HBO’s documentary Black Tar Heroin: The Dark End of the Street (sometimes available on Youtube) was released in 1999. It followed several young people who were regular heroin users. One of them was Tracey. She went on to stop using drugs, and now she is married with three children. She works as a counselor to people with substance abuse problems. The Big Fix is her memoir.

Most of The Big Fix is Mitchell’s own story. There are a couple of sections at the end of the book about drug policy and advice for people who are trying to stop using. She is skeptical about the 12-step approach, which discourages people from using substitute drugs like methadone as a way to reduce their dependency. She argues that there is good evidence that people tend to do better when they do have substitutes to keep them off heroin and avoid relapsing, which is one of the most dangerous parts of drug addiction.

Mitchell spends a lot of time contrasting her current life as a very busy mother of 3 who hasn’t used for 15 years with her former life, where she was living in the Tenderloin district of San Francisco, and was having sex with people in order to get drugs. She discusses how she got into drugs, which was not easily predictable. Growing up in Ohio, she had been a strong high school student, serious and hard-working. It was only when she left home and went to college that she started using alcohol and drugs. She had been unhappy and the drugs were probably a form of self-medication.

The Big Fix has plenty of gripping stories about living while using drugs, going to prison, then deciding to stop and build a new life. Mitchell writes clearly and with a fair amount of humor. Readers can see her writing style on her blog and see her talk about her experience in an interview. She performs her own unabridged audiobook with energy and feeling. The details of the story are specific to her, and it is a relatively simple narrative compared to the many relapses that other addicts go through — getting off heroin was by no means easy, but she did well with the recovery process.

© 2017 Christian Perring

Christian Perring is Vice President of the Association for the Advancement of Philosophy and Psychiatry.