CHARLESTON, W.Va. -- More than 22 million Americans struggle every day with addiction to alcohol and drugs. Another 100 million family members share their pain. In "Clean: Overcoming Addiction and Ending America's Greatest Tragedy," David Sheff provides a comprehensive account of the causes, consequences, and complexities of addiction.
His best-selling memoir "Beautiful Boy" chronicled a father's agonizing journey through his son's addiction. In "Clean," Sheff switches gears from loving father to objective journalist and advocate.
"The mission of Clean is to describe the scope of America's drug problem and why we've failed in our efforts to combat it," he writes. Quite a challenge. This author meets it.
The topics are wide-ranging: from addressing the scope of the epidemic, to research on the physiology and psychology of addiction, its prevention and treatment, as well as insights from therapists and loved ones who attend Twelve-Step meetings, and addicts themselves. These are often heartbreaking.
Several statistics startle. "Every day, an average of 8,120 people age twelve and over try drugs for the first time, and 12,800 try alcohol -- more than 20,000 people. That's more than 7 million people a year."
Nearly a quarter of those over 12 years old -- 60 million people -- binge drink (consuming five or more drinks at a time). More than 40 percent of college students binge. Abuse of prescription pills is America's fastest growing drug problem. Sadly, West Virginia leads the nation in this tragedy.
Several themes emerge. First and foremost is the paradigm shift from addiction as moral choice to addiction as a chronic, relapsing brain disease characterized by a compulsive need to use, despite harmful consequences. Drugs change the brain. The research is unequivocal. Addiction is a disease, like diabetes or cancer. Yet, the belief prevails that addicts are weak and wicked. It persists because the symptoms include denial, deceit and damaged relationships with loved ones. Why do addicts abuse drugs when they are destroying their bodies, their lives, and relationships with loved ones?
Addiction has been described as baffling and cunning. Research has dealt mainly with physiology. Effective treatments are limited and often unavailable. Sheff presents several effective evidence-based approaches, but cautions against many current treatments which are "often useless and sometimes harmful recovery programs based not on medical science but on tradition, wild guesses, wishful thinking, and pseudoscience, some of which borders on voodoo."
Just as many treatments are useless, so, too, has been the War on Drugs. Of the 2,300,000 Americans incarcerated, 85 percent of this population committed a crime because of or related to drugs. "Calls for an end to the war have come from doctors, politicians, economists, law enforcement officers, and business leaders." In a recent poll, only 10 percent of Americans consider the War on Drugs successful.
Given the complex nature of the disease, uncertainty and ambiguity abound. Why does AA work for some, but not others? What prevention techniques work best and with whom? Should addicts enter residential treatment programs or live at home and participate in outpatient programs? Which programs are best? How do the loved ones of teens detach?
At present, no one can provide definitive answers. Addiction is too complicated. However, Sheff is to be commended for pulling it all together in this thought-provoking book. He is hopeful that due to the efforts of researchers, addiction professionals, and city and state initiatives, such as the Governor's Task Force on Substance Abuse here in West Virginia, it's possible to envision dramatic change "when fewer people will try and use drugs, and when more addicts will be effectively treated."
Simone is a writer and professor emeritus from Marshall University.