David Sheff’s Addiction Manifesto - Page 2

By Will Godfrey 05/12/13

In an exclusive interview, the acclaimed author of Beautiful Boy and Clean expounds on the disease model, AA and the recovery movement, the failures of US addiction treatment and drug policy—and our reasons for optimism.

Grilling the Sheff Photo via

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You agree with most in this field that the US war on drugs has been a failure. You agree with most Americans that marijuana should be legalized. Yet you write that you don’t advocate legalizing other currently illegal drugs. Why should the arguments that apply to marijuana not also apply to those?

I feel like we’re just not there yet. There’s a practical fact: Pushing for legalization of other drugs right now would kill any progress that’s being made on marijuana. And marijuana should be legalized for a million reasons—social reasons, health reasons.

There are experiments now in different parts of the world with legalization or decriminalization of other drugs, and the returns aren’t in—but it looks really promising. It looks like it doesn’t increase drug use, and fewer people die. So I am hopeful that we will evolve to a place where we will look at those things. But the returns aren’t fully in. I can’t imagine a time when we’re going to legalize crystal meth; maybe there will be some way to make it work, so people can get safe. There’s arguments even for crystal meth, or heroin: You’re going to get cleaner drugs, you’re not going to get people dying because they’re taking drugs that have been tainted.

And drug dealers don’t ID...

Yeah—but we’ve got to do a lot of research and education before that will happen.

In Clean you're quite damning about the US addiction treatment industry. You use words like "pseudoscience," even "voodoo," and write that "addiction medicine is 40 years behind where it should be." What's behind this disaster?

Everything goes back to this: If addiction is a disease, there's a system that we know to rely on, the medical model. You go to the doctor when you're sick. But if addiction is something else, if it's about morals, choices, then it's a completely different universe. This goes back forever: Addicts look like bad people; they’re the criminals. Most crimes in America are related to drugs and alcohol. There’s a whole treatment system that built up over the years based on this model that people need to be chastised. Nic was in programs where he would break a rule—not going to enough meetings or not cleaning up the dishes well enough. He’d have to get a toothbrush and go to the floor of the bathroom and clean the grout. If you’re sick, it doesn’t make sense.

"There’s no monitoring: In some states you need a license to open a coffee shop or laundry, but anyone can open a treatment center."

A lot of the programs that I’ve been to are started by the loveliest people; they so badly want to help. But their only training is that they’ve been in recovery for a long time. They hit bottom maybe and were desperate to get well. That’s all they think will work—their whole model is based on someone has to hit bottom. It’s just haphazard. I heard all kinds of things: Somebody told me to send Nic to boot camp. That’ll straighten him out—get him marching in the desert! It’s a system in disarray. There’s no monitoring: In some states you need a license to open a coffee shop or laundry, but anyone can open a treatment center.

Earlier today we were also talking about some of the exploitation and unethical practices involved in the treatment industry. How prevalent do you think that is?

I would say most in the industry are good people who want to help, but there are people who are just cashing in. Nic was in bad shape—the police were there and I convinced the officer to let him get into treatment. He was on meth and shooting heroin and pretty psychotic, and I didn’t know what to do. I called a program and they were way, way expensive and I couldn’t afford it. They gave me the name of another program and said “This is a good program”...I only later learned that they owned this other program they referred me to.

Nic ended up in sober living houses after treatment. Nobody told us but there were kickbacks: “If you go through my program, what do you do next? Well, there’s this great place down the road...” These people are making 10k a month. A lot of people aren’t being helped and are leaving treatment. Too often they relapse and die.

You emphasize the importance of prevention and early intervention. To what extent has the very structure of the US health care system disincentivized these desirable approaches?

Don’t get me started! It’s something I could rant about for a long time. Health insurance companies traditionally have not covered addiction treatment. Maybe they’ll pay for somebody to get off drugs, to be in the hospital for seven days to detox, but that’s it. Then they end up paying for liver disease, or accidents they get into.

My sister-in-law’s a nurse and she told me about these “frequent flyers.” They come into the emergency room; she told me that 70-ish percent of people are in there because they’re addicts. They get patched up, if they have an infection, a broken bone, and they’re sent back out. There’s no attention to the fact that the real reason they’re there is because they’re addicted. They come back over and over again. She looked up the charts of one patient, and his costs in this emergency room over a year and a half were over a million dollars—on one patient. If we got him the first time...they say every dollar spent on treatment saves us $18 in other costs. The system has been set up backward and it’s costing a fortune. Plus it’s killing people.

One of the hopeful things is that under the Affordable Care Act, Obamacare, for the first time, in theory, insurance is going to pay for addiction treatment.

Somebody with cancer, you’re treated for a month. They evaluate, do you need more time? Maybe you need to stay another month. After two months, you’re doing better, you go home, keep seeing your doctor. Then it hits again. You go back into the hospital and insurance is there; it has to be.

"Insurance has to pay whatever it costs to help people who are ill with this disease."

With addiction, that doesn’t happen. Now, in theory, it will. It will have the potential to transform the whole treatment system. Because when insurance companies pay for treatment, they want results. They want programs to be using evidence-based treatments, and they’ll monitor them. The ones that don’t do it will either do it, or they’ll go out of business.

The last chapter of Clean is called “Ending Addiction.” You write about the medical, social and political advances that could contribute to that. We might all hope, but what do you think will happen? How far will we get?

I think the idea of ending addiction completely is a quixotic dream. But who knows? I’ve spent time with scientists who are showing that it may well be possible to create vaccines that will effectively prevent certain drug addictions, cocaine for instance—there’s some real evidence that that’s possible.

But that’s not going to happen for a while. In the meantime, my hope is that we start to treat this differently. We have to support treatment; we have to support prevention; insurance has to pay whatever it costs to help people who are ill with this disease. [When] the treatment system is regulated so that we know that programs are good, the numbers will go down. It’s within reach to imagine a time when fewer people become addicted, and when more addicts are treated. It’s about science and policy. Also the other piece of it, that goes back to something you asked earlier: I think that now is the time—something is shifting and I feel it—when people are just tired of hiding this problem.

We’re not going to take it any more. We are not going to suffer in silence, and we are going to demand of our legislators that they reject what we’ve been doing in the past. Stop spending money on programs that aren’t working. Spend more money on programs that work; get them into our schools, our communities, educate parents. And have treatment programs that are accessible to anybody who needs them. All those things coming together are going to cause a shift. Are we going to end addiction? Not tomorrow. Maybe someday. But in the meantime, we’re going to start saving lives.

Will Godfrey is the Editor-in-Chief of The Fix.

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Will Godfrey is the former editor-in-chief of TheFix. He was also the founding editor-in-chief of Substance.com, and previously co-founded a magazine for prisoners in London. His work has appeared in Salon, Pacific Standard, AlterNet and The Nation among others. He is currently the Executive Director at FILTER. You can find Will on Linkedin and Twitter.