TERRY GROSS, HOST:
This is FRESH AIR. I'm Terry Gross. Why do we imprison people who are addicted to illegal drugs instead of treating them for their addiction? That question is at the heart of David Sheff's new book. It reports the latest medical and scientific research about addiction and recovery, which Sheff says shows that drug addicts are gravely ill, afflicted with a chronic, progressive and often terminal disease.
In his previous book, the bestseller "Beautiful Boy," Sheff wrote about how his son Nic's addiction nearly destroyed himself and the family. Nic started smoking marijuana when he was 12, and eventually moved on to shooting heroin and crystal meth. Nic has been clean for five years. Nic and David Sheff joined us together in 2008, when "Beautiful Boy" was published. David Sheff's new book about addiction research is called "Clean."
David Sheff, welcome back to FRESH AIR. So...
DAVID SHEFF: Hi, Terry. Thank you.
GROSS: It's a pleasure to have you back. What were some of the assumptions you made about your son and his addictions that turned out to be wrong, knowing what you know now about, you know, the science and medicine?
SHEFF: When, you know, when Nic became addicted, I was completely uneducated, and basically everything I assumed at the time turned out to be wrong. I guess the main thing is that I was so blindsided, that I had this idea of, you know, what an addict looks like, and it didn't look like Nic. And I realized that, you know, anybody can become addicted. We all think we're immune, and no one is. We certainly weren't.
And the other thing is because of the crazy, insane, reprehensible behavior that comes with addiction often, I just couldn't understand. I thought Nic was making these horrendous choices. I just couldn't imagine what was going on.
And only when I realized that this is a disease, it's a brain disease, and my son was ill was I able to understand and also sort of look at him in a different way, with compassion instead of judgment and anger and fear.
GROSS: Yeah, addiction as a brain disease is one of the main points of your book. But what do you mean by that?
SHEFF: Well, first of all, Nic became a different person, and the only explanation I ultimately came to was that he was ill. At first, I didn't believe that. I thought, you know, he was just this selfish, crazy teenager. But then the more I learned, I mean, 10 kids would go out after school, you know, by the playground or wherever they go, and they all smoke pot. Or at a party on a Friday night, they'll all drink. And one of those, possibly two of those, will become addicted.
So there's something different about that person. There's something different about the brain. And I've seen brain scans. There's so much research now that shows that people with addiction process drugs differently. Their neurological system is different. A different part of the brain is in - is sort of in control. And, you know, we think about addiction as a morally reprehensible choice, but addicts act crazy because, in a way, that they are.
GROSS: You know, a lot of people hearing this will say, oh, he's letting addicts off the hook. He's making them not responsible for their own behavior. You can choose not to try heroin. You can choose not to try meth. And therefore, you won't get addicted to it, because you have to use it in order to get addicted in the first place. So, at the very least, it starts with a bad choice.
SHEFF: Well, addiction does start with a choice. I mean, even that, you know, I have some sense that it's not completely even a choice, in one way. Certain people are more likely to use drugs because of whatever it is: They've suffered some trauma in their life. They have risk factors like mental illness, people with learning disabilities, with attention problems.
So the likelihood of somebody, you know, using drugs, especially hard drugs, it increases for some people. But still, yeah, it is a choice to use or not to use at first. But so many people use. So many people try drugs, and a very, very few, you know, a small percentage become addicted. No one chooses that piece of it. So that's where the brain disease comes in.
GROSS: One of the things you learned with your own son is that he had underlying problems. I mean, he started smoking marijuana when he was 12. And after he was addicted and went into therapy, he was diagnosed with bipolar disorder, which you weren't aware of. He wasn't aware of that. And you learned that Nic wasn't alone, that, you know, a lot of people who become addicted have underlying psychological or psychiatric problems.
How does that interact? Like, how does an underlying psychological problem like depression or bipolar disorder affect somebody's likelihood of getting addicted?
SHEFF: The motivations for using drugs, often it's pretty obvious and common: you know, peer pressure. You know, kids are struggling growing up. They're stressed. You know, they get high, and it makes it a little bit easier. But they say, you know, the researchers say that anywhere from 60 percent up to, you know, 80-or-so percent of the people who become severely addicted have psychological disorders.
And, well, Nic describes the first time he used in high school as transformative. It wasn't so much about being high. It was about feeling OK for the first time in his life. He said that he didn't know that it was possible to feel an absence of the intense anxiety that he felt, the intense depression. So when he got high, it was just life-changing, and that happened.
GROSS: High on what?
SHEFF: We were skiing up in the mountains, and he brought a friend. And my wife Karen and I were - we went to bed, and he and his friend stayed up, and they were watching TV, and they broke into the liquor cabinet. And they poured, you know, huge, tall cocktails. And his friend sipped it and was so appalled that he spit it out and said, God, you know, what's - why do people drink this stuff?
Nic says that he sipped it, and it was heaven, and he downed the glass. And he said that feeling was just like nothing he'd felt in his life. And he spent - because he became addicted so quickly, when he was finally clean for a while, and so a doctor was able to diagnose that he had bipolar disorder and depression. Up until then, it was hidden, because he was using.
And Nic was self-medicating for whatever psychological disorders he has. There has been, you know, a lot of research that shows that it's so much more likely for somebody to become addicted if they have these disorders.
GROSS: So, you know, you write in the book that going through detox is just the first step. You know, after you've given up the drug and you've come out the other end, you still need treatment, and maybe not just, you know, a 12-step kind of program. Maybe you really need psychiatric treatment and medication to help you through whatever the problem was that helped lead to your addiction in the first place.
SHEFF: There was a really dangerous idea for so long that all someone had to do was get off drugs, they had to detox, you know, they had to go through cold turkey, and they would wake up in the morning, and they'd be sober. But the problem is whatever drove them to use in the first place is still there, and that is the biological underpinning of a lot of what leads to addiction and also the - whatever social stuff is going on.
I mean, if a kid is in a neighborhood that is really stressful, if their family is exploded in some ways, and they're suffering, if they have an underlying mental illness, you know, they're sober. They're clean for a minute, but then they're going to feel all of those things, whether it's depression or anxiety, or it's just stress or awkwardness.
And, you know, drugs have always been a solution for them, and so it's too hard to stay sober. And by then there also has been a change in the brain so that they are deprived of dopamine, so they're - if they were depressed, they're more depressed, and they don't feel - they don't feel joy. They don't feel that they can even function in life.
So, you know, this cycle, this cycle begins again. So being sober is just the first step. Getting off drugs is just the first step, and then treatment really begins. If someone has psychological disorders, most often they haven't been diagnosed. Whether they have or haven't, they need to be treated. If someone is struggling in some other ways in their life, they need help.
GROSS: David, let me reintroduce you for our listeners just joining us. My guest is David Sheff, and he's written a new book called "Clean: Overcoming Addiction and Ending America's Greatest Tragedy." And it's about evidence-based therapies that are proven to be reasonably effective for treating addiction. It's a follow-up, in a way, to a memoir he wrote a few years ago called "Beautiful Boy" about his son Nic, who became an addict when he was in his early teens and remained an addict for about 10 years and is now a professional writer.
Let's take a short break here, and then we'll talk some more. This is FRESH AIR.
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GROSS: You write that young people are more susceptible to addiction, and addiction is especially dangerous for young people, and this all has to do with the development of their brain; the part of the brain known as the prefrontal cortex is still developing when you're young. Talk about the importance of that part of the brain in a young person's development and then in addiction.
SHEFF: Well, kids are the most vulnerable to becoming addicted, and there are a lot of reasons. One of them is, you know, it's a really stressful time in their lives. I mean, being an adolescent is really hard. But there also is this underlying - teenagers' brains are developing more rapidly than at any other time in their life. But all the parts of the brain don't develop at the same time.
So the frontal part of the brain, which is associated with judgment and rational thinking, is lagging. So it's not in control. And meanwhile the first parts of the brain to develop is the rear portion, which is associated with pleasure-seeking and impulsiveness. So it's in control.
And that's - we always think about teenagers being impulsive, you know, they want to experiment, they have all kinds of crazy, reckless behavior. A lot of it is because of that. Their brain hasn't developed to the point where they can moderate these impulses. So it's much more likely that kids are going to use drugs, and they're more likely to use them excessively.
And then, because of the drugs, it makes things worse. So the development is even slower. So the part of the brain that normally would regulate, would help kids make better decisions, isn't in control. And so they start using more, and there's this cycle.
And that's where addiction comes from. Ninety percent of the people who become addicted started using when they were teenagers, before they were 18.
GROSS: A lot of memoirs written by people who had been addicts start with them hitting bottom, you know, the absolutely worst imaginable thing that happened to them because of their addiction. And then they hit bottom, and then they go into rehab, and they seek treatment, and then things start to turn around. And then the book kind of begins.
And so many stories, just like addict stories that, you know, are told, you know, start again with, like, hitting bottom, and I think a lot of people assume that if you love somebody who is addicted to a substance, that until they hit bottom and until they really realize that their life is at stake, that their dignity is at stake, that there's no way they're going to give up, you know, the drug or the alcohol. And you make in the point in the book that that's not necessarily true, that if you love somebody who is an addict, you don't need to wait until they hit bottom. You can intervene and perhaps intervene effectively.
SHEFF: If you love someone who's an addict, and their use is life-threatening, you don't wait until they hit bottom because that can mean that they're going to die. You have to do everything you can to get them in treatment. There has been a history of so much misinformation about the ways that we confront addiction. Part of it was just that we didn't know.
And now we know that it's too dangerous to wait for a person to hit bottom. I mean, I've heard over and over again that people were told that they had to let their kids, you know, their husbands, their wives whoever it was, they had to stand back, not to intervene, let them hit bottom so they would crawl into a treatment center and say please help me. That idea, it's so dangerous, it has killed so many people.
The other problem with it is that this is a progressive disease, which means that as long as it's not being treated, it gets worse. So the longer we stand back and we allow this to happen and allow the drug use to continue and allow the, sort of the behavior that is caused by the drug use to worsen so that someone is going to use more drugs and it's just a cycle, the harder it is to treat them.
So addiction is a disease like anything else. It's like cancer, like heart disease, like diabetes. And we know that, you know, at the first signs of serious illness we want to seek treatment. If someone in our families had early warning signs of any of those diseases, we would bring them to a doctor to figure out what is going on. We would not wait until the disease progressed because it's harder to treat, it's more dangerous, it's life-threatening. So we want to intervene the second we get a sense that there is a problem.
GROSS: But, you know, with addiction, and this is different from cancer, a person has to be willing to change, to stop using. And, I mean, you can lock them up in an environment where they can't get drugs, you know, whether that's prison or, you know, put them in rehab where there's not going to be any drugs. But when they get out, you know, unless there's constant surveillance, they still have to make that decision to not use.
Let me give you an example of a story that you've told about your son when he was addicted, that he would call you, you know, from the street and say you have to pick me up. I think I'm dying. You have to come get me and take me home. And you didn't want to do that because you'd been burned before. You'd take him home and he would steal from you. He would do things that would be dangerous for your younger children to observe.
So you finally said to him no, I'll pick you up and I'll take you to rehab. And your son said no, I don't want to go to rehab, it doesn't work for me. You need to take me home. And you said call back when you're ready to go to rehab, and you hung up. So if you had to do that over again, would you think that that was the right way of handling it?
SHEFF: No, I tried, though, so many times to get him into treatment, and I would do anything it took. I would drag him off the streets. I searched for him. When I could find him - you know, I just did whatever it took to get him into treatment. And it hadn't worked. Every time he would go into treatment, he would do fine for a while, and then he would relapse.
So my assumption was that relapse proved that the treatment hadn't worked. What I now know is that many times, not always but many times, relapse is a part of this disease. So addicts get sober. It's a chronic illness. The craving doesn't go away unless it's being treated in a way that it needs to be treated. And relapse is common.
So that means that even though Nic was resistant to going back into treatment, every time I had to do whatever I could to get him into treatment. And when Nic called up begging me to go back, telling me that he was going to die, so many times I had succumbed. I mean, all I wanted to do was - never mind to get him help, but I just wanted to see him, to see that he was alive.
But I finally listened to the messages of these rehab programs that talk about this tough love thing and that he had to hit bottom. And I hung up the phone, and I wept. It was the hardest thing I'd ever done. And he did call, you know, just a few days later and said he was ready to go into treatment. But he absolutely could have died.
GROSS: In that story, you basically had two options that I can think of. One is to say, well, if I'm not driving you to rehab, I'm not picking you up at all. And the other is OK, I'll take you home. You chose the "if I'm not driving you to rehab, I'm not taking you home at all." And you think you're lucky that he didn't die as a result and that he chose to go to rehab a few days later.
So in retrospect, do you think you should have chosen the other option, which would have been "I'll take you home," and maybe he wouldn't have gone to rehab?
SHEFF: I think that every situation is different, and in retrospect, it was fine. In retrospect, you know, it worked. But if I was there again, I would have gone to get him and brought him home and done everything I could to get him into treatment because every day he was out there, it was so dangerous.
I mean that night, I didn't sleep; of course, I was just petrified. And I had a reason to because he could have gone out and scored and overdosed and died. If I'd got him home, at least he would have been off the streets, and I may have been able to get him back in treatment, and I would have done everything I could to get him back.
And, you know, there was a good chance that I could have, and maybe not. And maybe he would have left again. But I would have done it again and again. I don't even know if it's - you know, in every circumstance if that's the right approach. But the way I feel now, yeah, you want to get your kid off the streets. It's too dangerous out there.
GROSS: David Sheff will be back in the second half of the show. His new book about the latest research into addiction and recovery is called "Clean." I'm Terry Gross, and this is FRESH AIR.
GROSS: If your child is under 18, you can force them to go into rehab, right?
SHEFF: In most places you can. It's - yes, you can. It's not easy. Sometimes it's in some states it's really complicated; you have to get judge's orders. You have to essentially commit them. A police officer maybe has to come and pronounce them, you know, a threat to themselves or someone else. But still, parents do have the legal right to get their kids into treatment.
GROSS: Did you ever do that?
SHEFF: I never had to resort to any kind of legal means of getting Nic into treatment. But still, I had a lot of leverage. You know, he was living at home. He would be desperate. He would want to come home. He would want help. So he would call me up and he would be willing to go to treatment. So I had some leverage. And parents do. Sometimes, you know, there are things - I never had to do a formal intervention but people do them. They're dangerous. One of the pieces of advice I got over and over again from professionals is that they must be done by professionals, by people who are trained to do interventions. They know what's going on and they understand the risks. But I never had to do that. I was able to get Nic into treatment other ways. But whatever it takes. Whatever it takes to get someone into treatment, that's what we got to do.
GROSS: What were the other ways?
SHEFF: Well, sometimes Nic would just get tired of being out there and he would be so desperate. He would, you know, he just wanted to get off the streets because he would be miserable. You know, it wasn't necessarily even life-threatening. And so he was willing to go into treatment, because that was my deal. I'll come pick you up, you know, drive you to a treatment center, check you in. And so he would do it. But as things went forward - I mean, the last time Nic relapsed, you know, he had been sober for a long time. It was after Nic and I talked to you on your show and, you know, one day we were together and he said, I cannot believe what I did. I was at someone's house. Just almost automatic, I opened up the medicine cabinet. There was a bottle of Vicodin. I took one. I thought to myself, just one, which is common for addicts to, you know, that's the first thing that they'll say to themselves and to us, and soon the bottle was gone and he said, I woke up this morning and realized that if I don't do something, I am going to be back on the streets within a week.
So he, you know, this was the first time I didn't have to say a word. He got on the phone, he called the Hazelden Treatment Center in Minnesota. He was on a plane that day. To me, it's possible to look back on that and say, you know, all the treatments before that were a failure: Here he was sober for such a long time and he relapsed again. But to me, it's the opposite: It shows that the treatments had helped him so much that he was able to recognize that he was in a free fall, that it was so dangerous for him. He knew - he had learned what they teach in a lot of treatment centers, this behavioral cognitive thing where you can interrupt either the craving that would lead to relapse or you can stop a relapse early. And if you can, you know, you've made so much progress.
One of the things they talk about with addiction is progress, not perfection. So, you know, when Nic got on that plane that day, I saw great, great progress. And since then he's been sober. So it shows that it's possible. I mean, people think that treatment can't work. Nic's proof that it does.
GROSS: So let's talk a little bit about 12-step treatment programs. You have a lot of experience with them because I think Nic had been in a 12-step program. You've probably gone to, you know, a 12-step program for parents.
SHEFF: Al-Anon. Yeah.
GROSS: Yeah? And then you visited them just as research for the book. So you see, you know, positives and negatives with the 12-step program. So I think most people know what the positive parts are. But what are some of the problems you have with 12-step?
SHEFF: The 12 steps are completely a profound, you know, treatment for so many people, but not most people, and that's the problem that I have. It's not with the 12 steps. It's only - many, many rehabs are based on this idea that the 12 steps are the key, are the only way to stay sober. That's my problem. You get people in treatment - especially teenagers - I mean, what is it to be a teenager? It is to feel, you know, this powerfulness, and part of the 12 steps is that you have to admit that you are powerless over your addiction. You have to turn your life over to a higher power. You know, teenagers - some do, of course, but part of being a teenager is you're not going to turn your life over to anyone. So a lot of people leave treatment. They get completely turned off to it. They won't go back. So my problem with the 12 steps is only when it's forced, and it is forced in many places. Nic was kicked out of some treatment programs because he wouldn't embrace the 12 steps. And so we have to understand that, you know, there are many ways to get sober. And the 12 steps is one and it works for some people, but there need to be alternatives.
GROSS: Did you find the 12 steps helpful?
SHEFF: I never went through the 12 steps. I think the idea of the 12 steps are - especially some of the steps - are unbelievably profound. But I did go to Al-Anon meetings and what I found there was something different that helped me. It was, you know, when Nic became addicted, I didn't know other families who had kids who were addicts. I was ashamed and I felt that I was the only one. And people told me over and over and over again, go to Al-Anon meetings, go to Al-Anon meetings. I would sort of roll my eyes and think, I am not going into one of those rooms where people are, you know, sort of whining and sitting around in a circle. And I walked into one of those rooms, finally and I felt, you know, these were my people. They know what I'm going through because they're going through it too.
So that comfort and that support was profound for me. Also going into these rooms, you know, I was suffering so much inside and so I would go through my day and I would have to, you know, put on his face that everything was OK and I had to work. I'd go to my younger children, Daisy and Jasper's school and, you know, I had to keep it together. I walked into these rooms and I didn't have to keep it together. I was allowed to just sit in the back and feel, you know, whatever it was, this just terror and other people were feeling it, and I was able to cry, and I was able to, you know, there was no pretense in those rooms. There was this openness that I found - it didn't make things go away, but it made it easier to get through some of the days.
GROSS: I'm sure that's true for a lot of addicts too, going to meetings like that, where you can be honest and have other people who've experienced the same thing.
SHEFF: It's true. You know, Nic ultimately, you know, he did work the steps and he says that many times it was really, really helpful to him, and he talks about that: going into those rooms and feeling connected to people and feeling supported. And that's huge and that's profound, and it helps many people.
GROSS: My guest is journalist David Sheff. His new book is called "Clean: Overcoming Addiction and Ending America's Greatest Tragedy."
More after a break. This is FRESH AIR.
GROSS: So one of the things you tackle in your book is the issue of marijuana and if it should be legalized or not, and if marijuana, you know, is just like a, you know, a wonderful, you know, but harmless drug, or whether there are real consequences with marijuana smoking. And you have an interesting take on this. You want to see marijuana legalized because you think the consequences of criminalizing marijuana are so, you know, devastating to society, but you say let's recognize that marijuana, for many people, does have harmful effects. What are some of the problems that you want to call attention to?
SHEFF: Marijuana is really dangerous for kids especially. You know, I guess I don't really care if an adult comes home after work and smoke a joint while they're, whatever they're doing at home. But teenagers and young adults, their brains are developing incredibly fast and marijuana, you know, a lot of people think marijuana is harmless. It's natural, whatever. It's not. I've seen scans of the brains of kids who are using pot and they're different. It really has an impact. It has an impact on cognition, on memory. There is evidence now that it actually lowers IQ. So it's really dangerous that people - and especially, you know, kids - believe that pot's harmless. It's not. Still, it should be legalized because we have to treat this problem, instead of as a criminal problem, it has to be treated as a health problem because that's what it is.
GROSS: And you're concerned about all the people who are doing time in prison and who are paying a huge price for having been caught with marijuana.
SHEFF: Yeah. America has more prisoners in the world than anywhere. You know, we think about Russia or China; we have more. And the lion's share of them are in because of drugs, and many, many of them are in because of marijuana. And even for kids, I mean kids are thrown into the criminal justice system and, you know, what's going to make someone use more? We catch a kid with pot. We kick them out of school. At some point they're going to end up in the criminal justice system and, you know, talk about elevating the stress in their lives, you know, decreasing their opportunities, decreasing the positive influence in their lives, things that actually might help them navigate this time without drugs and we put them in more and more and more stress. And so they're likely to use more drugs, more dangerous drugs, more dangerous combinations and become addicted. We have to intervene in every way we can, just as we'd intervene if they had another problem. If we saw early signs of diabetes or cancer or a heart problem, anything, we need to get them help.
GROSS: Let's end on a positive note.
GROSS: And if it's OK, if it's not prying into your son Nic's privacy, he sounds like he's doing really well now professionally as well as personally. Just give us a little update on his life, if that's not prying too much.
It's not. I mean Nic is really, you know, I think he's great. I mean, what can I say? He's an unbelievable person. I mean yeah, I'm his dad and so I'm prejudiced. But he's extraordinary. He's just as lovely person. He helps a lot of people get and stay sober. I hear from people all the time, you know, with kids who say, I read Nic's book, I heard him talk and that's why I've gone into recovery. He's really healthy. He exercises every day. He got married to this woman that we adore, you know, they were best friends when they were in sixth and seventh grade. He's writing like mad. He just had a novel accepted. He's always been just obsessed with movies and TV. And he has sort of this dream job. He's working as an assistant writer on a TV show, on "The Killing" which, oh, he just adores that work. So, you know, we're just so lucky. We're just so lucky. I mean, all these other things are great but the main thing is that he's alive. There were so many times when I just didn't think he was going to make it.
So now that this book is done, your second book related to addiction, are you going to keep investigating the subject of addiction as a journalist or you're going to try to head in a different direction now?
SHEFF: Well, I continue to write about addiction. I've got a couple, you know, pieces in the works just because there's so much to say and there's so much new every day. I mean now there's new medications. There's a lot of progress even with vaccinations. There are political issues that are coming up. So many times I've heard two kids are together or kids are at a party and, you know, there are drugs, people are shooting up or even just drinking, and somebody passes out. And no one does anything because they're afraid if they call 911, they're going to be arrested, and they will be in many places. They shouldn't be. Some states have what's called a Good Samaritan law, which protects them because, you know, no one should be punished for saving a life. I want to write about that.
The other thing is I feel that, you know, this is the time to change the way that we think about drugs. And I feel that there is an opportunity. I think it's going to happen. Part of it is because we do know that this is not a problem that's about morals or willpower, it's a disease. With the AIDS crisis, you know, there was this campaign that talked about silence equals death. Silence equals death with addiction too. We have to get out, speak about this, write letters, protest, have bike-a-thons. And it's starting to happen. People are tired of hiding in the darkness.
GROSS: David Sheff, thank you so much for talking with us and please send my best regards to your son Nic. I spoke with him once on the show and I'm so glad he's doing well. So thank you. Thank you very much.
SHEFF: Terry, thank you so much.
GROSS: David Sheff is the author of the new book "Clean." You can read an excerpt on our website, freshsair.npr.org.
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