The logic of associating personalities with specific drugs seems natural. A German-British psychologist named Hans Eysenck spent the mid-20th century turning the eye of the scientific community from Freud’s behavior-based theories to individualized psychology—pioneering the science of personality. He considered this pursuit of matching personalities with drugs a pet project.

Eynsenck believed the ways people are inclined to think aren’t always the ways that make us feel best. And because drugs are the easiest way to modify temperament, it’s only natural for us to seek out those substances that keep us on an even keel. For instance, he thought that introverts, whose brains are always chewing at problems, should crave depressants to quiet the incessant mental chatter. Extroverts, easily bored, should chase the rush of stimulants.

His theory condensed individualized drug cravings into an easy, logical framework—but he was wrong. Or at least, he vastly oversimplified the concepts of both “personality” and “drugs.” Worse, his theory wasn’t borne out by research. Study after study showed both introverts and extroverts drinking alcohol (a depressant) to excess. And extroverts didn’t limit themselves to uppers; it seemed they would reach for all kinds of substances.

So where does that leave us? Well, scientists kept trying to tie the two nebulous concepts together. Over the years, as new methods of personality screening emerged, researchers continued to distribute questionnaires to groups of drug addicts. One major breakthrough came when four sets of psychologists independently realized in the 1980s and 1990s that a person’s personality traits—tendencies that are partially genetic and tend to last throughout life—can be pretty reliably described using five factors.

Introversion and extroversion weren’t enough, they thought. We should also consider openness to new experiences (think Bear Grylls), conscientiousness (Haruki Marukami), agreeableness (Mother Theresa) and neuroticism (Woody Allen) when trying to understand why people act the way they do. Thus armed, personality psychologists began fitting the various personality traits they had come up with over the years into what came to be called the “Big Five.” And lo, with a more accurate representation of traits, a connection between personality and drug use began to emerge.

People who tested high on neuroticism (indicating that they tend to be impulsive, emotionally unstable and anxious), low on conscientiousness (tending to be disorganized, unambitious and lazy), and low on agreeableness (tending to be uncooperative, unhelpful or misanthropic), were more likely to have problems with alcohol or drugs than people whose scores were closer to the middle, or reversed. Perhaps more interestingly to the question of whether personality traits led their owners to cocaine over alcohol, or marijuana over mushrooms, higher scores for each risky trait were linked to higher likelihood of using “hard” drugs like heroin, amphetamines or crack.

“There is some evidence that the more ‘bad’ traits you have, the harder the drugs you’re going to use,” says Michigan State Department of Psychology professor Chris Hopwood. “So super, super-impulsive, sensation-seeking, neurotic people might be inclined to use something like heroin, for example, whereas if you’re a little bit less impulsive or have more anxiety about things maybe you wouldn’t. Maybe you would use other drugs but you would be too afraid to use heroin.”

Not all the personality factors that appear in people with drug problems are negative, however:

Sensation-seeking—a facet of openness to experience that’s common among extreme sports athletes, explorers, philanderers and roller coaster-enthusiasts—is almost always associated with drug abuse, but doesn’t necessarily scale with using harder drugs. Marijuana users, for instance, have been shown to be high in sensation-seeking, with closer-to-average levels of neuroticism.

Sensation-seeking seems to be about 60 percent heritable—meaning about 60 percent of the trait comes from your genes—and appears to be related to the brain’s dopamine reward system, the same system that makes most drugs of abuse pleasurable. Sensation-seeking may even be related to where you live, through interactions with neighbors—or, in the case of, say, New York City, through self-selection. A study by Jason Rentfrow, Sam Gosling and Jeff Potter that was analyzed by Richard Florida on the Atlantic’s Atlantic Cities blog showed that Openness to Experience scaled with drug use when compared within states. And which states had the highest levels of both illicit drug use and openness? Colorado, Vermont, Oregon, Washington, Nevada, Massachusetts, New York and California.

Given the personality characteristics that seemed to split “hard” versus “soft” drugs, scientists began to wonder if—even if they couldn’t predict who would take uppers over downers—there was a way to predict who would become an alcoholic and who would abuse illegal drugs. The studies showed some remarkable similarities: One study conducted among veterans suggested that all addicts share interpersonal styles that tend toward loner, rebel and pessimist stereotypes, for example, which surprised no one who has ever seen “Leaving Las Vegas.” But there did appear to be a little something extra that could push a person into hard drug addiction.

People who use illicit drugs often have been shown to have higher rates of both extroversion and susceptibility to boredom, which may drive them into more situations where drugs appear, or simply make them more likely to crave new subjective experiences. And those who are particularly susceptible to boredom have been shown to use opiates more often.

But this is where the studies break down. Most research on the topic of how personality relates to drugs of choice is conducted among people who already have drugs of choice—addicts. And as any addict knows, once you’ve taken a shine to a drug, it can be exceedingly difficult to disentangle the personality factors that came before from the ones that came after. By the time the personality questionnaires are administered, who’s to say what caused the drug use and what the drug use caused?

“It could go either way,” says Hopson. “A person who uses heroin might end up having problems in their life. Perhaps he loses his job, perhaps then he starts stealing things. You could easily tell a story that goes, the heroin started first and then the person started doing all kinds of mean antisocial things. Or you could tell a story that says that the person was sort of a ‘bad’ person, if you’ll forgive the language, and one of the bad things they did was use heroin.”

There are also direct effects of drugs that scientists have to consider. Crack and cocaine abusers, for example, have shown personality traits related to the symptom of paranoia in certain studies, as well as depression and impulsivity and a trait terrifyingly called “psychoticism.” Because long-term crack or cocaine use can cause many of these effects, however, it’s unlikely that those traits cause people to take up stimulants. Rather, it appears that long-term crack or cocaine use might be able to alter the expression of certain traits to create a “stimulant user profile.”

Regardless of the qualms of scientists, however, quiz websites and message boards hoping to connect personality to a particular drug have popped up all over the Internet. Many focus on Myers-Briggs personality types (ENFP, ISTJ, etc.), which are commonly used by career counselors to assess how people prefer to perceive and organize information. Others skip the science altogether, selecting a drug you’re likely to use based on the clothes you wear, the events you attend, where you live, and your perceived flaws.

Will science ever reach that degree of accuracy—explaining just what it is that seems to make neurotic writers more likely to drink than use heroin? It’s certainly possible, says Hopson. “One way to think about personality is in terms of traits, which are stable and heritable. But you can also think about personality dynamics, like how do I react if you insult me, for example. That’s sort of my guess is that which drugs you use depend on the more complicated personality dynamics.”

Assuming you’ve got the traits that push you toward drug use in the first place, what else might lead you to one substance over another? Hopson says factors that play a role include what your parents use, what your friends use, and even simply what’s available where you live. Which perhaps explains Hemingway’s situation better than we could have expected: there sure was a lot of rum in Cuba.

As I lay there in bed night after night praying that sealed doors and windows would at least contain the eau de cannabis indoors and not alert the neighbors to what I was up to, I inevitably questioned my wisdom. I’m not a drug dealer or suffering from some crippling illness. I don’t even smoke marijuana for fun; if I did, I’d at least have a better excuse for subjecting not only myself but my wife and son to the stress of running a clandestine suburban marijuana farm.

I’m just an author whose idea to research and write about medical marijuana laws and the legalization debate through hands-on experience seemed damned near genius when I concocted it in late 2009, while watching an episode of “Weeds.” That looks subversively fun, I thought. And profitable. And hey, I live in Colorado, one of what was at the time 13 states to approve medical marijuana use. Writing about this law and all of its attendant controversies — is it just a ploy by clever potheads to give legal cover to perfectly healthy stoners, or was there something to the whole medical benefits argument? — through complete immersion was a no-brainer. I’d be the A.J. Jacobs of pot and have far more fun than he had: Would you rather try to abide by the dictates of the Bible for a year or grow some weed and try to abide by your state’s medical marijuana laws?

Diving into the deep end of a subject is nothing new for me, even if it means breaking the law. I once tried to smuggle a diamond out of West Africa while researching diamond smuggling for “Blood Diamonds” (the rough diamond I bought on the black market in Freetown, it turned out, was a fake, but I didn’t know that until I got to the United States). I learned how to pick locks for “Flawless,” a book about a diamond heist, and I even snuck myself into the vault that was robbed so I could see what it was like. Compared to those minor crimes committed in my dedication to research, what was growing a little pot?

A lot more than I’d bargained for, as it turned out. First of all, it’s no minor crime. It’s a federal felony to grow even a single marijuana plant, with a minimum fine of $250,000 and a minimum five-year prison sentence. This is true whether you’re growing to alleviate the symptoms of chemotherapy, to get stoned watching “South Park” or for journalistic research. I knew this going in, of course, and figured that with so many people growing marijuana in Colorado at the time — in late 2009, in the wake of the Ogden memo, which signaled that the feds were going to leave state-sanctioned medical marijuana users and their suppliers alone, you were hard-pressed to find someone who wasn’t at least considering the idea — there would be safety in numbers.

While this turned out to be generally true, there were a number of worrisome developments once my plans were too far along to stop, primarily a steady stream of arrests and DEA raids on people using the medical marijuana law. The most high-profile was the case of Chris Bartkowicz, a suburban grower in nearby Denver, who was raided by the DEA and busted for growing more than 200 plants. He came to the attention of the DEA by going on the nightly news — using his real name and not bothering to obscure his face — to boast about his grow operation, an unfortunate decision compounded by the fact that his house was located within 1,000 feet of an elementary school, an automatic sentence enhancement.

I had no plans to even remotely follow his example. Once I qualified as a medical marijuana patient (with the help of a doctor whose definition of “severe pain” helpfully included my complaints about a sore back) I would only be growing six plants, the maximum allowed under state law for individual patients. My home is half a mile from the nearest school. And I obviously didn’t intend to issue a press release to the TV stations about my little project

But still. Bartkowicz faced 40 years in prison (he took a plea bargain and will serve five). I was fairly certain that the DEA wouldn’t waste its time taking down such a small-timer like me, but once the pot began to bloom in the basement and become fragrant, even I started to wonder if they’d somehow multiplied from six into 600. A Catch-22 of the state medical marijuana law is that the only way you can prove you’re in compliance with it is after you’ve been busted. If it’s the DEA that does the busting, whether you’re toeing the line or not is immaterial — federal law trumps state law.

The slamming doors in the night turned out to be nothing, of course. Just some neighbors coming home from a late dinner. Is this really worth it? I asked myself, crouched in my underwear and peering through the curtains.

The answer was yes, and for a most unexpected reason. Before this experiment, I was perfectly ambiguous about whether marijuana was legal or not. I wasn’t opposed to recreational smoking but because I don’t use it myself, I haven’t felt much enthusiasm to agitate for its legalization. If you’d pressed me, I would agree that the expense of enforcing its total prohibition — an expense borne not just by taxpayers, to the tune of some $13 billion annually, but also by those who are busted and face personal and financial ruin — makes little sense, but also that there are more pressing issues to deal with. And like many who haven’t given the matter much thought, I had some skepticism about its purported medical benefits. Without a pressing medical need prompting me to find out for myself, I was happy to let more interested parties hash it out.

What propelled me into the debate was the outrage medical marijuana laws had generated, not just in Colorado but across the country. The often ill-considered over-reaching by marijuana proponents — for many reasonable people who are undecided about pot, garish dispensaries blazing neon pot leaves from their local strip malls feel like being given the finger — was nothing compared to the militaristic hysteria unleashed by the federal government. Cops were busting into homes and blowing away the family pets looking for reefer and in many cases, turning up next to nothing. Perfectly sober businesses (to speak in relative terms) that followed the letter of their state laws were being pulverized under the heels of DEA agents. Although my personal experiences with marijuana are limited (and well in the past), I knew enough about the effects of pot to realize that the governmental reaction was far out of proportion to the actual threat.

That perception became sharply focused the more I learned about marijuana’s potential as a valid therapeutic tool in treating everything from cancer to nausea. The government’s rabid insistence that medical marijuana is as real as the tooth fairy is simply wrong. The National Institute of Cancer sees promise in its ability to attack tumors. It’s been known for decades to battle chemo-induced nausea better than oral drugs that have the obvious drawback of being vomited up before they can take effect. MS patients have used it to ease the spasticity in their muscles. Cannabinoids — marijuana’s unique ingredients that interact with specific receptors in the brain — have anti-inflammatory effects and can relieve pain. Importantly, cannabinoid receptors aren’t found in the parts of the brain that regulate breathing, which could be one of the reasons no one has ever died of an overdose, making marijuana safer than many foods we eat.

Delving further, I found that one of my own relatives, a cousin who had lost a battle with mesothelioma, had used marijuana to cope with chemotherapy. She lived in New York, where her caring friends and family members had no choice but to deal in the criminal underground to get it, while in nearly a third of the states (most of them in the West) patients could shop with dignity at their choice of dispensaries. That perfectly healthy people who’ve faked their way into the system can do so too is — to me, at least — a small price to pay for those patients to safely obtain the relief they need. It’s certainly not an abomination worthy of the crackdown that has resulted.

Medical marijuana laws are not perfect. They can indeed be easy for healthy people to abuse. Without the involvement of regulators early in the process of developing systems for sale and distribution, which requires a state government more willing to address the issue than simply by plugging its ears and covering its eyes, hoping it will go away, chaos can result. Cops and politicians are going gray overnight with impotence and confusion, usually causing them to overreact and unleash the hounds. Chronically strait-laced citizens who will never believe anyone but the government on this issue see them as evidence of moral meltdown.

But one of the unintended consequences of these laws is that it forces more reasonable folks who might never have given much thought to the issue of medical marijuana — people like me, in other words — to take the effort to sort through the hype. It sounds trite to herald my enlightenment as something newsworthy when so many have figured out long ago what an indefensible failure the war on marijuana has been and that it’s morally repugnant to continue it in the face of mounting evidence of its credibility as a medical substance. But the truth is, without medical marijuana laws and all of their attendant upheaval, I never would have been interested enough to grow my own and embark on my own process of discovery. I may never have seen the light.

In that regard, federal drug cultivation laws were the best ones I’ve ever broken.

Of course, everyone in Kermit — just about everyone in the wooded hollows of Mingo County — knew the Sav-Rite was a pill mill. It handed out Xanax, Lortabs, Vicodin — all manner of the prescription painkillers and anti-anxiety drugs that are crippling Appalachia like a rogue disease — to anyone with an excuse. Kermit, which sits in the poorest, most remote corner of southwest West Virginia at the Kentucky border, was drawing pill addicts from all over the Eastern seaboard. People were throwing pill parties in the parking lot. Trading pills, buying, selling, injecting, snorting, the works.

This went on for years before the law could stop it. In February, more than two years after the DEA and FBI stormed the Sav-Rite, seizing cases of files, its owner, John T. Wooley, pleaded guilty to selling prescription pills by fraudulent means. Wooley, in cahoots with a pill mill “pain management” clinic that existed to sell scripts, was filling prescriptions as if the fate of mankind depended on it.  The Kermit Sav-Rite, along with another one Wooley owned in a tiny hamlet about 10 miles from Kermit, together doled out enough hydrocodone, the main ingredient in Vicodin and Lortabs, for every man, woman and child in West Virginia (population: 1. 8 million). The Sav-Rites moved almost 3.2 million dosage units of hydrocodone in 2006, the year the U.S. attorney used to make a case, compared with the national average of 97,000. Wooley, who sold the Kermit store a few months ago (he lost the other to the feds’ raid), faces four years in prison and a $250,000 fine at his sentencing in May. At 76 years old, he could probably better afford the fine than the time. Agents who raided the Kermit store said cash drawers were so stuffed they couldn’t close.

But shutting down pill mills in these parts is like playing Whac-A-Mole: As soon as a lawless “pain management” clinic or pharmacy is smacked down, others spring up. Investigations take years before prosecutions can be secured.  And pill mills are only part of the problem. Most often, pill addicts get their drugs from friends or on the street. Drug gangs from cities like Detroit, Atlanta and Columbus, Ohio, have also moved in on the action, setting up drug “stores” in residences and other fronts. Almost fondly, people here recall when Oxycontin was jokingly called “hillbilly heroin ”and pill addicts were “pillbillies.” No one is joking now. What is happening in Appalachia, about 10 years into an explosion of prescription drug abuse, is so pervasive a problem that law enforcement officials say they cannot solve it alone.

The West Virginia newspapers offer daily examples of what the Mingo County sheriff, Lonnie Hannah, calls the “spinoffs of drug abuse”: Murders, assaults, robberies, burglaries, domestic violence, child abuse, child neglect, elder abuse, DUIs, overdose deaths. West Virginia, the ninth smallest state, has the highest rate of prescription drug overdose deaths in the nation.

Hannah estimates that two-thirds of the crimes and incidents his department handles are related to pill abuse. Chasing down pill dealing is more than enough work by itself. “It’s all over the county,” Hannah said, at his headquarters in the city of Williamson (nickname: Pill-iamson), the Mingo County seat. Authorities keep busting pill mills and dealers in the city of 3,000 residents, only to see them start up again. “Whenever we move in,” Hannah said, “they move around to someplace else.”

People in these parts have a word for pill abuse: “pilling.”  So much of it goes on that everyone has a story. They know someone who has abused or is abusing pills. They know parents who have lost custody of their children or neighbors who have lost good jobs or friends who have died because of them. They are shocked to hear that in some places in the country, say, San Francisco, pilling is neither a word nor a fact of life.

But that could be changing.  As the Centers for Disease Control and Prevention keeps warning, prescription drug abuse is spreading. Pills, especially Xanax, the anti-anxiety drug manufactured by Pfizer, and Vicodin, Loracet and Lortabs, highly addictive opioid painkillers familiar to anyone who has had a wisdom tooth removed, are being abused more and more, all over. What started out as a situation in poor isolated areas of the country left to their own devices has taken root and spread, across Appalachia and beyond.

You can find pockets of pill abuse from Orange County, Calif., to Staten Island, NY (sometimes now called Pill Island). Nationally, the abuse of prescription pain relievers, as evidenced by treatment submissions, has gone up 430 percent in the last decade, according to a new report by the Substance Abuse and Mental Health Services Administration in Washington, D.C. The report says states with the highest rise in prescription painkiller abuse include Maine, Vermont, Delaware, Kentucky, Maryland, Arkansas, Rhode Island and West Virginia.

Last June, pill addiction on Long Island raged into the headlines when a 33-year-old Army veteran, David Laffer, shot and killed four people in a Medford pharmacy while he robbed the store for hydrocodone. A Vicodin addict, he had been getting the drug through doctor shopping — going from one doctor to another to sidestep the monthly limit for scripts — until he lost his job and his insurance.

“If there is a discussion of doctor shopping and prescription pill abuse,” Laffer said upon his sentencing to life without parole, “then perhaps some good can come from this.”

Laffer’s story lingered for barely more than a news cycle. But the spread of pilling may be the saving grace for Appalachia and the other mostly poor, mostly rural parts of the country where little white pills are leveling entire communities.

They offer the cautionary tale: Political leaders, health professionals and community groups in these parts who have been crying for help can show the rest of the country what can happen when pilling runs rampant.

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Once, maybe just a few years ago, domestic mayhem like the kind described in the March 28 Williamson Daily News would have been the talk of Mingo County for days on end.

A 911 call brought sheriff’s deputies to unincorporated Dingess, a cluster of houses off a gutted path that can only generously be called a road. A couple had been fighting over pills.

Officers found 32-year-old Charles Earnest Chapman bleeding from stab wounds over his left eye and his abdomen, blood all over the house, a small white pill and pill residue by a children’s play area, and two kids, barely toddlers, hanging out of wide-open windows. In the yard lay an empty bottle of Lortabs, 90 mg. April Dawn Vance, 24 years old, had stabbed Chapman and fled the house, she told officers, after Chapman had knocked her to the ground, beat her and choked her. The children became wards of the state, the couple wards of the county jail.

The story did not prompt a single comment in the local news. Nor did this home invasion, reported the same week: In Williamson, Mingo County’s big city, with 3,000 residents, a man arrested for robbing a house admitted to another robbery where he and a cohort stalked an 85-year-old man, busted into his house, beat him to the floor and stole $340 from his wallet. Police said the man admitted he used the money he stole from the elderly man to buy pills. The Williamson police chief advised residents to lock their doors and windows and be vigilant.

Shootings have become news briefs. On April 2, a 33-year-old Mingo County woman, an admitted pill addict, was sentenced to 40 years in prison for shooting her husband to death during an argument.

Too many pill stories have knocked the shock out of the populace. Southwest West Virginia in the age of pilling is like a country that has been living with war for so long, people could barely remember peace.

Ask people how pilling started and most blame coal mining and Oxycontin. Miners spend much of their time in backbreaking positions, crouched, bent and folded over, and men anxious to keep their jobs have long relied on strong painkillers to keep going. Oxycontin began making the rounds here in the late 1990s. Its maker, Purdue Pharma, touted it aggressively to doctors as a safer alternative to hydrocodone-based pills like Percocet or Vicodin because of its time-release formulation.

That proved a boon to Purdue Pharma, which sold over $1 billion worth of Oxycontin a year. It also proved a lie: In 2007, Purdue Pharma pleaded guilty in federal court in Virginia to misleading doctors and patients by making false claims about Oxycontin’s safety. It paid a $600 million fine, the only time that Big Pharma has been publicly implicated in the pill abuse epidemic.

These days, the coal mining industry in West Virginia is rife with pilling.  In March, a lobbyist for the West Virginia Coal Association told state lawmakers that the association suspects that miners from Kentucky and Virginia who were suspended after failing mandatory drug tests are now working in West Virginia. West Virginia is considering mandatory drug testing as well, especially after several incidents. In one recent accident, the lobbyist said, a miner high on prescription drugs crashed a locomotive into a mine car, killing a co-worker.

Oxycontin, public health experts and addicts themselves will tell you, is not the most-abused prescription drug in West Virginia. In 2010, the drug was reformulated to make it harder for addicts to crush, snort and inject it.  But public health experts say that even before then, by the mid-2000s, hydrocodone-based pills like Vicodin and Lortabs, and Xanax (generically, alprazolam), a benzodiazepine used to treat anxiety and panic disorder, were the drugs of choice in the dirt-poor areas of Appalachia, along with methadone and Percocet. Research on why points to “social determinants” such as poverty, lack of education and lack of opportunities, said Robert Pack, a public health expert at the East Tennessee University College of Public Health who has been studying pill abuse since 2002.

Mingo County (population.: 27,000), which became famous for the Hatfield-McCoy feud of the late 19th  century and the Matewan union-busting massacre of 1920, is second only to its neighboring county, McDowell, for the highest rate of overdose deaths from pills in West Virginia.  Both counties are poor, McDowell the poorest in the state.

But the women at Crossroads, a kind of halfway house for recovering addicts in the town of Gilbert, at the southern end of Mingo County, come from very mixed backgrounds. Some come from broken homes and awful childhoods, others from loving parents. Some never finished high school, others are college graduates.

They consider themselves lucky. They landed in jail or committed to mental wards and were forced to go clean.

Crossroads, run by the Mingo County STOP  (the Strong Through Our Plan Coalition, a nonprofit community organization focused on drug prevention and treatment), requires a 90-day commitment. But many of the women end up staying longer, some longer than a year, as they earn high school equivalency diplomas and, often, try to regain custody of children they lost to the state.

Crossroads is a white single-wide trailer with a big sign on it; the whole town knows what it is and why its residents are there. But that has not hurt their job prospects. Every woman at Crossroads has a job. Local employers like hiring them, they say, since they know the women are clean and routinely drug-tested.

On a recent visit, the women were buzzing over the break-in, the night before, of one of Gilbert’s four pharmacies. The thieves had sawed through concrete dividing the building’s cinder blocks, the same break-in technique used at the Kermit Sav-Rite some months ago.

Long discussions with six of the eight women, who ranged in age from 21 to 37, found few patterns. Several had started using pills after doing other drugs. Others were given a pill by a friend. One had become hooked after receiving a legitimate prescription.

Most ended up on the Oxy Express, driving 15 hours with others, every two weeks, to central Florida to obtain scripts from pill mills there. Until recent crackdowns in Florida, it was the go-to place for pill heads from Appalachia to get their drugs. They’d buy cheap prescriptions and come up and sell them for five times what they paid. The general price on the street for pills is $1 per milligram, so that a 30 mg. Lortab costs $30. But in rural southern West Virginia, because of the demand, the pills cost more: 30 milligrams for $40, 90 milligrams for $100.

Now, the women said, more pill users are heading to Georgia and other states.

Several of the women became criminals: thieves, armed robbers.  One of them had just found out that her best friend and pill partner, 21 years old, had been sentenced to 30 years in prison for armed robbery.

Christine, a 35-year-old recovering opioid addict from Charleston — she did heroin, pills, “anything I could shoot up” — works as a bookkeeper at a local company.  She had done drugs all through college and for years on end afterward, supporting her habit by selling pills and manufacturing methamphetamine. She was saved, after two overdoses in a month, when her mother and brother had her committed to a hospital. Now, a year and a half after entering Crossroads, she is a sponsor to other women and to inmates at the county jail.

Gilbert, with 450 residents, is not exactly a haven from pilling. Its nickname is Pillbert. The former executive director of Crossroads was forced to quit when she confessed that she herself was in active addiction.  Her husband, a church pastor, was fired from the church after he was spotted at a methadone clinic, receiving treatment for his pill addiction.

But the women at Crossroads tend to come from other parts of the county, or outside it altogether. For them, Gilbert is safer than returning to their own towns.

Christine said she thinks Gilbert will be a great place to raise her son, now 3 years old. She is hoping to get him back from her sister in Columbus within a year.  “Of course,” she said, “nowhere is completely safe.”

In the years since the events of the first book, Clegg has rebuilt his career as an agent and become one of the best-known faces of addiction recovery. (He is also the rumored muse for “Left-handed,” a recent book of poetry by Jonathan Galassi, and the supposed inspiration for one of the lead characters in “Keep the Lights On,” Ira Sachs’ well-reviewed new film about a troubled gay relationship).

Now Clegg has written a follow-up, “Ninety Days,” a tumultuous chronicle of his early sobriety. The book begins with Clegg’s release from rehab and follows him as he struggles to keep clean for 90 days, a milestone for those in recovery. Over the following weeks, he tries to rebuild his shattered life — befriending other recovering addicts, searching for a new apartment and shuttling from meeting to meeting — but before long, he is once again drinking, smoking crack and having anonymous drug-fueled sex. Thus begins a dramatic series of relapses.

The book, which is written in straightforward, readable prose, is an often-vivid testament to the difficulties of overcoming addiction and the value of companionship. Despite occasional moments of cattiness (Clegg can be ungenerous in his description of other meeting attendees), Clegg comes across as a deeply troubled but a perceptive and sympathetic man, learning lessons about addiction in some very difficult ways.

Salon spoke to Clegg over the phone from Manhattan about the fallout from his first book, the unique appeal of recovery memoirs and why he won’t be writing another book.

It’s been a long time since the events of this book happened, and now you’re doing interviews and publicity about them. Does it feel strange to be rehashing all this stuff?

I wouldn’t say it’s strange, because one of the ways I’ve stayed sober is to stay very close to the things that happened, both when I was using and also in early recovery. I can’t talk enough about those early days of getting sober, because it’s the things I did and the lessons I learned — and the things suggested to me in those early days — that keep me sober today. The more comfortable I get and the more I forget it, the more vulnerable I am to relapse. And it’s pretty simple. Those experiences in those first 90 days are ones I never want to get away from and never want to forget.

Your first book was about your descent into drug addiction and alcoholism. This book is about your recovery. Why did you write it?

It came from a sense of not being finished when I completed the writing of “Portrait of an Addict.” During the three years it took to write that, I felt tethered to this live thing that needed my care and attention. I had this expectation that when I was done I would feel severed from that and I didn’t. So I just kind of didn’t stop writing. But I don’t feel connected to it, or any writing, at this point. I feel completely done.

In what sense?

Finishing this book, the process definitely stopped. I was reading the audio book a couple weeks ago and I hadn’t seen the text in a while. Reading from beginning to end, I almost couldn’t identify with the person who wrote the book. I identified with the person who lived the experiences, but I couldn’t really identify with somebody who would sit for six hours at a time and see that [book] to completion. I just don’t have it in me right now; it’s beyond my imagination that I’d be able to write anything longer than an email. Which is a relief, let me tell you. These books just sort of bullied their way into existence. I have a pretty busy day job as an agent, so I’m kind of amazed that they exist, these things.

What do you think is the overall message of this book?

I thought that once I got out of rehab that if I just stayed away from drugs and alcohol and followed a few simple suggestions there would be a clean narrative of getting sober, that there’d be a before and after that would be clearly defined. And that process for me was a lot messier than that. So if there’s a message in there, it’s that the only way that, in my experience, I’ve gotten sober and seen other people get sober is by asking for help and getting involved deeply in a community of addicts and alcoholics in recovery.

The first book was such a huge success. How did you deal with the sudden fame that came with it? The book included some pretty shocking scenes.

I guess I dealt with that in the same way I dealt with every difficult or wonderful thing, which is one day at a time. If I step back and regard any aspect of my life, whether that be my relationship with my family, or my job, or that publication, or this one, I will probably get overwhelmed and driven to my knees in exhaustion and despair. I was busy at that time doing my job so I just did everything that I always do but maybe with a little bit more desperation. I didn’t stop and look around and try and make meaning of any of it. I just kind of showed up to what I needed to show up to — whether it was an interview or working on the copy-edited manuscripts or whatever — and then moved on to the things that crowd my life.

Do you think your disclosures from “Portrait of an Addict” have changed the way people interact with you?

Because my collapse and the revelations of my alcoholism and drug addiction were so known to people in the book publishing world, it sort of mediated or affected every interaction I had professionally when I came back to work, whether that was with prospective new clients or colleagues. I think because that history was informing so many of my interactions and relationships, I got used to it as a kind of third person in the room. In terms of people outside the sphere of book publishing, it was challenging. I’m a self-conscious person by nature, and there were certainly uncomfortable moments.

Is there one big moment is “Ninety Days” that stands out to you as being particularly meaningful?

When I look back and try and locate some moment where a great shift occurred, it was the feeling [at one point during the recovery period covered in the book] when I was walking toward a place where I did drugs all the time. I was walking towards the door and thought of Polly (this woman I got sober with who is still very close to me) who was not sober at the time. She was, at that point in her recovery, pretty dire — like life or death. I felt like if I went in and got high and went down that rabbit hole, she might show up to a meeting and find out that I had relapsed and that that would keep her out of there.

My involvement in her recovery and connection to her was the thing that stopped me from walking through that door. Somehow the pull of my feeling of usefulness and responsibility to Polly was greater than my desire to use. That was the first time anything stood between me and a drink or a drug. And I turned around and walked away. Very soon after that, the obsession to use and to drink lifted, which was something that hadn’t happened in all of the time that I had tried to get sober.

To me that reminds me how important it is to stay connected to other people in recovery. To me recovery is sort of moving from the first-person singular to the first-person plural. For me as an addict, I can get very consumed with my own anxieties and worries and struggles and ambitions. And if I get too wrapped up in those thing and lift away from my usefulness to other addicts, I’m most vulnerable to relapsing.

In the book, you enter a lot of spaces in which people are meant to be anonymous. There must have been tension between describing the people and wanting to preserve their privacy.

I felt very comfortable talking about my experience getting sober without naming the program of recovery that I’m involved in. And in the instances where there are people in the program that I got sober with and who are still in my life, I spoke to them about the fact that I was going to describe our experience and went to lengths to protect their anonymity and their privacy and followed their lead in terms of what they were comfortable with and what they weren’t. The main point is to transcribe my struggle to get a toehold in sobriety and maintain it. I didn’t feel that the focus of the book is on anyone else’s recovery necessarily, outside a handful of relationships that I had and still have.

One person in the book about whom this question arises is the character of Asa, whom you describe extensively as he helps you during your early sobriety. I’m assuming you weren’t able to get his permission to write about him.

I didn’t think so. He was, he made it clear at a certain point that he didn’t want to have any contact with me because he was no longer sober. But I’m very happy to report that he’s come back into recovery and is sober. He knows that he is in the book, and that he is well masked. I went to great lengths to protect his privacy.

You’ve been the rumored “muse” of a few projects that have gotten coverage in the media in the last few months. How does it feel to be the subject of that kind of attention?

I don’t really have anything to say about that.

One of those projects, the film “Keep the Lights On,” recently got a distribution deal. Did you have any participation in that?

I guess I can’t really speak to any books or films that any other people wrote that I may or may not be connected to by speculation in magazines and elsewhere. It’s not my place.

Fair enough. Going back to your book, the most famous recovery memoir in recent years is the controversial “A Million Little Pieces,” by James Frey, which you allude to in the book. Did other recovery memoirs affect your way of thinking about this book?

You know I haven’t read, probably very consciously, other books of addicts and recovery — but particularly in the last seven years, when I’ve been involved in working on these two books. People I got sober with would use this phrase, “compare and despair.” I probably internalized that while getting sober and set out not to read other books about addiction and recovery when I was writing these. I would probably think they were better writers than me, or be affected by it so I just felt like in the writing of these books, I just had to follow my own instincts.

What do you think is the appeal of the addiction and recovery memoir for readers?

I think there are a lot of alcoholics and addicts in this world. And they touch a lot of people. It’s a disease that cuts through all class and age and race, and affects many, many people. I certainly myself felt very lost when I was first trying to get sober, and other people in my life felt incredibly lost. Both experiences are very isolating, so when reading an account of somebody getting sober — or in the case of David Sheff’s book “Beautiful Boy,” reading an account of a parent whose kid is an addict — I think identification is a powerful thing. It makes the struggle feel less singular, and it shows at least one particular path which one may choose to take or not take in any of those circumstances, whether you’re an addict yourself, or the father of an addict, or the daughter or son. I think people look to books to find answers, separate from addiction and alcoholism, they look to stories to illuminate their lives more clearly, to more clearly find their way.

I think there’s also the appeal of witnessing someone’s downfall and redemption.

Perhaps. People tend to make mistakes, and the reading of how someone may prevail against those mistakes may be encouraging to some people. If it is, that’s one use of those books.

For the first time in sixteen years, Andrew has stopped taking the psychotropic medications his psychiatrist father prescribed after ten-year-old Andrew caused an accident that rendered his mother a paraplegic. Like the illegal drugs his high school buddies take, Andrew’s meds serve as a metaphor for the feelings of inadequacy, disappointment and rootlessness endemic to my generation of twenty-somethings. Judging from the film’s cult-hit success, its target audience of my peers apparently found the metaphor apt. When Andrew falls in love with a quirky, vibrant girl he meets in a doctor’s waiting room, she shows him how to reengage with his feelings—and the world. Presumably, he leaves the medications behind.

For several years, “Garden State” remained my favorite movie about my generation. It spoke to me as a young person growing up in turn-of-the-millennium America—though not as a young medicated person. In fact, I completely forgot psychiatric drugs were even mentioned. Funny, because I myself have been taking medication since high school, and “Garden State” is one of just a couple of films I know of to allude to the psychological impact of growing up taking psychotropic drugs. Although it touches on this important phenomenon, the film never really examines its underlying assumptions that medications numbed Andrew’s pain and guilt, and that getting off them allows him once again to experience the agony and ecstasy of life.

For the first time in history, millions of young Americans are in a position not unlike Andrew’s: they have grown up taking psychotropic medications that have shaped their experiences and relationships, their emotions and personalities and, perhaps most fundamentally, their very sense of themselves. In “Listening to Prozac,” psychiatrist Peter Kramer’s best-selling meditation on the drug’s wide-ranging impact on personality, Kramer said that “medication rewrites history.” He was referring to the way people interpret their personal histories once they have begun medication; what they thought was set in stone was now open to reevaluation. What, then, is medication’s effect on young people, for whom there is much less history to rewrite? Kramer published his book in 1993, at a time of feverish — and, I think, somewhat excessive — excitement about Prozac and the other selective serotonin reuptake inhibitor antidepressants, or SSRIs, that quickly followed on its heels and were heralded as revolutionary treatments for a variety of psychiatric problems.

For most people, I suspect, medications are perhaps less like a total rewriting of the past than a palimpsest. They reshape some of one’s interpretations about oneself and one’s life but allow traces of experience and markers of identity to remain. The earlier in life the drugs are begun, the fewer and fainter those traces and markers are likely to be. All told, the psychopharmacological revolution of the last quarter century has had a vast impact on the lives and outlook of my generation — the first generation to grow up taking psychotropic medications. It is therefore vital for us to look at how medication has changed what it feels like to grow up and to become an adult.

Our society is not used to thinking about the fact that so many young people have already spent their formative years on pharmaceutical treatment for mental illness. Rather, we focus on the here-and-now, wringing our hands about “overmedicated kids.” We debate whether doctors, parents, and teachers rely too heavily on meds to pacify or normalize or manage the ordinary trials of childhood and adolescence.

Often, the debate has a socioeconomic dimension that attributes over-medication either to the striving middle and upper-middle classes, or to the social mechanisms used to control poor children and foster children. We question the effectiveness and safety of treating our youth with these drugs, most of which have not been tested extensively in children and are not government-approved for people under eighteen. We worry about what the drugs will do to developing brains and bodies, both in the short and long term. The omnipresent subtext to all this: what does the widespread “drugging” of minors say about our society and our values?

Certainly, these questions are worth debating—even agonizing over. But they ought not to constitute the be-all and end-all of our society’s conversation about young people and psychiatric drugs, particularly with millions of medicated teens transitioning into adulthood. Too much of the discussion occurs in the abstract, and drugs too easily become a metaphor, as in “Garden State,” for a variety of modern society’s perceived ills: the fast pace of life and the breakdown of close social and family ties; a heavy emphasis on particular kinds of academic and professional achievement; a growing intolerance and impatience with discomfort of any sort. Far too rarely, though, do we consult young people themselves. How do they feel about taking medication? How do they think it has shaped their attitudes, their sense of themselves, their academic and career paths, their lives? How do they envision medication affecting their futures?

My cohort lives with some powerful contradictions. On the one hand, we have grown up with the idea that prolonged sadness, attention problems, obsessions and compulsions, and even shyness are brain diseases that can—and ought—to be treated with medication, just as a bodily disease like diabetes ought to be treated with insulin. The 1990s, sometimes called “the Decade of the Brain,” encompassed a period of unprecedented growth in understanding how the brain works, which generated enormous enthusiasm about the prospects for discovering the underlying mechanisms behind mental illness, enthusiasm that many say was overwrought and premature.

Direct-to-consumer pharmaceutical advertising on TV, which the U.S. Food and Drug Administration authorized in 1997, has allowed drug companies to define the public’s understanding of mental illness and psychiatric medications — and this is especially true, I think, for young people who knew no other paradigm. Even as we grew up, though, immersed in the idea of an “imbalance” of particular brain chemicals — an outdated theory that has not held up to the science — we have inherited the American ideal of self-sufficiency, of solving one’s problems through one’s own resourcefulness. As we’ve sought to forge our identities, we have often struggled to reconcile the two.

My peers and I lived through — had indeed been the vanguard of — the psychopharmacological revolution. Prozac was not the first of the selective serotonin reuptake inhibitor antidepressants, but it was the first to hit the U.S. market, gaining FDA approval at the end of 1987. Thanks to national education campaigns trumpeting depression as a major public health issue and few other new psychiatric drugs being introduced, Prozac made a huge splash. Other SSRIs such as Zoloft and Paxil followed a few years later.

Starting in the early 1990s, new kinds of antipsychotic medications were released. Originally used for schizophrenia, these “atypical antipsychotics” were increasingly prescribed to stabilize the mood swings of childhood bipolar disorder and to quell irritability associated with autism and behavior disorders. Longer-acting formulations of the stimulant Ritalin, which had been used in children since the 1950s, appeared, as did other drugs for attention deficit/hyperactivity disorder. By the mid-1990s, the prescribing of psychotropic drugs to children was front-page news in major newspapers. When I entered college in 2001, college counseling centers were reporting an overwhelming influx of patients, including growing numbers who arrived at school with a long history of mental illness and medication.

Since reliable statistical analyses lag years behind actual shifts in medical practice, the statistics about the actual number of kids prescribed medication began to hit the media when these children had already entered adolescence, or even adulthood. When the data did emerge, it confirmed what people already sensed, a massive increase in the number and percentage of children being treated with psychiatric drugs. Although children and teenagers were — and still are — prescribed such drugs less frequently than adults (with the exception of stimulants), the rate of growth is remarkable. Between 1987 and 1996, the percentage of people under twenty taking at least one such drug tripled, from about 2 percent of the youth population to 6 percent, at minimum an increase of more than a million children. Between 1994 and 2001, the percentage of visits to doctors in which psychotropics were prescribed to teenagers more than doubled: to one in ten visits by teenage boys and one in fifteen visits by teenage girls between the ages of fourteen and eighteen. In 2009, 25 percent of college students were taking psychotropic meds, up from 20 percent in 2003, 17 percent in 2000, and just 9 percent in 1994. The prescribing of more than one medication has become far more common in child psychiatric patients in recent decades—even though, as the National Institute of Mental Health’s head of child and adolescent psychiatry research noted in 2005, there was “little empirical evidence of efficacy and safety from well-designed studies.” Although statistics about medication use show a clear increase, nationally representative data is still severely lacking.

Many children and teenagers were also facing the prospect of taking medication for far longer than people who first encountered psychotropic drugs in adulthood. In the 1980s and 1990s, doctors tended to prescribe drugs for a limited period of time for both adults and children, except for bipolar disorder and schizophrenia, long considered intractable, lifelong conditions. But it became increasingly clear to doctors that ADHD persisted into adulthood in about two-thirds of people, and that an early bout of anxiety or depression often portended more frequent and more severe episodes later in life. And so my peers and I found that a drug initially prescribed by a pediatrician as a stopgap measure for some alleged hormonal or developmental problem often became a long-term, perhaps indefinite commitment.

The medical profession wasn’t the only force driving the increase in prescriptions. Our parents, the ubiquitous baby boomers, are notorious for seeking medical solutions to every ailment (one book on the subject, by journalist Greg Critser, cheekily dubbed them “Generation Rx”). The boomers also tend to be portrayed as overly indulgent parents, obsessing endlessly about their children’s fragile self-esteem and all-important academic performance. They wanted us, their children, to be not just happy, fulfilled, and confident, but also high achievers from a young age. They worried that their children could come under the influence of — or be outright harmed by — the unhappy, disaffected kids who captured headlines in the 1990s for their dramatic suicides or school shoot-outs.

The boomers tried to be cooler or more hip than their own parents, but most of them were far from “anything goes” when it came to their offspring. As one of the subjects of my book put it, describing his parents’ and teachers’ expectations, “You can’t not function. You can’t wake up in the morning and not be able to function.” The goal, he said, was to strike a magical balance between being “happy-go-lucky” and “efficient.” These conflicting expectations and aspirations produced some rather stressed-out children—and some parents, teachers, and doctors readily inclined toward pills to help manage the effects of that stress.

My peers and I also came of age in a time when the economics of health insurance were changing drastically. In the 1980s and 1990s, most employer-based health insurance moved toward a managed-care model, and state- and federally funded health coverage for children expanded. The government and the HMOs were both eager to keep costs down, and therefore preferred relatively cheap psychiatric drugs to long-term talk therapy (despite a growing medical consensus that the most effective treatment for most psychiatric conditions was a combination of medication and therapy).

Meanwhile, a shortage of child psychiatrists, especially in poor and rural areas, meant that many troubled children could not see a specialist. As a result, already-busy pediatricians shouldered more of the burden of treatment: in the late 1970s, about 7 percent of all visits to pediatricians involved a child with emotional or behavioral problems, but by the mid-1990s, that rate had nearly tripled. Increasingly, those visits involved writing a prescription.

Prescribing data collected between 1992 and 1996 showed that pediatricians prescribed 85 percent of psychotropic medications.

As psychiatrists switched from forty-five-minute visits with time for psychotherapy to fifteen-minute “med checks,” prescriptions often came with little continuing discussion about how kids felt about taking medication, or how it was affecting them. That was fine by some, but not by others. One young woman I interviewed, who received her prescriptions from time-crunched psychiatrists who scheduled fifteen-minute appointments they often cut short, wished there had been time to “talk about feelings, not just symptoms.” One young man told me that even though psychiatric medication is “so much a part of our culture,” he could “probably count on one hand” the conversations he’d had about his medication use, or anyone else’s.

Most psychotropic drugs, it’s important to note, were and still are prescribed to children and teens without official FDA approval for the relevant condition and age group. As long as clinical trials have shown a given medication to be safe and, under certain narrow requirements, effective for some condition, and as long as the pharmaceutical companies don’t advertise a drug for a nonapproved use in kids, doctors can legally prescribe it “off-label.” Off-label prescribing to children is nothing new, in large part because concerns about the ethics and legality of conducting drug trials on minors have plagued medical research for decades. (As the pediatrician and pharmacologist Henry Shirkey observed in a 1968 article in the Journal of Pediatrics, children were becoming “the therapeutic orphans of our expanding pharmacopoeia,” and people calling for drugs to be tested in children were still reiterating Shirkey’s formulation three decades later.) Historically cautious, doctors used to wait a number of years after a new medication came on the market before prescribing it to children. But with all the hoopla surrounding the introduction of new psychotropic drugs in the late 1980s and 1990s and an influx of young patients seeking treatment, fewer doctors bothered to wait.

This sharp increase in prescribing made the lack of research all the more acute. Controversies brewed. Did antipsychotic drugs cause dangerous obesity and early-onset diabetes? Did stimulants stunt growth or increase the risk of drug abuse later in life? Did taking antidepressants or stimulants before puberty predispose children to bipolar disorder in adulthood? Did SSRIs like Prozac increase the risk of a teenager attempting suicide?

In the late 1990s, responding to the precipitous rise in prescribing and what researchers called a shameful lack of safety and efficacy data, the National Institute of Mental Health began funding a series of major, multisite medication trials in children and teenagers.

They led to some important findings, with trials for major depressive disorder and obsessive-compulsive disorder concluding, for example, that combined medication and cognitive-behavioral therapy (CBT), a short-term therapeutic treatment focused on refocusing thought and behavior patterns, was the optimal regimen for the greatest number of children, compared to a placebo or to either medication or CBT alone. These so-called “multimodal” studies were groundbreaking because they were some of the first to compare the efficacy of different treatments, measuring one drug against another, drugs against therapy, and standardized, carefully managed treatment against “community care,” the treatment a child would ordinarily receive in his or her local area. They also were comparatively long-lasting, which produced certain notable findings. For example, children in the government’s major ADHD trial at first seemed to do best on medication alone, compared to various other combinations of treatments. But when the same children were assessed two years after the study ended, there were no differences in either ADHD symptom reduction, or improved school or family relationship functioning, among different treatment groups. Medication’s superior effects, in other words, did not last. The vast majority of studies are not this wide-ranging or long-term.

As a result, myriad issues remain unsettled and hotly debated today and continue to bedevil parents, doctors, and young people as they weigh the relative risks and benefits of embarking on psychopharmaceutical treatment. Recently, some studies have questioned the efficacy of antidepressants for mild and moderate depression in adults, which has generated considerable public interest and raised questions in many people’s minds about the wisdom of taking the drugs at all, let alone long term.

In fact, as psychiatrist Peter Kramer pointed out in a column in the New York Times, this particular new evidence only applies to episodic, not chronic and chronically recurring, depression, and it doesn’t say anything about the drugs’ efficacy for many other conditions, including numerous anxiety disorders, severe depression, menstrual-related mood disorder, and the depressive phase of bipolar disorder. Other studies have raised troubling questions about how some psychotropics may affect the brain long term; the drugs are effective at preventing relapse for as long as they are continued, but some evidence suggests, for example, that the changes the drugs cause may set patients up for withdrawal symptoms that look very much like relapses, prompting, some have argued, a kind of psychological dependence on the drugs. The studies have generated considerable controversy in the mental health profession and in the popular media.

Overall, extended, decades-long longitudinal studies tracking outcomes of medication treatment in kids remain close to nonexistent, because of the great expense and effort involved in tracking people over many years. As a result, the original group of medicated children has entered adulthood with very little information about the lasting physical, emotional, and cognitive effects of using psychiatric medication during childhood and beyond. They are left with the legacies of using medication, though in many cases they’re not quite sure what those legacies are, or will be.

I don’t mean to suggest that every young adult who spent his child or adolescent years taking medications is preoccupied with the existential implications of that treatment. Undoubtedly, many would contend that the effects were simple: the drug either worked to resolve symptoms, or it didn’t. But I suspect that taking a little time to reflect on a drug’s role in their own coming-of-age stories would allow them to see just how wide-ranging and complicated the impact of medication has been.

Excerpted from “Dosed: The Medication Generation Grows Up,” by Kaitlin Bell Barnett (Beacon Press, 2012). Reprinted with permission from Beacon Press.