Dopesick, homelessness, and the casualties of culture

When faced with a friend who has succumbed to prescription opioid addiction, we commonly hear the expression, “There but for the grace of God go I!” But what if it is not divine grace at work here, rather simply the math of probability?

I recently viewed the excellent Hulu television miniseries Dopesick, based on a book of the same name by Beth Macy. [1] Judging on my past study on the mathematics of addiction, the basic premise of this book and series appears to be accurate. It is this: “Normal” people were ensnared into drug addiction by Purdue Pharma’s pain reliever OxyContin primarily because the drug really messes with the brain’s volition system, which is your self-perception that you have control over your own actions.

I have written frequently on this blog about volition, which might be seen as a synonym for choice or free will, but without the political or theological baggage. My personal definition of volition is “whatever is going on in your brain that makes you perceive that you have control over a task with options, say, turning to the left or turning to the right.” The “volition problem” from a neuroscience point of view is that, no matter how close you look into your brain, you will find no clean “yes/no” switch that nicely translates into a “choice.”

Sometimes (and some neuroscientists would say always) that perception of volition is an illusion. The “conscious” part of your brain is “watching yourself” perform actions, such as picking up a coffee cup, which is actually the rest of your brain probabilistically repeating a well-refined past habit. That is, until you spill your coffee and say, “I didn’t intend to do that!” Your brain sometimes “guesses wrong.”

Moral judgement cast on the “dopesick”

Here’s the deal: The OxyContin which your doctor (a “normal person”) prescribes to treat a your (also a “normal person”) bad back may take you on a downward spiral toward drug abuse. Or it may not. Prescription pain meds took a friend of mine on a fatal ride after years of struggle. The person next door, on the other hand, might have a powerful opiate prescribed by a dentist sitting in a drawer undesired and unused for years.

Is there a “moral flaw” in some people that causes them to “succumb to sin” and “the Devil’s drugs”? Or instead, is there some natural probability, some combination of genes, environment, and fate, that selects only some of us for drug addiction?

Our public drug policy and community attitudes on drug abuse are primarily based on that first assumption, that drug abusers are “weak” or even “sinful.” And this even with the growing data set indicating that a consistent percentage of the public will predictably encounter issues with particular substances at some point in their lives. We just cannot peg exactly who. That Satan is quite the statistician! “I get 25% of opiate users for my addiction snare, but only 10% of the Home Shopping Network viewers.”

OxyContin is unique in this regard primarily in its more overt effect on your “volition brain.” Yet, scientists and social workers in this field have long seen predictable addiction rates for various drugs, alcohol, sex, food, gambling and even shopping. All of these “play with” both our “pleasure centers” and our ability to “just say no” to varying degrees. They all screw with our “volition brain,” some with more severe consequences than others.

Volition is a fragile thing in most of us. One of my favorite “Psychology 101” experiments demonstrates that a stress as simple as requiring people to memorize a seven-digit number will increase the percentage of a group who will choose cake versus fruit by up to 50% when both are offered to them.

A certain percentage of us will become “casualties of culture” when particular set of genetic, environmental, and personal stresses pushes us into various forms of “cake abuse.” A culture that throws cake and opiates and other “life pleasures” at us in an abundance that was never encountered by our hunter-gatherer forebears too often leaves behind its “walking wounded,” whether as credit risks, diabetics or “dopesick” addicts.

The U.S. has not been kind to its “casualties of culture.” Just growing older will cause most of us to gradually slip out of the ever-moving cultural mainstream until they stick us into a home somewhere and forget about us. Where are you on the current cultural “wave”? Personally, I am sliding fast off the back end.

Casualties of culture

The ever-moving cultural norm.

Homelessness and housing availability

The current crisis in homelessness in some communities has a similarity to drugs in its probabilistic nature, causing resultant “casualties” simply by chance. Certain identifiable communities have higher rates of homelessness than others, even after taking better weather into account. We are increasingly becoming aware that homelessness is significantly a function of the availability of affordable housing in the community.

In short, the odds of you winding up homeless in some communities is worse than others, regardless of your individual circumstances. In communities where “normal people” struggle to find affordable housing, such as Los Angeles, people who might otherwise find a safe place to call home find themselves with no place to go at night. Where general vacancy rates are higher, the homeless issue often “magically” drops to a lower threshold.

housing vs. homelessness

Source: Matthew Yglesias, Slow Boring, “Homelessness is about housing”

These are “casualties of culture” in more than one way. Recent reports indicate that 1500 “people on the streets” have died during the Covid pandemic from various causes in Los Angeles. In contrast, Finland has driven its homelessness problem down to minimal levels using a “Housing First” policy – getting everybody housed in some form with assistance but not judgement.

But ***I*** found a job and a house, so why can’t you?

Granted, programs to deal with drug addiction and homelessness are expensive, and they are mostly paid for by the very people who have not been touched at the family level by these problems. And these are the people that vote. The homeless and drug-addicted have few advocates in Congress and likely none in the K Street lobbying firms. On the other hand, the direct and indirect economic costs of drug abuse and homelessness are also huge. Take your pick. Which would you rather pay for — a safe shelter and treatment program for your “no-good” nephew or increased crime and insecure streets?

And yet we refuse to look at “defense” spending under the same criteria. President Biden’s “Build Back Better” plan has been required to predict social services costs in a 10-year forecast, while “defense” spending is approved annually to the tune of $780 billion. That is $7.8 trillion in ten years. And that spending authorization will pass through Congress with only some hiccups from ideological senators who want to spend more.  No Social Security-like “trust fund.” No offsetting taxes imposed. No “means testing” of suppliers. No moral finger-wagging from the people doling out the money. As I have written before, the defense budget is mostly a jobs program for middle class workers and huge corporations, intentionally placed in almost every congressional district in the U.S.

We Americans have enough and to spare to address our failing of the “casualties of culture.” Odds are, however, that won’t happen.


  1. Macy, Beth. Dopesick: Dealers, Doctors and the Drug Company that Addicted America (Little, Brown and Company, 2018).

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