Posts Tagged ‘books about addiction’

Book Review: “Dreamland: The True Tale of America’s Opiate Epidemic,” by Sam Quinones

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I’m happy to tell my readers of a great new book. Published in 2015, this book is about the pain pill epidemic in the U.S., and how black tar heroin from Mexico quietly filled the void when pain pills became less plentiful.

The story of how this nation found itself in the middle of an opioid addiction epidemic isn’t a new tale, but the scope of the story has rarely been told with the completeness found in this book. The author talked to, or attempted to talk to, key people in all the realms affected by addiction: pain management experts, drug company leaders, addicts, parents whose children died from opioid addiction, doctors who prescribed OxyContin, everyday members of drug rings, prominent leaders of drug rings, law enforcement personnel, and addiction treatment personnel.

This book covered the pain management movement of the late 20th century, and how pain management experts grossly underestimated the risks of prescribing opioids long-term for chronic pain. Those experts taught other doctors that the risk of triggering addiction was almost zero, and that physicians had an obligation to relieve pain in their patients. Pain was described as the “fifth vital sign,” with the implication that a patient’s reported pain level was as objective as their pulse, blood pressure, body temperature, and heart rate.

All of these recommendations were based on thin evidence. Some of the pain management experts were also employed by drug companies marketing powerful opioid pain relievers, creating at the least the appearance of a conflict of interest.

The author described the inappropriate marketing of pain medications in general, and then focused on Purdue Pharma’s criminally inaccurate promotion of OxyContin. Purdue taught its young and attractive drug representatives to say things about OxyContin that were not true. These drug reps pushed their product with fervor, using falsified material provided to them by their company (p. 265). Purdue wasn’t the only drug company to oversell its products, but they did the best job of it. Ultimately, their marketing strategy lead to a criminal case brought in Southwest Virginia, and resulted in Purdue Pharma, along with their three top executives, pleading guilty to a felony count of misbranding. They were ordered to pay a fine of $634.5 million…but the company’s profits have been estimate to exceed three billion dollars thus far.

For me, the most interesting part of the book described the Mexican drug dealers. In a relatively small, agricultural area of Mexico, sugar cane farmers switched to growing opium poppies. The crop was easier to harvest, and much more profitable. Then young men from the area were recruited to travel north to the U.S. to sell the semi-processed heroin known as black tar. This was not a centralized drug unit, but rather multiple small organizations of growers, transporters, and driver-salesmen. Many of these groups were from Xalisco, a city in the Mexico state of Nayarit.

Each group had a handful of drivers located in smaller U.S. cities, ready to deliver black tar heroin to young addicts who called them on the phone. By delivering the product, middle and upper class addicts didn’t have to travel to bad neighborhoods for their drug. The drivers carried only small amounts of black tar heroin with them, in balloons which they carried in their mouth. If stopped by the police, they could swallow the evidence. Even if they were caught, the amount of heroin was so small that they were only deported, not jailed.

The drivers-dealers didn’t use the product, so they weren’t tempted to dilute the product for personal use. Drivers were paid by the hour, so that also gave no financial incentive to dilute the product. These young Mexican men were polite, and taught to give the best possible customer service, to keep the business of the addicts. In fact, they frequently ran sales on their product, as an incentive for customer loyalty.

This heroin was cheap and potent. Opioid pain pill addicts who were desperate to avoid opioid withdrawal switched to heroin because they could get high with less money. Because the tar could be snorted, the stigma of IV use was avoided – at first. Ultimately as the addiction progressed, addicts who started using intranasally eventually switched to IV use.

Groups of heroin sellers competed with each other to sell the most heroin, but they didn’t engage in violence. Since they were all from the same relatively small area of Mexico, and violence in the U.S. would bring repercussions from relatives back home. The drivers delivering the product were cautioned to stay away from blacks, since the Mexicans believed blacks to be more violent.

Because these heroin-selling groups avoided all violence, they were able to concentrate of profits. They didn’t call attention to themselves, making it easier to pass under the radar of law enforcement.

Groups of heroin dealers from Nayarit settled in mid-sized cities. They avoided cities where established drug cartels controlled the sale of heroin, such as New York City, Los Angeles, Philadelphia, Baltimore, or Detroit, fearing there would be violence from the cartels. Instead, they settled into cities like Salt Lake City, Portland, Oregon; Columbus, Ohio; and Charlotte, NC. They needed cities where other Mexicans worked in order to blend in with the populace. The book tells of opioid addiction in Huntington, WVA; Denver, Colorado; Boise, Idaho; Santé Fe, New Mexico; Nashville, TN; and Myrtle Beach, South Carolina.

These Mexican farm boys returned home with money and spent ostentatiously in order to impress their neighbors and friends. They hired bands, threw parties, and built houses with the money they earned from selling heroin. In a relatively poor area, young men saw there was a way to make their fortunes, so recruiting new drivers wasn’t difficult. In fact, the supply appeared to be inexhaustible.

The author makes the point that all of this happened slowly and without much publicity, but I question this conclusion. He says that it was only when Phillip Seymour Hoffman died that the U.S. sat up and took notice.

Maybe I have a different view since I’ve been treating opioid addicts since 2001, and saw a rapid rise of opioid addiction in my state since then. At conferences we seem to talk little about anything else – but then, I go to Addiction Medicine conferences.

The book has its flaws. It was a little repetitive, and many chapters were short, giving the book a choppy feel, but this was because the author described events chronologically, and described what was happening in multiple areas to multiple people.

He described drug abuse in Portsmouth, Ohio, which he called the birthplace of the pill mill. I don’t agree with this. Ever since doctors could prescribe medications that caused euphoria, there have been pill mills. Sadly there are always a handful of unscrupulous doctors who prescribe freely to patients willing to pay. I don’t think Portsmouth was the location of the first pill mill, and sadly it won’t be the last.

The most distressing thing that I read was how the Mexican drug families would move into a new city and go to the methadone clinics to recruit its first customers. From there, word of mouth via the addict grapevine resulted in plentiful business for the Mexicans.

That’s appalling. I’m sure it seems like no big deal to people wanted to make money off of addicts, but to target people who are in treatment to get well, and then tempt them into a relapse…that is low down. The book also describes how drug rings would pay more attention to an addict if he said things about quitting heroin. The dealers would offer this person an exceptional deal to remain a customer.

I know this is good business. But this business breeds death and misery.

I struggle with how to provide security at opioid treatment programs. I don’t like it when an armed guard in the parking lot makes it feel like a police state, but then I want our facility to be safe, and free from interlopers such as these described in the book.

I was also disappointed about the lack of information about treatment. Granted, the title implies only coverage of how the opioid epidemic emerged and evolved, but it would have been nice to add even a small section to readers who are addicted themselves, or who have relatives who are addicted.

Aside from the few nit-picky flaws, this book is great – it’s well-written, informative, and entertaining. It’s one of the best books I’ve read about this country’s story of opioid addiction. It picks up where “Pain Killers,” by Barry Meier left off.

This book should be read by anyone interested in our pain pill epidemic. Addicts should read it so they can realize where their money goes. Families of addicts should read it to better understand the compulsion of addiction. Law enforcement personnel should read it to hear the stories of the addicts, and come to see them as people with a disease, not just as criminals. Every doctor should read it, to better understand risks to patients who are prescribed heavy opioids. Treatment center personnel should read it to get a better idea of the milieu of addiction in the U.S.

Addiction Fiction: “All Fall Down” by Jennifer Weiner

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Sometimes the greatest facts can be transmitted by fictional stories.

My bookshelves at home are groaning under the weight of all sorts of written material about addiction. I have textbooks, journals, and SAMHSA publications about addiction and treatment. I also have numerous autobiographical memoirs written by people with addiction issues, which seems to be a whole new exploding genre, with more books coming out each month. I’ve read The End of My Addiction; More, Now, Again: A Memoir of Addiction; Pill Head; Rolling Away; Drinking: A Love Story; Dry: A Memoir; Beautiful Boy: A Father’s Journey Through His Son’s Addiction; Tweak; Leaving Jersey Dirty; Broken: My Story of Addiction and Redemption; Lit: A Memoir; Parched: A Memoir; Hit Hard; The Adderall Diaries; Junky; and probably many others that don’t come to mind at present.

But I can’t think of any fiction I’ve read about addiction, probably because I tend towards non-fiction in my reading life. So this new book I recently read was unusual for me, and I enjoyed it. I also found many truths contained within the fictional story.

In this novel, All Fall Down,” the protagonist, Allison, narrates the arc of addiction from occasional pain pill use to compulsive and uncontrolled use, and then through the bad consequences that follow. The book gives a fresh and accurate account of the protagonist’s stay in an inpatient rehab, and ends by describing her life in early recovery.

I am particularly impressed by the way the author describes the thoughts of Allison, the protagonist. The author has great insight into the mind of someone in active addiction. Allison lies to herself about how many she takes, about the reasons she takes the pills, and that she functions better with the pills than without. I found the author’s description of Allison’s thought process and self-deception to be accurate and believable. I hear the same self-deceptions in my work. Allison tells herself she deserves a few extra pain pills because she’s under emotional stress dealing with a difficult family situation. She tells herself everyone uses something to get through the day. She resolves again and again to cut back on her pill use, and then has moments of clarity when she realizes she’s using more than ever.

When Allison has these moments of clarity, the author accurately describes her confusion and self- blame. Allison realizes she’s doing things that are against her personal beliefs, resolves to stop, and yet can’t. The author truthfully describes the self-reproach and shame an addict feels when she can’t control her drug use.

Eventually, she admits she needs help, but still has to be forced into treatment by her family.

Buprenorphine makes a brief appearance, and I’m not too happy about how it was portrayed. In desperation because her pill stash was gone, Allison goes to an urgent care to get a prescription for pain pills, so a made-up reason. She surprises herself by being honest to the doctor about how much oxycodone she’s using. Even more surprising, the doctor is knowledgeable about opioid addiction and prescribes Suboxone. But in the book, the doctor doesn’t set her up in an addiction treatment program. Then Allison goes into precipitated opioid withdrawal after she takes the Suboxone, and has to go to the hospital. The hospital talks to her family and Allison is eventually admitted to an abstinence-only treatment center called Meadowcrest.

Meadowcrest gets harsh treatment from the author, but the details are amusingly accurate. Allison is dismayed that most of the treatment center staff have few counseling credentials, other than being past graduates of the treatment center themselves. She also illustrates the petty meanness some people are capable of when given power over other people. She describes Michelle, an overweight recovering addict who delights in thwarting Allison’s plans to use the phone or go to her daughter’s birthday party. She describes how some of the treatment center staff talk down to patients they are supposed to be helping, by calling them selfish and lazy.

This author does such a great job of describing all of the facets of early addiction and treatment that I can’t help but think she must either have personal experience or has a close friend or family member who went through opioid addiction and recovery.

I appreciate the honesty of the Allison character. She thinks the slogans of 12-step recovery are dumb and trite, and that she’s different from all the other patients because she never injected opioids or was homeless. She feels out of place around patients who have obviously gone much farther down in their addiction. She resents the twelve step program and finds some of the steps to be shaming. She has a difficult time with the idea of a higher power.

Then gradually, as Allison slowly starts bonding with other patients, she acknowledges she has the same feelings as they do, underneath the addiction circumstances. She comes to see that when she was stopped from driving by a teacher at her daughter’s school when she was impaired, that was her bottom. For other people, stealing or prostitution constituted the low of their addiction, but the feelings of shame and self-reproach were the same.

Allison starts to focus on her similarities to other addicts, rather than her differences. She starts to feel empathy for other addicts and wants to help them recover. Her own healing begins.

By the end of the book, Allison is going to 12-step meetings and she feels connected to the other people there. She sees that the slogans do have value, even though she finds them trite. She still struggles with any concept of a Higher Power, and is honest about that. She often doesn’t want to go to meetings but still goes, if only to see how the other addicts are doing. She develops a focus outside of herself, and begins to do things that are helpful for her and her recovery. Her marriage may be over, but she’s able to tolerate not knowing what will happen, allowing things to play out on their own.

This book will resonate with all people who have addiction, but especially with the relatively well-to-do opioid addicts who didn’t experience the low-bottom consequences of jails and institutions. I think the author accurately described the inner experience of the opioid addict. She certainly illustrated the failings of the Meadowcrests of the world while still showing how they can help people.

After I read the book and wrote this blog entry, I went to Amazon and read the book’s reviews. The people who liked it and gave the book five stars seemed to be either life-long fans of the author, Jennifer Weiner, or to have had some previous encounter with addiction. The readers who didn’t like it, and gave it one star, said the book was boring and depressing, or that it wasn’t like the author’s other books and they were disappointed. A few of the one-star readers said they were in recovery themselves, or worked in a treatment center, and they didn’t feel the book gave a realistic portrayal of addiction.

It’s always fascinating to me how two people can read the same book and come away with such opposite views.

I recommend this book for people with opioid addiction, in recovery or out, and for those who love them. It’s a great book for anyone who has been puzzled by the weird behavior of the addicts in the world.

I’d like to see more addiction fiction like this…

Check Out CASA’s New Free Publication

If you’ve never browsed CASA’s website, you need to do so. CASA, which stands for Center on Addiction and Substance Abuse, at Columbia University, has helpful information about addiction and its treatment that you can download for free. They have information about how to reduce the risk of addiction in teens (“The Importance of Family Dinners” series), information about the cost and impact of untreated addiction on society ( “Shoveling Up”), in formation about substance abuse and the U.S. prison population (“Behind Bars” series), and the availability of drugs on the internet (the “You’ve got Drugs” series). All of these contain useful and thought-provoking data.

This summer, they published a masterpiece: “Addiction Medicine: Closing the Gap between Science and Practice.” I’ve read most of this book, and admire the clarity and call to action it presents. This publication outlines all aspects of what is wrong with addiction treatment in the U.S., and how to fix it.

Every politician should read it. Every parent should read it. Physicians and treatment center personnel should read it. Anyone who is concerned about the extent of addiction and its poor treatment in the U.S. should read it.

CASA describes their key findings of the drawbacks of the U.S. system – or non-system – of addiction treatment. This nation is doing many things wrong, to the detriment of people afflicted with addiction, their families and their communities. Our mistakes are based on ignorance, misperceptions, and prejudice. All of these impede our ability to help our people with addiction. The CASA report clearly describes these factors, saying they all contributed to our present situation. We have declared a war on people who use drugs, not on drugs.

The CASA report describes how public opinion about addiction isn’t based on science. We now have science that proves addiction is a brain disease. We know that continued use of addicting substances alters the structure and function of the brain, affecting judgment and behavior about the continued use of drugs even when bad consequences occur. We know that at least half of the risk for developing addiction is determined by one’s genetic makeup. Yet surveys show that about a third of U.S. citizens still feel addiction is due to lack of willpower and self-control. Why are public attitudes so disconnected from science?

Addiction is a complicated diagnosis, existing as it does at the end of the continuum from occasional drug use to regular use to compulsive use. People often compare a drug user with a drug addict. They say that since the drug user was able to stop when he wanted that the drug addict should be able to stop when he wanted. This compares apples to oranges. If someone can comfortably stop using drugs when given a good enough reason to do so, this person isn’t an addict. They may be a drug abuser, a problem user, and at high risk for addiction, but they haven’t crossed the line into uncontrollable use.

The CASA report illuminates what addiction medicine physicians have been saying for years: addiction treatment and prevention isn’t treated by physicians and health professionals. Most addiction treatment is provided by counselors who, for the most part, aren’t required to have any medical training. Only six states require a bachelor’s degree to become an addiction counselor, and only one (Alabama, go figure) requires a master’s degree.

Even when physicians are involved in the treatment of addiction, most of us have very little, if any, training in medical school or residencies about addiction prevention or treatment. Ironically, most of our training focuses on treating the consequences of addiction.

In medical school and residency, I spent countless hours learning about the proper treatment of cirrhosis, gastritis, anemia, pancreatitis, dementia, and peripheral neuropathy from alcohol addiction. I had little if any training about how to treat alcohol addiction, and none about how to prevent it.

We know brief interventions by physicians during office visits can reduce problem drinking and are an effective way to prevent problems before they occur. Yet few physicians are trained to do this brief intervention. Even if they are trained, primary care physicians and physician extenders are being asked to do more and more at each visit with patients, and asked to do it with less and less time. Often, primary care providers aren’t paid to do brief interventions, and an opportunity for prevention is lost. Yet that same patient may consume hundreds of thousands of healthcare dollars during only one hospital admission for the consequences of with alcohol addiction.

When I practiced in primary care, I often thought about how I never got to the root of the problem. I felt like I was slapping Band-Aids on gaping wounds. I would – literally – give patients with addiction strikingly absurd advice. “Please stop injecting heroin. You got that heart valve infection from injecting heroin and you need to quit.” I could see it was ineffective, but I didn’t know any better way at the time. I thought if there was a better way to treat patients, I’d have learned about it in my training.

Wrong. Instead, I learned about this vast body of scientific literature about addiction treatment by accident, when I worked at an addiction treatment center for a few days, covering for a doctor friend of mine.

In coming blogs, I’ll outline more of the points made by this timely publication. In the meantime, read it for yourself at  http://www.casacolumbia.org

Bibliotherapy: More Addiction Memoirs

If I Die Before I Wake, by Barbara Rogers

Anyone struggling with addiction to drugs including alcohol can get something out of this book. The author describes what her addiction was like, what happened to get her into recovery, and what it’s like now. And she went further than that. She described the trials she faced while in recovery, and how she applied the spiritual principles of the twelve steps as she went through these trials. This book is like going to a really good speaker meeting. It will resonate with both newcomers and old-timers in recovery. I will be recommending it to my patients.

Pill Head, by Joshua Lyons

I was envious as I read the book, because he did such a great job of writing an interesting, engaging book, while also educating the reader with (mostly) accurate facts about the disease of opioid addiction. It’s more interesting than my own book, Pain Pill Addiction, though I have more science in mine. Anyway, the author shows the dividedness of many addicts. He wants to be in recovery, and hates the negative consequences that are occurring as a result of his addiction, but he still wants to use pain pills. I don’t think people newly in recovery should read it because it may trigger cravings in the places he describes drug euphoria. His story isn’t one of hope, and I wish he’d waited until he was further into recovery to write the book.

 

Loaded, by Jill Talbot

            Ugh. I didn’t like this book. It was false advertising, for one thing. It was more about her unhappy love life than it was about her alcohol addiction. For the first two-thirds of the book, she laments about how dating married men made her lonely. Duh. Then toward the end she does talk of some sticky situations due to alcohol, and describes her fellow patients at a drug rehab. But then she is vague about her relapse back to drinking, and if she was able to do controlled drinking, or if she went back to her former state.

Wired: the life and Fast Times of Jim Belushi, by Bob Woodward

            It could have been cut in half and been a much better book. The renowned author put in a great many details of the days and nights during the years leading up to the star’s death from drug overdose, and it felt like too much after a few chapters. We get it. He was a wild and crazy guy. He did outrageous things and was tremendously talented and deeply flawed. Maybe knowing the ending made it sad from the start. Another big talent obliterated by addiction.

Broken, by William Cope Myers

            He’s the son of the famous journalist William Myers, and now a spokesman for Hazelden recovery center in Minnesota. This memoir is one of the better ones. He does a good job of describing the guilt that comes after a drug binge, and about his family’s disappointment in him. With a famous father, the press of expectations was an added stress that may have pushed his addiction further.

Go Ask Alice, by Anonymous

I came across a paperback copy in a bargain bin at a thrift store, and bought it to re-read. I read it as a teen, and at that time suspected it was written by an adult to scare kids away from drugs. I wondered if I’d think differently reading it as an adult. I didn’t. I certainly didn’t sound like it was written by a fifteen year old. It’s a fair book, but probably fictional.

Can’t Find My Way Home, by Martin Torgoff

I’ll re-read this one. It’s a comprehensive history of drug addiction in the U.S. from 1945 until 2000. Focused on the various political movements and popular trends of different years, it puts drug use into cultural context. It also gives some specifics behind some famous drug users and drug legalization proponents. It was fascinating. At the end, the author unexpectedly described his own recovery. Anyone wanting to read more about the 1960’s and 70’s drug culture should read this book.

“The End of My Addiction,” by Dr. Oliver Amiesen

            I only got this book because a few patients mentioned it. I pre-judged this book, thinking the author must be a pompous doctor, hater of Alcoholics Anonymous, who wrote a lame book on a half-baked theory about addiction treatment, just for his self-glorification. I was completely wrong. The author writes about his own addiction with self-awareness and humility. He doesn’t claim to have all the answers, but presents a credible treatment that may benefit alcoholics. He started himself on high-dose baclofen, a muscle relaxant that’s been around for years. It quenched his thirst for alcohol. He presents a good enough argument to justify a large randomized controlled trial to test the theory that high-dose baclofen suppresses alcohol cravings. The book is well-written and interesting. Dr. Amiesen describes his own travails with addiction in some detail.

Bibliotherapy: Books About the History of Addiction and Treatment

Great books about the history of addiction and its treatment have languished in obscurity, never getting the recognition that these bits of history richly deserve.  I’m going to do my small part to encourage people to read these great books.

 The Addicts Who Survived: An Oral History of Narcotic Use in America, 1923-1965, by Courtwright, Joseph, and Des Jarlais. This book, published by the University of Tennessee Press in 1989, is now out of print, so hopefully you can find a copy at your library. I’m so glad I bought one of the few copies. This amazing book is filled with interviews with intravenous heroin addicts who lived through the so called “classic era” of opioid addiction. I got a feel for how fragile life is for IV addicts, and how miraculous it is to survive addiction for 30 years. Many of the survivors went into methadone programs, and credit methadone with saving their lives. Other addicts went on methadone, but are frank about their criticisms of methadone treatment, and their regrets. As an added bonus, this book has interviews with key people who made history during the classic era of opioid addiction in the U.S.: Vincent Dole, M.D., one of the three original investigators of the efficacy of methadone maintenance as a treatment. Dr. Dole describes the harassment and interference he experienced during his work, both from law enforcement and the medical community.

 The Fix, by Michael Massing.  There’s much great history in this book. Much of the book talks about the governmental decisions regarding the treatment of addiction and addicts. The author describes effective treatments for addiction which weren’t continued, because of political pressures. It also describes how policies that didn’t work nonetheless remained in practice because of politics. This book gives us insight into dealing with the present wave of pain pill addiction. If you have to read one book on the history of addiction treatment in the U.S., make it this one. It’s interesting because the author also includes stories of real-life addicts and their struggles to find treatment and recover.

 The American Disease: Origins of Narcotic Control, by David Musto. This may be the best-known book about the history of opioid addiction and treatment in the U.S. The author gives exhaustive references, valuable in their own right. This book may be dense reading for anyone not already interested in the topic, but I loved it. He gives a painstaking history of drug addiction against the background of American culture and politics. Anyone who has input into drug policies needs to read this book.

Dark Paradise: A History of Opioid Addiction in America, by David Courtwright. Much like The American Disease, it is packed full of information, along with insights and interpretation of the information. It covers much of the same information as the other book. It differs in the interpretation of opioid addiction history.

 Hooked: Five Addicts Challenge our Misguided Drug Rehab System, by Lonnie Shavelson. The author, a physician and journalist, follows five addicts with no money through the process of accessing addiction treatment. He documents in excruciating detail the pitiful systems called “treatment” for these addicts. Gaps in care and communication breakdowns would frustrate anyone, but these people are more fragile than most. The roadblocks they face are depressing. This is a fascinating and entertaining book, and left me with a feeling of frustration. It’s a vivid description of how broken our healthcare system is for the indigent.

Slaying the Dragon: The History of Addiction Treatment and Recovery in America, by William White. Written in 1998, this book has it all. It’s probably the most comprehensive book about the history of addiction treatments. Even if you don’t work in the field, you’ll think the book is interesting. It’s a well-written and scholarly book.  Particularly interesting was the descriptions of quack cures for addiction promoted throughout the ages. Some things never change. People desperate and suffering from a disease are vulnerable to different species of snake oil treatments now, as ever in history.

Addiction: from Biology to Drug Policy, by Avram Mack. Written nearly 10 years ago, parts of this might be a little out of date, but it’s still packed with information. It covers technical material, but is accessible to the educated layperson. He has some interesting stories to illustrate his meanings.

 The Narcotic Farm: The Rise and Fall of America’s First Prison for Drug Addicts, by Nancy Campbell, 2008. In this little-known book, the author explains how drug addiction was treated from 1935 until 1975. The Narcotic Farm was a unique facility that served both voluntary patients and prisoners who had addiction. For its time, the Farm was moderately open-minded and willing to try new treatments. Sadly, most of the addicts treated to the Farm relapsed, probably because they had no continuing treatment when the addicts returned home. The pictures in the book are great, and tell much of the story of the Narcotic Farm.

We need these books. We don’t have to keep re-inventing the wheel because we can look to the past for guidance about the treatment of the addicts in this country. Our past method of incarcerating addicts clearly did not, is not, working. Public policy makers all over the country at all levels of government need to read these books.

If you know of more such books, tell me.