Beautiful Boy: My Answer to David’s Question
I understand why Beautiful Boy is a #1 New York Times bestseller. It’s a very moving and insightful account of one father’s journey through his son’s addiction, a journey millions of parents have made. David (the author) does not hold back. His writing is powerful, emotional, lucid, and honest. He loves his son Nic to the ends of the earth, there is no doubt about that. Nic is more than just a beautiful boy, he is everything to David. And why wouldn’t he be, he is his son, even when high on methamphetamine and other drugs. At times I laughed, other times I cried. I did not want to be reminded that as a parent there are limits to my ability to protect my son. But it is one of the gifts of the book.
It is often overwhelming reading David’s account of his son’s addiction, and his tireless pursuit to save him. At one point in the book he asks the question: What would you do if a family member were addicted to this drug? He receives many answers from addiction researchers, drug abuse counselors, interventionists, friends, teachers, and members of Al-anon. He leaves few stones unturned, and in the end, realizes that no one person has all the answers. He must decide for himself how to deal with his son’s addiction (and his own addiction to his son’s addiction). I could not agree more. At the same time, I could not help but get frustrated by some of what he was told, and even more, by what he was not told. Here is my answer to David’s question.
Help for David
I would utilize the Community Reinforcement and Family Training (CRAFT) approach for dealing with Nic and his addiction. When compared to the two approaches most discussed in the book (Al-Anon and doing an Intervention), CRAFT has been shown in clinical trials to be significantly more effective. In one trial, CRAFT resulted in 64.4 percent of addicts entering treatment compared to 22.5 for Interventions and 13.6 for Al-Anon. I would add that if it were me, I would likely skip Interventions, but utilize Al-Anon with CRAFT since there are many positive benefits to connecting with others who are going through similar challenges.- For family members and friends trying to help an addicted loved one, the end result is most often perpetual trauma. David at one point says, “I have been so traumatized by his addiction that the surreal and the real have become one and the same.” There are many references throughout the book that support the painful fact that trauma pervades not only Nic’s life as an addict, but his father, family, and likely some friends. It is also a sad truth that good trauma therapy is hard to find, and rarely done to any significant degree in substance abuse treatment. For David, who clearly has engaged in a lot of therapy, I would want to explore the degree to which these therapies sufficiently addressed trauma. I have explored this topic in a paper I wrote about treating trauma, as well as in a section about core issues. Understanding trauma and its treatments are as complex as addiction, if not more so. One of my favorite trauma authors recently came out with a new book that I believe should be read by anyone who has experienced trauma, and in my book, that includes us all: 8 Keys to Safe Trauma Recovery. This is tough work, not for the faint of heart. But something tells me that after what David has been through with his son, trauma work would be a walk in the park.
Help For Nic
David says towards the end of the book, “rehab isn’t perfect, but it’s the best we have.” I am not surprised he reached this conclusion given that when you go searching for help, it is really the only answer. Treatment works. Research says it does, even if you have to go multiple times. And Nic is a testament to this outcome: he goes to many residential (and outpatient) programs and does well for sustained periods of time following treatment before he relapses. I too believe in treatment, but also believe strongly that current treatment practices fall short of what is possible and necessary for long-term success.- This entire website is dedicated to helping you understand the solution to addiction. My answer for Nic (and David) is summarized in the top five things you should know about addiction and the solution to addiction. David is right when he says in the book that there is no one right path for anyone, but there are specific things that can make a difference in whether a person continues to go through life cycling in and out of treatment, or progresses beyond their addiction.
- For Nic, among the most significant factors that will likely influence his future outcomes is the degree to which his developmental deficits and constrictions are addressed. Among the best frameworks for understanding how to assess development is Stanley Greenspan’s six developmental levels (or stages) of the mind. The deficits and constrictions resulting from early traumas, as well as drug abuse, can be healed over time utilizing developmentally-based psychotherapies. Although meth and other drugs of abuse can result is significant brain changes that impact emotional development, this type of therapy is really the best we have. Unfortunately, in my experience, it is not taught in graduate schools, is completely unknown in residential treatment facilities (and even if it was known, the therapy is done over years, not months or 28 days), and requires significant skill in delivery. It also is the right therapy following trauma resolution work. The good news is that there are some gifted therapists in most places that can do it, it just may require some effort finding them.
- David correctly writes that his son has a chronic, relapsing medical condition that will require long-term care. Yet sadly, it appears that Nic’s care has suffered from our treatment system being a patchwork of acute-based programs, where aftercare is self-help meetings and ”working a program.” Nic needs to stop going in and out of treatment, and instead engage in treatment for many years. The evidence is in the book. When he is in treatment and working his program he does very well, until he stops working his program and relapses. “Working a program” is a 12-step construct that does not include the work I believe is critical to long-term success (see previous bullet point). Staying in treatment for years makes sense when you understand that it is outpatient (not residential), involves resolving underlying drivers of addiction like trauma, is adapted to changes in development over time, and includes the exploration of more than just pathology, like the idea of Me to We. If we are to successfully help people move beyond addiction, we must get outside the black box of traditional addiction treatment and utilize what we know from a variety of fields (e.g., systems science, positive psychology, ecopsychology, education). We can and we must do better, for Nic, and everyone else that suffers.
I want to add that Nic published his own book about his experiences abusing methamphetamine and other drugs, called Tweak. I look forward to reading it in the near future, and hearing his side of the story.
One final comment is related to how David ends the book. He says “I believe we need an all-out war on addiction modeled on the war on cancer.” He goes on to suggest what such a campaign would look like, the funding it would require, and the benefits it could bring. He adds that a research network like that set-up for cancer could test out many promising addiction interventions, including new medications. The good news is that it has been done, and has been bridging the gap between practice and research for many years now. It is the National Drug Abuse Treatment Clinical Trials Network. Check it out.
Well stated John. As the mother of a recovering addict, I can truly relate to David’s trials and your statement, “He must decide for himself how to deal with his son’s addiction (and his own addiction to his son’s addiction)”. Never have I experienced the helplessness, sadness, depression, and anxiety than the years my son was involved in drug abuse. Your “help” for both David and Nic is well grounded in science and provides a direction for parents of children involved in drug abuse as well as those individuals seeking answers for themselves…
I was really intrigued by this father and son story of struggle with addiction that I reserved the book Beautiful Boy as well as Nic’s book Tweaked at the Library and anxious to read both book. A father’s point of view as well as a son’s point of view. I have always viewed drug treatment as a quick fix but it is never quite fixed and sometimes the person needs to take themselves out of the environment that was literally killing them and not go back to that environment after treatment. Recently on a show “Drug Nation” a young man and his wife, newly sober, are visiting the graveside of a friend that died of an overdose and all he could think of was, “where did he get that dope, it must be some good dope if it killed him.” All he wanted to do was go to where this young man(6 feet under) had purchased the drug that took his life. That really touched me to hear it put that way.
It is really exciting to think about how we are so close to bridging the gap between research and practice. I believe that is the best equation to conquering addiction, people need to collaborate to get the best results. I was also curious if Tweak is out yet. You said that you look forward to reading it soon and I was just curious when soon was? Your blog gave me a good perspective of the actions that are being taken to overpower addiction. Thanks so much
After reading your blog I am going to be picking up the book “tweak” for my personal reading. Looks like this book will be interesting at the least.
Everyday many people struggle with addiction issues in their family and it often tears families apart. Addictions can influence every aspect of a human being and really change them as person. I have never read Beautiful Boy but by reading your blog, it sounds like an amazing story and is much like one I can relate to. My best friend had an addiction problem and I had to watch her family go through incredible measures to try and get her clean and after she relapsed once, she then made the decision her self to get clean. Like you said, the addict must want to become sober, and until then nothing will really make them stay clean. She just celebrated her 2 years sober 4 days ago and it is so amazing. I definitely agree with you that being sober is something that is long term, there is not a short term fix. Being in a facility for 28 days does not clean up an addict. I really appreciate your information and opinions on addiction. Thank you.
I have started to read the book Beautiful Boy and I have already been touched by the message that this text brings to life. The personal account of addiction is not masked or cleaned up for the purpose of publication, but really gets into the real issues and struggles. I personally have dealt with a family member who was addicted to alcohol and prescription pain medication. The effects on my family have still not all surface, but the day to day struggle is enormous without optimism and hope. This book has already touched on something for me that is all too familiar.
Mike, yes, the book Tweak is out and I plan to read it in the next few weeks. I have lots of air travel coming up so it may even happen sooner. It is rare that both a father and son are willing to share intimate details of their struggles, and are good writers.
J
I am interested to read both of these books from what you have noted, and slightly saddened by the fact that you say that the research and medications are out there yet this author of Beautiful Boy did not know about them, and publishes a book leading the public to believe unknowing. I hope that soon that can change.
I was recently caring for a patient in an acute hospital setting who had inflicted substantial harm to herself, again. She has a long history of abuse, and also has an extensive list of prescription pain killers, sedatives for various “ailments”. I found it frustrating that in our current non-connected medical system that this could be happening. This patient was soon to be transfered to an in patient treatment center for further psych evaluation. My frustration is partially related to the feeling of being in a catch 22 situation. the medical caregivers have become scarred of being sued for not covering someone’s pain, and the patients get sicker and sicker and the doctors just pass them off the the psych centers when they can’t solve the problem anymore.
Ember, to the author’s credit he did provide useful information to the public on a number of fronts, including mentioning research findings and discussing addiction medications. My blog post illustrated that even the best reporters (and fathers) can still miss things. Addiction is complex, there are many pieces to the puzzle that are constantly changing. As to your point about the intersection between pain management and addiction, it too is complex and requires significant coordination among care givers – something that often does not happen as you point out.
J
I am grateful as always to the insights and resources that you share in your blog. This entry brought tears to my eyes as I think of my sons and their addiction difficulties. Both of them have underlying feelings of low self-worth directly related to a life-changing car accident that the three of us were involved in fifteen years ago when my sons were 13 and 15.
The accident resulted in me breaking my neck and becoming quadriplegic while both my sons escaped major physical injury. However, each of them suffered mental and emotional injury that they carry with them to this day. One son feels guilty for asking to take that car ride on that day. The other son feels guilt that he may have caused more damage when he pulled me from the vehicle after it began to catch on fire. Although I have repeatedly spoken with them stating that all the actions were my choice and not theirs, they still hold on to the guilt from their teenage years.
I have ordered both books in order to help my sons and myself with better management of their addictions and with my own struggles as well. Thank you, John, for your ongoing efforts.
It is hard for me to imagine the pain and suffering you and your family have experienced as a result of the tragic accident. I am honored that you shared your story, and moved by your tenacity to continue to “work your stuff” and help others. Your son’s are lucky to have you as a father.
J
I have not been able to put the book Tweak down. I feel totally like I am Nic and living his nightmare. I have never shot up or done any illicit drugs but I find in reading Tweak when Nic is using I am almost nauseated and can feel him getting high. He is an amazing writer and is raw and holds nothing back on his thoughts and feelings. If you haven’t read this book I recommend reading Tweak. He is so raw and insightful that if you are recovering from addiction that you will feel the cravings from this book.
Angela, thanks much for the updated review, I will most definitely read it on my next flight! Words of caution to those in recovery: reading triggery material can cause cravings. Cravings can cause lapses. Lapses can cause relapses. Relapses can be dangerous.
J
I have just discovered this site and all the information on addiction. I am incredibly grateful. I have a son who has been in rehab twice, and, yes, I believed each time was a *fix*. It wasn’t. He went from both rehabs to 12-Step programs, which helped for a while. But as of this writing he is again suffering, shamed, and confused.
Thinking of addiction as a chronic condition rather than an acute condition has opened my eyes and given me more understanding of this terrible wasting condition. And much to think about.
I will look for both books reviewed above–and pray that each of them has a happy ending, either within their covers or outside of them–in the lives of their authors.
Thank you.
Glad you found the site, and sorry to hear about your son. Be sure to check out my child information and resources. Also, reading the Five Critical Things to Know about addiction will provide additional information about addiction being a chronic condition.
Long-term solutions necessitate identifying key leverage points for change that most often perpetuate ongoing addictive behavior. Most commonly, they include untreated traumas, and the fact that addiction treatment does not address developmental deficits and constrictions - issues that require ongoing therapy by a skilled clinician. If your son remains an emotional 10 year-old, then no treatment will have great long-term outcomes because it is hard to successfully be in initimate relationships, hold down a good job, parent, and deepen all that life has to offer with the emotional skills of a child.
Good luck, hang in there, have hope…there is a solution to addiction: manage the chronic problems, resolve the underlying traumas and developmental issues, and access creativity – it is the forcefield of life.
J
I bought Tweak for my youngest son and Beautiful Boy for myself. Although I haven’t finished reading Beautiful Boy yet, my son zipped through Tweak (pun intended) and asked me to buy three more copies for his friends.
The writing style in Tweak reflects the pace of a meth lifestyle and made a real impact on my opioid/alcohol-using son because it mirrored the addiction behavior of so many other drugs.
I have still not read it yet, but all reviews so far have been very positive. Will read on my next plane ride in a few weeks.
J