This whole piece is a good example of how fine writing can hoodwink you. Garbage analysis from start to finish.

"Unlike in Europe, where cities and towns existed long before industrialization, much of America’s heartland has no remaining preindustrial history, given the destruction of Native American societies. The gutting of that industrial backbone — especially as globalization intensified in a country where market forces are least restrained — has been not just an economic fact but a cultural, even spiritual devastation."

From time immemorial, people---especially cultural critics and journalists---have blamed social phenomena on culture, the era's degradation, political changes or something else they are interested in anyway. It flatters you for your command of politics and history: turns out all that stuff you read about because it interests you is actually solidly causative in explaining something important. What a nice coincidence.

I am pretty sure that when the history of this era is written by real social scientists, what they will decide is much more technical and boring...having little to do with the topics that capture our attention for other reasons (manufacturing jobs and trump's election in this case). For example: a bunch of new opioids had been invented, which insurance paid for and doctors prescribed. Large amounts of heroin were available at low prices from increasingly competent and seamless sellers. In what world would these phenomena take place and the amount of addiction not increase?

I used to live in England. There is not as much of a crisis there although there is plenty of economic hardship, loss of manufacturing jobs, etc. The difference is that the NHS won't pay for everybody to load up on a thousand pills, and England is an island where you can't easily smuggle in tons of heroin.

Sometimes the article really veers into the absurd. Consider this passage:

"A huge boom was kick-started by the Civil War, when many states cultivated poppies in order to treat not only the excruciating pain of horrific injuries but endemic dysentery. Booth notes that 10 million opium pills and 2 million ounces of opiates in powder or tinctures were distributed by Union forces. Subsequently, vast numbers of veterans became addicted — the condition became known as “Soldier’s Disease” — and their high became more intense with the developments of morphine and the hypodermic needle. They were joined by millions of wives, sisters, and mothers who, consumed by postwar grief, sought refuge in the obliviating joy that opiates offered."

Right here Sullivan offers a total explanation for why everyone got addicted to painkillers: the government was literally manufacturing them and giving them in massive quantities. But that's not literary enough, so he turns around and fabricates something out of whole cloth:

"the epidemic of the late 1860s and 1870s was probably more widespread, if far less intense, than today’s — a response to the way in which the war tore up settled ways of life, as industrialization transformed the landscape, and as huge social change generated acute emotional distress. This aspect of the epidemic — as a response to mass social and cultural dislocation — was also clear among the working classes in the earlier part of the 19th century in Britain. As small armies of human beings were lured from their accustomed rural environments, with traditions and seasons and community, and thrown into vast new industrialized cities, the psychic stress gave opium an allure not even alcohol could match."

Ah so it was the "psychic stress" of industrialization. So losing manufacturing jobs causes addiction, but also so does gaining them. Interesting that manufacturing jobs are such a powerful explanation in an era when our president is constantly banging on about manufacturing jobs. Suppose we hadn't industrialized at that time; I'm pretty sure people still would have gotten addicted given how many free opiates they were getting. In that case Sullivan probably would have said, "The rural isolation of Americans...the soul-crushing vicissitudes of farming born alone...caused Amercians to take refuge in opiates."

Also worth remembering Andrew Sullivan is serially wrong.