Cracked

by Drew Pinsky
Regan Books, 2003
Review by James E. de Jarnette, Ph.D. on Jan 5th 2005

Hilariously funny and mixed with pathos and compassion from the start to the finish, Crackedby Drew Pinsky is informative and very familiar to of those professionals who have ever dealt with in-patient alcohol and drug abuse patients.

How often have I heard patients say, "All I need to do is get sober; then I can control my life." There is something intrinsically wrong with this statement when this same patient has used it on three other admissions to detox and treatment.

Katherine is a perfect example of a user who thinks all she needs to do is get off the drugs. Getting off is the necessary first step, of course. It's dramatic and interesting. But it's only the first step in treating the disease. It's like getting into position to do the work. Katherine is falling apart all over the place. Having hid the truth about what she'd been using –a common tactic among addicts--now, in addition to her opiate withdrawal she's dealing with a Valium habit, too. She's a mess in every way. She discovered that there aren't any quick fixes. How can there be, when the patient has used drugs to regulate emotions she can't manage normally? Generally, these over-whelming emotions are related to childhood traumas--pain, abuse neglect, abandonment, and overall feelings of powerlessness. There aren't any simple eight-hour cures for that. (page 17)

In the afore-quoted monologue by Pinsky, the foundation for the remainder of the book is laid bare. Alcohol and Drug Abuse is just the tip of an iceberg that goes down many fathoms into a cold sea of past wreckage. He continues by putting this in a much broader psychosocial perspective.

I have plenty of reasons to call the culture up on charges. Katherine, Amber, Mitch, and hundreds more just like them. The culture is like a living, breathing beast that feeds its own need to exist and grow at the expense of the individual. Our world is full of people with narcissistic problems who look to escape those feelings and be gratified--and the culture steps right up to meet those needs. Many of those contributing to the culture are sick themselves. It doesn't take a shrink to count the number of celebrities who end up in rehab, getting into fights, or posing for mug shots. The media has become an instant-response machine, ratcheting our tolerance ever upward in cycles of arousal and gratification. All of this can be arresting, fun, sexy, most of all, it sells. But it doesn't heal. (page 19)

Pinsky talks about an issue that many people not adequately trained in the behavioral sciences, and some who are, just don't talk about. What do you do with the family, significant others, and friends of the patient receiving treatment?

"I know it's tough to understand, but what you need to do is let us take care of her. These nurses know what they are doing. They've done thousands of detoxes…"

"If she's going to have a successful recovery, you're going to have to change as well. I know you're eager to get her back the way she was before the drug use really took off, but that is simply not possible. She has some real serious problems here, and she's going to have to work very hard at growing and changing."

Hoping to get through to Jack enough that he'll get off her back and maybe even start taking a look at his own problems, I take a stab at educating him. "I think a simple way to think of relationships is like a lock and key. Emotionally, when tow people come together they fit together in much the same way the jagged edge of a key fits with the tumblers of a lock. But any traumatic emotional change can change the way those tumblers are shaped."

"That's what happens when a drug addict starts coming to terms with her problems--and it can be very scary to be involved with someone who's going through those emotional changes. It can be very uncomfortable when you no longer fit the way you always did. It can feel like you are losing your partner." (page 108)

I really enjoyed this book on so many levels. I treat a large number of addicts and substance abusers. The information contained in this book is very good for professionals as well as substance abusers/addicts. I plan on recommending it to my patients and I recommend it to you.

James E. de Jarnette, Ph.D., Forensic Child Custody Evaluator

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