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• W2007218276 abstract "Book Review Health AffairsVol. 32, No. 10: Economic Trends & Quality Trade-Offs A Son’s Addiction, A Nation’s CrisisH. Westley Clark Affiliations H. Westley Clark ( [email protected] ) is director of the Center for Substance Abuse Treatment (CSAT) at the Substance Abuse and Mental Health Services Administration (SAMHSA), Department of Health and Human Services (HHS), in Rockville, Maryland. The views and opinions expressed in this review are his own and do not necessarily reflect those of CSAT, SAMHSA, or HHS. PUBLISHED:October 2013Free Accesshttps://doi.org/10.1377/hlthaff.2013.0798AboutSectionsView PDFPermissions ShareShare onFacebookTwitterLinked InReddit ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsDownload Exhibits TOPICSAddictionSubstance use disorderDrug usePublic healthPharmaceuticalsDiseasesCancer patientsMental health servicesAffordable Care ActDiabetes There are a lot of self-help and tell-all books about addiction on the market. There are also annual reports detailing the epidemiology of drug abuse from state and federal agencies, exploring the incidence and prevalence of this persistent public health problem. A reader could piece together a comprehensive understanding of the complex problem of substance abuse in America from the websites of the National Institute on Drug Abuse, Office of National Drug Control Policy, Substance Abuse and Mental Health Services Administration, Centers for Disease Control and Prevention, Drug Enforcement Administration, Food and Drug Administration, and Health Resources and Services Administration. Or that same reader could turn to David Sheff’s Clean: Overcoming Addiction and Ending America’s Greatest Tragedy , a comprehensive and easy read on addiction. Sheff’s expertise in substance abuse comes from being the parent of an addict—an experience he detailed in his previous book, Beautiful Boy: A Father’s Journey through His Son’s Addiction . In Clean , Sheff moves beyond his own family, although he continues to reference his experience, into the realm of public health, translating the technical jargon of professionals into plain English and, in doing so, rewarding the reader with a coherent view of addiction. Clean appears at the dawn of the expanded implementation of the Affordable Care Act on January 1, 2014. The book can help show that drug abuse is not about being weak willed or about choosing to be an addict. Instead, drug abuse is about being affected by a disease. The federal government estimates that sixty-two million Americans will be eligible for the behavioral health services covered by the Affordable Care Act. However, unless those who suffer from addiction present themselves for treatment, and unless there are sufficient treatment providers who are knowledgeable about addiction, the existence of new resources will be moot. Not everyone will be satisfied with Sheff’s literary attempt. He takes on a few sacred traditions—not out of hostility, but with the understanding that there are many pathways to recovery. The notion that a single approach will work for all, if only everyone adhered to the tenets of that approach, is far too simplistic for a public health problem. Such a unitary view of addiction ignores its complex underpinnings.Sheff writes: “Drug abuse is almost always the result of kids starting to use early, genetics, and other problems—stress, trauma, mental illness, or some combination…. The new paradigm is rooted in recognizing that drugs are a symptom, not a cause, and whatever problems underlie them must be (and can be) addressed.” In effect, he champions the mantra of the Substance Abuse and Mental Health Services Administration: “Behavioral health is essential to health, prevention works, people recover, and treatment is effective.”However, in his zeal to transform the reader’s understanding of addiction and address the issue of discrimination, Sheff devotes too little attention to the importance of aligning behavior with treatment strategies. Addiction may be a brain disease. However, one view is that the person suffering from addiction needs to persist in the attempt to overcome that disease. Thus, if one strategy fails, another one must be pursued; if the second one fails, yet another must be pursued; and so on, until the addiction has been resolved.Treatment adherence is a recurrent theme in medicine and is part of a number of models of care. Sheff notes that “kicking an addict out of treatment for relapsing is like kicking a cancer patient out of treatment when a tumor metastasizes.” A less dramatic analogy would be a chronic condition, such as diabetes. A number of strategies are associated with treating the various types of diabetes, but patient adherence is a sine qua non of a promising response. Nevertheless, clinicians don’t kick the patient out of treatment when one approach fails and another option exists. Not everyone will be happy with Clean . Some people will object to the very name of the book, which highlights the often-used phrase, “clean and sober.” Others may find the wealth of facts in the book overwhelming. However, given the persistent public health problem of drug use in America, Sheff’s plain English presentation of addiction should be applauded, and his book should be regarded as a must read for every parent with a child and every family with a member who suffers from addiction. Loading Comments... Please enable JavaScript to view the comments powered by Disqus. DetailsExhibitsReferencesRelated Article Metrics History Published online 1 October 2013 Information Project HOPE—The People-to-People Health Foundation, Inc. PDF download" @default.
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• W2007218276 title "A Son’s Addiction, A Nation’s Crisis" @default.
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