Addiction Breaking, Community Care, Resistance

In How to Break an Addiction, Annie Xibos Spencer tells the story of opioids within the context of “the dead but dominant paradigm” of capitalism and colonialism, with a focus on the US. With a poignancy and precision informed by history, labor, and economic theory, and interwoven and overlaid with personal narrative, Spencer’s narrative is itself an act of resistance as it pieces together the collective memory and consciousness that capitalism intentionally rips apart, severing our connections to ourselves, each other, the land and its creatures. Spencer pans this quilt, and then zooms in on each patch, each thread, telling the story of each piece of fabric, each stitch: how opioids fit into the bigger picture of capitalism exploiting pain for profit, and how the very individuals who are most victimized and harmed by capitalism’s failing and violent systems are dehumanized and scapegoated for these failures. 

Challenging the predominant disease-and-disorder model of addiction, Spencer opens the door to understanding and addressing the opioid crisis in more effective and compassionate ways. Harm reduction work in particular has the potential to both repair lives and strengthen communities in ways we badly need right now. 

“Addicts” under capitalism

Addiction is most commonly understood and treated in the US through the brain disease model, which focuses on the genetic, biological, neurological, and environmental factors that contribute to addiction. This model of addiction does not account for the structural and systemic oppression and state-imposed violence that cause generational trauma, factors that often underlie drug use and drug-related harm. Pointing the finger at individuals distracts from the reality of a sick society lacking connection and meaning. Yes, biology can, and often does play a role in addiction–and I don’t think it’s the whole story.

My understanding of chemical addiction has been shaped partly by my experience. Alcohol, not opioids, was my drug of choice, and I have been sober now for nearly eight years. But when I reflect on my own experience, I mostly consider myself someone who–like lots of people–has leaned on whatever I could access to cope with unmanageable pain, to be able to exist in a reality that felt unbearable. I remember feeling like the color literally returned to my world when I drank, and drinking was also the exact thing that dulled the vibrancy of my world.

Capitalism requires we replicate a knowledge system that “partitions, reduces, isolates, and immobilizes the interdependent concert of life,” Spencer writes. Instrumental to this “paradigm of partition” is the language, often dehumanizing, that is used to talk about people who use drugs. Our language for describing drug use and drug-related harm inadequately captures the nuances of addiction and, more often than not, places the onus on individuals. Within the broken American medical system, use of disease and disorder-based language is often necessary for people to access evidence-based treatment—although for plenty of people these same terms have been useful and supportive. Either way, our current language fails to capture and speak to what is ultimately a universal human experience: attempts to stop pain and suffering. There is actually nothing disordered about that impulse.

Spencer’s narrative describes this partitioning at different scales: separation from our bodies, from fellow human beings, and from the planet itself. This partitioning is both a driver of substance use, and a critical method of capitalistic accumulation and control. For a long time, I thought I was the problem. I drank to cut myself off from myself, in order to survive in a world built to eat us alive. To be “good” under capitalism, humans have to become severed from our emotions. To continue replicating, capitalism must continue accumulating: not only stuff–land, capital, labor–but our human wholeness as well. Yet, “addicts” are separated and othered even though, as Spencer points out, we are all addicts under capitalism: “We consume because it is what is on offer to correct for a pervasive sense of being out of balance.”

Not a standalone crisis

I live in Philadelphia, a little more than a mile south of Kensington and Alleghany, considered by many to be one of the epicenters of the so-called opioid “crisis.” To be clear: My use of quotations is in no way meant to downplay or dismiss the unmeasurable and ongoing grief, trauma, violence, and tremendous suffering connected with opioid use in America; rather, I reject the idea that the opioid crisis is a standalone crisis. It is part of a larger history that includes the War on Drugs, and a carefully executed and ongoing assault on people that use drugs. To fail to recognize this broader historical context is an example of the “false forgetting” that Spencer revisits many times in their work. False forgetting speaks to the ways in which capitalism, as a method of control, seeks to erase our knowledge of and orientation within historic and spatial contexts in order to control narratives and produce disorientation. 

The War on Drugs has shape-shifted over time, but it continues. In Philadelphia, as in many cities and towns across the US, the humanity of people who use drugs is legislated against through measures that run the gamut: forced drug treatment, encampment sweeps, restrictions on mobile services (that make it harder for harm reduction organizations to do the life-saving work of distributing safer use supplies, providing food and medical care, and more), are among a host of policy measures that stand in direct opposition to what public health evidence says. At the federal level, Health and Human Services Secretary  Robert F. Kennedy, Jr. has gestured towards policy positions that could lead to increased involuntary commitment in response to overdose trends in the US. Coerced treatment flies in the face of years of public health evidence that points to these policy measures being not only ineffective, but deadly. Spencer’s work explains that none of this is an accident. The people targeted by these measures are individual scapegoats, blamed for what Spencer describes as “the embedded social dysfunction of a global economic system structured on insatiable ways of being.”

While using drugs isn’t a part of my life anymore, I still have crutches I lean on that span the gamut: from healthy (a balanced mix of of self care and community care practices that help me feel connected to myself, human and non-human creatures, and natural world around me) to less so (*cough cough* TikTok doom scrolling). We all have crutches. More often than not, the only difference between me and people I see on the streets of my hometown of New York City and in my adopted home of Philly is privilege: access to resources, and things like a steady income, cute cats, and a stable and safe place to live.

Harm reduction: community care as resistance

Spencer’s analysis points us to harm reduction, which offers us an antidote to colonized and partitioned consciousness. The National Harm Reduction Coalition describes harm reduction as “a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use.” Harm reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs.” The movement began in the 1980s in the UK as a response to the health harms of injection drug use (originally HIV and AIDS, and later, Hepatitis C). The core of harm reduction philosophy is “helping people be as healthy as possible, whether they choose to use drugs or make changes in their lives.”

One of the practices that keeps me grounded in my own sobriety is volunteering with harm reduction organizations in Philadelphia that all do vital, life-saving work–with very little funding and a ton of volunteer labor. They provide food, clothing, medical care, safer use supplies, and so much more. I am one of a network of volunteers that helps with assembling safer use kits and outreach efforts. When we show up in parks or empty parking lots to unload trucks, feed people, clean and wrap wounds, and give out safer use supplies, kids’ toys, and clothes, there is something deep and unspoken that underlies what can be messy but loving energy. It’s a pulse that says, “I got you and nothing else matters. You are a human being no matter what everyone else and all these other broken and oppressive systems say.”

In my experience, doing harm reduction work carries a healing frequency, and it can feel like a sort of choreographed dance we all have a role in. It is almost always a little chaotic (with loving, warm energy) at the start. People mill around, anticipating the arrival of trucks to be unloaded and stations set up, but in time, things fall into place and the work becomes almost self-sustaining, like you are part of a mycelial network. Individually, we might feel like we are doing something mundane and unimportant—like putting alcohol swabs in a works kit—but collectively, we are part of a collaborative and caring organism. 

My recovery requires me to cultivate an ability to sit in discomfort, and ultimately to be with myself. In more recent years, reestablishing my sense of self has given me an increased ability to connect outside of myself. Spencer writes that “alienation is the primary affective state of life under capitalism.” Capitalism wants us to stay numb and disconnected from ourselves and each other. I think of my sobriety as an act of resistance in and of itself, and harm reduction work as an outward expression of that. 

Spencer writes that “fascism taps the unpleasant emotions that are essential and unavoidable in a class society under capitalism.” Harm reduction stands in diametric opposition to this. For me, it is a practice of loving resistance in that it is rooted in our connection to each other. It is a reminder that we are all we have. In this moment, where we need models for resisting oppression more than ever, harm reduction shows us that things can be done differently. That seemingly small and highly localized acts of care can change, and even save, someone’s life. That resistance can look like showing up in the messiness of what we are, meeting each other where we are, and doing our best to show up for each other; like choosing to lean into the pain and wisdom contained in stories of lived experience, and leading with care, instead of turning towards blame, punishment, and stigma. 

Of course, resistance also includes fighting like hell to reject carceral and oppressive, inhumane systems and policy measures; to inform this work, we must continue to build coalitions, networks, and policy agendas that center lived experience, community care, and public health evidence (where applicable). This work can be incremental and even “messy”—that’s often what building something new looks like!

Harm reduction stands in opposition to the structured oppression of capitalist systems that Spencer excavates, dissects, and exposes to the harsh light of day. Harm reduction is a practice, one that chips away at the illusory walls of separation that make us think we are alone—that there are sick and disordered people who go “over there,” and “normal, healthy people” who stay over here. To me, harm reduction embodies what Spencer describes: “healing, done well, makes us a threat to the dis-order of things.”

Featured illustration by Kimmie Dearest