Hooked

Michael Stein Examines The Addict
By JOHNETTE RODRIGUEZ  |  June 16, 2009

Providence author and physician Michael Stein has an uncanny ability to make a medical case history read like a novel in his newest book, The Addict (William Morrow, 288 pages, $26). It's not only that he makes us care about the patients whose lives he describes; it's also that he puts himself into the narrative. He asks us to see him as a human being in a specialized situation, not a white-coated stick figure responding with little or no emotion to the pain of the people who walk into his office.

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THE DOCTOR: Stein's The Addict is authoritative, informative, and thought-provoking.

Stein finds himself in the unique position of asking questions and hearing stories during most of his office hours — what could be a better set-up for a writer? Yet he makes few notes during his interviews, relying on his memory of dialogues and monologues to convey the essence of the particular person, a young female opiate addict, who is profiled in The Addict, subtitled: One Patient, One Doctor, One Year.

Stein is careful to explain in a preface that he conflates some of "Lucy's" characteristics so that she won't be recognized, except perhaps by herself. He also does this with the handful of other addicts whom he outlines. But it is Lucy's story (along with his own) that forms the focus of the book.

Stein has been an internist for 20 years, is married with two teenage boys (at the time of writing the book), and oversees a program of treatment for opiate addicts that includes doses of a drug called buprenorphine, first approved in 2003. Intended to help wean addicts off of opiates, buprenorphine is prescribed by Stein in very limited doses, partly to create an incentive for the drug user to return to his office for "talk therapy," partly to keep it from becoming a black-market substance itself.

Stein's portraits of Lucy over the course of a year always start with a physical description: What do her clothes and the book she is reading indicate about her mood on that appointment day? Her posture seldom varies; she sits sideways in a metal and plastic chair, staring at the back of his office door when she speaks. Unlike some of his patients, she is quite willing to talk about herself, but like most, she is skillful at hiding key pieces, and she is not above lying to him.

How does he break down those walls of self-delusion? Why is he so drawn to work with addicts? What binds him to this particular young woman? His answers are reflective, still questioning himself. Does he identify with her feeling of aloneness, since he also spent an isolated adolescence after his father died when he was 13 and his mother left him on his own too many nights? Does he feel a protectiveness toward her? Does she remind him of someone he once knew? Is there a kinship because she always has a book with her?

Whatever the reasons, this 29-year-old woman stirred the writer in Stein to share the ups and downs of the journey he witnessed during a year of treating Lucy. She tells him about her overly-critical parents, her too-perfect younger sister, her addiction to various substances from the time she was 13, beginning with Robitussin and later, for most of a decade, Vicodin.

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