How did you decide that you would structure the book as an oral history?

Oral history methods are my favorite tools as a historian. Since I am working on a history topic that is recent and on a problem that is ongoing, this was the best tool for me. I wanted to preserve the stories of people who experienced loss and sorrow, as well as those who are innovating and changing the standard narrative about addiction. History is all about change, and I am drawn to how individual narrators find their place in historical moments through the process of oral history. Giving that kind of respect to people, when you’re in an interview situation and listening deeply, also affirms who they are, where they’ve been. For me, a lot of the power of this project has been that I’ve been able to help my narrators see how important their lives and their work is to a bigger issue, a bigger audience.

The passage where your daughter nearly lost her leg was so chilling. Was it hard to write about?

Yes, but the whole book was hard! That highly personal and intimate experience was my entry point to opioid addiction in our country, and I decided that if I wasn’t open and honest about what happened, readers might not identify with the many other narrators who have similar experiences. I wanted readers to trust me to be honest and forthcoming but also perhaps feel what the experience was like. Stories do this — they have connected and bound humans together forever, haven’t they? That’s my goal.

You write about the stigma parents face when a child becomes addicted. How can parents conduct self-care as well as child care?

Parents need to have as much of a support system while parenting teenagers as they usually have while parenting toddlers. Many parent friendships tend to drop away during the teen years, and this can be natural and normal, but it can also be due to other things. Stigma and judgement from other parents is palpable sometimes—you know, that kind of hollow, sympathetic look when a parent friend expresses concern, say they can’t imagine what they’d do (while also telling you how strong you are!), but you know also secretly grateful it’s not their kid–that’s the feeling. This creates isolation and despair. Finding support groups, like NarAnon or AlAnon can really help, but I think befriending other parents who will be honest about their own struggles is best–these formal support groups can lead to such friendships, so don’t be afraid of them. This project taught me (yet again) that we all have to be more open and empathetic with each other, in general, and not isolate parents whose kids you know are struggling.

You address the Minnesota Model and how it may not be an ideal option for addictions like fentanyl, which induces deeper cravings. Is the Minnesota Model adapting to today’s challenges?

It doesn’t bode well for anyone when clients die upon leaving treatment. A pithy remark from people who work in harm reduction is, “dead people can’t recover,” so first we need to help keep them alive, and that is what harm reduction measures focus on (the most recent being Narcan/naloxone to reverse an opioid overdose, and the oldest being condoms and clean needles). And that is also what evidence-based medications for opioid use disorders can do. The Minnesota Model was revolutionary when it was created, and its abstinence-based model, as promoted in AA, continues to be the gold standard for what is called “recovery” from addiction. This is perfectly fine and effective for some people. But we have more tools at our disposal. The Minnesota Model, especially the bigger, well-resourced and influential institutions, have been doing research about their treatment models for a long time, and especially recently as a result of the opioid epidemic, and they have slowly begun to incorporate some use of medications for opioid use disorders. My observations acknowledge their work but I also suggest that we do more stigma-bashing, creative-thinking, and working together for a more widespread, accessible integration of the medical approach, in combination with whatever other kinds of therapies or affinity-group support models people need to live a healthy life.

You write about the inequities in overdose deaths and how Indigenous people have an outsized proportion of overdose deaths in MN, with far less media focus. Are there states or regions around the country that are having success with an equitable recovery infrastructure?

We don’t really have to look outside Minnesota — the White Earth Nation, has worked tirelessly to create social supports and care systems to address the epidemic. My point in that part of the book is that when we look at specific communities, the impact of the epidemic is much more severe than it appears when integrated into data–this isn’t a white person’s epidemic, as it often appears in the media. Based on my narrators’ insights and experiences, we need to increase access to evidence-based care for everyone, dismantle stigma at every level of society and throughout our laws and institutions. We have the tools we need to end the epidemic, but stigma about drug users, combined with dangerous class and race prejudices, keep too many people on the margins, their pain and poverty overlooked, as if all of it, addiction included, is a matter of choice.

You’re a proponent of giving young people scientific facts when it comes to guiding them to make smart choices. How early should parents start arming children with info?

Oh, I wouldn’t put an age on it. And I am not a child development expert. I did have teenagers and I currently teach college students. What I hear from them is that parents need the knowledge first, and then they can decide whether and how to bring substance use up with their kids. What I wish is that we had a more science-based approach to teaching drug education that was standardized across the nation, but that seems unlikely in our current political environment. We still think that scaring middle school kids with friendly police officers from the D.A.R.E. program will keep them from experimenting with drugs and alcohol, and that has had tragic consequences, much like abstinence-based sex education. I think understanding the dangers, knowing the science, learning about the impact on one’s body, and paying attention to children’s mental health needs are critical components to begin ending the epidemic, as well as problematic drug use in general.

Do you fear that worry about addiction is keeping people with chronic pain from trying painkillers, which could improve their quality of life. Is the fear of addiction also a social ill?

It sure doesn’t seem like addiction is something anyone was really afraid of when pain pills flooded the market. And I wish Big Pharma had been honest about opioid dependence and not used a letter to the editor in JAMA as if it were a scientific study. (See Dreamland by Sam Quinones for this shocking history.) Of course people with chronic pain deserve to be treated for their pain! I am not a physician, so people should go to their doctor about chronic pain. What saddens me is that if you look back at the history of pain research, you will see that prior to the FDA approving Oxycontin in 1996, there were doctors and scientists who were looking for non-prescription alternatives to chronic pain, when pain clinics were not places where people lined up to get opioid prescriptions. I read an incredibly exciting article in the Washington Post recently that I would recommend on what is currently happening with chronic pain research.

What is next for you?

I need to get my collection of oral history interviews ready to be archived, and I need to clean up my office. After that, I will pick up my 2013 dissertation(also oral history based) about the long-term effect of trauma on an extended community of brave Girl Scouts sleeping at camp in rural Oklahoma, when three of their own were murdered in 1977. The long arc of trauma in this story is not something we tend to examine in a culture that is becoming desensitized to violence (well, until it happens to them), and I have historical observations and questions about why that is: can I expose trauma’s ills on our society in the same way I am trying to expose stigma in Opioid Reckoning? History is not for the faint of heart, especially what I study, in case you hadn’t picked up on that by now.

Photo by Lucia Possehl