51 pages • 1 hour read
Beth MacyDopesick: Dealers, Doctors, and the Drug Company that Addicted America
Nonfiction | Book | Adult | Published in 2018A modern alternative to SparkNotes and CliffsNotes, SuperSummary offers high-quality Study Guides with detailed chapter summaries and analysis of major themes, characters, and more.
Background
Geographical Context: Appalachia
Appalachia is loosely defined as areas through which the Appalachian Mountains run, as far south as northern Mississippi and as far north as southern New York. There is some debate about these geographical boundaries, but Appalachia is a useful term when it comes to discussing cultural connections among rural communities throughout the eastern United States. In Dopesick, Macy highlights the ways in which Appalachian culture made rural communities vulnerable to the opioid epidemic and the influence of Appalachian values on responses to the epidemic.
In popular culture, Appalachia is paradoxically both the birthplace of American myths about self-reliance and of poverty as a moral failing. In popular American history, European settlers in places like Kentucky and Virginia are portrayed as hard workers who civilized the wilderness, and their descendants are seen as the laborers responsible for extracting the coal and timber needed to industrialize America. The reality of Appalachia it has always been a diverse place which includes BIPOC residents whose labor and resources contributed to the consolidation and growth of the United States.
While hard work and self-reliance are certainly regional values, the collapse of resource-extraction industries like coal before the Great Depression in the 1930s led to a lack of economic opportunity and dependence on massive government programs to stem poverty and its ill effects. The federal government’s New Deal programs of the 1930s brought necessities like electricity to Appalachian communities, for example.
Ideological Context: Twelve-Step Programs
“Alcoholics” Anonymous (AA) is the most famous of the 12-step programs designed to support people who want to recover from substance and alcohol abuse disorders. “Narcotics” Anonymous (NA), the program used to support many people recovering from addiction to opioids, is modeled on AA. AA was founded in 1935 when Bill W. and Bob S., two white, affluent men, began meeting together to hold themselves accountable for maintaining their sobriety; NA was founded nearly 20 years later. According to its website at AA.org (2023), AA “has a simple program that works. It’s based on one alcoholic helping another.” NA’s mission is that “every addict in the world has the chance to experience our message in his or her own language and culture and find the opportunity for a new way of life,” according to their website at NA.org.
AA’s beliefs about addiction and recovery are detailed in Twelve Steps and Twelve Traditions, a 1953 book that describes the steps to sobriety and how to apply those principles to day-to-day life; these same 12 steps are at the center of NA. Working through those 12 steps requires a person seeking sobriety to admit that their lives are out of control due to addiction, believe that only a power higher than themselves could make life bearable, turn their lives over to that higher power, admit wrongdoing, ask forgiveness of that higher power and others for any harm done, rely on spiritual tools like prayer or meditation to sustain sobriety, and share this mode of recovery with others with addictions. Contemporary AA meetings and their partner recovery groups emphasize that one’s “higher power” need not be theologically Christian, but in practice, group culture reflects similar ideology.
In Dopesick, Macy highlights the prevalence of the 12-step model as an impediment to a scalable, effective system to support recovery. Macy describes the current rehabilitation industry as one that leads to inadequate support for people like Tess Henry, who was not able to stay in recovery by relying on 12-step programs alone. Henry also faced challenges because members of her meeting stigmatized her for relying on medication-assisted treatment. The “Narcotics” Anonymous pamphlet states this:
NA is a program of complete abstinence. By definition, medically assisted therapy indicates that medication is being given to people to treat addiction. In NA, addiction is treated by abstinence and through application of the spiritual principles contained in the Twelve Steps (“Narcotics Anonymous and Persons Receiving Medication-Assisted Treatment,” 2016).
The benefits of 12-step programs are that they are volunteer-driven and bring people from the same geographic community together for a common purpose—something especially important for rural and under-resourced communities where access to rehabilitation may be limited. However, critics of 12-step programs, like Macy, believe that strategies like harm reduction and medication-assisted treatment can provide more evidence-based support for people recovering from addiction without relying on preexisting spiritual beliefs or creating stigma around medication-assisted treatment.
