Primary Submission Category: Place/Communities
“Not until affluent whites started getting in trouble with the heroin and the opiates…that’s when everything started changing”, On-the-ground interpretations of the policy shift from the criminalization to the medicalization of addiction in neighborhoods that have experienced both the crack cocaine and opioids drug epidemics: Presenting distortions of the past from solidifying inequalities in the future
Authors: Sabrina Sanchez
Presenting Author: Sabrina Sanchez*
Background: Addiction discourse has evolved recently and rapidly resulting in the widespread adoption of a medicalization of addiction paradigm that centers the biological realities of addiction rather than the former preeminent criminalization of addiction paradigm that centered personal (ir)responsibility. These societal narratives shape subsequent social responses and are understood differently by those with racially stratified life experiences. The most recent American drug epidemics, the crack era and opioid epidemic, have resulted in markedly different societal interventions, the first marked by a criminalization of addiction and the War on Drugs, and the second marked by a medicalized understanding of addiction centering treatment.
Methods: Mixed methods were used. Qualitatively, I conducted focus groups and interviews with 47 participants across four stakeholder groups that included community members, social service professionals, people who use opioids, and law enforcement professionals. Quantitatively, I used GSS data from 1986-2018 to create logistic regression models.
Results: Black Americans disrupt white revisionist logics that function to: 1) decontextualize and differentiate the opioid epidemic from the historical context of the criminalization of addiction, 2) recast and remove personal responsibility from individual drug users to structural economic issues, environmental factors, and biology, and 3) neutralize or ignore the role of race in the paradigm shift. Instead, they 1) posit that new racialized logics were developed and deployed and 2) highlight the unaddressed substance abuse needs from the crack cocaine epidemic. Quantitative results from the GSS lend credence to the idea that racialized logics were central to the paradigm shift from the criminalization to the medicalization of substance abuse. Racial identity predicts support for increasing federal funding for drug treatment rehabilitation programs beginning in 1986 through 2014. Across this period Black respondents have 2.6-1.7 times the odds of supporting increases for funding drug treatment programs relative to whites accounting for respondents educational attainment, respondents mothers educational attainment, respondents father educational attainment, work status, marital status, income, age, gender and homeownership status (p<.001). In 2016, racial stratification (being Black) no longer predicts support for increasing federal funding for drug treatment programs and this dissolved relationship holds through 2018 as the proportion of whites who support increases in federal funding for drug treatment programs grows such that the odds of support for increased funding of drug treatment makes Blacks and white statistically indistinguishable.
Implications: Black participants explicitly highlight unaddressed needs related to the crack cocaine epidemic and implicitly call attention to the need to prevent racialized logics from disproportionately driving benefits of the paradigm shift to whiter communities and leaving unaddressed burdens in less well-resourced communities.