Dreamland by Sam Quinones (May 2017)
Dreamland examines the progression of the opiate epidemic over the last two decades. It introduces us to the many groups- including dealers, law enforcement personnel, and victims- impacted by the crisis. Quinones, an author and journalist with significant experience examining the relationship Mexicans have with the United States, takes advantage of his unique understanding in weaving together his account of the crisis.
One up: Dreamland is written with a great deal of empathy for all parties involved in the epidemic. Writing with empathy is challenging enough; to do so with the topic at hand is a major achievement.
The key is Quinones's ability to dig and dig until he finds the motivations underlying an act. A frequent pattern I noticed was an impoverished person initiating a series of events. As these little chains accumulated, the scale of the crisis grew and more communities were impacted.
The very start of the epidemic he describes is rooted in the poverty and hopelessness many young rural Mexicans felt was inevitable were they to remain in the communities they grew up in. People might report being content in poverty, he notes, but this is hardly evidence of a preference to remain impoverished.
He extends the idea when examining how the US healthcare and welfare systems create incentives for the poor to sell pills on the underground market. One example describes how painkillers worth thousands on the street are accessible to Medicaid recipients for just a few dollars. For those seeking a way to bridge the gap between their living expenses and welfare checks, the chance to sell pills at huge markups was not an opportunity to pass up.
Finally, he cites how the loss of community and togetherness accelerated the spread of drug use. For a long time, American towns used public recreation such as parks, swimming pools, and town events to help everyone feel well off regardless of their income or wealth. As these public institutions gave way to profit-seekers, the sense of isolation grew and the disconnected residents were primed to cave in against the promises of escape and pleasure offered by easily accessible drugs.
One down: I mentioned once how Lincoln In The Bardo author George Saunders suggested a (novel?) way of writing a longer piece of fiction- simply write a few shorter pieces and link them together. The comparison he made was to a carpenter who knows how to build one room. If the carpenter repeats this multiples times and builds many rooms, he will one day have the opportunity to connect these rooms into a house.
I saw a little of this method in Dreamland. Quinones is a journalist and a lot of this book is based on his reporting and investigation. Thus, the structure of the book loosely resembled a scrapbook; a story related in one chapter would be followed by a new topic in the following one.
I suspect the format sometimes worked against the author. At times, the changes felt more jarring to me than free flowing. Of course, the sheer volume of people involved here speaks to the far-reaching the impact of the epidemic. I cannot help but feel, though, that a story or two could have made way for a closer look at one of the more compelling characters or stories (1).
Just saying: In describing addiction treatment strategies, Quinones points out how one commonly overlooked step in recovery is repairing damaged neural pathways. For most addicts, a range of thirty to ninety days is required before the brain damage caused by excessive drug usage is fully healed. He later notes how the US healthcare system does a better job fighting disease than it does promoting wellness. Perhaps if drug addiction was considered a disease, the mechanisms for battling addiction would improve.
These two observations reminded me of David Sheff's Clean, a book I read back in May of 2015. Clean starts with a simple premise- addiction is a disease, not a moral failing- and goes on to explore how medical research, the success of particular treatment programs, and various individual success stories are bolstering this idea.
A culture-wide shift to this view of addiction could have significant ramifications for how treatment programs are constructed and how the resources of the healthcare system are deployed. Seeing addiction as a chronic disease, for example, would reframe a relapse as a signal to return to treatment instead of 'proving' how a 'weak-willed' person cannot get his or her life in order. Instead of seeing it as a failure of treatment, it could be seen instead as a naturally occurring part of a 'two steps forward, one step backward' recovery trajectory.
One idea I still remember to this day from Clean is the HALT acronym. Even the strongest-willed people struggle to face down their demons whenever feeling Hungry, Angry, Lonely, or Tired. Those in the support system for a recovering addict can contribute by doing what they can to help prevent these moods. It may not seem like much but anything preventing a potential relapse is a big contribution in a battle against addiction.
Footnotes / imagined complaints
1. What's for dinner? Again?
I wonder if the structure explains the puzzling overuse of the expression 'delivered like pizza' in this book. Quinones turned to this analogy time and again to describe the reliability and efficiency of the heroin delivery system. Perhaps he wrote many of the chapters here as separate pieces, never intending to put them all together into one book.
Or perhaps he just likes pizza. Who knows? I like pizza.
