Liminality

In Dopesick, liminality describes the unstable ground between addiction and recovery, asking for help and finding it, or being treated as a patient and being judged as a criminal. The term becomes the title of the book’s tenth chapter, where individual crises unfold amid institutional gaps and social stigma. Tess Henry’s brief plea for help and the later poster marking her last sighting make that in-between state especially stark: the possibility of rescue is present, but resolution is not guaranteed.

A Chapter About In-Between States

The book places liminality within a crisis that cannot be contained by a single boundary. Families confront loved ones moving among drug use, rehabilitation, prison, recovery, and relapse, while the systems meant to respond divide responsibility between criminal justice and health care. Shame helps keep those gaps hidden; people with addiction struggle to survive and stave off withdrawal as relatives and volunteers try to keep them alive. Liminality thus describes more than an individual’s uncertain progress. It also names a social condition in which urgent need exists between institutions that do not reliably meet it.

The chapter’s evidence spans experiences that are not equivalent but share the pressure of being stuck between recognition and response. In Roanoke, Virginia, the author began reporting on heroin in the suburbs in 2012, after two decades covering marginalized families for the Roanoke Times. At first, many families were too ashamed to speak on the record. Five years later, nearly everyone agreed to be named, but that greater willingness to speak did not mean that stigma or the barriers to help had disappeared. The shift from silence to public testimony is itself a threshold: families become more visible, while the conditions they describe remain difficult to change.

Stigma at the Threshold of Treatment

For Tess, liminality appears in the mismatch between treatment and the community’s measure of what counts as recovery. She had attended Alcoholics Anonymous and Narcotics Anonymous meetings, but felt stigmatized for taking buprenorphine. Some participants regarded medication-assisted treatment as not being clean, or as merely replacing one opioid with another. Although Narcotics Anonymous officially accepted medication-assisted treatment, longtime members whom the meeting leader asked to sponsor or mentor Tess declined. A relative said the rejection must have felt like daggers. Treatment could therefore offer a route away from uncontrolled use while its social setting withheld the recognition and support that might help sustain that route.

The book sets this experience against a wider divide: public-health experts and criminal-justice officials in the Appalachian Bible Belt often held sharply different views of Suboxone. In this context, treatment does not simply mark a clear passage from sickness to health. A person can be receiving medication and still be treated as if recovery is illegitimate. Liminality captures the tension between clinical care and a moralized idea of abstinence, and the loneliness produced when the two do not align.

Family Silence and Public Speech

The threshold between private shame and collective support also shapes families’ experiences. In 2012, parents in different parts of Virginia did not yet have Facebook groups through which to share rehabilitation advice, coping strategies, or material support. Robin Roth felt branded as a parenting failure and suffered in silence and anger after the death of her only child, Scott Roth. At Spencer Mumpower’s federal sentencing in 2012, she carried a framed portrait of Scott to the witness stand and confronted him with questions about the pain his actions had caused. The portrait made the loss present in a formal proceeding, but it could not restore the family or resolve the grief that had preceded it.

A later meeting at a Lutheran church on the outskirts of Hidden Valley brought together two mothers of opioid-addicted young men at Families Anonymous. The chance meeting connected families who had been navigating the crisis largely on their own, and opened a view onto the spaces left between the health-care and criminal-justice systems. Its importance lies not in making those systems whole, but in showing how peer support and volunteer effort arise where formal responses leave families exposed.

Janine Underwood’s attempt to move from private experience to public action reveals another limit. She told the local school board and county officials about her son’s story, hoping to secure support for a risk-prevention council running on a few small federal grants. She had chosen the Hidden Valley school zone because she believed its affluence would protect her family, yet the problem was acute in Hidden Valley and nearby Cave Spring. After she spoke, she recalled, there was dead silence; the school board declined to support the program, and the county provided its usual $2,000. Her testimony crossed into public view, but the institutional response remained meager.

Tess Henry: A Plea and an Unresolved Ending

In early 2016, the author drove Tess and her baby to Narcotics Anonymous meetings and recorded interviews with her permission. Tess was distracted at meetings, taking frequent cigarette breaks and checking her phone. She disliked one meeting in southeast Roanoke because familiar drug dealers lingered outside the church. She had preferred meetings in Black neighborhoods, which she described as funnier, with participants who had more clean time and were “way more real.” Her unease shows that entering a recovery space did not remove the networks, judgments, and experiences she carried with her.

On February 11, 2016, Tess texted, “Can yoi please come gwt me”. The misspelled, immediate request is a small but concrete record of a moment when she reached outward. The available evidence does not establish what followed that message, and the text should not be made to stand for a completed rescue or a settled recovery. Instead, its urgency sits beside the barriers described elsewhere in the chapter: help-seeking can be real without becoming a reliable passage into safety.

A missing poster later circulated by Help Save the Next Girl stated, “Last seen June 11, 2016”. Set beside the February plea, the poster gives Tess’s story a stark chronology but not a resolution. The chapter’s liminality is concentrated in that distance between asking to be found and being publicly marked as missing. The book leaves the uncertainty visible rather than converting it into a simple account of either recovery or failure.