80 percent of adolescents in the United States try drugs, but only 10 percent become addicted [View all]

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Overcoming Addiction and Ending America’s Greatest Tragedy
By David Sheff

374 pp. An Eamon Dolan Book/Houghton Mifflin Harcourt. $25.

If that book, “Beautiful Boy,” was a cry of despair, “Clean” is intended as an objective, if still impassioned, examination of the research on prevention and treatment — a guide for those affected by addiction but also a manifesto aimed at clinical professionals and policy makers. Sheff’s premise is that “addiction isn’t a criminal problem, but a health problem,” and that the rigor of medicine is the antidote to the irrational responses, familial and social, that addiction tends to set off.

Sheff, a journalist, writes that America’s “stigmatization of drug users” has backfired, hindering progress in curbing addiction. The war on drugs, he says bluntly, “has failed.” After 40 years and an “unconscionable” expense that he estimates at a trillion dollars, there are 20 million addicts in America (including alcoholics), and “more drugs, more kinds of drugs, and more toxic drugs used at younger ages.”

Sheff says that drug addiction is a disease as defined by Stedman’s Medical Dictionary, since it causes “anatomic alterations” to the brain that result in “cognitive deficits” and other symptoms. But isn’t drug use an act of free will, distinguishing addiction from other diseases? Sheff responds that behavioral choices contribute to many illnesses: think of unhealthy diets and diabetes.

Like other diseases, addiction has a substantial genetic component. Mental illness and poverty are major risk factors. These susceptibilities help explain why 80 percent of adolescents in the United States try drugs, but only 10 percent become addicted. Sheff emphasizes the vulnerability of adolescents. Neuroscience corroborates our intuition that their impulsivity develops faster than their inhibitions, and drugs may stunt their emotional growth, making them yet more prone to addiction.

http://www.nytimes.com/2013/04/21/books/review/clean-by-david-sheff.html?_r=1&utm_source=feedly&