Can You Drink Your Way to Sobriety?

This episode explores the unconventional treatment of alcohol addiction using a medication called naltrexone, which is known to mitigate cravings and change the experience of drinking.

1. Naltrexone can be an effective treatment for alcohol addiction by altering the body's response to alcohol.
2. Traditional methods like Alcoholics Anonymous may not be suitable for everyone, emphasizing the need for alternative treatments.
3. The episode highlights the stigma and lack of awareness surrounding the use of medication in treating addiction.
4. It suggests a shift from a one-size-fits-all approach to a more personalized treatment plan.
5. The success of Katie's treatment provides hope and a new perspective on managing alcohol addiction.

1: Introduction

The episode introduces the topic and Katie's background with alcohol, setting the stage for a discussion on addiction treatments. Bari Weiss: "Today we’re sharing an episode in which they look at some of the hidden truths and misconceptions about alcoholism."

2: Katie's Story

Katie recounts her early days of drinking and the progression of her addiction. Katie: "I loved nothing more than sitting on my porch... drinking a six pack of PBR by myself."

3: Turning Point

Discussion on how the COVID-19 pandemic exacerbated Katie's drinking problem, leading her to seek treatment. Katie: "Covid was the push I needed to try something desperate and different."

4: Discovering Naltrexone

Katie finds an article about naltrexone and decides to try it out, leading to a pivotal change in her treatment approach. Katie: "I wanted a second beer to be as appealing as a big gulp full of Dymatap."

5: The Sinclair Method

Exploration of the Sinclair Method, which involves taking naltrexone before drinking. Katie: "The Sinclair Method turned everything I knew about treatment on its head."

1. Educate Yourself About Naltrexone: If struggling with alcohol addiction, research naltrexone as a possible treatment option.
2. Consult Your Doctor: Always discuss potential treatments with a healthcare professional before starting.
3. Consider Alternative Treatments: Be open to non-traditional methods if conventional ones haven’t worked.
4. Support System: Build a support network that understands and supports your treatment choices.
5. Track Your Progress: Keep a log of your drinking to monitor changes and improvements over time.

Today, we have a special story from two friends and former Free Pressers, Andy Mills and Matt Boll. They have a new podcast, Reflector, that I think you’re going to love, and we’re sharing an episode where they look at some of the hidden truths and misconceptions about alcoholism and how to treat it.

Alcohol consumption increased more during the Covid years than it had at any time in the past 50 years. In fact, Americans were drinking so much that from 2020 through 2021, there were approximately 178,000 alcohol-related deaths, which is more deaths than from all drug overdoses combined, including opioids.

And yet most Americans with a drinking problem never speak to their doctors about their drinking, and fewer than 6 percent of them receive any form of treatment whatsoever.

Today, a woman named Katie tells the story of her self-experimentation with a little-known but highly effective drug to combat her alcohol addiction.

It’s not only an incredibly moving story of one woman’s journey but it also gets to the bigger question of why these types of medications aren’t widely used in America, and it challenges everything we know about alcoholism and how to treat it.

People

Katie, Gabrielle Glaser, Dr. Mark Wellenbring

Books

"The Irrationality of Alcoholics Anonymous" by Gabrielle Glaser

Content Warnings:

None

A
From the Free Press, this is honestly. And I'm Barry Weiss. And today we've got a special story from two friends and former free pressers, Andy Mills and Matt Bull. They've got a new podcast that I think you're going to love. It's called Reflector. Today we're sharing an episode in which they look at some of the hidden truths and misconceptions about alcoholism and how best to treat it. Alcohol consumption increased more during the COVID years than it had in any time in the past half century. In fact, Americans were drinking so much that from 2020 to 2021, there were approximately 178,000 alcohol related deaths in America. That's more deaths than from all drug overdoses combined, including opioids. And yet, most Americans with a drinking problem never speak to their doctors about their drinking, and less than 6% of them ever receive any form of treatment whatsoever. Today, a woman named Katie tells the story of her self experimentation with a little known but highly effective drug to combat her alcohol addiction. This isn't only a moving story of one woman's journey, but it also gets to some bigger questions about why these types of medications aren't widely used in America and challenges a lot of what we know about alcoholism and how to treat it. Well be right back with this wonderful episode of Reflektor. Stay with us. Im a year round Tosson Turner, and in the summer heat, it gets bad. But that changed the minute I found cozy Earth bedding. Now I sleep on the cool side of the pillow every night, and so can you. Their bamboo sheet set keeps you cool, and the best thing is that they get softer after every wash. If you don't sleep cooler and more comfortably with cozy earth sheets, they'll refund your purchase price and your shipping, no questions asked. You even have a hundred nights to try them out. Cozy Earth's bath collection is also a game changer, especially their luxe bath sheets. They're soft, they're plush, and they never pill. Just like all cozy Earth products, they come with a ten year guarantee. Cozy Earth products are built to last, so upgrade your nights and transform your days with Cozy Earth. Go to cozyearth.com Barry Bari and use code berry for up to 40% off. That's cozierth.com b a r. I mention that you heard about Cozy Earth from my show, and they'll send you free socks. Whether youre selling a little or selling a lot, Shopify helps you do it. Shopify is the global commerce platform that helps you sell at every stage of your business. From the launch stage to the real world storefront stage to the millionth order stage. Shopify is there to help you grow. Whether youre selling scented candles or cell phone cases, Shopify helps you sell everywhere, from their all in one ecommerce platform to their in person POS system. And now you can sell with less effort. Thanks to Shopify magic, which is powered by AI. Shopify powers 10% of all e commerce in the US. And they're the global force behind millions of other entrepreneurs of every size across 175 countries. They're behind brands like Allbirds, rothy's, Brooklinen, and millions of other entrepreneurs sign up for a $1 per month trial period@shopify.com. honestly, all lowercase. Go to shopify.com honestly right now to grow your business, no matter what stage you're in. Again, that's shopify.com honestly.

B
Katie, can you hear me?

C
I can.

B
How are you?

C
I'm doing good. How are you?

B
I'm doing great. How are you feeling about this story today?

C
I feel a little nervous about it, actually.

B
Is this the first time you've talked publicly about any of this?

C
Publicly? Yeah, I have talked to a few people about it. I talked to you about it when it was happening and I eventually talked to my wife about it. But the number of people I've talked to about it is very small. It feels a little bit like I'm in a confessional right now.

B
Good. Think of me as a kindly priest.

C
You're my priest.

B
Hello there. This is Father Andy Mills, and you're listening to reflektor. Just kidding. I'm actually not a priest, though I do have a degree from a christian college. It was protestant. And I am, as they say, no longer affiliated. Today we have a story that is both deeply personal and scientifically, sociologically a mystery. It's something that I've reported on and been confounded by for nearly a decade. We will hear from authors and researchers and doctors. But first, my friend and fellow reporter, Katie, who became a lab rat in her own self experimentation. So, Katie, where do we start?

C
You wanna start at the beginning?

B
Yeah.

C
So I started drinking when I was a teenager, and alcohol really immediately. We worked well together. I have a long history of alcoholism in my extended family, sort of classic irish catholic family. And so I should have had maybe some inkling that it would become a problem later in life. But like most teenagers, I think I felt invincible. And also that nothing bad would ever happen to me.

B
We're talking, what? Beers at parties?

C
Beers at parties.

B
We talked about shots yep. Perhaps a four loko.

C
Oh, my God. Four loko was later in life. Okay, teenage years, that was like keg beer. But four loco I did at one point later in my twenties, climb a crane with a four loko in my pocket and then walk out onto the arm.

B
Oh, Katie.

C
Smart.

B
And did it feel any different? Did it seem any different, the kind of drinking that you were doing or the experience that you were having with drinking compared to your friends?

C
In retrospect, yes. I drank alone from almost the very beginning of drinking. It wasn't just social for me. I loved nothing more. When I was in college and I had my. Got my first house to sit on my porch reading the New Yorker and drinking a six pack of PBR by myself. And I was doing that when I was 19 years old.

B
Wow.

C
Yeah, I loved it. I really loved it. And I had bad experiences, but that somehow never deterred me. So, like, getting sick, I went to the hospital when I was, I think, 18 from alcohol poisoning. You might think that would dissuade one from continuing to drink, but the next day, I was drinking again. So I think I caught the bug really early.

B
How should we understand the parts of this that were, like, really fun and then the parts of it that sucked and why the fun kept outweighing the suck in those early days?

C
In the early days, the fun really did outweigh the suck. And it took a long time for the equation to flip there. The thing that I loved about drinking is that it gave me energy. It made me really social. I'm sort of a shy person, and alcohol cut that out entirely. It was my way of making friends, and I was incredibly good at walking into a bar and making friends with everybody at the bar. I would later make enemies with them, but at least that first day, I would make friends with them. So that was a big part of it. It was very social. I lived in heavy drinking towns, and the thing that we did was go to the bar, and we went to the bar every day. The thing is, I didn't stop drinking when I left the bar. I would stop and get alcohol on the way home, and I would continue to drink at home. And then, you know, I got into trouble. So when I was in my, I think, mid twenties, I would go to this bar a lot. I went to this bar almost every night, and I still love this bar. If I could go to the bar and not get shit faced, I would do it.

B
This would be the place.

C
This would be the place. My whole social life revolved around this bar. So I was leaving the bar one night. I was riding my bike because I was a responsible person. I wasn't going to drive. I wrecked my bike, hit my head.

B
Did you have a helmet?

C
I did not have a helmet. I left the helmet at the bar. Very smart. So somebody called 911. I was put in an ambulance, taken to the ER, and I didn't have health insurance. And I was broke because I spent all of my money at the bar. And I had a hard time keeping a job because I was always at the bar or hungover. So in a moment of what I still think was absolute genius, when they asked me my name, I told them someone else's name.

B
Someone else who had insurance, I assume.

C
Yes. It was my ex girlfriend. I didn't give him her insurance card. I was not planning on committing insurance fraud. I just knew I couldn't pay the bill.

B
So you lied?

C
I lied. Yes, I lied. I did a lot of lying in those years. Later, after they scanned my brain and I guess, concluded that there was nothing immediately wrong with me, I unhooked myself from divs or whatever monitoring they had, and I left. I just walked out of the hospital and I went to the nearest bus stop and I laid down and I fell asleep. And I woke up when a bus driver picked me up and drove me to my house. He didn't drive me to, like, the nearest bus stop. He drove me, actually, to my front door. Very nice man. And then I woke up the next day and didn't remember any of this until I saw the hospital bracelet with my ex's name on it. That night, I went back to the bar.

B
So you wake up and do you think, holy shit, I took things too far. I need to pull back? Like, what goes on in your head at that moment?

C
I did. I knew that I had a drinking problem. And there were moments like this that made it absolutely undeniable that I had a drinking problem. But I also thought it was. I'll be honest with you, I thought it was funny.

B
Yeah.

C
And so I go back to the bar and I get my helmet and I drink some more that night. And I told all my friends this story, and they all thought it was hilarious. I had a million stories like that. I later broke my two front teeth. I am absolutely covered in scars from bicycle accidents. I once burned down the porch of my own apartment building. I was a hurricane.

B
Katie says that despite all of this, she just kept drinking.

C
It became harder and harder to deny that I was having really serious health effects. Like, at some point, I started getting the shakes in the morning, through her.

B
Twenties, through her thirties into her later thirties. But occasionally she says that she would try and find some way to stop.

C
I knew I had a problem, and I did things like the master cleanse, where you don't eat for ten days and drink lemon water and cayenne, stuff like that. Yoga. I went to therapy.

B
She tried drinking only non alcoholic beer. She tried replacing drinking with smoking weed. She swore that from now on, she would only drink on the weekends, those kind of things.

C
To try to restart my life.

B
Eventually, after all this failed, she even decided to start attending Alcoholics Anonymous meetings. But that, she says, just like everything.

C
Else, it never worked.

B
Mm hmm. And why do you think that is? Why didn't something like Alcoholics Anonymous work for you?

C
I think the fundamental problem that I had with AA was that for me, addiction meant that I was constantly thinking about drinking. Like I might have been working or reading or engaged in a conversation, but in the back of my mind, I was thinking about drinking and about how I wanted to drink, but I needed to quit. That was all that I thought about for years. Alcohol was the principal thing on my mind at all times. And the only thing that alleviated that obsession, that craving, was drinking itself. So I went through periods of sobriety, but those periods of sobriety didn't alleviate the obsession. And, in fact, they only made me obsess more.

B
You're saying that during those clean spells, you were always thinking about it, and did you know in the back of your head that, like, oh, eventually I'm gonna give in to this, but I need to wait a few weeks or a few months.

C
Yes.

B
So that when I do it, I don't feel like a total failure.

C
Yeah. It wasn't even about being a total failure. It was knowing that in the back of my head, I knew that eventually I would always drink, because the obsession never, ever went away. And periods of sobriety did not make the obsession go away. And so for me, the fundamental barrier of AA is that AA is about total abstinence. And they say just one day at a time, but really, it's about total abstinence for the rest of your life. And I was afraid that if I was abstinent for the rest of my life, I would be stuck in this loop of obsession with no chance of alleviating it for the rest of my life. Does that make. Does that make sense to you?

B
Yeah. But I am curious about how that felt beyond just the part of your mind is wanting to do it. What was the feeling that kept you coming back.

C
It's an intense physical craving. I think if you haven't experienced addiction, maybe the only way to understand it is imagine that you really have to pee. It's like your whole body. That's all you can think about. You gotta pee until you relieve yourself. This is the only. It's physically uncomfortable. It's making you anxious. You must do this thing, and you must do it soon. That's what it felt like. And so I might wake up in the morning and say, this is it. Today's a new day. I am done. And by noon, I had to pee. Metaphorically speaking. I would find myself walking to the store to get alcohol while my brain is saying, don't do it, don't do it. You're going to regret this. You're going to regret this. And my body is just like, fuck you. I'm out. I'm doing this. We're doing this now.

B
When do things get bad enough that you think maybe the time has come to try something, even if it's weird and desperate?

C
Covid. Before COVID I kind of had my shit together, right? I was in a good relationship. I owned a house. I had a steady job. I still had the mental obsession about alcohol, but I had a regimented schedule that sort of kept me on the straight and narrow. And then Covid happened, and all of a sudden, I was out of work. I got laid off from my job. So I was at home alone, mostly because my wife was a. What do we call them back then?

B
She's an essential worker.

C
She's an essential worker? Yes. She works in healthcare, so she was at the hospital quite a bit. And it was also a stressful time. If you remember back then, it felt like the world was ending. And what do you do in the world? End? Drink. And when the lockdown started, I really quickly started drinking. And at first it was just like a beer, and then it was two, and then within a matter of weeks, I was waking up every day, walking to the 711 down the street, feeling absolute shame and humiliation that the one person in the world who knew what I was up to was the filipino woman who owned the 711 and coming home and basically drinking all day.

B
According to data released by the CDC, alcohol consumption increased more during the Covid-19 pandemic than it had at any time in the past 50 years. Even though bars were closed for weeks on end and people weren't out on the road doing their daily commutes, Americans were drinking so much that from 2020 to 2021, there were around 178,000 alcohol related deaths, which is more deaths than from all drug overdoses combined. And that includes opioids. For Katie, that meant a lot of day drinking, occasionally blacking out on her porch, and living in this state of almost constant humiliation about all of it.

C
During this period, I woke up almost every night at about 330 in the morning, so full of guilt and shame. And also convinced, not, I think, falsely, but also aware, that I was killing myself. I was doing something really damaging to my body, and I looked terrible. I was puffy. I looked like an alcoholic. And I did that for like a year, like a full year of waking up every morning and saying, I'm not going to do it. I'm not going to do it. Today will be different. Today will be different. And it was never different.

B
Katie says that eventually she started looking around online for some kind of help, researching different rehab centers, trying to imagine what it would be like for her family, for their finances, for her to go away for six months or maybe even nine months. And then she stumbled in to a very different idea.

C
So about a year into this, a year into Covid, I remembered something that I had read, like, maybe seven or eight years before. It was in the Atlantic magazine, and it was called the irrationality of Alcoholics Anonymous, and it was by a writer named Gabrielle Glaser.

D
I wrote a piece in 2015 called the Irrationality of Alcoholics Anonymous.

B
This is journalist Gabrielle Glaser, who I had actually met back when she first published this story in 2015. I hope the past nine years have treated you well.

D
They have treated me well, and thank you.

B
And it is at the time I was reporting a story for public radio about addiction and addiction treatments that included Glaser's reporting in the Atlantic.

D
That article was about the over reliance our country has on Alcoholics Anonymous. And what I did was examine the roots of that reliance and why it had come to dominate our rehab system.

B
I remember being really surprised by Glaser's findings that AA, this faith based group that formed in the 1930s, started right around the same time that the medical world had finally found a cure for tuberculosis, which meant that they suddenly had all of these empty wards in hospitals all around the country. And since they had no clue what to do with people when they came in sick and addicted to alcohol, when AA essentially offered to take over these empty wards and said that they would take care of these people, they were like, sure. And thus began this split between the medical world and the treatment of alcohol addiction that has endured in America ever since. Even though and maybe most surprisingly, twelve step programs like AA have not proved very effective. In fact, most studies show that they have a quote unquote success rate that hovers somewhere around the single digits.

D
So why, if we have millions and millions of people who over drink, do we turn to something that is not based in evidence, is not based in science?

B
And I'll just add that AA itself doesn't claim to be a treatment. It is a support group.

D
So why does almost every rehab treatment center in the United States have this as its foundation?

C
Part of it was about the irrationality of alcoholics Anonymous and about how the success rates of AA are much lower than most people would expect. More importantly, Glaser talked about a different form of treatment.

D
What I looked at in particular was a drug called naltrexone, which is an opioid antagonist that if you take it, it blocks the brain's ability to produce dopamine and some other neurochemicals that make you feel great when you have that first sip of wine or beer or whatever your drink of choice is.

B
Hello there, doctor. Thanks for sitting down with me again all these years later.

E
Yeah, nice to see you.

B
This is Doctor Mark Wellenbring, physician and addiction psychiatrist. It's nice to see you, too. As you can tell, I have gotten older. I understand that just like Glaser, he was also a part of my reporting back in 2015 because he uses a number of medications when treating addiction, especially this drug, naltrexone.

E
The naltrexone works by blocking opioid receptors in the brain, and that's what gives you the craving, the desire.

B
Mark says that this perpetual state of intense craving is something that his patients, much like Katie, report to being key to their struggle to control their drinking.

E
And people get a little crazy during that phase where they begin to imagine that they can control it again. They have a positive recall of previous times, usually way in the distant past, when they had a good time drinking.

B
And the reason that naltrexone is so helpful is because it allows patients to go ahead and satisfy their craving to drink while completely altering their experience of drinking itself. And it does that in two key ways. The first is that it blocks the pleasure that you get from alcohol.

E
You can still get just as impaired while you're taking naltrexone, but you can't have any fun doing it.

B
Or as glaser puts it, it literally is a buzzkill. And the second effect is even more surprising, which is that over time, drinking alcohol with naltrexone in your system works to dull the brain's impulse to drink.

E
It all, which decreases the desire to drink.

B
And doctor, as I understand it, this is a drug that you've been using for years and that isn't new and just coming off the market with, like, a study or two, right?

E
It's very well studied. Very well studied internationally, yes. And it consistently comes up with about the same effect.

B
Right. That people find that it helps them fighting the cravings and it helps them reduce their drinking. Yeah. Back in 2015, when I first interviewed doctor Wellenbring, he shared with me some naltrexone studies from all over the world, the Netherlands, the UK, Iran, the US, that all showed that this was an effective treatment. In fact, in one of them, from Finland, a study of about 150 people had a 78% success rate in helping heavy drinkers reduce their drinking to, quote unquote, normal levels. And for some people who have a drinking problem, that is their goal, to just be able to have the occasional drink without it taking over their lives, while many other people use naltrexone to get totally sober altogether.

C
So the drug is designed to take away cravings. And Glazer, she didn't have a drinking problem herself, but she ordered this drug from a pharmacy in, I think, Thailand or India.

D
I found some guy in Thailand who had been an australian guy, or a british guy, I think it was, who credited his life turnaround with having taken this medication for over drinking. And it was his mission to provide this medicine online to anybody who wanted.

B
It, including a writer for the Atlantic who just wanted to give it a go. Yeah.

C
Yeah.

D
Who had $39 and two weeks later got a ten day supply of naltrexone.

C
So she took this drug, naltrexone, and then she drank a glass of wine. This is how this protocol works. You take this drug, wait at least 1 hour, and then you drink.

D
So I took it at 630 and 730. I opened up a bottle of wine and poured a glass, and I tasted it, and it tasted fine. But a couple of sips in, I realized, huh, this is not getting me anywhere.

C
And there was this line in the piece.

D
And she said it honestly was about as attractive to me as opening a bottle of dymatap, pouring that into a beautiful wine glass and sipping it just had no appeal whatsoever.

C
And I remembered that line, and that's what I wanted. I wanted a second beer to be as appealing as a big gulp full of dime a tap. So I decided to try it. I got the drug and I read everything I possibly could about naltrexone, and I did it.

B
And as I understand it, Katie, this time around, you weren't just gonna try this new method like you had done the yoga and the cleanses before. You were going to try this while at the same time reporting on it and its effectiveness, or lack thereof.

C
That's exactly right. I decided to write about this project under a pseudonymous, and I did it in part because I wanted to learn as much as I could about it. And so writing about it was an excuse to call up people and ask them about their experience. But I also felt like I was doing a service because it is really hard to get information on this drug.

D
The drug was approved a long time ago by the FDA for treatment of alcohol use disorder, but almost nobody is aware of it, nor does anybody even think of using it.

C
My doctor didn't know about it. I took the Gabrielle Glaser article to my doctor. In order to get this drug, a lot of people have to really convince their doctors to prescribe it to them because they've never heard of this use for naltrexone. And so I thought, I'm going to do this. This is going to be experiment, and I'm going to write about it, and I'm going to sort of chart my path, and maybe this will be helpful for other people who are going through this.

B
So Katie talks her doctor into giving her a prescription for naltrexone. But from her online snooping, she learns that most drinkers say that naltrexone doesn't work very well if you follow the directions that are on the bottle.

E
You know, one of the things about naltrexone is that it's a short acting drug, and most people prescribe it incorrectly.

B
Doctor Wellenbring says that even when doctors are willing to prescribe naltrexone, they often do so by simply instructing patients to take it once daily.

E
So they prescribe it either to take it at night or first thing in the morning. But the trouble is, is that by the time the witching hour comes around, most people start drinking around five. And they start to think about drinking, anticipate drinking around 03:00.

B
And so even though that is the moment that you want this drug to be most active in your system, if you're just popping the pill early in the morning or late at night, that's really when it's at its weakest.

E
So most doctors will experience it as not working very well.

B
And this is why many people who use naltrexone will follow alternative treatment plans, like one of them called the Sinclair method. The Sinclair method is a treatment plan that was developed by a guy named Doctor David Sinclair, who had successfully used it in these now somewhat famous rat studies.

C
He took rats that were bred to be alcoholics. Right. Or to have that propensity for alcoholism. He bred party rats, which are actually.

B
My favorite kind of rat.

C
But continue, really. I mean, what other kind of rat do you want to hang out with?

B
And one of the things that Sinclair's method showed was that if you gave these rats naltrexone, not every morning, not every night, but before they drank, over time, they seemed to completely lose interest in drinking at all. Okay, so, Katie, you start this self experimentation. What did that look like? Where did you begin?

C
So I started out doing as much research as I could, and the best place to get information on the Sinclair method is not from doctors. It's from Facebook. I know that this sounds crazy.

B
Wait, you're telling me during the COVID years, you went on Facebook to do your own research?

C
Crazy. I did. To get health information.

B
This is gonna go great.

C
Yeah. So there are Facebook groups where people talk about their experiences. So I started there. I watched YouTube videos. So I had gotten to a point where I was drinking probably two to three bottles of wine per day.

B
I knew I had a problem. I just wasn't ready to say I was an alcoholic.

C
There's a fairly robust kind of YouTube presence for the Sinclair method.

B
One day, I started poking around on the Internet, and I came across the Sinclair method, and it sounded too good to be true. I was pretty sure it was bullshit, and I did it and never looked back.

F
Hey, everyone, it's Katie. And I wanted to make a quick video today just about my experience with taking the medication naltrexone. Following the Sinclair method.

C
There is one creator in particular named Katie Lane, who is really helpful, who really explains how it works, what to expect.

F
My whole practice was to just take the medication, wait an hour, and drink. And the progress I've made in nine months is I went from drinking pretty much seven days a week, really heavily, down to someone who drinks just a couple of times a month. And when I drink, it's.

C
So there's really two parts of the Sinclair method, I guess three parts. Take the pill, wait at least 1 hour, and then drink. And I know that this sounds absolutely crazy. It is as though I am telling you you can cure diabetes by eating donuts. It sounds insane because the messages that we have all, as Americans, absorbed about alcohol use disorder alcoholism is that once you are an alcoholic, you can never drink again. You can never drink normally. The only treatment for that is abstinence. Turns that on its head. It sounds batshit crazy.

B
This is one of the primary reasons that it's so controversial. On the one hand, yes. The idea of taking a pill to dispel something that we generally think of as, like, a moral failing that goes against the ethos of a certain strain of american thought. But the idea that you would not only hand them a pill, but then hand them a drink, right. In the course of trying to overcome alcohol addiction, that is a step too far for even the person who is committed to the idea that addiction is just an illness like any other. That's a step too far, right?

C
Absolutely. And I can see why, and I think for, especially for the families of alcoholics, the idea that you're gonna give somebody permission to indulge in this thing that has caused so much heartache in your lives, I can see why that is absolutely terrifying. And I also don't wanna deny that AA is really effective for some people. Obviously not everybody. I know plenty of people who say that aa has saved their lives, and I do not doubt them whatsoever.

B
Yeah. All right, so walk me through it. What was day one like?

C
So, day one, I did the thing that you're supposed to do, which is eat a full meal when you take the pill. For the first time. I drank a full glass of water. I took the pill, I set the kitchen timer, the little cream colored kitchen timer, and I waited. I don't think I'd actually waited an hour when I wanted to drink.

B
For years, Katie says she busied herself cleaning the house, sweeping, dusting, anything to keep her mind distracted. Until finally.

C
And then I started drinking.

B
She went to the fridge, cracked open. A tall boy of PBR took a sip, then another, then another. And I guess the most obvious question is just, was there anything noticeably different happening as you were drinking that day?

C
It's just not as fun. That's, like, the best way to explain it. You can still get drunk, but you don't get buzzed. So it's like you have the body high, but not the mental high. And frankly, the body high of being drunk isn't really fun. It's the thing that makes you stumble and feel nauseous, but you're not getting the rush.

B
So what happens? Do you grab the second beer? Do you say, oh, this isn't very fun. I've been looking for a way to kick the habit. This is it. I took the pill. And now I don't want another beer.

C
No. I kept drinking. And part of it was probably habit. I had this very regimented habit of like, I'm going to drink until 1 hour before my wife gets home, and then I put down the booze and I take a shower and I start prepping dinner. And none of that had been addressed. You do have to address your habits on the Sinclair method. And I wasn't there yet. So I think on that first day, I did drink a full six pack of beer.

B
Okay, so pretty much the same amount of beer that you would have drank no matter what?

C
Yeah. Yeah.

B
Okay. So what about the second day? So the second day, again, Katie does all the same moves.

C
I ate the meal, I drank a full glass of water, I took the pill, I set the kitchen timer, and I waited.

B
And yet again, she drank all six beers in a row, just like normal.

C
And that first week, I drank the same number of days and I drank the same number of drinks.

B
So you're taking this pill that you hope will really help, and yet you're drinking pretty much the same. Why didn't you just quit?

C
I didn't quit because I knew that this wasn't an overnight cure.

F
So if you're just starting out on the Sinclair method and you're not noticing the results right away, just stick with it. Don't lose hope. The addiction to alcohol took me years and years to learn, and it's just going to take time to unlearn the addiction.

C
And I knew that it can take months, even years for some people to see a difference. And I was prepared for that. I didn't really have any decreases in drinking, serious decreases, until around twelve months, but I still remain committed.

B
This is actually something that you hear quite a lot in these YouTube testimonials, which is that while some people do find relief in the first day or the first few weeks, for others it can take substantially longer.

C
And it wasn't until month 13 that I noticed my drink of choice, which was dry white wine. It just didn't taste right anymore. It really wasn't until a month, maybe six weeks into it, that I started to notice any change at all.

B
And when you started to see that something was changing, what did that look like?

C
One of the things that I read when I was learning about this period was that it's essential to start having what are called alcohol free days. And alcohol free days are days when you don't drink, but they're also days when you don't take naltrexone. And the reason these are so important is because on the days when you don't take naltrexone, your endorphins are hypersensitive. And so on those days, you want to do things that are going to kind of jazz, you go for a walk in the woods, go for a hike, exercise, take some sort of improv class. If you're one of those freaks, something that's going to cause you joy, because on those days, highs are going to be higher, natural highs are going to be higher. So within maybe six weeks of this process, I said, okay, I'm going to have an extra alcohol free day this week. And so that's how I started. I started incorporating more and more alcohol free days, and at the same time, I started pushing back the time of the day when I would start drinking. So my window is getting narrower. So I went from six drinks a day to four drinks to three drinks to two drinks. This was a very gradual process. And a lot of it was not like introspection. That was one of the things that I really love about the Sinclair method, because unlike AA and other twelve step programs, there's this idea that, you know, the drinking isn't really the issue, it's not the root of the issue. There's something else that's causing you to drink. Maybe it's trauma, maybe it's depression, maybe it's your childhood. And for me, that's never been the case. My problem is drinking.

B
Yeah. And that's actually a very good distinction, because for a lot of people who go through bouts of heavy drinking, it often is because they're having trouble with a breakup, they're lonely, they're not dealing with something in their lives, and they're getting lost in alcohol. And for those people solving the I'm lonely problem, or I'm not dealing with something in my life problem often naturally leads to the end of their alcohol abuse.

C
Totally.

D
We tend to look at drinking problems as this binary thing that you either are or you aren't, and you're headed one way and oh, man, the only thing you can do is take on the twelve steps and stop drinking for the rest of your life.

B
Glaser, Doctor Wellenbring and many others say that it is more accurate to think about problem drinkers as being along a spectrum, which is part of the reason that there is this frustration with the over reliance on twelve step programs like aaeh. A growing body of research suggests that by adding medications like naltrexone into the treatment toolkit, so to speak, the focus can begin to shift away from the one size fits all model and to an approach where treatment is focused on an individual based on their individual circumstances. And with this shift, instead of continuing to see these single digit success rates, this could lead to many, many more drinkers finding a way to get their lives back.

C
So during this period, I was just trying to create better habits. So, like, I joined a gym, and that was really helpful because on those alcohol free days, I would go to the gym, I would work out, I would get some little runners high, or whatever they call it.

B
Yes. There's a healthier way to hit those endorphins.

C
Right? Right. I don't think I actually ever got the runner's high. I mostly got a. Got the runner's pain. But just trying to incorporate these things and writing about it as well really gave me a reason to interview people and get tips and find out what worked and what didn't and really think deeply about what I was doing and be really intentional about it.

B
Okay. So at this point, it seems to me that you would feel pretty optimistic about this lab ratting yourself experimentation. What about, though, your reporting side of this? What were you finding out? What was interesting to you as a reporter?

C
As a reporter, one of the things that I was most interested in is why doesn't everybody know about this? This has been around since the 1990s. There have been plenty of trials. The success rates in trials are extremely high, especially when compared to things like twelve step programs, abstinence only programs. And so one of my main questions was why, when I go to a doctor and tell a doctor that I have a drinking problem, why isn't this the first thing that my doctor tells me about?

B
Right?

C
I mean, of course, there's not one answer to that question. There's the history of the twelve step program in America, how popular that's been, and the fact that this is the antithesis of that, this goes against everything that we've been taught to believe about addiction. There's economic forces. The rehab industry, maybe you want to call it the rehab industrial complex is huge and powerful, and this can get conspiratorial really quickly.

B
Right. Big rehab is keeping us addicted.

C
Right. And this is during the COVID years. And I'm getting my information from Facebook. You know, I'm a reporter. I'm a natural skeptic and a trained skeptic. And so I had to be really careful about what's real here, what's not real here.

B
I can see where, like, quickly you start going, ooh, am I headed into a sort of kooky part of the Internet, a kooky part of the culture.

C
Exactly. I'm not the sort of person who's going to, like, burn sage in my house and think that it's going to wave away the cold. Like, I don't have the sign in my yard, but I do believe in.

B
Science in that house.

C
Yes. Yeah. And so, you know, I did, I did have some skepticism because it seems like a miracle drug. And I am always going to be skeptical of anything that purports to be a miracle drug. But at the same time, it was working. I'm looking right now at my drinking log. And so I started this in April, and by July, the number of drinking days that I had that month had halves. That august, I drank five days. That August, that's September. I drank one day. I'm not drinking and I'm not thinking about drinking. I get, I sort of get emotional thinking about it because it was like I had freedom for the first time. I had been looking for this for so long, and there it was. I just like ate a fucking pill. You're gonna cut this, right?

B
No, katie, I'm letting the world know. You are not always the funny and the sarcastic. Sometimes you are the wrong, the sweet. Well be right back.

A
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C
We JCPenney Valle la Pena de coupon.

B
Gabby, let's actually go back to 2015 for a minute because I'm curious. After you published this Atlantic article. What kind of response did you get?

D
People were so enraged.

B
Again, this is journalist Gabrielle Glaser by.

D
The suggestion that there was anything wrong with Alcoholics Anonymous and that you would prescribe a pill for someone who suffers from addiction.

B
She says that the responses ranged from, you're not a doctor, you've never been addicted, you don't know what you're talking about, all the way over to you're gonna get people killed with this irresponsible reporting and making people think that a pill could save them.

D
On the other hand, there was an incredible groundswell. I was deluged with requests for help, and probably hundreds of people wanted the link for the guy in Thailand. But overwhelmingly, people wrote to say, thank you. I had no idea. Why didn't I learn about this medication sooner? Why doesn't my doctor know about it?

B
This exact question, the same question that Katie would ask herself many years later. This is what fueled my original interest in reporting about this back in 2015. And I've got to say that at the time, I was completely convinced that due to a number of reasons, we were about to witness a big societal pivot. And I wasn't alone. When I talked to Gabrielle Glaser and Doctor Mark Wellenbring, all three of us were excited about the fact that very soon we were going to witness a historical sea change in how we treated alcohol addiction with these medications. Gabby, you know, one of the reasons that I called you up, and I wanted to talk to you again about all this, all these years later, is because of this idea of the sea change. And I just want to know, from your point of view, did that sea change ever come?

D
I would love to say, oh, yes, and here are all the reasons why. But I don't think it has, Andy, because the year that I reported that piece, roughly 1% of the 18 million Americans who were on the spectrum of alcohol use disorder had been prescribed any medication whatsoever. And again, there are a handful, but we're focusing on naltrexone, so let's keep it there. What I found in 2021 was that 1.6% of people who are on this spectrum are prescribed any of these medications.

B
Right. You're saying that in all the years since, it's gone from 1% to 1.6%?

C
Right.

D
That's nothing. That's an increase in minuscule number.

B
So, doctor, on this idea that we had spoken about earlier about a coming sea change, I just wanted to know from your point of view, did that sea change ever come?

E
The answer is no. And I'm afraid I was more optimistic then. So most programs still are twelve step, and they don't believe in medication. They don't read the literature, they don't believe in it, they don't believe in medication.

B
You're saying this is doctors, this is state representatives, this is. People who hold power in this space are still unconvinced that medications are gonna play a significant role.

E
That's right. It's not even part of the conversation for most people.

B
And according to doctor Wellenbring, Glaser and many others, some of this has to do with professional medical education. Back in 2015, out of all the medical schools in the country, only 14 of them had even a single course in addiction medicine. And in the years since, that number has only slightly gone up. A study that came out from Washington University's School of Medicine in 2021 revealed that most people with alcohol problems do not even talk to their doctors about their drinking. Now, some of that is likely because of shame. Surely some people just don't want to admit to their doctors that they have a problem. But obviously there's something else that's happening here too, especially because this just isn't the case in so many other countries around the world. So if the US has failed to see the sea change, has there been a sea change in other parts of the world?

E
There's no sea change that had to happen in other parts of the world. AA is uniquely american.

B
So why do you think it is that we've failed to make this sea change? I mean, I've heard everything from people saying that big pharma can't make any money off of a drug like naltrexone, which they admit sounds conspiratorial. I've heard people say that it's because medical professionals in med school still aren't being given the resources and the education needed to treat this. I've heard some people say it's the continual kind of puritanical mindset of America that still, down deep, believes that you should bootstrap yourself to sobriety. What do you think it is?

E
I think it's all of those things. And I think still it's just the proportion of people who are working in treatment programs as counselors are twelve steppers. I do think the puritanical aspect is still very appealing to people more broadly, and I also think there's a punishment aspect to it. People love no one more than a reformed sinner.

D
I think it has to do with the fact that at the end of the day, we are a very christian country, and we love redemption narratives. And the redemption narrative of AA is something that. It's really kind of a metaphor. Right. I was blind, but now can see. Popular culture rewards that narrative, of course, and we see it. This person was out of control. They'd been in a drunk driving accident. Their life was over, and then they found sobriety, and now they're all better. And we see it. And that you don't see someone going to their doctor's office and getting a pill. That's not romantic, that's not dramatic. We don't see the possibility of that reflected in the popular culture that we consume.

B
So you're saying that on a very deep level, this just hasn't penetrated society? Not just hasn't penetrated the medical schools or the doctor's office, but in this very ephemeral sense of who we are and how we should live. The naltrexone story just hasn't penetrated to that yet. It's like the intense power of social norms that dictates so much of our lives. Right? This is just not yet a part of that.

D
Precisely.

B
This part of the naltrexone story is something that Katie had hoped to affect by the reporting that she was doing. It's now been 18 months since Katie had her last drink. She no longer wakes up in the middle of the night with shame and humiliation. But when she reached out to some of the outlets who have published her.

C
Work before I started pitching stories under the pseudonym, I got very little response there from any sort of mainstream outlets.

B
She says that she offered up her reporting and her sources to other journalists who had staff jobs that she knew personally.

C
I was like, I can connect you with other people who can talk about this. So I thought, maybe there's a way for me to sort of use my connections to get this in the news again.

B
No luck. She started this sub stack, but never managed to get beyond a few hundred and readers. She got another substack to publish one of her stories, but they put it behind a paywall, and it wasn't seen by very many people at all.

C
And I really just felt like, okay, I have reached a dead end here. I have done what I can to try to get this in the public's attention.

B
And so in the end, she just dropped it.

C
And so the shame that I'd felt for years about drinking and about hiding the drinking, the shame had alleviated, right? But now I started to feel a new sort of shame because I wasn't willing to come out and say, this worked for me.

B
You had successfully kept this a secret?

C
Yes.

B
Now it's been dealt with, so why tell anybody?

C
Exactly. That's how I felt. But I also felt guilty, because I see all over the place, I see how many people are suffering. I see the wreckage that alcohol has.

B
On people's lives and how hard it.

C
Is to quit and how hard it is to quit. And for some people, the abstinence only model, the thing that they think is the only answer, it's just not gonna work. And it will work for some people, and for those people, keep doing it. But for some people, relapse is inevitable. And this is who the Sinclair method is for. The Sinclair method is for people who are going to relapse at some point. And I started to feel just immensely guilty about the fact that I wasn't willing to stand up and say, hey, this worked for me. And then what changed is that I. About four or five months ago, I bought a house in the town where I went to college. So the town where my drinking really accelerated for the first time. And I needed to make friends. And the way I've always made friends in the past is through drinking. Right. Going to bars. I've always been very good at making friends over drinks, but I can't do that anymore. I mean, I could, like, take a pill and go drink, but at this point, I haven't had a drink in well over a year, and I'm just sort of not interested. And so I needed to make friends. And I'm not religious. Wasn't going to meet people at church. I'm too old for pickleball. Although I hear that's a good way to do it.

B
Actually, no one is too old for pickleball. That's the real secret about it, Katie. But we can talk about that later.

C
Good point. And so I thought, I know where I'll go meet people. I'll go to AA. And one of the other reasons I wanted to go to AA was because AA might not work for everybody. But I do think it offers people something that's really important and something that the Sinclair method doesn't. And that's connection. Accountability.

B
Right? A community.

C
A community. A community. Because there are Facebook groups and there are online meetups with the Sinclair method. But I wanted to meet people in real life, in this town where I was moving back to people who understood what I was going through, what I had been through. And so I started going to meetings, and. Oh, my God, Andy, these meetings were so depressing. I mean, AA can be a very fun, uplifting place. You have a lot of people who are great storytellers in AA. But what I saw in those meetings was people who might not be drinking, but who hadn't found a way out of the obsession. And I ended up just feeling bad for them, feeling bad that they were struggling, and also feeling guilty that I, you know, I'm not gonna stand up in an Amy meeting and be like, praise the Lord, people. I have the solution.

B
I've got a six pack of beer now, trek zone, and I just need an hour of your time.

C
Meet me at the bar. And so I knew that wasn't gonna work, but I was seeing in real time people going through the exact same thing that I had been going through. People talking about how they would have these periods of sobriety, and then something would happen. Maybe something bad happened. Maybe something good happened. Maybe it was just a fucking sunny Tuesday and they wanted a beer, and then all of a sudden, they're binging and they're relapsing, and the cycle continues over and over. And I just felt like, you know what? There is another way. There is. And I know this way. And these people don't know about this way. And for some of these people in these rooms, they don't want the other way. They don't. And they're going to hear everything that I'm saying, and they're going to say, you are a lunatic. Even worse, you're a dangerous lunatic.

B
Yeah.

C
But there's another way.

A
Thanks for listening. If you like this episode, there is much more of where it came from. Please go check out reflector wherever you get your podcasts. You can also go to reflector Dot show and sign up there to make sure you won't miss anything at all. The other episodes cover a number of issues, including a look back at our series, the Witch trials of JK Rowling. I hope you check it out. Last but not least, if you want to support honestly, there's one way to do it. It's by going to the Free Press's website@thefp.com, and becoming a subscriber today. We'll see you next time.