Hooked: Five Addicts Challenge Our Misguided Drug Rehab System

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Summary: Shavelson points out failing of substance abuse treatment sy
Review: Dr. Shaverson has pointed out extremely well the failings of our treatment system for addictions that primarily hires recovering people who are poorly trained at best, untrained at worst to treat what a highly trained specialized counselor or psychologist should be handling. Dr. Shavelson also adeptly points out that a disease is normaly treated while it's in progress, and one does not get treatment for drug addiction until they are clean! I recommend this reading to all who believe that 'AA,' 'NA,' etc., are the only way to treat addictions, and that only the 'recovering' person can treat addictions! Ronald E. Hestand, MA, MS, EdD(Candidate), Registered Addictions Specialist

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Summary: our rehab process
Review: drug rehab right between the eyes that pulls no pun ches and shows us where we need to go next

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Summary: Review of "Hooked"
Review: Especially for anyone who has been associated with the American substance abuse treatment system as a provider, this book should cause a sober reflection on the problems that permeate our disjointed efforts to help people gain and maintain recovery from addiction. The author's purpose is to investigate the experiences of five "hard-core" addicts as they attempt to access the (comparatively) rich service network of a major city. Perhaps the two major criticisms made are that clients are rejected or dismissed for demonstrating they have the problem for which they're coming to treatment (using), and that conventional treatment does not address the deep-seated psychological problems that the majority of seriously addicted people have. These observations are accurate. Although treatment advocates are certainly right to campaign for more public dollars, we must also look into our own house and make the changes suggested in this book.

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Summary: A must read for those interested in the subject
Review: Hooked is a very good book. It starts of as one of those investigative journalist things with a description of real drug addicts. Often books of this type look at these people as if they were the inmates of a zoo, but rather than doing that the book uses their problems to illustrate the difficulties which plague organisations which provide assistance to drug addicts.

One woman suffers from a combination of mental illness and drug abuse. Her attempts to find help are continually frustrated by the fact that when she applies for assistance from mental health professionals she is told that she has a drug problem and she is referred onwards. When she speaks to drug agencies she is told that she has a mental health problem and told to see a psychologist. In the last chapter of the book she is able to find an agency which will help her, but this occurs only after the intervention of one of the doctors. The intake staff is concerned about accepting her as they prefer people who have fewer problems and who are easy to deal with.

A lot of the book is focused on one person Mike who attends a live in facility for close to a year. His story illustrates how current rehabilitation facilities fail to have access to services such as detoxification and also use ritual humiliation as a means of controlling the inmates. Mike breaks a rule by developing a relationship with another inmate. He has to sit in a chair for three days and to go through a re-education session similar to those that featured in the Chinese Cultural Revolution. The author makes the point that the people running the program are generally untrained and not able to work out when such treatment is appropriate or whether those who might be put through it could suffer from major mental illnesses. Those people who suffer from substance abuse problems generally will have a background of some difficulty. In this case Mike was a person who was raped repeatedly as a child. There was however no psychological treatment available in the program. More important however is the inability of the program to deal with relapse. Drug addiction is a problem that is often defined by the tendency to relapse. However the response of Mikes program was to kick him out. That is despite the fact that if allowed back into the program his prognosis would have been good.

The author is an admirer of the Drug Court system. The reason for his admiration is that the Drug Court is better able to make the diverse and not well functioning elements of the treatment system accountable. Thus they use relapses to build the drug addicts skills in dealing with their addiction so that they are more likely to stay clean. They can also ensure that rehab placements accept people, provide them with appropriate care and they can also direct addicts to detoxification.

The book is not only an interesting discussion of the issues the author is able to interest the reader in the story of the addicts he studies. One can see them as humans and follow their struggle to get on top of their problems and to live lives as valuable citizens. A book which should be a must read for anyone with an interest in the area.

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Summary: NPR Interviews Author
Review: I have not read the book yet but will very soon. I just heard a radio interview with the author though. One very interesting observation he had was that addiction treatment is only offered to those who are CURED. That is, they are off drugs. He does not think that this is a good thing. He also found that a very high percentage of male addicts were sexually abused as children and a staggering 70% of women addicts were sexually abused BEFORE becoming addicted. Treatment focuses exclusively on the chemical problem with no help for the underlying cause. Looks to be a must read for those in the treatment field and those of us taking it One Day At A Time.

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Summary: Should Be Required Reading
Review: If I had sufficient funds at my disposal, I would send a copy of this book to every legislator, policymaker, prosecutor, judge, and mental health and drub rehabilitation provider. Lonny Shavelson has written a well-researched, compelling, and exquisitely human book about people tortured both by their psychological and drug afflictions and by the systems charged with helping them. After reading this book, I cannot imagine that anyone could successfully argue against the obvious: 1) that we must shift the majority of the "war on drugs" money from enforcement to treatment, 2) that we must reform and integrate the drug treatment and mental health systems, 3) that we must reorganize social service systems (housing, medical care, children's services, etc.) to deliver coordinated services, and 4) given the precursors to most drug addiction (child abuse and mental health issues), rethink where we spend drug prevention dollars.

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Summary: An Accurate Diagnosis and Treatment Plan
Review: Lonny Shavelson has managed to turn what might have been a dry, preachy treatise into a lean, suspenseful page-turner with just the right touch of inventive language. His work lets you know that a gifted writer has flexed his literary muscles just enough to show you that he's in charge of the material. But, at the same time, he has definitely succeeded at not letting his writing get in the way of absorbing life stories and the transmission of many useful nuggets of information. During his two years of journalistic investigation, Lonny gained the trust of some "difficult patients" and placed a very human face on the individuals who carry around the stigmatizing labels of "alcoholic" and "addict" in our society. He has accurately diagnosed the problems in San Francisco's system of public health care as it relates to substance abuse treatment and offered a constructive solution in prescribing more and better training for the system's substance abuse counselors and improved communication between the worlds of mental health and drug treatment.
However, he would need to walk on water or at least wield a magic wand to dissolve the intense political wrangling and top-heavy administrative structures of San Francisco's Department of Public Health and each and every one of the more than 130 drug treatment programs in San Francisco. Having worked as a psychiatrist for nearly 10 years at San Francisco General Hospital, I, unfortunately, have had a front-row seat in witnessing the retarding effect that San Francisco's bureaucratic stranglehold inflicts on our city's most vulnerable and needy. While Lonny is a very talented humanitarian, journalist, and writer, he, after all, is only human, too.

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Summary: Treatment for the treatment system!
Review: Over 2 million Americans in prison, another million each year arrested on drug charges, economic development tied grimly to building prisons and jails. America made a wrong turn somewhere. It isn't like we don't know where and when. It was when we lost faith in the ability of therapists to treat addicts, became afraid and decided they must go to jail and for longer and longer periods of time. Those who understand addiction know that jail sentences do not cure it, regardless of the length. But, judges and prosecutors and victims and voters don't care. They want to feel safe. So the burden falls on those of us who believe drug treatment is a better alternative. And our confidence is shaken by pretty low success rates. Lonny Shavelson has discovered what most have missed. We cannot clean up the addicts until we clean up the treatment system. The system has built a career on convincing us that if someone does not do well in recovery it is not the fault of the therapy or therapist. "The addict just didn't want it badly enough," they say. Not true, Shavelson argues. His book is a must read for policymakers looking for what Shavelson calls, "the elusive secret to effective rehab." It is coerced treatment, make 'em go and make 'em stay long enough for it to work. But...and this is the key to Shavelson's book...the "secret lies...not only in coercing addicts into programs, but in coercing the programs to do rehab right." No legislator or governor should spend another nickel on treatment until they read this book and put it to work in the treatment system. Treatment folks should read it as a "self help" guide. Hold up the mirror to your face! For all of you, a curious thing will happen as you read this book. You will come to understand that no one just becomes an addict. Sure some make bad choices but for most the bad choices were made for them. Childhood traumas, sexual abuse, genetic predisposition. As you read about the lives of the 5 addicts Shavelson tells us about, you find yourself...caring. If we are going to meet this challenge, that is what we must do. Caring is the elusive answer. We must care enough to do what we need to do. For anyone who is involved in the substance abuse issues at any level, this book is required reading. Wonderful book.

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Summary: A Masterful Work
Review: The ultimate, and most accurate praise of Lonny Shavelson's journalism is that he makes it look easy. And how easy could it possibly have been to write "Hooked?" Following five addicts through the horrors and small triumphs of their lives--and not just following, but living it with them. Shavelson's compassion and passion are as much in evidence as his journalistic talents, and I much appreciate his willingness to inject his own observations and opinions into this page-turner of a book. It's hard to believe anything this gritty could be so, well, addictive to read--but it is. You won't fully understand America till you read this book.

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Summary: Hooked on this Book!
Review: This skillfully written account of the struggles of five addicts, each of whom the author followed for several years, is not only informative about the promises and perils of rehab, but incredibly moving in its portrayal of courageous attempts to put wrecked lives back together. Set in San Francisco's maze of competing bureaucracies, with forays into homeless encampments and drug lairs as well as welfare hotels and a suburban home, the book makes a powerful argument for a coordinated approach to treatment that meets an addict's long-term psychological and physical as well as short-term behavioral needs. A surprising finding is that people mandated to treatment by drug courts do better than people who "demand" it: the latter are not only stonewalled by hard-pressed administrators, but abandoned to their old environments after "graduating" from whatever program they managed to get into; whereas the drug courts place their clients, track them tenaciously, and give them chance after chance to succeed, often in the face of public opposition.

Lonny Shavelson is also tenacious in following his chosen addicts, several of whom lapse and relapse and are all but lost to the streets. Each of these five is lit from within, at least briefly. One falls through the cracks, but most appear to have been saved, if not through grace, through their own hard work and the faith of a few people in the system...along with the author. This is a riveting read, about people who demand our attention, respect, and empathy. Others in similar circumstances deserve better from the system.