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Book Review: The Big Fix: Hope After Heroin

It’s hard to watch the documentary Black Tar Heroin: The Dark End of the Street and imagine any of its five young subjects surviving past the age of thirty. Indeed, as heroin addiction has ballooned into a national epidemic, it’s hard to imagine anyone overcoming her need for this powerful substance and living a healthy life again.

With her book, The Big Fix: Hope After Heroin, Tracey Helton Mitchell, one of the subjects of the film, challenges popular conceptions about recovery and advocates for more diverse and comprehensive programming to overcome this pervasive addiction.  A certified addiction specialist and supervisor, Helton Mitchell’s expertise is much more than practical or academic — it’s personal.

Of Black Tar Heroin, Helton Mitchell writes, “When I agreed to do the film, I thought I would soon be dead from an overdose or homicide and that my story would be no more than a cautionary tale.” In reality, her story has become something much more powerful; as she notes, it is a story of transformation, of survival, and of hope.

Part memoir, part advocacy argument, and part educational text, The Big Fix relates Helton Mitchell’s experiences using, getting clean, staying clean, and helping others. It includes her reflections on such programs as needle exchanges and methadone clinics. And it makes a powerful argument for changing the way we as a society approach addiction and recovery. Clearly written and presented, it is an extraordinarily timely book, as heroin use has become a pervasive problem throughout much of the United States and the world. Likewise, it has something to offer to any audience.

Part One, “My Story,” makes up the bulk of the text. From the grudging, “Let’s Get This Out of the Way: Life Before Recovery” and “Clean and Sober Sucks” to “A New Sense of Self” and “From Mr. Now to Mr. Right,” the chapters in this section relate the disparate aspects of Helton Mitchell’s experiences living in the Tenderloin district of San Francisco as a user and then later when she was in recovery. She writes compellingly of the moment she decided to get clean for good after several failed attempts: “I am not doing this anymore…. This was my eleventh time kicking heroin, and it would be my last.”

Following this, she details the challenges of the rehabilitation program she volunteered for, the temptations of casual sex and alcohol, and the extensive psychological and personal work involved in getting clean. “After the chemicals left my body,” she reflects, “I was flooded with a life-time of memories I had tried to stuff down.” The Big Fix is as much, if not more so, about the life Helton Mitchell makes for herself as it is the substance she had to kick. Her family and her career helping those like her form the heart of the book. She doesn’t shy away from the realities of her life as an addict nor does she spare the reader the grim details of that time. However, her emphasis is on the recovery process.

The second and third sections, “Beyond the War on Drugs” and “Heroin Addiction and Recovery: What You Need to Know,” relate the need for advocacy and provide the educational purpose of the book. Intimately acquainted with recovery programs, Helton Mitchell argues we need to change the way we treat addicts in and out of treatment. The twelve-step program, she notes, is just one approach and its all-or-nothing philosophy can cause particular problems for those recovering from heroin addiction, particularly those who need methadone or other medication-assisted treatment (MAT), because, she says, “Some recovery communities consider MAT a ‘crutch.’”

Moreover, she discusses the unique challenges of being a woman in the meeting environment, which left her vulnerable to predatory males. Helton Mitchell goes on to advocate for several practical solutions we should implement as a society: reform MAT systems to be more affordable and patient friendly; regulate and standardize Sober Living Environments as well as rehab programs; and institute Good Samaritan programs nationwide to encourage people to call emergency services during an overdose situation. She particularly argues for naloxone — a life-saving drug that can reverse an opioid overdose in progress — distribution among users. The final pages of the book serve as a recap and condensed guide, useful for the casual reader.

The Big Fix: Hope After Heroin takes us beyond the cautionary tale of Black Tar Heroin. It gives voice to the experiences of recovering addicts and provides a 21st century approach to treating — not punishing — drug users. Helton Mitchell’s frank tone and accessible prose make this a must-read for anyone working in recovery, considering recovery, or supporting someone in recovery, as well as policymakers and advocates. Using her own experiences, she challenges us to think beyond statistics and social stigmas. Above all, she reminds us of the humanity of those who may seem to be lost. For all of us, The Big Fix should be a welcome source of hope.

The Big Fix: Hope After Heroin

Seal Press, March 2016

Hardcover, 272 pages


Book Review: The Big Fix: Hope After Heroin

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Julia Patt

APA Reference
Patt, J. (2016). Book Review: The Big Fix: Hope After Heroin. Psych Central. Retrieved on December 5, 2020, from
Scientifically Reviewed
Last updated: 28 Jul 2016
Last reviewed: By a member of our scientific advisory board on 28 Jul 2016
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