Monday, June 24, 2013

Clean by David Sheff

Clean: Overcoming Addiction and Ending America’s Greatest Tragedy
by David Sheff is a unique look at the disease of addiction, told through the journalistic lens of a man with first-hand experience.  For those who are not aware, David Sheff’s son is an addict.  Both he and his son have published memoirs about their experiences and it is these memoirs that compelled me to read this book.

The author offers personal stories from his own experience as well as that of others.  The subjective stories serve as a foundation for the more objective research that supports his contentions that addiction is a disease and, therefore, must be treated as such.  Unfortunately, the stigma of addiction is not perceived in the same way as addiction for, after all, the addict has a choice.  Use or don’t use. How is this a disease?

And this is where Sheff excels because he is able to explain why addiction should be defined as a disease.  Furthermore, it should be treated as such.  A patient who has a remission is no less guilty of failure than an addict who has a relapse because addiction causes neurological changes in the addict’s brain making the option of choice impossible.  And while I can agree with what Sheff says, strongly supported with scientific evidence, it is not always easy to feel the truth on a more personal level.  Nonetheless, I found myself nodding when he drew a parallel between how an addict is not unlike an obese person who has a choice to consume something the first time but then has that choice removed by a genetic chemical reaction beyond the individual control.

Sheff challenges a lot of sacred cows.  He does not see the “twelve steps” as the only real solution to addiction.  He dares to suggest that alcohol is no less tolerable than methamphetamine.  He even dares to suggest that waiting until the addict hits “rock bottom” is a dangerous game to play when some addicts are heading towards self-destruction.  He pulls no punches and hits all of his points hard.  Whether you agree with him or not, he demands attention.  Where some writers would invite the reader to consider the information offered, he shoves the reader’s nose in the reality of addiction and then asks, “What now?”

A great book to invite the reader to think, to reconsider, to possibly redefine, even where there are some areas with which the individual may disagree with the author’s assessment.   

6 comments:

  1. As someone who has suffered from addiction in the past, I definitely agree with this author that it should be also be classified as a disease. I suppose it depends on what your definition of "disease" is since drug/alcohol abuse can fit under either category. While it is true that the addict has a choice, these addictions can spiral out of a control in which it becomes a disease.

    This book sounds like it would be a worthwhile read for me.

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    1. Jason C, I would definitely read this book and recommend it to anyone. The author points out that if someone is predisposed genetically to addiction, while the first use is indeed a choice, all choice after that one time is gone completely. Just as we are beginning to realize that there are certain neurological responses in people who become obese, addicts have a neurological response that cannot be anticipated. And because drugs literally change how the brain functions, an addict's behavior--choosing to use, trying to be sober, relapsing and starting all over again--can be seen as part of an ongoing treatment. I especially agree with his saying that a short term inpatient rehab is not adequate, especially where there is concurrent diagnoses that need to be addressed. The addict who is self-medicating doesn't just need to detox and psychiatric help must also be in place to treat all aspects of the disease.

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  2. Over the span of 15 years I've read or thumbed through countless books on addiction. Clean is definitely on my top 10 list. Most books out there just aren't worth the time as they parrot what has been written over and over again and are mostly centered around AA principles. Clean does a good job of explaining what addiction is, what happens to people who suffer with addiction and what both bad and good treatment looks like. David Sheff is through with his explanations and tries to cover it all. People don't realize that addiction has been considered a disease since 1956 by the American Medical Association. I think part of the problem is that addicts had been 'handed off' to AA rather to doctors, researchers, psychologists and the like. We thought people who suffered with this disease could be 'cured' by following the 12 steps. If they failed it was because they weren't working the program. The problem is that we failed them. We called it a disease but didn't treat it like one - instead we blamed the addict and blamed them again when they couldn't recover. Hopefully things are changing. I think Mr. Sheff's book is helping. Groups like The Anonymous People are also leading the way. The more we know about addiction the more we can help those who suffer from it. Thanks for the great review Satia.

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    1. I think his drawing a parallel between someone eating something with which they are allergic, consciously choosing to eat a food not knowing they are genetically predisposed to react to it differently from most people, was especially powerful. For some people, the reason that one time becomes an addiction is rooted in a neurological response that simply cannot be ignored. That we are criminalizing addicts instead of treating them is irrational and serves no one, not even society.

      I'm going to look up The Anonymous People because some of what Sheff said about anonymity being a double-edged sword especially resonated with me. Thank you for reading and leaving a comment.

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  3. I heard an interview with this author, but forgot to get it on my TBR -- thanks for pointing me to this review.

    I'm reading Salt Sugar Fat by Michael Moss now and becoming more convinced that obesity is a food addiction and that Big Food knows this and engineers the food to make it more effectively addictive to those of us who are susceptible.

    Joy's Book Blog

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    1. Joy, Sounds like a great book! In fact, this inspired me to write a post which I've post-dated for Tuesday. Rob and I eat a lot of home-cooked meals. Very few prepackaged, processed foods. Because of his diabetes, we don't even have a lot of sugar in our home. Mostly lean proteins (fish, chicken breast, loins, etc.) and we add salt to food at the table, if at all, preferring to taste our food before we add anything to it. A nutritionist, when she looked over my food diary, was so impressed, she had no suggestions for what I might do to improve it. Food is a powerful addiction, one that's impossible to avoid, and making healthy choices should be easier than it is.

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