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Alyssa Thomas

ENG 1201

Professor Hellmers

29 October 2021

Literature Review: How has addiction impacted the city of Dayton?

For the past several years, the city of Dayton has been actively battling the

addiction crisis that has torn through the city and impacted the lives of nearly all of its

inhabitants. Dayton has an extensive history coping with the effects of addiction, but the

recent resurgence of heroin, fentanyl/fentanyl-related compounds, and

methamphetamine has cast an unignorable pall over the last decade. The worsening

addiction crisis suggests lasting effects on our individual communities including social,

political, and economic challenges that may not be easily mitigated or managed

throughout our lifetimes. For many, the effects of this insidious disease are obvious.

Addicts can be seen on nearly every street corner panhandling while others roam the

city seemingly lost in a far-off trance. Nearly every day, there are reports of sizable drug

busts and much of the city’s crime is influenced by an unyielding dependence on

substances. Other effects are much more subtle, many of which we have yet to

experience but the question still remains – how has the addiction crisis impacted the city

of Dayton?

The disease of addiction has undergone significant historical evolution. Originally

thought to be an immense moral failing, addicts were frequently sent to asylums to

recover from their respective spiritual maladies. The classification of addiction as a

disease – and its treatment as such – is a much more recent development. “The
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concept of alcoholism and other drug dependency as being a disease first surfaced

early in the 19th century. In 1956, the American Medical Association (AMA) declared

alcoholism an illness, and in 1987, the AMA and other medical organizations officially

termed addiction a disease.” (Angres & Bettinardi-Angres, 2010). Presently, the disease

of addiction is classified in the Diagnostic and Statistical Manual of Mental Health

Disorders and is independent of previously associated diagnoses. “No organism in

nature is separate from the system in which it lives, functions and dies, and no natural

process can be understood in isolation from its physical and biological context. From an

ecological perspective, the addiction process doesn’t happen accidentally, nor is it

preprogrammed by heredity. It is a product of development in a certain context, and it

continues to be maintained by factors in the environment. The ecological view sees

addiction as a changeable and evolving dynamic that expresses a lifelong interaction

with a person’s social and emotional surroundings and with his own internal

psychological space. Healing, then, must take into account the internal psychological

climate — the beliefs, memories, mind-states and emotions that feed addictive impulses

and behaviours — as well as the external milieu. In an ecological framework recovery

from addiction does not mean a “cure” for a disease but the creation of new resources,

internal and external, that can support different, healthy ways of satisfying one’s

genuine needs. It also involves developing new brain circuits that can facilitate more

adaptive responses and behaviours.” (Maté, 2008). Nonetheless, the stigma remains.

No matter its origin or classification, the disease of addiction has lasting effects not only

for the individual but for the societies in which they dwell.
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As addiction spreads throughout Dayton, there are notable upticks in

incarceration rates, increases in the transmission of communicable diseases, and the

city’s prostitution rates have skyrocketed. Overdose rates have soared, plummeted, and

soared again causing overflow in the city morgue and influx of business for area

mortuary services. The increasing death toll, coupled with social services calls from

mandated reporters, has caused a sharp increase in the amount of children in need of

foster care services yet a steep decline in their availability. Furthermore, the effects of

addiction oftentimes create (or, in many cases, are created by) a dire need for mental

health services although many individuals remain untreated. Despite the ever-

increasing strength, determination, and resilience of Dayton’s recovery community, it is

difficult to grasp onto the glimmer of hope of a brighter future for our city.

Although there has been a slight decrease in the incarceration rate for drug-

related offenses in the Dayton area, this is likely attributed to the drastic change in

police protocols in response to COVID-19. “In 2020, officers made 817 arrests in

connection to drug possession and 49 arrests in connection to drug trafficking. That’s

less than in 2019, when officers made 60 trafficking arrests and 956 possession

arrests.” (Perry, 2021). Many of these offenders are now offered treatment either in lieu

of conviction or as a condition of their release but the long-term effects of these

modifications remain to be seen.

Intravenous substance use is a major contributor to the spread of communicable

diseases. In a study conducted in 2019 by the Department of Public Health, reports of

hepatitis, HIV, and sexually transmitted diseases have seen an increase. In 2018,

hepatitis C reports comprised 23% of the 1,932 diseases reported. There were 63 new
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cases of HIV reported in 2017, an increase from previous years. Chlamydia cases

began increasing in 2018 and “the number of syphilis cases reported in 2018 was 5

times higher than the number reported in 2014.” (Department of Public Health, 2019). In

a 2019 report by the Dayton Daily News, more than two thirds of sex workers in Dayton

have some history of substance abuse further lending to the communicability of

diseases in the Dayton area. (Frolik). (While the Dayton Daily News takes some stock in

delivering a certain shock value to its readers, their coverage of the addiction crisis as it

continues to unfold has presented unbiased information that can be corroborated with

the use of data from other agencies.)

According to a report by the Department of Health, ‘unintentional drug poisoning’

has surpassed vehicle accidents as the leading cause of death since 2007. “In 2019,

4,028 people died of unintentional drug overdoses, which was a 7% increase over 2018.

Black non-Hispanic males had the highest drug overdose death rate in Ohio compared

with other sex and race/ethnicity groups. Fentanyl was involved in 76% of overdose

deaths in 2019, often in combination with other drugs. That percentage was up from

73% in 2018, 71% in 2017, and 58% in 2016. Fentanyl was involved in 82% of all

heroin-related overdose deaths, 77% of all cocaine-related overdose deaths, and 72%

of all psychostimulant/methamphetamine-related overdose deaths. Carfentanil was

involved in 508 fentanyl-related overdose deaths in 2019 compared with 75 in 2018.”

(2021). These results – intended to deliver the grim truths of the addiction crises and

offered by a reputable governmental agency – are unable to be ignored.Although there

has been significant disputing how to best address these issues, the alarming death

rate has spurred several Naloxone-based programs including Project DAWN (Deaths
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Avoided with Naloxone) promoting revival and harm-reduction through Narcan

distribution.

Many of these concerns, while alarming, have little bearing on how many law-

abiding citizens go about their day-to-day lives. However, the children impacted by a

loved one’s substance use continues to increase and the availability of necessary

resources decreases with continued demand. “County agencies have struggled to

recruit and train enough foster parents, at times sending children from Montgomery

County to homes as far away as Arkansas and Missouri. Taxpayer costs have risen as

the children required longer stays in foster or group homes and needed more intensive

care. Montgomery, Greene, Warren, and Miami counties saw the total number of kids

removed from homes increase nearly 20 percent from 2013 to 2017. Traumatic

experiences such as seeing a parent overdose, or living through a long foster-care stay,

increase the likelihood that children will face a future of unemployment, homelessness,

addiction or criminal activity.” (Wedell, 2019). Though some reunification programs are

implemented in various drug courts or children’s services agencies, success rates are

abysmal and the effects of addiction continue to impact the newest generation in

unimaginable ways.

With the inclusion of the substance abuse diagnosis found in more recent

editions of the Diagnostic and Statistical Manual for Mental Health, it is evident that

mental health and addiction are firmly and, often inseparably, intertwined. “Many studies

have demonstrated that addictions often co-occur. A systematic review of studies found

that, on average, 23% of individuals with one addiction also had a second addiction,

with estimates for co-occurrences between 11 addictions ranging from 10% to 50%
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(e.g., 50% between tobacco and alcohol addiction, 20% between gambling and alcohol

addiction, or 10% between Internet and work addiction)… Multiple explanations for the

co-occurrence of different addictions have been suggested. Some authors suggest that

different addictions have considerable overlap in etiological, phenomenological, and

clinical presentations and may therefore be best understood as different expressions of

the same underlying disorder. Other possible mechanisms are cross-reinforcement and

cross-tolerance, which have been demonstrated between alcohol-use disorder (AUD)

and tobacco-use disorder (TUD)… Multiple studies have found that polysubstance

dependence and polysubstance use are associated with increased rates of psychiatric

comorbidity. A study using the US national Veterans Health Administration register of

472,642 veterans with at least one SUD found that 26.8% of them had at least two

SUDs and that having two or more SUDs was associated with more medical and

psychiatric disorders. Using the same sample, MacLean, Sofuoglu, and Rosenheck

found that combined AUD and TUD was associated with higher prevalence rates of

other SUDs (e.g., cocaine use disorder) and schizophrenia. Hence, the co-occurrence

of SUDs is common and associated with increased risks of other mental disorders.”

(Simon, Marmet, et al. 2019).

Although, shockingly, many of the long-term emotional and sociological

consequences of the disease of addiction have yet to truly be seen in Dayton, the

financial strain has been all-too-apparent. In a 2019 report, the Dayton Police

Department indicated a sharp rise in financial costs from 2015 – 2018 in direct

correlation with the rise of the epidemic. “With the rise of opioid related deaths from

2015 to 2018, the financial impact to the City of Dayton due to this epidemic rose as
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well from 2015 to 2018. The City of Dayton distributed more than $500,000 for naloxone

(also known by the brand name Narcan,) a medication designed to rapidly reverse an

opioid overdose. The cost for this naloxone was borne by a number of institutions. While

the half million-dollar price tag was just for naloxone, the City spent an additional

$340,000 in 2016 on emergency response by first responders. By 2017, that price tag

almost doubled to $610,000.” (Hamilton, 2019). While sparing no expense to ensuring

harm reduction measures are implemented throughout the county, government-funded

and private insurance companies have been making significant payouts in direct relation

to substance abuse. “Medicaid, a state and federally funded health care program for

more than 3 million low-income and disabled Ohioans, is paying the biggest share of the

bill when it comes to the opiate crisis. Just three years ago, in 2014, Ohio Medicaid paid

out $59.3 million for medications used to treat opioid addiction, such as Suboxone,

Buprenorphine, Naloxone and Vivitrol. In 2016, the tab hit $126.6 million – 113.5

percent increase. Ohio was among 31 states that expanded Medicaid to cover more

low-income people through the Affordable Care Act, also known as Obamacare.

Expansion in 2014 led to an additional 715,000 signing up for Ohio Medicaid, nearly

one-third of whom suffer from drug abuse issues. Roughly 112,000 Ohioans sought

publicly funded treatment for alcohol or other drug addiction, 47 percent of whom had

opiate addictions. (That figure doesn’t include people seeking treatment through private

insurance plans or cash payments.)… A once-a-month injection of Vivitrol, a drug

administered to quash cravings, costs more than $1,000 a shot. Outpatient detox runs

$1,000 to $1,500. And 90 days in a high-end inpatient drug rehab program can cost as

much as a year at an Ivy League university, putting it well out of reach for all but the
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wealthiest Ohio families. The cost for group counseling, outpatient programs,

detoxification and other services for alcohol and other drug addiction was $100.3

million, according to the Ohio Department of Medicaid. By 2016, it soared to $216.5

million. A 60 to 90 day stay in an inpatient rehab program runs $12,000 to $60,000 while

outpatient counseling runs $5,000 to $10,000 for a three-month course, according to

national data from AddictionCenter.com. A year of methadone maintenance — a drug

used to quash cravings for heroin — runs about $4,700.” (Bischoff, 2017). Medicaid and

similar programs have become the lifeblood of tens of thousands of Daytonians

struggling with addiction yet there is much debate over whether the benefits outweigh

the substantial costs. I guess that truly depends on who you ask. Though it is well

documented that addiction is a chronic disease, there is an alarming subset of people

who continue to believe in the choice model of addiction. This results in a perhaps not-

so-surprising lack of compassion and, at times, derision for the suffering addict and all

those impacted by their plight. It is preferable in times of dissent to instead focus on the

immutable facts of the future we now face.

In contrast, the addiction crisis has spurred a new conversation in the city of

Dayton – one of recovery, change, and possibility – and the amount of available

recovery meetings (Alcoholics Anonymous, Narcotics Anonymous, Celebrate Recovery,

etc.) continues to grow. If one wishes to learn about the plight of the still-struggling

addict or become inspired by various lengths of clean-time and in-between-time, one

should look no further than the Dayton Fellowship Club, Southside Club, or the Outcast

Motorcycle Club. Recovery-based churches and community centers have been

cropping up in the most drug-addled communities making recovery freely available in

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the most drug-addled and hopeless neighborhoods. Former addicts now have the

opportunity to become Peer Recovery Support Specialists and are tasked with dredging

the trenches for the most broken-hearted, spiritless individuals desperately seeking to

surrender to an easier, simpler way. The Dayton Fellowship Club describes this

unflagging devotion to recovering addicts in their 30 th Anniversary Program:

“Collaborations have become an indispensable part of the history of the Club. Another

important aspect of our relative success has been the capacity to apply ourselves to

service while working on multiple fronts. We provide peer to peer support and

intervention, host recovery meetings and provide clean recreation for addicts and their

families, do community outreach and advocacy, pay bills, make repairs, find new

leadership, and raise funds. Keeping the door open is probably best described as a

project fueled by the prayers of a concerned membership and compassion of a caring

community. We are grateful to be able to serve.” (Dayton Fellowship Club, 2020).

As previously mentioned, many of the effects of addiction on the person are

observable and clearly documented. The effects of addiction on the community, to the

untrained eye, are more obscured although there are definite social, political, and

economic outcomes of this addiction epidemic. “The addiction crisis and its many

tentacles is extracting a huge public price tag. Congress spent the better part of the past

two weeks debating funding measures — efforts that will no doubt add to the more than

$1 billion sent to the states over the past two years to cover treatment costs. Yet those

who live the crisis every day say money is only one side of the equation. ‘I think the

biggest problem that we have in terms of switching the narrative from being an addicted

community to being a recovering community is an education about what exactly is this

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thing we’re wrestling with and being able to humanize it to some degree,’ said Greg

Delaney, a Xenia pastor in long-term recovery who has been helping lead other faith-

based groups to embrace the recovery movement. ‘We go ahead and we label the

addict. We label the prostitute… We never take any time to pull the lens back and say

how did they get there?’” (Wedell, 2018).

As we continue to navigate through the opioid epidemic and the resurgence of

the methamphetamine crisis, it is imperative we explore these implications within the

guidelines of the recovery lens. It is clear that the city of Dayton will, much like the

suffering addict, require time, compassion, and therapeutic intervention in order to

recover.
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Works Cited

Bettinardi-Angres, Kathy and Daniel Angres. "Understanding the Disease of Addiction."

Journal of

Nursing Regulation 1.2 (2010): 31-37.

County, Public Department of Health Montgomery. "Community Health Assessment."

2019. Public Department of Health Montgomery County. 28 October 2021.

<https://www.phdmc.org/report/community-health-assessment>.

Frolik, Cornelius. "Dayton’s prostitution problem closely tied to drug issues." Dayton

Daily News 28 January 2019. <https://www.daytondailynews.com/news/crime--

law/dayton-prostitution-problem-closely-tied-drug-

issues/F6ifLmG7zoqduaahpMSHEL/>.

Health, Ohio Department of. Ohio Department of Health. 2021. Website. 14 October

2021. <https://odh.ohio.gov/wps/portal/gov/odh/know-our-programs/violence-

injury-prevention-program/resources/ohio-overdose-prevention-network>.

Hurst, Shannon. Interview. Alyssa Thomas. 17 October 2021. Interview. 17 October

2021 .

Mate, Gabor. In the Realm of Hungry Ghosts: Close Encounters with Addiction. Toronto

: Knopf Canada, 2008. Book.

Mulvaney-Day, Norah, et al. "Mental Health Parity and Addiction Equity Act and the use

of outpatient behavioral health services in the United States, 2005–2016."

American Journal of Public Health (2019): S190-S196. <https://web-p-ebscohost-

com.sinclair.ohionet.org/ehost/pdfviewer/pdfviewer?vid=15&sid=2dc47aba-f603-

4b48-bdb8-83afac92353a%40redis>.
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Prevention, Centers for Disease Control and. Centers for Disease Control and

Prevention. 15 July 2021. 17 October 2021.

<https://www.cdc.gov/drugoverdose/>.

Simon, Marmet, et al. "Unique versus shared associations between self-reported

behavioral addictions and substance use disorders and mental health problems:

A commonality analysis in a large sample of young Swiss men." Journal of

Behavioral Addictions (2019): 664-677. <https://web-p-ebscohost-

com.sinclair.ohionet.org/ehost/pdfviewer/pdfviewer?vid=11&sid=2dc47aba-f603-

4b48-bdb8-83afac92353a%40redis>.

Szalavitz, Maia. Unbroken Brain: A Revolutionary New Way of Understanding Addiction.

New York: St. Martin's Press, 2016. Book.

The Anonymous People. Dir. Greg D. Williams. Perf. Kristen Johnston. 2013.

Documentary.

Weddell, Katie. "Foster care system struggles to keep pace with opioid epidemic."

Dayton Daily News 17 February 2019.

<https://www.daytondailynews.com/news/local/addiction-toll-our-region-

children/7asqQRMl3vSJzF8FhCMqKM/>.

Wedell, Katie. "Dayton cut overdose deaths in half — and learned these lessons to

prevent another crisis." Dayton Daily News. Dayton, 10 March 2019. Newspaper

Article. 17 October 2021. <https://www.daytondailynews.com/news/local/dayton-

cut-overdose-deaths-half-now-model-for-addressing-

addiction/siwxOxBukiAYmKPA51NbTO/>.
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—. "Three Things I Learned Covering the Opioid Crisis in Dayton." Dayton Daily News.

Dayton, 11 March 2019. 17 October 2021.

<https://www.daytondailynews.com/news/local/things-learned-covering-the-

opioid-crisis-dayton/JNX5QJAIfVTuhQTva59KCP/>.