EDITOR’S NOTE: The following is an excerpt from The Opioid Epidemic and U.S. Culture, edited by Travis D. Stimeling, which will be published in December 2020 by West Virginia University Press. The chapter from which this excerpt is drawn was written by Natalie Shaffer.

Our Secrets Keep Us Sick

I was one of those people who never entertained the thought of staying in West Virginia past high school. I knew the accepted narrative around success in the Mountain State was, if you wanted to make something of yourself, you had to leave and do it fast before you got stuck. So I did. After graduating from West Virginia Wesleyan College, I spent years away from the lush forests and electric autumns of my home, away from friends, and away from the familiar. I found myself “forced” to return due the nonrenewal of a job contract and a mother freshly diagnosed with stage IV breast cancer. I returned viewing West Virginia as a necessary pit stop on the way to my next successful endeavor.

During those years away, roughly 2006 to 2011, the use and prescription of opioids increased in astronomical percentages. The resultant heroin usage, as it was simply cheaper to obtain on the street, became a commonplace conversation in my home state. A study conducted in February 2019 using data collected from the West Virginia University Medicine health care system found the hospitalization rate for opioid overdoses increased 13 percent on average each year in a similar fashion to the opioid overdose death rate for the state, 12 percent, between 2008 and 2016. During the same time, the percentage of patients with a repeat opioid overdose increased annually by 13 percent on average. Drug overdose deaths more than doubled in the United States between 2000 and 2016, and since 2010, West Virginia has found itself at the center of the crisis with the highest opioid overdose death rate of 52.0 per 100,000, more than 250 percent higher than the national rate of 19.8 per 100,000 in the United States. In 2019, more than 80 percent of the overdose deaths in West Virginia were attributed to opioids.

I knew none of those statistics when I returned to Morgantown, West Virginia. After settling back in, I entered what would become a long-term relationship with a brilliant and charismatic athlete. A few years later, they sustained a back injury during a soccer match and were placed on high-dose opioid medication following their surgery. During this recovery their grandmother passed away, and they learned their team, and livelihood at the time, would not offer them a spot the following season due to the injury. Physical, emotional, and spiritual emptiness ushered in a new age of what I now can label as “active addiction” into our home. Eventually they came to identify as an addict, sought help, and oscillated between periods of being “in” and “out” of recovery. As I fought to finish a graduate degree, pay all our bills, and “make sure they were not using” (i.e., babysat another adult), resentment festered on both sides that could not be dissolved. I was irritable, unreasonable, and angry. They were all of those things too. At the advice of a friend, there I sat in an NA meeting, on an uncomfortable folding chair, listening to what other addicts do to get through the day and unlearning the story of what addiction looked like.

Replacing Existing Cultural Narratives

The cultural narrative I knew pertaining to addicts was that they were “bad” people who made the “wrong choice” of using and deserved what they got as a result. I knew from the personal experience of watching a disease take over and tear down another remarkable human being’s life, remove their passion, and erase their connection to anything and anyone other than drugs that this narrative was not accurate. It was just easier. I knew from listening to the stories shared in various twelve-step meetings filled with dignity, authenticity, and courage that these were not “bad” people. In fact, most of the individuals I met had more self-awareness and genuine intention behind their actions than the “good” people I knew and interacted with on a regular basis. But these were all thoughts I struggled to reconcile in my personal life. My professional and academic life seemed as far removed from addiction as possible, a good arm’s length, a safe distance.

I was back in a graduate program at West Virginia University in March of 2017 and attempting to finish writing my uninspired thesis on violence in American opera and new second degree in choral conducting when I traveled to the American Choral Directors Association National Conference in Minneapolis, Minnesota, and had the pleasure of attending a session presented by Dr. Kristina MacMullen of the Ohio State University titled “A Voice of Reason: Social Justice, the Greater Good, and Why We Sing.” She shared her experience identifying an issue of social injustice in her community, human trafficking, and the steps she took to generate a platform to educate and inspire others by creating a multimedia choral concert as part of a three-day summit hosted at the Ohio State University. I knew this session would become the new focus of my thesis and, perhaps more importantly, that this was the work I wanted to do.

At the same time I was finishing my thesis, I found myself offered the opportunity to take over as director of a homeless choir. The choir began earlier that year at the request of a local free medical clinic, Milan Puskar Health Right, in a conversation with my conducting advisor. Health Right was looking to expand activities at their local drop-in center, the Friendship House, as a means of promoting harm reduction and social engagement among their clients. I was involved from the beginning as an assistant and enjoyed attending weekly rehearsals with the group. After hearing about my change of thesis subject and passionate interest in social justice through choral music, my advisor suggested I take over their role as artistic director of the yet unnamed choir. As the group and I continued to work together, we began to trust one another. Over time, I learned their stories. As I listened, I came to realize addiction was at center of nearly every narrative. It became exceedingly clear that this issue of social justice, present in both my personal and professional life, would become the focus of my work in collaborative social justice.

Getting in the Work, Not in the Way

The “homeless” choir I have the pleasure of working with came to be known as the Voices of Hope Choir, a community choir for those experiencing homelessness, addiction, mental illness, and their allies. I assumed everyone would be on board with my elaborate plans of constructing and presenting a counter-narrative concerning addiction and want to push full steam ahead. Many of the members are happy simply coming and singing once a week for an hour. That is the best they can do, and that is all they can afford to give of themselves. Their mental energy is conserved for meeting their tangible needs for the remainder of the day and not for the betterment of society. I can hardly find fault with that and would be blind to my own privilege to expect more.

Some of the members are social workers and healthcare providers from Health Right who come next door to participate with us. They spend their entire workday attempting to bring about a more humane existence for others. They, too, reserve the right to not want to march into a city council meeting every month and explain why refusing to install new benches out of fear that homeless people will start sleeping on them, or addicts will pass out on them, in a nice part of town is less than humane and then sing a song as proof of the inherent worth of each choir member. The work is hard and tiring, and not everyone signed up for that.

I knew nothing formally about directing a choir of people dealing with homelessness, mental health issues, and addiction, so like any academic worth their salt, I started researching. I read about the Dallas Street Choir in Dallas, Texas, founded by Dr. Jonathan Palant in 2014, and discovered some basic ideas about incentive programs, repertoire selection, and behavior expectations. It was from an email exchange with Dr. Palant that I realized I would need to make song lyric sheets simple and ensure they were printed in a large font, as many members would have vision issues and most would not have corrective lenses to assist their reading.

The general setup of his group rehearsals would not work for us, so I continued researching. I came across the website for the Voices of Our City Choir in San Diego and its founding directors Steph Johnson and Rob Thorsen. Their vision statement and mission explanation provided a basic example that I showed the Voices of Hope members as we crafted our own. They also provided an education and advocacy model that I shared with [my assistant director] Ryan [Fieldman] and other core group members. These are members who are present at nearly every rehearsal and feel a sense of accountability to the choir and to the other individuals who attend on a regular basis.

The transient nature of the choir’s members offers perhaps the largest hurdle when it comes to planning and performing from a director’s viewpoint. The core group of individuals supporting Voices of Hope make it possible to invite new members each week and help everyone feel up to speed. At this point the core members are Ryan Fieldman, assistant director and peer recovery coach; Caitlin Scott, director of The Friendship House; Diane Green, business manager of Milan Puskar Health Right; Jacob Eye, peer recovery coach; Wes Bergen, local minister; and Jordan Hunter, a social worker for Health Right. These individuals set up chairs, arrange rides when we perform outside of walking distance, run rehearsal if I am not present, and create accompaniment for some of our pieces. Because each of them comes to the group with a different background and level of understanding of addiction, homelessness, and music, their voices offer insight, ideas, and necessary feedback throughout the process. That is not to say that their voices are valued over other members. I encourage anyone to suggest repertoire, provide feedback about performance events and rehearsal, and simply check in emotionally if they feel so inclined.

Our rehearsals work like any other choir I have directed in the past. We begin with warm-ups. For individuals not familiar with choir, these can sometimes feel foreign, silly, and unrelated to just singing some songs. Some members come to Voices of Hope with years singing experience in school choirs and jump right into this practice. Others attend multiple rehearsals before they are willing to participate in warm-ups. Ryan feels that warms-ups are one of the most functional things we do during choir because they get everybody centered. When we make our way through the breathing exercises and get everyone focused on just enjoying that hour, he sees a change. He observes that whatever was going on mentally seems to dissipate and by the end of the hour choir members seem noticeably calmer: “Everyone seems to be getting along.”

As a director, this is the main time I can actively work on technical aspects of singing like breath support, relaxation in the jaw and neck, intonation, and counting. Some members requested the opportunity to learn the basics of reading music, so I use the end of our warm-up period to introduce basic rhythms that we read and clap and basic pitch patterns that we work out using numbers rather than solfège (do-re-mi) syllables.

When teaching a new song to the group, I primarily work by rote. This instruction strategy is efficient for us as I get to model proper breathing, vowel shape, and phrasing for them rather than try and explain all those parts. Once we have worked on a piece for a while, I invite any members who feel confident to sing with me and newcomers to echo back. Some pieces that were suggested by members, like Jim Croce’s “I Got a Name,” were not familiar to me and full of variations on the written melody. In this case I asked a member who knew the song well to do their best to sing parts for us, and I amended my score accordingly to be prepared to lead in the future. I believe the experience of watching me not knowing everything was comforting and equalizing, as well. For melismatic passages, I simply use hand motions to convey the melodic contour.

Some members have asked to start using sheet music, so they follow the shape there while others follow my hand. Our binders are organized alphabetically and contain a simple lyric sheet as well as a copy of sheet music for each song in our repertoire. A table of contents became necessary as some members became easily frustrated with the alphabetical order, so amending the binders to include page numbers and a table of contents served us well.

At this point, Voices of Hope has standards that we keep in rotation all the time in both rehearsal and performance and seasonal pieces that are new and added to the end of the binder. We divide our year into fall semester (August–November), holiday (December), spring semester (January–May), and summer (June and July).

The Voices of Hope has successfully hosted members of the city council and the mayor at the Friendship House, introduced these government leaders to individuals who frequent the drop-in center, and performed some of our favorite songs including “Hotel California” by the Eagles, “Linger” by the Cranberries, and “Let It Be” by the Beatles. Choir members voiced their desire to be a part of the Morgantown Art Walk last fall, so we set up outside the Friendship House and prepared three different sets to perform throughout the evening. Passersby could sit and listen or explore the drop-in center, which was left open so people could view the client-created art that adorned the walls. Choir members invited friends and family to come see them perform, meet the group, and to sing “Take Me Home, Country Roads” by John Denver with us. Ryan recalled the sense of belonging and fellowship present among members as they rushed to set up chairs, hang additional lighting outside, and prepare refreshments for visitors on both occasions.

I do not want to paint the picture that every discussion goes smoothly and along my time frame. Nor do I want to portray our rehearsals to be the epitome of efficiency, professionalism, and collaboration. We strive to adhere to our guidelines and vision statement, “Rewriting the narrative around homelessness and addiction in our community through music making, group participation, and advocacy,” and we are completely human in that attempt. When writing our first song together, our version of Bob Marley’s “Three Little Birds,” I planned for one rehearsal to be enough time to complete lyrics for three verses and one chorus together. I thought we would use a whiteboard and work together seamlessly to create our song. That process took four weeks and almost inspired a fight as some members felt their voices were not being heard in the process of creating lyrics.

Do we have days where we warm up, run through eights songs, and leave feeling totally accomplished? Definitely. Do we have days where everyone is stressed out, talking over top of one another, arguing about whether a passage should say “she said” or “and said,” or passing out in a chair at the back of the room because they used right before they came by? Yes, we do. And the members keep coming back. So do I.

As Ryan and I discussed why our recipe seems to work, we identified the emotional and physical reactions to the rehearsal and performance processes. Ryan, a recovering addict and peer recovery specialist for Health Right, shared his experience that any kind of connection is going to help. His basic understanding is that, neurologically speaking, enjoyable group activity that offers human connection releases endorphins, and the brain will in return produce dopamine:

And it just feels you know … people may not be able to describe it the same way I just did, but it just feels good. It’s like a natural high. So I mean maybe it’s a sneaky way of saying like, hey, there is something else that like can make you feel this way. And I think if people are able to consistently do those things, then they just kind of inherently learn that like, hey, there’s other ways I can make myself feel good, you know? It’s like ok, well … there’s the seed, and maybe something will grow from that.

Other members have shared at the conclusion of rehearsals that choir was the best hour they had in weeks. Some members sit quietly crying or in reflection while others sing around them; some members get angry or frustrated and leave rehearsal only to return and apologize to the group. The open space created at rehearsals coupled with the ability to gently hold one another accountable are both building a sense of community.

A specific moment I saw this community pull together was at a family- friendly holiday event hosted by the West Virginia Black Bears baseball team. The Voices of Hope was invited for the second year to sing carols while families made crafts, had cookies, and took photos with Santa. The holidays can be a challenging time for individuals in recovery and for those experiencing homelessness, as memories and intense feelings of nostalgia and grief can cloud present reality and lead to disconnection. When we attended the event, a member who had not sung with us long, in early recovery from addiction and recently released from incarceration, told us they invited their ex-partner to stop by and bring their daughter. They shared with the group that the child was born while they were in prison, and because of the rules and itinerary of their recovery house, they had only met their daughter once. Near the end of the event, the member found them and spent a few minutes holding their daughter and speaking kindly to their ex. Group members stood back taking pictures and sharing in the joy that their friend could spend this small amount of time with their family. They offered support after the child left, and sadness crept across the member’s face. The new member smiled through his tears and thanked everyone for their kindness and sharing their stories of estranged loved ones. One member replied, “We are all a lot of things, but we are also members of the Voices of Hope, and this is kind of what we do.”

Off the Page

At times, our vision statement—“Rewriting the narrative around homelessness and addiction in our community through music making, group participation, and advocacy”— seems lofty, but it is what we do. On the advocacy front, the Voices of Hope performances open channels of communication with city leaders, state legislators, and members of local law enforcement and judicial systems as we invite them to sing with us at the Friendship House or offer holiday carols at their doorsteps. A different face of addiction is shared with the outside community as we sing, laugh, and generally get down during family-friendly events downtown or organize a fundraising concert with all proceeds going to the Morgantown Community Kitchen that has fed them many times and to which they would like to give something back. We have attended city council meetings as a group, not to perform, but to support one another in voicing concerns about topics from bench installation, Narcan accessibility, and safety.

Some of the seemingly smaller scale and less tangible accomplishments occur in our group participation and musicking. Milan Puskar Health Right considers the Voices of Hope part of their harm-reduction approach to recovery. Rehearsal is an hour of singing and generally some time in fellowship before and after during which members are not using. Any measurable amount of time in which their clients are not actively harming themselves is an achievement.

The Friendship House views Voices of Hope as one of its most successful groups, where members continually bring friends with them to try out choir and are always ready to share why they participate. I view it as a successful group because members tell me things like, “Well it was either come to choir or sit at home and shoot some smack, so I brought my ass down here,” and then flash me a smile like a child who is fully aware of their level of orneriness. I am not conceited enough to believe my choir is keeping this addict from using all day or ever again, but I do share in their joy and freedom of engaging with life, without drugs, and truly enjoying those moments. Recovery involves building a tool kit of people, places, and things that help keep you sober, grounded, and accountable. For some members choir is simply enjoyment, and for others it is a functional tool.

Success in the twelve-step recovery programs is a life that is happy, joyous, and free. As I redefine success with Voices of Hope and in my career through that lens, I am happy to see collaborative social justice, the truly effective kind, evolving from choral musicking. We are building community, both insular and external, through connections centered around choral music, which, I hope, will continue to foster social change. Social change and the notion of social justice, working toward a society where every individual is honored as they are at that moment, equates to a sense of freedom. The path to solutions is already present in the voices of those individuals around me. As we keep connecting those voices to community members in positions of leadership or with talents and means to collaborate with them, changes will occur. Most imperative to me is the reminder that the changes may be solely within the members of my group and myself but not the community at large, and that is still a West Virginia success story.