David Sheff on Prescription Drug Abuse Prevention Panel at the Clinton Foundation Health Matters Initiative Conference

Mental Health & Prescription Drug Abuse Prevention Panel

Panel Moderator: Dr. Travis Stork, Emergency Room Physician and Co-Host of The Doctors; Noopur Agarwal, Vice President, Public Affairs, MTV; The Honorable Patrick J. Kennedy, Co-Founder, One Mind for Research, Founder, The Kennedy Forum, Author, MHPAEA; John MacPhee, Executive Director and CEO, The Jed Foundation; David Sheff, Author and New York Times Columnist; Nora D. Volkow, MD, Director, National Institute on Drug Abuse

Time.com Viewpoint: We Need to Rethink Rehab

This article by David Sheff was originally published at Time.com.

When my son Nic became addicted to methamphetamine and other drugs, I was panicked, overwhelmed and desperate to save his life but had no idea what to do. I’d heard about rehab, where you send people with drug problems, but I soon learned that there’s no standard definition of it; instead it’s a generic word for a wide variety of treatments, including some that are outrageous. Past-life therapy? Exorcism? Tough-love programs in which patients are made to scrub bathroom tiles with a toothbrush or cut grass with scissors? Even in more-typical rehabilitation programs, patients are not seen by licensed practitioners — no doctors or psychologists — only self-anointed “experts” with no training or credentials, unless you count their own recoveries from addiction to heroin, alcohol or other drugs.

I chose a rehab center for Nic that was recommended by a friend who had sent her son there. The program lasted 28 days, after which he relapsed. Over the next six years, he was admitted to six residential treatment programs and four outpatient programs. He would do better for a while, but then relapse. Each relapse was crushing. I thought he might die.

Every year in the U.S., 120,000 people die of addiction. That’s 350 a day.

I’ve already written about my experience with Nic, but for my new book, Clean, I wanted to understand why so many suffer and die. So I undertook an investigation of the treatment system that so often fails. I learned that no one actually knows how often treatment works, but an oft-quoted number of those who abstain from using for a year after rehab is 30%. Even that figure is probably high. “The therapeutic community claims a 30% success rate, but they only count people who complete the program,” according to Joseph A. Califano Jr., founder of the National Center on Addiction and Substance Abuse and a former U.S. Secretary of Health, Education and Welfare. “Seventy to eighty percent drop out in three to six months.” Over the course of my research, I did hear one statistic that I trusted. Father John Hardin, chair of the board of trustees at St. Anthony’s, a social-services foundation with an addiction-recovery program in San Francisco, told me, “Success for us is that a person hasn’t died.”

The treatment system fails because it’s rooted in an entrenched, inaccurate view that addicts are morally bereft and weak. If they weren’t, the belief goes, they’d stop using when drugs began to negatively impact their lives. Most treatment centers in the U.S. are based on an archaic philosophy that’s rooted in the 12-step model of recovery. These programs have saved countless lives, but they don’t work for a majority of people who try them. It’s not a fault in the program itself. Its founder, Bill Wilson, wrote, “These are but suggestions.” But many rehabs require them. This is particularly problematic for teenagers and young adults, the very people most susceptible to addiction. Twelve-step programs require people to accept their powerlessness and turn their lives over to God or another higher power. Many adolescents question religion, and in general teenagers aren’t going to turn their lives over to anyone.

In many 12-step-based programs, patients are berated and yelled at if they don’t “surrender” and practice the steps. They’re warned — in some cases, threatened — that if they don’t, they’ll relapse and die. It can become a self-fulfilling prophecy. Addicts don’t think they can be treated if they don’t embrace the program, and so they give up on the idea that they can be helped. They do relapse. Some die. When they do, they’re blamed. Blaming the victims is convenient for those who treated them, because it absolves them of accountability. They can take credit when their patients get well, but they take no responsibility when they don’t. But the bigger problem with 12 steps is that a growing body of evidence has proved that addiction isn’t a choice subject to willpower but a brain disease that’s chronic, progressive and often fatal.

Though they aren’t available to many people who need them, there are alternatives to 12-step-based treatments that can improve an addict’s prognosis. These treatments don’t rely on best guesses or tradition. Rather than require contrition and prayer, they use therapies that have proved effective in clinical trials, including cognitive-behavioral therapy designed to train addicts to recognize and interrupt the cues that trigger the relapse mechanism; motivational interviewing, a therapy approach widely used to treat many psychological disorders that helps addicts engage in treatment; contingency management, which essentially rewards addicts for clean time; and psychopharmacology.

Absurdly, the latter remains controversial in the addiction-treatment community, with some factions claiming that you don’t treat drug problems with drugs. But you do, at least in many cases. One of the most effective interventions for opiate addictions is medication, including the opiate agonists and partial agonists methadone and Suboxone. These drugs have proved so effective that Steve Shoptaw, an addiction specialist and psychologist in the department of family medicine at UCLA, says, “I won’t treat opiate addicts unless they take Suboxone.” Most researchers agree that no single therapy is appropriate for every addict. Often they’re used in concert. An effective treatment regimen may include AA, but only for those patients who are open to it.

Currently there’s a chasm between these and other evidence-based treatments (EBTs) and rehab programs. Every day addicts fall into it, and many never make it out. Most people in need find themselves in the same frustrating position I was in when I was desperate and overwhelmed, shopping for programs and doing the best I could to navigate an unnavigable system that’s also largely unregulated. In many states, anyone can open a rehab program — no licenses or accreditation are required.

This is slowly changing. More people are being educated about the fact that addiction is a disease and therefore requires treatments based on the medical model. The more consumers are educated and demand EBT, the more the billion-dollar rehab industry will adapt and offer it. That is, the industry will adapt or it will die and be replaced. In the meantime, those who need treatment must do the best they can to find programs that offer EBT. The place to start is by receiving an assessment from a psychologist or psychiatrist who is trained in addiction medicine. Even finding these professionals can be a challenge, but the American Society of Addiction Medicine maintains a directory that is available online. A competent doctor can determine the severity of addiction and the presence or lack of co-occurring psychological disorders and prescribe the next step. It may include a brief intervention, therapy, psychopharmacology, an inpatient or outpatient program that offers quality care or a combination of these things.

Meanwhile, the National Institute on Drug Abuse is funding the Treatment Research Institute in Philadelphia, directed by Tom McLellen, the former deputy director of the Office of National Drug Control Policy, to create and test a science-based method of rating treatment quality and determining the likelihood of favorable outcomes of treatment programs. Working with consultants from Consumer Reports, the Treatment Research Institute hopes to create a guide that will help those who need treatment and raise standards in the industry. Another hopeful development is the founding of an organization that could be for addiction what the American Cancer Society is for cancer, called Brian’s Wish to End Addiction. In addition to supporting treatment research, the organization will also launch education and other prevention campaigns and lobby for policy so that, for example, insurance will adequately cover addiction treatment.

After a hellish decade, my son got and stayed sober. His current treatment regimen includes regular sessions with a psychiatrist who sees him for his addiction and co-occurring bipolar disorder and depression. He’s been in recovery now for five years. But of the nation’s 20 million addicts, only 10% will ever receive treatment. And the majority of those who do will be failed by the existing system. Nic is one of the lucky ones. I’m one of the lucky ones. But this should not be about luck.

Authors Gin Phillips and David Sheff Win the 2008 Barnes & Noble Discover Great New Writers Awards

This article originally appeared at barnesandnobleinc.com

NEW YORK, NY – March 4, 2009 – Barnes & Noble Inc. (NYSE: BKS), the world’s largest bookseller, announced this afternoon that Gin Phillips’ debut novel, The Well and the Mine(Hawthorne Books & Literary Arts), and David Sheff’s moving memoir, Beautiful Boy(Houghton Mifflin), have been named the winners of the 16th annual “Discover Great New Writers Awards,” for fiction and nonfiction, respectively. Each writer was awarded a cash prize of $10,000, and a full year of additional marketing and merchandising support from the bookseller.

Writing professor Benjamin Taylor’s novel The Book of Getting Even (Steerforth Press), an unusually perceptive coming-of-age story, and NPR correspondent Eric Weiner’s humorous travelogue, The Geography of Bliss (Twelve), took second place honors, each receiving $5,000. Zachary Lazar’s novel Sway (Little, Brown), set amidst the decadence of the late ‘60s, and Nia Wyn’s Blue Sky July (Dutton), a poetic journal of the first seven years of her son’s life, won third-place honors, each receiving $2,500. The awards were presented this afternoon at a private ceremony, and the winners and finalists will read from their work tonight, March 4, at 7:00 p.m. at the Tribeca Barnes & Noble (97 Warren Street at Greenwich Street) in New York City.

The Well and the Mine, Gin Phillips’ first novel set in Depression-era Alabama, is a Greek chorus of Southern voices weighing in on life in a small coal-mining community after a young girl witnesses the sight of an infant thrown in her family’s well. Jurist Mark Jude Poirier offered the following comment on the prizewinner: “Phillips artfully engages the traditions of Southern literature but somehow remains fresh and original. A brilliant and memorable debut.”

Writers participating in this year’s fiction jury panel included Kate Christensen, winner of the PEN/Faulkner Award and author of several novels including the forthcoming Trouble; Suzanne Finnamore, author of two novels and a memoir of her divorce entitled Split; and fiction writer Mark Jude Poirier, who wrote the screenplay for the indie hit film Smart People.

The nonfiction winner, Beautiful Boy, is David Sheff’s heartrending account of his efforts to save his son, Nic, from the horrors of methamphetamine addiction. Nonfiction jurist and 2002 Discover Award winner (A Death in Texas) Dina Temple-Raston had these words for the prizewinner: “From the early pages of this book until its conclusion, readers will find themselves not only rooting for a young man who (in less deft hands) would have lost our sympathy, but also for a father who clearly – like any parent – would give anything to shoulder his son’s struggle in his stead. I couldn’t put this book down.”

Writers on the nonfiction jury panel included Edward Dolnick, a historian and science writer whose most recent book is The Forger’s Spell; travel essayist J. Maarten Troost, whose Lost on Planet China was published last year; and NPR correspondent Dina Temple-Raston, who writes about current events.

The Discover Awards honor the works of exceptionally talented writers featured in the Barnes & Noble “Discover Great New Writers” program during the previous year. In 2008, the Discover Great New Writers program featured the work of 63 previously unheralded fiction and non-fiction writers.

Starbucks Selects “Beautiful Boy”

This article originally appeared at news.starbucks.com

Starbucks Entertainment announced today the next title in its book program: David Sheff’s “Beautiful Boy: A Father’s Journey through His Son’s Addiction” to be published by Houghton Mifflin – a compelling true story examining addiction, trust, and renewal told by the parent of a meth addicted teenager. Continuing its commitment to connect customers with great books, Starbucks will begin offering “Beautiful Boy” on February 26, 2008 at more than 6,500 Starbucks Company-operated locations across the U.S.

“We seek titles that will inspire conversation both in our stores and with our customers,” says Ken Lombard, president Starbucks Entertainment. “David’s story embraces a depth of emotion, support and human resilience that brings readers face-to-face with an epidemic that is sweeping the nation. We are excited to have the opportunity to present this genuine, personal memoir to our customers.”

Beautiful Boy” takes readers through the gripping journey of addiction from a fresh perspective ? that of a concerned parent. Sheff’s pragmatic storytelling winds through his own stages of denial, to the self-realized acceptance of helplessness and the struggle to protect his family, to renewed hope and recovery. “Beautiful Boy” is the fourth book by Sheff, a brilliant writer best known for works that have appeared in various newspapers and magazines including the New York Times Magazine, Rolling Stone, and Fortune, among others.

“Often we learn about the effects of substance abuse on the user, but we rarely hear the story from the perspective of loved ones ? the friends and family members who often feel powerless,” shares Sheff. “I am gratified that in addition to carrying ‘Beautiful Boy‘ in its stores, Starbucks support will encourage much needed discussion about drug abuse and addiction.”

Along with appearances at traditional booksellers, Sheff will participate in a Starbucks book tour, making stops at 10 Starbucks stores across the U.S. beginning February 26. At each location, Sheff will share thoughts on the experiences he and his family endured throughout the addiction and the resulting rehabilitation.

“We’re so pleased that Starbucks decision to feature ‘Beautiful Boy‘ will bring so many readers to this very special book,” said Janet Silver, Vice President and Publisher of Houghton Mifflin.

Selected as #1 Non-Fiction 2008 by Entertainment Weekly

This article was originally published at entertainmentweekly.com

Entertainment Weekly ranked Beautiful Boy as the #1 Non-Fiction Book for 2008.

#1 BEAUTIFUL BOY, David Sheff

When Sheff’s oldest child, Nic, became addicted to crystal meth, the once imaginative kid turned into a twitchy, larcenous tweaker who stole from his kid brother’s piggy bank and lied to everyone, especially his dad. Sheff’s is the story of a child’s addiction, but it is also a statement about parental love and its limitations.

Beautiful Boy #1 New York Times Best Seller List

Beautiful Boy reached #1 on the New York Times Best Seller List in April and May 2008.

In addition, Entertainment Weekly named it the #1 Best Nonfiction Book of 2008 and it won the Barnes and Noble Discover Great New Writers Award for nonfiction in 2008. Amazon.com selected it as one of the “Best Books of 2008” and Starbucks picked it as one of the few books it would sell in its coffee shops.

Paramount Pictures Buys Screen Rights to Beautiful Boy and Tweak

This article originally appeared at prnewswire.com

Brad Pitt’s Plan B Entertainment Will Produce

HOLLYWOOD, Calif., April 30 — Paramount Pictures announced today that it has purchased the screen rights to the current New York Times non-fiction bestsellers Beautiful Boy: A Father’s Journey Through His Son’s Addiction by David Sheff and Tweak: Growing Up on Methamphetamines by Nic Sheff, for development and feature film production by Plan B.

The critically lauded Beautiful Boy, published by Houghton Mifflin Co., chronicles the teenage Nic Sheff’s descent into methamphetamine abuse from the point of view of his father, journalist David Sheff, as he struggles to help his son overcome addiction. In Tweak, Nic Sheff himself details a harrowing summer during which he lapsed back into drugs and how he eventually recovered. Beautiful Boy and Tweak immediately became non-fiction bestsellers. Beautiful Boyis currently #1 on the New York Times Bestseller list. The books were hailed for the unique approach of a father and son tackling the same experience from two different perspectives, and they are recognized as definitive books about a problem that is epidemic in American society.

Beautiful Boy is being sold in Starbucks stores around the country as part of the Starbucks Select book series. The film will be produced in association with Starbucks.

Plan B Entertainment is actor/producer Brad Pitt’s production company, which has an overall deal with Paramount and has previously produced such films as the Oscar(R)-winning “The Departed,” “Troy,” “Charlie and the Chocolate Factory,” “A Mighty Heart” and “The Assassination of Jesse James by the Coward Robert Ford.” Among Plan B’s upcoming projects for Paramount are “Eat, Pray, Love” based on the bestselling novel with Julia Roberts to star and Ryan Murphy to direct; the action film “The Killer” and the fantasy horror film “Black Hole,” both of which will be directed by David Fincher; the horror/thriller “World War Z”; and the adventure film “Lost City of Z.”