Radiolab – "The Fix"
Release Date: December 18, 2015
Hosts: Jad Abumrad and Robert Krulwich
Produced by WNYC Studios
Episode Overview
Theme:
This episode dives deep into the question: Can addiction—particularly alcoholism—be “fixed” with a pill? Using compelling stories, recent research, and a broad array of voices, the episode explores the potential and limitations of medications in treating addiction, the cultural resistance these treatments face, and the personal complexities that can make recovery more than just a pharmacological problem.
Key Discussion Points & Insights
1. The Search for a Fix
- Origin Story: Amy O’Leary, a former intern and now editorial director at Upworthy, recounts her personal connection to alcoholism and her discovery of Dr. Olivier Ameisen’s memoir, The End of My Addiction, where he claims the drug baclofen eliminated his compulsive drinking.
- Amy O’Leary (03:21): “He'd been in, you know, detoxes and medical treatment facilities, you know, upwards of a half dozen times. His practice had fallen off. He was losing everything in his life.”
- Ameisen experiments with baclofen after reading about its effects on cocaine cravings and reportedly becomes “totally indifferent to alcohol.”
- Amy O’Leary (04:16): “And then at one point he says the switch flipped. And once the switch hit, he just became absolutely indifferent to alcohol.”
2. Scientific Examination of Baclofen
- Addiction Researcher’s Perspective: Dr. Anna Rose Childress from the University of Pennsylvania discusses her early research involving baclofen and how it inspired Ameisen. She describes both disappointment with early clinical results and striking anecdotes from individuals like Ed Coleman—who found his cocaine cravings vanished after increasing his baclofen dose for spasms.
- Anna Rose Childress (10:07): “He had had a drug deal gone wrong, been shot in the neck, paralyzed... when he doubled his baclofen dose... cocaine no longer had the highest.”
- Ed Coleman (10:47): “I would try to use cocaine. I couldn’t feel the effects of it... I didn’t have no cravings.”
3. Other Medications and Off-Label Treatments
- Beyond Baclofen: The conversation reveals a suite of medications (acamprosate, gabapentin, topiramate, disulfiram, naltrexone, etc.) that target cravings or block alcohol’s effects, with varying levels of evidence and acceptance.
- Dr. Mark Willenbring (12:46): “There’s another drug, acamprosate or campral... and this other drug, Gaba... disulfiram, Chantix, Suboxone, Naltrexone, buprenorphine.”
- Success Rates: Naltrexone, in particular, is cited as effective, drastically helping many heavy drinkers reduce consumption—yet it remains vastly under-prescribed.
- Jad Abumrad (14:19): “One particular study in Finland with about 150 people showed that this drug had a 78% success rate in helping very heavy drinkers reduce their drinking to normal levels.”
- Cultural and Systemic Barriers:
- Gabrielle Glaser (15:08): “About 1% of people who suffer from alcohol use disorder are ever given the choice or an option to take any sort of medication.”
4. Cultural and Historical Divide
- The separation between medical treatment and community-based/12-step programs like Alcoholics Anonymous is rooted in logistical and historical quirks—such as early AA founders appropriating TB hospital wards for alcoholism “units,” which led to cultural separation.
- Gabrielle Glaser (16:24): “It has been completely segregated... Thus began 80 years of separation. And that’s where we are now.”
- Philosophical Divide: Medicine views addiction as a disease to fix biologically; 12-step and AA traditions frame it as a spiritual/moral struggle.
- Jad Abumrad (17:42): “On the one hand, you’ve got someone in the medical sciences who might be inclined to see addiction as a purely biological phenomenon… On the other hand… there’s something deeply wrong here, something in the person, in the spirit, in the soul.”
5. Efficacy and Controversy of AA
- Research suggests AA’s one-year success (retention) rates are in the single digits, but this is hard to measure due to the nature of voluntary participation.
- Gabrielle Glaser (18:32): “For every 100 people who show up in an AA meeting… only five… will be sitting there on December 31.”
- Jad Abumrad (18:59): “AA… doesn’t claim to be a treatment. And also, when you start talking about success rates, that gets really squishy…”
6. Public Response and Sea Change?
- Through a phone-in with Brian Lehrer’s show, listeners share a wide spectrum of experiences—some cynical about the “pill fix,” others hopeful and finding real help through these medications.
- Caller (27:09): “There is no quick fix. There is no magical medication.”
- Caller (27:23): “I have been offered naltrexone… it's very effective. It does help cut the craving.”
- Many are desperate for alternatives, frustrated with the lack of available pharmaceutically-based treatment options.
7. Personal Story: Billy Webb
- Billy’s journey (29:11–39:55): Illustrates the complexity of addiction—even when medication works to suppress cravings, identity, loss, and emotional pain can remain. Billy’s trajectory involves repeated treatment attempts, moderate success on naltrexone, and ongoing struggles despite being able to “drink like a normal person” for the first time.
- Billy Webb (34:11): “When I took the naltrexone, I actually was able to limit my drinking to two to six drinks a night… I was blown away.”
- Billy Webb (35:53): “I missed feeling like myself... That’s the only person that I knew.”
- Ultimately, his story highlights that medication may help with craving, but does not “undo” the underlying emotional and existential void—the “thing that makes the addiction go is really deep.”
- Jad Abumrad (39:17): “Pills will be a big part of that, seems to me. But the pills can’t get all the way down, you know?”
8. Why Addiction Hooks Us
- Dr. Nora Volkow (Director, National Institute of Drug Abuse) and Dr. Anna Rose Childress suggest addiction exploits the very brain circuits that evolved to let us love, bond, and seek rewards.
- Nora Volkow (40:31): “Drugs will light up the same circuits in your brain that are usually engaged when you're in love, when you're hanging out with your friends, when you're being hugged by your kid.”
- Anna Rose Childress (41:14): “They would be exquisitely attuned to the promise of rewards... for our patients, in some sense, they're the fittest of the fit and being punished for it.”
Notable Quotes & Memorable Moments
- Addiction’s Medical ‘Switch’:
- Jad Abumrad (08:04): “What if it’s simply a switch in your brain that got stuck in the on position and you can use a pill to just switch it right off?”
- Why Meds Are Invisible:
- Gabrielle Glaser (15:08): “About 1% of people who suffer from alcohol use disorder are ever given the choice or an option to take any sort of medication.”
- Identity and Addiction:
- Billy Webb (35:53): “I missed feeling like myself. I didn’t. I didn’t...”
- Andy Mills (36:29): “He came out of his shell alongside alcohol, being creative, writing music, performing music. Alcohol's there. His first girlfriend, alcohol was there... you take that alcohol away, what was left was an empty guy that I didn't know.”
- Evolutionary Irony:
- Anna Rose Childress (42:02): “For our patients, in some sense, they’re the fittest of the fit and being punished for it.”
Key Timestamps
- Introduction and Amy’s Story: 01:05–07:36
- Baclofen Research & Dr. Childress: 08:39–12:25
- Other Medications & Dr. Willenbring: 12:34–14:44
- Medical vs. 12-Step Model: 15:03–19:47
- Brian Lehrer Listener Call-In: 25:06–28:39
- Billy Webb’s Story: 29:07–39:13
- Psychological Depth/Evolutionary Framing: 39:41–42:09
Conclusion
Main Takeaways:
- While certain medications can dramatically reduce cravings and facilitate moderation or abstinence for some, their use is rare due to cultural, systemic, and philosophical barriers.
- Addiction remains a complex, multi-layered problem—one that medication alone cannot completely “fix.” The psychological, social, and existential dimensions are as important as the biological.
- A potential cultural shift towards integrating medical treatments with traditional psychosocial support is beginning, but faces skepticism, stigma, and resistance.
- Crucially, addiction exploits the same neural circuits that make us loving, creative, and social—turning an evolutionary strength into a vulnerability.
Memorable Closing Reflection
- Jad Abumrad (39:17): “Pills will be a big part of that, seems to me. But the pills can’t get all the way down, you know? The thing that makes the addiction go is really deep.”
- Pat Roos (42:21): “How do you live your life when you have to be sober?”
For listeners and readers alike, “The Fix” offers hope, caution, and a nuanced look at both the promise and the limits of modern medicine in the fight against addiction.