Beautiful Boy: Afterword Summary & Analysis

David writes an afterward to the book in October 2008. Tweak, Nic’s book, is published in February 2008. David is breathless reading it, learning about Nic’s self-destruction from his own perspective. Nic had nearly died many times, and David learns that Nic also nearly lost an arm due to an infection from shooting up. But reading also helped David understand how Nic’s biggest victim was himself. David, Karen, Jasper, and Daisy were simply “collateral damage.”

Beautiful Boy is published in February as well, and David and Nic go on tour to talk about the books. They meet hundreds of people, many of whom break down as they speak about their own stories. Many of them have more tragic endings: children or loved ones who died. Hearing this, David is flooded with gratitude that Nic is alive.

There are also stories of hope: people who have been in recovery for three days to 37 years and everyone in between. One girl says she spent her last $20 on Nic’s book instead of meth. People tell one another not to give up hope. One woman talks about her daughter, a heroin addict who disappeared for a year, was raped, and spent time in jail, but who is now three years sober.

The last leg of the tour brings David and Nic back to California. Nic then returns to Savannah, Georgia, where he’s lived for the past two years. Three months later, he moves back to Los Angeles. Later in the summer, Nic reveals that he had relapsed a few weeks earlier, more than two years after he had stopped using the last time. But this time, he stopped his relapse before it led to catastrophe and immediately checked himself into a residential program.

David then writes about addiction more broadly: in 1971, President Nixon began the war on drugs. It has cost hundreds of billions of dollars, while the use of drugs has risen steadily. First-time users are younger, and the drugs are stronger and more widespread. More than 20,000 people die each year of drug overdoses alone, and there are related tragedies—like crime, accidents, suicide, illness, lost productivity—that also harm the nation.

Health insurance companies, Medicare, and Medicaid often refuse to pay for treatment of illness or injuries caused by drugs or alcohol. Payment of life insurance may be denied if drug or alcohol abuse led to death. Addiction also remains a secret because of the deep shame associated with it. Addicts are often viewed as having a character deficiency rather than a serious illness. Besides criminalizing addiction, society tends to overlook the issue.

Stigma and prejudice also curtail financial support for research into addiction, and thus few effective treatment options have been developed. Costs for the best treatment programs may run at $30,000 to $50,000 a month, and therefore addicts very rarely get the treatment they need. Caregivers are also often less likely to want to treat addicts because of their belligerence and the persistence of their illness.

In 1971, Nixon also declared a war on cancer, which is now much more treatable than it was in the past. In contrast to addiction, the incidence of cancer began dropping in 1990 and has fallen every year since then. David argues that a similar war on addiction is needed: it must be organized and heavily funded. He writes that we spend more than $10 billion a year researching cancer, and each year we misspend more than $50 billion on the war on drugs. We spend billions on prisons, but the annual budget of the National Institute on Drug Abuse, which conducts almost all drug-related research and development, is less than $1 billion.

More money will allow for better medications, cognitive and behavioral therapies, and combination treatments. Insurance companies should be required to cover comprehensive addiction treatments. RAND Corporation’s research found that for every dollar spent on treatment for addiction, taxpayers save more than seven dollars in other services through reduced crime and medical fees and increased productivity.

The other necessary step is prevention: intervening early and preventing the progress of addiction. Some addictions may resist treatment, just like cancer. But cancer treatment has still made dramatic progress, relieving suffering and saving millions of dollars and millions of lives. A war on addiction would do the same: reduce crime, reduce homelessness, reduce emergency room visits and prison populations, and alleviate “immeasurable suffering.”