The Addict by Michael Stein

I first heard about this book in my June issue of Brown Alumni Monthly. Dr. Michael Stein is a professor at Brown and this book chronicles the relationship he has with a patient who is trying to correct her all-consuming addiction to painkillers.

Stein runs a program that provides buprenorphine as an alternative to Vicodin; while there are differences between this type of program and one that replaces heroin with methadone, the parallel is valid for the purposes of understanding the story. He seems to be compassionate but not soft, and was definitely likable as a narrator. Lucy, the title character, is likable too, despite her low self-image and erratically sad behavior relating to drug abuse.

The cover of the book include the subtitle "One Patient One Doctor One Year" but this is an oversimplification. Stein's book covers several patients' stories, which not only provides some context for Lucy's story but also for Stein's. A leading expert on addiction, Stein easily covers research on drug abuse, clinical trials he has run, as well as several intimate portraits of patients in a very readable format.

What most held my attention about this book is that it was the first one I had read from the doctor's point of view. I have read several books on mental health and addiction, including Appetites, My Name is Bill, Parched, Drinking: A Love Story, Prozac Nation, Holy Hunger, and More Now Again, but they are all from the point of view of the patient. There are glimpses of the doctor's point of view in many of these books, but always through the patient - in fact one of the most memorable parts of Prozac Nation occurred when Wurtzel had just attempted suicide and she hears her (excellent) Dr. Sterling on the phone commenting to another doctor, "Well, you know how it is, me and all my suicidal patients." Wurtzel grants her some "gallows humor" and the book quickly moves on...but I always wondered about the doctor's side.

And Stein provides a great view into that - his most striking characteristic is his measured competence, appropriately interspersed with concern and worry. We see Lucy as he does - weekly or monthly, with no additional information as to what the time is like in between other than her depictions of it. She is a sympathetic character, and clearly a favorite patient of Stein's (if they have favorites), but she is imperfect and he is appropriately distanced and clinical in his description of their interactions.

Lucy seems to be really invested in changing her life. My view into addiction, heavily influenced by the books listed above, is obviously slanted towards high-functioning addicts who can write and publish a book (or collaborate with an author). It was interesting in contrast to read about a recovery journey that was 'in-progress' with a patient who was motivated but not so much so that she was writing a book.

While I liked Stein as a (true-life) character and came to trust him as a doctor, I did wonder if Lucy would have benefited from seeing a psychiatrist too - Stein is an internist who provides talk therapy along with the buprenorphine. I didn't notice anything about their interactions that made me think he was not providing great health care but I also don't know how a psychiatrist would have changed her chances of recovery.

I appreciated reading this book and look forward to picking up Stein's other memoir, The Lonely Patient, sometime in the future.