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217 of 225 people found the following review helpful
5.0 out of 5 stars A Landmark Book on Addiction
As the father of a recovering heroin addict, I will tell anyone who asks me that David Sheff's Beautiful Boy: A Father's Journey Through His Son's Addiction is probably the best book I've ever read. As a matter of fact, Beautiful Boy helped me come to grips with my own son's addiction and prompted me to work on my own recovery. As a result, I was able to get my own life...
Published 20 months ago by Deanokat

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28 of 34 people found the following review helpful
3.0 out of 5 stars Too much and too little
Unlike Sheff's compelling last book, CLEAN is a disappointment, trying to cover everything from the war on drugs to the disease explanation of addiction, to getting and staying "clean". It attempts to accomplish too much and winds up not doing much of it well. Spends way too much time on the "this is your brain on drugs" concept and not enough on the many ways to overcome...
Published 18 months ago by ThinkingCritically


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217 of 225 people found the following review helpful
5.0 out of 5 stars A Landmark Book on Addiction, March 3, 2013
By 
Deanokat (Michigan, USA) - See all my reviews
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As the father of a recovering heroin addict, I will tell anyone who asks me that David Sheff's Beautiful Boy: A Father's Journey Through His Son's Addiction is probably the best book I've ever read. As a matter of fact, Beautiful Boy helped me come to grips with my own son's addiction and prompted me to work on my own recovery. As a result, I was able to get my own life back. Even better, as I write this review my 23-year-old son is eight months clean and sober--the longest stretch of clean time he's had since he was 16.

That being said, it should come as no surprise that Clean: Overcoming Addiction and Ending America's Greatest Tragedy is probably the most anticipated book ever for me. I pre-ordered it from Amazon as soon as I heard about it and have been eagerly awaiting its publication. Luckily, I was able to get an advance copy through Amazon's Vine program.

David Sheff's latest offering is to be commended for many reasons. First and foremost, though, is its explanation of how addiction works and its attempt to break the stigma frequently associated with this ancient disease. "Most drug use isn't about drugs; it's about life," Sheff writes in the Preface. "Our prevention and treatment efforts have failed mostly because they've focused on dealing with the drugs themselves, but drug abuse is almost always the result of kids starting to use early, genetics, and other problems--stress, trauma, mental illness, or some combination of these factors. 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. Until they are, our prevention and treatment systems will continue to fail most people."

Sheff outlines the six precepts that underpin Clean in the Preface. They are:

1. Most drug use isn't about drugs; it's about life.
2. Addiction is a disease.
3. This disease is preventable.
4. This disease is treatable.
5. As with any other illness, the prevention strategies and treatments most likely to work aren't based on tradition, wishful thinking, or faith, but science.
6. Drug abusers and addicts can do more than get off drugs; they can achieve mental health.

Those precepts are the road map for the book, and Sheff does a fabulous job of backing them all up using scientific evidence, case studies, and his own expertise and experience.

Regarding the stigma associated with addiction, Sheff states: "This stigma associated with drug use--the belief that bad kids use, good kids don't, and those with full-blown addiction are weak, dissolute, and pathetic--has contributed to the escalation of use and has hampered treatment more than any single other factor." As the father of a recovering addict, I know all too well how that stigma affects addicts--and families of addicts--in a negative way. Kudos to Sheff for attacking it head-on.

Another misconception Sheff takes on has to do with relapse: "The main problems with America's addiction-treatment system stem from its roots in the archaic notion that addiction is a choice, not a disease. One common symptom of the disease of addiction is relapse. Kicking an addict out of treatment for relapsing is like kicking a cancer patient out of treatment when a tumor metastasizes." Again, Sheff is telling it like it is and striving to destroy the old myths associated with addiction.

Every page of this book has interesting and valuable information on it. Some paragraphs are so full of information that I found myself re-reading them so I could absorb everything Sheff had to say. I will probably re-read the entire book several times. It's that good and that informative.

This is not only a book about addiction; it's a book about hope. It lets people know that addiction can be prevented. And even if one does succumb to addiction, that there are ways to treat the disease and for people to get clean and stay clean. Sheff ends the main part of the book with his own take on the twelve steps, entitled "The Clean Paradigm in Twelve Steps." (Example: "12. End the war on drugs and treat addiction for what it is--not a criminal problem, but a health crisis.") He also provides a very informative Appendix--"Just Say Know"--where he describes "the most prevalent drugs and their effects, starting with the most ubiquitous drug of all." (That would be alcohol.)

If you have been affected by addiction, you must read this book. If you have kids entering their formative years, you must read this book. If there is a history of addiction in your family, you must read this book. Even if you don't fit any of those categories, I'd still recommend you read Clean to get a remarkable insight into one of the biggest issues facing our country today.

For those who are interested, here is how Clean is broken down, section by section:

I: AMERICA ON DRUGS
1. This Is Your Brain on Drugs
2. This Is Our Country on Drugs

II: WHY WE USE
3. Everybody Does It
4. Helping Kids Grow Up

III: WHEN DRUG USE ESCALATES
5. Use Becomes Abuse, and Abuse Becomes Addiction
6. Addicts Aren't Weak, Selfish, or Amoral; They're Ill
7. Don't Deny Addiction, Don't Enable It, and Don't Wait for an Addict to Hit Bottom--He Could Die
8. The Next Hurdle: Getting a Person into Treatment

IV: GETTING CLEAN
9. The Treatment Minefield
10. Detox

V: STAYING CLEAN
11. Beginning Treatment
12. Primary Treatment
13. Treating Drug Problems with Drugs
14. Where Does AA Fit In?

VI: TREATING A CHRONIC ILLNESS
15. Treating Dual Diagnosis
16. Relapse Prevention

VII: ENDING ADDICTION
17. The Future of Prevention and Treatment
18. Fighting the Right War

Epilogue

Appendix: Just Say Know
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80 of 85 people found the following review helpful
5.0 out of 5 stars Such an important book, March 12, 2013
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David Sheff not only pulls the curtain back, he blows it off the rod so we all can get a real look at addiction and what is NOT working. He demonstrates how we are 40 years behind on addiction therapy. If you have children, YOU HAVE TO READ THIS BOOK. Addiction can happen anywhere to anyone and it does.

Mr. Sheff was the author of Beautiful Boy - his son's own journey into and through the landscape of drug addiction.

One of the most important take-aways I got from this book was the fact that 9 our of 10 addicts started before 18. Can you even believe that? So, if you could somehow devise a way to keep your kids from trying before they turn 18, 90% of your battle would be won. Anyway - I thought that was some real food for thought.

Another take-away - this one too heartbreaking - just when an addict falls down and off his program - that is when the system fails him and throws him out of the program, the halfway house. JUST when this support and help is needed so much.

A big chapter is devoted to AA. Totally non-judgmental. Just the facts, descriptions. Interesting.

A thorough review of therapies, which ones have the best results and why. Following a daily schedule, chock full of habits - can really help. This seems so simple and yet is so profound.

And Dear G*D - - - the COST of some of these programs - and insurance doesn't help - HOW CAN regular people help their family get this kind of help?!? WHY can't we have more effective treatment programs at better costs, why isn't insurance helping with this?? Lots of food for thought there.

Okay - what I thought could be done a little better:

1. A one page - WHAT DO I DO NOW - for the parent/loved one/etc. when my son/daughter/person - is in trouble - I don't have time or attention to read the 350 pages - I need a one page cheat sheet.

2. A simple glossary in the back of the book. CBT - means what again? You could use a glossary in the back to look it up - OH YEAH - Cog. Behavior Therapy...

Those were my two little shortcomings comments.

Great book - so much to think about - to discuss - long overdue.
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43 of 44 people found the following review helpful
5.0 out of 5 stars With gratitude..., April 14, 2013
By 
Lori (Rocklin, CA USA) - See all my reviews
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What I appreciate most about this book is that it is the first I have read that does not claim to hold the only way to sobriety, or the only truth about addiction. I appreciate the nod to parents who lose their minds when a child is dying, that we not compound the indignity by taking fire at the parents as "co dependents".

But we have a long way to go. I wish I could put this book in the hands of our local judges, probation officers, jailers and police, and insist that they read it. They continue to mete out punative sentences, or insist upon ineffective treatment, too much or too little, that can especially ruin young lives.

Two of my children have suffered severe addiction lasting over 15 years. I have seen them through Hazeldon (four times), Caron Foundation, Michael's House, Bishop Gooden (3 times)and at least five other top-name facilities... in and out of ICU, chasing paramedics to hospitals after overdoses, into long term in-patient and out-patient treatment facilities for years. I hate to say this... by far the best rehab has been jail. That's not to say anything positive about jail except that it did essentially the same thing as all the rehabs... it bought them time away from the environment and allowed them time to detox (horribly, without any medical attention... but, it is what it is.) In terms of effectiveness, though, they always relapsed again eventually. It is clear to me that there is no punishment strong enough to "cure" addiction.

One of my kid's came through it--the one everyone thought wouldn't live another day and he has been five years sober. It just happened when it was ready to happen. My other son is still struggling addiction with everything he's got, but holds a great job, smiles, is kind, loving and always thoughtful. He has chosen Methadone treatment, and because of that, there is no hospital, rehab or other treatment facility that will accept him. If he wants to finally get totally clean, he will have to do it by himself... cold turkey. My thought at this point is that we are buying him time, and praying for the miracle. Harm reduction is the thing I humbly appreciate. I never thought I would wind up praising the run down, miserable looking Needle Exchange (I used to find these clean needles in his room and toss them out, until the day he explained that all that would do is cause him to take worse chances with his using)... because of these folks, my son doesn't have HIV on top of heroin addiction. I have learned to be grateful where I never thought I would.

David Sheff has been through all of this, and is still fighting the good fight. His son, Nic, must be one fine son--and I have read both of his great books. "Clean" can't make big proclamations about what treatment to seek or where because at this time the science is still too new, the statistics aren't all in. I am SO GRATEFUL he acknowledges that white-knuckling it through AA is not the way for everyone. My son has gone to hundreds of AA meetings, and I honor that he hung in there, continuing to try when it was so obviously NOT a fit. Maybe the thing David contributes the most in this book is humility... and trust in the goodness of those who are struggling with addiction.

I never saw my sons having any fun with this. I have held my younger son's head while he threw up, went through withdrawals, dozens of times. I've watched him sit suicidally alone in his room, while trying to detox before going to jail. I haven't seen the partying everyone imagines. And by far the worst (for me) is the abandonment I have felt, for them and for myself, when things go so terribly wrong.

Thank you, David, for your great book. And I expect that you will write another ( or Nic will!) as newer and more potent resources become known.
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59 of 64 people found the following review helpful
5.0 out of 5 stars Completely comprehensive, March 18, 2013
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While I don't agree with all the author's stances and suppositions, I feel this is one of the most comprehensive books on addiction and the myriad recovery options available. He covers addiction from biology to various treatment facilities to sober living and sustaining sobriety. He writes from personal experience that is well documented in his other book, Beautiful Boy: A Father's Journey Through His Son's Addiction. This book is useful for family members of addicts as well because it covers codependency and gives exhaustive detail for parents on how to spot drug use in their children. The author does an excellent job explaining how the brain of an addict works using simple analogies such as spaghetti and fruit fly studies to do so. This book is highly recommended to someone suffering with addiction or to a person who loves an addict and needs some solid direction.
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14 of 14 people found the following review helpful
5.0 out of 5 stars Thought provoking book, April 7, 2013
Thank god David Sheff doesn't give us the same clichés we've been hearing about drugs and addiction for years. In this book he combines thorough research with often original and helpful conclusions. "Clean" is depressing and hopeful at the same time.
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28 of 34 people found the following review helpful
3.0 out of 5 stars Too much and too little, April 4, 2013
Unlike Sheff's compelling last book, CLEAN is a disappointment, trying to cover everything from the war on drugs to the disease explanation of addiction, to getting and staying "clean". It attempts to accomplish too much and winds up not doing much of it well. Spends way too much time on the "this is your brain on drugs" concept and not enough on the many ways to overcome substance use disorders. I saw no mention of the fact that most people recover without setting foot in a treatment facility - they do it on their own (they just make up their minds and quit), through individual counseling, or by going to a self-help group. As the parent of a young person who overcame a serious drug problem with the help of an individual therapist, I feel the "go to a treatment program" message is over-emphasized. Focuses on the minority of people with severe substance use disorders, failing to recognize the far greater numbers with moderate to mild problems who need guidance, too, often different guidance than the severely afflicted need.

Sheff has certainly come a long way from his view in Beautiful Boy that AA is a must for recovery, but while he now acknowledges recovery is possible without AA, he fails to mention the alternatives, such as SMART Recovery and Women for Sobriety. And "interventions" are given multiple pages while the CRAFT approach, which has been shown to be far more effective at getting loved ones into treatment, is mentioned in a single sentence and not well-explained.(CRAFT is the Community Reinforcement and Family Training approach, co-developed by psychologist Robt Meyers, Ph.D. See his book, Get Your Loved One Sober: Alternatives to Nagging, Pleading, and Threatening, that explains some strategies.) Finally, calling a book "CLEAN" shows provincial thinking - it's a pejorative label that reflects the very stigma that Sheff is trying to break. (People with addictions are not "dirty" when they're using.) For a solid guide to effective help for the many different shapes and forms of substance problems, Inside Rehab: The Surprising Truth About Addiction Treatment-and How to Get Help That Works by Anne Fletcher, is a better resource.
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10 of 11 people found the following review helpful
3.0 out of 5 stars Addiction Frustrations, May 6, 2013
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David Sheff presents a book full of information about addictions but offers little in the way of solutions or encouragement which reflects the nature of addictions in our culture. The book seems to accurately diagnose the current climate of addictions in this country: frustrating. Clean is full of research, interviews, statistics and anecdotal stories of addictions -- some leading to recovery and others to deaths.

I appreciate Sheff's passionate hope for ending the tragedy of addictions. In the Epilogue of the book, Sheff writes, "It's reasonable to envision a time not too far away when fewer people will try and use drugs, when more addicts will be effectively treated. And in the long term? We just might end addiction." Unfortunately, there is absolutely no evidence for such a vision in Sheff's book. This would take a miracle, and sadly, in Sheff's analysis miracles are not included because God is not included, except negatively.

Sheff presents in several ways the huge drug problem in America and the overwhelming nature and plethora of addictions. He has experienced first hand the trauma of drug addiction and has written about it in his previous book "Beautiful Boy" about his son Nic's addiction. Sheff writes intimately about addictions in this book, too. This is a bulk of information about addictions. Sheff emphasizes again and again that addictions are a disease and not a character or moral problem or a choice for the addict. He is heavy on the disease aspect but completely ignores the invidual's responsibility in the equation of addictions. The addict is never responsible in Clean; it is always the culture, the treatment, the doctors, the schools and the government that are at fault. I think overcoming addiction requires that both sides of the equation are equally weighed. In Sheff's model, he focuses on only what deals with the biochemical physical disease part of addiction which is the medical treatment and science of addictions. As a result, he glosses over key revelations in addictions research and recovery that I think are key elements in overcoming addictions the Twelve steps included.

Sheff cites a quote from a research finding that the following elements in a child's life protect him or her from becoming addicted to drugs, "A strong bond between children and their families; parental involvement in a child's life; supportive parenting that meets financial, emotional, cognitive, and social needs; and clear limits and consistent enforcement of discipline." Research shows that parents with strong values and a stable family environment fortify children against addictions. Teaching healthy stress-managment techniques also contributes to addiction prevention--it also lessens kids' depression and anxiety which both contribute to drug use/abuse. All of the above ought to suggest that in addition to education encouraging a healthy faith in God and participation in a faith community would be beneficial to preventing and overcoming addiction; however, Sheff ignores faith and only mentions religion as a "problem" along with superstitions that hinder treatment. He devotes a chapter to AA and for the most part maligns the program due to its "religious" element that he sees as offensive. He minimizes family systems theory and relies heavily on doctors making diagnoses and effective treatment decisions; however, he asserts several times that doctors are poorly trained regarding addictions treatment.

For Sheff, addiction treatment doesn't require "people to seek forgiveness for harm they've caused others. Redemption of one kind or another isn't needed to treat an illness." He only mentions a spiritual awakening or epiphany as something that isn't necessary. Yet, he continually returns to the correlation between stress and drug abuse. Nothing can reduce stress like forgiveness, redemption and a spiritual awakening! But Sheff emphasizes again that progress is slowed by problems such as "the roots of treatment in superstition and religion rather than science." Sheff strongly opposes programs involving "tough love" or "contrition" elements.

In my experience and awareness, treatment works best when science and faith are combined--this should be the avenue of emphasis rather than pitting one against the other. Sheff rejects faith as helpful and therefore offers little hope to readers truly looking for ways to overcome addiction. I have worked in medically-based addiction treatment centers and have had significant interaction with faith-based addiction treatment programs. The faith based programs are profoundly effective in helping residents maintain sobriety in comparison. I would heartily recommend the faith-based programs following medical detox for addicts. Sheff completely rejects faith-based treatment programs, and actually advises people to avoid them.

What will be frustrating for readers looking for solutions is that the programs recommended are the types that cost at a minimum of $6000-$10,000 per month and have no guarantees. Sheff offers hope that some of these programs will accept insurance; however, I think that is rare and will be minimal even when accepted. Many of the faith-based programs will work with clients on payment methods and are often supported by charitable donations; however, these are off-limits for Sheff. Too many addicts have already lost their financial means and are not candidates for private pay models he often discusses like Hazelden or Betty Ford or Menninger.

Despite offering a heartfelt look at addictions, I think Sheff's views are too skewed by his own biases to be an accurate or effective guide to overcoming addictions. While he cites research that shows that 90% of addicts begin their abuse as teenagers, he offers little in the way to help families prevent their children and teens from seeking alcohol or drugs. This is a statistic that ought to be a huge wake up call for parents to make their children their number one priority along with creating a stable family life. Sheff focuses most of his solutions on legalizing marijuana and getting the government to spend more money on research. He runs through family and school education without going into any depth.
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9 of 10 people found the following review helpful
5.0 out of 5 stars outstanding, April 7, 2013
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I am buying copies for friends with teenagers, my baby's high school principal, and a colleague who is parent of tweens.
Important book. Easy (but very hard) read. Compassionate, thoughful, to the point.
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5 of 5 people found the following review helpful
3.0 out of 5 stars A little disappointed, June 6, 2013
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Sheff has APA's endorsement for this book. Wonder why. All of the new data about drugs and treatment centers are helpful, but the discussion(s) about EBT's just doesn't impress me. In my private practice, I must work with what I get. I frequently will refer to inpatient care promptly, but Sheff's swing to the medical model so strongly doesn't leave me much treatment recourse.
AA is attacked in the context of treatment that doesn't work very well, then mentioned again later as useful.
The text rambles and, frequently, jumps to an anecdote. Okay..that's an N=1, and my basic statistics course says that isn't very persuasive. Some addicts get better when they buy a dog, too.
I think I must have been looking for a thorough review of the reasons why counseling, including AA, works. Even some of my alcoholics have the insight to discover that cognitive restructuring, social learning, desensitization and MI all can be present in AA. Telling the addict that the program is spiritual frequently just "muddies the water." Looking for a compelling reason to quit seems to be the fulcrum for response to treatment. I don't think that was emphasized in the book.
This may turn out to be a reference book for resources for me, and, otherwise, not very educational.
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8 of 10 people found the following review helpful
1.0 out of 5 stars Disappointing, February 17, 2014
This review is from: Clean: Overcoming Addiction and Ending America’s Greatest Tragedy (Paperback)
I read David Sheff's and Nic Sheff's autobiographical books about addiction so I expected Clean to be a breakthrough book showing families of addicts how to navigate the addiction treatment system. I saw Sheff's comments in the media following Philip Seymour Hoffman's death, implying that people who read Clean would understand how the death could have been prevented. The book's initial pages make broad claims to know how substance abuse can be scientifically treated and one of America's greatest social problems solved. What followed is a muddled, overwritten, confused journey into contradiction. With tiresome repetition Sheff praises evidence based treatment, even when he acknowledges that research has not yet produced evidence about the vast majority of controversies surrounding addiction treatment. He also tirelessly urges families to consult licensed experts, even while acknowledging these experts disagree, and in any case, do not have empirical research to resolve their conflicts. On top of this, he ridicules and minimizes 12 step programs. This is not a manual but a hollow attack on 12 step programs, which are not to the taste of the author. I bought the book knowing he had this prejudice and eager to see the evidence on which he bases it. The prejudice is there but the evidence is not. This book is as unhelpful to professionals as it is to families because it lacks a competent review of existing research. Sadly it shows that even the most profoundly felt and articulated personal experiences can fuel convictions with no empirical support and cast doubt on those that quietly save the lives of adults and adolescents who lack access to the welter of therapies (some proven to be ineffective) that Sheff prescribes to replace 12 step programs.
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Clean: Overcoming Addiction and Ending America’s Greatest Tragedy
Clean: Overcoming Addiction and Ending America’s Greatest Tragedy by David Sheff (Paperback - January 7, 2014)
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