News & Politics

Poverty, Addiction, and Medicaid Cuts: A Former Addict's Call to Occupy Wall St.

An addict-turned-social worker explores the relationship between poverty and addiction, exposing how Medicaid cuts could have disastrous consequences on entire communities.

This week the City of Philadelphia was awarded the dubious distinction of the nation’s "poorest large city," with one quarter of the adult population and one third of children living below the poverty line. Philly’s been big and poor for a long time now, but this is a significant uptick from previous census numbers, and the total economic impact of the ongoing Great Recession has probably not yet been felt. While attempts to de-stigmatize addiction by painting it as a disease that doesn’t discriminate by race, class or gender are well intentioned, the fact is that while addiction may not discriminate it certainly does tend to cluster geographically, and there is a correlation between urban poverty and elevated levels of addiction.

Philadelphia is also the nation’s ninth most segregated city, so the scope of its addiction crises is generally left to the imaginations of the city’s professional class, who stick mostly to the Center City district and a handful of low crime, comparatively high-income neighborhoods. When you step outside this tight circle of comfort and privilege, the drop off is steep and the neighborhoods plagued by addiction—and the violent crime that comes along with our prolonged and pointless War on Drugs—stretch out like a vast plain, dotted with tens of thousands of abandoned properties and vacant lots. In recent year, efforts by the police to flood high drug and crime neighborhoods (Operations Sunrise and its sequels, such as Pressure Point) with boots on the ground and crush the drug trade have only served to disperse it further. Now drug commerce has spread its net over the newly impoverished neighborhoods abandoned by the remnants of what was once the city’s massive working class whose lives were consumed, generation after generation, by jobs in the city’s equally massive manufacturing sector. But the plants have long fled south or overseas, and the working families fled too. 

To call this blasted landscape “vast” is no exaggeration; I am talking about literally miles of land inhabited by families surviving below the poverty level and whose only realistic hope is, not surprisingly, not to end up on the street. As a social worker I have traveled through these neighborhoods routinely for years and can tell you that once you step outside the sharply defined circle of race and class that encloses the city’s professionals, the conversation focuses obsessively on one topic and one topic only: drugs. Who’s taking them, who’s quitting them, who’s selling them, who got killed over them; these are the day-to-day events that guide hundreds of thousands of lives in Philadelphia’s poorest neighborhoods—which is to say in the vast majority of Philadelphia outside Center City. It’s impossible to ride a public bus through this city and not come away with the impression that addiction and its associated social costs are not the most pressing issue of our time. I guess it all depends on where you live, though; the big houses of the Main Line still sustain their expensive upkeep, becoming more and more like gated communities every decade.

What’s most maddening is that while the city’s most vulnerable populations are trapped in a cycle of poverty and addiction that the recession has only aggravated, the state of Pennsylvania is moving to make devastating cuts to Medicaid, the primary source of funding for addiction treatment for the urban poor. Dope addicts in North Philly don’t go to cushy seaside dry-out resorts when they decide to kick; they go wherever the state is willing to pay to send them. Many of these treatment facilities are already in ailing physical condition, understaffed by undertrained professionals and so crowded that a free bed is like hitting the lottery. Deeper cuts to this particular section of our nation’s vanishing safety net could have a profoundly negative impact, pushing addicts who are already at the fringes and dire states of homelessness and incarceration.

Nearly eight years ago this former addict found himself hopelessly addicted to narcotics and in need of a medically monitored detox and rehabilitation. I got the help I needed through, you guessed it, Medicaid. Jobless, uninsured and without the money to pay for rehab, the Department of Welfare footed my bill. After getting and staying clean, I payed this debt to the state back through (1) the prevention of my own need for future publicly funded services by returing to the labor force, (2) the taxes on my future labor production, and (3) the easing of costs to tax payers of other addicted individuals by returning to the same neighbors where I used drugs to do social work for programs shown to reduce the social costs of addiction. This is your social safety net, people, working exactly the way it was designed to.

Philly’s poverty-and-addiction dynamic isn’t unique. Detroit, Baltimore, Buffalo, Cleveland, St. Louis…long is the list of once-great American cities still reeling from the abandonment of industry and now collapsing from within under the weight of poverty and addiction.

Yet suddenly, as if overnight, the Occupy Wall Street movement has sprung up, tapping into an underground river of fear and fury of the many millions of Americans—not just the college grads with $50,000 in student loans and no job—who are beginning to recognize that they, too, may be left behind “when the economy recovers.” They are asking, with growing urgency, what if this time it’s different? What if the jobs don’t come back? What if this—what we are living through now—is the “new normal”? If so, then why are we destroying the safety net; “reforming” Medicaid, Medicare, Social Security; blowing up the New Deal, the Great Society, and the entire social contract that drove the 20th century, just when we need them most? Who owns America anyway?

“We are the 99%,” the rallying cry of the Occupy Wall Street movement, is a shorthand way of asking all these questions, of mobilizing the fear and fury at the growing economic disenfranchisement, at the corporate corruption and greed that we all know got us into this mess—and that has largely managed to escape “reforming.” May a thousand Occupy Wall Streets bloom. (This weekend there are OWS actions planned on both Saturday and Sunday. To find an occupation near you, go to the Occupy Together website.)

But where does the street-level drug addict living in an abandoned house in North Philly fit into the occupation scheme? Some protesters at the various occupation sites have reportedly tried to bring “drug law reform” messaging into the discussion of OWS goals, but are being shouldered aside by those who hope to counter the media’s defensive criticism that the movement is unfocused by keeping its demands narrowly focused on banking reforms. 

Meanwhile, the Obama administration has hung progressive drug-law reformers out to dry, continuing to pursue an enforcement strategy that will shut down even the burgeoning medical-marijuana movement. How will addicts get needed but controversial services like safe, legal heroin injection sites when the biggest, strongest advocacy groups are getting shut down by a Democratic president over decriminalizing marijuana? Addicts remain a disorganized, financially compromised crowd, and many of those in recovery choose to remain anonymous, hampering the ability to form grassroots coalitions that could engage in political direct action to stop cuts to addiction treatment funding.

America’s cities are facing bankruptcy. Philadelphia, like many other poor cities dependent on barely adequate state funding that is currently under fierce attack by Republican governors bent on dismantling government behind the banner of fiscal austerity, is in for a rough ride. Those of us on the front lines, forced to work with dwindling resources to provide fewer services, can’t work miracles. Those who are fortunate enough to still live inside the contracting circles of privilege, even those progressives who are part of the 99%, need to recognize that the bottom 10% are already living your worst nightmare. When we come to occupy Wall Street—or, in Philly, CIty Hall—listen to those of us who are honored to speak on their behalf, and lend us greater support if we are all to make it through these hardest of hard times.

Jeff Deeney is a Philadelphia social worker and a writer who is in recovery. He is a weekly columnist for the The Fix.