Current Books

Savior Complex

By Colleen Foy-Sterling, MD

Cracked, by Drew Pinsky, 273 pages, Regan Books, $15.

Cracked: Putting Broken Lives Together Again, by Dr. Drew Pinsky, describes the author’s experiences as medical director of a Southern California drug detox center. If Pinsky’s name seems familiar, it may be because he co-hosts the “phenomenally successful radio show Loveline,” to quote from the book’s cover. (I have never heard this show, but my husband assures me that it focuses on sex much more than love, despite its title.)

With no previous knowledge of Pinsky, I was originally drawn to this book (his third) because treating patients with the comorbidity of drug dependence is an inexorable part of my professional life: I work at the Petaluma Health Center and spent six years practicing at the Mission Neighborhood Health Center in San Francisco. When I saw the cover of Cracked—which features Humpty Dumpty crying while the King’s Men try to fix him up—I began leafing through the book, thinking I might benefit from hearing how a colleague responds to the challenges of working with drug-addicted patients.

Cracked delivers a useful, informative, and direct description of daily life in a Pasadena rehab center—at least from the point of view of its almost-celebrity medical director. Pinsky is not involved in the patients’ psychiatric care, but he is charged with ameliorating pain and suffering while his patients attempt to withdraw from heroin, methamphetamines, cocaine, pain medications, and alcohol.

As a family physician, I appreciated Pinsky’s description of the physical and psychic pain that addicts endure when they are trying to quit, and I came away with an immediately expanded vocabulary that I could use when confronting patients and preparing them for withdrawal. Within days of beginning Cracked, I became more sensitive to the signs and symptoms of early withdrawal. I better appreciated that because patients are often reluctant to admit their addiction in the first place, they cannot be expected to report that their problems are related to addiction.

Pinsky’s patients do it all, and they exhibit many behaviors that I have seen in my own patients, including transparent lying, overt obsequiousness, and dissimulations of surprise when their attempts to deceive are discovered (aka, “the amazing myriad of explanations of just how a tox screen came back positive”). As a result of reading Cracked, I have increased the number of urine tox tests I administer on new patients because of the common practice of using pain medications to take the edge off the rebound or withdrawal from cocaine and methamphetamines. I also feel more empathy for chronic pain patients who have felt trapped by years of medication. As Pinsky confirms, such patients are desperately craving and absolutely believe they must have their refills.

Pinsky describes drug withdrawal in almost unbearably illuminating detail. His stories of this prolonged, complicated, and downright painful process reminded me that referrals to addiction specialists and programs such as DAAC and LEAP must remain central to any physician’s intervention strategy. Putting broken lives together again is a grueling process.

Pinsky is an unflinchingly honest writer. No person or thing is spared analysis as he dissects his patients, the detox center atmosphere, his frustrations with insurance companies, and his own shortcomings. Despite these self-criticisms, he has a savior complex that is hard to take at times: he enjoys his relationships with the neediest patients a little too much. Nonetheless, he is frank about his own “addiction” to saving others, and he realistically portrays his feelings of attraction to needy, pathetic, and sexy female patients.

Indeed, sexual attraction is a recurring theme. In one scene, the unit counselor Betty, a recovering heroin addict, leans toward the kind doctor and blurts out: “I need to have you—right now.” Pinsky’s professional response: “Almost reflexively I shot back, ‘That is just not possible.’ And, strangely, I felt a flood of guilt and confusion.”

While such an interaction has not happened in my own practice, I appreciate Pinsky’s honesty. And, as I must reluctantly admit, the Peyton Place sexuality of his book does keep you reading. Accordingly, I read Cracked with more interest than I would have generated for a review article on drug abuse from the journal of the American Academy of Family Physicians.

While Pinsky’s honesty is admirable, disclosure alone does not justify his behavior. I could not help but wonder whether he is just a classic narcissist, with a side order of “sexually frustrated professional” thrown in for flavor. On the other hand, maybe the sexy portions of the book were included as an editor’s ploy to spice up the quotidian saga of a drug rehab center—as if drug treatment were not dramatic enough!

Pinsky seems to blatantly get off on saving his patients. He pointedly obsesses about a particular female patient “who gets to him,” even as he describes his experiences with male patients as difficult and tough, involving much lying from the patients and macho confrontation from the doctor. Maybe Pinsky, like the rest of us, should do some soul-searching about these human relationships and how they color our practice.

Shortcomings aside, I thought Cracked was a good read, partly because I was fascinated by Pinsky’s ego, but also because he offers many important insights into the world of addiction. Read it while on vacation or post-call.

Sonoma Medicine, Volume 56, Number 2 (Spring 2005).