Chris Hedges is a senior fellow at The Nation Institute and writes a weekly column for Truthdig. He was part of the New York Times team that won the 2002 Pulitzer Prize for the paper's coverage of global terrorism.

During the two years Joe Sacco and I reported from the poorest pockets of the United States, areas that have been sacrificed before the altar of unfettered and unregulated capitalism, we found not only decayed and impoverished communities but shattered lives. There comes a moment when the pain and despair of constantly running into a huge wall, of realising that there is no way out of poverty, crush human beings. Those who best managed to resist and bring some order to their lives almost always turned to religion and in that faith many found the power to resist and even rebel.

On the Pine Ridge Lakota reservation in South Dakota, where our book Days of Destruction, Days of Revolt opens, and where the average male has a life expectancy of 48 years, the lowest in the western hemisphere outside of Haiti, those who endured the long night of oppression found solace in traditional sweat lodge rituals, the Lakota language and cosmology, and the powerful four-day Sun Dance which I attended, where dancers fast and make small flesh offerings.

In Camden, New Jersey, it was the power and cohesiveness of the African-American Church. In the coalfields of southern West Virginia, it was the fundamentalist and evangelical protestant churches, and in the produce fields of Florida, it was the Catholic mass.

Those who are not able to hang on, fall long and hard. They retreat into the haze of alcohol – Pine Ridge has an estimated alcoholism rate of 80 per cent – or the harder drugs, easily available on the streets of Camden: from heroin to crack to weed to something called Wet, which is marijuana leaves soaked in PCP. In the produce fields, drinking was also a common release.

In West Virginia, however, the drug of choice was OxyContin, or “hillbilly heroin”. Joe and I went into some old coal camps, largely abandoned, and there it was as if we were interviewing zombies; the speech and movements of those we met were so bogged down by opiates that they were often hard to understand. This passage from the book is a look at some of those West Virginians, discarded by the wider society, who struggle to deal with the terrible pain of rejection and purposelessness that comes when there is a loss of meaning and dignity. Chris Hedges, August 2012

A Community on Overdose

About half of those living in McDowell County depend on some kind of relief check such as Social Security, Disability, Supplemental Security Income (SSI), Temporary Assistance for Needy Families, retirement benefits, and unemployment to survive. They live on the margins, check to check, expecting no improvement in their lives and seeing none. The most common billboards along the roads are for law firms that file disability claims and seek state and federal payments. “Disability and Injury Lawyers,” reads one. It promises to handle “Social Security. Car Wrecks. Veterans. Workers’ Comp.” The 800 number ends in COMP.

Harry M Caudill, in his monumental 1963 book Night Comes to the Cumberlands, describes how relief cheques became a kind of bribe for the rural poor in Appalachia. The decimated region was the pilot project for outside government assistance, which had issued the first food stamps in 1961 to a household of fifteen in Paynesville, West Virginia. “Welfarism” began to be practiced, as Caudill wrote, “on a scale unequalled elsewhere in America and scarcely surpassed anywhere in the world.” Government “handouts”, he observed, were “speedily recognised as a lode from which dollars could be mined more easily than from any coal seam”.

Obtaining the monthly “handout” became an art form. People were reduced to what Caudill called “the tragic status of ‘symptom hunters’. If they could find enough symptoms of illness, they might convince the physicians they were ‘sick enough to draw’… to indicate such a disability as incapacitating the men from working. Then his children, as public charges, could draw enough money to feed the family”.

Joe and I are sitting in the Tug River Health Clinic in Gary with a registered nurse who does not want her name used. The clinic handles federal and state black lung applications. It runs a programme for those addicted to prescription pills. It also handles what in the local vernacular is known as “the crazy cheque” – payments obtained for mental illness from Medicaid or SSI – a vital source of income for those whose five years of welfare payments have run out. Doctors willing to diagnose a patient as mentally ill are important to economic survival.

“They come in and want to be diagnosed as soon as they can for the crazy cheque,” the nurse says. “They will insist to us they are crazy. They will tell us, ‘I know I’m not right’. People here are very resigned. They will avoid working by being diagnosed as crazy.”

The reliance on government checks, and a vast array of painkillers and opiates, has turned towns like Gary into modern opium dens. The painkillers OxyContin, fentanyl – 80 times stronger than morphine – Lortab, as well as a wide variety of anti-anxiety medications such as Xanax, are widely abused. Many top off their daily cocktail of painkillers at night with sleeping pills and muscle relaxants. And for fun, addicts, especially the young, hold “pharm parties”, in which they combine their pills in a bowl, scoop out handfuls of medication, swallow them, and wait to feel the result.

A decade ago only about 5 per cent of those seeking treatment in West Virginia needed help with opiate addiction. Today that number has ballooned to 26 per cent. It recorded 91 overdose deaths in 2001. By 2008 that number had risen to 390.

Drug overdoses are the leading cause of accidental death in West Virginia, and the state leads the country in fatal drug overdoses. OxyContin – nicknamed “hillbilly heroin” – is king. At a drug market like the Pines it costs a dollar a milligram. And a couple of 60- or 80-milligram pills sold at the Pines is a significant boost to a family’s income. Not far behind OxyContin is Suboxone, the brand name for a drug whose primary ingredient is buprenorphine, a semisynthetic opioid. Dealers, many of whom are based in Detroit, travel from clinic to clinic in Florida to stock up on the opiates and then sell them out of the backs of gleaming SUVs in West Virginia, usually around the first of the month, when the government cheques arrive. Those who have legal prescriptions also sell the drugs for a profit. Pushers are often retirees. They can make a few hundred extra dollars a month on the sale of their medications. The temptation to peddle pills is hard to resist.

We meet Vance Leach, 42, with his housemates, Wayne Hovack, 40, and Neil Heizer, 31, in Gary. The men scratch out a meager existence, mostly from disability checks. They pool their resources to pay for food, electricity, water, and heat. In towns like Gary, communal living is common.

When he graduated from the consolidated high school in Welch in 1987, Leach drifted. He went to Florida and worked for the railroad. He returned home and worked in convenience stores. He held a job for 11 years for Turner Vision, a company that took orders for satellite dishes. He lost the job when the company was sold. He worked at Welch Community Hospital for six months and then as an assistant manager of the McDowell 3, the Welch movie theatre. His struggle with drugs, which he acknowledges but does not want to discuss in detail, led to his losing his position at the theatre. He is preparing to start a course to become licensed as a Methodist minister and serves the two local United Methodist churches, neither of which muster more than about a half dozen congregants on a Sunday. The 20 theology classes, which cost $300 a class, are held on weekends in Ripley, about four hours from Gary.

Leach is seated in his small living room with Hovack, who bought the house when his home was destroyed by flooding, and Heizer. Hovack was given $40,000 from the Federal Emergency Management Authority to relocate. Heizer tells us how he almost lost his life from an overdose a few weeks before.

The three men are the sons and grandsons of coal miners. None of them worked in the mines.

“My dad worked with his dad,” Heizer says, nodding towards Leach. “My grandfather died in the coal mines in 1965. He had a massive heart attack. Forty-nine years old.”

“It was good growin’ up in McDowell County twenty-plus years ago,” Leach says.

“Except for when the mines would go on strike,” adds Hovack. “That was rough. I can remember that.”

“Welch used to be a boomin’ place,” Vance says. “When you went to Welch you really thought you went somewhere.”

“Used to be about three thee-ay-ters in Welch many, many years ago,” Leach says.

“All them stores,” says Hovack. “I can remember my mom goin’ to take me to Penny’s and Collins. An’ H&M. But when the US Steel cleaning plant went out, that was it for this county.”

“I went to school here in Gary, and when the plant closed down I was ’bout twelve or thirteen and my friends in school would say, ‘My dad and mom, we’re movin’ ’cause they have to go look for work,” Hovack says.

“You seen a lot of people depressed after that, wonderin’ how they were gonna make it, how they were gonna pay their bills, how they were gonna live, how they were gonna pay their mortgage,” says Leach. “It was devastating. A lot of people didn’t have a good education, so there wasn’t anything else to turn to. The coal mines was all they ever knew. My dad, he didn’t finish high school. He quit in his senior year, went right into the mine.”

Heizer speaks in the slowed cadence of someone who puts a lot of medication into his body. He recently lost his car after crashing it into a fence. His life with his two roommates is sedentary. The three men each have a television in their bedrooms and two more they share, including the big-screen television that, along with an electric piano for Hovack, were bought with Heizer’s first disability cheque. The men spent the $20,000 from the cheque in a few days.

“I became disabled back in late 2006,” Heizer tells us. “I had degenerative disc disease and I hurt my back. I was workin’ at this convenience store. They knew that I had a back injury, but yet they had me come in on extra shifts and unload the truck. Now I’ve got four discs jus’ layin’ on top of each other, no cushion between them. For three years I lived here without an income, and my dad helped support me, and then last November I finally was awarded my disability.”

Heizer, who is gay, saw his drug addiction spiral out of control four years ago after his boyfriend committed suicide. He tells us he has been struggling with his weight – he weighs 324 pounds (147kgs) – as well as diabetes, gout, and kidney stones. These diseases are common in southern West Virginia and have contributed to a steady rise in mortality rates over the past three decades.

OxyContin takes a few hours to kick in when swallowed. If the pills are crushed, mixed with water, and injected with a syringe, the effect is immediate. Heizer says that after the drug companies began releasing pills with a rubbery consistency, they could not be ground down. Heizer heated the newer pills in a microwave and snorted them – leading to his recent overdose. It took place at his mother’s house. He went into renal failure. He stopped breathing. His kidneys shut down. He was Medevac’d to a hospital in Charleston, the capital of West Virginia, where he stayed for four days.

“I was just sittin’ around watching TV and started aspiratin’,” Heizer says flatly. “The medication was goin’ into my lungs. You gurgle with every breath. You are drownin’, basically. I remember walkin’ down my mom’s steps and gettin’ in the ambulance. I remember at Welch, they put me on the respirator and then transferred me. After they put me on the respirator, I stopped breathing on my own. And then I remember in Charleston wakin’ up an’ they had my hands restrained so I wouldn’t pull the tubes out. I had a real close call.”

The men sit in front of their flat-screen television and chat about friends, classmates, and relatives who died of overdoses. Hovack talks about a niece in her early twenties, the mother of two small children. She recently died of a drug overdose. He tells us about a high-school classmate, an addict living in a shack we can see from the window. The shack has no electricity or running water. The men, who rarely leave the house, mention the high bails being set for selling drugs, with some reaching $50,000 to $80,000. They joke about elderly grandmothers being hauled off to prison for drug dealing.

“I’ve seen a lot of busts in the county over the last few years, and a lot of the people that have been arrested are elderly people that are sellin’ their medication just to live,” Vance says. “When I was workin’ at the hospital I seen ODs all the time. Young people were comin’ in. It’s bad. The depression and the pain. I guess some people that hang and live in this area, they just have to turn to somethin’.”

“Since the drug problem is so bad you see the crime rate as well,” Leach says. “People breakin’ into homes, stealin’ whatever they can to sell or pawn, just to keep up with their drug habit.”

Heizer, seven weeks later, dies of a drug overdose, sitting on the living room couch in front of the big-screen television.

Chris Hedges is a senior fellow at The Nation Institute and writes a weekly column for Truthdig. He was part of the New York Times team that won the 2002 Pulitzer Prize for the paper’s coverage of global terrorism. He has written for numerous publications including Harper’s Magazine, the Nation, Granta, and Foreign Affairs, and is the author of the bestsellers Death of the Liberal Class, Empire of Illusion, and War Is a Force That Gives Us Meaning. The above excerpt is from his new book, Days of Revolt, Days of Destruction.

A version of this article first appeared on TomDispatch.