Empire of Pain

Empire of Pain


Therapists are taught to screen for substance abuse in the first session. Conventional training teaches that traditional psychotherapy will not be helpful if a client is actively abusing a substance and encourages clinicians to refer addicts to a substance abuse treatment program. Some therapists use a tough love approach and refuse to move beyond a first session with a substance abuser. With alcohol use, some clinicians have success helping clients reduce levels of use while preparing to begin Alcoholics Anonymous meetings, intensive out-patient or in-patient treatment. Such treatment can be life-changing for those who are ready for the all-encompassing journey that recovery entails. But with opioid use, there is no in between. Psychotherapy is not the solution and intensive treatment is necessary.

Before diving into Patrick Radden Keefe’s Empire of Pain: The Secret History of the Sackler Dynasty, I understood the dangers of opioid addiction. But I did not understand its gruesome origins. I did not understand the role that one family played in developing a crescendo of addictive drugs beginning with Valium, progressing to MS Contin and ultimately to OxyContin.

While haunting, the book is a captivating education in the history of pharmaceutical marketing, dynastic corporate corruption, and drug dealership. Keefe employs painstaking research and demonstrates the details of OxyContin’s harrowing impact on American culture. The award-winning author of Say Nothing is tireless and unsparing in his breakdown of how three brothers – sons of Jewish Immigrants – transformed the pharmaceutical industry, created the novel strategy of aggressive marketing, and simultaneously compiled a priceless art collection. Ironically, the Sackler family aggressively plastered their names on museum wings throughout the country while remaining meticulous in extricating the family name from any association with their multiple drug companies.

Arthur Sackler, the oldest brother and the family pioneer, was the first doctor to try treating mental illness with through medication. Before his efforts, people who were severely mentally ill were housed in asylums for life. As a Jew, Sackler was unable to find a more mainstream residency following medical school, and he worked at a psychiatric institution where he spearheaded efforts to treat severe mental illness not just with talk therapy, but with psychiatric medication. His work helped patients finally return to their homes and re-enter the mainstream. Unfortunately, the eldest Sackler’s breakthrough accomplishments were grossly counteracted by multiple money-making schemes and deceptive marketing strategies that ultimately hurt so many more than he helped.

Empire of Pain walks readers through an inter-generational saga of greed, pathology, egoism and deception the scale of which seems unparalleled in American history. Readers discover family hubris at the highest levels and take a comprehensive, page-turning journey through its tragic fallout. This astounding book is essential reading for healthcare professionals and for anyone who has lost a loved one to opioid addiction.

Elisabeth LaMotte

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