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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.
- Sales Rank: #45965 in Audible
- Published on: 2013-04-02
- Released on: 2013-04-02
- Format: Unabridged
- Original language: English
- Running time: 809 minutes
Most helpful customer reviews
250 of 258 people found the following review helpful.
A Landmark Book on Addiction
By Deanokat
As the father of a recovering heroin addict, I will tell anyone who asks me that David Sheff's Beautiful Boy: A Father's Journey Through His Son's Addiction is probably the best book I've ever read. As a matter of fact, Beautiful Boy helped me come to grips with my own son's addiction and prompted me to work on my own recovery. As a result, I was able to get my own life back. Even better, as I write this review my 23-year-old son is eight months clean and sober--the longest stretch of clean time he's had since he was 16.
That being said, it should come as no surprise that Clean: Overcoming Addiction and Ending America's Greatest Tragedy is probably the most anticipated book ever for me. I pre-ordered it from Amazon as soon as I heard about it and have been eagerly awaiting its publication. Luckily, I was able to get an advance copy through Amazon's Vine program.
David Sheff's latest offering is to be commended for many reasons. First and foremost, though, is its explanation of how addiction works and its attempt to break the stigma frequently associated with this ancient disease. "Most drug use isn't about drugs; it's about life," Sheff writes in the Preface. "Our prevention and treatment efforts have failed mostly because they've focused on dealing with the drugs themselves, but drug abuse is almost always the result of kids starting to use early, genetics, and other problems--stress, trauma, mental illness, or some combination of these factors. The new paradigm is rooted in recognizing that drugs are a symptom, not a cause, and whatever problems underlie them must be (and can be) addressed. Until they are, our prevention and treatment systems will continue to fail most people."
Sheff outlines the six precepts that underpin Clean in the Preface. They are:
1. Most drug use isn't about drugs; it's about life.
2. Addiction is a disease.
3. This disease is preventable.
4. This disease is treatable.
5. As with any other illness, the prevention strategies and treatments most likely to work aren't based on tradition, wishful thinking, or faith, but science.
6. Drug abusers and addicts can do more than get off drugs; they can achieve mental health.
Those precepts are the road map for the book, and Sheff does a fabulous job of backing them all up using scientific evidence, case studies, and his own expertise and experience.
Regarding the stigma associated with addiction, Sheff states: "This stigma associated with drug use--the belief that bad kids use, good kids don't, and those with full-blown addiction are weak, dissolute, and pathetic--has contributed to the escalation of use and has hampered treatment more than any single other factor." As the father of a recovering addict, I know all too well how that stigma affects addicts--and families of addicts--in a negative way. Kudos to Sheff for attacking it head-on.
Another misconception Sheff takes on has to do with relapse: "The main problems with America's addiction-treatment system stem from its roots in the archaic notion that addiction is a choice, not a disease. One common symptom of the disease of addiction is relapse. Kicking an addict out of treatment for relapsing is like kicking a cancer patient out of treatment when a tumor metastasizes." Again, Sheff is telling it like it is and striving to destroy the old myths associated with addiction.
Every page of this book has interesting and valuable information on it. Some paragraphs are so full of information that I found myself re-reading them so I could absorb everything Sheff had to say. I will probably re-read the entire book several times. It's that good and that informative.
This is not only a book about addiction; it's a book about hope. It lets people know that addiction can be prevented. And even if one does succumb to addiction, that there are ways to treat the disease and for people to get clean and stay clean. Sheff ends the main part of the book with his own take on the twelve steps, entitled "The Clean Paradigm in Twelve Steps." (Example: "12. End the war on drugs and treat addiction for what it is--not a criminal problem, but a health crisis.") He also provides a very informative Appendix--"Just Say Know"--where he describes "the most prevalent drugs and their effects, starting with the most ubiquitous drug of all." (That would be alcohol.)
If you have been affected by addiction, you must read this book. If you have kids entering their formative years, you must read this book. If there is a history of addiction in your family, you must read this book. Even if you don't fit any of those categories, I'd still recommend you read Clean to get a remarkable insight into one of the biggest issues facing our country today.
For those who are interested, here is how Clean is broken down, section by section:
I: AMERICA ON DRUGS
1. This Is Your Brain on Drugs
2. This Is Our Country on Drugs
II: WHY WE USE
3. Everybody Does It
4. Helping Kids Grow Up
III: WHEN DRUG USE ESCALATES
5. Use Becomes Abuse, and Abuse Becomes Addiction
6. Addicts Aren't Weak, Selfish, or Amoral; They're Ill
7. Don't Deny Addiction, Don't Enable It, and Don't Wait for an Addict to Hit Bottom--He Could Die
8. The Next Hurdle: Getting a Person into Treatment
IV: GETTING CLEAN
9. The Treatment Minefield
10. Detox
V: STAYING CLEAN
11. Beginning Treatment
12. Primary Treatment
13. Treating Drug Problems with Drugs
14. Where Does AA Fit In?
VI: TREATING A CHRONIC ILLNESS
15. Treating Dual Diagnosis
16. Relapse Prevention
VII: ENDING ADDICTION
17. The Future of Prevention and Treatment
18. Fighting the Right War
Epilogue
Appendix: Just Say Know
70 of 72 people found the following review helpful.
With gratitude...
By Lori
What I appreciate most about this book is that it is the first I have read that does not claim to hold the only way to sobriety, or the only truth about addiction. I appreciate the nod to parents who lose their minds when a child is dying, that we not compound the indignity by taking fire at the parents as "co dependents".
But we have a long way to go. I wish I could put this book in the hands of our local judges, probation officers, jailers and police, and insist that they read it. They continue to mete out punative sentences, or insist upon ineffective treatment, too much or too little, that can especially ruin young lives.
Two of my children have suffered severe addiction lasting over 15 years. I have seen them through Hazeldon (four times), Caron Foundation, Michael's House, Bishop Gooden (3 times)and at least five other top-name facilities... in and out of ICU, chasing paramedics to hospitals after overdoses, into long term in-patient and out-patient treatment facilities for years. I hate to say this... by far the best rehab has been jail. That's not to say anything positive about jail except that it did essentially the same thing as all the rehabs... it bought them time away from the environment and allowed them time to detox (horribly, without any medical attention... but, it is what it is.) In terms of effectiveness, though, they always relapsed again eventually. It is clear to me that there is no punishment strong enough to "cure" addiction.
One of my kid's came through it--the one everyone thought wouldn't live another day and he has been five years sober. It just happened when it was ready to happen. My other son is still struggling addiction with everything he's got, but holds a great job, smiles, is kind, loving and always thoughtful. He has chosen Methadone treatment, and because of that, there is no hospital, rehab or other treatment facility that will accept him. If he wants to finally get totally clean, he will have to do it by himself... cold turkey. My thought at this point is that we are buying him time, and praying for the miracle. Harm reduction is the thing I humbly appreciate. I never thought I would wind up praising the run down, miserable looking Needle Exchange (I used to find these clean needles in his room and toss them out, until the day he explained that all that would do is cause him to take worse chances with his using)... because of these folks, my son doesn't have HIV on top of heroin addiction. I have learned to be grateful where I never thought I would.
David Sheff has been through all of this, and is still fighting the good fight. His son, Nic, must be one fine son--and I have read both of his great books. "Clean" can't make big proclamations about what treatment to seek or where because at this time the science is still too new, the statistics aren't all in. I am SO GRATEFUL he acknowledges that white-knuckling it through AA is not the way for everyone. My son has gone to hundreds of AA meetings, and I honor that he hung in there, continuing to try when it was so obviously NOT a fit. Maybe the thing David contributes the most in this book is humility... and trust in the goodness of those who are struggling with addiction.
I never saw my sons having any fun with this. I have held my younger son's head while he threw up, went through withdrawals, dozens of times. I've watched him sit suicidally alone in his room, while trying to detox before going to jail. I haven't seen the partying everyone imagines. And by far the worst (for me) is the abandonment I have felt, for them and for myself, when things go so terribly wrong.
Thank you, David, for your great book. And I expect that you will write another ( or Nic will!) as newer and more potent resources become known.
96 of 101 people found the following review helpful.
Such an important book
By InfoFish
David Sheff not only pulls the curtain back, he blows it off the rod so we all can get a real look at addiction and what is NOT working. He demonstrates how we are 40 years behind on addiction therapy. If you have children, YOU HAVE TO READ THIS BOOK. Addiction can happen anywhere to anyone and it does.
Mr. Sheff was the author of Beautiful Boy - his son's own journey into and through the landscape of drug addiction.
One of the most important take-aways I got from this book was the fact that 9 our of 10 addicts started before 18. Can you even believe that? So, if you could somehow devise a way to keep your kids from trying before they turn 18, 90% of your battle would be won. Anyway - I thought that was some real food for thought.
Another take-away - this one too heartbreaking - just when an addict falls down and off his program - that is when the system fails him and throws him out of the program, the halfway house. JUST when this support and help is needed so much.
A big chapter is devoted to AA. Totally non-judgmental. Just the facts, descriptions. Interesting.
A thorough review of therapies, which ones have the best results and why. Following a daily schedule, chock full of habits - can really help. This seems so simple and yet is so profound.
And Dear G*D - - - the COST of some of these programs - and insurance doesn't help - HOW CAN regular people help their family get this kind of help?!? WHY can't we have more effective treatment programs at better costs, why isn't insurance helping with this?? Lots of food for thought there.
Okay - what I thought could be done a little better:
1. A one page - WHAT DO I DO NOW - for the parent/loved one/etc. when my son/daughter/person - is in trouble - I don't have time or attention to read the 350 pages - I need a one page cheat sheet.
2. A simple glossary in the back of the book. CBT - means what again? You could use a glossary in the back to look it up - OH YEAH - Cog. Behavior Therapy...
Those were my two little shortcomings comments.
Great book - so much to think about - to discuss - long overdue.
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