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Durkheim and the Sociology of American Overdose Deaths
This item just came up on my news feed:
Drug overdose death rates have increased in 26 states and Washington, D.C., and overdoses continue to outpace car crashes as the leading cause of injury-related deaths, according to a new report.
Nearly 44,000 people die from drug overdoses each year, a figure that more than doubled from 1999 to 2013, and more than half of them stem from prescription pills.
I was surprised by that. I haven’t looked into this deeply at all, but the first question that came to my mind was to how many of these deaths were in fact suicides, rather than overdoses — and indeed, quite where that line would be drawn, given that most adults are well aware that it’s dangerous and potentially life-threatening to take these drugs. It seems to me this kind of death must involve at the very least a carelessness about staying alive, if not a fully-formed and conscious suicidal intent.
I don’t know how such data are collected, precisely, nor what criteria are used to determine whether a drug overdose death was accidental or deliberate. Perhaps someone here would know more and could fill me in. But something about this makes me suspect that what we’ve got on our hands here is a rising suicide rate — of some kind.
I’m persuaded that Durkheim still has a great deal of importance to say to us on the subject of suicide rates. For those of you who haven’t read him, he’s worth it. He was unpersuaded that suicide could be explained entirely by the psychological characteristics or individual circumstances of those who committed it. He instead sought to explore the social facts, or sociology, of suicide rates in different countries at different times. His case — that some societies or cultures within those societies are more prone to suicide — is extremely persuasive.
He drew a distinction among four kinds of suicide: egoistic, anomic, altruistic, and fatalistic. He rejected the idea that altruistic and fatalistic suicides accounted for sufficiently many as to be all that sociologically significant. It’s simplified quite a bit here, but these notes explain what he views as the key concepts:
Egoistic suicide:
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Individual being insufficiently integrated into the social groups and society
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E.g. explains difference in suicide rates of Protestants and Roman Catholics (Catholics more strongly integrated)
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Unmarried and childless less integrated, therefore higher suicide rate
Anomic Suicide
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Took place when society did not regulate individuals sufficiently
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Where norms and values are disrupted by rapid social change leading to uncertainty /guidelines for behaviour increasingly unclear
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Anomic suicide increases during times of economic depression/boom/bust
I have no idea whether anyone is thinking about his work in the context of a “more than doubled” rate of drug overdoses since 1999. But do you find the idea that Durkheim’s thought might be relevant to this as instinctive as I do? Perhaps relevant enough that it might be worth dusting off a copy of Durkheim before assuming that the remedy lies, as this article might suggest, in “education for physicians about ‘overprescribing medication’ and the dangers of prescribing opioids?”
I have to think both physicians and patients already know they’re dangerous, don’t they?
Doesn’t it sound to you as if something a bit deeper is going on?
Published in General
Addiction is not always easy to label, particularly given the possible varieties of human experience. “Addict” is pejorative to many. Maybe we should think in terms of “dependency” here; it is just a biological fact if physical withdrawal occurs, as you describe for Benadryl. It may have had no adverse effects on your life.
As to the Norco, I can’t say for sure, but probably not, since the doses are spaced farther apart than several half-lives of the drug. If you were using them addictively you would need them more often to stave off withdrawal. In general, no withdrawal, no addiction.
It still seems to me that Durkheim’s way of viewing things is relevant, though. It still seems that basically, what we’re describing is a kind of suicide. I bring it up because the way we view this might be a clue about the best way to solve the problem. In other words, we might want to be studying the people who are dying this way to see what qualities they have in common, sociologically. It may be quite useless to tell physicians what they presumably already know (that these drugs can kill, so be careful) if indeed what we have is a growing cohort of people who don’t all that badly want to live.
I agree. The final act leading to death (by OD or otherwise) is the completion of a process underway, sometimes for years. It may be intentional or merely “negligent,” based on a small desire to live.
In the US, feelings of belonging or true community have become difficult to achieve. Durkheim: “Suicide rates are dependent upon the degree to which individuals were integrated into society.” This insight is the basis of 12-step recovery, in essence a fellowship of shared suffering which focuses on solutions and personal responsibility, rather than the problem.
We are all born with this in common: we come into the world dependent on others (usually parents) for our very survival. Even minimal maturation presents everyone with the question, “On whom or what can I depend?” I believe this fundamental human dependency forms the basis of our social nature. In an atomized society, and/or growing up on a fractured single-parent family this dependency need is usually unmet. This leads to the search for behaviors and/or substances on which one may have the illusion of reliable dependency. This leads to addictions and an inevitable cohort who will, sooner or later, overdose and die.
(con’t) The initial dependency on others for our survival, then, with which we are “imprinted” (think salmon), operates in the background as we mature and attempt to find healthy dependencies. In a sense, addiction, whether behavioral (like overeating or sex addiction) or ingestive (like opioids) is a shortcut in an attempt to find healthy, mutual dependencies. Initially, the comfort provided by the addiction seems like a reliable solution. Then biology steps in and requires ever more and one reverts to the imprinted belief, “I will DIE if I don’t get my next fix.” At that point, very bizarre behaviors will be employed to obtain the needed drugs. In 12-step recovery, one comes to depend on the principles of the group, rather than individuals. Dependency on individuals may also become unhealthy and addictive. That is why Alcoholics Anonymous says the “anonymity is the spiritual foundation of all of our traditions.”
I often explain that “spiritu” means breath or life. In order to feel truly alive, or inspired to continue living, one must have a sense of usefulness, belonging, acceptance; having made mistakes (guilt) is not the same as being a mistake (all addicts feel the latter – shame). That is why being accepted in a fellowship is healing and it requires addicts to make amends for their past wrongdoing. No victimhood allowed: “There are no victims, only volunteers.”
So, I believe Durkheim is correct and the founders of AA recognized this in 1935 and devised a solution.
That’s my intuition, too — which I’d use as no more than the basis for empirical research — but I suspect it’s one worth pursuing. Many things have happened since 1999 that could be closely connected to this.
Agreed again, although the research may be difficult to conduct and be highly subject to confirmation bias. State-funded sociologists, I bet, would find the need for more government programs to offset the alienation that the existing avalanche of programs are mainly responsible for creating in the first place. Great topic, as always, Claire. Wish I could see you again in Paris.
Well it’s nice to know my own mother is “probably not” an addict ;-)
Of course “addict” is pejorative to many – and with good reason! The behavior ordinary people associate with addicts is different from mere physically dependency. There’s criminality, dishonesty – a whole host of behaviors associated with addiction that, when you’re a basically honest, non-criminal human being, it is quite frankly demoralizing to be associated with.
Moreover, ordinary people quite reasonably associate addiction not with improved functioning, but with craving a chemical “high” even though it obviously degrades functioning. Seeking pain relief because you want to continue working ought to be morally different from seeking a “high” that takes you away from your responsibilities, and again, it’s demoralizing to have the two behaviors conflated.
Most people I know who rely on having an opioid about the house for occasional flare-ups of chronic pain are already maxed-out on NSAIDs, Tylenol, yearly PT visits, and localized treatments. Honestly, they’d rather take Prednisone instead of an opioid, but long-term Prednisone treatment is an even worse option. We might wish to consider that treating these people as if they were addicts – always under the suspicion of criminality – is a supremely bad idea, and itself degrading to the social fabric.
BTW, my thoughts as to the incompetence of the state to fashion the solutions likely to be suggested by state-funded sociologists are guided by a first principle: “you can’t coerce community into existence.” True community, by its very nature, I believe, can only be voluntary. This, and only this, liberates the human interactions which allow us to see ourselves in the mirror of others. Self-actualization, I believe, is the result of an evolving self-image, ever modified by honest feedback we receive from others who care about us by virtue of the desire to associate freely in such a community. In this framework of analysis, an individual’s task is to develop “boundaries.” This concept enables one to filter such feedback and learn what is valid and ought to affect us versus what stems from others’ own issues, prejudices, etc., and may be discounted. I have personally found this approach very helpful.
To illustrate (as was taught me): Someone says he thinks I am an axe murderer. I feel no need to rebut the assertion. It is his “stuff,” not mine. So, to the extent I feel the need to defend a statement or assertion made about me, I become willing to consider the possibility there is at least some truth in it. This has proved a good barometer as to what I may need to reconsider about myself. This has been key in my ability to not relapse in 24 years.
My father was in the hospital dying. My sister was there and I was asked what would be allowed. I noted that Catholic practice required air, water and food (as long as the patient was able to swallow), and that they could medicate him to alleviate at least some of the pain. That is what the hospital did. Nothing extraordinary, merely some pain relief because he had gotten to the point where he was not swallowing anymore.
That, I think, is different from someone suffering chronic pain and distress. I don’t know how to alleviate that completely but perhaps some portion of the pain might be blocked without killing the patient. Maybe kill the nerves to that area?
The goal is typically not to alleviate it completely, but enough so that the person can live a more normal life.
Ideally, the cause of pain is completely cured – for instance, with physical therapy. When pain concentrates in muscle, trigger-point injections may bring relief. Iontophoresis can also deliver targeted pain relief – sort of like in Star Trek.
Nerve blocks can bring complete relief of pain, but at great functional expense:
Nerves are conduits for information. People in chronic pain often receive information of poorer quality than healthy people would via their nerv- conduits, but it still typically contains a lot of important information. Lepers lose appendages because leprosy deadens nerves, making it easy for lepers to injure themselves without noticing it in time to take care of it: humans need pain for the information it carries, which is one reason why chronic pain sucks so much – the information has become garbagey, perhaps even false.
So yes, it is possible to do nerve blocks that completely relieve pain (I had an accidental block done to my sciatic nerve once – sweet relief… but then I couldn’t walk for an hour). Botox injections, which do “kill” nerves, can be used for stubborn cases – but with discretion.
Here you go Claire:
http://www.foxnews.com/health/2015/06/19/dr-manny-how-prescription-drug-abuse-is-helping-to-fuel-violence-in-america/
Some of the above comments included doctors who were called on the carpet because they didn’t prescribe the “desired” drug – that made me mad. We have a mental health crisis in the US – not enough doctors or enough time spent on treatment, patients get pushed through and given their “doses”, then these drugs are sold on the street, the HIPPA laws are such that the physicians cannot discuss anything with the family – all is private, so they don’t know what is going on, except from what the patient tells them. It is a broken system. Sadly, you wrote the story, then comes the tragedy to back it up.