pharmaceutical companies that produced those opioids pulled off the perfect crime. They peddled addictive products that were prescribed by trusted physicians, while those who became addicted gained scant sympathy. After all, once they were hooked, they were, by definition, drug addicts. Richard Sackler, former president of Purdue Pharma and mastermind behind the marketing campaign that launched OxyContin and remade opioid prescribing practices in this country, is now infamous for referring to those who became addicted to his blockbuster drug as the "scum of the earth."

For this we vilify Sackler--what he did was deplorable--but it's also true that every time any of us has accepted drug addict as an unsavory epithet, we've given an assist to him, to Purdue, and to the rest of the pharmaceutical industry that profited not only from addiction but from our prejudice toward it. By looking down on those afflicted with this disease, we, the public, helped insulate corporate perpetrators from responsibility.

In the process, we have also missed the chance to witness something incredible.

"A Searching and Fearless Moral Inventory"

On another night in the county jail, our little group strategized together. These women would soon have to explain their criminal records to prospective employers who increasingly run background checks on applicants. So, quietly at first and then with more confidence, they practiced reflecting on their pockmarked pasts, affirming how much they had learned (a lot) and their efforts (herculean) to regain control of their lives. All of them referenced the importance of embarking on a 12-step program to recovery.

This is something I heard again and again from people in long-term recovery. Beginning with an admission of powerlessness over addiction, 12-step programs are so often transformational in part because they involve radical responsibility-taking. Even when something is someone else's fault, the steps encourage you to look inward and ask: What was my own role? What responsibility do I have in all this? A pivotal moment comes in step four, which calls for "a searching and fearless moral inventory" of oneself. This is a breathtakingly tall order--and one that pays commensurately large dividends for those with the courage to undertake it.

"I accept myself wholly for who I am and every single thing that I've done in my life," says Raj Aggarwal, who became addicted to OxyContin in the 1990s and subsequently switched to heroin. When he made that switch, he told almost no one. Whereas Oxy, which was widely prescribed by doctors, was socially acceptable, heroin was not. Like so many others, the deeper Raj waded into addiction, the more isolated he became.

Today, he has been sober for more than 15 years, and his enviable self-acceptance has liberated him to be a force for good in the world. Raj is the founder and president of Provoc, a Washington, D.C.-based organization that helps businesses create positive social change. Provoc has designed successful campaigns in areas ranging from expanding clean energy and combatting racism to boosting voter participation. Over video chat he told me that he used to think addiction was the worst thing ever to happen to him. Now, he says, "My greatest challenge has turned into a tremendous source of strength."

The soul-searching that Raj and others engage in as part of their recovery process is not only applicable to addiction. Let's say you're angry about something devastating a family member said, or a colleague's poor behavior, or maybe you're despondent--who isn't?--over our broken democracy. Consider the 12-step approach to investigating your own role in the situation. This doesn't mean other people aren't responsible, too. It just gives you a shot at seeing your actions (or your lack of them) with greater clarity. In other words, it allows us to own our shit--and then, perhaps, to take the next right step forward.

This is largely a foreign concept in our culture, at least to people who aren't in recovery, but its promise is bottomless. As one example, it's relevant to the problematic way the media have covered the current opioid crisis. When addiction is rampant in communities of color, the subject tends to draw minimal attention. But in recent years, as great numbers of white people have been afflicted, the media have zoomed in with stories of blue-eyed kids dying untimely deaths. And this is a place where I bear responsibility. I took up the subject of addiction only after it enveloped my overwhelmingly white hometown. In other words, I initially focused on (and so privileged) the concerns of people white like me. In retrospect, 12-step-style, I see what I did and that it reinforced the white supremacy that drenches our American world.

Maybe you've heard this one from the visionary novelist James Baldwin: "Not everything that is faced can be changed. But nothing can be changed until it is faced." Here lies the key to overcoming the opioid crisis: that people in recovery are teachers for how to face the hardest things of all.

"As Long As You're Breathing, There's Hope"

When he filed his complaint against Purdue Pharma, Minnesota Attorney General Keith Ellison said, "The Sackler defendants were motivated not by human dignity or the value of human life, but by unlimited greed above all else." Billionaire Richard Sackler unrelentingly pushed addictive drugs that destroyed lives and pulled at the threads of unraveling communities. Why? To make yet more money, of course. It turns out that, in this story, there are many kinds of addiction, and if money is your drug of choice, then (as the recent responses of multi-billionaires to the possibility of a wealth tax suggest) you'll never have enough, no matter how much you've amassed.

And so, while we malign the Sackler family and other corporate executives for what really does appear to be jaw-dropping greed, their condition is instructive. At a more modest level, many of us are skating along, feeding ongoing cravings for electronic devices or wine or work or money or just fill in the blank yourself. Like minor versions of those billionaires, we, too, are often chasing a high--a brief sense of euphoria to distract us from something underneath.

Anna Du Puis told me that her drug use was a search to fill an "internal barren place of desolation." Raj said OxyContin offered him blissful relief from his difficult childhood as an immigrant in a white neighborhood. In many thousands of cases, opioid addiction resulted from people in chronic pain searching for an answer. Yet there are many kinds of chronic pain, including despair, or a crushing sense of emptiness. Maybe the Sacklers, nightmares of greed as they have been, are in some deeper sense more like us than we'd care to think.

There is now a growing call to put them and other pharmaceutical executives in jail. After all, why should people who committed low-level crimes thanks to their addiction to the very drugs the Sacklers peddled, like the women in my class, get locked up, while they walk away with blood on their hands and billions stuffed away in bank accounts? The answer mostly has to do with who has good lawyers. Just as in the financial and foreclosure crises of 2007-2008, when corporations inflicted widespread devastation, we are unlikely to see executives behind bars for what their companies did.

And yet, as Sam Quinones, author of the remarkable book Dreamland about the roots of the opioid crisis, points out, the public has already won important victories. Back in 2014 when he was finishing his book, he says, Purdue was "untouchable."

In the years since then, individuals and families have rejected isolation and spoken out about drug addiction. Their outcry, in turn, has transformed the problem from something taboo into a priority for local governments--and thousands of lawsuits have been the result. Quinones acknowledged that pharmaceutical companies will likely never pay anything close to the full cost of what they've done. And yet, as he told me by phone, "We have probably seen the last of Purdue Pharma the way it once looked, and that right there is stunning." He's right: that is no small feat.

Still, there's something else that future settlements could require, something that Raj Aggarwal sees as a potentially just approach. What if a team of people in recovery from drug addiction were enlisted to teach the pharmaceutical executives what it really means to take responsibility? It's an idea that honors those whom they most victimized, while giving the perpetrators a framework for grappling with what they've done and beginning to make amends.

Imagine the Sacklers embarking on a searching 12-step moral inventory of themselves. (I, at least, fantasize about this.) Cynicism tells us that, even if this were to come to pass, a group of white-collar criminals would never listen, but Anna Du Puis takes a more charitable view. "As long as you're breathing, there's hope," she told me.

I learn so much from people in recovery that sometimes I think my head will explode. Instead what happens is that my heart grows.

At the county jail, we finish our final class in that windowless room and the women file back to their cells. They will soon be released. Even though I know the odds are against them, I allow myself a tiny serving of optimism. Maybe, eventually, they will be viewed as true teachers among us.