Clean: Overcoming Addiction and Ending America’s Greatest Tragedy by David Sheff

Book Review: Clean: Overcoming Addiction and Ending America’s Greatest Tragedy (Mariner Books, 2013) by David Sheff

David Sheff wrote Beautiful Boy: A Father’s Journey Through His Son’s Addiction, which received quite a bit of attention when it was published in 2008. Although I never read the book, I remember seeing it for sale in Starbucks, and I paged through it a few times while waiting for my coffee. Clean, which is Sheff’s latest book, provides an overview of the issue of addiction in the U.S. Here are some of the most interesting facts and statistics contained within the book:

– Drugs kill more people than any other non-natural cause. Every day, drugs (including alcohol) kill over 365 Americans.

– Approximately one in twelve Americans over the age of 12 is addicted to drugs.

– Teens in America use drugs at a higher rate than teens in any other country.

– Abuse of prescription pills is America’s fastest-growing drug problem.

– Ninety percent of people who need help never receive it. Addicts are more likely to end up in prison than in rehab.

– Studies of twins indicate that genes account for about 50 percent of the risk for addiction. (The other 50 percent includes use at an early age, stress, anxiety, environment, mental illness, and more.)

– Nine out of ten people who become addicted began using before they were eighteen.

– Sleep-deprived kids have a higher risk of using than those who get a full night’s sleep.

– DARE (Drug Abuse Resistance Education) is the most widely used program in U.S. schools. However, numerous studies have found that DARE does not work. It does not lower drug use.

– Six out of ten addicts have at least one co-occurring mental health issue (e.g., anxiety, depression, or bipolar disorder).

In his discussion of prevention, Sheff points out that it is important to help children deal with their emotions. He refers to a study in which parents were asked why they thought their children used alcohol. The parents responded that their children probably used in order to gain social acceptance with peers or because using feels good. However, the children in that study indicated that stress was their number one reason. Here is the excerpt:

In the survey, 60 percent of kids did admit that they used because drinking (the survey focused on alcohol) was fun.  But teenagers’ primary motivations were to “forget their troubles” (32 percent); deal with problems at home (24 percent); and cope with school pressure (20 percent).  Their parents were clueless.  In the study, only 7 percent of parents connected drug use with teenagers’ stress.  Most parents assumed that the number one reason kids used drugs was that “drugs are fun.”  When kids listed their reasons for using, however, “drugs are fun” came in fifteenth on a list of sixteen….All stages of life have their stresses, but adolescence is particularly fraught with them because of the external pressure kids face and the fact that their brains are not yet developed to handle those pressures effectively (p. 32).

A school-based program that aims to prevent drug use by helping children cope with their emotions is found at Our Lady’s Catholic Academy, which is a prekindergarten through eighth grade school located in Queens, New York:

Each day begins with an activity designed to make children aware of their emotions: they fill out mood charts.  Younger kids use strips of colored paper to describe their moods — blue for feeling blue, for instance.  Older children describe their emotions in words — angry, sad peaceful.  As the children mature, they learn to assess the nuances of their feelings, and their vocabulary expands: “I’m feeling disheartened”; “I’m feeling anxiety” (p. 63).

Besides Our Lady’s Catholic Academy, Sheff also discusses the San Francisco Unified School District’s Wellness Centers as offering a model of prevention.

Within the book, Sheff clarifies that, contrary to common perceptions, addiction is not a moral issue or a character flaw. It’s based in genetics and should be thought of as a brain disease. Scientific studies show that even mice and flies can be genetically predisposed to addiction. In an attempt to refute the idea that addiction is some sort of character flaw, Sheff says:

We can assume that the flies who become addicted aren’t succumbing to peer pressure.  It’s doubtful that they’re weak, selfish hedonists choosing to party (p. 275).

For me, the most interesting part of the book was the chapter on Alcoholics Anonymous. Sheff delves into the history of AA, and he also describes some of the meetings that he has observed. Apparently, some of the meetings are for addicts only, whereas other meetings are open to anyone. Sheff points out that one of the first steps in AA’s twelve step program requires addicts to surrender to a higher power, and this can be an obstacle for many non-religious people. People who do not believe in God can feel alienated and hopeless if they cannot move through this step. Although many AA groups are accepting toward members who do not believe in a higher power, some chastise members who cannot bring themselves to believe. Sheff says that the twelve steps were originally designed as suggestions and that AA in its original form did not reprimand addicts if they could not accept the steps. A doctor from Stanford that Sheff interviewed said that AA and “rigid my-way-or-the-highway programs” based on AA must be distinguished from one another:

Many people don’t know what’s part of the core of AA and what’s distorted or misused (p. 218).

Overall, the book is packed with information. A broad (yet perhaps somewhat cursory) overview is given to a wide range of topics.  Although the book cites several studies from peer-reviewed journals, much of the information in the book is anecdotal and based on informal interviews.  This is a book; it’s not an article in a peer-reviewed sociological or psychological journal, so take it with a grain of salt.

Sheff’s son, Nic, has also written two books about his experiences with addiction. Here are links to the books:

Tweak: Growing Up on Methamphetamines

We All Fall Down: Living with Addiction