Modern Wisdom #993 - Katie Herzog: A Controversial New Cure for Alcohol Dependence

Date: September 13, 2025
Host: Chris Williamson
Guest: Katie Herzog (journalist, podcaster, author of Drink Your Way Sober)

Episode Overview

In this illuminating and candid conversation, Chris Williamson sits down with journalist and podcaster Katie Herzog to discuss her lifelong struggle with alcohol dependence and her eventual recovery through an unconventional method: the Sinclair Method, which leverages a medication (naltrexone) to break the cycle of addiction. The episode delves into the culture of drinking, different types of alcohol use disorder, the limitations of traditional recovery programs like AA, and why a medical approach to addiction is both controversial and underutilized.

Herzog offers a deeply personal narrative about her years spent in bar culture, her failed attempts at sobriety, and the surprising, evidence-based method that finally liberated her from alcohol. The result is a moving and often humorous exploration that challenges cultural stigmas, offers practical hope, and advocates for broadening the options available to those struggling with alcohol dependence.

Key Discussion Points and Insights

Katie Herzog’s Drinking History and Alcohol Culture

• Early Start and Escalation

  • Katie began drinking in middle school and loved the effect from the start, escalating her use through high school, college, and into adulthood. (00:02)
  • She became a “barfly” after college, finding community among older men day-drinking in bars.
  • Drinking was tightly woven into her social life and identity: "My life was lived in bars. This is what my friends and I did." (02:05)

• Consequences and Dark Humor

  • Incidents caused by drinking included multiple hospital visits, employment issues, dropping out of grad school, and a notorious episode where she accidentally burned down a porch while drinking and smoking alone. (01:42)
    • "While the fire department was in my house... dragging a hose through my carpeted living room... I was outside in a patch of woods drinking vodka." [03:53 - Katie]
  • Such stories, though serious, were seen as "badges of honor" within her peer group, reflecting cultural normalization of excessive drinking. (12:28)

• Natural Recovery vs. Entrenched Addiction

  • Many people “age out” of heavy drinking through natural recovery—lives change, responsibilities grow, and alcohol takes a back seat.
  • Katie did not naturally recover, despite wishing she would: "That was my hope… It just never happened." (07:23)

The Nature and Nuance of Alcohol Use Disorder

• Spectrum Disorder

  • Alcohol Use Disorder (AUD) exists on a vast spectrum, from occasional over-indulgence to severe, daily dependence.
  • Katie describes two broad categories:
    • "Reward drinkers" (get energized/euphoric from drinking)
    • "Relief drinkers" (drink for anxiety/sedative effects)
  • "Alcohol really does have very different effects on different people. My wife gets sleepy, I get wired." [22:35 - Katie]

• Cravings and Powerlessness

  • Cravings can be all-consuming and override willpower or rational intent—to the point of addiction feeling like a hijacking of the brain.
    • "No matter how many times I woke up and told myself today would be different… my brain had been hijacked by alcohol." [17:36 - Katie]

• Obstacles to Recovery

  • Social stigma, normalization, and denial (“vacillating denial”) kept her drinking and kept others from intervening or recognizing the problem. (12:52)
  • Previous attempts at recovery (AA, therapy, willpower, moderation strategies, lifestyle changes) all failed to curb cravings or change her fundamental relationship to alcohol. (27:59–30:01)
  • Many people channel addictive tendencies into healthy habits, but Katie notes that this is not a universal solution. (31:00)

Cultures of Sobriety, Shame, and Support

• Social Support — Double-Edged Sword

  • Alcohol served as a vital connector—removing it loses not only the substance but often the social environment and identity built around it.
    • "I was so judgmental of people who didn't drink... it was a reminder there are other ways to live." [12:58 - Katie]

• AA and the Limits of the Traditional Paradigm

  • AA’s approach works for many, offering community and accountability, but is predicated on abstinence and personal transformation.
    • For Katie, AA didn't address her cravings or root cause: "AA never addressed the root cause of my drinking, and that was that I liked to drink." (45:42)
    • She was skeptical of introspection and the spiritual dimensions of 12-step programs ("I'm the one lesbian who doesn't like to process in this world… I needed to solve that problem." [47:13])

• Changing Cultures and Generational Shifts

  • Younger generations are drinking less, but are also less socially connected in person, which brings its own risks.
  • There’s a pushback against both excessive drinking and excessive sobriety as a "performance." (86:45–88:46)

The Sinclair Method: The "Controversial New Cure"

• Naltrexone and the Science

  • Naltrexone, an opioid blocker synthesized in 1963, was approved for alcohol use disorder in 1994.
  • Traditional prescription: daily use to reduce cravings.
  • Sinclair Method (named after researcher John David Sinclair): Take naltrexone only before planned drinking; over time, the brain "unlearns" the association between alcohol and reward (a process called 'pharmacological extinction'). (52:09–56:55)
    • "You take the drug, it blocks your opioid receptors from getting an endorphin rush from alcohol. You drink as normal, but over time, you just… stop wanting it." [52:42 - Katie]
    • Animal studies and follow-up with humans confirmed that reward-seeking can be safely extinguished in most types ("reward drinkers").

• Katie’s Experience

  • During COVID, her drinking escalated; reading about the Sinclair Method prompted her to try it discreetly.
  • Over seven months she followed the method with discipline: pill one hour before drinking, tracking habits, gradually increasing alcohol-free days.
  • Result: Ceased to crave alcohol, found it easy to abstain, hasn't drunk for three years, ultimately told her wife after a year and a half. (58:18)

• "Sinclair Method and this drug freed me from that. I basically stopped thinking about it." [61:40 - Katie]

• Effectiveness and Limitations

  • Not a one-size-fits-all: Works especially well for “reward drinkers,” less well for “relief drinkers.” (69:46–71:00)
  • Genetic factors (especially the ASP40 allele on the OPRM1 gene) may determine responsiveness.
  • Close adherence is essential; cheating the protocol undermines progress. (58:18)

• Barriers to Adoption

  • Many doctors lack addiction medicine training; there are legal, ethical, and economic reasons for caution.
  • Naltrexone is off-patent and cheap—no economic driver for pharma companies to promote or educate about it.
  • Cultural/care standard inertia: prescribing a medication that enables (structured) continued drinking is counterintuitive for many. (64:21–69:02)

Notable Quotes & Memorable Moments

• On Alcohol’s Place in Social Life:
  • "Alcohol and community—it is such a bonding experience… The problem is just that for some people, it doesn't stop there." [14:47 - Katie Han]
• On the Paradox of Addiction:
  • "That's the fundamental problem. That's the paradox. I need to quit, but I don't want to stop. I love this thing, but I hate this thing." [49:31 - Katie]
• On the Limitations of AA:
  • "AA never addressed the root cause of my drinking, and that was that I liked to drink." [45:42 - Katie]
• On Sinclair Method’s Liberating Effect:
  • "Sinclair Method and this drug freed me from that. I basically stopped thinking about it." [61:40 - Katie]
• On Shifting Cultural Norms:
  • "It almost felt like a life hack… I lived for so many years with this mental obsession... Sobriety felt like a relief." [81:07 - Katie]
• On the Cultural Shift and Its Double Edge:
  • "It's not just that young people aren't drinking... they're also not socializing with each other in person. I cannot see that as a net positive." [88:48 - Katie]
• On Purpose for Writing the Book:
  • "The main message... is broadening the way that we think about this [alcohol dependence]. Because the abstinence or nothing narrative... keeps people drinking longer." [92:18 - Katie]
• On Accepting Change:
  • "The price that you pay to try and help the world become slightly better—Mary, it's humiliating." [94:40 - Katie, closing joke about writing a self-help book]

Timestamps for Key Segments

• Opening: Katie’s Alcohol Story (00:02–04:41)
• Natural Recovery and Ageing Out (05:41–07:23)
• Culture, Denial, and AA (08:19–14:25)
• Types of Alcohol Use Disorder (19:46–25:09)
• Failed Recovery Attempts (27:59–31:00)
• Cultural Shifts & Generational Trends (85:27–89:58)
• History of Addiction Treatment/AA (36:09–44:56)
• Sinclair Method Explained (52:09–58:01)
• Katie’s Personal Sinclair Method Journey (58:01–61:40)
• Barriers to Sinclair Method Adoption (64:08–69:46)
• Genetic Factors/Effectiveness (71:00–72:16)
• Purpose of the Book (92:18–94:40)

Additional Resources

• Katie Herzog’s Website/Book: Drink Your Way Sober – drinkyourwaysober.com/org (check website)
• Katie’s Podcast: Blocked and Reported (culture/Internet, not recovery-focused)

Takeaways

Katie’s journey is both sobering and hopeful. For those struggling with alcohol, her message is clear: recovery does not have to follow a one-size-fits-all path, and medication-assisted approaches like the Sinclair Method are underexplored but potentially life-changing. The conversation also offers critical reflection on culture, community, and the importance of broadening the conversation around addiction and recovery.

For more, listen to the full episode or reach out to Katie through her website or podcast.