Clean: Overcoming Addiction and Ending America's Greatest Tragedy

by David Sheff

A myth-shattering look at drug abuse and addiction treatment, based on cutting-edge research 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. The existing addiction treatments, including Twelve Step programs and rehabs, have helped some, but they have failed to help many more. To discover why, David Sheff spent time with scores of scientists, doctors, counselors, and addicts and their families, and explored the latest research in psychology, neuroscience, and medicine. In Clean, he reveals how addiction really works, and how we can combat it. “A guide for those affected by addiction, but also a manifesto . . . for America as it confronts its drug problem. [Sheff] has performed a vital service by compiling sensible advice on a subject for which sensible advice is in short supply.” — New York Times Book Review “As a journalist, father, and clear-eyed chronicler of addiction, David Sheff is without peer.” — Sanjay Gupta, M.D., chief medical correspondent, CNN

Genres: Addiction, Nonfiction, Psychology, Health, Science, Self Help, Education

400 pages, Paperback

First published January 1, 2013

About the author

David Sheff is the author of the #1 New York Times bestselling memoir Beautiful Boy. Sheff's other books include Game Over, China Dawn, and All We Are Saying. His many articles and interviews have appeared in the New York Times, Rolling Stone, Playboy, Wired, Fortune, and elsewhere. His ongoing research and reporting on the science of addiction earned him a place on Time Magazine's list of the World's Most Influential People. Sheff and his family live in Inverness, California.

Reviews

[Erin Cataldi · Rating 5 out of 5]

This was definitely one of the hardest books I've read this year, not because it was badly written but because the subject matter was very personal and not at all comforting like I hoped it would be. I'm not going to go into details in this book review but those of you who know me, know why I find this subject hard. It's something that I never would have guessed would affect me or anyone I care about, but who am I kidding, this is the 21st century. Addiction is more prevalent then ever.

Prior to this book, I knew the concept behind addiction and thought I had it all figured out. Basically after reading this, I realized I know nothing on this subject. In my head, addicts were selfish people who didn't know when enough was enough and tore their family and friends lives to pieces in their selfish downward spiral. Clearly, I have a very old fashioned way of thinking, I had never once considered addiction a "real" disease.

Author, David Sheff, does a marvelous job of outlining addiction (why we use, the disease, drugs and alcohol in our culture, etc.), and ways to get addicts clean (he describes dozens of different treatments, not everyone can get clean the same way) and stay clean. David has a lot of experience dealing with addiction, his son Nic spent years addicted to hard drugs and later wrote the book, "Tweak." David Sheff outlines the struggles of dealing with addiction as a family in his first book, "Beautiful Boy" ("Clean" is his second novel).

Some interesting facts and tidbits that I took away from this book:

1. Comparing money spent on cancer and AIDS research as compared with addiction research = "the total spent on AIDS is $3 billion - or $3,000 per infected person. We spend $29 per addict." (page 290)

2. "In Vancouver, at a supervised injection site called, Insite, drug users are given not only clean needles but a safe place to shoot up and stay while they're high... A series of studies has shown that Insite is effective at getting addicts into treatment, lowering crime in the neighborhood, and reducing the number of overdoses and illnesses from drug use." (page 302)

3. In Portugal the government decriminalized the possession and use of all drugs - not only marijuana but heroin, cocaine, and the rest. Drugs are still illegal, but users caught with small quantities aren't sent to jail. Instead they face a panel consisting of a psychologist, social worker, and legal adviser who recommend appropriate treatment... A study found that five years after personal possession was decriminalized, illegal drug use among teens had declined, rates of new HIV infections had dropped and the number of people seeking treatment for drug addiction had more than doubled. Prior to the change in policy, Portugal had one of the highest rates of drug use in Europe, afterward, it had one of the lowest." (pages 303-304)

4. "A majority of patients who enter treatment never complete it. Among those who do, 40 to 86 percent relapse in the first year." (page 17)

5. "The stigma associated with drug use - the belief that bad kids use, good kids don't, and those with full blown addiction are weak, degenerate, and pathetic - has contributed to the escalation of use and has hampered treatment more than any single other factor."(page 25)

6. Addiction IS a disease. " A disease is "an interruption, cessation, or disorder of a body, system, or organ structure or function," according to "Stedman's Medical Dictionary. It's "a morbid entity ordinarily characterized by two or more of the following criteria: recognized etiologic agents, identifiable group of signs and symptoms, or consistent anatomic alterations." Addiction fits every one of these criteria." (page 89) Addicts aren't weak, selfish, or amoral - they're ill.

7. "Researchers have found that if a person makes it to two years [being sober], his likelihood of relapse diminishes dramatically, and after five years, most addicts will continue to stay sober." (page 266)

Sorry I got a little wordy on the statistics, but those are only just a handful of what you can discover in this book, I learned soo much. I learned how complex addiction is and how hard it is to treat. This is an absolute MUST read, a real eye opener, and very present in our society as we reflect on the United States failed drug war.

[jv poore]

As a HUGE fan of Mr. Sheff, I could not wait to get this book in my hands. The writing is as amazing as I expected, but the facts are simply more than I can handle.

Mr. Sheff has become remarkably knowledgeable about addiction, particularly as it relates to undiagnosed and/or unacknowledged mental disorders/chemical imbalances, and his presentation of the information is so straight-forward that, to me, it is impossible to deny.

There are reasons that conventional "rehabs" don't work well; there are answers to this problem. Sadly, those that can make a difference continue to keep their heads in the sand, their fingers in their ears as they sing at the top of their voices "La, La, La...can't hear you....La, la, la".

As I was reading this, a dear friend was disintegrating, and no one would help. The frustration with the injustice of it overcame me, and despite wracking my brain, I couldn't, and still haven't figured out how I can help, and the anger, the utter senselessness of the situation, was more than I could bear. I am embarrassed by my cowardice, but there it is. I closed the book.

I will be stronger. I will pick up where I left off, and I will find a way to help those folks that are suffering from depression, and/or are bipolar, and have been forced to turn to illegal drugs in order to lift themselves up enough to get through the day.

[Bev Ethington · Rating 5 out of 5]

Just started this book and find it very encouraging. There was a comment though that Mr. Sheff made early on that has bothered me. He said that he became addicted to his son's addiction. Having experienced addiction in our family I know what Mr. Sheff meant or at least I think I do. Words are tricky. Addiction is a disease. Mr. Sheff knows this, the medical community knows this, most people know this and yet the word 'addiction' or 'addicted' is many times used incorrectly. It's my humble opinion that Mr. Sheff might have used the word 'addicted' incorrectly.

His feelings of despair over his son's addiction didn't make him addicted to his son's addiction. Nor would a father's feeling of despair over a son's mental illness, or cancer make the father mentally ill or have cancer.

Because we worry, despair or fear for our children or loved one's who suffer with addiction this doesn't mean that we are addicted as well.

To say that addiction is a family disease may be accurate - but so would saying that cancer is a family disease as families will become emotionally involved in their loved one's health. It is only human that if we love someone we will hurt with them when they hurt - when they are sick we care for them.

A person can only deal with a disease with the 'capabilities' that they have. Education about a disease helps with the angst and anger. Our society claims it is 'addicted' to all sorts of behaviors or things. But to use the word addiction incorrectly I think is harmful to those who suffer with this disease. Addiction needs to be understood for what it is - a chronic but treatable brain disorder in which people lose the ability to control their need for alcohol or other drugs. There can also be co occurring diseases or conditions that cause a person to self medicate.

I'm still early on in Mr. Sheff's book but I am so encouraged by his writing of it. There seems to be a definite shift in the way we think of and how we treat addiction.

Page 101 - Have you ever been caught up in a conversation with someone and their just not 'getting' what you are saying....then someone else walks into the room listens to the two of you, seeing that obviously your both on different 'wave lengths' - they interput and say the same things you just said but in a different way and all of a sudden the look of confusion on the other person's face lifts and 'the light' goes on and they say "Oh, Okay I get it".

That's what is going on with this book . All the rhetoric, all the studies, all the past PBS specials - everything, everywhere that you have ever heard about addiction is laid out step but step and discussed in a manner almost anyone can understand - and if they can't their just being stubborn - sticking with the stigma, anger and misinformation that they have gotten used to.

Almost every page - I'm telling myself I have to remember that - Yes, yes, yes, that is the debate - this is how it should be discussed !!! People need to hear where we came from, where we are now and where we are going so that recovery can become a possibility for everyone who has this disease of addiction.

I would recommend this book to anyone because almost everyone knows of or is directly involved with someone who struggles with the disease of addiction. This book should be a textbook in Addiction 101 - starting with family doctors on up. It is a sad state of affairs when doctors can't offer at least a resource for their patients to go to for help - they themselves should be the first step to help but so many shrug their shoulders -they have no idea what to do or say.

[Lorianne DiSabato · Rating 3 out of 5]

I’ve recently finished David Sheff’s Clean: Overcoming Addiction and Ending America's Greatest Tragedy, which I found a bit disappointing. My expectations were probably too high, as Sheff’s Beautiful Boy—a memoir of his son’s meth addiction—was both heartbreaking and hauntingly human. It’s clear that Sheff’s experience as the father of a recovering addict has shaped his thinking, making him sound urgent and at times almost quaintly old-fashioned: Ward Cleaver after watching Reefer Madness. Whereas in Beautiful Boy, Sheff came across as a quintessentially laid-back Boomer parent who initially wasn’t concerned by his son’s pot-smoking, in Clean Sheff seems to have made a complete about-face, arguing that if teens are biologically predisposed to addiction, they can become addicted after trying drugs only once.

If you weren’t aware that addiction is an illness, not an absence of will-power, Sheff’s book will be a revelation, especially when he discusses the phenomenon of dual-diagnoses, where coexisting mental illnesses complicate (and potentially cause) drug abuse as sufferers seek to self-medicate. (Sheff’s son, for instance, was ultimately diagnosed with clinical depression and bipolar disorder, and his recovery from drug addiction is contingent upon ongoing medical treatment for those illnesses.) But if you have a friend or loved one who is an addict—or if you yourself are an addict—you’ve already seen firsthand the ravages of drug abuse, addiction, and mental illness, so I’m not sure you’ll learn much new from this book. Perhaps friends and family members of addicts will find comfort knowing they are not alone: Sheff is an excellent writer, and his book is filled with anecdotes from his son’s addiction as well as the countless people he’s met and talked to after publishing Beautiful Boy. But given the book’s urgent insistence that addiction is an illness that needs to be treated with scientifically proven, medical methods, there’s a surprising lack of actual science in Sheff’s account.

Clean is clearly a layman’s account of drug addiction and treatment, written for other laymen. Apart from an occasional mention of dopamine receptors and how addicts’ reward centers operate differently from those of non-addicts, Sheff says little here about neurology and how the chemistry of addiction and its treatment actually work, biologically speaking. Instead, Sheff spends a lot of time telling parents how they should do everything in their power to prevent their child from experimenting with drugs, including wholesome admonitions to eat together as a family, reminders to talk with your children about drugs, and other bits of parental advice that aren’t exactly “new.” As much as Sheff insists addiction must be viewed (and treated) scientifically, Sheff is neither a scientist nor a science writer, and this is not a science book. Instead, it is a cultural polemic: a book that tries to change the widespread belief that addiction is a moral failing rather than a medical imbalance. Without much science to back up that claim, however, I’m not sure how convincing Sheff’s argument is. If you already believe that addiction is an illness, you’ll find comfort and corroboration in the numerous anecdotes Sheff shares. But in the relative absence of hard science, I’m not sure Sheff’s approach will sway many skeptics.

[Larry Bassett · Rating 2 out of 5]

If you're looking for a good book with an overview of drug and alcohol addiction you should probably keep on looking because I don't think this is the book. What do you will get from this book is that addiction is a disease not a moral deficiency. If you Artie think that read no further. The other thing the author talks a lot about his evidence-based therapies. He likes to call them EBT's and he is quite into things that have initials. The problem is he seems to think that a quote from TIME Magazine provides the same kind of evidence as an article in the Journal of the AMA. And don't forget everything is very complicated so it would be too easy to say that it's genetics because pretty much it's everything. The skies son had a drug problem and he missed handled it and now he and his son have written books and are making a career of it.

One of the more interesting things I found in the book was a somewhat friendly critique of 12 step programs. He outlined several well-known deficits of AA leading off with the problem for people who can't deal with the God or higher power aspect of the programs.

When he talks about treatment programs he seems primarily to be talking about the ones that cost tens of thousands of dollars. He basically seems to think that the 28 programs that are about all that are covered by insurance are generally not adequate. He definitely has a bit of a pie in the sky attitude about the solution which is to have significant social programs that cover all the ills of society. Not very realistic in the current atmosphere of putting social programs so we can build bonds. He might be absolutely right but it ain't going to happen anytime soon.

He also has a pretty interesting discussion about marijuana but he is a few years behind the times as is much of the book. He points out that marijuana is addictive for about 5% of the people and that it is a dangerous drug for children. But still he supports legalization. With conditions of course. All those good intervention programs that are never going to happen in our current political society.

My main concern about the book is that he seems to think if you put something in quotes, that makes it a fact. And he puts a lot of things in quotes and some things contradict each other. The it's complicated factor covers most of that. I think he just tried to do too much in one book.

[Todd N · Rating 2 out of 5]

I had high hopes for this book after hearing the interview with the author on Fresh Air, but ultimately I couldn't finish it. It's just too meandering and filled with too many personal stories and the bits that dig into the science of addiction and recovery feel secondary to the personal stuff. Too bad.

I have more than a passing interest in this topic, but I didn't feel this book was worth the slog after 70 pages or so. There are some interesting bits though, like only one out of ten addicts started taking drugs after 21. But I would need some more rigid logic to convince me that this is causal (and not more anecdotes, please).

That reminds me. It seems like if you want to be described as a wonderful kid with tons of amazing qualities, the quickest way to do this is become an addict in adulthood. But remember: all of our kids are special little snowflakes, not just the self-destructive ones despite what the best seller list and NPR would have you believe.

[Kalem Wright · Rating 2 out of 5]

"Clean" is David Sheff's prescription for ending the addiction crisis in America. He explores the state of the research through interviews with recovering and active addicts, family members, researchers and service providers and explores failings in the system in educating consumers and providers, access to quality and evidence-based care, philosophically harmful and moralistic treatment models and implementing best practices.

He illustrates the impact of drugs on the developing and developed brain and works very hard to dispel myths about drugs and their users. Sheff's work is generally written to proselytize readers to the belief that addiction is a disease that can and must be treated medically. Rather than defining the disease model and guiding readers through the conditions in the host, agent and environment - a strategy that would have given this book some sorely-needed structure - Sheff elects for exhausting and frequent analogies to cancer care, a little apples-to-oranges.

Sheff also has beef with unregulated and self-proclaimed addiction specialists without credentials and takes great pains to educate readers on what certifications and licenses to look for. He also spells out current best practices such as SBIRT, CBT and DBT, community-based treatments, etc. However, some of his recommendations fly in the face of some of the professionals he cites within the work, muddying the message.

Had this book been subtitled "How to Help Your Loved One Get Into Treatment and Recover," it would be hard to find fault with anything in the book. He clearly is a passionate advocate for recovery in whatever form it may assume and a how-to guiding families through the process armed with his experience would have been an absolutely laudable book to write.

"Clean" was profoundly frustrating to read. Sheff calls for wonderful changes and necessary accountability in the system. It is well-researched, and contains powerful human stories as well as excellent research data. It's impressively digestible in its explanation of neurochemistry. However, it's ponderously slow, lacking a vision and incoherent as a memoir and/or advocacy work.

[Kristen Hernandez · Rating 5 out of 5]

It was so refreshing to read a very well-written book that actually agrees with my specific thoughts on substance abuse. I have been constantly told that people who do substance abuse are just selfish and could stop if they really wanted to or that we should just legalize every drug that there is. People do not seem to understand that this is not just an individual's problem, this is a societal issue! With more authors, like David Sheff, we could slowly change the worst domestic issue that we have in our country. We need to begin training and implementing models that have cognitive-based therapies, not moral-based treatment. I appreciated every case study because it allows the reader to visualize and understand how anyone is susceptible to this disease; you do not have to be living in poverty or have to had an awful childhood. When Sheff delved into the topic of AA, I was fascinated. I have long gotten into discussions with people about AA and how it really was not effective for large sample, but only was for a small sample, and it felt good to know that I was not the only person who felt this way and that there were even studies that proved this.

I would recommend this book to not only someone who is or knows someone who is struggling with addiction, I would highly recommend this book to every single person in the country, so people can understand that by shunning drug abusers, we are only feeding to the mental health disorder and the societal problem. It is time that we make a change, and in order to do that we need to stick by each other and know that this is not a choice, this is a disease.

[Audrey · Rating 4 out of 5]

This was good. He has a couple very strong messages - one being that addiction (like alcoholism)is a disease, not an indication of weak moral structure, and not simply poor judgement. This is not a new message for me, but it is for many people. What was a new idea for me is that we need to TREAT addiction the way we treat other diseases. It seems obvious, but yet it doesn't happen. And he made me look at why. Lots of reasons, addiction carries great stigma and people don't talk about it. It's difficult and costly to treat - and many people believe addicts choose to be addicts so why spend the time and money. But Sheff's socio-political message is that we need the equivalent of the American Cancer Society for addiction. We, as a country, need to raise awareness, fund research and license and regulate treatment facilities. I heard this guy speak in Berkeley a couple weeks ago and he said he could open a substance abuse treatment center tomorrow. To open a coffee shop or a laundromat, he would have to jump through several hoops, but to open a treatment center for addicts all he has to do is say he is doing it. Weird huh? His writing, like his speaking tends to be sort of rambling, and the book is filled with anecdotal stuff - speaking to doctors, shrinks, addicts and all manner of medical and scientist types. But I think his conclusions are strong and worth reading and thinking about.

[Andrew Shaffer · Rating 4 out of 5]

Clean starts off with a well-meaning premise that grabbed my attention: “Addiction is a preventable, treatable disease, not a moral failing. As with other illnesses, the approaches most likely to work are based on science.” Sheff (Beautiful Boy) provides ample evidence and expert opinions in his quest to prove, without a shadow of a doubt, that addiction is an illness and not a moral failing on the part of users. When he sticks to science and statistics, Clean delivers; when Sheff digresses into multi-page first-hand accounts of addicts, the book grinds to a halt. I’m glad I kept reading: Toward the end, Sheff has a funny visit to a laboratory to observe drunk fruit flies that would feel at home in a Mary Roach book. Despite its uneven pacing, Clean is a must-read for anyone who has family or friends who are alcoholics or substance abusers. If you’ve ever wondered why addicts don’t “just stop” or “say no,” the answers are in this book.

[David Cooke · Rating 3 out of 5]

As the parent of a child battling addiction, I am drawn to books that share common or similar experiences. David Sheff wrote a very powerful story, "My Beautiful Boy" which chronicles his experiences with a son's addiction. This book is designed to shed light on the issue of drug abuse in this country. Sheff clearly shares the pain and frustration that most parents experience regarding the stigma of abuse. Most people, until it hits home, sees addiction as a choice people make and have little empathy for those who use and abuse drugs. Sheff correctly points out that addiction is a disease. He believes that if society recognized and understood addiction as a disease, we would and could be better equipped to treat it. Instead, addiction is treated as an affliction in society and there are too few professional resources and programs to eradicate this disease.

Unfortunately, in his assessment of the problem, he doesn't do a wonderful job in clearly defining the answer. He clearly defines his definition of a professional drug counselor or program; however, he doesn't give many of us hope for finding or accessing these resources. He continues to re-emphasize what the problem is, why it exists, and what prevents it from being fixed. Yet, he never really clearly defines the exact model for correcting it. If he did, it wasn't obvious or memorable.

If you want a great educator on how frustrating drug abuse treatment is in our country the first 140 page paint a bleak, painful picture. After that, the book kind of rambles on.

[Jess Dollar · Rating 4 out of 5]

I'm really glad I read this. I heard the author on Fresh Air, so when I saw the book at the library I figured I would give it a try. I have a lot of experiences dealing with addicted people, and this book helped me understand addiction and addicted people in a more comprehensive, objective way.

I also think this a great book for parents to read as it talks about how especially damaging drug use and abuse can be on young people and how to help your kids navigate their teen years without alcohol, marijuana, or harder drugs. It gave me some food for thought about how I talk about drug abuse with my kids.

This book is an absolute MUST for anyone currently dealing with addiction or an addicted family member. That's who the book is primarily geared toward, and it really delivers by offering a non-judgmental, scientifically guided appraisal of drug abuse and drug treatment programs.

[Adam · Rating 3 out of 5]

Good piece but kind of boring. Didn't offer any life changing insights like I hoped.

[Patricia Baker · Rating 3 out of 5]

This was a hard book to read as it contained a lot of information about addiction. I had read his other book about his son's addiction and thought it had some merit to discussion addiction and treatment.
I have to agree with Mr. Sheff that addiction is a medical problem, that it needs to be addressed as soon as it is suspected as a problem. I agree with him in that addicts should not be labeled bad people, they are just ill people. I'm not sure that AA or NA is the way to go because of the loss of religious involvement. I also agree with Mr. Sheff that an addict should not be kicked out of treatment or rehab because of an infraction. There should always to a second or third chance discussed with this addict.
Mr Sheff makes a point that no cancer patient gets kicked out of chemo or radiation because of a singular failure of treatment. I feel that parents and school teachers should have yearly instructions on addiction, what to look for, where to get help. I think some parents have no clue that their child has an addiction problem until the police or ED become involved. Would recommend this book to parents who have children in middle school because a lot of his information starts with that age group.

[Amy · Rating 4 out of 5]

Very interesting book by someone who knows of what he speaks. David Sheff watched his son Nic spiral into a horrifying drug addiction. He spent years worrying, enabling and desperately trying to help his son. Nic, at the time of this writing had been five years clean, and still is as far as I know. But, the point of this book is to inform people of the risk factors related to addiction, preventative programs that are being implemented, different types of treatments for addiction, and to explain how addiction should be viewed not as a choice, but as a disease. Sheff explains how addicts brains are different, how addiction continues to change the brain so that what may have at one time been a choice, is no longer a black and white issue. Most interesting to me is Mr. Sheff's attempt, along with others who are researching addiction, to start a society, the American Addiction Society, based on the tenants of the American Cancer Society. This would work to find ways to treat addiction, teach prevention and change the stigma of addiction that keeps people from seeking treatment and skews public opinion to be less likely to support/fund/back scientific research on the subject.

[Shelley Fearn · Rating 4 out of 5]

I doubt anyone would deny that this is an important book for the lay person. Sheff clearly expresses his premise that addiction is a disease and not a moral failing. What he subsequently writes elevates this book from the usual nonfiction book on addiction written for the lay reader.

Sheff, in a very orderly and forthright manner, describes the science behind the change from treating addiction as a fault to treating it as a disease. He covers the possible causes of addiction, its trajectory, and the treatments available.

I hope that every parent, teacher, minister, and anyone who has suffered because of addiction reads this book. According to Sheff, the problem is only growing and must be dealt with as aggressively as we treat cancer.

[Angela Fitzsimmons · Rating 4 out of 5]

The idea that addiction is a disease is not new but it's a hard one to internalize and embrace. Sheff is working hard to cast addiction as a public health crisis in our country, which I believe it is, but titling his book "Clean" does something to undermine this. If an addict isn't "clean" then s/he must be "dirty." That implication still feels stigmatizing to me.

Sheff's personal experience with addiction has evolved from a narrative retelling of his own family's story (in Beautiful Boy) to a journalistic investigation of evidence-based treatments. Both of these are fine and helpful books but I have to admit that I was left wanting more of a call to action.

[Thomas Noonan · Rating 3 out of 5]

I've read and watched quite a bit on addiction (and some as it relates to prison population, cutting down deaths, mental health's role, et cetera) and this may be the most complete treatment of it.
It's well-researched, put together with empathy, and incredibly thorough, but given the nature of the subject matter only has a marginal call to action as an individual. It didn't open my eyes to anything new but it did reinforce my existing thoughts.

-Treatment is preferred over punishment for both addicts and people surrounding them
-Addiction often starts or is used in place of self-medication
-Demonizing addictive behavior does not help the problem for the addict or society
-Mind-altering substances, if not checked, and especially if consumed early in life, often spinout, even "harmless" substances like marijuana and alcohol.

Much of what is said about free will in this book could be expounded to deny it to all of humanity, as many professors now do. I don't agree with that philosophy, and so I felt consistently talked at throughout the book when it got brought up. It is also why his oft-used addiction-as-cancer analogy doesn't ring completely true to me.

Overall, things are better than they were 30 years ago and if we continue to prioritize mental health treatments as we've started to, it will only continue in that direction, but we haven't reached a point where we've found a type of treatment that works well for a significant portion of addicts, let alone a majority, only left to try one after another until one clicks, which is as frustrating a solution as there ever was one.

[Ashley Thompson · Rating 3 out of 5]

I think the author has some excellent points about addiction and I appreciate that he wants to take a new perspective on addiction and how we treat it. As a psychology doctoral student whose one of main interests is addiction I did have some issues with the book. First the term "clean" implies people who use drugs are "dirty" and therefore "less than" which I believe furthers the stigma Sheff is trying to fight. He also does not use person first language instead he uses "addict" as if people who have addiction are summed up by their disease and that's their whole identity. We do not say "cancers" we say "people with cancer" because they are so much more than their disease. I do not believe Sheff had these negative intentions as he seems to be a great advocate in the addiction field. Some of the research needs updating and he seems to brush off the fact that a lot of research suggests intervention may cause more harm than good. I personally believe his book "Beautiful Boy" was better

[Paul · Rating 5 out of 5]

Read this book! Clean is a wonderful introduction to the world of addiction and recovery. Sheff wrote an earlier book, Beautiful Boy that chronicled the son's struggles with addiction. In clean, Sheff demonstrates that addiction is a disease and not a moral failing. Sheff also discusses what some of the current treatments are for addiction. He also discusses various myths and preconceptions some people have about drug abuse. He pays special attention to the the misperceptions people have about marijuana use, that it's no harmful. The end of the book contains an appendix that describes briefly some of the potential risks for use of various drugs. I think many of us have at least known a friend or relative who has struggled with drug addiction. This book is useful to anyone who wants to know more about addiction and recovery.

[JoAnn W. · Rating 5 out of 5]

I wish everyone would read this book. Unfortunately, Goodreads has it listed by the wrong title. "The Thirteenth Step" is not its name. "Clean" is its name.

One out of twelve Americans has a problem with drug/alcohol addiction. This is one out of twelve Americans OVER TWELVE! Yes, that's right. Mr. Sheff reports that 90% of all who battle substance addiction began using BEFORE AGE 18 and 95% began using before age 21. These addiction statistics cover all regions of the country and all social and economic classes. Parents frequently have no idea their teens are using.

It is one of our most serious national public health problems and has reached epidemic proportions. Mr. Sheff lays it all out.

[Brent · Rating 5 out of 5]

The war on drugs has failed. The costs of rehabilitation, medical complications, and a lost generation should cause us all to ponder a better way. This book is an attempt to review the research on prevention and treatment of addictions in an objective manner. The science behind our biases are exposed and it is an urgent read for teen, parents, teachers, government, and other stakeholders in the battle.

[Brie · Rating 5 out of 5]

This is one of the most important books on addiction I've read and I've read plenty of them. This book offers hope as well as hard facts, and it's a great guide for people who are trying to find the right care, whether the reader is an addict herself or an addict's loved one. Highly recommended.

[Retha Van zweel · Rating 5 out of 5]

Very insightful and relevant, and very very sad & scary for every parent with pre-teens & teens.BUT Not just applicable to drugs, but to everyone who is living/had lived with any form of addiction. Highly recommended.

[Tom Costello · Rating 5 out of 5]

The best part was how to look for a treatment that scientific and evidence bases. What questions to ask of any treatment center.

[Tori · Rating 4 out of 5]

This didn't really have any new information that I hadn't heard before, but it was the best summary I have read of everything all in one place.

[Chris · Rating 1 out of 5]

I could not finish this book because of the explicit and descriptive drug use. I read Beautiful Boy though this one made me want to vomit so I stopped listening.

[Travis Lupick · Rating 3 out of 5]

This review was originally published in the Georgia Straight newspaper.
Learning one’s child is using drugs ranks among the most frightening moments a parent can experience. For those families, David Sheff has written Clean: Overcoming Addiction and Ending America’s Greatest Tragedy.
The New York Times contributor presents years of exhaustive research on prevention strategies, methods of intervention, and seemingly countless options for treatment and rehabilitation.
He insists that addiction is not a result of moral weakness, covering genetic predispositions, childhood trauma, stress factors, and what’s going on at a neurological level inside the brain of a drug user. Addiction is a disease and should be treated as such, he emphasizes.
He’s also not afraid to tackle popular misconceptions in ways that might irritate conservative sensibilities.
D.A.R.E.—the prevention program most widely adopted in North American schools—is astonishingly ineffective, Sheff reveals. Confrontational interventions popularized by reality-television programs often backfire. Treatment facilities’ zero-tolerance policies are counterproductive to the point of being criminal. “The War on Drugs has failed,” he writes. “We lost.”
It’s the result of a search through conflicting information that’s deeply personal. For years, Sheff’s son Nic struggled with an addiction to methamphetamine. “Part of me feels solely responsible,” Sheff conceded in a 2005 essay for the New York Times Sunday Magazine.
But while Sheff is aptly suited to the task he’s assigned himself, Clean’s strength as a guide for parents is also a weakness. Some sections read like an introduction for families who just discovered drugs in a teenager’s backpack. That risks leaving readers without children feeling like they can’t relate to problems framed this way.
And while confronting uncomfortable truths like those noted above, Sheff is careful not to stray too far outside the accepted discourse of conservative America. Clean is unabashedly a book about addiction within the borders of the United States, but even a single chapter examining other cultures’ attempts to deal with drug problems would have been a valuable addition.
Vancouver and its harm-reduction programs receive three paragraphs. Countries moving toward an end to prohibition, such as the Netherlands and Portugal, receive a couple of pages between them. But that’s it. These jurisdictions’ alternative approaches to drugs are in many ways successful, Sheff notes. And yet he doesn’t discuss them beyond brief mentions.
Omissions aside, Clean is a valuable addition to a nonfiction genre crowded with bold claims and questionable evidence. It’s a tour of addiction in America that relies on science, providing objective information about a disease that’s much more common than we like to admit.

[John Martindale · Rating 3 out of 5]

David Sheff tries to make the case that addiction is a disease and I did find some of his arguments pretty compelling. I myself have experienced the power of addiction (though never to drugs) and I can contest to how I feel powerless, how I can't seem to think clearly, care like I should or keep from doing irrational actions. Yet, I still must question Sheff's conclusions, because he overlooks a groundbreaking study done in the 70s, that is largely forgotten today. According to Sally Satel, during the 1970s opium and high grade heroine flooded southern Asia and it was estimated that at least 50% of all the men serving in the army tried one of the drugs during the Vietnam war and between 10-25% became addicted, deaths from overdoses begun to sore. The GI Addiction epidemic became a big deal and there was lots of fear, once the soldiers returned home, the the addiction would continue. So Richard Nixon demanded drug testing to be done and made it so no one could return to the States unless they passed (this was known as Operation Golden Flow). If they failed the test, they would have to enter an army sponsored rehab until clean. Once this was announced, almost every just stopped using the drug. And a 3 year study done on them after they returned home, showed out of all the heroine addicts, only 5% relapsed in the next 10 months, and 12% relapsed briefly by the end of the 3 year follow up. This study undercuts the "once an addict, always an addict" and the belief that addiction is a chronic brain disease. If so, then how is it that 87% of the veterans who were strongly addicted to a hard drug, managed to just stop cold turkey and never relapse again? There were lots of motivating factors, for one in Asia the drugs were cheap and helped them deal with the stress of war and once they learned they couldn't come back home unless they were clean, they found the motivation to say stop. Once back in the states, the fear of arrest, the high price of heroine and the shady drug culture didn't seem worth the risk, so most just transitioned back into ordinary life. This shows that in many ways the disease model ultimately fails. Lets says 50 percent of the solders got terminal cancer while in Vietnam, and the insensitive president said "You can't return back home until you are cancer free" then guess what, none of those with cancer would have come home, they couldn't have just made the decision not to have cancer. See how there is a difference? See how addiction being a disease is not quite accurate? Our sure the drug does mess with the brain, but there are other factors involved, maybe we have a little more of a choice then we thought.

[june3 · Rating 3 out of 5]

I will admit that I wound up skimming most of this book after the first few chapters.

David Sheff is so well-intentioned.
He has access to experts everywhere.
He has personal experience that counts where it matters.
He could had said so much, but this book wanders about and doesn't have nearly the impact that it could have had.

I almost cried with frustration at the missed opportunities for thoughtful discussion.

As but one example, on p. 14 of the edition that I have from the library, Mr. Sheff states "..I was stoned throughout high school." Not really a surprise, I suspected the same was true for many of my high school and college classmates. Yet no further thoughts on this (at least not right there). Not as part of a guilt-trip (heaven knows no one needs that). But just thinking - why didn't he succumb to addiction like his son (and so many others) did? What is the turning point? Is there a turning point? He speaks later on about the complicating issue of dual diagnosis and depression, but was that an issue throughout? Does he or anyone else have any sense of this? Some significant personal reflection on this issue would mean a lot.

Likewise, the section(s) on legalizing marijuana. There are very few people who think jail sentences for marijuana users makes sense for all sorts of reasons. But how does this help young people on the brink of addiction exactly? Is he trying to say that marijuana is safe? (I did not get that impression at all.) Is he trying to say that he thinks marijuana is NOT a gateway drug? Or that if it is legal that it won't be a gateway drug? This whole part felt very political (and contradictory) as opposed to prescriptive and helpful, particularly for very young people at risk.

I was hoping for something much more incisive and insightful.