Introduction

While the opioid epidemic rages on in the United States, exacerbated by the Covid-19 pandemic (American Medical Association, 2021), adolescent drug abuse is largely unaddressed in secondary and university classrooms. With increased media representation such as The Queen's Gambit, released by Netflix in 2020 and celebrity testimonies like Demi Lovato’s four-part documentary, the opioid epidemic is entrenched in both popular culture and the experiences of adolescents across the nation. While our content analysis primarily focuses on representations of people with addictions set in the United States, depiction of opioid use disorders is not only pertinent to readers from the United States. Alenezi et al. (2021) asserted that opioid misuse and death rates are on the rise in the United Kingdom, with Scotland having the highest misuse rates. Häuser et al. (2021) also noted that prescriptions of opioids in European countries have risen between 2004 and 2016.

Opioid misuse in the United States is so widespread that in 2017, the U.S. Department of Health and Human Services declared the abuse of prescription and non-prescription opioids a public health emergency. In that same year, over 4,000 deaths of 15–24 year-olds were attributed to opioid overdose (Office of Juvenile Justice and Delinquency Prevention, 2020). According to the National Institute on Drug Abuse (2014), “people are most likely to begin abusing drugs … during adolescence and young adulthood” with the Centers for Disease Control (2020) confirming that by twelfth grade, half of US students have used marijuana and two-thirds have used alcohol, while nearly 20% have used prescription medication without a prescription.

Illicit use of substances is dangerous not only because of the drugs’ biochemical risks but also because of the risky behaviors that frequently happen alongside use: reckless driving, violence, unsafe sex, use of other drugs and alcohol, and suicide (Bhatia et al., 2020). In a recently published meta-analysis on the effect of drug use on academic and behavioral outcomes, William Jeynes (2021, p. 25) refers to drug use in the US as an “overdose epidemic” also noting that the negative effects of drug use are exacerbated by age. All of these factors underpin that finding ways to facilitate candid conversations about drug use and abuse in schools is critical.

Recognizing that youth already have negative opinions and assumptions about people with addiction is essential in beginning these conversations. Adlaf et al. (2009) found that of 4078 youth surveyed about perceptions of substance use, over half would ‘definitely’ or ‘probably’ feel ashamed if friends knew they had a family member with addiction; about one-third of students reported being afraid to talk with a person with addictions or make friends with a person with addictions; and more than one in five reported that they would be upset or disturbed to be in class with someone with drug addictions. This study indicates that youth hold assumptions, stigmas, and stereotypes related to people with addictions. In another analysis of nationally representative survey data, Corrigan et al. (2009) found that people with drug addiction are viewed as more responsible for their condition and recovery from addiction than those with other health conditions; that they are viewed as more dangerous than people with other health conditions; and that they are viewed as less deserving of help than people with other health conditions. Across youth and adult surveys, findings suggest the assumptions youth develop about addiction remain largely unaddressed as they continue through life.

Furthermore, research has demonstrated that the traditional English Language Arts (ELA) curriculum favors canonized texts (Glaws, 2021), indicating that nuanced portrayals of people with addictions are not likely represented in students’ assigned readings. Facilitating learning about people with addiction in ways that question stigmas and stereotypes largely influenced by popular culture and media outlets is imperative (McGinty et al., 2019). We became interested in what young adult literature (YAL) texts were visible through various popular online lists in an effort to identify how YAL may influence conversations about people with addiction and connected experiences in secondary classrooms.

Stories have the potential to alter readers’ perceptions of people who have been historically marginalized and/or silenced (Ginsberg & Glenn, 2020), but such shifts cannot happen without texts that represent marginalized experiences like adolescent addiction. However, the publishing industry for children’s and YAL reveals a lack of representation of authors and protagonists outside of white, middle class normative characters (Cooperative Children’s Book Center, 2019). These disparities in publishing speak to the ways that popular books reproduce normative representations of adolescents and ignore non-normative ones, including adolescent drug addiction.

We posit that YAL texts contribute to the social construction of addict as a label. Addict, as a socially figured label, refers to someone who abuses drugs or alcohol resulting in a series of stereotypes and social stigmas (Anderson et al., 2015; Avery & Avery, 2019; Goffman, 1986). As a genre, YAL has important work to do examining representations of people with addiction and people in recovery to expand the ways that YAL readers, scholars, and educators understand those experiences and their conceptions of people with addictions. Teacher educators, researchers, and secondary educators need to be aware of the prevalence of substance abuse experiences in adolescents, as well as how they can select YAL that will challenge negative assumptions and stereotypes about adolescents with addictions.

To launch this larger agenda, we conducted a critical content analysis of ten YAL novels that center protagonists experiencing addiction or recovery guided by three main research questions:

  • What aspects of protagonists' identities are represented in YAL about addiction?

  • How do these identities intersect with addictions to create narratives about addiction?

  • What figured worlds are created based on the identities and experiences found across these texts?

Theoretical Framing

Our study uses Holland et al.’ (1998) discourse analysis tool of figured worlds to understand how adolescent addiction is constructed through selected YAL texts. Holland et al. (1998, p. 52) defines figured worlds as “a socially and culturally constructed realm of interpretation in which particular characters and actors are recognized, and significance is assigned to certain acts, and particular outcomes are valued over others.” We posit there are myriad social definitions of addiction, which we theorize as figured worlds that shape narratives about people with addiction in publishing and media (McGinty et al, 2019). Connotations of the label addict are figured based on racial and socio-economic identity markers as well as geographical location, including positioning white, middle-class drug users as victims and positioning people experiencing poverty and people with Black racial identities as criminally deviant drug users (Anderson et al., 2015; Tiger, 2017). According to James Gee (2014, p. 178).

Because figured worlds deal in what is taken as typical or normal, they can sometimes become means to judge and discriminate against people who are taken as untypical or not normal. Often the sense of typical or normal that is captured in a figured world lapses over into a notion of what is ‘appropriate’ or ‘good.’

The notion of a figured world allows us to interrogate the social construction of adolescents with addictions through YAL texts, which act as cultural artifacts that carry these social meanings. In this study, YAL texts are the means by which figured worlds are “evoked, collectively developed, individually learned” (Holland, 2001, p. 61). By authoring texts that center experiences of addiction, authors are drawing on figured worlds of addiction as well as contributing to them.

Understanding the History of YAL, Poverty, and Addiction

This project builds on a small body of literature that theoretically or peripherally addresses youth experiences with addiction in YAL. A chapter in Kia Jane Richmond’s (2019) book provides an overview of YAL and addiction, explains medical definitions of addiction and alcoholism, and discusses the importance of this topic to young people and teachers. Richmond reviews three books: Beneath a Meth Moon (Woodson, 2012), Dope Sick (Myers, 2009), and Clean (Reed, 2011)—two of which are included in our analysis. She notes that the three novels all “include symptoms that are authentic based on descriptions included in the Diagnostic and Statistical Manual of Mental Disorders 5th Edition. However, only Woodson’s and Reed’s texts include references to characters receiving treatment for substance use” (p. 172). Richmond’s text provides teachers with a framework for examining YAL texts; however, Richmond primarily approaches these texts through medical perspectives of addiction; our study seeks to understand in more detail the social construction of people with addiction.

Despite looking across several research databases and a long tradition of YAL books that explore adolescent addiction, we were not able to find any research literature analyzing portrayals of youth protagonists with addictions. We did find one content analysis that peripherally addressed addiction as a topic that appears in YAL connected to poverty. In their content analysis, Crag Hill & Janine Darragh (2016, p. 42) found that across their sample of texts, 37.8% of the “books portrayed a character with some sort of …drug addiction.” This tells us that addiction appears in YAL texts with measurable frequency, but Hill & Darragh’s study was not primarily focused on experiences of addiction and thus offered no critical analysis of portrayals of addiction. Finally, Meagan Lacy (2015) conducted a literary analysis of children’s books about experiences of children of alcoholics. While this study offers insight about portrayals of adult substance use in children’s literature, it does not examine portrayals of adolescents with addictions. These foundational studies guided our work, but also speak to the need for work like ours.

Methods

Data Sources

This study analyzes ten YA novels centering adolescent protagonists experiencing addiction and/or recovery. For text selection, our goal was to identify ten texts that are accessible to teachers through internet searches. As former teachers, we used what Joseph Murphy (2019) recognizes as craft knowledge to reflect on how we selected books as practicing teachers and how our practicing teacher colleagues currently select new curricular materials for secondary classrooms, and we followed these methods to build a list of potential texts. We began as most teachers would, with Google searches to find book lists that were specifically about addiction in YAL. From search engine optimization research Dirk Helbing et al. (2019, p. 92) remind us that, “we know that the first page of Google search results receives about 90% of all clicks.” In our Google search, a list curated by the Young Adult Library Services Association (YALSA) ranked high in the first page of Google search results. Because of this, we used it as our initial source. The Young Adult Library Services Association is an organization specific to YAL services, and as teachers, we often drew on lists from YALSA when searching for new texts. We selected only the books from that list that featured a protagonist with a substance use disorder.

In order to expand our text set, we sought additional curated lists about YA and addiction and ultimately drew on three additional lists including a curated list from SOHO press, the Amazon Bestseller List in “Drug Addiction and Alcoholism”, and a Goodreads List. We drew on a list curated in 2019 by SOHO press, which is a popular YAL press. We felt comfortable drawing on this list despite it being curated by a specific publisher because it included texts from various publishing houses and not just SOHO. We also drew on two crowd-sourced lists, both an Amazon bestseller list and a Goodreads list, because these lists can indicate the books that are already being purchased and read by YAL book consumers. As a brief note, the Amazon and Goodreads lists are responsive lists that have likely changed based on book purchased and read over the two years since we originally sourced our texts. We used all of these lists to create a spreadsheet of titles based on publication dates, separated into ten-year time periods.

After compiling our lists by decade, we realized that a significant number of texts about addiction began to be marketed around 1999. For example, between 1999 and 2009, ten YA books about addiction appeared in our searches, whereas only three YA books about addiction appeared between the three decades prior (1969–1999). Based on this discovery, we set specific inclusion criteria that included: (1) a protagonist is a person with substance abuse, addiction, and/or is in recovery; (2) the text was published within the last 20 years. To further reduce our sample to ten texts, we included novels that were on the YALSA list or that showed up on more than one book list. Our goal in text selection was not to be comprehensive in our coverage of the field, but rather draw on texts that are visible to teachers based on the ways that practicing teachers source new texts for building curriculum. We included a tenth book with an earlier publication date as an exception to the criteria: Go Ask Alice (Sparks, 1971) because it appeared on every list we referenced, and its enduring popularity might encourage teachers or YA readers to pick up the book despite its age. After using these search parameters, we were left with the following ten books:

  • Go Ask Alice (Sparks, 1971)

  • Crank (Hopkins, 2004)

  • Finding Hope (Nelson, 2016)

  • Clean (Reed, 2011)

  • Beneath a Meth Moon (Woodson, 2012)

  • Far From You (Sharpe, 2014)

  • The Way I Used to Be (Smith, 2016)

  • Other Broken Things (Desir, 2016)

  • Wild Bird (Van Draanen, 2017)

  • Heroine (McGinnis, 2018)

Data Analysis

To interrogate the social construction of adolescents with addictions, we employed a critical content analysis approach. We assigned two readers to each of the novels in our sample and followed Kathy Short’s (2017, p. 7) steps of critical content analysis: decide on a research question, read deeply within a critical frame, explore context and related studies, use theoretical tenets to frame close readings, examine power and agency, revisit theory and texts to develop themes, and select passages reflecting themes to use in analysis. We read each book deeply to understand what figured worlds were being constructed based on guided reading questions: what identities the protagonists hold, what common experiences the protagonists may have, and what portrayals of the protagonists were common across our text set. Utilizing Barney Glaser and Anselm Stauss’ (1967) constant comparative methodological approach, we wrote reflective memos throughout the data collection process, noting issues that emerged during all stages of data collection.

We initially coded in response to several guided reading questions including: What intersections of gender, race, ethnicity, and SES are represented in this text? How does the character seem to be dealing with/experiencing/making sense of their addiction throughout the text? What access does this character have to therapy, rehab, social services? What is the environment/setting of the novel?

After answering the guiding questions for each individual novel, we compiled our data into a common document organized by question. We first coded independently, then shared our codes with each other in a collaborative Google Doc. We used iterative rounds of inductive, descriptive coding, described by Johnny Saldaña (2016) as first-cycle coding to look across novels for commonalities. We used comments in our shared document to engage in conversation through which we compared our codes, condensed them into categories, and developed themes from data collected. For example, we initially had separate codes for gender, race, and socioeconomic status which we condensed into a category of “identity.” Finally, we looked at our categories to analyze if there was a network (Saldaña, 2016) to help generate what we are calling figured worlds. Our findings include themes we identified through our content analysis and how those themes create figured worlds within this body of literature.

Findings

Our findings detail three themes that work together to construct figured worlds: the majority of protagonists in the texts are middle class, white teenage girls; the protagonists’ experiences around addiction are preceded by one or a series of traumatic events; and, due to their privilege, the protagonists have ready access to rehabilitation facilities and other mental health supports. These findings work together to build a figured world of addiction that is marked by racial and socio-economic privilege that both limit the protagonists’ risk of being criminalized and maximize their access to mental health and rehabilitative services. While we provide representative examples from several novels that exemplify each theme, each theme is largely present across our entire data set.

Intersections of Identity: Female, White, Middle Class, Protagonists

Across ten books, eight of the protagonists (80%) are white, middle class teen girls. These findings are especially significant because the identity markers of whiteness and middle-class socio-economic status (SES), consistent across all texts, demonstrate the privilege the protagonists have and the ways these privileges function to minimize their interactions with police (discussed later in our Findings section). These identity markers position the protagonists as victims of addiction who have potential to return to innocence rather than criminals who are jailed or outcasts who are ignored.

Discussing Representations of Gender

All ten books in our sample featured female protagonists. Only two of the ten texts included gender identities in addition to those of adolescent girls. Finding Hope employs a dual-narrator perspective from a brother struggling with substance use disorder and the sister who wants to help him; two of the five narrators in Clean are adolescent boys. These three male perspectives left 80% of the storytelling to female protagonists. This finding implies that girls and women have more experiences around addiction than boys and men. The overwhelming appearance of female voices in these texts inaccurately portrays the realities of substance abuse: that men are more likely to use both illegal and prescription drugs (NIDA, 2020), and leaves us wondering what effect this consistency of a singular identity may have on the way young people understand people with addictions as a category of other. After realizing the lack of diverse gender identities represented within our text set, we examined the intersection between race and gender to analyze further inequities in representation.

Moving from Gender to Race

We looked for explicit racial markers in the texts and referenced Kirkus Reviews to confirm characters’ races. In our data set, four protagonists are explicitly identified as white females: Mickey in Heroine, Hope in Finding Hope, Wren in Wild Bird, and the five protagonists in Clean (a multi-narrator text). Protagonists often used their skin color to describe themselves. For example, Hope in Finding Hope (Nelson, 2016, p. 18) notes she has “gangly arms, long, brown hair, too-white skin and knobby knees like a stork” and Kelly in Clean (Reed, 2011, p. 5) describes herself as “a middle-class white girl with a nice house and still-married parents.” Kelly uses her whiteness, gender, and SES to distance herself from stereotypes of addicts by stating she isn’t what you imagine a drug addict to look like. These identity markers act as a shield for Kelly to exempt her from harmful interactions with the police and position her as a sympathetic character. Mickey in Heroine and Wren in Wild Bird also self-identify as white when describing their physical appearance, leaving no room for interpretation from the research team.

In the texts with an explicit identification of whiteness, some authors also describe the novel’s setting or community as majority white. In Heroine (McGinty et al., 2019), Mickey explains the overwhelming whiteness in her town when she describes her best friend, Carolina: “she’s also the only Puerto Rican for about a hundred miles… the kid whose skin wasn’t the same color as everyone else’s” (pp. 4–5). Similarly, a therapist in Clean (Reed, 2011) addresses the whiteness of all five protagonists, along with the privilege it affords them to stay at an in-patient rehabilitation facility:

Imagine you’re poor black kids. Now imagine you’re drunk and high on cocaine and you run your mom’s car into a house. What do you think happens to you?... Do you think a judge will give you a slap on the wrist and tell your parents to send you to an expensive private rehab?... the only things you have going for you are race and money (p. 117–118)

This scene centers an adult instead of the adolescents themselves, and the therapy session quickly moves on after this comment. One of the protagonists in Clean who is at the rehab facility as a result of the exact scenario the therapist described—crashing a car while high, and receiving few legal consequences—again demonstrates how whiteness protects the characters. The counselor’s comment is the only explicit recognition of the connection between race, socioeconomic status, and privilege in the book and the only such instance we found throughout our text set.

Six texts do not mention racial identity of the protagonists, but imply whiteness, including Sophie in Far From You, Natalie in Other Broken Things, Edy in The Way I Used to Be, Bree in Crank, Laurel in Beneath a Meth Moon, and the unnamed protagonist in Go Ask Alice. Kirkus Reviews notes a lack of racial markers in reviewed books, and often explains implied whiteness through a default white lens. In Kirkus’s (2016) review of The Way I Used to Be they wrote: “Absent ethnic and cultural markers, Eden and her family and classmates are likely default white” (para. 2). Some characters revealed physical traits like hair color, which also likely signaled whiteness, like Laurel in Beneath a Meth Moon describing her hair as blonde and almost white (p. 66). While her skin color wasn’t explicitly described, physical markers such as almost-white hair contributed to our default white reading of Laurel. In Other Broken Things, “Natalie specifies the racial makeup of the Alcoholics Anonymous group but never directly reveals her own” (Kirkus, 2016). The racial makeup of the Alcoholics Anonymous group includes many characters of color, therefore implying those characters are other and Natalie is default white.

Our text set implies that if readers are a young white female, addiction is something they can overcome through the support of family and rehabilitation services. None of the protagonists, despite a range of law-breaking behaviors including DUIs and theft, encounter long-term consequences from police interaction. The figured world of whiteness in addiction is also misleading, as the 2018 National Survey on Drug Use and Health indicated nearly equal illicit drug use across all racial groups surveyed (SAMHSA, 2019). Based on the texts we sourced, racially diverse readers do not have the opportunity to see their experiences reflected within our text set, and there is no substantial commentary on the systemic racism that protects and provide rehabilitative services to wealthy, white people with drug addictions while jailing and monitoring people of color and those experiencing poverty (Tiger, 2017; Volkow, 2019).

This figured world also plays into safe and normative portrayals of having an addiction. As the term “young adult literature” is a marketing tool for book publishers and sellers, there is risk in writing stories that stray too far from the socially accepted norm. Writing books about characters with addictions, especially adolescent characters, is certainly outside of what society considers normative. In turn, it may be important from a revenue perspective to make the identities that the protagonists hold be racially normative and conform to traditional gender identities rather than featuring transgendered or nonbinary characters. Publishers may be trying to sell narratives appealing to what Roberta Seelinger Trites (2000) refers to as an assumed reader—white, middle class, females.

The intersections of the gender and racial identities of these characters also work to locate them in positions of relative innocence and normativity. Seelinger Trites (2000, p. 47) writes, “Identity politics matter most in adolescent literature…in terms of how an adolescent’s self-identifications position her within her culture.” We see identity politics at work in our text set as the protagonists avoid legal consequences characteristic of drug and alcohol policy since the cultural shifts resulting from the war on drugs (Jensen et al., 2004). The protagonists’ racial and gender identities help position them in ways that allow their return to innocence at the end of the narratives. This narrative innocence also reinforces social constructions of white girlhood as innocence that is routinely denied to racially diverse people of similar ages and experiences both in YAL and in society (Eaton, 2017; Epstein et al, 2017; Toliver, 2018). The normativity of our text set is only amplified by the ways that these characters' race-based and gendered identities intersect with their socio-economic status.

Building on Race and Gender to Consider Socio-economic Status

Six of the protagonists have parents who hold jobs that suggest upper-middle class privilege (e.g. dentist, lawyer, physician). In Heroine (McGinnis, 2018), Mickey’s mother is an obstetrician-gynecologist (OBGYN); her connections in the medical field afford Mickey easier access to physical rehabilitation services after her car accident. In Finding Hope (Nelson, 2016, p. 28), the family has enough money to send Hope to a private school: “all the money that used to be funneled into Eric’s hockey would pay for me to attend the Ravenhurst School for Girls.” Wren’s family in Wild Bird (Van Draanen, 2017, p. 92) has enough money to send her to an “expensive counselor” when she begins failing classes her freshman year. Throughout the novel, Wren visits four therapists: Dr. Ramirez, Dr. Yalsen, Pia Boyd, and Dr. Goth, while noting “all therapy did was make me hate everyone, everything, even harder” (p. 202). Beside Wren’s one comment that her counselor was expensive, there is no recognition of the financial burden therapy can put on a family. The money spent on multiple therapists further highlights Wren’s family’s upper-middle class SES as there is no concern at the cost of these services.

Natalie in Other Broken Things (Desir, 2016, p. 69) often references her family’s wealth by specifying luxury brands she is wearing and mentioning that her parents drive a Lexus. She consistently comments on her family’s wealth: “I almost feel guilty about the number of Coach and Kate Spade purses in my closet, but whatever, I can’t help my parents being rich.” Natalie does not recognize that her wealth is the reason she is not suffering severe legal consequences despite crashing her car while driving drunk and underage. While talking about her alcohol use, she asks a friend if they want to hear her “poor-little-rich-girl sob story?” (p. 163). Natalie’s character is the most explicit about her family’s affluence with her constant reference to their wealth and the fact that she is not allowed to box because her father believes it is a sport for people in lower socioeconomic groups. Being wealthy appears to be an important identity marker that Natalie carries with her without the recognition of the privilege her family’s wealth affords her.

While Bree in Crank (Hopkins, 2004) does not appear as wealthy as Natalie, she shows disdain for people who are not affluent. Throughout the novel she moves between the middle-class setting of her mother’s house and the working-class setting of her father’s. In the beginning of the novel, she dreads visiting her father because she “had zero desire to see how the working class lived” (Hopkins, 2004, p. 29) and describes him as living in a “blue collar kingdom” (p. 29). Bree explicitly compares her bedroom at each house, describing the bed at her father’s house as “Bedzilla” with a thin, mildewed mattress and “thrift-store” sheets (p. 59) while her room at her mother’s house is “Pin clean, pretty in mauve… pillow-top mattress to die for” (p. 60). The juxtaposition of Bree’s bedrooms serves to highlight the different SESs of her parents and the comforts she enjoys while living at her mother’s. Bree acknowledges that she is first introduced to meth during her time at her father’s house. She says, “in school [in her mother’s town] I was never confronted with drugs… As I watched, one thing became obvious. Where the party went, my dad followed” (p. 66). This juxtaposition makes a statement to the reader that drug availability exists more frequently in communities with low SES. It paints her mother’s middle-class home as safe and idyllic compared to her father’s, which is dangerous with easy access to meth.

Taken together, the majority white, female, and affluent status of the protagonists in our text set contribute to a figured world which implies that if you are a white female with familial wealth you will not suffer long-lasting—or any—legal consequences for drug abuse. As Perry Nodelman (2008, p. 177) notes, “I might define it [children’s and young adult literature] as literature produced for and in order to construct the subjectivity of the children of the middle class.” Our text set constructs the idea that for children of the middle class or high SES status, addiction to drugs can be easily addressed through financial means. These assumed readers, white and from middle to upper SES families, can assume that addiction can be a temporary mental health issue with an easy fix to it based upon the stories represented in our text set. It makes sense that our text set features a majority of middle to upper class protagonists as YAL is written primarily for middle class readers.

Texts Promoting the Notion that Access to Rehab is Assumed and Instantaneous

Our second finding is that across texts, adolescents struggling with substance abuse can easily access rehab services and facilities. While portrayals of rehab are important for authors to include to destigmatize seeking help for substance abuse, we found the ease with which characters accessed rehab problematic as it relies on white privilege and middle-to-upper SES.

The link between wealth and access to rehabilitation services is explicitly referenced in several texts. Wren in Wild Bird (Van Draanen, 2017, p. 42) notes that her wilderness therapy camp costs as much as a new car, and that she is annoyed with her parents for “wasting so much money to send me to Desert Jail.” Having tens of thousands of dollars to send a child to therapy camp is not a luxury many people can afford. This representation of disposable income as commonplace across our text set is problematic. In Heroine (McGinnis, 2018, p. 29), Mickey gets into a car accident and acknowledges, “Mom and Dad put a lot of money into my [physical] rehab.” Her family first spends money on getting her leg rehabilitated from the accident, and when her drug abuse is revealed, she receives instant access to more rehabilitation services, noting her step-mother secured her a place in a recovery group. There are no barriers to Mickey receiving support for her addiction, and no criminal consequences, as her step-mom reassures her, “You’re a minor. You’ll get a slap on the wrist. Group counseling and some therapy” (p. 383). Her family’s SES allowed Mickey instantaneous access to social services that would support her on the path to recovery.

In Other Broken Things (Desir, 2016, p. 5), Natalie spent time at a rehabilitation facility prior to the book’s opening: “So here I am. Two days out of rehab, two months after a DUI.” She also has instant access to a psychiatrist outside of the rehabilitation center, noting she sees “a prestigious psychiatrist… I don’t have the first clue why he even wanted to take on my little problem, but my parents have money and I'm guessing that accounts for a lot” (p. 36). Natalie’s upper-middle class SES allows her to take for granted the support services her family provides for her as she often complains about going to see her psychiatrist. Clean (Reed, 2011, p. 117) is the only text that explicitly linked SES, race, and privilege when the therapist said “the only thing you have going for you are race and money.” Many of the protagonists in that book acknowledge the rehabilitation center’s costs with statements like, “This place is kind of a country club as far as rehabs go” (Reed, 2011, p. 56). Throughout our text set, protagonists whose families were affluent or middle class were able to afford services such as therapy, rehab, or psychiatry as they sought to recover from their drug addiction; money is a direct corollary to treatment access.

In Finding Hope (Nelson, 2016), the family is described as middle class; however, Hope’s brother Eric is homeless throughout most of the book as a result of his meth addiction. His family kicked him out and changed the locks after he’d “stolen Mom’s bank card and drained her account of hundreds of dollars” (Nelson, 2016, p. 29). Eric’s lack of monetary support leads to him breaking into a pharmacy to steal items to resell in order to buy meth. Although Eric is homeless and without money for most of the book, his family’s SES provides him access to rehab at the conclusion of the novel. Eric spends “twenty-eight days in a hospital, sixty-seven days and counting as an outpatient” (p. 220). There is no mention of the family needing financial assistance or wondering how they would afford help for Eric. Eric needs help, and he gets it. This presentation is problematic for adolescent readers to imagine they might have instantaneous access to rehabilitation services should they need it.

Only two texts included families and protagonists outside of middle to upper-class SES including Laurel, who is identified with working class markers in Beneath a Meth Moon (Woodson, 2012), and Bree’s father in Crank (Hopkins, 2004). Laurel is homeless after becoming addicted to meth, but she is displaced for the entirety of the novel following the devastation of Hurricane Katrina. The novel depicts the challenges of access to rehab in rural areas. Laurel’s boyfriend, T-Boom, who introduced her to meth, says, “There’s a place up in Summitville I been hearing about, thinking about. Say they can clean you up real good, all the way so you don’t slip back to wanting it” (Woodson, 2012, p. 15). His description of the rehab center as “up in” another town as well as his awareness of it through word-of-mouth channels suggests these characters live in a physical and cultural place with limited access to resources and public health information. When Laurel is eventually picked up by police officers who deliver her to a rehab center, one asks if she’s entering the center for the first time. After she says yes, the second officer says, “Won’t be her last time” (Woodson, 2012, p. 138). Their exchange suggests that Laurel is in a community that may distrust or devalue the process of rehab, or that has experienced a cycle of rehab and remission because of the widespread distribution of opioids. The treatment center is not thoroughly discussed in Beneath a Meth Moon leaving many questions unanswered for readers. We wondered if the clinic was free, if it provided consistent care, and if there were requirements patients had to satisfy to qualify for treatment.

In Crank there is a mention of a clinic; however, Bree does not expand on how long she was at the clinic or how she got access to a clinic. The reference to the clinic is brief. Bree says, “The clinic was gated, walled and secure… I wept, as my sisters wept at what might have been, had we turned in another direction” (Hopkins, 2004, p. 523). The reader can assume Bree’s mother arranged her treatment, as her father only talks to Bree once after she returns to live with her mother. The differences in levels of support from Bree’s mother and father are not explicitly linked to SES, but throughout the novel the author draws a stark contrast between the wealth of each parent and the support they each provide Bree. Although Beneath a Meth Moon and Crank add nuance to the wealthy list of protagonists in this text set who easily access care, neither of these texts adequately discuss how underserved communities access care. Readers are left with more questions rather than answers about how people similar to Laurel or Bree’s father would access rehabilitation services and what it would cost them.

Throughout our text set, there is no substantial discussion of the financial hardship of rehab or the systemic oppression and barriers and exclusions people experiencing poverty and people of color have to overcome in mental health care systems indicated in empirical research (Saloner & Lê Cook, 2013; Tiger, 2017; Volkow, 2019). The construction of this figured world is problematic for adolescent readers, as they may imagine rehab is readily accessible without systemic barriers. This could be attributed to publishers wanting to push a safe narrative of addiction. Having access to therapy and rehabilitation services creates a narrative for readers that addiction is a problem to solve, through rehabilitation and therapy, one that is easily remedied with money. This is a safe narrative in the sense that the majority of adolescents in our text set receive the help that they need and readers are left satisfied by the book's endings.

Texts Perpetuating the Narrative that Addiction is preceded by a traumatic event

In nearly every text, protagonists began abusing alcohol and/or drugs after experiencing a traumatic event. These traumas include experiences of sexual abuse and rape, car accidents, and displacement and bereavement following a fatal environmental disaster. The appearance of the trauma-precedes-addiction trope across the majority of texts creates a figured world in which addiction always results from a traumatic event. While this experience may often be true for people experiencing substance use disorders, our sample of texts creates a figured world in which trauma precipitating addiction is universal.

Two texts from our sample demonstrate instances of sexual abuse as the cause of addictive behavior. In both The Way I Used to Be (Smith, 2016) and Finding Hope (Nelson, 2016), the protagonists begin to participate in destructive behaviors connected to drugs and alcohol after being raped. In Finding Hope (Nelson, 2016), one of the two protagonists, Eric, is groomed and raped by his hockey coach. He describes the role of substance use in alleviating his pain when reliving his trauma, saying, “I couldn’t handle the memories this clean. I needed a fix” (Nelson, 2016, p. 96). In The Way I Used to Be (Smith, 2016) Edy also demonstrates a dependence on drugs and alcohol to cope with her experience of being raped (note: as literacy educators, not medical professionals, we did not feel qualified to determine if her dependence escalates to an addiction). However, Edy’s relationship with drugs and alcohol begins after Edy is raped by Kevin, her brother’s best friend. She begins to feel “turned inside out” and “raw and exposed” (p. 45); in order to cope, she begins binge drinking and using drugs. Throughout the text, Edy acknowledges that she is becoming dependent on drugs and alcohol to feel okay. In response to a friend stating they don’t have to drink to have fun, Edy replies, “That’s nice, Cameron. I, however, do have to be wasted to have a good time” (Smith, 2016, p. 265). In another instance, Edy binge drinks with her friend Mara, “until there was nothing left” (p. 240). These two texts help set up a narrative that trauma is a catalyst to drug and alcohol use. There was no mention of social drug or alcohol use prior to being raped for either of these characters. This strengthened the corollary between a traumatic event causing drug/alcohol use as it is a new habit for both protagonists.

Another traumatic event featured across texts is a car accident resulting in severe injuries. In Heroine (McGinnis, 2018) and Far From You (Sharpe, 2014), the physical injuries sustained in the car accidents appear to cause both the protagonists’ initial access to drugs and eventual substance use disorders. This causal relationship is implicitly acknowledged in both texts. Immediately following the car accident, Sophie in Far From You (Sharpe, 2014) is prescribed narcotic pain killers and quickly becomes addicted to them. She attributes her addiction to the accident implicitly when she states, “The withdrawal is bad enough — like my body is one giant, throbbing bruise and spiders crawl underneath my sweaty skin — but the pain, undulled and persistent, is too much to take. With the pills, I can move without hurting too much” (p. 23). The way she conceptualizes her need for the pills is due to the pain from injuries sustained in the accident, not due to the addictive nature of narcotic pain pills or the fact that she is abusing them.

In Heroine (McGinnis, 2018), Mickey also survives a car accident and sustains injuries that threaten her successful high school softball career and her identity as an athlete. Her description of opioid use and misuse depicts a physical dependence underpinned by emotional need. Mickey acknowledges both needs early on by explaining that Oxy enables her to push harder during physical therapy and comforts her emotionally because “it wraps up all my nervous what ifs and can’ts and says—screw it” (p. 41). As Mickey’s dependence on Oxy escalates into addiction in order for her to perform in rehab and on the softball field, so does her emotional reliance on opioids.

After Mickey finishes her prescription of OxyContin and buys more from a local dealer, she rationalizes her addiction to pills. She explains that she is taking the pills so her mom can be proud of her, so she can be a great catcher, and so “that [Carolina] and I can go on with our lives like that night never happened, like I wasn’t behind the wheel in a car that didn’t land upside down in a ditch” (p. 91). The emotional and physical consequences from the accident cause Mickey to abuse OxyContin on a daily basis to achieve a “comfortable numbness [she’s] come to depend on” (p. 102). Both Sophie and Mickey continue to abuse legally prescribed pain killers until their lives spiral out of control, and in both cases their addictions are precipitated by car accidents. These traumatic events, which result in physical injury as well as emotional loss, introduce opioids into their lives. This causes a narrative to be shaped for the reader that without a traumatic accident the protagonists would never have interacted with drugs or become addicted. The accident is positioned as the main cause of addiction rather than the person who is abusing their prescription.

While a car accident threatens Mickey’s athletic career, the end of Natalie’s career as a boxer seems to be the catalyst for her addiction in Other Broken Things (Desir, 2016). Her father views boxing as inappropriate for someone of their socioeconomic status and insists that she give it up, and she begins drinking to fill the void created by the loss of her beloved sport. Natalie admits that she has an “addictive personality” (p. 160) and that without boxing to focus on, she is “drinking every day” (p. 162) by bringing a water bottle full of vodka and orange juice to school. The trauma of losing her identity as a boxer contributes to Natalie’s escalating alcohol misuse, which is followed by a traumatic car wreck and loss of an unborn child.

In Beneath a Meth Moon (Woodson, 2012), Laurel begins using meth following Hurricane Katrina during which her mother and grandmother are killed when they refuse to leave Pass Christian, Mississippi, and she is permanently displaced with her father and much younger brother. After moving to rural Iowa, a basketball player, T-Boom, shows interest in her. Once she learns of his Cajun heritage, she feels at home with him. Almost immediately after they meet, T-Boom introduces her to methamphetamine. At the moment she first uses it, she describes the power of meth in the context of trauma, saying, “I felt like I was holding up the whole world and there was no water anywhere, no roads in front and behind me filled with empty land and tore-up houses. No past” (p. 72). The way meth transports her out of her grief eventually takes over her life, and the novel unfolds through time jumps between past and present that show her experiences with both addiction and recovery.

This cause and effect representation of addiction across the majority of our text set is dangerous in the sense that it doesn’t allow for every day experiences with drugs to appear in our text set. Trauma preceding addiction creates a narrative that if a reader experiences a traumatic event then they may come to depend on drugs and alcohol rather than getting introduced to substances in their communities or with peers without trauma. In nine of the ten texts we analyzed, the protagonists experienced trauma that was linked to their addiction with implicitly or explicitly causal language.

An Outlier: Go Ask Alice

Go Ask Alice both embodies and inverts the themes we found across the other nine texts in our set. The unnamed protagonist is a white upper-middle class female (her father is a college dean), and she has ready access to intervention resources, but Go Ask Alice was the only novel that depicted a character who was an exception to the trauma-precedes-addiction trope. The protagonist in this text does experience sexual, emotional, and physical trauma in the text, but these events occur following the onset of her addiction. This presentation of substance use as causal of trauma and destruction is consistent with the crafting of Go Ask Alice as a morality play; it was intended by the author to serve as a cautionary tale rather than a contemporary YA realistic fiction novel like the others in the set (Katsoulis, 2009). The protagonist’s accidental ingestion of LSD in a spiked soda at a party leads to the loss of her virginity, homelessness, rape, estrangement from her family, ostracization by her friends, and eventually, her death. Its presentation of incidental drug use as an irreversible moral choice has undoubtedly contributed to the figured worlds of addiction in YAL thanks to its status as a bestseller for decades (Oppenheimer, 1998).

Implications: Why Does this Matter for Scholars and Readers?

While our content analysis is not exhaustive of all potential texts, nor is it a representative sample of all books published, this analysis covers ten highly visible books based on sales lists, popular text lists, and credible recommended reading lists. The inclusion of these texts across academic and consumer-facing lists influences perceptions and figured worlds created about addiction. We believe this content analysis is an important contribution to YAL research because it initiates a conversation about how popular YA texts, authors, and list curators may be influencing a larger cultural narrative of addiction that contradicts important research-based findings about who has addictions and the nuances of the experiences these people have.

Our initial observation that few YA texts about protagonists with addiction were published before 1999 suggests a lag between lived experiences of addiction and stories that reflect those experiences. Even though the Diagnostic and Statistical Manual of Mental Disorders began classifying substance abuse as an independent diagnosis in the 1980s (Robinson & Adinoff, 2016), only three YA novels about protagonists with addiction appeared on popular lists in the three decades prior to 1999–2009. Ashley Strickland (2015) notes that the field of YAL was expanding rapidly during this time which stands in stark contrast to the lack of narratives published centering protagonists with addictions. We wonder why the field of YAL, one usually so responsive to tackling important issues in the world such as #MeToo and #BLM, has been so slow to take up topics like the opioid epidemic. We are also left to wonder about the methods that popular list curators are drawing on to find books and how their implicit biases may be influencing which texts they make visible.

In addition to this lag in YAL portrayals of people with addictions, the three themes we found across our corpus of texts demonstrate the circumscribed nature of these portrayals. Each of these themes raises questions about how addiction is portrayed in books, how and why these books are marketed to a wide audience, how addiction may be perceived by YAL readers, and whose identities merit nuanced narratives of experiences with addiction.

Across mental health studies, a different portrait of adolescents with addictions emerges. One review of literature found that a family history of substance abuse was a significant risk factor for the development of adolescent substance use disorder (Gray & Squeglia, 2018); the heritable nature of substance abuse is not depicted in the majority of the texts we examined here. Further, males are more likely to experience substance use disorders when broadly defined (Gray & Squeglia, 2018; SAMHSA, 2019); the majority of protagonists across our text set are female. In a study of prescription opioid use and misuse, female adolescents had a higher incidence of prescription opioid use disorder than males by a slight margin (50.94 to 49.06%) (Carmona et al., 2020), but even that slightly higher incidence does not align with the overwhelming appearance of female protagonists across our texts. In the Substance Abuse and Mental Health Services Administration’s 2019 report, rates of occurrence of substance use disorders were roughly the same across racial and ethnic categories, with the exception of American Indian and Alaska Native (AIAN) adolescents, who experienced substance use disorders at nearly twice the rate of their white counterparts.

Socio-economic class as an influencing factor in substance use disorders is also worthy of discussion here. While the protagonists in our text set are middle class or affluent, Carmona et al., (2020) found that prescription opioid misuse and disorders were distributed almost evenly across socioeconomic strata with the Substance Abuse and Mental Health Services Administration reporting the same findings in a similar study. In other words, affluent white teen girls are not the only adolescents misusing substances. While the Cooperative Children’s Book Center notes an uptick in representation for BIPOC characters starting in 2014, we wondered why we didn’t find diverse intersectional identities in this text set about addiction and recovery.

Trauma also plays a significant role across our text set. This trope in the texts is not completely misaligned with research on adolescent substance use disorders. Carmona et al. (2020) found that adolescents in their study had a higher prevalence of prescription opioid use disorders if they had experienced a major depressive episode in the previous year. Basedow et al. (2020) reported that adolescents who experienced traumatic events had substance use disorders three times as frequently as their peers; those with PTSD following traumatic events had a 5-times higher prevalence of substance use disorders. However, the role of trauma in our text set is also limited to the experiences of young adults following trauma. Research indicates that early exposure to traumatic events (e.g., in early childhood), as well as prenatal exposure to drugs and alcohol are also significant risk factors for the development of adolescent substance use disorders (Gray & Squeglia, 2018), and those experiences are not represented across our text set. While trauma may increase the likelihood of substance use disorders, our text set leaves out everyday drug and alcohol use, supplanting it with a traumatic event as a primary way that substances get introduced to adolescents. This is not representative of the real world of substance use, as readers could be led to believe they will only develop an addiction after experiencing trauma.

Finally, the depiction of access to rehab for affluent families reflects who receives the most substance abuse treatment: adolescents living at 200% of the poverty level receive treatment 1.6 times as often as students living in poverty (SAMHSA, 2019). However, male adolescents, both white and Hispanic/Latino, receive substance abuse treatment nearly twice as frequently as females (SAMHSA, 2019). The accessibility of treatment as it is impacted by wealth is not inaccurate, but the lack of male protagonists in rehab across our text set is. The discrepancies between the texts we analyzed and the existing data about adolescent substance misuse raise questions about whose stories are told in YAL and how those texts are categorized based on identity and community.

Moving Forward: What’s Next?

This Critical Content Analysis considers how addiction manifests as figured worlds across a text sample that is highly visible to the public. We hope this work supports other literary scholars who study children’s and YAL and education researchers in deep textual analysis by identifying ways they can support young people in critical analysis of these texts. Using Short’s (2017, p. 1) definition of critical as a “stance of locating power in social practices in order to challenge conditions of inequity”, the significance of this work lies in its examination of the figured worlds of addiction in these selected texts and in its investigation of whose stories are likely to find purchase in popular book lists and potentially in secondary or university classrooms.

Our findings are useful in sparking conversations about representation of people with addictions in YAL and establishing a research agenda for future work at the confluence of YAL and mental health. These findings also offer insight for educators who work with young people about how YAL may (or may not) help adolescents navigate their understanding of substance use disorders. On a cultural scale, our content analysis of these popular texts offers a literary microcosm for examining how the crisis of escalating opioid use is contextualized within our culture and economy.

This study raises important and interesting questions that merit further investigation, including interrogating why the texts we identified are the most visible. Further research should include identifying books that center stories of addiction across a wider range of gender, racial, and ethnic identities, and what categories those books are marketed under. We see merit in questioning why stories of Black, Indigenous, and other People of Colors’ stories connected to addiction aren’t getting the same popular traction as the texts we were able to identify. Finally, inquiry is needed into the list curator’s selection processes; that is, to critically consider whether people choose texts for lists like the ones identified in our sample because they are safe depictions of experiences of addiction.