Substance use and abuse is rampant in Dawn’s life. Early in the novel, Dawn references her mother’s alcoholism. Whenever she enters a new room, it is often littered with beer cans, and someone is drinking or drunk or has fallen into a drugged-out stupor. Her Papaw makes his own corn liquor, to which she has easy access, and she later assists in Hubert’s illegal alcohol operation. Substance abuse pervades the atmosphere like a thick fog that keeps many people in her community stuck. At 15 years old, Dawn is desensitized to the drug use she witnesses, and even seems to expect it for herself. In this sense, it represents the cyclical nature of her family members’ habits: like her mother, Dawn turns to alcohol to drown out her pain, despite resenting her mother for her addiction and the consequences it has on the family.

Looking back, Dawn realizes that many of the people she knows are abusing the drug Oxycodone. Drugs like Oxycodone have ravaged the region where Dawn grows up, wherein many towns face similar economic struggles to Canard County. Substance abuse signifies their feelings of defeat in the face of obstacles they feel are beyond their control, like losing a spouse, in Momma’s case, or facing the threat of lost employment, like the coal company employees.