“Straight to two hundred,” Scott answered. He didn’t think it made sense to drop his dosage, high as it was, since he had been on 200 mgs before.
5. When methadone made the news, it usually wasn’t pretty. The year Scott began his treatment program, methadone accounted for less than 2 percent of opioid pain-reliever prescriptions but almost one-third of the overdose deaths caused by opioid pain relievers. The medical community attributed the troubling rise of methadone-related deaths to the increasing use of the drug to treat pain, not addiction. When it comes to treating heroin addiction and its broader social ramifications, methadone has been highly effective since being introduced in 1964. Known as a full opioid agonist, it feeds an addict’s cravings and allows him to function without impairment, if the dose is right. The evidence is consistent. Methadone reduces or eliminates heroin use, lowers overdoses as well as criminality associated with drug use, boosts patients’ health, and helps many live full, productive lives. When it comes to heroin addiction, the drug simply outperforms abstinence-only programs like AA. “You hear all these harsh stories about methadone,” one expert said, “but you never hear about the tens or hundreds of thousands of people who are taking methadone every day, who work, who have largely conquered their habits and lead normal lives.” Scott was becoming one of those people. Peter Friedmann, quoted in Harold Pollack, “This Drug Could Make a Huge Dent in Heroin Addiction. So Why Isn’t It Used More?,” Washington Post, November 23, 2013. See also Herman Joseph, Sharon Stancliff, and John Langrod, “Methadone Maintenance Treatment (MMT): A Review of Historical and Clinical Issues,” Mount Sinai Journal of Medicine 67 (1999): 347–64; Centers for Disease Control, “Vital Signs: Risk for Overdose from Methadone Used for Pain Relief—United States, 1999–2010,” Morbidity and Mortality Weekly Report 61 (2012): 493–97.
6. Sally Satel, “Happy Birthday, Methadone!,” Washington Monthly, November/December 2014.
24. CAN’T WIN FOR LOSING
1. This means that to divide the urban poor into two groups, the unstable and the stable, the undeserving and deserving, the decent and street, is often to misrecognize as immutable that which is regularly transitory and tenuous. Stability and instability: these are not fixed states as much as temporary conditions poor families experience for varying periods of time. Problems bleed into each other. The murder of a loved one can lead to depression, which can lead to job loss, which can lead to eviction, which can lead to homelessness, which can intensify one’s depression, and so on. Policymakers and their researchers can be prone to aiming a silver bullet at one of these problems. But a shotgun’s wide blast might be preferred. On cascades of adversity among low-income families, see Timothy Black, When a Heart Turns Rock Solid: The Lives of Three Puerto Rican Brothers On and Off the Streets (New York: Vintage, 2009); Matthew Desmond, “Severe Deprivation in America,” Russell Sage Journal of the Social Sciences, forthcoming; Kristin Perkins and Robert Sampson, “Compounded Deprivation in the Transition to Adulthood: The Intersection of Racial and Economic Inequality Among Chicagoans, 1995–2013,” Russell Sage Journal of the Social Sciences, forthcoming; Bruce Western, “Lifetimes of Violence in a Sample of Released Prisoners,” Russell Sage Journal of the Social Sciences, forthcoming.
2. Milwaukee neighborhoods with more children had more evictions, even after accounting for their poverty rate, racial composition, and a number of other things. In neighborhoods where children made up less than 10 percent of the population in 2010, 1 renting household in 123 was evicted. In those where children made up at least 40 percent of the population, 1 household in every 12 was. All else equal, a 1 percent increase in the percentage of children in a neighborhood is predicted to increase a neighborhood’s evictions by almost 7 percent. These estimates are based on court-ordered eviction records that took place in Milwaukee County between January 1, 2010, and December 31, 2010. The statistical model evaluating the association between a neighborhood’s percentage of children and its number of evictions is a zero-inflated Poisson regression, which is described in detail in Matthew Desmond et al., “Evicting Children,” Social Forces 92 (2013): 303–27.
3. That misery could stick around. At least two years after their eviction, mothers like Arleen still experienced significantly higher rates of depression than their peers. See Matthew Desmond and Rachel Tolbert Kimbro, “Eviction’s Fallout: Housing, Hardship, and Health,” Social Forces (2015), in press. See also Marc Fried, “Grieving for a Lost Home,” in The Urban Condition: People and Policy in the Metropolis, ed. Leonard Duhl (New York: Basic Books, 1963), 151–71; Theresa Osypuk et al., “The Consequences of Foreclosure for Depressive Symptomatology,” Annals of Epidemiology 22 (2012): 379–87.
4. Another approach involves surveying a person’s resources before trying to access them. Because in poor neighborhoods the most accepted way to say no is to say, “I can’t,” people sometimes try to take that option off the table. So, for example, instead of asking, “Can I get a ride?” you ask, “You got gas in your car?” Instead of asking, “Could you make me a plate?” you ask, “You eat?” When someone knows you have gas in your tank or food in your refrigerator, it’s harder to give a good reason for turning him or her away. Through everyday interaction, the poor have picked up what political fund-raisers and development officers have spent millions of dollars to discover: that there is a delicate art to “the ask.” Knowing how to ask for help—and, in turn, when to extend or withhold aid—is an essential skill for managing poverty.
Asking social workers for help comes with its own set of rules. You don’t want to ask for nothing, because you’ll receive nothing in return. But you also don’t want to come off as too needy, too hungry, too on the edge—because Child Protective Services might soon pay you a visit. I once met a woman, a thirty-three-year-old mother of two teenage girls, who drank a lot. She attributed her drinking to traumatic events that happened to her as a child. “I remember. Down to the smell.”
“Have you ever seen a counselor?” I asked.
“No. I thought about it. But they get too deep into your business. I had somebody make a false allegation against me with child services in California. They didn’t find nothing, but it was traumatizing just the same, having somebody come through my door…and talk to my kids by theyself.”
If she told someone how damaged she was, and how she coped, would she be allowed to keep her children? This mother didn’t know and wasn’t going to find out.
5. I did not personally witness this interaction. Arleen told me about it.
EPILOGUE: HOME AND HOPE
1. Lewis Mumford, The City in History: Its Origins, Its Transformations, and Its Prospects (New York: MJF Books, 1961), 13; with special thanks to Rowan Flad and Shamus Khan for etymology insights.
2. Alexis de Tocqueville, Democracy in America (New York: Perennial Classics, 2000), 511.
3. Gunnar Myrdal, An American Dilemma, vol. 2, The Negro Social Structure (New York: McGraw-Hill Publishers, 1964 [1944]), 810.
4. Plato, The Republic (New York: Penguin Classics, 1987), 312. I have changed “men” to “people.”
5. Mary Schwartz and Ellen Wilson, Who Can Afford to Live in a Home? A Look at Data from the 2006 American Community Survey (Washington, DC: US Census Bureau, 2007).
6. Chester Hartman and David Robinson, “Evictions: The Hidden Housing Problem,” Housing Policy Debate 14 (2003): 461–501.