'Opioid Reckoning' questions the 'Just Say No' and 12-step approaches

Amy Sullivan, a professor of U.S. history at Macalester College, teaches the class Uses & Abuses: Drugs, Addiction and Recovery in the U.S. Her family has also been touched by the opioid epidemic, which has killed some 500,000 Americans, and causes more annual deaths than cars or guns.

"Amy Sullivan, a professor of U.S. history at Macalester College, teaches the class, Uses & Abuses: Drugs, Addiction and Recovery in the U.S."

Sullivan's new book, "Opioid Reckoning: Love, Loss and Redemption in the Rehab State," draws on interviews with more than 50 Minnesotans connected to opioids either through their work or personal experience — and sometimes both. She shares how this powerful drug has impacted the state known for its pioneering addiction treatment. This interview has been edited for length and clarity.

How accessible have opioids become?
Heroin, opioid pain pills and illicit fentanyl are in every small town and in every suburb. They're everywhere. Prescription pain pills are the way most kids start. If people don't realize these things are in, like, every single medicine cabinet in every home in the United States, then they must be living under a rock.

Why is reducing the stigma associated with addiction so important?
Speaking as a mom and as a historian, in the United States we hold parents, particularly mothers, responsible for everything. Like, if your child turns out well, it was your parents. If your child has a problem, it must have been something the mom or the dad did. So we're used to this idea, especially now in this time of helicopter parenting, that we can somehow prevent bad things from happening to our children. And prevent them from trying that first thing.

Parents whose children end up having a substance use disorder feel stigmatized, and they feel that their child did something wrong. But think of all the kids who tried that same drug and it didn't cause a problem for them. So why do we pretend that it's just the kids who get addicted who are the problem? We're not acknowledging that of course everybody tries things, everybody experiments.

The so-called Minnesota Model for alcohol treatment was revolutionary for its time and has helped millions achieve sobriety. Why doesn't it translate well to opioids?

Fentanyl is responsible for a majority of the overdose deaths that have happened in the last five or so years — it can be up to 100 times stronger than heroin or morphine. The immediacy of that potential for death really does change the story. When you add something as addictive as heroin or methamphetamine, your brain has been altered in some ways. The cravings are profoundly intense.

People were leaving the 28-day or 60-day, 12-Step, Minnesota Model-type rehab, and they were going and using, because they had been craving that whole time they were in there. They leave, they use, and they die. The Minnesota Model is being forced to change because if people die, they can't recover.

People from all walks of life develop opioid use disorders, but you book points out that we tend to focus on those who are privileged.
It's very sad when anyone dies of an opioid overdose. But it's not more sad because they were the football star. In Minnesota, for every one white person who dies of an overdose, seven Native Americans die. Looking at our Indigenous population, we have one of the highest overdose death rates in the country. For every one white person who dies from an overdose, two African Americans die.

Why is it important to teach young people using scientific information about the dangers of drugs and alcohol rather than taking the 'Just Say No' approach?
We need to teach young people how to make good choices, but also teach them what the consequences are for different things they might come across at a party.

There's a book called "Buzzed: The Straight Facts About the Most Used and Abused Drugs From Alcohol to Ecstasy" that I use every time I teach my Drug Addiction and Recovery class, and when my students read it, they say, "Oh, my gosh, why didn't I learn this in high school?"

We know that kids are going to try things. They are going to experiment. If we trusted teenagers, we would give them the knowledge that they need to make the good decision. Ignorance, hope and fear — that's not a drug prevention measure.

How can we support those whose loved one struggles with problematic substance use?
Think about the things you would do if they were sick with something else. And withhold judgment. You don't need to ask, "How did this happen?" You don't need to ask, "Why didn't you tell me earlier?" Just be there and listen and be a loving friend and ask, "What can I do to help you this week?"

What do you hope people take away from your book?
The point is to illuminate the complexity of what addiction does to individuals, to families, to our communities and our country. We aren't thinking of this holistically. We're still wanting to blame the one person instead of seeing it as a bigger issue.

Once I started hearing different people's stories and realizing how many times there were so many similar aspects, it was like, "Why aren't we going to do something different now? Why are we going to pursue abstinence drug education when we know abstinence doesn't work?" Say No to Drugs didn't work — we have proof.

Book Launch Event
'Opioid Reckoning' by Amy Sullivan
Date: Oct. 25, 7-8:30 p.m.
Location: Macalester College, John B. Davis Lecture Hall, 3 S. Snelling Av., St. Paul.
Register: For in-person or online attendance, go to tinyurl.com/u3dfse4s