An enterprising treatise on drug abuse and addiction intervention. During the time when Sheff chronicled his son's "hellish" heroin and methamphetamine addiction (Beautiful Boy: A Father's Journey Through His Son's Addiction, 2008), his desperate attempts to gain a compassionate understanding of the nature of drug dependency educated him thoroughly. This follow-up to that research defines the roots of addiction with clean, accessible language, examining the classic patterns of abuse from the first hit to full-blown dependence and from denial ("anosognosia") to treatment and recovery. Sheff offers new, sustainable solutions to a problem that has reached epidemic levels in this country (nearly 1 in 10 Americans has a drug problem). Among the many precepts the author lists is a belief that the drugs themselves are a "symptom" and not the sole cause of an addiction. He addresses the sciences of drug dependency, risk factors, the broken addiction-treatment system in place today and a family's crucial role in prevention. In terms of recovery, Sheff compares drug (methadone) versus drug-free (AA) routes toward achieving sobriety and eliminating relapses. Particularly fascinating is the author's profile of a Chilean doctor's observational research on the relentless behavioral patterns of fruit flies and mice exposed to alcohol mist, which demonstrates the seductive and ultimately irresistible nature of drugs like alcohol and cocaine. Sheff veers away from labeling addiction as a lost cause and rather offers new models, strategies and alternative therapies for abuse intervention and promising reform. Intelligent and thought-provoking views into the complexities of addiction and recovery.]] Copyright Kirkus Reviews, used with permission.

The statistics are sobering: drugs kill more than 300 people in the U.S. every day. Almost 10 percent of Americans older than 12 are addicted to drugs. About 90 percent of those who require treatment for addiction never get it. Sheff evaluates our nation's approach to the problem of drug abuse and finds it sorely lacking. Drug addiction is a chronic illness like diabetes, cancer, and heart disease but doesn't get treated as one. It doesn't afflict only bad people or just those who lack willpower. It is treatable and preventable. Once we acknowledge that drug addiction is indeed a disease, our public policy, research, and treatment will profoundly change. Sheff chronicled his oldest son's drug addiction in the memoir Beautiful Boy (2007). Here he lashes out at the pseudoscience, moralizing, and scare tactics that characterize the current system. He shares addicts' stories and information from researchers and experts and reports on his visits to treatment programs. Sadly, no surefire treatment presently exists for all types of addiction. In Clean, Sheff advocates not for punishing drug addicts but for treating them.--Miksanek, Tony Copyright 2010 Booklist

IT must be the purest agony to be the parent of a child succumbing to drug addiction. David Sheff's previous book was an account of his son Nic's descent from a thoughtful boy to a sullen pothead to a self-destructive methamphetamine fiend, and of his own tormented and bewildered reaction. If that book, "Beautiful Boy," was a cry of despair, "Clean" is intended as an objective, if still impassioned, examination of the research on prevention and treatment - a guide for those affected by addiction but also a manifesto aimed at clinical professionals and policy makers. Sheff's premise is that "addiction isn't a criminal problem, but a health problem," and that the rigor of medicine is the antidote to the irrational responses, familial and social, that addiction tends to set off. Sheff, a journalist, writes that America's "stigmatization of drug users" has backfired, hindering progress in curbing addiction. The war on drugs, he says bluntly, "has failed." After 40 years and an "unconscionable" expense that he estimates at a trillion dollars, there are 20 million addicts in America (including alcoholics), and "more drugs, more kinds of drugs, and more toxic drugs used at younger ages." Sheff says that drug addiction is a disease as defined by Stedman's Medical Dictionary, since it causes "anatomic alterations" to the brain that result in "cognitive deficits" and other symptoms. But isn't drug use an act of free will, distinguishing addiction from other diseases? Sheff responds that behavioral choices contribute to many illnesses: think of unhealthy diets and diabetes. Like other diseases, addiction has a substantial genetic component. Mental illness and poverty are major risk factors. These susceptibilities help explain why 80 percent of adolescents in the United States try drugs, but only 10 percent become addicted. Sheff emphasizes the vulnerability of adolescents. Neuroscience corroborates our intuition that their impulsivity develops faster than their inhibitions, and drugs may stunt their emotional growth, making them yet more prone to addiction. Although the medical approach to drug abuse has yielded techniques with proven effectiveness (Sheff's touchstone is "evidence-based treatment"), he is scrupulous about not overselling it. "Addiction medicine isn't an exact science," he concedes, "and it's still a relatively new one." Treatment programs have success rates that are only comparatively less dismal than doing nothing. Just a small minority - even the claim of 30 percent may be inflated - of addicts who have been treated remain sober for a year. "The persistent possibility of relapse," he says, is a "hallmark of addiction," which he calls a chronic disease requiring lifelong vigilance. He laments the variable quality of treatment programs. Even in some expensive clinics, medical professionals are scarce, and the worst programs border on "voodoo." Sheff may lose some readers as he sprints through the research for every aspect (neuroscience, social science, psychology, law) of every stage (preventing early use, identifying abuse, detox, treating addiction, maintaining sobriety) of every drug problem. Though leavened by profiles of addicts and their healers, "Clean" feels overstuffed and miscellaneous, in the same way that a 300-page overview of everything we know about cancer would. Nevertheless, Sheff is a skilled journalist on an urgent mission. He prevailed over the anger and hopelessness he felt at his son's affliction by calling upon great reserves of love and discipline to investigate what might help - first as a father and then, in this book, as a reporter and an advocate. His forbearance and clearheadedness could serve as an example for America as it confronts its drug problem. He has performed a vital service by compiling sensible advice on a subject for which sensible advice is in short supply. 'Addiction medicine isn't an exact science,' Sheff writes, 'and it's still a relatively new one.' Mick Sussman is the assistant day editor for The Times.

Reviewed by Hunter R. Slaton. Sheff's bestselling Beautiful Boy: A Father's Journey Through His Son's Addiction flipped the script on the traditional first-person addiction memoir, painting an agonizing portrait of what one family went through when its "beautiful boy," Nic Sheff, descended into years of methamphetamine addiction, deceit, and relapse. By the final page, he had been clean for a full year. But while the story may have ended for Sheff's family, the tragedy continues for the 20 million Americans who are currently addicted to drugs and/or alcohol. Thus, Sheff the elder is back; in his latest, he takes a macro look at the micro problem detailed in Beautiful Boy, to examine the state of addiction and addiction treatment-sadly lacking, he finds-in the U.S. today.As Sheff sees it, the chief impediments to preventing and treating addiction are the same ones that existed when Alcoholics Anonymous was founded 78 years ago: the stigma associated with addiction, and the belief that drug abuse is a choice, rather than a disease. Sheff once held this belief, but his thinking evolved over years of grappling with his son's addiction. Clean is at its best when the author grounds his conclusions in real-life trials and tribulations, whether his or others'.Unfortunately, the book is at times too thinly peopled, descending into rote lists of best practices and expert opinions, as exemplified by the chapter "Beginning Treatment": "All support staff working with patients should be well trained and closely supervised"; "Programs should evaluate whether it would be beneficial for family members to be involved in treatment"; and so on. These passages are a perfect illustration of why a writer should always "show" rather than "tell."But when Sheff lets recovering addicts and their families make his case for him, the story is gripping and vibrant-Luke Gsell tells about finding himself in rehab on the night before his 15th birthday, gobbling down stolen Dramamine: " 'Everything snapped,' Luke said. 'I thought, This is my one shot and I'm getting high. I was tripping on seasickness pills in rehab... I recognized that I was an addict. I said, 'I'm done with this.' " The book is not this vivid or cathartic throughout, but Sheff makes his case methodically and convincingly, finishing with a stark look at the failure of the War on Drugs-and a comparison to the far more effective wars on cancer and AIDS, fought with the weaponry of "education and prevention, changing public policy, and improving treatment," rather than "interdiction, arrest, prosecution, and eradication." "The war must be ended," Sheff concludes-and a new, more benevolent approach, outlined in a set of cleverly rewritten "12 Steps," begun. Hunter R. Slaton is an editor at the TheFix.com, an online magazine about addiction and recovery. He lives in Brooklyn, N.Y. (c) Copyright PWxyz, LLC. All rights reserved.