When journalist David Sheff and his son, Nic Sheff, released their twin memoirs (“Beautiful Boy” and “Tweak,” respectively) in 2007-08, readers had the unusual opportunity of seeing addiction’s hellish impact on families from both sides of the awful divide between an addict and his loved ones.
It’s impossible to decide who got more beat up in the process: The father, who watched his son “shooting poison into his arms, arms that not 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.” Or the son, whose meth-addicted descent took him to places that were unimaginable, including stealing from his little brother and prostituting himself on the streets.
David Sheff followed up his memoir with “Clean,” just released in paperback, in which he transforms his horror, helplessness and self-blame into a rigorous exploration of the field of addiction and recovery. His quest took him across the country – into labs, treatment centers, clinics, schools and research centers – exploring everything from the risk factors associated with drug use to the efficacy of various treatment programs and the promise of new therapies. He’s well past the hand-wringing stage, and is issuing a national call to action.
David Sheff will talk about “Clean” at 7 p.m. Thursday, Macalester Plymouth Church, 1658 Lincoln Av., St. Paul. William Moyers, vice president of public affairs at Hazelden Foundation, will moderate the discussion, which is free and open to the public.
In a recent interview, I spoke with Sheff about teens, marijuana, buprenorphine, and his beautiful boy. Here are excerpts from our conversation:
MinnPost: “Clean” notes that illicit drug use among teens is higher in the United States than in other countries. Why do you think that is?
David Sheff: There was a survey of kids across the country and their parents, thousands of them, and the main question was, “Why are you using?” Overwhelmingly parents said that the reason was peer pressure and that kids just like to get high. But the kids responded differently: They said that by far the No. 1 reason was stress. It really says a lot. We all know adults who come home from a really stressful day and say, “I need a drink” – because it works, it does alleviate stress. And if you’re a kid dealing with anything from the intense expectations around academics – filling out college résumés when you’re 12 – to poverty, a family in disarray, depression, psychiatric problems, learning disabilities, autism, or eating disorders, you are really susceptible to using as well.
MP: Why have so many of the country’s education and prevention efforts – especially those geared to teens – failed?
DS: Teenagers are smart, and we’ve been talking to them as if they aren’t. They are very skeptical of the messages they receive from adults on any issue. So many of the warnings about drugs in the past have been perceived to be exaggerated – “This is your brain on drugs” – and once they’re perceived to be exaggerated, kids sort of write off everything you say. Also, 70-some percent of schools in America use DARE, and research has shown that not only does DARE not work, it actually increases drug use … because it normalizes it. There’s so much exposure – a sense of, you know, everyone out there is doing it – almost as if you’re not cool if you’re not. That’s not the message that was intended.
MP: What does a successful prevention campaign or program look like to you?
DS: Instead of saying, “This is your brain on drugs” [and showing images of sizzling fried eggs], show what happens to your brain in an objective way. I talked to a group of teenagers and showed scans of kids’ brains who don’t use and scans of kids who’ve used a lot of drugs, including just pot, and you can see the impact. That’s very powerful for kids, and it makes them think – because you’re not talking down to them, you’re giving the facts. It’s not emotional or hysterical.
Another thing that’s been shown to work is to acknowledge who teenagers are. Part of being a teenager is wanting to rebel – they want to be different. Thetruth.com was a really effective anti-smoking campaign, for example. It wasn’t warning about the dangers of cigarettes so much as showing kids how they are being manipulated by the tobacco companies. Really powerful stuff that was shown to lower cigarette smoking. Teenagers like to think that by using drugs they’re rejecting their parents and popular culture. But this [campaign] is showing that, no, you’re actually doing the opposite – you’re doing exactly what they [the tobacco companies] want you to do.
But the only way that we’ll make a big impact is to work on what is stressing out kids overall and try to address that culturally. There are a lot of high schools now proactively looking for kids who are having problems at home – their parents are getting divorced, there may be violence. And even more subtle problems, such as breaking up [with a boyfriend or girlfriend]. We all know it’s such a temporary problem and people recover and that it happens all the time. But teenagers don’t know that. The pain they feel and the fear they have about being alone and rejected is huge, obviously. Another huge piece of this is training parents, teachers and pediatricians who are on the front lines. One study showed that among kids who were having serious drug problems, about 6 percent of pediatricians were able to diagnose the problem. That means 94 percent were not.
If you think your kid is using, they’re using. We may worry, but we push the worry aside, and the problem gets worse. And of course, the sooner we’re able to help kids, the less likely they’ll get worse.
MP: We’ve come a long way in understanding the disease of addiction, but the notion that it is a moral failing – a matter of choice – persists. Is this unique to American culture? And what’s been the impact of this thinking?
DS: They have surveyed people across the country, and the words people use to describe drug users, especially addicts, are “weak-willed,” “immoral,” “sinners” – really dramatic stuff to show that there is this judgment instead of an acknowledgment that these people are having psychiatric problems including addiction. And there are some countries where alcoholism and addiction are so stigmatized that the last thing anyone would ever do is go into treatment. If you look at the official numbers of people who are addicted in China, for example, it’s really trivial. But when I’ve talked to people in the field, they say there’s no distinction between a criminal and someone who’s addicted, and no recognition that an addict needs help. It’s true in some countries in the Middle East, too.
The reason it’s important to focus on this is because it explains in some ways every stage of the problem. The idea that it’s “bad kids” who are using puts this moral judgment on them when they’re very young. It makes it worse. Kids are already on some level feeling bad about themselves. They’re treated worse [if they are using], in some cases kicked out of school – all the things that are the opposite of what you want to do. You want to embrace a child who’s experimenting with drugs and try to educate them.
That judgment extends to people when they’re older. People who are on drugs are thinking with a part of their brain that makes them do things that they would never do otherwise – the moral center of the brain is dismantled, and the part of the brain that’s in charge is the one related to impulsivity, driven by a need to feed the addiction. People who do that stuff appear to be immoral. And we’re afraid of them, understandably, in many cases. But moral judgment makes the problem worse: People don’t seek treatment, their drug use increases, they go underground and become isolated, and they eventually enter the court systems.
The more we as a culture acknowledge that addiction is a disease, the more we’re going to treat it early. And when we treat it early, the less likely that someone who’s addicted is going to progress to the point where they are breaking into someone’s home or becoming violent.
MP: Minnesota, like other states, is once again debating a medical marijuana law. What do you think so far about the nature of this debate – medical marijuana and legalization generally – in our country?
DS: There’s research that says marijuana helps tolerate chemotherapy and things like that. If it helps people who have cancer, of course, they should be able to have it. Critics correctly charge that some people are abusing the system. I read about somebody in California who said his wrist hurt from typing too much, and they gave him a [prescription]. But that’s a problem of execution.
I think this question about medical marijuana is a red herring, and it’s too bad we’re talking so much about that.
The legalization question overall is complicated, too. A lot of the people who support legalization say that marijuana is harmless and that it’s natural and safer than drinking alcohol. But it really does not do the argument justice, because they’re not acknowledging research that says marijuana actually is harmful to kids. For teenagers whose brains are developing and who may have other issues – like learning disabilities or attention deficit disorder – marijuana has a huge impact. A lot of times marijuana affects cognitive functioning. So I don’t think kids should smoke pot.
But I think the approach we are taking actually makes it worse. When it becomes about criminal justice, legality, arrests – once again we are back to the moral question. “These are bad people doing bad things,” instead of saying, “It’s normal for kids to be curious about marijuana and drinking … and so we want to help them instead of labeling them and stigmatizing them.” And also, by the way, there is some research that suggests that illegality makes it more attractive to some kids.
And marijuana laws are not enforced across the board equally. We have 2 million people in prison right now, and a huge majority of those are disproportionately African-American. There are statistics that show that African-Americans use drugs at the same rate as others, but that they are three times more likely to be arrested. And again, that’s the last thing you want to do – put someone in the criminal justice system if they’re starting to use drugs.
My major qualm is because of the argument that some people make that once marijuana is legal, we’re going to have the equivalent of cigarette companies advertising to kids and pushing it. A part of legalization should be putting into place regulations that can control that. I think we should legalize marijuana and regulate it more intensely than cigarettes and alcohol. And it could be a model for increasing regulations for cigarettes and alcohol. And I think we should be talking about the real problem – which is why people use and how we can stop them.
MP: Did you read the New York Times investigation on buprenorhpine? And if so, what did you think?
DS: It’s just really dangerous what the Times did. Every single piece of research that I’ve read – and I’ve read a lot and I’ve talked to a lot of specialists – says that if you have an opiate addiction, the prognosis is so much better, and I mean hugely better, for patients who are given Suboxone or buprenorphine or vivitrol [to support their withdrawal and recovery].
Roots in the Twelve Step world suggest very clearly that you do not treat drug problems with drugs. But Hazelden rocked the whole world last year by announcing that they were going to start using Suboxone [for opioid addicts]. [Medical Director] Marvin Seppala said there were just too many people going in for treatment and relapsing after they left. Nobody wants to support drug companies, but we need everything we can get that is going to help people get sober and stay sober. And if we have a medication for a problem that you know is chemically rooted – and addicts’ brains process drugs differently – and would help interrupt that process, then great. We are a long way off, but research also has suggested that soon there will be vaccines for certain kinds of addiction. And behavioral treatments are getting better, too.
MP: This process of coming to understand that addiction is a family disease – is that a never-ending process? Is any parent whose child struggles with addiction ever able to achieve some peace around this?
DS: I didn’t think you could, but I think I have. It’s been five and a half years that Nic’s been sober. And I really get it. I understand that my son has this illness – and understanding that changes the dynamic completely. Instead of looking at him as I first did – as selfish, out-of-control, arrogant – I know he has this illness. And the research suggests that the longer he stays sober the more likely he’ll stay sober.
We know that relapse can be a part of recovery, and so I understand that too. Every day, by the way, I get so many letters from people who are struggling with addiction, and as you can imagine they are heartbreaking. People ask me, when they’re so hurt, just so damaged by this process by a child who’s addicted, is it ever possible to forgive, to have a real relationship with them again, to trust them enough to come home?
Forgiveness is possible, but it takes time, it takes effort. And in treatment Nic was able to become aware enough to understand that he had to do a lot of work himself to repair the damage – especially with his little brother and sister. I hear it over and over: Recovery is possible. Not only can you get sober, but your life can be better than it ever was – you appreciate things and you appreciate people in a different way. It’s absolutely true, and I see it in our family.