Overcoming Addiction and Ending America’s
Addiction is a preventable, treatable disease, not a moral failing. As with other illnesses, the approaches most likely to work are based on science — not on faith, tradition, contrition, or wishful thinking.
These facts are the foundation of Clean, a myth-shattering look at drug abuse by the author of Beautiful Boy. Based on the latest research in psychology, neuroscience, and medicine, Clean is a leap beyond the traditional approaches to prevention and treatment of addiction and the mental illnesses that usually accompany it.
The existing treatment system, including Twelve Step programs and rehabs, has helped some, but it has failed to help many more, and David Sheff explains why. He spent time with scores of scientists, doctors, counselors, and addicts and their families to learn how addiction works and what can effectively treat it.
Clean offers clear, cogent counsel for parents and others who want to prevent drug problems and for addicts and their loved ones no matter what stage of the illness they’re in. But it is also a book for all of us — a powerful rethinking of the greatest public health challenge of our time.
New York Times (Science)
“Clean is a reference work and a manifesto”
by Abigail Zuger, M.D., The New York Times
Addict’s Father, Now Advocate
“Beautiful Boy” was a page turner, a dark fable that spoke to worried parents everywhere. “Clean” is a reference work and a manifesto, an annotated map of the same frightening territory where dragons still lurk at the edges.
In “Clean,” Mr. Sheff changes perspective, writing as advocate and journalist rather than distraught father. Still, his story line recreates that of “Beautiful Boy,” tracing the trajectory of addiction from cradle to rehab and beyond with the same question in mind: How does a promising clear-eyed kid from a good family wind up in an inconceivable sea of trouble?
His answer, bludgeoned home with the repetitive eloquence of the missionary, is entirely straightforward: The child is ill. Addiction must be considered a disease, as devoid of moral overtones as diabetes or coronary artery disease, just as amenable as they are to scientific analysis, and just as treatable with data-supported interventions, not hope, prayer or hocus-pocus.
This perspective is easy enough to articulate but very difficult to sustain — hence Mr. Sheff’s determined reiterations. The symptoms of this particular relapsing illness, after all, include deceit, denial and the betrayal of near and dear. Cardiac patients stop to rest halfway up a flight of stairs not because they want to, but because they have to. Similarly, addicts lie and steal, over and over again, not because they want to but because they must.
Wrapping the mind around this formulation requires an enormous act of will, and it is Mr. Sheff’s foremost achievement that his arguments are likely to influence even the angriest and most judgmental reader.
New York Times (Sunday Times-TBR)
“David Sheff Is a Skilled Journalist on an Urgent Mission.”
by Mick Sussman, The New York Times
It must be the purest agony to be the parent of a child succumbing to drug addiction. David Sheff’s previous book was an account of his son Nic’s descent from a thoughtful boy to a sullen pothead to a self-destructive methamphetamine fiend, and of his own tormented and bewildered reaction.If that book, “Beautiful Boy,” was a cry of despair, “Clean” is intended as an objective, if still impassioned, examination of the research on prevention and treatment — a guide for those affected by addiction but also a manifesto aimed at clinical professionals and policy makers. Sheff’s premise is that “addiction isn’t a criminal problem, but a health problem,” and that the rigor of medicine is the antidote to the irrational responses, familial and social, that addiction tends to set off. Sheff, a journalist, writes that America’s “stigmatization of drug users” has backfired, hindering progress in curbing addiction. The war on drugs, he says bluntly, “has failed.” After 40 years and an “unconscionable” expense that he estimates at a trillion dollars, there are 20 million addicts in America (including alcoholics), and “more drugs, more kinds of drugs, and more toxic drugs used at younger ages.”Sheff says that drug addiction is a disease as defined by Stedman’s Medical Dictionary, since it causes “anatomic alterations” to the brain that result in “cognitive deficits” and other symptoms. But isn’t drug use an act of free will, distinguishing addiction from other diseases? Sheff responds that behavioral choices contribute to many illnesses: think of unhealthy diets and diabetes.Like other diseases, addiction has a substantial genetic component. Mental illness and poverty are major risk factors. These susceptibilities help explain why 80 percent of adolescents in the United States try drugs, but only 10 percent become addicted. Sheff emphasizes the vulnerability of adolescents. Neuroscience corroborates our intuition that their impulsivity develops faster than their inhibitions, and drugs may stunt their emotional growth, making them yet more prone to addiction.
Although the medical approach to drug abuse has yielded techniques with proven effectiveness (Sheff’s touchstone is “evidence-based treatment”), he is scrupulous about not overselling it. “Addiction medicine isn’t an exact science,” he concedes, “and it’s still a relatively new one.” Treatment programs have success rates that are only comparatively less dismal than doing nothing. Just a small minority — even the claim of 30 percent may be inflated — of addicts who have been treated remain sober for a year. “The persistent possibility of relapse,” he says, is a “hallmark of addiction,” which he calls a chronic disease requiring lifelong vigilance. He laments the variable quality of treatment programs. Even in some expensive clinics, medical professionals are scarce, and the worst programs border on “voodoo.”
Sheff may lose some readers as he sprints through the research for every aspect (neuroscience, social science, psychology, law) of every stage (preventing early use, identifying abuse, detox, treating addiction, maintaining sobriety) of every drug problem. Though leavened by profiles of addicts and their healers, “Clean” feels overstuffed and miscellaneous, in the same way that a 300-page overview of everything we know about cancer would.
Nevertheless, Sheff is a skilled journalist on an urgent mission. He prevailed over the anger and hopelessness he felt at his son’s affliction by calling upon great reserves of love and discipline to investigate what might help — first as a father and then, in this book, as a reporter and an advocate. His forbearance and clearheadedness could serve as an example for America as it confronts its drug problem. He has performed a vital service by compiling sensible advice on a subject for which sensible advice is in short supply.
Free Will Hunting
Substance abuse and addiction have reached epidemic proportions in the United States. Every day, on average, about 8,120 individuals age 12 and over try drugs for the first time and 12,800 try alcohol. About 60 million people binge drink. Mortality rates from abuse of prescription pills are skyrocketing. All-in-all, in addition to destroying families, devastating inner cities, and causing crime and car accidents, substance abuse is responsible for more deaths than any other “non-natural” cause.
In Clean: Overcoming Addiction and Ending America’s Greatest Tragedy, David Sheff, the author of Beautiful Boy, a moving account of the addiction and treatment of his son, Nic, draws on research in psychology, neuroscience and medicine to present a new approach to dealing with what may well be our greatest social problem. Sheff insists that addiction is an incurable but treatable disease, not a moral failing. Since choice “has nothing to do with the disease,” he emphasizes, it is counter-productive to exhort young people to “Just say no” or dismiss addicts as dissolute or undisciplined. Treatment must be based on evidence, not urban legends, guilt or wishful thinking.
Providing a wealth of information and practical advice, Clean is the best book on drug abuse and addiction to appear in years. Sheff’s claims about choice, however, raise far more questions than they answer.
Clean busts a mountain of myths. People living below the poverty line, he reveals, are 100 percent more likely to abuse or be addicted than more affluent individuals. Sheff cites studies that show that the DARE program, which is used in 75 percent of the nation’s school districts, may actually raise rates of drug use. He demonstrates that addicts will not respond best if they’re allowed “to hit bottom.” He makes a compelling case that “no one really knows how often AA works and for whom,” and that we do know that AA retention is low and attrition is high. Although he cites no studies, Shef claims that “the science based approach rejects cold-turkey detox.”
Sheff also makes specific recommendations about treatment options and how to make informed selections. He sorts out types of accreditation and licensing for facilities; favors programs where psychologists, clinical social workers and family therapists are “full-time and don’t just stop by weekly” and psychological and physical examinations and medications (if necessary) are administered on site; and he advises nailing down ahead of time the assistance staff will provide with a transition to a new program when the patient is ready or he or she has been expelled.
Grounded in evidence of genetic predispositions and the effect of drugs on the brain, Sheff’s main theme — that addiction is a disease, not a character flaw — does counter a pervasive and pernicious tendency to “blame the victim” (or the parents of the victim). But it leaves us struggling to comprehend the role of “free will” in resisting the disease.
In our judgment, Sheff is neither consistent nor clear in distinguishing between drug abusers and addicts or in finding a way to understand or explain the choices users make. Hard put to explain “why some people do stop using on their own,” he speculates that members of this small group “aren’t as addicted in the first place.” His analogy, that “blaming an addict for relapse is like blaming a cancer patient when radiation and chemotherapy don’t work,” doesn’t seem entirely appropriate.
Throughout his book, it is worth noting, Sheff acknowledges that choices are available to abusers and addicts. “Before a person can change his behavior,” he writes, “[he] has to want to change it.” Motivational interviewing “can help addicts understand the conflict between their life goals and their drug use.” Given “cues” during Cognitive Behavioral Therapy, Sheff asserts, addicts can be taught to select alternative behaviors to defuse triggers — like going for a run — when they reach a “choice point.” When Luke Gsell took Dramamine and drank beer while in rehab to celebrate his 15th birthday, came down from it, recognized he was an addict and vowed “I’m done with this,” Sheff declares that “if he needed confirmation that his decision was a smart one, he received it the next day,” when his roommate OD’d after taking 36 pills. And in the appendix to Clean, Sheff concludes, “If kids are to make informed choices about drugs, they need to have facts about them. They need to know what they’re risking in order to get high.”
Free will is an elusive and enigmatic concept. Although philosophers have gone free will hunting for centuries, they have never really understood why people choose what they choose. Nor is free will yet amenable to measurement by scientists. We believe that choice, as it is commonly understood, and as Sheff himself uses it, is relevant to the scourge of abuse and addiction, and to the tactics, strategies, and policies his extraordinarily valuable book lays out to help us to overcome them.
Glenn C. Altschuler is vice president for University Relations and the Thomas and Dorothy Litwin professor of American Studies at Cornell University.
Patrick M. Burns is associate director of Young Alumni Programs at Cornell University.
— Library Journal
“Gripping and vibrant.”
— Publishers Weekly
“Intelligent and thought-provoking views into the complexities of addiction and recovery.”
— Kirkus Reviews
“How do we prevent kids from using drugs, and how do we effectively treat addiction? Clean cuts through the technical jargon and marketing nonsense to summarize our best knowledge on these topics. The case studies illuminate the challenging process of treatment and the remarkable changes that occur with recovery. Clean is a major contribution to our understanding of this disease and how to fight it.”
– Richard A. Rawson, Ph.D.
Professor and Associate Director UCLA Integrated Substance Abuse Programs
“David Sheff has written the most important book about addiction in a decade. Clean is a blueprint for thinking clearly – and empathetically – about America’s costliest and most misunderstood public health crisis.”
– Benoit Denizet- Lewis, The New York Times Magazine and
author of America Anonymous: Eight Addicts in Search of a Life
“David Sheff’s CLEAN is an important expose of a failed system; by replacing it, we will save countless lives, help people get clean and stay clean, and help the US end its catastrophic war on drugs.”
– Richard Branson, Chairman, The Virgin Group
“CLEAN will change not only how you look at drug abuse – but also what you think should be done about it. This book is essential reading on one of our most important social problems.”
– Eric Schlosser, author of Fast Food Nation and Reefer Madness
“David Sheff knows addiction as no parent would ever want. Through it all, he’s tapped into a unique ability to convey the pain, wisdom and love that he’s experienced through many turbulent years with his son Nic. As a journalist, father and clear-eyed chronicler of addiction, David is without peer.”
– Sanjay Gupta, MD
Chief Medical Correspondent, CNN
“David Sheff is one of our strongest and most compassionate voices on the profound costs of addiction to the family and to society. Clean should be read by anyone affected by the number one public health issue in America, which means it should be read by everybody.”
-Chris Kennedy Lawford, Advocate and author of Recover To Live
“Providing a wealth of information and practical advice, Clean is the best book on drug abuse and addiction to appear in years… Clean busts a mountain of myths… An extraordinarily valuable book.”
– Glenn C. Altschuler, Cornell University, and
Patrick M. Burns, Cornell University.
Reviewing for The Huffington Post
In Beautiful Boy, David Sheff gave voice to silent – the millions of addicts and their families. Now in Clean, he offers them a path toward healing. Our nation is sinking in to an epidemic. This book offers realistic hope for recovery from addiction for those who suffer the disease.”
– Drew Pinsky, MD