Ok so I don’t have any expertise with addiction, recovery, AA, etc but I thought this was a compelling podcast about Katie’s personal experience with Naltrexone. I’m sure plenty of alcoholics could benefit from it, with or without AA. I think it’s great she’s trying to get the word out since it was clearly life-changing for her.
I think this was an important episode and I appreciate hearing Katie's experience with Naltrexone. And pointing out how this is not something that is common amongst primary care providers to know much about or suggest.
The episode was not touted as a high-level, broad or comprehensive view on best ways to treat alcohol addiction. It was touted as a personal experience (and success!) with a tool that does not seem to be broadly used. In that regard, it was something to raise awareness and to help more people (both clinicians and people/patients) that this option exists and can be extremely useful for the right person.
This is just like other "addictions" or disordered relationship with a substance. obesity and weight loss a great example. Programs that help change habits are helpful and all that some people need. (and there are all kinds of programs and advice for weight loss). Others don't get the results needed with just advice or support. There are multiple medications to help with weight loss - again, each is a TOOL. The tool works for some people but not others. Semaglutide (GLP1 meds) being a newer tool that does happen to have even higher success rates. But - doesn't work for everyone. No tool does.
The thing I have noticed - opioid use disorder is the more high-profile addiction right now. Much focus, money, resources goes to this. I've wondered why we are not putting near as much effort and money into alcohol (on a state or federal level). All primary care doctors are encouraged to become prescribers of Suboxone - despite not having other supports available in their office to supplement the medication. The medication alone is helpful but seems a broader support network would be even more so. There has never been the same encouragement to take on MAT prescribing for alcoholism. There are cities where some in the medical community advocate for "safe centers" - places where opioid addicts can get clean needles and be allowed to use drugs with people just waiting to reverse the effects with Naloxone. This makes no sense to me, but there are many advocates that focus on this. Again, nobody suggesting these things for alcohol dependence. So, there is some different way that people who tend to focus on disenfranchised people and circumstances feel much more sympathy for "those experiencing opioid addiction" and not so much for alcoholics. That, to me, is an interesting thing overall.
"Rarely have we seen a person fail who has thoroughly followed our path. Those who do not recover are people who cannot or will not completely give themselves to this simple program, usually men and women who are constitutionally incapable of being honest with themselves." Katie just dipped her toes in and never followed through. She's like most of her generation that just want a solution without working for it, like a magic pill. Sadly, she is now a dry-drunk and will wonder why she hasn't found peace even though she isn't drinking.
I'm an Addiction Recovery Coach and have 17+ years in recovery. I've also worked in treatment centers for over 10 years. I have a family that has been tragically affected by the results of addiction. I know from experience what this disease looks like in it's various forms and stages, including recovery.
I am very concerned regarding this podcast. I have NEVER commented on a podcast before and I apologize that this is a lengthy comment. I'm just extremely worried the biased information shared in this podcast has the potential to kill some alcoholics or extend their misery and increase the damage done to their families, loved ones, their health and society.
When we are in the grips of our addiction, we will go to great lengths to try and control our drinking. Our deepest desire is be able to keep drinking forever without suffering the consequences. The idea of a medication that allows us to control our drinking would be a dream come true. Especially if it means we don't have to go to AA or address the difficult underlying issues that cause us to drink and use. Your podcast could give someone false hope that they have a plan to address their problem drinking. They can even play your podcast for their loved ones to prove they have a legitimate recovery plan. While I see the benefit of Naltrexone as a tool to help with cravings. My observations is it only works as part of a much more thorough recovery plan. After all, our drinking is not simply a response to cravings. It's due to several possible causes. For example, we often have a genetic disposition for addiction from our family. We have possible trauma and abuse in our past. We struggle with mental health, environmental influences and other dysfunctional circumstances in our lives. If we just take a medication that addresses cravings, then we might not be motivated to address our underlying issues like trauma, dysfunctional childhoods, abuse, mental health issues, etc.
Another part of the podcast that is very disappointing is the negative portrayal of Alcoholics Anonymous. To say AA's effectiveness is in the single digits is disgustingly uninformed, biased, inaccurate, dismissive and dangerous. Every program struggles to achieve a positive success rate because it is very difficult. Most people that enter recovery and treatment are not there completely on their own accord. They are often forced or nudged by concerned family members, employers, the legal system, negative consequences of their actions, etc. Since they really aren't there because they want to stop drinking or using, their chances of staying in recovery are almost zero. They are not ready to commit to the changes required to stop their problem use or drinking so they go back. However, the success rate for people willing to truly address their addictions and underlying issues is probably close to 75%. Maybe a little less if you account for relapses but some of those people get reengaged and are successful going forward. All programs can give people a decent start on their recovery journey. However, it's eventually up to the individual to take responsibility for their recovery. You can't fault any program if someone isn't successful since no program, except maybe jail, can physically stop someone from drinking/using if they want to.
12 Step Programs have saved millions of lives for more than 80 years. There is NO program or approach that has that kind of LONG TERM record of success. Not only do these programs help people stop drinking and using. They also help people rebuild relationships with loved ones, improve their outlook on life and positively contribute to society. I've seen true miracles in 12 step programs and hundreds of examples of incredible kindness, support and love from AA members for their fellow addiction sufferers. I've seen families saved and flourishing due to 12 step recovery. I've seen people in almost full liver shutdown come back and help numerous people avoid the same hell of slowly dying an awful death. I've seen incredibly tragic stories be turned around to give other people hope that anyone can come back from the grips of addictions. I GUARANTEE, you won't see these kinds of beautiful events if people just take a pill that might keep them sober, but doesn't help them create a life so complete that they don't want to go back to drinking or using.
One final point, AA and 12 Step programs are FREE!!! When people are so concerned about the cost of treatment, why do some people downplay a program that requires no financial sacrifice of it's participants? These programs are also available in almost every country in the world literally every second of everyday. They are available in very rural areas and the biggest cities in hundreds of languages. There are even meetings in China where they are outlawed but continue to be there for the next person that is suffering from this disease.
Does that sound like a program with single digit success rates?
The podcast did not disparage AA for all. I think it made it possible to have another option. As with most things, more than one option may be the answer. AA relies heavily on a "higher power". what if someone doesn't have one?
During 36 years of sobriety based on AA principles, I recognize that many times the only higher power l was capable of seeking was the one who is greater than alcohol. For alcohol was truly the power l knew as greater than myself as l reached the end of 30 years of drunken struggles to live life on my terms. At many other times, I can contemplate God, but I'm sure I'm not the only alcoholic who sometimes clung to His most basic manifestation in our lives in a difficult passage. Doorknobs, lightbulbs and medicinal props may work for others, but never did it for me.
I'll start off by saying I like Andy and his podcast. I've listened to his other episodes and they're pretty good. However, he allowed his biases to creep into this episode. When interviewing the reported and talking about why Americans feel the way they do about alcoholism and allows the "well America is a puritanical Christian nation" comment to go unchecked. This fits well within his "I used to be Christian before I found out how bad they are" schtick.
The reason people don't feel bad for alcoholics is because alcoholism is a choice. The alcoholic made the choice to start drinking in the first place and allowed themselves to continue to up the ante to the point that now their body is addicted to it. The addiction is very real, but the way it started isn't by chance.
We feel bad for cancer victims because of the randomness of the cruelty. They didn't ask for this and generally speaking nothing they did knowingly contributed to getting cancer. Except for lung cancer for smokers, we don't give a shit about them as a society. And this is largely for the same reason: the average person with common sense asks rhetorically "Well, what did you think was going to happen?"
I wrote largely the same response to Bari's episode about Ozempic and her guest basically saying the same thing, it's so sad that we don't "treat obesity like a disease" and we want to "make them feel bad". No, we just don't pity people who make destructive choices and have to live with the consequences.
That being said, this approach seems highly effective and I'm all for it going mainstream. Regardless of their individual choices, I don't want people to continue to destroy their lives. Just don't expect me to pity you, pat you on the ass, and tell you it isn't your fault.
Can you take Naltrexone and smoke crack, shoot heroin or pop pills like OxyContin your way to sobriety? How about Fentanyl? Be good to know. Is AA preventing its use on these addictions?
Naltrexone works based on my own personal experience. I was married to an alcoholic and I researched solutions. I was shocked to hear about Naltrexone and that it could CURE alcoholism. After failing to convince my wife to try it, as a last ditch attempt, I got a prescription for myself in order to set an example.
We drank every night in my home, and, while I knew my wife had a problem, I thought my drinking was under control. After taking it for about a week, I was stunned to find that I didn't care about drinking anymore. My wine glass would sit half drunk and not get touched again. I had no clue the strength of my desire for alcohol until it was gone. My brain was literally rewired to not crave alcohol.
It was life changing. I still take Naltrexone when I drink to make sure I never get back to the way I was. Unfortunately, my (now ex) wife never did try it. She went the AA route and is still fighting (mostly unsuccessfully) her addiction to this day.
Naltrexone is NOT well known. Whenever I have moved and get a new primary physician, I have to explain why I need a Naltrexone prescription. They look at me like I'm crazy when I tell them it's a cure for alcoholism. A proud moment came from one physician who, after a few years, asked me if I was the guy that told him about Naltrexone. I told him yes, and he said he's used it for several patients and it worked just like I said it would. He's a believer now.
Word is slowly spreading, but it deserves to be THE standard approach IMO... at least until something better is discovered in the future.
I wrote a detailed letter to the editor about this but I'll only post part of it here.
I've been sober for 13 years and I'm a Licensed Mental Health Counselor. Who currently has some clients that are in recovery.
Naltrexone, Methadone, and Suboxone aren’t news. They are drugs that are commonly used all across the United States and have been in widespread use for at least a decade. It is rare that I have a client in a dedicated substance abuse treatment program who isn’t prescribed one of these medications. So, the ignorance shows through immediately here. Podcast hosts aren’t addicts, they’ve never been through recovery themselves, they have never worked in a recovery program, or bothered to talk to anyone who has, and quite frankly, it shows. If you are going to your PCP expect to be disappointed. PCP’s are responsible for knowing every little thing about the human body, which is an insane amount of information to cover. Needless to say, they aren’t very good at any of it. They just have a basic understanding of everything. I frequently have to correct the inaccurate mental health diagnoses that PCP’s issue to patients. They never spot Bipolar disorder and very dangerously put bipolar people on SSRI medications. This is why people need to be in a substance abuse treatment program and not just go to their PCP. Most PCP’s will tell you to enter one, but people ignore it.
You’re already off base in the whole premise of your podcast episode. Next, you mention a study of 150 participants that had a stunning 75% success rate in lowering drinking. I literally put my face into my palm when I heard this. Journalists should not cite research that they do not understand. Journalists don’t understand statistics very well or how these studies are constructed. The podcast host even stated 150 participants as though it were a large number. That number is so small to the point of being meaningless. When studies are that small you need to wait for enough research to be published for there to be a meta-analysis on the subject. The smaller a data set is, the more prone it is to random variations in the data. Thus, it becomes extremely important to know who those 150 people were and how the researchers found them.
There was a Cochrane review of AA’s effectiveness in which there was a meta-analysis of over 10,000 participants, and they found AA to be an effective intervention.
They found AA led to a 42% success rate in participants being sober after one year.
Also, Katie sounds like she has a comorbidity, a dual diagnosis, with how she describes obessing over alcohol. That stuck out to me even as someone who has spent time in AA and worked with many addicts.
The difference is what The Sinclair Method proposes - to take Naltrexone AND continue drinking. When alcoholics are prescribed meds at clinics or by doctors they are told to STOP drinking.
In the podcast, they stated that Naltrexone is uncommon and little known. I don't have a problem per se with the Sincliar method. Often alcoholics can't stop drinking cold turkey since alcohol withdrawals can kill you.
It is WIDELY unknown - everyone knows what AA is, but unless you have sought out help for alcoholism (which majority of alcoholics don't), you would not have heard of Naltrexone. You work in this field, so it's well known to you, but not the general public.
It is relatively unknown to general practitioners, especially the Sinclair Method of using it. Right after I heard this story (it's been available for a while), I reached out to 3 family practice doctors, and while they had a vague understanding of the drug, none of them had ever prescribed it, and they all had to do some research on it.
Doctors who work as addiction specialists know naltrexone very well - but if a person just goes to see their GP, they might have to do some convincing!
If someone wants to get sober they need to get into a treatment program with competent professionals. PCP's aren't addiction recovery specialists and probably should not be prescribing naltrexone anyway since they aren't familiar with it.
Think back to what the doctor said in the podcast about PCP's prescribing naltrexone incorrectly and it being ineffective. Addiction recovery is a specialty, its unreasonable to expect a PCP to be able to do everything.
I agree with Miles that the latter part of the podcast which was focused on putting down AA was a bit too much especially when it got into “why would be so?” And then began to make conjectures as to what was wrong with American society. What are some other reasons that a medication for alcoholism might not take off? It’s funny that a core reason was discussed over and over in the podcast, many drinkers get positive reinforcement for their drinking: they feel good, they have friends who also drink and the camaraderie is great etc. I would imagine it would take a lot of negative reinforcement to try the pill. And then you’re faced with the challenge of the average Americans ability to take a medication regularly for a long period of time (spoiler alert: it’s poor). I would assume that’s compounded by the fact, as described in this podcast, that the benefit of the pill may take weeks to months. I assume many folks will give up on it and go back to what was fun, drinking. I imagine they would need a support group to keep encouraging them, a support group as exemplified by AA. Last point, as expected with journalism covering medicine there was a lot of testimonial and narrative. I would have like more science, (ie here are the studies, the quality of the studies, the outcomes and cautions about the results). Thanks.
I don't get your objection. Naltrexone is the perfect answer for what you describe as negatives. While using Naltrexone, you still go out with friends and drink all you want including camaraderie and all. The only difference is you take the medicine about an hour before. You still get drunk, still have fun with friends, and still need a DD to get home.
Naltrexone is not a drug that you need to stop drinking on. It actually only works when you do drink.
In my experience, it takes a week to start having a very noticeable impact and a month is maximum impact. The impact is you don't care if you drink or not. Unlike AA, there's no willpower involved, so there's no need for a support group.
As a former therapist with a decade of recovery, I appreciate The Free Press and the Honestly podcast for their diverse viewpoints on addiction, which are valuable for learning. However, there are some inaccuracies and biases regarding Alcoholics Anonymous (AA) that need addressing.
Firstly, AA is distinct from rehab centers. While rehabs face issues related to financial incentives and growth, AA operates on a different model. AA refuses contributions from foundations or individual donors and is entirely self-financed through small donations collected during meetings held worldwide.
Additionally, the portrayal of AA's beliefs about the causes of drinking is inaccurate. AA does not attribute alcoholism to childhood experiences or current traumatic events. Instead, AA emphasizes an individualized approach, where many members find faith and belief in a higher power as crucial elements in overcoming addiction.
While I support exploring all options to improve the lives of addicts, alcoholics, and their communities, it's crucial to provide accurate information about existing ones like AA, which has been effective for many. Misrepresenting AA undermines a method that has helped countless individuals and could potentially assist many more. Keep the diversity of methodology on the treatment of addiction coming….just add in more balance please.
Thank you, Katie! This will change so many lives, I wonder if it can be tracked? How many people will try the Sinclair Method after hearing this story? Could save marriages, could save lives!
"Vast majority of treatment centers are crooked" that's quite a bit of an overstatement. Most treatment centers do an incredibly difficult job of attempting to help people with a very challenging, sometimes tragic disease. It's expensive to treat these individuals due to the staffing levels it takes and the necessity of providing housing, labor, benefits, meals and other services. Treatment centers need money to sustain their existence or they won't be around to help the next group patients that need care.
Yes, there are centers that do completely unethical things and should be shut down. It's disgusting when this happens to people that are struggling and often don't have resources to loose by getting poor treatment. However, I'd say 85% or more are trying their best with the limited resources available.
It's awesome you benefited from naltrexone and vivitrol. However, those things alone rarely work. Finally, if you think people in AA and 12 Step programs are weak dependents on their higher power and Jesus you don't know much about the program. Yes, a higher power or the group can get people started and are very important but those entities don't save us. We still have to take action and do the work. We also focus on helping others and that is when the real magic of recovery happens.
Congrats on 10 years and I hope you never have to take a drink again,
I deleted the initial message, as I don’t want it to be taken the wrong way, and certainly don’t want to offend the AA community. I definitely don’t think all people in AA are weak dependents, but I do believe that AA can take away some of the personal responsibility and makes some believe that they’re forever powerless against alcohol. I know I certainly was when I arrived at treatment. But I was until I wasn’t - for me, about 16 days in to it, I could feel a shift. I could feel myself starting to gain the upper hand the wrestling match. It would be a few years before I was fully confident, but it had begun. I’ve attended meetings where the old heads would lecture (borderline yell) at the newly sober group about how if not for their meeting, their group, and their daily attendance, they’d be face down in a gutter in no time flat. And I believe that they believed this. I also think this is among the reasons so many AA loyalists struggled mightily - even with years of sobriety under their belts - during Covid. I think AA has helped millions of people, saved countless lives along the way. So yes, it does work if you work it. I also think you can still drive a Model-T across the country and do it on mostly unpaved roads. That’s how it used to be done. But I also believe there are better ways now. That’s all. As for the always growing rehab industry, I’ve seen awful things from some of the most reputable places. Egregious, unforgettable and unforgivable stuff. I’ve seen friends get roped in to it, as they’ll gladly exploit newly sober people with few options to keep on staying there and work for almost nothing. And I know what I saw and went through at the very place that I credit with getting me sober - a very high-end, high profile, Bay Area rehab. Disgusting practices. They’re predatory businesses, not medical care facilities. They want you to stay and pay for another month, not stay sober.
THANK YOU Patrick for your very thoughtful response and I don't disagree with any of it. Some of the old timers do get aggressive with how they share and when they talk that way I feel very uncomfortable. However, I'll hear the next person share that they needed exactly that kind of approach from someone to get their attention. My sponsor used to tell me to not judge what others share because, while it may not appeal to me, it might be exactly what some other person in that room needs to hear. That also speaks to something in AA that is incredibly important. Finding a healthy, knowledgeable sponsor and group. My counselor told me to try different meetings and different meeting times to find a healthy, helpful group of members. I often see people go to one meeting and judge the entire AA organization by that experience. I get passionate about standing up for AA and 12 steps because it's been the approach I've seen work for most people long term. I also know that nobody goes to AA because they want to. However, if they stick it out and are open to the process they end of extremely grateful for being a member of AA. I also advocate for AA and 12 Step meetings because they are all over the world and available 24 hours a day. It's also FREE which is so important since treatment is often so expensive. Finally, since 12 steps is focused
I also agree with the concerns about some of the treatment organizations being questionable and doing unethical things. However, I do think most of them are trying to do good, especially the staff members that are in the trenches with the patients while they are there. I also know how expensive it is to keep a treatment facility operating so I understand their focus on bringing money in. I often got upset with a facility I worked at because they were so focused on keeping patients at the facility since they were basically a paying customer. My supervisor knew my frustrations so they had a very honest meeting with me. They explained that we were barely keeping the doors open and how it would be unfortunate if we ended up having to close. Especially since we were one of the few Medicaid providers.
I'm very happy that you are free from addiction. Let's both keep it that way.
Would you really say that anyone who chooses the AA route is "free from addiction"? My personal experience with it is that AA teaches, based on reality, that it's a daily struggle no matter how many years sober someone is.
Absolutely and some people don't come to many AA meetings after they have been sober for a while. The way I look at and it says in the big book is that we are "recovered" as long as we are taking care of our recovery and our overall emotional and/or spiritual health. I haven't wanted to drink in 15+ years so I'd say yes, I am free from my alcohol addiction. However, I want to stay in recovery not so I don't drink again but because the AA program helps me grow and I bring value to myself and the people around me. If I don't continue my program to expand my mental health, emotional health and spiritual connection then I can get to a point where a drink sounds like a nice break from reality and an escape.
I continue to go to meetings and focus on my personal recovery so I can be there to help others That gives me a way to turn my alcoholism into a positive and a way to encourage and support new people instead of a curse that caused me and my loved ones pain in the past. Plus, people were in the meetings when I first started and they helped me so now it's my opportunity to show up for others and give back.
I can see what you mean, and I agree with you. This point is among my list of issues with AA. But Kelly also points out a list of pretty concrete positives from AA. I went to meetings everyday for my first 30 days, and off and on for awhile after. Ultimately, I found that AA wasn’t for me, but I found my groove and my way to stay sober. I still drop in to meetings from time to time, and I am always glad to take people to their first few meetings, get them in the door and comfortable with a group going through the struggles of staying sober. Perhaps for some it really is a day-to-day struggle, forever. Perhaps I’m fortunate that this ultimately wasn’t the case for me. If there was a clear roadmap to beat alcoholism that worked for everyone, someone would’ve printed and made themselves rich from it. Everyone has a different path.
Ok so I don’t have any expertise with addiction, recovery, AA, etc but I thought this was a compelling podcast about Katie’s personal experience with Naltrexone. I’m sure plenty of alcoholics could benefit from it, with or without AA. I think it’s great she’s trying to get the word out since it was clearly life-changing for her.
This would not be a safe approach with patients who already have cirrhosis. For them, they need complete abstinence, starting yesterday.
If they need transplant, they need 6 months complete sobriety (exceptions exist however).
there would be no leeway for a Sinclair protocol.
I think this was an important episode and I appreciate hearing Katie's experience with Naltrexone. And pointing out how this is not something that is common amongst primary care providers to know much about or suggest.
The episode was not touted as a high-level, broad or comprehensive view on best ways to treat alcohol addiction. It was touted as a personal experience (and success!) with a tool that does not seem to be broadly used. In that regard, it was something to raise awareness and to help more people (both clinicians and people/patients) that this option exists and can be extremely useful for the right person.
This is just like other "addictions" or disordered relationship with a substance. obesity and weight loss a great example. Programs that help change habits are helpful and all that some people need. (and there are all kinds of programs and advice for weight loss). Others don't get the results needed with just advice or support. There are multiple medications to help with weight loss - again, each is a TOOL. The tool works for some people but not others. Semaglutide (GLP1 meds) being a newer tool that does happen to have even higher success rates. But - doesn't work for everyone. No tool does.
The thing I have noticed - opioid use disorder is the more high-profile addiction right now. Much focus, money, resources goes to this. I've wondered why we are not putting near as much effort and money into alcohol (on a state or federal level). All primary care doctors are encouraged to become prescribers of Suboxone - despite not having other supports available in their office to supplement the medication. The medication alone is helpful but seems a broader support network would be even more so. There has never been the same encouragement to take on MAT prescribing for alcoholism. There are cities where some in the medical community advocate for "safe centers" - places where opioid addicts can get clean needles and be allowed to use drugs with people just waiting to reverse the effects with Naloxone. This makes no sense to me, but there are many advocates that focus on this. Again, nobody suggesting these things for alcohol dependence. So, there is some different way that people who tend to focus on disenfranchised people and circumstances feel much more sympathy for "those experiencing opioid addiction" and not so much for alcoholics. That, to me, is an interesting thing overall.
"Rarely have we seen a person fail who has thoroughly followed our path. Those who do not recover are people who cannot or will not completely give themselves to this simple program, usually men and women who are constitutionally incapable of being honest with themselves." Katie just dipped her toes in and never followed through. She's like most of her generation that just want a solution without working for it, like a magic pill. Sadly, she is now a dry-drunk and will wonder why she hasn't found peace even though she isn't drinking.
I'm an Addiction Recovery Coach and have 17+ years in recovery. I've also worked in treatment centers for over 10 years. I have a family that has been tragically affected by the results of addiction. I know from experience what this disease looks like in it's various forms and stages, including recovery.
I am very concerned regarding this podcast. I have NEVER commented on a podcast before and I apologize that this is a lengthy comment. I'm just extremely worried the biased information shared in this podcast has the potential to kill some alcoholics or extend their misery and increase the damage done to their families, loved ones, their health and society.
When we are in the grips of our addiction, we will go to great lengths to try and control our drinking. Our deepest desire is be able to keep drinking forever without suffering the consequences. The idea of a medication that allows us to control our drinking would be a dream come true. Especially if it means we don't have to go to AA or address the difficult underlying issues that cause us to drink and use. Your podcast could give someone false hope that they have a plan to address their problem drinking. They can even play your podcast for their loved ones to prove they have a legitimate recovery plan. While I see the benefit of Naltrexone as a tool to help with cravings. My observations is it only works as part of a much more thorough recovery plan. After all, our drinking is not simply a response to cravings. It's due to several possible causes. For example, we often have a genetic disposition for addiction from our family. We have possible trauma and abuse in our past. We struggle with mental health, environmental influences and other dysfunctional circumstances in our lives. If we just take a medication that addresses cravings, then we might not be motivated to address our underlying issues like trauma, dysfunctional childhoods, abuse, mental health issues, etc.
Another part of the podcast that is very disappointing is the negative portrayal of Alcoholics Anonymous. To say AA's effectiveness is in the single digits is disgustingly uninformed, biased, inaccurate, dismissive and dangerous. Every program struggles to achieve a positive success rate because it is very difficult. Most people that enter recovery and treatment are not there completely on their own accord. They are often forced or nudged by concerned family members, employers, the legal system, negative consequences of their actions, etc. Since they really aren't there because they want to stop drinking or using, their chances of staying in recovery are almost zero. They are not ready to commit to the changes required to stop their problem use or drinking so they go back. However, the success rate for people willing to truly address their addictions and underlying issues is probably close to 75%. Maybe a little less if you account for relapses but some of those people get reengaged and are successful going forward. All programs can give people a decent start on their recovery journey. However, it's eventually up to the individual to take responsibility for their recovery. You can't fault any program if someone isn't successful since no program, except maybe jail, can physically stop someone from drinking/using if they want to.
12 Step Programs have saved millions of lives for more than 80 years. There is NO program or approach that has that kind of LONG TERM record of success. Not only do these programs help people stop drinking and using. They also help people rebuild relationships with loved ones, improve their outlook on life and positively contribute to society. I've seen true miracles in 12 step programs and hundreds of examples of incredible kindness, support and love from AA members for their fellow addiction sufferers. I've seen families saved and flourishing due to 12 step recovery. I've seen people in almost full liver shutdown come back and help numerous people avoid the same hell of slowly dying an awful death. I've seen incredibly tragic stories be turned around to give other people hope that anyone can come back from the grips of addictions. I GUARANTEE, you won't see these kinds of beautiful events if people just take a pill that might keep them sober, but doesn't help them create a life so complete that they don't want to go back to drinking or using.
One final point, AA and 12 Step programs are FREE!!! When people are so concerned about the cost of treatment, why do some people downplay a program that requires no financial sacrifice of it's participants? These programs are also available in almost every country in the world literally every second of everyday. They are available in very rural areas and the biggest cities in hundreds of languages. There are even meetings in China where they are outlawed but continue to be there for the next person that is suffering from this disease.
Does that sound like a program with single digit success rates?
Kelly from Denver, CO
The podcast did not disparage AA for all. I think it made it possible to have another option. As with most things, more than one option may be the answer. AA relies heavily on a "higher power". what if someone doesn't have one?
During 36 years of sobriety based on AA principles, I recognize that many times the only higher power l was capable of seeking was the one who is greater than alcohol. For alcohol was truly the power l knew as greater than myself as l reached the end of 30 years of drunken struggles to live life on my terms. At many other times, I can contemplate God, but I'm sure I'm not the only alcoholic who sometimes clung to His most basic manifestation in our lives in a difficult passage. Doorknobs, lightbulbs and medicinal props may work for others, but never did it for me.
My higher power is my obligation to, and desire to be there for, my family.
Higher power isn't God (although it can be for many).
My point being everyone has a higher power they just need to discover it.
I'll start off by saying I like Andy and his podcast. I've listened to his other episodes and they're pretty good. However, he allowed his biases to creep into this episode. When interviewing the reported and talking about why Americans feel the way they do about alcoholism and allows the "well America is a puritanical Christian nation" comment to go unchecked. This fits well within his "I used to be Christian before I found out how bad they are" schtick.
The reason people don't feel bad for alcoholics is because alcoholism is a choice. The alcoholic made the choice to start drinking in the first place and allowed themselves to continue to up the ante to the point that now their body is addicted to it. The addiction is very real, but the way it started isn't by chance.
We feel bad for cancer victims because of the randomness of the cruelty. They didn't ask for this and generally speaking nothing they did knowingly contributed to getting cancer. Except for lung cancer for smokers, we don't give a shit about them as a society. And this is largely for the same reason: the average person with common sense asks rhetorically "Well, what did you think was going to happen?"
I wrote largely the same response to Bari's episode about Ozempic and her guest basically saying the same thing, it's so sad that we don't "treat obesity like a disease" and we want to "make them feel bad". No, we just don't pity people who make destructive choices and have to live with the consequences.
That being said, this approach seems highly effective and I'm all for it going mainstream. Regardless of their individual choices, I don't want people to continue to destroy their lives. Just don't expect me to pity you, pat you on the ass, and tell you it isn't your fault.
It is.
Can you take Naltrexone and smoke crack, shoot heroin or pop pills like OxyContin your way to sobriety? How about Fentanyl? Be good to know. Is AA preventing its use on these addictions?
Naltrexone works based on my own personal experience. I was married to an alcoholic and I researched solutions. I was shocked to hear about Naltrexone and that it could CURE alcoholism. After failing to convince my wife to try it, as a last ditch attempt, I got a prescription for myself in order to set an example.
We drank every night in my home, and, while I knew my wife had a problem, I thought my drinking was under control. After taking it for about a week, I was stunned to find that I didn't care about drinking anymore. My wine glass would sit half drunk and not get touched again. I had no clue the strength of my desire for alcohol until it was gone. My brain was literally rewired to not crave alcohol.
It was life changing. I still take Naltrexone when I drink to make sure I never get back to the way I was. Unfortunately, my (now ex) wife never did try it. She went the AA route and is still fighting (mostly unsuccessfully) her addiction to this day.
Naltrexone is NOT well known. Whenever I have moved and get a new primary physician, I have to explain why I need a Naltrexone prescription. They look at me like I'm crazy when I tell them it's a cure for alcoholism. A proud moment came from one physician who, after a few years, asked me if I was the guy that told him about Naltrexone. I told him yes, and he said he's used it for several patients and it worked just like I said it would. He's a believer now.
Word is slowly spreading, but it deserves to be THE standard approach IMO... at least until something better is discovered in the future.
I wrote a detailed letter to the editor about this but I'll only post part of it here.
I've been sober for 13 years and I'm a Licensed Mental Health Counselor. Who currently has some clients that are in recovery.
Naltrexone, Methadone, and Suboxone aren’t news. They are drugs that are commonly used all across the United States and have been in widespread use for at least a decade. It is rare that I have a client in a dedicated substance abuse treatment program who isn’t prescribed one of these medications. So, the ignorance shows through immediately here. Podcast hosts aren’t addicts, they’ve never been through recovery themselves, they have never worked in a recovery program, or bothered to talk to anyone who has, and quite frankly, it shows. If you are going to your PCP expect to be disappointed. PCP’s are responsible for knowing every little thing about the human body, which is an insane amount of information to cover. Needless to say, they aren’t very good at any of it. They just have a basic understanding of everything. I frequently have to correct the inaccurate mental health diagnoses that PCP’s issue to patients. They never spot Bipolar disorder and very dangerously put bipolar people on SSRI medications. This is why people need to be in a substance abuse treatment program and not just go to their PCP. Most PCP’s will tell you to enter one, but people ignore it.
You’re already off base in the whole premise of your podcast episode. Next, you mention a study of 150 participants that had a stunning 75% success rate in lowering drinking. I literally put my face into my palm when I heard this. Journalists should not cite research that they do not understand. Journalists don’t understand statistics very well or how these studies are constructed. The podcast host even stated 150 participants as though it were a large number. That number is so small to the point of being meaningless. When studies are that small you need to wait for enough research to be published for there to be a meta-analysis on the subject. The smaller a data set is, the more prone it is to random variations in the data. Thus, it becomes extremely important to know who those 150 people were and how the researchers found them.
There was a Cochrane review of AA’s effectiveness in which there was a meta-analysis of over 10,000 participants, and they found AA to be an effective intervention.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012880.pub2/full
You don’t want to fight me when it comes to my occupation. I am very good at what I do, and you should take the time to talk to people like me.
This link is more succinct the first one links to the full study:
https://www.cochrane.org/news/new-cochrane-review-finds-alcoholics-anonymous-and-12-step-facilitation-programs-help-people
They found AA led to a 42% success rate in participants being sober after one year.
Also, Katie sounds like she has a comorbidity, a dual diagnosis, with how she describes obessing over alcohol. That stuck out to me even as someone who has spent time in AA and worked with many addicts.
The difference is what The Sinclair Method proposes - to take Naltrexone AND continue drinking. When alcoholics are prescribed meds at clinics or by doctors they are told to STOP drinking.
In the podcast, they stated that Naltrexone is uncommon and little known. I don't have a problem per se with the Sincliar method. Often alcoholics can't stop drinking cold turkey since alcohol withdrawals can kill you.
It is WIDELY unknown - everyone knows what AA is, but unless you have sought out help for alcoholism (which majority of alcoholics don't), you would not have heard of Naltrexone. You work in this field, so it's well known to you, but not the general public.
In the podcast, they were stating it was unknown to medical professionals which is false. This podcast isn't simply about raising awareness.
It is relatively unknown to general practitioners, especially the Sinclair Method of using it. Right after I heard this story (it's been available for a while), I reached out to 3 family practice doctors, and while they had a vague understanding of the drug, none of them had ever prescribed it, and they all had to do some research on it.
Doctors who work as addiction specialists know naltrexone very well - but if a person just goes to see their GP, they might have to do some convincing!
I said that in my original post.
If someone wants to get sober they need to get into a treatment program with competent professionals. PCP's aren't addiction recovery specialists and probably should not be prescribing naltrexone anyway since they aren't familiar with it.
Think back to what the doctor said in the podcast about PCP's prescribing naltrexone incorrectly and it being ineffective. Addiction recovery is a specialty, its unreasonable to expect a PCP to be able to do everything.
KATIE....I recognize your voice but I'll respect your privacy. Thank you for your story.
Katie posted it on the Blocked and Reported podcast feed too. It’s not a secret that it’s her.
Then why no mention of her last name?
I agree with Miles that the latter part of the podcast which was focused on putting down AA was a bit too much especially when it got into “why would be so?” And then began to make conjectures as to what was wrong with American society. What are some other reasons that a medication for alcoholism might not take off? It’s funny that a core reason was discussed over and over in the podcast, many drinkers get positive reinforcement for their drinking: they feel good, they have friends who also drink and the camaraderie is great etc. I would imagine it would take a lot of negative reinforcement to try the pill. And then you’re faced with the challenge of the average Americans ability to take a medication regularly for a long period of time (spoiler alert: it’s poor). I would assume that’s compounded by the fact, as described in this podcast, that the benefit of the pill may take weeks to months. I assume many folks will give up on it and go back to what was fun, drinking. I imagine they would need a support group to keep encouraging them, a support group as exemplified by AA. Last point, as expected with journalism covering medicine there was a lot of testimonial and narrative. I would have like more science, (ie here are the studies, the quality of the studies, the outcomes and cautions about the results). Thanks.
I don't get your objection. Naltrexone is the perfect answer for what you describe as negatives. While using Naltrexone, you still go out with friends and drink all you want including camaraderie and all. The only difference is you take the medicine about an hour before. You still get drunk, still have fun with friends, and still need a DD to get home.
Naltrexone is not a drug that you need to stop drinking on. It actually only works when you do drink.
In my experience, it takes a week to start having a very noticeable impact and a month is maximum impact. The impact is you don't care if you drink or not. Unlike AA, there's no willpower involved, so there's no need for a support group.
As a former therapist with a decade of recovery, I appreciate The Free Press and the Honestly podcast for their diverse viewpoints on addiction, which are valuable for learning. However, there are some inaccuracies and biases regarding Alcoholics Anonymous (AA) that need addressing.
Firstly, AA is distinct from rehab centers. While rehabs face issues related to financial incentives and growth, AA operates on a different model. AA refuses contributions from foundations or individual donors and is entirely self-financed through small donations collected during meetings held worldwide.
Additionally, the portrayal of AA's beliefs about the causes of drinking is inaccurate. AA does not attribute alcoholism to childhood experiences or current traumatic events. Instead, AA emphasizes an individualized approach, where many members find faith and belief in a higher power as crucial elements in overcoming addiction.
While I support exploring all options to improve the lives of addicts, alcoholics, and their communities, it's crucial to provide accurate information about existing ones like AA, which has been effective for many. Misrepresenting AA undermines a method that has helped countless individuals and could potentially assist many more. Keep the diversity of methodology on the treatment of addiction coming….just add in more balance please.
Thank you, Katie! This will change so many lives, I wonder if it can be tracked? How many people will try the Sinclair Method after hearing this story? Could save marriages, could save lives!
I remember this topic! Does the drinking drug work after all? I recommended it to some folks after learning about it on this substack...
"Vast majority of treatment centers are crooked" that's quite a bit of an overstatement. Most treatment centers do an incredibly difficult job of attempting to help people with a very challenging, sometimes tragic disease. It's expensive to treat these individuals due to the staffing levels it takes and the necessity of providing housing, labor, benefits, meals and other services. Treatment centers need money to sustain their existence or they won't be around to help the next group patients that need care.
Yes, there are centers that do completely unethical things and should be shut down. It's disgusting when this happens to people that are struggling and often don't have resources to loose by getting poor treatment. However, I'd say 85% or more are trying their best with the limited resources available.
It's awesome you benefited from naltrexone and vivitrol. However, those things alone rarely work. Finally, if you think people in AA and 12 Step programs are weak dependents on their higher power and Jesus you don't know much about the program. Yes, a higher power or the group can get people started and are very important but those entities don't save us. We still have to take action and do the work. We also focus on helping others and that is when the real magic of recovery happens.
Congrats on 10 years and I hope you never have to take a drink again,
I deleted the initial message, as I don’t want it to be taken the wrong way, and certainly don’t want to offend the AA community. I definitely don’t think all people in AA are weak dependents, but I do believe that AA can take away some of the personal responsibility and makes some believe that they’re forever powerless against alcohol. I know I certainly was when I arrived at treatment. But I was until I wasn’t - for me, about 16 days in to it, I could feel a shift. I could feel myself starting to gain the upper hand the wrestling match. It would be a few years before I was fully confident, but it had begun. I’ve attended meetings where the old heads would lecture (borderline yell) at the newly sober group about how if not for their meeting, their group, and their daily attendance, they’d be face down in a gutter in no time flat. And I believe that they believed this. I also think this is among the reasons so many AA loyalists struggled mightily - even with years of sobriety under their belts - during Covid. I think AA has helped millions of people, saved countless lives along the way. So yes, it does work if you work it. I also think you can still drive a Model-T across the country and do it on mostly unpaved roads. That’s how it used to be done. But I also believe there are better ways now. That’s all. As for the always growing rehab industry, I’ve seen awful things from some of the most reputable places. Egregious, unforgettable and unforgivable stuff. I’ve seen friends get roped in to it, as they’ll gladly exploit newly sober people with few options to keep on staying there and work for almost nothing. And I know what I saw and went through at the very place that I credit with getting me sober - a very high-end, high profile, Bay Area rehab. Disgusting practices. They’re predatory businesses, not medical care facilities. They want you to stay and pay for another month, not stay sober.
THANK YOU Patrick for your very thoughtful response and I don't disagree with any of it. Some of the old timers do get aggressive with how they share and when they talk that way I feel very uncomfortable. However, I'll hear the next person share that they needed exactly that kind of approach from someone to get their attention. My sponsor used to tell me to not judge what others share because, while it may not appeal to me, it might be exactly what some other person in that room needs to hear. That also speaks to something in AA that is incredibly important. Finding a healthy, knowledgeable sponsor and group. My counselor told me to try different meetings and different meeting times to find a healthy, helpful group of members. I often see people go to one meeting and judge the entire AA organization by that experience. I get passionate about standing up for AA and 12 steps because it's been the approach I've seen work for most people long term. I also know that nobody goes to AA because they want to. However, if they stick it out and are open to the process they end of extremely grateful for being a member of AA. I also advocate for AA and 12 Step meetings because they are all over the world and available 24 hours a day. It's also FREE which is so important since treatment is often so expensive. Finally, since 12 steps is focused
I also agree with the concerns about some of the treatment organizations being questionable and doing unethical things. However, I do think most of them are trying to do good, especially the staff members that are in the trenches with the patients while they are there. I also know how expensive it is to keep a treatment facility operating so I understand their focus on bringing money in. I often got upset with a facility I worked at because they were so focused on keeping patients at the facility since they were basically a paying customer. My supervisor knew my frustrations so they had a very honest meeting with me. They explained that we were barely keeping the doors open and how it would be unfortunate if we ended up having to close. Especially since we were one of the few Medicaid providers.
I'm very happy that you are free from addiction. Let's both keep it that way.
Kelly
AA works - still working - for Anthony Hopkins
Would you really say that anyone who chooses the AA route is "free from addiction"? My personal experience with it is that AA teaches, based on reality, that it's a daily struggle no matter how many years sober someone is.
Absolutely and some people don't come to many AA meetings after they have been sober for a while. The way I look at and it says in the big book is that we are "recovered" as long as we are taking care of our recovery and our overall emotional and/or spiritual health. I haven't wanted to drink in 15+ years so I'd say yes, I am free from my alcohol addiction. However, I want to stay in recovery not so I don't drink again but because the AA program helps me grow and I bring value to myself and the people around me. If I don't continue my program to expand my mental health, emotional health and spiritual connection then I can get to a point where a drink sounds like a nice break from reality and an escape.
I continue to go to meetings and focus on my personal recovery so I can be there to help others That gives me a way to turn my alcoholism into a positive and a way to encourage and support new people instead of a curse that caused me and my loved ones pain in the past. Plus, people were in the meetings when I first started and they helped me so now it's my opportunity to show up for others and give back.
I can see what you mean, and I agree with you. This point is among my list of issues with AA. But Kelly also points out a list of pretty concrete positives from AA. I went to meetings everyday for my first 30 days, and off and on for awhile after. Ultimately, I found that AA wasn’t for me, but I found my groove and my way to stay sober. I still drop in to meetings from time to time, and I am always glad to take people to their first few meetings, get them in the door and comfortable with a group going through the struggles of staying sober. Perhaps for some it really is a day-to-day struggle, forever. Perhaps I’m fortunate that this ultimately wasn’t the case for me. If there was a clear roadmap to beat alcoholism that worked for everyone, someone would’ve printed and made themselves rich from it. Everyone has a different path.