On average, 115 Americans die every day from an opioid overdose. That is one American every 12.5 minutes, a staggering statistic. As a public health professional with over a decade experience in injury and violence prevention, which includes poisonings such as drug overdoses, reading Saving Bobby: Heroes and Heroin in One Small Community provided me a rare perspective. I am familiar with the mind-boggling statistics in the scientific literature such as: 1) Clinicians wrote nearly a quarter of a billion opioid prescriptions in 2013, which is enough for every American adult to have their own bottle of pills; 2) in 2014, nearly two million Americans either abused or were dependent on prescription opioids; and 3) in 2016, drug overdoses became the leading cause of death among Americans under 50 years old..
Saving Bobby, put a human face on an epidemic that is currently impacting millions of people in the United States, from those who are living with opioid addiction to the loved ones, community members, and care takers of those individuals. Renée Hodges describes her experiences of preparing for, welcoming, and caring for her nephew, Bobby, during a difficult and profound time in his life involving addiction. Bobby started taking prescription opioids under the care of his doctor in college for debilitating back pain. By the time Bobby graduated from college in 2009, he was addicted to prescription opioids.
Opioids are prescription medications used to treat pain. The most commonly prescribed opioids include codeine, hydrocodone, and oxycodone; however, heroin is the same substance. Scientists are researching the pathways of addiction including one which illustrates a person starting to take prescription opioids to treat pain as instructed by their doctor or dentist, inadvertently becoming addicted to these medications, and switching to using heroin after their formal medical care ends because that person has become addicted and heroin is cheaper and readily available in most American cities.
Hodges describes receiving her despondent nephew, Bobby, at her home in Durham, North Carolina in the Spring of 2013 so that he could seek further treatment at Duke University after he had spent time in various rehabilitation centers throughout the country since his college graduation. She structures the book chronologically, starting with the preparations for Bobby’s arrival. As his aunt, she is in regular communication with Bobby’s parents who live in Louisiana and clearly describes her evolving revelations of the commitment she is making for his care. Simultaneously, while preparing for Bobby’s arrival, she learns of the death of one of her dearest friend’s sons due to overdose, which immediately crystalizes the life-or-death circumstances surrounding the care of her beloved nephew.
Hodges documents the sixteen-month experience of caring for Bobby, by including emails, texts, and journal entries, which describe the heartbreaking reality of how insidious escapism and stigma of addiction live on the pages and in the airwaves of mainstream media. Becky Georgi, a licensed clinical addictions specialist, also captures some of these phenomena in the Additional Notes section of the book:
Addiction occupies space in the public mind as a failure of character rather than a medical affliction, a lack of willpower rather than a legitimate disease, a choice that’s made rather than an illness that strikes. On an individual level, shame drives addictive illness and interferes with a family’s ability to get help. On a much broader scale, the shame associated with heroin use carries such a powerful stigma that the culture itself interferes with family members supporting their loved one.
When family members see their loved one suffering, what can they do to stop the downward spiral of this insidious illness? The family must reach out beyond the shame, talk to each other, and get help.
That is exactly what Hodges did. Hodges was forthright about the circumstances around Bobby moving in and living with her family to her community of friends. She did not hide in the shadows of shame surrounding her nephew’s addiction. Instead, she reached out to provide Bobby with opportunities to learn, engage in and contribute to his new community, and recover his health. Hodges describes her heartfelt struggles in caring for Bobby, and requests help not only for Bobby, but also herself as his primary caretaker, providing a perspective that is not often discussed. For this reason alone, Saving Bobby, is worth reading. Hodges includes personal reflections and communications with her therapist, family members, and friends seeking guidance and support regarding the decisions she makes related to Bobby’s care. Each decision is considered independently and as part of a bigger picture, which requires a steadfast commitment to the dynamic nature of addiction treatment and recovery. Her community abides and Hodges’ determination to provide comprehensive and holistic care for her nephew is notable. She seeks out and secures substance use disorder treatment, and therapies that address Bobby’s physical, mental, social, and spiritual health. Hodges’ commitment to Bobby, her other family members, and her community of friends is palpable.
Candidly, Hodges admits some of the mistakes she made in Bobby’s care and shares glimpses of the impact the experience of loving and caring for someone who lives with addiction had on her family. She shares some of her own family’s history with addiction and notes the changing cultural dynamics of addiction in the United States, including the incongruous past social acceptability of addictions to substances such as alcohol, in contrast with the current lack of social acceptability of other substances, such as heroin. Though she focuses a lot of her energy on addressing the shame and stigma associated with addiction in her family, she does not examine the language that she uses to describe people living with addition. In the beginning of the book, Hodges uses charged words to describe people living with addiction like junkie and addict and people who are in recovery as “clean.” These words are limiting, hold judgment, and perpetuate the misconception that addiction is a choice or a moral failing and not a chronic brain disease, which should be treated like other mental health conditions. Understanding that addiction impairs an individual’s decision-making ability by changing the actual structure and function of the brain needs more so than ever, to be translated into the language we use to describe it. Individuals are a sum of many parts, of which for some people, addiction is only one. The words we use around addiction can either support a path to recovery or dissuade it. Regardless of the language that Hodges used to describe people living with addiction, her compassionate care of Bobby and personal exploration and edification of this issue were pivotal to Bobby’s recovery.
Lastly, of note, Bobby’s experience of addiction treatment was well resourced with his immediate and extended family. This should not and does not take away from the bravery and compassion that is described in Saving Bobby; however, not everyone is so lucky. Both abstinence-based and medically assisted treatment options are expensive and access is limited. Though there is much work happening to address these concerns, the trends in the data do not yet demonstrate that the epidemic is abating. Many people around the country are working hard to understand and provide evidence to prevent opioid overdoses and enhance treatment options. In my opinion, Bobby is the hero of this and his story and Renée Hodges is the warrior that lifted him up and protected him with the ferocity of a loving mother and friend. May all individuals living with addiction be so lucky.
1. Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2017. Available at http://wonder.cdc.gov.
2. IMS Health, National Prescription Audit (NPATM). Cited in internal document: Preliminary Update on Opioid Pain Reliever (OPR) Prescription Rates Nationally and by State: 2010-2013.
3. Centers for Disease Control and Prevention. Vital Signs: Variation Among States in Prescribing of Opioid Pain Relievers and Benzodiazepines — United States, 2012. MMWR 2014; 63(26);563-568.
4. Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2017. Available at http://wonder.cdc.gov
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