There was a time early in his son’s addiction to methamphetamines and heroin that David Sheff reacted with disbelief when told that addiction is a disease.
“My son isn’t ill,” the freelance journalist and author recalled thinking. “He’s a selfish, reckless, remorseless, narcissistic teenager obsessed with being high.”
The first time he forced Nic into treatment, said Sheff, the youngster tried to kick out the car window in an effort to escape.
Sheff — author of the bestselling “Beautiful Boy: A Father’s Journey Through His Son’s Addiction” and the subsequent (and also bestselling) “Clean: Addressing Addiction and Ending America’s Greatest Tragedy” — recounted some of his journey before a packed audience during a psychiatry grand rounds lecture in the auditorium of 55 Park St. His talk, co-sponsored by the Poynter Fellowship, was also the Department of Psychiatry’s annual Ribicoff Lecture.
Today, following a decade of personal experience and years of journalistic research, Sheff is convinced that addiction is, in fact, an illness, and believes that it cannot be prevented and successfully treated until that fact is commonly accepted and understood. He said the addict should be treated with as much compassion as someone with cancer or any other disease.
During his talk, Sheff recounted the “years of hell” that he and his family lived through while watching Nic “descend” deeper into addiction and relapse “time after time after time.” His life, the journalist said, was a rollercoaster of despair, hope, and fear. Every time his phone rang, he wondered if it would be the call from police announcing that Nic was dead. In the throes of drug use, Nic would disappear so often that the local police dispatcher became accustomed to Sheff’s phone calls asking if there was any news of his son, and once suggested that the father try calling the morgue.
Since writing “Beautiful Boy,” Sheff said he was received thousands of letters from parents who have been through the same anguish. He realized that his family “was one of the lucky ones,” he told his audience. Nic, now 31, is celebrating his fifth year in recovery.
His own investigation into the causes and treatment of addiction led Sheff to visit research laboratories, clinicians, drug treatment centers, crack houses, emergency rooms, 12-step programs, needle exchange programs, and prisons. What he learned convinced him that addiction is a neurological and genetic disease.
Scans of addicts’ brains, he noted, show “startling” anatomical and structural differences. He also cited work being done by Ulrike Heberlein at the University of California-San Francisco with fruit flies, which has demonstrated that cravings for drugs “trump basic survival instincts.” The addicted flies would repeatedly suffer electric shock to obtain alcohol or cocaine.
Recognizing addiction as an illness is the first step toward solving the public health tragedy, Sheff told his audience. He noted that addiction is the number-three cause of death in America, killing 350 people daily.
“We are losing one person every 19 minutes — after cancer and heart-related deaths,” said Sheff, who argued that greater attention must be paid to understanding and treating addiction.
The journalist acknowledged that it will take a “culture shift” to change people’s thoughts about addicts, noting that most believe drug abusers have a choice over whether or not to use drugs. Sheff said that one in 10 of the 80% of people who try drugs before the age of 18 become addicts.
“People are threatened … [T]hey don’t want to accept that sometimes behavior is not in our control. Our culture emphasizes self-determination and willpower,” he said. “We want to be masters of our own destiny, but sometimes we aren’t.”
He advocated for education about addiction — not only for the public but also for physicians, most of whom are not trained to identify or treat addiction, Sheff claimed. Since drug use commonly begins in the teenage years, pediatricians are among those who should be well trained, he said.
Asked why they take drugs, most youngsters cite stress as the biggest factor, Sheff said, and thus treating that is key to preventing drug or alcohol abuse.
“We can only help [end addiction] when we stop focusing on the drugs themselves and focus on why people use them,” said Sheff, adding, “Stress is related to addiction on the most primal level.”
He said that genetics and psychological disorders — including anxiety, bipolar disorder, depression, and trauma — are also contributing factors.
“It’s useless to tell the child who is being bullied or failing in school, or who is being traumatized by family turmoil, to ‘Just say no,’” maintained Sheff. “It’s pointless to tell our children to make good choices about drugs if they offer them a reprieve from the darkness they feel or the connection that they so badly crave. People in pain are desperate for relief.”
Sheff recounted how some of the “treatments” his own son had were punitive rather than compassionate. For bad behavior at one facility, Nic had to cut the grass with scissors and clean grout with a toothbrush.
Sheff said 12-step programs also may fail with teenagers, as “what 17-year-old admits he is powerless about anything or turns his life over to another person?”
The journalist decried the hesitancy of some drug therapists to prescribe medications such as suboxone (or buprenorphine) for opioid dependence because they don’t want to treat drug dependence with other drugs. Scientific evidence has shown that such medications can be beneficial, said Sheff, arguing that addiction treatment must be evidence based.
In Nic’s case, Sheff noted, it took years before a doctor conducted psychological testing that revealed his son suffered from bipolar disorder and depression. Previous treatments might have been more successful had he been diagnosed earlier, Sheff suggested.
While some discouraged Sheff from writing about his family’s experience of addiction, the author said the response he has received since the publication of his books has been wholly positive and empathetic. He said that stigma is “the single biggest roadblock” to treatment and an understanding of addiction.
“We don’t know how pervasive addiction is because addicts and families already keep it secret,” he said, later adding: “When we choose to no longer hide our own or our child’s addiction, we can feel tremendous relief … We can learn we are not alone.”
Sheff said that he is hopeful about the future, in part because President Obama’s Affordable Care Act requires mental illness, including addiction, to be treated the same as physical illness, and insurance can now fully cover addiction treatment. Some best practices in the treatment of addiction are being established, and the families of addicts have started some grassroots movements, much the same way AIDs activists did in the 1980s, Sheff said.
“I’m hopeful because of people like you in this room,” concluded Sheff, referring to the Yale doctors and researchers who are actively engaged in trying to better understand and treat addictions.
Sheff was introduced by Dr. Robert Malison, professor of psychiatry and director of the Clinical Neuroscience Research Unit and the Neuroscience Research Training Program, as well as chief of the Cocaine Research Clinic. He called Sheff’s books about addiction “a testament to a father’s love for his son,” and added, “We are working our hardest to make good on what you, David, would like to see realized.”