Great White Fright—The Addiction Devastation of the Middle Class

By Zachary Siegel 11/08/15

A new report shows the very real results of the collapse of the working class.

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Anyone affected by substance abuse needs to read this alarming report. The middle class is being decimated, but not by diabetes, heart disease, cancer or any of the other usual suspects. It’s drugs, alcohol, and suicide that are the primary drivers behind the shocking mortality rates for middle-aged, white Americans with no more than a high school education. 

As a society, we deem substance abuse and suicide to be the expression of both personal and social crises. This report forces us to acknowledge the current social conditions that, while negatively impacting this particular class, we nonetheless feel as a collective. 

Such disturbing findings bring to mind the work of French sociologist Émile Durkheim, who in 1879 meticulously cataloged suicide. By default, we think of suicide as an individual act. But Durkheim observed that suicide takes different forms, one of which is in a social phenomenon he termed, anomie suicide. What this meant for Durkheim is a rapid collective derangement, one which results in fatalistic suicide. What this report reveals is not the death of individuals but death en masse. 

Durkheim’s concept is fitting, given Americans in this socially isolated group have seen an increased 134 deaths per 100,000 people from 1999 to 2014. That means “half a million people are dead who should not be dead,” Dr. Angus Deaton, recent Nobel laureate who co-authored the report with his wife Dr. Anne Case, told The Washington Post. 

Many of these deaths stem from overdose (opiates), cirrhosis of the liver (alcohol), and suicide. Drinking oneself to oblivion or nodding away the days on pain pills is in itself a form of resignation, not dissimilar from actual suicide. 

What’s happening to this class of mostly middle-aged white men, whom contemporary identity politics—mainly coming from leftists—view as exemplars of wielding unjust privilege?  

“At this point, we don’t have answers,” Dr. Case told The Fix. “We know that the mortality rate increases are largest for those with a high school degree or less, which is the group that has suffered the most economically,” she said. 

The Fix’s Professional Voices editor, Dr. Richard Juman, is in agreement with Dr. Case’s analysis. “This is a group of people that likely expected to be doing better at this point in their lives than they are,” he said. “Economic forces such as globalization, the outsourcing of certain kinds of jobs that this group would previously have occupied, and the increasing reliance on technology have all likely contributed to making things a bit tougher for this group.” 

Professor Greg Scott, a sociologist and documentarian at DePaul University in Chicago, said to The Fix, “That group, that’s my generation. I’m right in there, I’m 47-years old.” 

That drugs are the culprit is intriguing to Scott, who has made a career of filming and working alongside Chicago heroin addicts. “Drugs fascinate me sociologically,” he said, “because they’re always a really interesting optic through which to examine any social issue. If you want to understand capitalism at its rawest, go to a drug community.” 

The lack of capital this group is facing is unanimously considered to be what’s causing the high mortality. A quote from Durkheim, which dates back to 1879, eerily encapsulates what we may be experiencing in 2015: "To pursue a goal which is by definition unattainable," Durkheim concluded, "is to condemn oneself to a state of perpetual unhappiness."

The unattainable goal in mind here: the American Dream—if you work hard, play by the rules, you will beat the odds and come out on top. But the current middle-aged white crisis is telling us that both morally and politically, something is deeply awry in American communities. Or as Marcellus in Hamlet said, “Something is rotten in the state of Denmark.” 

These economic drivers are easily quantifiable. Median household incomes for those with a high school diploma or less fell 19% between 1999-2013. While the average GDP per capita has increased by 16%, people at the bottom have not seen any growth in earnings. Those at the top, of course, get rich in a winner-take-all society. 

“It was once the case that with a high school degree a person could find a ‘good’ job, with benefits and job security,” said Case. “Many of those jobs are gone, and aren’t expected to return any time soon. We think this is likely to be one of the deep underlying reasons for the increase in the deaths of despair.”

On Wednesday, a day after the report was published, democratic-socialist and 2016 presidential hopeful Bernie Sanders appeared on MSNBC's All In with Chris Hayes.

When Bernie was asked to respond to the results of the study at hand, he said, "When I talk about the collapse of the American working class, that's what I'm talking about.” 

Bernie continued, “What it tells you is that there are millions of people in this country, working class people, who are seeing their standards of living going down, who are experiencing very high levels of unemployment—they are in despair, they don’t see anything in front of them in terms of a future that is going to work for them.” 

Or if they do see a light at the end of the tunnel, it’s an oncoming train belting toward them. 

The mad irony, of course, is that what we’re seeing here are the potential dangers of right-wing economic policy. Middle-aged white men overwhelmingly vote Republican, which in recent years has ventured into a libertarian abyss called the “far right.” This platform calls to eliminate the following social programs: social security, Medicare, welfare, and everything else aimed to support the disenfranchised. Of course, these programs were put in place post-Great Depression by Franklin Delano Roosevelt, to help those suffering from the exact social conditions from which this middle-aged, lower middle-class are now suffering. 

There is yet another disturbing conclusion to draw from this report, which is less quantifiable than the economic drivers, but nonetheless visible. Authors Deaton and Case write, “The increased availability of opioid prescriptions for pain that began in the late 1990s have been widely noted, as has the associated mortality." 

In the same MSNBC segment, Sanders noted the connection to mass opioid use, “This opiate addiction leading to heroin, of course, is a disaster. Suicide rates are soaring… this is a crisis,” the white-haired wiry Senator wailed. 

While middle-aged whites are dying from drugs, alcohol, and suicide, so are young (and often affluent) adults overdosing in obscene numbers. The CDC reports that heroin use more than doubled among young adults (mostly white) between the ages of 18-25 in the past decade. And out of this group, 45% were addicted to prescription opioids before making the switch to heroin. 

What’s driving this uptick among the young to find it attractive to sleep their supposed best days away? 

I find it no coincidence that Juman, Case, and Sanders all used the word “despair” to describe the current condition of Americans who are using drugs and performing suicide in never-before-seen numbers. Now is the time to acknowledge that alienating social conditions are indeed major contributors to addiction. Too often, because they’re so immeasurable and chaotic, these environmental factors are left overlooked.   

Case and Deaton’s report does back this notion of alienation. Case noted in her correspondence with The Fix that reports of chronic pain, psychological distress, and social isolation have increased substantially in the group of middle-aged whites. Sam Quinones, who authored Dream Land: The True Tale of America’s Opiate Epidemic, found a similar isolation among young adults in his investigation. We’re isolated by technology and excess. There is a cutting critique of St. Reagan running through his carefully reported book. 

Durkheim observed, in the late 1800s, the breaking of social-bonds indeed contributed to increased suicide. Present-day addiction researchers such as Bruce Alexander, who spearheaded the famous Rat Park study, also see social ties and sense of community as major environmental factors contributing to addiction. Recent studies that have examined sober-living homes observe those who make friends, who feel a sense of community and belonging, tend to remain abstinent for longer periods of time. But putting everyone in sober homes isn’t the solution needed to address the current crisis. The Marxists would call for revolution, which is unlikely. But what could be useful is if middle-aged white men begin to vote in their best interests. 

Solutions can also be seen in how we address and treat social illnesses. While it may be concise to call addiction a phenomenon occurring in an individual's brain, no amount of rewiring neural connections or deprogramming deeply-learned habits will ameliorate the social conditions occurring beyond the body, which are driving people to anesthetize pain they’re not entirely responsible for. The main culprit, as I see it, is the destruction of meaningful ties to communities—the death of solidarity. Essentially, I think we’re all adrift, floating down a river of entropy. But that’s because I’m a pessimist. 

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Zachary Siegel is a freelance journalist specializing in science, health and drug policy. His reporting has also appeared in Slate, The Daily Beast, Salon, Huffington Post, among others. He writes often about addiction, sometimes drawing from his own experience. You can find out more about Zachary on Linkedin or follow him on Twitter.