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The Addict: One Patient, One Doctor, One Year

The Addict: One Patient, One Doctor, One Year

3.5 2
by Michael Stein

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“A gripping, illuminating book . . . Dr. Stein is drawn, in an almost Sherlock Holmesian way, toward trying to fathom and analyze addicts’ behavior. . . . hauntingly and successfully, Stein lets readers make a doctor’s experiences their own.” — New York Times

“Beautifully told… [with] great insight, empathy


“A gripping, illuminating book . . . Dr. Stein is drawn, in an almost Sherlock Holmesian way, toward trying to fathom and analyze addicts’ behavior. . . . hauntingly and successfully, Stein lets readers make a doctor’s experiences their own.” — New York Times

“Beautifully told… [with] great insight, empathy and compassion.” — Abraham Verghese, author of The Tennis Partner, My Own Country, and Cutting for Stone

The Addict is the powerful and revealing narrative of Dr. Michael Stein’s year-long treatment of a young woman addicted to Vicodin. Dr. Stein has followed up his award winning book The Lonely Patient with “a useful, sensible, and often inspiring guide to how the medical profession does—and should—treat the sick, and the sick at heart.” (Francine Prose, O magazine)

Editorial Reviews

Janet Maslin
[Stein] loves to listen and analyze. That's what makes The Addict a gripping, illuminating book…Lucy's story alone would not be enough to make The Addict a compelling book. It's the doctor's story that leaps out, and his reluctance to reveal much about himself only serves to make him more intriguing…Dr. Stein has written one other nonfiction book, The Lonely Patient, in which his empathy for the terminally ill and description of what goes on inside his white coat came through. This time, even more hauntingly and successfully, he lets readers make a doctor's experiences their own.
—The New York Times
Publishers Weekly

With a crisp detachment that belies his vulnerability and caring, Stein (The Lonely Patient) masterfully records the relentless pain-physical and psychological-that brings Lucy Fields, a 29-year-old Vicodin addict, to his door with "a peculiarly common modern American condition." Though the literate and likable Brown University med school prof administers another drug that should block the effects of the Vicodin, he readily admits its success is far from perfect. A daunting addiction unfolds; Fields, college-educated and from an intact family, paradoxically defies yet also encompasses the stereotypical drug-user-she is both self-aware and self-destructive. It's Lucy's arc of illness that keeps this haunting narrative moving forward, but it's Stein's clear-eyed compassion that catapults her story from pathetic to sympathetic. "To enjoy treating addicts... one needed a sense of irony, the belief that everyone's life vacillated between euphoria and sorrow," Stein says. Experts might disagree on treating addiction, but Stein's prescription is hard to dispute: first treat the illness, and then the aching soul sickness that caused it. "To work with addicts is to enter the profession of possibility," he learns. In this uplifting chronicle, Stein celebrates Lucy's victory and his own. (Apr.)

Copyright © Reed Business Information, a division of Reed Elsevier Inc. All rights reserved.
Library Journal

Stein (The Lonely Patient) here re-creates his heartrending struggle to help patients overcome their addictions to commonly prescribed painkillers and other life-threatening drugs. Charting therapeutic challenges and inevitable recidivism, Stein brings to life his all-too-human patients in a narrative that is as readable as any work of compelling fiction. Therapists, addicts, and their family members will be riveted.
—Lynne Maxwell

Kirkus Reviews
Compassionate but sometimes tedious look at the grim realities of addiction and recovery. "Eleven million Americans take opiates for nonmedical, recreational reasons," writes Stein (Medicine/Brown Univ. School of Medicine; The Lonely Patient: How We Experience Illness, 2007, etc.). In 2008, Vicodin, a chemical cousin to opiates, was the single most prescribed drug in the United States. It's no wonder that addicts abound, and drug-recovery programs like the one run by the author always have plenty of patients. "Lucy," a waif-like 29-year-old child of privilege who had been addicted to Vicodin for years, wasn't all that different from the hundreds of others who came into the author's office over the years seeking solace, treatment or just more drugs. In many ways her story exemplified the journey through addiction toward recovery-with backslides into addiction-and it here inspires Stein to a meditation on what it means to be in the grip of a desire so powerful that it can make you abandon all others. "Let me describe the ways I've ruined my life," Lucy said at one point during treatment, a remark that any number of the author's patients could have made. Recounting his interactions with Lucy, Stein takes the opportunity to correct misconceptions about addicts and addiction: You can't become addicted overnight, he writes, and addicts aren't moral weaklings with no self-control; it's as real a disease as depression. His book also illustrates that the emotional bond between patient and doctor is not one-sided. Recounting Lucy's tumble back into drug use, his dismay and resignation are poignant and palpable; a passage toward the end showing her at uneasy peace with herself rings with endearingcontentment. Stein's prose is strongest at its most medical, however; detours into description or philosophy are often perfunctory and dull. A heartfelt attempt to explain an often misunderstood disease.

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The Addict
One Patient, One Doctor, One Year

Chapter One

Wednesday, April 16

It had rained the first week in April that year, and though the reappearance of the sun raised the temperature to only forty-five New England degrees, it made me hopeful again. My new patient sat on her black Converse high-tops, her legs tucked under, as if she was trying to keep herself from running away. She appeared to be in her late twenties and was wearing a loose gray sweater over a pink and green polka-dot blouse. With her chin tipped into her collar, eyes toward the floor, she appeared shy, or embarrassed. She was tall but slight and had rolled up her sleeves to the elbows.

"I'm here for your program," she said. "You still have openings, right?" Her soft voice gave me an impression of politeness.

Sixty minutes isn't enough time to learn a patient's complicated history so I was happy to start at a gallop. I was grateful she required no transition from the general cheerfulness of just meeting each other to the serious conversation, filled with effort and nervousness and specifics, that would constitute the rest of the hour. The answer to her first question was a simple yes or no.

"Yes, I do," I answered, as if we were getting married, which in some sense, we were; from that moment forward, our time together would, like any pair's, get snagged on expectations, hopes, and fears, mixed with promise and excitement.

My exam room also serves as my office in the hospital clinic. At the far end, just past the examining table, is a large window with a fifth-floor view of the neighborhood and the two multifamily triple-deckers whose ownersseem determined to hold on despite the encroachment of hospital buildings and parking lots. This window gives the room an unusual brightness every season, particularly on spring mornings. My new patient had chosen the metal chair whose bent rods and plain plastic seat and back offered, really, just the ideogram of a chair. This uncomfortable seat does not give the exam room a sense of well-being. I'd recently thought of bringing in a chair from home, my mother's old chair, which my wife had reupholstered in maroon velvet for my birthday. But I hadn't gotten around to it. On the wall behind the patient's chair is a large photograph of vines that my brother-in-law, an artist, had computer-manipulated into the shape of a man kneeling. There are books on the shelves above my desk—textbooks about renal and heart disease, dermatology primers with pictures of common eruptions, guidebooks for how to examine the knee and the shoulder—but I have no pictures of my children under glass, no diplomas in thin black frames on the walls; I've never liked that. Along the opposite wall, there is a small chrome sink next to which I keep square packages of bandages, paper-doll white, and cellophaned rolls of gauze in perfect soft cylinders along the back of the counter. The cabinet above is a cave of supplies, sticks, scalpels, and screw-lid cups hiding in the dark in undisturbed neatness, nothing loose, shaggy, or irregular.

By 11:00 a.m. on that Wednesday, I had already seen three patients, listened to their uncertain stories, examined them, come up with plausible explanations for their symptoms, tried to bestow comfort, and made plans to see them again. I am an internist, a doctor for adults with heart disease, high blood pressure, headaches, hepatitis, and other ailments and illnesses. I take histories and perform physicals. Taking a medical history has a discipline to it, but it's also like listening to gossip where the only topic is the patient who tells stories about herself. On the other hand, the physical, examining a vulnerable and tender body, trying to know its secret past of wounds and scars is exhausting. Physicals confirm histories, but also provide information that patients can't, or won't, communicate. Of course, what doctors don't know about patients, after an hour, even after a year of providing care, is endless. Too often, we are wholly unprepared for what we learn along the way.

What patients don't know about me might be vaster but matters not at all. They expect to know little; few ever ask if I have children (I do) or where I went on vacation (I rarely leave home for more than four days), or even where I'd trained, my history of successes and failures. In my twenty years of practice, it has been the rare patient who mentions that they know I am a writer, even though several of my books are for sale in the hospital gift shop.

When I look at patients, I immediately wonder, where, physically, the damage is. Although she was dressed like a teenager, Ms. Lucy Fields had turned twenty-nine recently—her date of birth was stamped on the upper-right corner of her purple chart, which lay open on my desk. She looked healthy—there were no physical signs of illness. Her mouth had a determined shape.

"Can you tell me a little about yourself?" I asked.

Sitting sideways, studying the back of my dark-stained office door and giving me only her profile, she shifted on the metal chair, keeping her feet tucked. She had put her tiny black purse, a white paper coffee cup, and a blue plastic bag with a drawstring on the floor beside her chair. Pretty with her long, black hair that she parted in the middle and pale blue eyes, she was not pretty enough to create envy among the nursing assistants who were known to judge each of my patients. She looked like a girl I went to high school with who always covered herself densely in layers. There is often something in a patient's character or looks or choice of words that binds me to them from the start. Without this connection, I am just a man in a white costume, and they are merely strangers asking me to guarantee they'll live forever.

The Addict
One Patient, One Doctor, One Year
. Copyright (c) by Michael Stein . Reprinted by permission of HarperCollins Publishers, Inc. All rights reserved. Available now wherever books are sold.

Meet the Author

Michael Stein is the author of the award-winning The Lonely Patient as well as five novels. He has been treating addiction for more than twenty years and is a professor of medicine and community health at Brown University.

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The Addict: One Patient, One Doctor, One Year 3 out of 5 based on 0 ratings. 6 reviews.
Anonymous More than 1 year ago
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reader222 More than 1 year ago
I wanted to like this book, and did - for the first half. The second half was dull. Mostly it consisted of what went through the doctor's head. It was a little creepy. The doctor was a little attracted to Lucy, I think. And why is he counseling her?? He was supposed to be writing the prescription but how about sending her to a therapist?? M.D.'s don't have the kind of training needed, and he isn't a psychiatrist.
Anonymous More than 1 year ago
harstan More than 1 year ago
In 2008, the most commonly prescribed drug in the United States is Vicodin. Not well known is that Vicodin shares a close "DNA" chemical imprinting with the illegal opiates. With that background, Dr. Stein provides a profound look at helping a Vicodin addict kick the habit, physically and psychologically. Twenty-nine years old Lucy Fields visited Dr. Field having become totally addicted to Vicodin after using it for years. Lucy is a college graduate coming from an affluent family. She is fully aware of her health crisis, which brought her to the medical school professor for treatment. This terrific memoir filled with pathos and compassion will nuke the concept held dearly by talking heads who refuse to accept American pharmaceutical addiction as a health issue perhaps even worse than the illegal drug problems they prefer to rant about. Dr. Stein stays professional for the most part except for some minor well-earned pontification. However, Lucy puts a human face on medically treating legal addictions as readers will be spellbound by her real story. Harriet Klausner