Book review: David Sheff’s ‘Clean’ explores addiction, recovery

By Jeff Baker, The Oregonian, April 6, 2013

Reading: Sheff discusses his new book “Clean” at 7 p.m. April 12 at Powell’s Books at Cedar Hills Crossing, 3415 S.W. Cedar Hills Blvd., Beaverton.

David Sheff

David Sheff

It started when David Sheff wrote an article for The New York Times Magazine called “My Addicted Son” in 2005, and it’s never stopped. It’s a river of sorrow and pain, people reaching out for help to a journalist they’ve never met. Sheff turned that article into “Beautiful Boy: A Father’s Journey Through His Son’s Addiction,” a No. 1 best-seller, and the river kept rising.

“I guess I was completely unprepared for the flood,” Sheff says. “It just continued — calls, letters, emails. People are in so much pain because of drug problems in their families. Almost every day I get requests from people asking for specific advice for how to deal with our disastrous system, and from people sharing their stories.”

The stories often are unbearably sad. “Beautiful Boy” ended on an upbeat note, with Sheff’s son Nic building a new life after years of meth addiction and Sheff resolving to live in the moment and not let his son’s disease control his life. Many, many other stories have a different ending.

“I’d get all these messages from people,” Sheff says. “‘My son didn’t make it.’ ‘My lovely daughter died.'”

At readings and public events, it was more of the same.

“I can often tell before they’ve said a word,” Sheff writes in his new book “Clean: Overcoming Addiction and Ending America’s Greatest Tragedy.” “Their faces show me the hell they’ve endured. Some can barely get out a syllable before they break down in tears.”

The story is too big; the river is too deep. Sheff couldn’t walk away. The author of five books, including the famous Playboy interview with John Lennon and Yoko Ono, Sheff wanted to move on to other topics after “Beautiful Boy” and work on a business book. No way.

“I felt like I had no choice,” Sheff says. “This is a huge national crisis, and it’s a huge story, and it’s not that nobody’s talking about it, but we’re not talking about it enough. I have my limited skills as a journalist and a father, and the journalist part is really part of my mindset, to use my skills to try to solve problems.”

The problem can’t be overstated. Addiction (including alcohol and drugs) kills more people than any disease except cancer and heart disease, and is the No. 1 cause of non-natural death. “Every day drugs kill more than 320 Americans, more than any other preventable health problem,” Sheff writes in “Clean.”

“Approximately 117,500 deaths in the U.S. are directly attributed to drugs, but that doesn’t take into account the more than 100,000 additional fatalities that are caused by drugs but counted as suicides, homicides, automobile and other accidents …

“Nearly one in 10 Americans over the age of 12 is addicted to drugs. … Drug abuse and addiction overwhelm America’s health care system … drugs are linked to more (emergency room) visits and hospital admissions than any other single issue. At any given time in America, 15 percent of all hospital beds are occupied by people with drug problems.

“Drugs are also the number one cause of crime. People who are either high or seeking money for drugs are involved in more than half of all burglaries. More than half of America’s federal prison inmates today are in on drug convictions. … Almost 80 percent of kids in the juvenile justice system are there because of problems related to their substance abuse. … It’s estimated that at least 60 percent of homeless people suffer addiction, which often occurs along with mental illnesses.”

And on it goes. The stories become numbers, and the numbers add up to a crisis that drags us all down, the straight and the stoned falling together and the young confused and high.

“American teenagers use drugs at a higher rate than teens in any other country in the world,” Sheff writes. “In this competition, the contest isn’t even close.”

It doesn’t have to be this way. Drug prevention strategies can work, and drug treatment programs can be effective. There are ways to get kids to stop using drugs, and ways to get people to stop before they become addicted and to stop once they are addicted. It isn’t easy, and it can be brutally confusing and expensive, but it is possible.

“Clean” and another excellent new book, Anne M. Fletcher‘s “Inside Rehab: The Surprising Truth About Addiction Treatment — and How to Get Help That Works,” provide answers to some of the issues around addiction and recovery:

Initial drug use and mixed messages: The median age of initial drug use is 14. Eighty percent of teens will use drugs before they turn 18, and 90 percent of those who become addicted begin using before 18. Marijuana use is increasing among teenagers, as is binge drinking.

The first step is to understand that while drug use among teenagers is common, it is neither a sign of moral weakness nor a phase to be shrugged off.

“Do we really believe that 80 percent of our kids are bad?” Sheff writes. No, and we need to reach them before their teenage years. The older a person is before initial drug use, the less likely they will become addicted.

Young people use drugs for many of the reasons adults do: because doing it makes them feel good, because their friends do and to relieve stress. Kids whose parents are addicts and kids who have behavioral disorders or mental illnesses are at significantly greater risk for addiction.

Anti-drug education and advertising campaigns are an expensive failure. There is some evidence that popular programs such as an anti-marijuana campaign that cost more than $1.4 billion increased use by making smoking weed seem more normal. Popular culture is awash in pro-drug entertainment, and kids pay far more attention to rappers and “Pineapple Express” than adults telling them to just say no. Campaigns that encourage teens to make their own choices and clearly show that drugs such as heroin and ecstasy are deadly have been shown to be effective.

What parents can do: Pay attention, be involved, act early. If you think there’s a problem, there probably is. Don’t hesitate to get help. Children under 18 can be sent to treatment programs without their consent. It’s a difficult decision to send a child away from home for months, but it can save a life.

Why addicts act up: It’s in their brains. (Key word: dopamine.) The criminal actions that addicts, young and old, take (often against their families) are not necessarily a result of free will or poor choices but involve brain chemistry. This is one of the trickiest, most frustrating aspects of addiction: the lying, stealing and rationalizing seems to be about choosing to get high. It’s not.

Addiction is a brain-based, chronic disease that is genetic in origin. It is progressive (the more you drink, smoke, shoot or otherwise ingest, the worse you get) and chronic (you can and will get better if you stop, but some changes are permanent and the predisposition to use probably remains for a lifetime). Not everyone with an addictive brain structure or nervous system becomes addicted, of course, but some studies have shown that neurological abnormalities in addicts predate drug use.

Won’t stop or can’t stop? If people know they’re addicted, why won’t they stop drinking or taking drugs? It must be a matter of weakness or lack of willpower and not a brain disease, right?

Sheff bats this popular argument aside with a couple of well-struck points. First, he notes that many addicts (like many schizophrenics) don’t recognize or acknowledge they’re sick because a “part of the brain that’s damaged is the same part that’s responsible for self-awareness and self-analysis.”

Second, all sorts of diseases involve choice: People who eat fatty foods do so knowing it can lead to heart disease and diabetes. Smokers know all about emphysema. Sunbathers run the risk of skin cancer.

What about rehab? Fletcher thinks the biggest problem with rehab is the lack of trained professionals. “A team approach is ideal at a rehab — with qualified addiction counselors, as well as physicians and mental health professionals who have expertise with addictions,” she writes in Psychology Today. “Unfortunately, many states don’t even require a bachelor’s degree to become a certified or licensed addiction counselor.”

Another trend she identifies is the split between abstinence-based rehab programs and those that use drug therapy. The “Minnesota Model” pioneered by Hazelden and followed by most rehabs believes that using methadone and other drugs such as Suboxone to treat addiction is substituting one drug for another and is not “true abstinence.” This is changing fast — Hazelden, the granddaddy of inpatient rehabs, announced late last year that it will prescribe Suboxone for patients addicted to heroin and other opioids.

And what about Alcoholics Anonymous? Sheff heaps praise on AA for saving countless lives, at little or no cost. A few pages later, he wonders about its second A, the principle of anonymity. People have a right to privacy, and addiction had more of a stigma when AA was founded in the 1930s, but he wonders whether anonymity contributes to feelings of shame and prevents those who are sober from talking openly about their success. (Drinkers and drug users are under no such restrictions.)

I’ve heard many stories of people who know each other or work in the same company not acknowledging each other at AA meetings, and I’ve interviewed prominent people with AA coins on their desks who refused to talk about their sobriety.

“I’ve had the same experiences, and I don’t understand it,” Sheff says. “I’ve done a lot of interviews in Hollywood, and the only person I’ve ever interviewed who was out front about it was Martin Sheen, who said it saved his life. So many times in the middle of an interview I’ve had people say, ‘Can we go off the record?'”

So what now? It seems as if drug therapy for addiction is at roughly the same place it was for mental health 40 or 50 years ago.

“Absolutely, that’s true,” Sheff says. “It’s definitely making a difference, and 20 years from now it will be so much more refined. There’s a lot more research going on right now that’s changing things dramatically. It’s not easy — everybody wants it to be easy, and addiction is too hard for that. It would be great if we could solve it with a pill, but we can’t.”