Like banking and agriculture, the medical industry is big business in the United States, with many tens of billions of dollars (both public and private) going into research, prevention, treatment, lobbying, and the like. But when it comes to respect, certain diseases—cancer, heart, and lung—get treated like royalty while others—drug addiction—not so much.
Here’s the heartbreaking facts: More than two million Americans currently struggle with an opioid disorder, 42,249 died from opioid overdose in 2016, the problem is worsening by the day.
Unlike cancer and heart disease, where great advances have been made over recent decades, drug addiction has proven especially difficult to treat because so little is understood about the human brain. Seemingly, every addict is unique in their addiction to their drug of choice.
And then there’s the stigmatization of drug abuse. For an inspiring lesson in how to win the shame game and also deal a blow to opioid addiction, this week’s Foreword Face Off interview features Renée Hodges, author of Saving Bobby: Heroes and Heroin in One Small Community (She Writes Press). Hodges says it’s a misunderstanding that addicts use drugs to feel high, instead “they use them to feel normal. Because it [addiction] is a brain disease, it changes behavior, causing addicts to do things most would never dream of doing if they were not addicted.”
Not only a beautifully written memoir from a veritable Joan of Addiction, we found Saving Bobby to be a guidebook, offering specific, proven ideas for caregivers to help an opioid addict beat the odds.
One of the interesting details of your story is the fact that you’re Bobby’s aunt and not a mother or grandmother, the two relations most commonly thrust into the role of helping an addict. But in the book, you write about the long history of addiction in your family and the fact that you suffer from the guilt of NOT having an addiction. Was it this guilt that caused you to take such an interest in your nephew? What else compelled you to play the role of caretaker?
Sometimes, the best gift that a parent or grandparent can give to their recovering addict/alcoholic (I’ll use addict from here on out for ease) is to be able to turn their loved one over to someone else for care, to let them go and love from afar. Mothers, parents and grandparents can be too close to the situation, and a geographical change or a caregiver change might be just what the addict needs to see their situation more clearly, especially if there is a pattern of rehab, recover, release, and repeat. Bobby told me that it was the change in both location and caregivers that allowed him to see how his addictive behavior affected his family and friends.
Of course, this lesson and most of the lessons I have learned from the sixteen months my nephew lived with my husband and me were learned in hindsight.
The reasons I decided to help Bobby are a mix of personality and circumstances. I am an impulsive thinker and an idealist, which is sometimes a blessing and can also get me in trouble! I’ve often described myself as a “fixer” and you know the saying, “If you want something done, give it to a busy mom!”
As for circumstance, in March of 2013 my brother called to tell me that his son, my nephew Bobby, had left the half-way house and was contemplating taking his life. I was only vaguely aware of the many years that Bobby’s family had been dealing with his addiction to opioids and heroin because addiction was not something we discussed in our family. Bobby became addicted to opioids while in college, almost six years prior, after a physician prescribed Oxycontin for a back problem. This was at a time when there was little talk about how addictive opioids could be, and by the time Bobby graduated (several years late) he was a full-blown addict.
Yes, there was a long history of addiction in my family. My family did not know to seek outside help, nor was it OK to talk about alcoholism, so we denied and ignored it, even to each other. Because my parents and my grandparents did not know to talk about the disease, my brother, sister, and I did not know we had a genetic predisposition to addiction. And, because we didn’t know to talk about it, Bobby did not know that genetically he had a much higher chance of addiction than others. It became a vicious cycle.
It was monumental when my brother reached out to me. I offered to have Bobby come to Durham for a complete physical. Rationally, I thought, find and fix the chronic back ailment and maybe it would lessen Bobby’s want and need for pain relief. Naively I thought it would only take a few weeks to get the diagnosis, find an apartment, and let Bobby begin looking for a job.
Was my offer to have Bobby come to Durham based on some long-hidden guilt? Maybe. I did have some survivors guilt since I had never struggled with addiction and I’d been judgmental and resentful of some of my family members. But it was probably more like an unexplained aligning of the stars.
On the same day that Bobby began traveling to Durham to stay with us my best friend’s son, a young man I had watched grow up, accidentally overdosed on heroin and died. In my deep grief, and because of the extremely uncanny coincidence of his death as Bobby arrived in Durham, I became determined that there must be a higher purpose for Bobby. The precipitous nature of these events more than anything else is the primary reason I became Bobby’s caregiver.
Early in the book, as Bobby moves into your house and you began to understand the depths of his problems, you write about your husband’s deep discomfort with the new arrangements. While he was tentatively supportive, emotionally you guys weren’t on the same page at all. Can you talk about the stress on your marriage and whether it had lasting effects?
I like to say that my husband and I grew up and grew together. We started dating our freshman year in high school when I admired his “Earth” shoes, the ugliest pair of brown leather shoes with “negative heel technology,” where the heel was lower than the toe. We married at age 24 and were celebrating 30 years of marriage and 39 years together when Bobby came to stay. We were also newly empty nesting.
Our personalities are like two teams on opposite ends of the field. For example, Will is not an impulsive decision maker. It takes days of research and many trips to the store or internet before Will will buy an item, usually the first one he looked at. On the other hand, I have always been of the opinion that if you let the first one pass you by, you may never get the chance again!
We learned that the key to a winning marriage is for both of us to play on the forty-yard line, in the middle of the field, and to give up the ball when needed. Because we love each other we know that if we both played in our own end zone we would never play the game. So, although our personalities are very different, this is our attraction. Together we see the playing field from all angles.
No matter what your personality may be, taking in a recently released addict when you had envisioned your newly empty nesting life relaxing on a beach, is stressful. I made the decision to see a psychologist weekly while Bobby was living with us. This decision may have been the best one I made and I’m sure it contributed to maintaining and strengthening my marriage. In therapy, I would lay bare my indecisions, my anxiety, and my questions on how to balance Will and help Bobby. Seeking professional advice to guide me through the stressful times just made sense to me. This decision helped me put Will first, unless of course it was an emergency, and to help Bobby in the best way I could.
As days turned into weeks and weeks into months, Bobby and Will began to connect, slowly and very deeply. Throughout the process Will kept me from being too idealistic, and I kept Will from giving up on Bobby too soon.
Today my marriage is stronger than ever, and Will is my biggest supporter, other than Bobby and my three children. In the end, the very things that helped Bobby’s recovery are the reasons why my husband loves me. Like I said, those things sometimes get me in trouble, but in this case they were a blessing. And his support, even when the situation may not have been his first choice, speaks to his love and flexibility.
Although he is a more private person, Will’s recognition that we might give others hope in the face of overwhelming doubt by sharing our story also motivates his support. This brings my analogy full circle: we are a dedicated team that came together and pursued the same goal. I call that a winning combination!
Your emotional rawness and willingness to put it all out there throughout Saving Robby is disarming, but hugely important to the power of the book. And you write at a very high level. At what point did you decide to make your experience with Bobby a book? From a writing standpoint, was it clear from the beginning how you wanted to tell this story?
Thank you for the compliment. I believe my personality is a bit like my writing. I am a very open person, and I love people and enjoy making deep and lasting connections.
I did not set out to publish a memoir. I first had an inkling of an idea when Bobby was ready to move out after our sixteen-month journey. Before he moved on he mentioned that he would like me to write down his story because he wanted to always remember where he came, how far he has come, and so he never ends up back there again.
I was enthusiastic and even though I have no experience with writing a manuscript, I was excited. I went through my computer and phone and collected every email and every text over that sixteen-month journey. Apparently, I never empty the trash!
I also typed up many of my journal entries, months of writing to myself late at night in order to alleviate anxiety and help me fall asleep. I had chronicled every step of our journey together. Those emails, texts, and journal entries became the starting point for the memoir.
I didn’t know how powerful Bobby’s and my story was until I asked my book club to read and help put the finishing touches on it. It was their emotional response that persuaded Bobby and me to turn the manuscript into a memoir and publish. Bobby is now a drug counselor and is speaking about his experiences openly. Publishing a book seemed to be the right step.
It is raw and it is vulnerable. But, it is also a beautifully inspiring and hopeful story of recovery. I grappled with letting the public read this intimate story. In the end I knew that I could not ask Bobby to shed his shame and be honest about his disease without me being courageous enough to do the same. I knew that this story would be a teaching tool and give others hope so putting it all out there was more than worth it.
The successful treatment of opioid addiction is elusive. Why might this be so, and are you aware of any therapies or treatments that have shown promising results?
Every situation is unique. I have written a very personal story about one young man’s recovery and how the shame and stigma of his disease was lessened by community. I am not a doctor, counselor, or therapist so I don’t feel qualified to talk on promising therapies or treatments. This is not a “one size fits all” situation. However, it is a story of hope and I believe we must have hope to face addiction in all its complexity.
Here is what else I believe: I believe that we must change the way insurance covers stays for addiction treatment. Twenty-eight days is barely enough time for an addict to detox, much less address other mental health issues or emotional issues contributing to substance abuse.
Bobby’s story illustrates how ill-prepared many addicts are when they are beginning recovery. We want desperately to believe our loved one is fully recovered after a stay in rehab, but in thinking this way, we are missing a crucial and the most vulnerable period of an addict’s recovery. When a patient is discharged and leaves the safety and security of a treatment center or halfway house, we say go get a job, go get an apartment, or go be normal now.
When Bobby came to live with us it was apparent that he was not yet ready to be out in the world. Not surprisingly, it would be a little bit longer than the two weeks we had planned—like sixteen months longer.
For example, Bobby did not have money, a job, job skills, or training, and he had few prospects. He did not have a wife or kids waiting at home for him. He did not have anywhere to live. Bobby had huge gaps in his resume. He still had a chronic back problem.
Bobby had also lost touch with the outside world. There are no newspapers or magazines in rehab and TV is heavily monitored because of the ads for alcohol, prescription drugs, and sexual innuendo. Therefore, Bobby did not know what was happening in the news, in politics, or in sports. Technology had left him behind.
Bobby was also in a state of “learned helplessness.” This state is a byproduct of treatment where an addict has been told what to do, think, and feel, and subsequently is unable to function without guidance when released.
Bobby carried so much shame that he self-isolated from the rest of the world. Yes, Bobby was substance-free and newly released from rehab and a halfway house, but he had a long way to go before he would have a successful long-term recovery.
I believe we must make treatment available for all who are suffering, regardless of financial ability. And I believe we should consider step-down medical treatments. Good (evidence-based) treatment does work.
I also believe that we need to change the way we talk about addiction. It is not a parenting problem or a character flaw, it is a disease and it is not shameful. Transforming our language and perceptions around addiction is easier said than done and the change will come slowly but it must happen. Lives depend on it.
It’s heartbreaking to imagine that crucial moment when incidental, recreational drug use explodes into the day-to-day habit of full blown addiction. No doubt, the great majority of drug addicts are shocked and dismayed by their descent, and would give anything to return to a more normal, drug-and-alcohol-free life. And then there’s the shame, which you stress is terribly destructive to the addict and his family. Addiction is crazymaking. With all you’ve gone through, what does the word now mean to you?
Let me start with what the word addiction is not. As I said, it is not a parenting failure. It is not a moral failing. It is not a choice and it is not shameful. It was hard for me to think of addiction in this way until I sought professional guidance for Bobby and for myself.
Now I understand that addiction is a disease, much like heart disease, lung disease, and cancer. Addiction is chronic and over time it rewires the way the brain functions. Addicts don’t use drugs to feel high, they use them to feel normal. Because it is a brain disease, it changes behavior, causing addicts to do things most would never dream of doing if they were not addicted.
There is great shame and stigma associated with addiction and its behavior. Several weeks after Bobby came to stay, he came to me in the kitchen and said, “Aunt Neé, Mrs. Wollman asked me to walk her dog.” “Great,” I replied, thinking he needed the money. “No, Aunt Neé, Mrs. Wollman asked me to walk her dog.” This time I turned around and looked at him. “Aunt Neé, she asked me to walk her dog. She trusts me.”
No one had trusted Bobby with anything since he became addicted in college nearly seven years earlier. I tear up every time I tell this story. A small gesture such as walking a dog meant so much more to Bobby. And Bobby was the best damn dog walker ever.
This was the first of many self-esteem boosters for Bobby. My small community began asking Bobby to do the odd errand, to help in their garden, to remove debris from a yard. They invited him to baseball games, to get ice cream, to go to church, and to go out to dinner with their families. They looked at Bobby without stigma. They saw someone who had a disease and needed a hand up, and they offered it. This reaching out helped Bobby choose to save himself.
Our readership is heavy on librarians. Will you offer us a reading list of your favorite books on the opioid crisis and addiction?
I’ve listed some of my favorites and the more well-known books on the current epidemic. What sets Saving Bobby: Heroes and Heroin in a Small Community apart from these and other books on addiction is that Saving Bobby is a hopeful book about recovery, chronicling the sixteen months after an addict has left the safety of a rehab facility and the difficulties someone in recovery has in assimilating back into society.
Dreamland: The True Tale of America’s Opiate Epidemic\
By Sam Quinones\
Bloomsbury Press. (2015)\
Quinones looks at the over prescription of pain medication in the 1990s and the influx of black tar heroin from Mexico to the United States.
Clean: Overcoming Addiction and Ending America’s Greatest Tragedy\
By David Sheff\
Eamon Dolan/Houghton Mifflin Harcourt. (2013)\
Examines the available research on prevention and treatment to argue that “addiction isn’t a criminal problem, but a health problem.”
In the Realm of Hungry Ghosts\
By Gabor Maté\
North Atlantic Books (2010)\
Focuses on the social, cultural, and biological causes of addiction.
By David Sheff\
Mariner Books (2009)\
Sheff’s memoir of battling with his own son’s substance abuse.
What’s next? To what great cause will you devote your extraordinary energy and willpower?
I would like to help Bobby begin a speaking career. He is charismatic and intelligent, and his good looks don’t hurt him! And he has a story of hope and encouragement for both caregivers and those in recovery. Bobby has gone on to get his Master of Social Work, graduating near the top of his class, and is now counseling others with addiction. He is working to become a Licensed Therapist and is just shy a few hours.
I think Bobby and I are a great team. We have plans to publish a self-help book in 2019 to help caregivers and loved ones who are beginning the recovery journey. Hope is the best gift we can share.