Clean Talk: A Myth-Shattering Look at Addiction

This article originally appeared at houghtonmifflin.com

David Sheff first opened our eyes to the horrors of drug abuse in his bestselling memoir Beautiful Boy, a harrowing work that detailed the heartbreak caused by his son’s drug addiction. In Clean, he takes on the traditional views of addiction and its treatment, demonstrating why 12-step programs don’t work for more than 90% of those who try them—and revealing the approaches that science has shown do work.

Based on the latest research in psychology, neuroscience, and medicine, as well as conversations with scores of scientists, social workers, addicts, and their families, Clean offers clear, cogent counsel for addicts and those who love them. Sheff deals with addiction for what it is—an illness—and suggests that the approaches most likely to succeed are based on science rather than faith, tradition, contrition or wishful thinking.

Sheff explains why our country’s failure to stem the tide of addiction directly relates to the belief—as persistent as it is wrong—that addiction is a moral failing, rather than a disease. He counters this widely held belief with several shocking facts: that teens are especially prone to drug use; that the earlier one experiments with drugs, the more likely one is to become addicted; that drug addiction is almost always a symptom of another illness; that the co-occurring illnesses—ranging from PTSD to depression to obsessive disorder—are rarely treated in many recovery programs.

In addition to exploding all-too-common myths, Sheff offers surprising, invaluable, and practical advice:

• How do you know if you or a loved one has moved from use to abuse?
• Should you tell your kids about your own drug use?
• Is it better to let someone hit the bottom? (Sheff’s answer: No!)
• What do you do when sobriety puts you right back in the place you were when you got addicted?

All in a manuscript that’s easy to access and understandable for readers at many levels.

If You Want to See Inequality in the U.S. at Its Worst, Visit an Impound Lot

San Francisco afternoon, I returned to where I’d parked my car, but it was gone. A “No Parking” sign indicated that parking was prohibited after 3:00 PM on weekends. It was 3:15. I called the telephone number on the sign and a clerk affirmed that my car had been towed to an impound lot.

I took a cab and entered a single-story brick building where a few dozen people were crowded together in a scene that evoked Kafka; weariness, frustration and anger were palpable. Some stood in line, some paced and some sat hunched on the floor. A family huddled in a corner, an infant asleep on the father’s shoulder. A woman on a pay phone wept as she begged whomever was on the line to find money so she could get her car back–she said she needed $875. “I’m gonna lose my job if I’m not there at 5.”

Clerks sat on stools behind Plexiglas. At a window, a man pleaded with an agent, “I have to pick up my kids in less than an hour. What am I supposed to do?” At the next window, another man railed loudly and furiously, yelling, “How the hell am I supposed to get my goddam money if I can’t get to goddam work?” The clerk said, “If you can’t get cash, you can pay by credit card or cashier’s check.” The man shouted, “And if I had a goddam limousine, we wouldn’t be having this conversation.”

A man waiting in line with me told me that he owned a landscaping business that depended on his truck, which had been towed three days earlier. “I can’t work,” he said. “The crew don’t work. Everything I need is in the truck.” It had been towed when he parked in a red zone in front of an auto-parts store. He’d been late to a job and ran into the store to buy a spark plug for a broken lawn mower. He didn’t have money enough that day to pay the $472 towing fee. After the first four hours, charges began accumulating—about $65.00 a day. (They didn’t include the $72 cost of the parking ticket.) He had borrowed $700, which he held near his chest in an envelope. He said it would take “I hope no more than a year” to repay the loan, for which he was being charged 50% of the loan amount. “I had no choice,” he said. He had already lost four days’ income and didn’t know how he was going to pay his bills, including rent, due that week.

When I reached the front of the line, I handed the clerk my credit card, on which she charged $472. I retrieved my car and drove home. I left behind the roomful of my fellow citizens, a disparate group bound together by the fact that they didn’t have the cash or credit required to free their impounded cars, a fact that threatened livelihoods, stressed families and broke budgets, forcing some people to choose between essentials and paying fees that would continue to accumulate and leave them without another essential, transportation, which in turn could lead to other calamities. If they didn’t find a way to pay the fees, they would ultimately lose their cars (the city auctions them), a loss that for some would be a devastating setback. For me, a towed car was an inconvenience. For them, it was a catastrophe.

Some cases of injustice in America are reported far and wide, such as the horrific shooting of Michael Brown, the unarmed man in Ferguson, Missouri, targeted by police in what many view as an egregious case of racial profiling. However, we don’t often hear about the countless quieter injustices suffered by tens of millions of Americans on a daily basis. They experience inequities of access to opportunities, quality medical and dental care, quality education, healthful food, affordable and safe housing, childcare, credit, psychological counseling, legal representation, insurance and more. For them, events that others weather unhappily but routinely—a towed car, for example—can lead to a crippling spiral of stress, debt, joblessness, illness and, in many cases, incarceration.

The final injustice comes when they die early, which many do—and not only by violence. More often, death comes slower, from under- or untreated physical and mental illness, poor nutrition and chronic stress as it impacts health. Several years ago, Senator Bernie Sanders presented a report to the Senate Subcommittee on Primary Health and Aging, in which he highlighted research that showed that the wealthiest Americans on average live at least 6.5 years longer than those in the lowest income group. In 2009, the mortality rate for African American infants was more than twice that of white infants. The poor in this country have higher rates of diseases such as diabetes, heart disease and depression, according to Dr. Steven Woolf, director of the Center on Society and Health at Virginia Commonwealth University. According to the Health and Aging report, “The lower people’s income, the earlier they die and the sicker they live,” Woolf said. “Neighborhoods in Boston and Baltimore have a lower life expectancy than Ethiopia and Sudan. Azerbaijan has a higher life expectancy than areas of Chicago.”

When events like the Michael Brown shooting occur that inflame people and motivate them to take to the streets to protest, we are reminded that there is not justice for all in America. We must also acknowledge and condemn the daily injustices born of a system that slowly grinds down the people who can least afford it, and, in too many cases to count, leads to their early death. In the line at the San Francisco impound lot, I overheard the crying woman ahead of me telling the clerk, “I need my car to get home to my children.” The clerk responded, “I wish I could help you, ma’am, but if you don’t have the money, there’s nothing I can do.”

David Sheff’s latest book is Clean: Overcoming Addiction and Ending America’s Greatest Tragedy, the follow-up to his New YorkTimes No. 1 best seller, Beautiful Boy: A Father’s Journey Through His Son’s Addiction. Follow him on Twitter @david_sheff.

From Time.com

David Sheff on Prescription Drug Abuse Prevention Panel at the Clinton Foundation Health Matters Initiative Conference

Mental Health & Prescription Drug Abuse Prevention Panel

Panel Moderator: Dr. Travis Stork, Emergency Room Physician and Co-Host of The Doctors; Noopur Agarwal, Vice President, Public Affairs, MTV; The Honorable Patrick J. Kennedy, Co-Founder, One Mind for Research, Founder, The Kennedy Forum, Author, MHPAEA; John MacPhee, Executive Director and CEO, The Jed Foundation; David Sheff, Author and New York Times Columnist; Nora D. Volkow, MD, Director, National Institute on Drug Abuse

Time.com Viewpoint: We Need to Rethink Rehab

This article by David Sheff was originally published at Time.com.

When my son Nic became addicted to methamphetamine and other drugs, I was panicked, overwhelmed and desperate to save his life but had no idea what to do. I’d heard about rehab, where you send people with drug problems, but I soon learned that there’s no standard definition of it; instead it’s a generic word for a wide variety of treatments, including some that are outrageous. Past-life therapy? Exorcism? Tough-love programs in which patients are made to scrub bathroom tiles with a toothbrush or cut grass with scissors? Even in more-typical rehabilitation programs, patients are not seen by licensed practitioners — no doctors or psychologists — only self-anointed “experts” with no training or credentials, unless you count their own recoveries from addiction to heroin, alcohol or other drugs.

I chose a rehab center for Nic that was recommended by a friend who had sent her son there. The program lasted 28 days, after which he relapsed. Over the next six years, he was admitted to six residential treatment programs and four outpatient programs. He would do better for a while, but then relapse. Each relapse was crushing. I thought he might die.

Every year in the U.S., 120,000 people die of addiction. That’s 350 a day.

I’ve already written about my experience with Nic, but for my new book, Clean, I wanted to understand why so many suffer and die. So I undertook an investigation of the treatment system that so often fails. I learned that no one actually knows how often treatment works, but an oft-quoted number of those who abstain from using for a year after rehab is 30%. Even that figure is probably high. “The therapeutic community claims a 30% success rate, but they only count people who complete the program,” according to Joseph A. Califano Jr., founder of the National Center on Addiction and Substance Abuse and a former U.S. Secretary of Health, Education and Welfare. “Seventy to eighty percent drop out in three to six months.” Over the course of my research, I did hear one statistic that I trusted. Father John Hardin, chair of the board of trustees at St. Anthony’s, a social-services foundation with an addiction-recovery program in San Francisco, told me, “Success for us is that a person hasn’t died.”

The treatment system fails because it’s rooted in an entrenched, inaccurate view that addicts are morally bereft and weak. If they weren’t, the belief goes, they’d stop using when drugs began to negatively impact their lives. Most treatment centers in the U.S. are based on an archaic philosophy that’s rooted in the 12-step model of recovery. These programs have saved countless lives, but they don’t work for a majority of people who try them. It’s not a fault in the program itself. Its founder, Bill Wilson, wrote, “These are but suggestions.” But many rehabs require them. This is particularly problematic for teenagers and young adults, the very people most susceptible to addiction. Twelve-step programs require people to accept their powerlessness and turn their lives over to God or another higher power. Many adolescents question religion, and in general teenagers aren’t going to turn their lives over to anyone.

In many 12-step-based programs, patients are berated and yelled at if they don’t “surrender” and practice the steps. They’re warned — in some cases, threatened — that if they don’t, they’ll relapse and die. It can become a self-fulfilling prophecy. Addicts don’t think they can be treated if they don’t embrace the program, and so they give up on the idea that they can be helped. They do relapse. Some die. When they do, they’re blamed. Blaming the victims is convenient for those who treated them, because it absolves them of accountability. They can take credit when their patients get well, but they take no responsibility when they don’t. But the bigger problem with 12 steps is that a growing body of evidence has proved that addiction isn’t a choice subject to willpower but a brain disease that’s chronic, progressive and often fatal.

Though they aren’t available to many people who need them, there are alternatives to 12-step-based treatments that can improve an addict’s prognosis. These treatments don’t rely on best guesses or tradition. Rather than require contrition and prayer, they use therapies that have proved effective in clinical trials, including cognitive-behavioral therapy designed to train addicts to recognize and interrupt the cues that trigger the relapse mechanism; motivational interviewing, a therapy approach widely used to treat many psychological disorders that helps addicts engage in treatment; contingency management, which essentially rewards addicts for clean time; and psychopharmacology.

Absurdly, the latter remains controversial in the addiction-treatment community, with some factions claiming that you don’t treat drug problems with drugs. But you do, at least in many cases. One of the most effective interventions for opiate addictions is medication, including the opiate agonists and partial agonists methadone and Suboxone. These drugs have proved so effective that Steve Shoptaw, an addiction specialist and psychologist in the department of family medicine at UCLA, says, “I won’t treat opiate addicts unless they take Suboxone.” Most researchers agree that no single therapy is appropriate for every addict. Often they’re used in concert. An effective treatment regimen may include AA, but only for those patients who are open to it.

Currently there’s a chasm between these and other evidence-based treatments (EBTs) and rehab programs. Every day addicts fall into it, and many never make it out. Most people in need find themselves in the same frustrating position I was in when I was desperate and overwhelmed, shopping for programs and doing the best I could to navigate an unnavigable system that’s also largely unregulated. In many states, anyone can open a rehab program — no licenses or accreditation are required.

This is slowly changing. More people are being educated about the fact that addiction is a disease and therefore requires treatments based on the medical model. The more consumers are educated and demand EBT, the more the billion-dollar rehab industry will adapt and offer it. That is, the industry will adapt or it will die and be replaced. In the meantime, those who need treatment must do the best they can to find programs that offer EBT. The place to start is by receiving an assessment from a psychologist or psychiatrist who is trained in addiction medicine. Even finding these professionals can be a challenge, but the American Society of Addiction Medicine maintains a directory that is available online. A competent doctor can determine the severity of addiction and the presence or lack of co-occurring psychological disorders and prescribe the next step. It may include a brief intervention, therapy, psychopharmacology, an inpatient or outpatient program that offers quality care or a combination of these things.

Meanwhile, the National Institute on Drug Abuse is funding the Treatment Research Institute in Philadelphia, directed by Tom McLellen, the former deputy director of the Office of National Drug Control Policy, to create and test a science-based method of rating treatment quality and determining the likelihood of favorable outcomes of treatment programs. Working with consultants from Consumer Reports, the Treatment Research Institute hopes to create a guide that will help those who need treatment and raise standards in the industry. Another hopeful development is the founding of an organization that could be for addiction what the American Cancer Society is for cancer, called Brian’s Wish to End Addiction. In addition to supporting treatment research, the organization will also launch education and other prevention campaigns and lobby for policy so that, for example, insurance will adequately cover addiction treatment.

After a hellish decade, my son got and stayed sober. His current treatment regimen includes regular sessions with a psychiatrist who sees him for his addiction and co-occurring bipolar disorder and depression. He’s been in recovery now for five years. But of the nation’s 20 million addicts, only 10% will ever receive treatment. And the majority of those who do will be failed by the existing system. Nic is one of the lucky ones. I’m one of the lucky ones. But this should not be about luck.

The 2009 TIME 100: David Sheff

David Sheff wrote a beautiful book called, appropriately enough, Beautiful Boy — A Father’s Journey Through His Son’s Meth Addiction, one of the most compelling portrayals I’ve ever read of a parent’s loss of a child to drugs. In this journey, Sheff, 53, faces the overdose of his son Nic and his inability to protect him, the relapses that inevitably occur and the family’s struggle to cope with it all.

Many people still call addiction a moral failing. But 20 years of research tells us that it’s a disease that results in part from the damage that abused drugs do to the brain circuits required for self-control. Unfortunately that damage is long-lasting, meaning that the person remains vulnerable to relapse even after years of successful rehabilitation.

Sheff’s experiences highlight how poorly our society addresses addiction. We treat the medical consequences of the problem (overdoses, car accidents, cancer, HIV, mental illnesses) but not the disease itself. Our investments in research and services for addiction treatment are a fraction of the costs associated with drug-related incarceration and lost productivity. Yet punishment and stigmatization do nothing to ameliorate the problem. How could they, when about 50% of addiction is rooted in our genes and much of the rest is due to social and cultural factors such as stressful childhood experiences?

Nic Sheff is alive today thanks in great measure to the devotion and resourcefulness of his extraordinary family. But many others have not been so fortunate. David Sheff’s voice resonates loudly and makes us pause and ask why, despite our understanding of addiction as a brain disease, we fail to treat it as we do other medical illnesses.

Volkow is the director of the National Institute on Drug Abuse

Authors Gin Phillips and David Sheff Win the 2008 Barnes & Noble Discover Great New Writers Awards

This article originally appeared at barnesandnobleinc.com

NEW YORK, NY – March 4, 2009 – Barnes & Noble Inc. (NYSE: BKS), the world’s largest bookseller, announced this afternoon that Gin Phillips’ debut novel, The Well and the Mine(Hawthorne Books & Literary Arts), and David Sheff’s moving memoir, Beautiful Boy(Houghton Mifflin), have been named the winners of the 16th annual “Discover Great New Writers Awards,” for fiction and nonfiction, respectively. Each writer was awarded a cash prize of $10,000, and a full year of additional marketing and merchandising support from the bookseller.

Writing professor Benjamin Taylor’s novel The Book of Getting Even (Steerforth Press), an unusually perceptive coming-of-age story, and NPR correspondent Eric Weiner’s humorous travelogue, The Geography of Bliss (Twelve), took second place honors, each receiving $5,000. Zachary Lazar’s novel Sway (Little, Brown), set amidst the decadence of the late ‘60s, and Nia Wyn’s Blue Sky July (Dutton), a poetic journal of the first seven years of her son’s life, won third-place honors, each receiving $2,500. The awards were presented this afternoon at a private ceremony, and the winners and finalists will read from their work tonight, March 4, at 7:00 p.m. at the Tribeca Barnes & Noble (97 Warren Street at Greenwich Street) in New York City.

The Well and the Mine, Gin Phillips’ first novel set in Depression-era Alabama, is a Greek chorus of Southern voices weighing in on life in a small coal-mining community after a young girl witnesses the sight of an infant thrown in her family’s well. Jurist Mark Jude Poirier offered the following comment on the prizewinner: “Phillips artfully engages the traditions of Southern literature but somehow remains fresh and original. A brilliant and memorable debut.”

Writers participating in this year’s fiction jury panel included Kate Christensen, winner of the PEN/Faulkner Award and author of several novels including the forthcoming Trouble; Suzanne Finnamore, author of two novels and a memoir of her divorce entitled Split; and fiction writer Mark Jude Poirier, who wrote the screenplay for the indie hit film Smart People.

The nonfiction winner, Beautiful Boy, is David Sheff’s heartrending account of his efforts to save his son, Nic, from the horrors of methamphetamine addiction. Nonfiction jurist and 2002 Discover Award winner (A Death in Texas) Dina Temple-Raston had these words for the prizewinner: “From the early pages of this book until its conclusion, readers will find themselves not only rooting for a young man who (in less deft hands) would have lost our sympathy, but also for a father who clearly – like any parent – would give anything to shoulder his son’s struggle in his stead. I couldn’t put this book down.”

Writers on the nonfiction jury panel included Edward Dolnick, a historian and science writer whose most recent book is The Forger’s Spell; travel essayist J. Maarten Troost, whose Lost on Planet China was published last year; and NPR correspondent Dina Temple-Raston, who writes about current events.

The Discover Awards honor the works of exceptionally talented writers featured in the Barnes & Noble “Discover Great New Writers” program during the previous year. In 2008, the Discover Great New Writers program featured the work of 63 previously unheralded fiction and non-fiction writers.

Starbucks Selects “Beautiful Boy”

This article originally appeared at news.starbucks.com

Starbucks Entertainment announced today the next title in its book program: David Sheff’s “Beautiful Boy: A Father’s Journey through His Son’s Addiction” to be published by Houghton Mifflin – a compelling true story examining addiction, trust, and renewal told by the parent of a meth addicted teenager. Continuing its commitment to connect customers with great books, Starbucks will begin offering “Beautiful Boy” on February 26, 2008 at more than 6,500 Starbucks Company-operated locations across the U.S.

“We seek titles that will inspire conversation both in our stores and with our customers,” says Ken Lombard, president Starbucks Entertainment. “David’s story embraces a depth of emotion, support and human resilience that brings readers face-to-face with an epidemic that is sweeping the nation. We are excited to have the opportunity to present this genuine, personal memoir to our customers.”

“Beautiful Boy” takes readers through the gripping journey of addiction from a fresh perspective ? that of a concerned parent. Sheff’s pragmatic storytelling winds through his own stages of denial, to the self-realized acceptance of helplessness and the struggle to protect his family, to renewed hope and recovery. “Beautiful Boy” is the fourth book by Sheff, a brilliant writer best known for works that have appeared in various newspapers and magazines including the New York Times Magazine, Rolling Stone, and Fortune, among others.

“Often we learn about the effects of substance abuse on the user, but we rarely hear the story from the perspective of loved ones ? the friends and family members who often feel powerless,” shares Sheff. “I am gratified that in addition to carrying ‘Beautiful Boy‘ in its stores, Starbucks support will encourage much needed discussion about drug abuse and addiction.”

Along with appearances at traditional booksellers, Sheff will participate in a Starbucks book tour, making stops at 10 Starbucks stores across the U.S. beginning February 26. At each location, Sheff will share thoughts on the experiences he and his family endured throughout the addiction and the resulting rehabilitation.

“We’re so pleased that Starbucks decision to feature ‘Beautiful Boy‘ will bring so many readers to this very special book,” said Janet Silver, Vice President and Publisher of Houghton Mifflin.

Selected as #1 Non-Fiction 2008 by Entertainment Weekly

This article was originally published at entertainmentweekly.com

Entertainment Weekly ranked Beautiful Boy as the #1 Non-Fiction Book for 2008.

#1 BEAUTIFUL BOY, David Sheff

When Sheff’s oldest child, Nic, became addicted to crystal meth, the once imaginative kid turned into a twitchy, larcenous tweaker who stole from his kid brother’s piggy bank and lied to everyone, especially his dad. Sheff’s is the story of a child’s addiction, but it is also a statement about parental love and its limitations.

Beautiful Boy #1 New York Times Best Seller List

Beautiful Boy reached #1 on the New York Times Best Seller List in April and May 2008.

In addition, Entertainment Weekly named it the #1 Best Nonfiction Book of 2008 and it won the Barnes and Noble Discover Great New Writers Award for nonfiction in 2008. Amazon.com selected it as one of the “Best Books of 2008” and Starbucks picked it as one of the few books it would sell in its coffee shops.

Paramount Pictures Buys Screen Rights to Beautiful Boy and Tweak

This article originally appeared at prnewswire.com

Brad Pitt’s Plan B Entertainment Will Produce

HOLLYWOOD, Calif., April 30 — Paramount Pictures announced today that it has purchased the screen rights to the current New York Times non-fiction bestsellers Beautiful Boy: A Father’s Journey Through His Son’s Addiction by David Sheff and Tweak: Growing Up on Methamphetamines by Nic Sheff, for development and feature film production by Plan B.

The critically lauded Beautiful Boy, published by Houghton Mifflin Co., chronicles the teenage Nic Sheff’s descent into methamphetamine abuse from the point of view of his father, journalist David Sheff, as he struggles to help his son overcome addiction. In Tweak, Nic Sheff himself details a harrowing summer during which he lapsed back into drugs and how he eventually recovered. Beautiful Boy and Tweak immediately became non-fiction bestsellers. Beautiful Boyis currently #1 on the New York Times Bestseller list. The books were hailed for the unique approach of a father and son tackling the same experience from two different perspectives, and they are recognized as definitive books about a problem that is epidemic in American society.

Beautiful Boy is being sold in Starbucks stores around the country as part of the Starbucks Select book series. The film will be produced in association with Starbucks.

Plan B Entertainment is actor/producer Brad Pitt’s production company, which has an overall deal with Paramount and has previously produced such films as the Oscar(R)-winning “The Departed,” “Troy,” “Charlie and the Chocolate Factory,” “A Mighty Heart” and “The Assassination of Jesse James by the Coward Robert Ford.” Among Plan B’s upcoming projects for Paramount are “Eat, Pray, Love” based on the bestselling novel with Julia Roberts to star and Ryan Murphy to direct; the action film “The Killer” and the fantasy horror film “Black Hole,” both of which will be directed by David Fincher; the horror/thriller “World War Z”; and the adventure film “Lost City of Z.”

David and Nic Sheff featured on The Oprah Show

Addiction is a painful secret many families are too ashamed to discuss. In 2005, one father came forward in a very public way to share what it was like to love a child whose drug and alcohol abuse threatened to tear their family apart.

Award-winning journalist David Sheff wrote about his struggle to help his son Nic overcome a crystal meth addiction in The New York Times Magazine. After the article was published, David says he realized he was not alone. His story generated an overwhelming response from other parents of addicts.

“When this hit our family, we were like so many families in this country,” David says. “I was not naive about drugs. I used drugs when I was a kid. … But I still thought, like most of us, ‘This could never happen to our family.’ When it did, we were so blindsided. We were so devastated that I realized that this is something we have to talk about.”

David delves deeper into Nic’s drug abuse and its impact on their family in his book Beautiful Boy. “I realized the power of telling a story like this because it opens the door to other people,” he says. “It gives people permission [to discuss it].”

Using journals he kept throughout his life, Nic has also written a version of the story. In his memoir Tweak: Growing Up on Methamphetamines, he recounts his experiences as a teenage drug addict to the best of his recollection.

View the full story and additional resources at oprah.com.