You've hit the nail on the head in my opinion. For reference, I was addicted to heroin from 2004-2008, finally got into recovery after multiple failed attempts in 2008, and was broken enough to accept suggestions because I clearly was not as smart as I thought I was...
Since then, I went back to school for social work and public health (had to take $187,000 out for school - final tally with interest as of 12/23 was 226k). I have worked with people who use drugs since 2011, and I would agree with everything you said (though with some nuance):
America's consumerism and individualism is ultimately an empty system, devoid of any real feelings of satisfaction. You can buy a brand new car, house, technology, and it has already dropped in value by the time you leave the store. It's like when you do a line of coke and you know the comedown is about to come, so you rack up 4 more lines to be ready. Never enough. Except - we're sold on a system which tells us we can have 'The American Dream' - an illusive state of satisfaction that was much more easily attainable 50 years ago (if you were white).
Our spirituality has been broken by grifter Christian televangelists promising God for just 99.95$, by pederasty in the Catholic church, by political propaganda against Islam, by Anti-semitism, and by the commercialization of Buddhism into yoga cults that grift. People have lost connection with spiritual practice because they're all tarnished in some way or another, leaving people feeling empty and disconnected.
Suburban sprawl with it's infinite growth, infinite cost attached, leads to neighborhoods devoid of any of the culture that comes from city living. There's no music, no art, no interesting cuisine, just little segregated plots of land with guns behind people's doors and medicine in the cabinet. There's money but it's fading fast, there are good schools, but they struggle to compete with Tik Tok and the ongoing assault on public education.
The cities have increasingly become magnets for the wealthiest, and poorest, purging those of us who were once called 'Middle Class'. My neighbors all earn 2.5x my salary (as a therapist) on average. Most of my neighbors are not from around here. The wealth has bought systems of security while the poverty has created generational trauma and ripe breeding grounds for addiction, hopelessness, and the trap of getting tangled up in the dwindling safety net.
If I'm not mistaken, we're the only country where pharmaceutical advertisements are permitted, where it's normalized for a patient to be a conspicuous consumer (Unless you're one of THOSE patients....). We've increasingly medicated existential uncertainty with ritalin for several generations now, first pathologizing atypicality with various disorders, and then watching as people now self-diagnose these very same disorders as a means of feeling special, relevant, or simply to try and understand the suffering they experience. If you're not medicated, you're competing against people who are whether you realize it or not.
I turned to heroin because I'd done everything right, for the most part. I finished high school and got into a good university, I completed in 4 years and found myself unsure as to what to do next - I was 21 years old and despite having lived on my own for a few years at that point, I had no idea how to live a life. Opioids were cheap (Oxys were 40$ for an 80mg pill - diacetylmorphine was 120$/gram) and they were everywhere - normalized by the medical establishment and further stoked by the existential dread of 9/11, the kindling of new technology, and the threat of terrorism and war. The bubble burst and there was opium to numb it. Over time, my generation was decimated - I've lost count of how many friends, former using buddies, people from treatment programs, people in 12-step meetings, patients, and colleagues have died from overdose deaths, many dozen at least.)
Finally - our primary tool against opioids has been Suboxone and Narcan - we're throwing drugs at a drug problem. What we need, is access to ongoing restorative residential treatment programs with trauma-based career development, Criminal Justice reform, and guidance. We needed that a decade ago. What we get, is 5 days in detox and a referral to suboxone programs, where people with no lived experience are telling people trying to find recovery what's best for them. Meanwhile, the recovery support programs (12-step for example), don't view medication assisted treatment as 'truly sober' - so you're caught in a gray world of almost sick, almost sober, peeing in a cup once a week and having someone investigate your personal life so that can access the medication that you can't function without. I do my best to be a counterpoint against that, I'm open about my past, and I'm open about my expertise. My work speaks for itself, but I'm so fucking tired sometimes.
I just got loan forgiveness last week and private practice is calling. All told, 14 years to earn degrees I graduated with in 2012+2014. I've had to pay the equivalent of a second month's rent for the duration (aside from the merciful break in payments during the pandemic). I'll stay connected to public health work, but private practice is much more lucrative and much less taxing. I need to take care of my soul, man. This work is a grind and it's gotten harder as the drugs got stronger and more plentiful, as the cost to rent an apartment as tripled, and as so many people have left the field since CoVID.
So, that's my perspective on what has happened and why we are where we are.
Supervised consumption/Overdose Prevention/Community Engagement Sites are needed - Get people off of the streets so they can use in a space where others will look out for them. It'll keep them from the steps of the library, the subway station, or the starbucks bathrooms, and give them access to people who care.
Residential Treatment Programs that people actually want to utilize. If I hadn't 'had access to 9 months of publicly funded residential treatment, I wouldn't be here today posting this.
Include job training and criminal justice reform pathways for people in treatment, develop internships with companies who want to do business here.
You can't do one without the other.
