RxAppalachia: Stories of Treatment and Survival in Rural Kentucky by Lesly-Marie Buer

Abstract

Reviewed by: RxAppalachia: Stories of Treatment and Survival in Rural Kentucky by Lesly-Marie Buer Christopher M. White RxAppalachia: Stories of Treatment and Survival in Rural Kentucky. By Lesly-Marie Buer. (Chicago: Haymarket Books, 2020. Pp. 264.) RxAppalachia focuses our attention on the main theme that, in recent years, Americans associate with Appalachia. Leslie-Marie Buer refracts the drug problem through a multilayered lens that forces us to contend with the inequality, ineffective health systems, stigma, and violence that are built into the structures of our region and that affect poor women. Her book joins others in their timeliness, countering the version of Appalachia presented by the 2016 bestselling book Hillbilly Elegy, by another local, J. D. Vance. Where Vance writes a memoir with recycled portrayals, Buer gathers data and provides a platform for a diverse set of voices. Buer has a deeper point to make than Vance. She does this by moving the blame away from individuals caught up in the largely government-funded and regulated "solutions" to the myriad problems suffered by Appalachia's poor. At the same time, she highlights examples of individual agency and initiative. Vance emphasizes the negatives, with marginal positives; his Appalachia is the embodiment of violence, drugs, laziness, and parental irresponsibility—a portrayal that reinforces the stereotypes of the region. Buer instead invites us to see how the impersonal institutions, ubiquitous in Appalachia, often confine and cause more harm than good to the most vulnerable, who nonetheless strive to extricate themselves from their legal, economic, and social problems. Buer's research leads to the conclusion that the "neoliberal" U.S. political-economic model, the criminal justice and other systems as well as sexism, create an environment of "structural violence" against Appalachian women. In her version of Appalachia, women who do not fit into the neoliberal model's image of respectability can be punished by the legal system and stigmatized by society. Though drug use is widespread among all classes and regions of the United States, drug charges are felt more severely by those less able to defend themselves. Buer shows how the longtime impoverishment of Appalachia has complicated roots and consequences for poor women, and she fleshes these out with interviews with dozens of women and the people running the institutions with which the women must contend. Buer's research provides readers with the macro and micro causes of drug addiction. Macro-level causes include pharmaceutical companies' proliferation of addictive drugs like OxyContin and Valium as well as zero tolerance drug laws and coal mining's rise and fall in the region. Micro-level causes include choices made when offered drugs, "toxic" relationships, and difficulties in balancing childrearing and employment needs within legal and geographical confines, to name just a few. Buer also delves deeply into the [End Page 115] recovery realm, including 12-step and MAT models (Medication-Assisted Treatment). Given the wide range of organizations and theories the author covers, this book could be especially useful for students and professionals in Addiction Studies and Social Work. The author wants readers to see the processes that cause many women to become ensnared in systems that constrain their upward and outward mobility due to their status as poor Appalachian women with drug records. The activist nature of the publisher (Haymarket Books) gives the author more freedom to use critical and even opinionated language at times, but this works for the topic at hand. For example, Buer sees race and class as a factors for state interventions aimed at protecting certain groups of children, even at the expense of their own mothers' welfare. The results of the current "criminal justice" system are difficult to dispute, as are Buer's depictions. Thus, many poor Appalachian girls are born into a limiting system of inequality and stigma, and when they grow up, they come to inhabit a status as poor Appalachian drug-using mothers, which further entrenches them within socioeconomic categories that cause ongoing harm. Women who suffer in abusive relationships, exacerbated by drug and alcohol abuse, find little legal recourse to protect themselves or their children. Indeed, maternal drug use is considered a crime that leads to the loss of both custody and public empathy...