Crisis or epidemic?

Before writing this post (sometime last year), I did a Google search on “opioid crisis.” In .41 seconds the search turned up over 20 million hits. I followed with a search on “opioid epidemic” and got over 17 million results in about twice the time.

I suppose a greater number of sources, academics and advertisers think we have more of a crisis than an epidemic. In other words, it’s bad.

Nicholas Kristof, an op-ed columnist for the New York Times, published a breathless piece last October titled, “Drug Dealers in Lab Coats.” Teeing off from the previous Sunday’s “60 Minutes” and Washington Post joint investigation, Kristof wrote, “The opioid crisis unfolded because greedy people—Latin drug lords and American pharma executives alike—lost their humanity when they saw the astounding profits that could be made”

While I appreciate the effort to call American pharmaceutical companies to account for their part in shipping various and sundry opioid pills by the tractor-trailer load to vulnerable populations here and there across America, Kristof, in his perhaps justifiable outrage, oversimplifies and misses the big story.

Canadian physician, Gabor Maté, offered a far more timely assessment in his riveting book, In the Realm of Hungry Ghosts: Close Encounters with Addiction: “The question is never ‘Why the addiction?’ but ‘Why the pain?’”

I had watched the “60 Minutes” piece and was attempting to summarize it for the dozen or so men sitting around tables at the county jail shortly after it was aired. Some seemed disinterested but most listened intently. When I finished presenting the indictment of Big Pharma the two media companies had handed down, one of the participants offered a contrary opinion.

“If anyone thinks that disrupting the supply of opioid pills will end the opioid crisis, they obviously don’t know how far an addict will go to find something else to relieve his pain.” Another inmate quickly agreed. The first speaker continued, “I can tell you from experience, you will do anything and everything you have to in order to just get through the day.”

Recalling Dr. Maté, I nodded.


If you have read my blog posts or followed my thinking over the past couple of years, I wouldn’t be surprised if you believe you are hearing the unmistakable sound of a broken record. Fair enough; you could be right.

But I do try to keep balance and perspective in how I analyze what I see and hear when among those I meet in the county jail or the federal prison whose sentence has something to do with drugs. For example, I know that these men and women had a choice in whether to break the law or violate their parole. I know that some of them have a brother or sister who grew up in the same home and who did not abuse drugs or alcohol or steal to support a habit or break laws on drug possession or dealing.

This is a strong argument, one used by Stanton Samenow in his well-regarded work, “Inside the Criminal Mind.” Simplified, his thesis is that people don’t become criminals because of childhood experiences, poverty or any other environmental cause. No, they become criminals because they think differently from the rest of us. They buy into a host of “criminal thinking errors” and make most of their choices and decisions based on them, leading them to actions that victimize innocent people and break laws established for the good order of the community. In other words, it is not outside forces that turn people into criminals. They become criminals by pushing rational thoughts aside and believing irrational thinking errors.

Samenow notes how frequently he hears criminals cite alcohol or drugs as the source of their criminal behavior. Since upwards of 80 percent of those incarcerated abuse drugs or alcohol, Samenow acknowledges the temptation to connect addiction and criminality. But he offers this dispute:

Criminality…does not reside in the bottle, the pill, the powder, or in any other substance. Drugs bring out and intensify only what already exists within a person; they do not transform a responsible person into a criminal. If ten men get drunk, all ten will not rape, rob, or kill. They may fall asleep, become boisterous, or grow argumentative. Their behavior depends on their personality before they took the first sip.

William Raspberry, an African-American former columnist for The Washington Post, apparently had an ongoing feud with Samenow. Raspberry could not abide Samenow’s stubborn resistance to the role poverty has in incubating future criminals. Samenow acknowledged the disagreement in the last chapter of his book:

When this book was first published in 1984, syndicated columnist Williams Raspberry stated; ‘I’m prepared to offer Samenow a deal: I’ll give up the myth that criminals are caused by their environment if he’ll give up the myth that they are cured by psychiatry.’ Raspberry got the right idea about the ‘myth’ of the environment as creating criminals. However, he got the wrong idea about the rest of it.


Since 2009, when I first walked the long corridor of the federal prison in Waymart, I have seen enough to make me largely sympathetic to the thesis put forward by Stanton Samenow. But “largely” is not the same as exclusively. And in the midst of the opioid crisis that by all accounts is sweeping the nation and destroying tens of thousands of lives each year, I insist that the Gabor Maté question will not go away and demands as much attention as Samenow’s thinking errors:“Why the pain?”

I ask this question—or some form of it—with regularity nowadays. A few weeks ago I was talking with a new addition to my classes at the local jail. I recognized his last name and asked if he was related to a young man who’d been in my class a year or so earlier. Indeed, they were brothers. (His was the third situation I’ve encountered in the local jail where two brothers raised by the same parents have both been incarcerated, in two cases incarcerated at precisely the same time.)

As we talked, we closed in on the reason for his present incarceration—a parole violation. I asked if it was drug-related and he answered that it was. I asked about his history of drug use. It reached back to his teenage years and, as if to anticipate my next question, he noted how many times he’d been in rehab and then relapsed and how many times he’d been incarcerated. Both numbers staggered me.

I then asked Dr. Maté’s question: “Why the pain?” He clearly was not anticipating it. I said, “With the history you just provided, you must also have a history of pain and I’m guessing it didn’t start with a back injury.”

Looking down, he said, “I don’t want to talk about it right now.”

A couple of weeks later, I’d just arrived and taken my seat at the table. The men were already there. As I was getting my papers out and starting the signup sheet around the table, the same inmate began to tell me that all this “cognitive stuff” (part of the Smart Recovery® class I’d come to lead that day) wasn’t going to help him.

“Don’t get me wrong,” he said, “this CBT [Cognitive Behavioral Therapy] approach is good for some things. But it doesn’t even begin to get to the level I’m at.”

“I know,” I replied. I told him that from the moment we met and he told me that his drug addiction began in adolescence, and he didn’t want to talk about the pain, that I suspected that he likely had adverse and/or traumatic childhood experiences that still to this day are just too painful to talk about. I asked him if that was so.

He nodded, and I lamented aloud that the program we were both participating in (the prison’s recidivism-reduction program) was not really set up to do much more than allow him to acknowledge the pain. In other words, this wasn’t a group therapy session. He laughed and I asked him why he’d laughed. He then told this story:

“When I was going through intake here, they were asking me a bunch of questions. So I decided to tell them about some of my experiences. No sooner did I get into the gory details than the officer stopped the interview, called another CO who came into the room and put me in shackles and the two of them took me down the hall to a room and put me on suicide watch.” He paused and added, “That’s how much they want to hear about your pain around here.”

Once again I lamented the limitations of a place where confinement, rules, order and the needs of the prison itself overshadow any effort toward healing of deeply wounded souls. All I could say at that point was, “My colleagues and I want to do our best for you while here and be there for you when you get out.”


I felt uneasy having to reply in such a bland, even if sincere, manner. Isn’t this the place where the Christian teacher assures the pained inmate that God can make everything okay? Isn’t it here where we talk about the problem of sin and the solution in the death of Christ?

When I got involved at the county jail and expanded my involvement at the federal prison, I made a bargain with my overseers that my program would not be overtly faith-based and that I would not seek to evangelize those who participated in the class. It would be okay if I cited scriptural agreement with what I said about forgiveness or integrity, but my major point of reference would not be the Bible.

It was a bargain I accepted for the privilege of having access to men who either would not show up for a distinctly Christian program or who had been mandated by the courts to participate in the program in which I agreed to teach. While recognizing the limits of the bargain, I have not regretted the opportunity to be the believer I am and to hope that Christ is seen in me even when I am not naming the Name or reciting scripture.


I recently completed the class on integrity at the federal penitentiary. Two of the 12 chapters are on “woundedness and healing.” In the original edition I placed them in the middle of the book. When the revisions are finished, I’ll move them up toward the front of the book, for I am aware of nothing more likely to tear at integrity than unresolved pain, trauma and shame.

One of the participants in the course is an inmate I’ve known for at least three years. He had previously participated in the studies I’ve offered there and even comes on most occasions when I preach at the Christian services, even though he is the leader of another faith group at the prison. I consider him, in the words of Jesus, as being “not far from the kingdom of God.”

Due to repeated lockdowns and a couple of federal holidays, I ran into difficulty finding available time to finish the 12 weeks. So I made a deal with the class members that we’d get as far as we could and they could then take the remaining chapters with them and work on them until I could return, review them and award completion certificates to those who’d done the work.

The two chapters on woundedness provided the inmate I mentioned above an opportunity to let me in on more of his story. I knew he was serving a life without parole sentence for two murders, since that was public information. I also knew he had been a gang member before coming to prison. But that was the extent of my knowledge. When he turned the course work in, I learned a bit more, admittedly from his perspective.

He wrote about being forced into street life at the age of 14 where he “had to live by all means necessary.” He lost his childhood and his innocence as well. He wrote that when the gang took him in he had to do what everyone else did—sell drugs, murder, steal, rape and rob—or else be killed in retribution. All the while, he wrote, “I was a child!”

One of the chapters in the book has a section on trauma that includes questions about small traumas and large traumas the participant might have experienced. On the question about the small traumas, he wrote, “I don’t believe I suffered any small traumas. Everything in my life was get it done or DIE.” I was “in jail with a life sentence before I finished adolescence.”

He wrote in detail of the guilt and shame he experienced “What I lived is beyond shame!” He added, “But the guilt caused me to learn what a Man, Father, Friend, Adult is and to never [again] be who I was.”

Finally, he wrote, “I started the journey around 16 years ago and everyday I am trying to heal and understand.”


Anyone whose knowledge of this man is limited to the crimes for which he was prosecuted and received a life without parole sentence would be grateful that such a criminal will spend his life behind bars. Justice was served and there’s nothing more to discuss.

I would have had the luxury of such a thought had he never engaged with me on the importance of forgiveness and the challenge of rebuilding integrity in a life that had been disintegrated, and had he not listened intently to my preaching and thanked me afterwards for it. Could he just be blowing sunshine my way? Of course, and he wouldn’t be the first inmate to do so.

I know he has an active appeal in the courts and I have been told there’s a good chance his life sentence will be overturned. I wouldn’t mind that outcome for he certainly could be one of those prisoners who, if released, turns his life to the good and makes the world a better place.

He is one of a lengthening parade of men who have confided in me, sharing their stories of pain, dysfunction, addiction, criminal thinking and criminal activity. Some were nowhere near ready to repent and seek genuine healing and redemption. Some were. It is those prodigal sons who need—and deserve—more help than they are receiving from a nation that has grown weary of drugs and crime and seems to know but one response: incarceration.

If the statistics are right about this full-blown opioid crisis, our work has just begun and we all need to learn to ask the Gabor Maté question, “Why the pain?” and help the wounded find healing.


3 thoughts on “Crisis or epidemic?

  1. What a summary! I stayed glued to it Hampton. Why the pain? Perfect question. Thank you for your insights. It helps me to stay strong in my resolve to forgive and support Erin when she allows.

  2. Very well written! Great examples to illustrate your points. I’m thankful for your tireless efforts to engage and love these men.

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