addiction and Black History Month

Addiction and Black History Month aren’t exactly synonymous, but in a month set aside to “recognize the importance of Black history in the drama of the American story,” [1] it’s a worthy endeavor to examine the ways in which African-Americans have been plagued by addiction, influenced recovery and address the ongoing drug epidemic.

There are, of course, many facets of addiction (a term that encompasses both drugs and alcohol, for the purposes of this piece) that cross racial lines. As Tony Davis, a counselor in the Recovery Renewal Program at the drug and alcohol treatment center Cornerstone of Recovery puts it, “The disease of addiction doesn’t care if you’re black or white — it’s going to kill you.” But just as Cornerstone prides itself on the philosophy that a one-size-fits-all approach to treatment doesn’t work for every patient, it’s necessary to look at ways in which addiction issues have impacted the African-American community in the past, and issues facing that community in the present day that can be addressed in order to give all who seek recovery an equal footing to receive it.

Addiction and Black History Month: Slavery

addiction and Black History MonthIn examining addiction and Black History Month, it’s worth noting that the use of drugs and alcohol by the African-American community is primarily associated with slavery. While excessive use of alcohol was documented in ancient Greek and Roman cultures as problematic, a 2006 paper in the International Journal of Mental Health and Addiction [2] notes that the history of psychoactive substance use in Africa is relatively short except for the reports on the use of traditional substances such as alcohol, cannabis and khat.”

In 2002, however, noted addiction researcher William White, in a paper titled “Addiction and Recovery Among African Americans Before 1900,” [3] noted that “most African people brought to America as slaves came from West African cultures in which beer and wine had been blended into the economic, social, and religious customs since antiquity. Within non-Islamic African cultures, highly defined drinking rituals encouraged moderate drinking and stigmatized drunkenness as a threat to the order and safety of the tribe.” However, White added: “Alcohol problems rose in tandem with the colonization and deculturation of African tribes — a process strikingly similar to the rise of these same problems within many Native American tribes.”

That cultural shift was closely tied to slavery, according to a 2011 paper in the French journal Cahiers d’Etudes Africaines [4]: “It has been estimated that the liquor imported into West Africa accounted for 5 to 10% of the region' s overall export slave trade. At Luanda, the capital of the Portuguese colony of Angola, the weight of alcohol imports in its export slave trade was even higher: of the nearly 1.2 million captives shipped from this port town during 1710-1830 alone, 33% have been estimated as purchased through the importation of alcoholic drinks.”

With alcohol so closely tied to slavery on the African continent, it’s only natural to assume that it played a role in America. White writes that alcohol was largely prohibited by slave owners because “slave owners were worried about alcohol-related damage to their property, e.g., the financial loss incurred if a slave was injured or killed while drinking. Second, slave owners feared slave insurrections after the slave revolts led by Gabriel Prosser (1800), Denmark Vesey (1822), and Nat Turner (1831), and believed that alcohol could spark such rebellions.”

However, abolitionist and African-American scholar Frederick Douglass, in an in 1846 speech delivered in Scotland [5], pointed out that slave owners also used alcohol as a tool of control: “In the Southern States, masters induce their slaves to drink whisky, in order to keep them from devising ways and means by which to obtain their freedom. In order to make a man a slave, it is necessary to silence or drown his mind. It is not the flesh that objects to being bound — it is the spirit … to blind his affections, it is necessary to bedim and bedizzy his understanding. In no other way can this be so well accomplished as by using ardent spirits! On Saturday evening, it is the custom of the slaveholder to give his slaves drink, and why? Because if they had time to think, if left to reflection on the Sabbath day, they might devise means by which to obtain their liberty.”

Addiction and Black History Month: Emancipation

After the Civil War and the end of slavery, the biggest alcoholic threat to African Americans, White writes [3], wasn’t liquor: It “was the risk of what could happen to them when white people became intoxicated.”

“Freed Blacks often chose not to use alcohol, seeing sobriety as a prerequisite to personal safety and citizenship,” according to White. “Where Black people had access to alcohol, they were so moderate in their drinking habits that the medical community described them as racially immune to the influence of alcohol.”

Nevertheless, a number of black leaders during this time advocated on behalf of temperance, including Douglass; educator Sarah Woodson Early [6], who “was national superintendent of the Colored Division of the Women’s Christian Temperance Union and lectured widely on temperance, self-improvement, and the role of women”; and W.E.B. Dubois, the first black man to complete Harvard’s doctoral program and an early advocate of the temperance movement before turning a critical eye toward its role in discrimination.

It should be noted that temperance wasn’t just a black cause; a largely female-driven temperance movement also advocated against America’s growing love affair with alcohol, but the factors driving both movements were vastly different, according to a 2021 article in Politico [7]: “The secret to understanding Black prohibitionism — and prohibitionism more generally — is to realize that the liquor in the bottle, the morality of drinking, and the eternal fate of the drunkard’s everlasting soul were at best secondary concerns to temperance activists. Instead, the primary target of their ire was the liquor traffic: predatory capitalism and the immorality of getting one’s fellow man addicted to promote your own profit.”

Whereas white temperance, author Mark Lawrence Schrad adds, “Southern whites not only fretted about imaginary drunken Black mobs; they also objected to African Americans being granted access to the highly lucrative liquor traffic. They proclaimed ‘a rooted objection to granting liquor licenses to Negroes, inasmuch as this would be equivalent to establishing colored centres of political activity.’” And, Schrad points out, “The most frequent justification invoked by white lynch mobs in the American south was that Black men were raping white women while drunk.”

Those fictional narratives justified a number of hate crimes, but they had no basis in reality, as Schrad continues: “African Americans were far more temperate than their white counterparts. Postwar censuses found that the rate of alcohol poisoning among Black Americans was only a third what it was among whites, while African Americans died from liver cirrhosis at only a quarter of the rate of their white counterparts. In the Reconstruction South, Emancipation Day and Fourth of July holiday celebrations were marred not by uninhibited Black freedmen, but more often by drunken white mobs looking to disrupt Black celebrations.”

Addiction and Black History Month: Contemporary Problems

addiction and Black History MonthThrough the turn of the century, alliances between black temperance activists and women’s suffrage advocates helped both causes, but by the time Reconstruction came to an end, racial disparities in the South came roaring back with a vengeance. With Northern oversight removed, Southern politicians sought to rebuild antebellum society in a way that continued the hierarchy of slavery without the actual bondage, and as a result, black suffering continued. Addiction and Black History Month can’t be discussed in tandem without pointing out the vast number of tropes surrounding African Americans and drug usage throughout the early 20th century:

  • In 1914, The New York Times ran an article [8] by Dr. Edward Huntington Williams that lamented the horrors of a new “Southern menace” — “negro cocaine fiends. “Once the negro has formed the habit he is irreclaimable,” Williams wrote. “The only method to keep him away from taking the drug is by imprisoning him.”
  • Such hysteria played a role in the passage of the Harrison Act that same year, which made recreational use of drugs like heroin and cocaine illegal — but during congressional hearings, “experts” “testified that ‘most of the attacks upon white women of the South are the direct result of a cocaine-crazed Negro brain,’” according to an article in The Nation [9]. “When the Harrison Act became law, proponents could thank the South’s fear of blacks for easing its passage.”
  • In 1937, the Marihuana Tax Act was passed, and the commissioner of the Federal Bureau of Narcotics, according to Business Insider [10], used it as an excuse to push racism and xenophobia. Harry Anslinger, the article reports, “created a narrative around the idea that cannabis made black people forget their place in society. He pushed the idea that jazz was evil music created by people under the influence of marijuana.”

These “drug scares,” as they became known continued throughout the 20th century, but few had as big of an impact as the crack cocaine scare of the 1980s. According to Craig Reinarman, writing in 1994 for the University of California-Santa Cruz [11], “In the spring of 1986, American politicians and news media began an extraordinary anti-drug frenzy.  Newspapers, magazines and television networks regularly carried lurid stories about a new ‘epidemic’ or ‘plague’ of drug use, especially of crack cocaine.”

However, Reinarman goes on to add, “From its first appearance, crack has always been used heavily by the same population that has always used heroin heavily: the urban poor. Daily crack smoking, like daily heroin injecting, occurs mainly among the poorest, most marginalized people in American society — and only among a small minority of them. In its most popular year, crack was used heavily by only a small percentage of even the people who used cocaine. Crack never became a popular or widely used drug in the United States, or anywhere else in the world.”

Histrionics quickly trumped facts, however, and a broad swath of legal, cultural and social changes were initiated in an effort to squash the “crack epidemic,” which resulted in reverberations that continue to dominate any conversations about addiction and Black History Month.

The Fallout

So what happened in the wake of crack’s arrival? According to an article on the online news site Uproxx [12]:

  • An explosion in the prison population: “The federal government responded even more harshly, issuing a discriminatory ‘100 to 1’ decree for the possession or trafficking of crack versus the penalties for trafficking of powder cocaine; this stood for nearly 3 decades, until 2010, when the Fair Sentencing Act cut the sentencing disparity to 18:1. Someone convicted in federal court of possession of 5 grams of crack cocaine received a minimum mandatory sentence of 5 years in federal prison, compared to the sentence for powder cocaine. In 1996, approximately 60% of inmates incarcerated in the US were sentenced on drug charges.”
  • Those sentencing guidelines had a disproportionate effect on black communities: “The hypocrisy is stunning; departing from racialized images of crack users, data from National Institute on Drug Abuse (NIDA) shows that people reporting cocaine use in 1991 were 75% white; 15% black, and 10% Hispanic. People who admitted to using crack were 52% white, 38% black, and 10% Hispanic. Comparing that to US Sentencing Commission data showing 79% of 5,669 sentenced crack offenders were black, 10% were Hispanic, and only 10% were white.”
  • Today, according to PBS [13], “Black Americans represent 13% of the population in the U.S. and about the same percentage of drug users, but they represent 44% of those incarcerated for drug crimes.“

addiction and Black History MonthThese changes aren’t just applicable to the black community. PBS goes on to add that “Today, there are more people behind bars for nonviolent drug offenses than were incarcerated for all crimes, violent or otherwise, in 1970.” In addition: “2.7 million children in America have a parent behind bars. These children are more likely to be incarcerated during their lifetime than other children.” But there are implications for addiction and Black History Month that go far deeper than that, according to John McWhorter, a professor of linguistics for the University of California-Berkeley, writing for the Cato Institute [14]:

  • “The War on Drugs makes spending time in prison a badge of honor. To black men involved in the drug trade, enduring prison time, regarded as an unjust punishment for merely selling people something they want (with some justification), is seen as a badge of strength: the ex-con is a hero rather than someone who went the wrong way. In the 1920s, before the War on Drugs, black Americans, regardless of class level, did not view black ex-cons as heroes.”
  • “The War on Drugs discourages young black men from seeking legal employment. Because the illegality of drugs keeps the prices high, there are high salaries to be made in selling them. This makes selling drugs a standing tempting alternative to seeking lower-paying legal employment. The result is usually spells in jail, as well as a failure to build the job skills for legal employment that serve as a foundation for a productive existence in middle and later life.”

Even as national attention has shifted to the opioid epidemic, “the number of Blacks dying from opioid has reached an extended rate higher than the general population in numerous states such as Missouri, Illinois, Minnesota, Wisconsin, West Virginia and Washington, D.C.,” according to a 2018 article in the International Journal of Collaborative Research on Internal Medicine and Public Health [15]. “For instance, death rates in the states of Virginia and Wisconsin have numbers of Blacks with fatal overdose rate nearly double that of Caucasians.”

Addiction Treatment: The Challenges for People of Color

There are other racial disparities when it comes to drug use and suffering caused by it. In the preface to a 2014 collection of research for the American Psychological Association (APA) [16], Dr. Tamika Zapolski writes, “compared to their European American counterparts, African-Americans report a later initiation of alcohol during adolescence and generally lower rates and levels of use across adulthood. Despite these findings, African-Americans appear to experience more negative social consequences from drinking, experience more alcohol-related illnesses and injuries, and to some extent, are more likely to report alcohol dependence symptoms and/or diagnosis.”

Another APA collection of data reports [17] that “despite relatively uniform rates of substance abuse among racial and ethnic populations, there is a disproportionate rate of drug arrests for African-Americans. In addition, members of racial and ethnic minority groups are most likely to experience barriers that impede their ability to access substance abuse treatment.”

And even when they are able to access drug and alcohol treatment, the challenges because of race don’t end there. According to a 2018 report in the journal Health Affairs [[18], “racial and ethnic minorities with addiction disorders, who constitute approximately 40 percent of the admissions in publicly funded substance abuse treatment programs, may be particularly at risk for poor outcomes. Using national data, we found that blacks and Hispanics were 3.5–8.1 percentage points less likely than whites to complete treatment for alcohol and drugs, and Native Americans were 4.7 percentage points less likely to complete alcohol treatment … completion disparities for blacks and Hispanics were largely explained by differences in socioeconomic status and, in particular, greater unemployment and housing instability.”

While that particular study is almost a decade old, those problems persist across the country. Speaking at the February 2021 East Tennessee Opioid Conference, sponsored by the Metro Drug Coalition of Knoxville, Dr. Keith Gray — chief medical officer of the University of Tennessee Medical Center — called particular attention to what he described as “disparity within a disparity” when it comes to treatment opportunities for people of color.

"African-Americans are less likely to complete treatment no matter what they’re doing treatment for," he told attendees, as reported by WBIR-TV [19]. "Not seeing other African-Americans in treatment makes people less likely to show up for treatment."

In addition, WBIR reporter Cole Sullivan added, “underlying existing issues of education, access and affordability among communities of color is a larger issue of trust, Gray said. Addressing the issue of trust, he said, will allow for the improvement of equity for all.”

So how, then, do treatment programs address those issues of trust? It’s an important question to address during any discussion of addiction and Black History Month … particularly by treatment providers, counselors and administrators who can rely on their experiences as individuals in recovery, as well as members of minority communities.

Addiction and Black History Month: Recovery

addiction and Black History Month

From left: Rod Jackson, Andre King and Tony Davis.

While there’s a long and complicated history between addiction and Black History Month, there’s also a need to look at where things stand in terms of addiction treatment and recovery from drug and alcohol use. What Rod Jackson — the director of Stepping Stone to Recovery, Cornerstone’s sister facility that offers drug and alcohol treatment to TennCare recipients — is that there’s still a holdover of suspicion and perceived discrimination from the Reagan-era’s draconian crack policies.

“I think as a general rule, African-Americans as a whole have been ostracized for the use of drugs. You see it on TV, you see it in the movies, and I think it was majorly brought to the forefront in the Reagan era, when crack cocaine hit,” Jackson said. “To be specific about where we are, look at Knoxville: There’s roughly a 13% African-American population in this area, which means we would expect, as a general rule, the same proportion to be showing up here for treatment.

“This is a 46-bed facility, so if we get six patients here representing African-Americans here in East Tennessee, that would be about the same percentage. I would have that geographic norm. But what I do get is about half that during any given time frame. At some points, we’re at or exceed that, but right now, I have two. So in all reality, what’s the issue?”

For Davis, it comes down to economic disparity.

“One thing I know is that African-Americans don’t go to the best treatment, because they don’t have the means or the money or the insurance,” he said. “We need more resources that are suitable for black men and women, just like there are for white men and women.”

Jackson agrees, to an extent — but there are other issues at play as well. For example, the treatment of African-Americans by the medical community may play a role. He points to the Tuskegee studies that began in the 1930s, in which “researchers told the men they were being treated for ‘bad blood,’ a local term used to describe several ailments, including syphilis, anemia, and fatigue. In truth, they did not receive the proper treatment needed to cure their illness.” This went on for 40 years, according to the Centers for Disease Control [20]. And some of it, he believes from his own experiences, may be cultural views on addiction and addiction treatment as well.

“From my perspective, African-Americans may not see treatment as beneficial in solving their problems as other ethnicities do,” said Jackson, himself a recovering addict. “When I look back to growing up, before drugs infiltrated the community, there were always bootleggers around, and everybody drank. Culturally, it was acceptable, and there were areas where people could do whatever they wanted to, as long as you didn’t cause a major problem in the community.

“When the drugs came in, crime went up, the old folks began to get accosted and people just became more ill-spirited, mean-spirited and showed disrespect, and that’s when the tables began to turn and the police started getting called. But I think years of that acceptance have contributed to treatment not being sought as an option. Growing up, you took care of your business and your family, and you didn’t air your dirty laundry.”

Information and Identity: Navigating Both

One of the biggest issues for the black community, according to Davis and Jackson, is the lack of information available to communities of color when it comes to drug and alcohol treatment options. Some of that is cultural, Davis pointed out, but some of it is attributed to pride.

“A white family may have a young adult who has a drug problem, and they’ll keep it hush-hush, then everybody wants to know what happened when that young person overdoses,” Davis said. “That’s not just a black problem, and in some ways, we need to stop looking at race when it comes to addiction. We’re all trying to hide it when we need to be more open about it.”

As Jackson likes to point out to the clients with whom he does group: A great many addicts, but especially those in the black community, are told to “get your shit together. But no one ever told you how to get your shit together,” Jackson said.

“We’ll tolerate you because your family, and family ties are strong in ethnic communities, because regardless of what you do, you’re going to be family,” Jackson said. “Couple that with religion being one of the mainstays of the black community going back to the slavery period, and you see how religion provided hope in a way that black people didn’t think they needed much else: It’s the hope that ‘God will look after me while I’m picking cotton, that the slave master won’t sell my children.’”

In some cases, those community bonds that keep hope internal to its members can transcend socio-economic boundaries. A biracial Extended Care Counselor at Cornerstone of Recovery, Andre King was born to a black father but raised by a white mother. She made sure he never lost touch with his ethnic roots, but growing up in a majority-white, homogenous area of South Dakota, it wasn’t until he moved to Chicago for college and began forging strong relationships with black peers that he began to truly examine his racial identity.

“My first weekend there, I got drunk, and when you get drunk, you go with whomever accepts you,” he said. “I blacked out, and when I woke up, I was surrounded by all black people, and they became my friends, and introduced me to their friends, and it just grew from there. Initially, I tried to fit in, to talk a certain way, to wear certain clothes, essentially to assume the stereotype I had about what it mean to be ‘black.’ I was not being myself, and in order to be someone different, alcohol really helped put me at ease and not be so anxious.”

His sister eventually challenged his identity struggles, and he began to realize that while race makes up part of who he is, it doesn’t necessarily define him. Getting sober several years later, he said, helped in a couple of ways: It allowed him to move beyond racial stereotypes as one of the defining traits of his life, but it also allowed him to examine and acknowledge the privilege he received from his upbringing and his childhood environment.

“I came from a highly successful family — doctors, lawyers, pharmacists, and they were highly successful,” he said. “They prized education, and because they prized it, I took it seriously, whether I wanted to or not. That made me care more about working on my intelligence, because it’s part of the value system of the family I came from. What sobriety did was make me more confident in who I am.

“People tell me, ‘I just don’t think about your race,’ because I don’t fit any stereotypes. Or maybe I fit so many on both the black and white side. Either way, most people don’t acknowledge my ethnicity, and I like that. I like that I really can’t be put in a box. Sobriety has definitely helped me have the courage to be more myself.”

Addiction and Black History Month: Where Do We Go From Here?

addiction and Black History MonthKing is quick to point out, however, that worldview is shaped by experience, and his relatively colorblind experience means race isn’t as much of a factor for him as it might be for other people of color.

“I don’t look out into the world as a black man or a white man, and that is privilege,” he said. “I don’t feel like I navigate through the world through any particular lens, but I understand that as far as patients go, I have to assess how they look out into the world and meet them there. For instance, for me, my grandmother went to treatment in 1976. My mom went in 1982. My uncle went in 1986.

“So I come from a family that accepted addiction as a disease and sought treatment for it way before I was born. And a part of that was their education: My grandfather was a doctor, my grandmother a pharmacist, so they were aware of addiction in the realm of medicine, and I think that’s why they were more accepting of treatment.”

Davis, on the other hand, reached a point in his own addiction that he accepted help wherever he could get it, started at Knox Area Rescue Ministries. And while racial issues occasionally arose, especially back then, he had the willingness to stay the course regardless of whatever obstacles may have fallen into his path — due to skin color or otherwise. What concerns him, he said, is how other people of color who aren’t as committed might be discouraged from pursuing recovery if they encounter similar roadblocks.

“A lot of us, we don’t have the information, and that makes it so much harder sometimes,” he said.

Jackson agrees, although with a caveat: The treatment is out there, and the beds are available.

“The access is the same — why people are not accessing it is the real question, and I don’t know why,” he said. “If you want treatment, you can get treatment. But across the board, it’s all about the economics, and it’s all about availability. The question is, why would any minority come to Cornerstone or Stepping Stone as opposed to any other facility? What are we doing to welcome them here? That’s the real question.”

For one, he added, both facilities offer unparalleled recovery, a combination of 12 Step-based abstinence and evidence-based psychotherapies that work with patients of any skin color. And while the desire to get clean and sober should transcend any racial barriers — after all, he added with a chuckle, when it got bad, addicts didn’t vet their drug dealers or bartenders based on skin color — there are still ways he can relate, as a black man, to those who come to him for help.

Addiction and Black History Month may be important to examine together, but addiction, he and Davis and King agree, goes on the other 11 months of the year as well.

“We’ve been to treatment, we work in treatment, and we know exactly what it is we do,” Jackson said. “I can play the black card, because I am black. Many years ago, I thought I was a social worker who happened to be a black man, but I was wrong. I’m a black man who happens to be a social worker.”

SOURCES

[1]: https://africanamericanhistorymonth.gov/about/

[2]: https://www.researchgate.net/publication/226664317_Status_of_Drug_UseAbuse_in_Africa_A_Review

[3]: http://www.williamwhitepapers.com/pr/2002HistoryofAfricanAmericanRecovery.pdf

[4]: https://journals.openedition.org/etudesafricaines/16591?lang=en

[5]: http://www.museumofafricanamericanaddictionsrecovery.org/black-temperance-movement-1

[6]: https://www.monticello.org/getting-word/people/sarah-woodson-early

[7]: https://www.politico.com/news/magazine/2021/02/06/forgotten-black-history-prohibition-temperance-movement-461215

[8]: https://www.nytimes.com/1914/02/08/archives/negro-cocaine-fiends-are-a-new-southern-menace-murder-and-insanity.html

[9]: https://www.thenation.com/article/archive/how-myth-negro-cocaine-fiend-helped-shape-american-drug-policy/

[10]: https://www.businessinsider.com/racist-origins-marijuana-prohibition-legalization-2018-2

[11]: https://www.researchgate.net/publication/288951969_The_social_construction_of_drug_scares

[12]: https://uproxx.com/hiphop/snowfall-1980s-crack-epidemic/

[13]: http://www.pbs.org/black-culture/connect/talk-back/war-on-drugs/

[14]: https://www.cato.org/sites/cato.org/files/pubs/pdf/catosletterv9n1.pdf

[15]: https://www.iomcworld.org/articles/opioid-addiction-among-the-black-community.pdf

[16]: https://www.apa.org/pi/oema/resources/ethnicity-health/african-american

[17]: https://www.apa.org/pi/oema/resources/ethnicity-health/african-american/substance-abuse

[18]: https://www.healthaffairs.org/doi/10.1377/hlthaff.2011.0983

[19]: https://www.wbir.com/article/news/local/od-epidemic/concern-grows-over-inequalities-in-addiction-treatment-and-stigma-in-knox-county/51-08a2eeda-32f4-412c-9aab-f868a774c93b

[20]: https://www.cdc.gov/tuskegee/timeline.htm