NCFY Reads: 'Clean: Overcoming Addiction and Ending America’s Greatest Tragedy'

Photograph of young man wearing a hooded jacket.

“Clean: Overcoming Addiction and Ending America’s Greatest Tragedy”

by David Sheff

Journalist David Sheff recounts his teenaged son Nic’s descent into methamphetamine addiction and homelessness in vivid detail in his first book, “Beautiful Boy.” He struggles with how to help his son – Should he go pick him up when he calls from the streets? Give him money when he has no food? Find another rehab facility when he’s relapsed or run away from the last?  

Because he was able to find no good answers at the time, Sheff dedicated his second book to making sense of the research behind addiction and the evidence-based approaches that are emerging to prevent and treat it. The result is “Clean: Overcoming Addiction and Ending America’s Greatest Tragedy,” a helpful read for family and youth workers who would like a better understanding of what addiction does to the brain, how and for how long the damage affects behavior, and what practices might help reduce the impact.

Told through a combination of compelling addiction stories and interviews with leading scientists, Sheff reviews one by one the risk factors for substance abuse – genetics, poverty, divorce, trauma, learning disabilities, behavior disorders and mental illness, among others. Then he discusses what research shows about what could counteract those factors – that family strength matters, that honest conversations with adults who really listen helps, that youth development strategies give young people a reason not to use drugs. He writes:

Rather than fight the teenage brain, we can work with it. We can help kids become immersed in positive rather than negative experiences that can sate their curiosity, engage their passion, and harness their impulsivity. We can try to help lessen the stress on them, and we can teach them ways to deal with the stress they’re under. We can guide them so that they’ll be in situations in which it’s safe to succumb to peer pressure. We can provide them with facts about specific drugs and the way they affect the brain so they can make informed decisions. We can help them find safer and more effective ways to separate and smoothly transition into each new phase of life. Finally, we can diagnose their psychological and cognitive disorders early – and treat them. Only when we do all those things will we begin to turn the tide and decrease the number of people who try drugs, abuse them, and become addicted. 

In the final section of the book, Sheff reviews the different types of treatment strategies: detoxification, outpatient and inpatient rehabilitation, boot camps, sober living homes and 12-Step programs. While he finds huge gaps in the research about the effectiveness of each of the approaches, Sheff uncovers some components that seem promising: motivational interviewing, cognitive behavioral therapies and skill building.

Because the research isn’t definitive, “Clean” often raises as many questions as it answers: When and how do you intervene when someone is using, but not yet abusing, substances? Where is the most appropriate place to refer an addict? Are adult treatments appropriate for youth? For those looking for the answers that exist, though, “Clean” is a great place to start.

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