Heroin Addicts Often Seem Normal

At least, they did to me ten years ago

I recently saw an online suggestion that to treat hard drug addiction, you could provide drugs publicly at government facilities, conditional on (inpatient) treatment afterward. The idea being that (extreme) drug addicts have very high time preference, and so will accept a hit now at any cost, even a cost that would forcibly break their habit soon after.

Instinctively, I doubt this would work for almost any addicts, as even the most far gone addicts are still human beings with human faculties who can behave strategically when they need to. But also, the suggestion is an example of analysis that thinks of the typical drug addict as, like, the sort of obviously crazy, addicted, and presumptively homeless person you sometimes see on the street.

In my experience, many addicts aren’t like that.

Two Case Studies

In the summer of my youth, I lived with two different opiate addicts. One was (and is) a close friend, and the other I liked but was mostly just a roommate. I won’t go into lots of detail since it feels icky to mine my friends’ lives for content, but I will say that I had lots and lots of roommates before moving in with my wife, and neither opiate addict was a particularly bad one. They washed their dishes, responded well to requests or criticisms of basic house behaviors, and weren’t nearly as responsible for the rat infestation as I was.

(Okay, fine. A pretty girl who had a pet rat heard we had a rat problem and brought some rat food to ostensibly… lure out the rat? I don’t even remember the pretext. Anyway we hooked up and the rat food ended up just kind of left out. In the open. For the rats. Ah, to be young.)

I was pretty tangential to the social scene my addicted friends were part of, but they had friends over sometimes and some of them were closer to the stereotype for people with a drug problem; one guy in particular would occasionally steal things (though never from our house, that I recall), and was generally quite stressful to be around. But I had no idea one of my addicted friends had a drug problem, even though I lived with him during pretty serious crisis in retrospect.

Nor do I think I’m especially oblivious! I sometimes perceive things like subtle intra-relationship needling that my wife misses among our friends, and in general I’m a bit of a people pleaser and try to remain attuned to social cues. If anything kept me from seeing my friends’ addictions, it was that doing heroin seemed so beyond the pale to me that it was hard to imagine anybody going down that road.

Even in the case of the roommate who did more obviously have a problem, it didn’t really feel like a crisis from the inside. He’d just sort of invite shady people over to hang out in his room, then fall asleep with them over. Yes, yes, obviously bad stuff was going on there in retrospect, but it wasn’t like he looked gaunt, or like there were any obvious physical signs of drug use anywhere. There were bad specific moments, like one time he passed out in front of the house, but that was fairly indistinguishable from stories about alcoholic acquaintances, rather than a sign of something as directly lethal as heroin addiction. I mostly learned how bad it was when that roommate, feeling bad about exposing us to such behavior, spontaneously evicted himself. Alas, his subsequent attempts to get clean failed, and he died a year or so later.

But even that guy - may he rest in peace, really a sweet person - was way more obvious than my closer friend, who played video games with me almost every day, had a girlfriend and job, and maintained a seemingly normal and functional life while risking his life regularly.

In fact, having seen opiate addiction really get its claws into a community from a wallflower’s point of view, the distribution seemed pretty bimodal. The most dysfunctional people tended to get hit, and a smattering of highly functional and friendly people tended to get hit, though you’d only learn that years later, or when they died. Of course, for all I know people in the middle got hit too, and I just never learned it.

The Point

I’m not sure I have one.

I see a lot of discourse about addiction, but, like most discourse, it mostly radiates out from major cities. Major cities are where lots of the wealth is, so they attract a lot of beggars, and therefore a lot of the least functional drug addicts. So successful people living in major cities probably have a mental template of “drug addict” that looks like a raving guy pushing a stolen shopping cart around, or something. And indeed, when I visit major cities I see many such people, and living in a minor city I see a few.

But drug addiction, and drug use more broadly, is way more complicated than that. It’s fine to want to address the “roving unstable beggars who do lots of petty crime” problem, insofar as that problem exists, without also wanting to help address the “lots of random 25-year-olds suddenly die out of nowhere” problem. But in fact both of these problems fall under the “drug addiction” umbrella, and you can’t make good policy around drug addiction writ large without keeping both in mind.

Also I guess I just want people to understand that not every heroin addict is either a death of despair or a person suffering from a cocktail of serious untreated mental disorders. In fact, about half the heroin addicts I knew have fully recovered. Maybe the most surprising thing is how the distribution of recovery overlaps with the entire distribution of mid-addiction stability. My friend is totally fine now, and so is the guy who stole stuff and caused lots of problems. Meanwhile, my other ex-roommate is dead, and so is the second-most-problem-causing addict I knew at the time. This stuff just kind of hits a seemingly-random subsection of entire communities, and of the people hit, about half don’t make it. I’m not sure what to do about that. But it’s probably not simple.