Monday, May 13, 2013

Clean by David Sheff

Clean: Overcoming Addiction and Ending America's Greatest Tragedy, David Sheff.  New York: Houghton Mifflin Harcourt, 2013.  e-book 339 pps. with additional notes afterwards.

Some folks may have read David Sheff's book Beautiful Boy about his son's addiction and subsequent recovery.  David Sheff's newest work Clean is a somewhat repetitive overview of treatment for addictions based on the idea that the addict is suffering from a condition which interferes neurologically with proffered help to recover from said condition.  David Sheff correctly points out that addiction is not the only condition [he uses the word "disease," a word which I maintain is not precise enough and does not go far enough in describing addiction] that results in a thick layer of denial.  Other examples are some forms of dementia and traumatic brain injury [dependent upon where the lesions are in the brain itself]; and diabetes.

Sheff builds a case for treating addicts as people who are suffering from a physical condition rather than as people who need to find a god, get right with a god, pray, meditate, or look deep within for the defects which caused them to want to get loaded in the first place.  The problem with those who are caught up in active addiction is that their brains do not allow them the cognition which tells regular folks that they have to change what they are doing.  Sheff advises that cookie cutter grouping of addicts in a rehab doesn't work because of this.  Some addicts may be ready before others are to learn about addiction.

One takeaway from Clean is that the rehabilitation system ought to stop punishing addicts by throwing them out of treatment for doing things that addicts do.  Another is that legal system ought to quit punishing addicts or furnishing consequences for their behaviors which arise from their abnormal neurological states.  A third is that the sooner we quit treating addicts as if they were bad little boys and girls, the better off everyone will be.  I cannot agree with the first and the second points in their entirety, but I do endorse the third.  Every sick patient deserves basic human respect.  Although the etiologies of some particular cancers are demonstrably related to the quantity of fat consumed in a diet, no cancer patient is asked to confess his sins in order to receive amelioration from the cancer.  Nor is she told that she is being therapeutically discharged for puking after [or sometimes before when anticipatory vomiting takes place] a round of chemo.  There's not a whole lot of people screaming at cancer patients that their condition is their fault.  But there is a bunch of people who are sincerely butt-hurt and angry at the antics of both active addicts and addicts in recovery for a variety of reasons.  The Twelve Steps and their quasi-Christian feel in fact may not be optimal or even integral to the [formal, medical, rehabilitative] treatment of addiction.  If the scientific model of addiction is adopted then it follows that rehabs as we now commonly know them will have to change their methods.

A.A. owes its' roots to the Washingtonians-- who thrived contrary to what Bill W. claimed in his writings-- and to the Oxford group.  The first draft of the Big Book, if allowed to be published in its' original form, has a decidedly Christian slant and would have kept out a bunch of non-Christians from remaining in the rooms of Alcoholics Anonymous.  Indeed, the early A.A. groups excluded women.  Fortunately that changed.  We need more research into how to truly individualize treatment for addicts.  

sapphoq reviews says:  Although Clean was a worthwhile, if wordy, read I had some difficulty with the book.  In spite of the title, Clean deals primarily with alcoholism with the usual passing nod to addiction to other drugs.  I was initially hopeful that Clean would have some things to say about Narcotics Anonymous.  But like many books and treatment programs these days, N.A. is given a pat on the head.  I find this perpetuation of keeping addicts silent to be most distressing.  There are addicts who have barely used or never used alcohol in A.A.  They [usually are somewhat pressured to] identify as alcoholics and say things like, "Everything started and ended with alcohol."  There are also alcoholics who prefer N.A.  But unlike the addicts in A.A., the alcoholic who has never used other drugs is welcomed in the rooms of Narcotics Anonymous.  And the alcoholic almost always identifies as an addict in N.A. willingly, recognizing that the word addict includes addiction to the drug alcohol.
     Sheff does a fairly good job of describing adjuncts to recovery in the form of opiate substitutes, i.e. methadone and other medications.  He also points out the extra liability that a mental health diagnosis can be to the addict seeking recovery.  But he does not clearly offer his vision of what a treatment program using best practices might look like.  This is something that I would have been interested in hearing more about.  Not all rehabs, in-patients, out-patients, detoxes, halfway houses, and three quarter way houses are equal in their effectiveness.  Add to that the manipulation and belittling of addicts in early recovery that occurs by staff people who should know better [and by some folks with longer periods of recovery who have forgotten what they were like in early recovery], it is truly a jungle out there.
     Within the limitations that I have described, Clean is a worthwhile read for those who do not work in the addictions field and for some folks with some time away from active addiction.  Those who work in the addictions field will probably find nothing new [even if they are not implementing some of the suggestions].  And the general audience will probably be lost in the midst of all of the words.  Recommended with some hesitation.  

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