Karl Marx is credited with observing that, “history repeats itself, first as tragedy, second as farce.” It is hard not to remember this insight when reading the brilliant Addicts Who Survived two decades after its initial publication. After all, the year the book was published, 1989, was the same year Bush Sr. announced that the $2400 bag of crack he had in his hand was purchased (gasp!) directly across from the White House. Of course, the dealer – a high school student – had been lured to that spot by DEA agents in order to produce the theatrical prop. In the years preceding this stunt, crack had entered the public consciousness as it burned through poor inner city communities. The government had responded by setting mandatory minimum sentences for drug offenses and creating a legal disparity between crack and cocaine that led to imprisonment of the most vulnerable and stigmatized drug users. Meanwhile, HIV/AIDS rates were ballooning exponentially, and injection drug use was increasingly the mode of transmission. The most popular response to the problems associated with drug use and addiction was Nancy Reagan’s 1984 campaign to “Just Say No.” Her husband remained silent on the subject of AIDS until 1985, when he expressed skepticism about allowing HIV-positive children to attend school. Although early forms of harm reduction were emerging in the UK and junkies were unionizing in the Netherlands, the movement did not take significant form in the US until the mid- to late-1980s.
So when I bring Marx’s quote to mind, it is with the painful recognition that every farce is still a tragedy.
Marie Nyswander called the Classic Era of narcotics control “an artificial tragedy with real victims.” Calling addicts “victims” is important because victimization calls attention to the abuse of power that creates social injustice. It also implies helpless innocence and challenges the belief that addicts are dangerous predators or moral reprobates. As its etymology (“goat-song”) suggests, tragedy requires someone to bear the burdens of society’s ills and then, as any good scapegoat does, get pushed out of that society. The Classic Era seemed to have the same basic goal. The cost of social stigma and marginalization, as Nyswander noted, is measured in the lost lives of people who, with help, might have managed their habits and continued to live as productive members of society.
Addicts Who Survived, however, is not about victims; it is about survivors, and this is important too. Those interviewed refused to be tragic; they were scrappy, resourceful, righteous dope fiends who worked systems and relationships in order to live to old age. These addicts survived, and I believe the choice to use that term in the title suggests an important challenge to the political and social climate of the late 1980s and early 1990s.
The word “survive” resonated with a number of issues occupying the public mind at the time this book was published, including the inclusion of PTSD in the DSM III, second wave feminism, the arrival of ACT UP, the abstinence-based recovery movement, and the earliest articulations of harm reduction. These debates meant that the term itself was very much up for grabs.
The relationship between trauma and survival was amplified during the debate about including PTSD in the DSM III. When Vietnam veterans lobbied to have PTSD included as a legitimate diagnosis, they needed to shift its symptoms from a character flaw to a human response to trauma. In doing so, they were able to reposition themselves as victims of the war. The diagnosis also helped recognize that veterans were often as traumatized by what they had done as by what had been done to them. Complicating the relationship between victim and survivor through PTSD created the theoretical possibility that people can be both traumatizer and traumatized, agent and victim.
“Survivor” as an identity category was also emerging in the anti-rape movement, where women who were raped were no longer thought of simply as victims. The sex wars of second wave feminism also opened a conversation about stigmatized sexual behavior (including BDSM, pornography, and other transgressive pleasures) as those on the margins insisted on having their reality accepted as legitimate. Similarly, ACT UP also challenged the stigma of homosexuality in order for its members to emerge as righteous and fierce advocates for their own health and humanity.
Suggesting that addicts might remain addicts and still survive also challenged an assumption central to abstinence-based recovery movements like AA and NA. These groups insisted that unless an addict managed to become sober, he or she would die. Yet here were people who had remained addicted for decades during the harshest period of drug control to date, and they had survived.
Finally, survival must carry with it a certain pride. To survive is no small thing. Addicts who survived the Classic Era showed us both the power of humanity and the power of addiction. They embodied the impossibility of legal crackdowns masquerading as moral crusades and the necessity of creative yet realistic interventions like methadone maintenance.
This leads me to what I hope is the beginning of the end of our second, farcical era of narcotics control. Just say no didn’t work (again). Locking up addicts doesn’t work (again). Pushing them to the margins of society doesn’t work (again) and, indeed, it led to the rapid spread of HIV in those communities. But in the year before Addicts who Survived was first published, Tacoma opened up the first needle exchange and harm reduction started to take root (finally).
At its core, harm reduction is about respect. By paying respectful attention to the aging addicts who survived the era of Anslinger and his allies, David Courtwright, Herman Joseph, and Don Des Jarlais modeled the attitude that might have saved us from our tragic farce. If only we had paid closer attention, we might not have had to learn the same lessons a second time. Here’s hoping we have learned them for good.