|DR. MICHAEL STEIN|
An addict's journey through doctor's eyes
If you're an internist working with drug addicts, the odds that a YAVIS seeking treatment will appear in your office are pretty slim. So when it happened to Dr. Michael Stein one cold April morning, he took notice - and not only as a medical man, but also as a writer. The resulting account, "The Addict," is the detailed, often frustrating, but ultimately rewarding story of his work to help get one patient on the road to recovery.
YAVIS is an acronym that some mental-health therapists use to describe the "ideal patient": young, attractive, verbal, intelligent, successful. With the significant exception of the last adjective, Lucy Fields fit the bill.
Many chronicles of single-patient therapy feature a recalcitrant patient whose therapist patiently and ingeniously works to open up like a flower in a slow spring. Not in this case. Fields walked into Stein's office in full rhetorical bloom, speaking in complete, almost comely, paragraphs. And Stein takes these paragraphs down verbatim to share with his readers.
Lucy is a Vicodin addict. "In 2008," writes Stein, "Vicodin was the most prescribed medication in the United States . . . a pill chemically related to the opiates . . . morphine and heroin. It is offered by internists for back strain and by dentists for toothache, by surgeons . . . for incisional throbbing and by emergency room doctors for kidney stones." For most people, the drug eases the pain, makes them a little nauseous, maybe gives them a headache. For a small susceptible group, it briefly delivers heaven and then, for a more extended period, something like hell. From an initial prescription of four pills, the user may end up taking 80 pills a day just to avoid withdrawal symptoms.
When he met Lucy at his New England hospital, Stein was one of a few local doctors mandated by the government to supply addicts with buprenorphine, "which blocks the effects of Vicodin by attaching itself to the same opiate brain receptor." The use of buprenorphine can be successful, but it takes a shrewd, almost loving vigilance by the doctor and an enormous commitment by the patient.
Stein, a stern-looking man in his mid-40s with a tender heart, accepts Lucy for treatment. The doctor is intrigued by addicts. He admires them because of their "mental agility and . . . survivor's creativity." He sympathizes with many of them because he knows that they may have suffered early trauma leading to their addiction. While understanding Stein's sympathy, a reader might find his admiration puzzling. By definition monomaniacal, addicts - even under Stein's benign gaze - are often mean, unscrupulous, self-justifying, self-pitying, and sometimes criminal.
Lucy is most of the above, although she is uncharacteristically honest. The story she tells, while sometimes interesting, turns out to be rarely compelling. Her talk - a mix of intense self-scrutiny and meandering narrative - flows as lullingly as a river. Stein's pithy insights help to rescue the reader's attention, as does his occasionally vivid prose.
Breaking up the main narrative are lively, welcome portraits of other addicts in Stein's practice, and they are a pleasurable diversion.
Stein writes well, and Lucy's story - if you have the patience to stick with it - ends with a satisfying and deeply sad surprise. Intermittently tedious and over-analytical, the book is also a touching, honest account of one woman's fight with addiction. "The Addict" should be looked at the way Stein looks at his desperate patients: "I believe in second chances, and usually third chances as well."
Alec Solomita is a writer living in Somerville.