We need our cities to embrace those in need of help.
“Can You Tell Me How to Get to Sesame Street?” has been the theme song for that iconic children’s television series since its 1969 premiere. It is a universally recognized tune that engenders waves of hope-infused nostalgia about youngsters frolicking as neighbors gather and sweep away looming clouds of loneliness. It’s city living at its best. The air is sweet, every door opens wide, and everything’s A-OK.
But for those of us who’ve spent our careers helping people who struggle with alcohol and drug problems, the lyrics take on a deeper meaning. Like the children in the song, that joyful place is not where they live. They don’t even know how to get there. Anyone who has ever felt their life controlled by a substance — whether it’s alcohol, cocaine, opioids or cannabis — can attest to imagining a better place and hoping that someone or something can help you find it.
An estimated 46 million Americans 12 years and older — including more than 2.8 million people in New York State — didn’t just drink or use drugs in 2021 but experienced a diagnosable substance use disorder. More than 3,000 New York City dwellers died of accidental drug overdose in 2022, a 12% increase over the previous year. For them and their families, substances are a trap, a prison, sometimes even a death sentence.
I’ve been an addiction professional for decades, often working with courts to build and strengthen programs where people can find freedom from the stranglehold and fulfill their obligations to themselves, their spouses and children, and their communities.
Recovery does not emerge from isolation and exclusion.
There are an estimated 100,000 addiction treatment, recovery and prevention professionals who do such work, and an incalculable number of others who assist. We all intend to guide people successfully on a path to wellness — whether through professional treatment involving abstinence, counseling and sometimes medications; by focusing on continuing, yet safer, less harmful substance use; or some other approach. However, with even the best of intentions and well-designed treatment, sustained recovery is unlikely unless what people receive is complemented by a community that embraces them even when they are struggling.
As varied and distinct from each other as the many paths of recovery are, a handful of truths apply universally. One such truth is that people do not overcome addiction in the absence of hope and capacity. Another is that recovery does not emerge from isolation and exclusion. People who have turned to substances for momentary escape, for relief from physical or psychological pain or for pleasure — and get hooked — require sufficient internal and external resources and meaningful connection to others to recover and stay well.
All of which is to say: Vibrant cities — which often tempt people with drugs and alcohol around many corners — should also function as fertile breeding grounds for true, sustainable and contagious recovery.
While people of all income levels and backgrounds use drugs and become addicted at similar rates, those with money have many more options for receiving quality drug treatment when needed. Those with less have fewer options and are often competing for publicly funded treatment slots with the hordes of people referred via the legal system.
Vibrant cities — which often tempt people with drugs and alcohol around many corners — should also function as fertile breeding grounds for true, sustainable and contagious recovery.
And unlike wealthier people, who can often receive medications to treat addiction from the privacy of a doctor’s office, in some impoverished communities, accessing the most available medication requires daily visits to a public clinic. All too often, the stigma surrounding both getting addicted and getting help marginalizes and shames both the poor and prosperous into isolation. A city where the selfish and the greedy thrive while the poor and the needy languish is not a vibrant city. And neither is a city where only those who can drink and use drugs without problems or those who can abstain are welcomed and included.
Countries across the globe are acting decisively to create inclusive cities, where marginalized populations can be served by and be of service to the neighborhoods they call home. Researchers David Best and Charlotte Colman propose applying this concept to those in recovery. They write that cities should make recovery visible, celebrate it, attract others and create a safe environment supportive to those in need. Fifteen years ago, recovery research pioneer William White heralded “a coming age of American communities of recovery,” which he described as macro-level “networks of formal and informal services developed and mobilized to sustain long-term recovery for individuals and families.”
Creating “therapeutic landscapes of recovery” sounds nice, but what does it mean on the ground? In such a city, a collective of public, private and nonprofit decision-makers and consumers consider the well-being of addicted and recovering people and their families as they pay close attention to the social determinants of health: economic stability, education, health and health care, neighborhood and built environment, and social and community context..
All too often, the stigma surrounding both getting addicted and getting help marginalizes and shames both the poor and prosperous into isolation.
All these determinants can work together to prevent harmful drug use and addiction, reduce lethality risk and improve the quality of life for people who use drugs, and create communities that help make long-term recovery not just possible but probable.
Today, scattered throughout New York’s five boroughs — among endless temptations to use, drink, smoke or inject addictive substances — are addiction treatment centers, peer support groups, faith-based recovery ministries, impaired professionals programs, peer-led recovery clubhouses, nonalcoholic liquor stores, a collegiate recovery program, syringe service programs, overdose prevention centers, social enterprises, prevention programs, public awareness campaigns, marches, bike rides, recovery celebrations and a myriad of health, employment, housing and other recovery-supportive programs.
That sounds like a lot, but it is still not enough for the residents and visitors who need hope, help or connection on any given day or night. Hundreds of thousands are still searching for that elusive Sesame Street.