By David Sheff
The view that drug use is a moral choice is pervasive, pernicious, and wrong. So are the corresponding beliefs about the addicted – that they’re weak, selfish, and dissolute; if they weren’t, when their excessive drug taking and drinking began to harm them, they’d stop. The reality is far different. Using drugs or not isn’t about willpower or character. Most mild problematic drug use is related to stress, trauma, genetic predisposition, mild or serious mental illness, use at an early age, or some combination of those. Even in their relentless destruction and self-destruction, the addicted aren’t bad people. They’re gravely ill, afflicted with a chronic, progressive, and often terminal disease.
People also believe that addicts can’t be treated; at best, they can muster their willpower and manage their compulsion for a short time. But while it’s true that addicts who seek treatment are seldom cured, their disease is treatable when we reject the pseudoscience, moralizing, and scare tactics that characterize the current system. The disease of addiction can be prevented, and when we treat it the way we treat other diseases, those in its thrall can be freed to live long, full, healthy lives.
The mission of Clean is to describe the scope of America’s drug problem and explain how and why we’ve failed in our efforts to combat it. I show why we must waste no time in rejecting the existing paradigm that got us into this catastrophic mess. I provide scientific evidence that will change the way we think about drugs and addiction. Finally, and most important, I present the hopeful news that we can now effectively prevent drug use and treat addiction. When we do, we do more than help those with drug problems and their families. We also start to remedy America’s single greatest problem, one that affects almost every other problem you can name—the quality and availability of health care, the national and international economic crisis, poverty, spousal and child abuse, suicide, US competitiveness in the world economy, property crime, violence, shattered families, decimated neighborhoods, and many others.
As a young child, my firstborn son, Nic, was happy and excited about everything, kind and sincere and funny. Parents like me monitor external barometers to tell us how our kids are doing, and according to those, as Nic grew older, he did well. He had friends; he was a good student, an athlete (on the varsity swim and water polo teams), and a lauded student journalist. Most important, he seemed so joyful. But, beginning when he was twelve years old, he was also using drugs, initially smoking pot.
A decade later, I look back and ask, How did it start? How does it start for any of our children, our husbands or wives, partners, parents, siblings, friends—for anyone who becomes addicted? Nic says he tried drugs because he was curious, and everyone seemed to be using, “at least, everyone who was cool.” When he tried them, he felt fantastic. He used more and then more. He graduated from high school, but he also graduated to other drugs. He began college but didn’t last long there. Instead, he became homeless, sleeping in cars, abandoned buildings, and city parks. He lied to his family and stole from us. He took pills (psychedelics, ecstasy, uppers, downers), used cocaine, and—inconceivably to me—began shooting heroin, crack, and crystal meth.
I wrote about the years our family lived through his addiction in the book Beautiful Boy. Readers of it and of Nic’s own books—a pair of memoirs, Tweak: Growing Up on Methamphetamines and We All Fall Down—know many of the gory details. Over the course of a hellish half a dozen years, Nic dealt drugs, was beaten up, and was wanted by the police. Once, a doctor informed him that he would probably have to amputate Nic’s arm because it had become infected after Nic shot heroin and crystal meth. (Miraculously, the doctor was able to save it.) There were many times when Nic nearly died. I’d think, This cannot be happening to my son. Not to Nic. I thought he’d be protected by his intelligence, his education, us—his family. Nic didn’t look like the addicts I’d see on the streets. I’d walk by those hollow-eyed, trembling wraiths and avert my gaze. I thought it was impossible that Nic would become one of them, but he did.
The experts say that addiction is a family disease. For a long time, I didn’t understand what that meant. When Nic became addicted, I thought he was the one with the problem. He was the one who needed help. But my son’s addiction wasn’t destroying only him. It was destroying our family. It was destroying me. I couldn’t function. I couldn’t work, couldn’t take care of the rest of my family. Nic repeatedly disappeared—a day and a night, two days, a week—and I’d be out of my mind with worry. I couldn’t sleep. I did what parents who don’t know where their children are do. I called the police, the hospital emergency rooms. One time, when I called the local sheriff’s office looking for Nic, an officer asked, “Mr. Sheff, have you tried the morgue?”
I was in a state of unrelenting, immobilizing panic. As I described it in Beautiful Boy, I became addicted to Nic’s addiction. How could I not? My son was mainlining drugs—as I wrote, “shooting poison into his arms, arms that not that long ago threw baseballs and built Lego castles, arms that wrapped around my neck when I carried his sleepy body in from the car at night.”
For the sake of Jasper and Daisy, our younger children, my wife, Karen, and I carried on as normally as possible. They were not only confused and intensely worried about their big brother but also traumatized by their parents’ distress. When Jasper watched Nic being arrested, he was inconsolable. Back when she was in grade school, Daisy wrote about her childhood for a homework assignment. “I was born into a latticework of lovely oceans and hunched shadowed vampires tangled together in an inseparable knot. Most of what I remember about being little is marvelous, with my two wise brothers carrying me upon their shoulders.” But then, “everything sort of flipped over. Nic was tired and slinking and then he was gone. My strong pillar parents crumbled.”
During those hellish years, I tried everything I could to help Nic. I brought him to therapists and counselors and Twelve Step meetings and checked him into residential treatments, halfway houses, outpatient programs, and more, but his addition worsened. In family groups and at the Al-Anon meetings I attended, I heard other parents with stories similar to mine. In most cases, nothing had helped their children either. Even worse, when treatment failed, their kids were blamed—they were too weak, weren’t committed enough to staying sober, didn’t pray hard enough. I also learned that despite how bad it was for us, we were among the lucky ones. Nic survived; many people’s loved ones didn’t.
Eventually I learned that only a minority of those who are addicted are successfully treated. How bad is the current addiction-treatment system? Tom McLellan, a preeminent addiction researcher, knows as much about addiction as anyone in the world. “I was the addiction expert,” says McLellan, founder of the Treatment Research Institute and former deputy director of the Office of National Drug Control Policy in the Obama administration. “But I didn’t know what to do. I asked my colleagues—they’re experts—and they didn’t know what to do.” Groping his way through the dark, desperate to help his sons, McLellan did all he could. He had access to the best care possible, but it wasn’t good enough. One son is now in recovery, but his younger son died of an overdose of benzodiazepines and alcohol.
1. Most drug use isn’t about drugs; it’s about life.
Our prevention and treatment efforts have failed mostly because they’ve focused on dealing with 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 system will continue to fail most people.
2. Addiction is a disease.
No one chooses leukemia, heart disease, or depression. Abusing drugs, however, appears to many to be a choice, and a reckless and selfish one. It’s not. The new approach is based on the fact—a fact I’ll prove categorically—that addiction is a disease. Serious illness is always frightening, but it’s a relief to understand that it’s not a person’s fault if she’s addicted. Perhaps more to the point, blaming the afflicted for their condition has led to decades of flawed treatment and policy. But the evidence clearly proves that addicts aren’t morally bereft or weak-willed. They’re ill.
3. This disease is preventable.
Given the scale of illicit drug use and abuse, the ineffectiveness of decades of anti-drug campaigns, and the failure of a war on drugs that has cost more than $1 trillion, most people assume that it’s impossible to prevent drug abuse. Parents, schools, communities, and the nation itself have initiated campaigns to stop drug use, but they’ve failed. However, we now know that prevention initiatives failed not because it’s impossible to stop people from using and abusing drugs, but because our efforts were misguided.
4. This disease is treatable.
Most people, including most addicts, assume that addiction can’t be treated. On their own or with help, sometimes by relying on the traditional Twelve Step program, some people have learned to manage their addiction and stop using. But many more haven’t. Many of those who had successfully stopped using relapse, often repeatedly. Some early research indicated that the addicts could never fully recover because drugs caused permanent brain damage. We’ve since learned that traditional treatments often failed not because of intractable brain damage, but because they were inadequate. (In fact, some were useless, and some were harmful.) However, a host of recent findings about how addiction works have led to the development of effective treatments, and more are coming. Adding to this promising news is evidence that most brains damaged by drugs can recover. Sufferers of addiction can be restored to health.
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.
To date, prevention strategies have failed because they’ve relied on scare tactics and best guesses of what might work. When these efforts fail and drug use begins and escalates, desperate people who need treatment often wind up in the hands of charlatans, rip-off artists, or well-intentioned but incompetent practitioners. Once we understand that addiction is a disease and that it’s preventable and treatable, our course becomes clearer, because we have a model to follow. Just as there are proven prevention strategies that lower incidences of some cancers, diabetes, and heart disease, there are effective approaches to stop people from using drugs and nip early use in the bud, before it advances to full-blown addiction. And just as patients with other serious illnesses pursue the most effective treatments developed by science and tested in clinical trials, so too can addicts and their families.
6. Drug abusers and addicts can do more than get off drugs; they can achieve mental health.
As it’s defined by the National Academy of Sciences, mental health “is more than the absence of disorder.” Usually those with addiction, particularly those who’ve used drugs since they were teenagers, live their lives in pain and confusion. Drugs impeded their emotional growth at the very time when they would have been learning to navigate the world, to develop close relationships, and to mature in other ways. With sobriety comes the opportunity of transformation and a fulfilling life.