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- [00:01]
A
This would surprise nobody to know, but it is very possible to be an alcoholic and have a career and have a family. And it is detrimental for sure. I think especially if you start drinking young, you can kind of get emotionally and mentally stuck in your, you know, developmentally, in your 20s or teens even. That's, that definitely happens. But people manage, people manage to live these sort of bifurcated lives where you're, you're hungover at work, but you're still doing your job. And then you get off work and you drink.
- [00:34]
B
And now the good fight with Yasha Monk. One of the deadliest diseases and addictions in the United States and in most parts of the world is not heroin and it's not the opioid crisis, it is alcohol. And I always assumed that people who face problem with alcohol need to quit immediately, need to go to Alcoholics Anonymous and basically not have another glass of alcohol for the rest of their lives. That is what the culture broadly suggests. Well, my guest today was an alcoholic for much of her life, recognized during COVID that she had a serious problem with alcohol abuse and followed a very different method for how to quit, one that is assisted by medication and at least initially allowed her to keep having some amount of alcohol until her brain was retrained to no longer gain or seek pleasure from it. That guest will be known to many of you. Her name is Katie Herzog and Katie was a longtime writer for the the alternative weekly in Seattle and she has with Jessie Singel, the blocked and reported podcast that is very popular. She is also the author of a new book that is coming out in a few days called Drink your way sober the science based method to break free from alcohol. Katie and I talk about her life on alcohol, how she recognized that she had a problem with alcohol, how she was able to hide that fact from everybody in her life. Why suddenly, why finally she became determined to break that habit and how the so called Sinclair method helped her to do so. In the last part of the conversation was to have a broader discussion about how we should think about the role of medication in breaking addiction. I think a lot of people and a lot of doctors tend to have the instinct that if something is bad, we just have to root it out, root and branch. If you find these medicine assisted ways to manage the problem, at least initially, that doesn't seem like a radical enough solution. We talk about the advantages and disadvantages to these different approaches to the problem and we also talk about what people in the world who perhaps are recognizing that they have some amount of problem with their drinking should do in order to gather the strength and the courage to quit and to improve their lives. This is a tough topic, but it's an inspirational conversation and it's a very fun conversation. If you want to listen to the last part of this conversation and if you want to support this podcast, please go to yashamung.substack.com and become a paying subscriber. In fact, if you go to yashamon substack.com thegoodfight you will get 25% of the first year of this podcast. That means that you're paying about a dollar a week in order to get full access to the two interview podcasts and the weekly Good Fight Club panel discussion of recent news events. Jaschamung.sapsteadt.com the Good Fight. Katie Herzog welcome to the podcast.
- [04:20]
A
Thanks for having me, Jasia.
- [04:21]
B
I've known you writing for a long time. I listen to your podcast with Jesse Singel often. But you have a new book out that is personal in a different kind of way. And it tells the story of you becoming an alcoholic and managing to move beyond that. And managing to move beyond that in a way that's somewhat surprising perhaps to people. How, in your case do you think the alcoholism started? I mean, how do you go from drinking socially to hang out with friends to suddenly it becoming a problem?
- [04:52]
A
So it happened gradually. I started drinking young. I'm not a gen zer, so it was normal in my milieu to start drinking in high school or really younger. I had my first drinks when I was in middle school.
- [05:06]
B
I'm European, so I started to drink at the age of five.
- [05:09]
A
Right, right. You were weaned on wine. So I started young. And that's one of the risk factors for developing alcohol use disorder or alcoholism. People sometimes bristle at the term, but alcoholism. But I don't have a problem with it. So that's one of the risk factors. Another one is drink is a family history of alcohol abuse. I have a sort of I come from like Irish Catholic people, so there's some alcoholism in my blood. And then I also drank a lot. So there are other risk factors. Trauma is one of them. I don't have. I don't have any trauma. At least that I'm willing to admit.
- [05:42]
B
To yourself or to the world? Yes. A trauma free individual. That's a special occurrence today.
- [05:47]
A
Yeah, I think so. Although I sort of go with the old school definition of the term trauma. I'm not talking about people yelling at me online and things like that.
- [05:55]
B
I'M traumatized every time I open the newspaper.
- [05:58]
A
Yes, every time I open Twitter, which is why I don't do it anymore. So. So that's what happened. I basically. These three risk factors, I basically hit each one of those. And so while I started, yeah, you know, I drank a lot in college. It was very social, but it was also sort of antisocial, even in college. So I loved, When I was 19, 20 years old, I loved nothing more than. Than to sit on my porch by myself reading the New Yorker and drinking alone. I loved it. That was. If I could spend my life doing that, honestly, without the negative side effects, I probably would still be doing that. It's a fantastic way to live.
- [06:34]
B
And the only thing that's changed since then is that the New Yorker has really gone down the drainage.
- [06:37]
A
I never. Yes, my subscription has lapsed. I also no longer drink, but the New Yorker. Losing the New Yorker might have been more painful. And then, you know, as I aged, I really aged into bar culture. So I was, by the time I was in my early 20s, I was drinking, you know, 4 o' clock in the afternoon at a bar with mostly older men, like retired and out of work men. And women, some women as well. Alcoholism, it's not really sex based. And you know, as my friends, as my peers who are my own age, sort of a lot of them naturally aged out of that pattern of behavior, and I just never did. And I was hoping that I. That I would. And there's. And most people do. There's a phenomenon that you don't hear about that much in recovery centers or in AA meetings or places like that, but there's this phenomenon called natural recovery. Most people who binge drink in college just age out of it. As life changes, life gets in the way of their drinking, and so they stop.
- [07:40]
B
And part of that is that obviously when. I mean, I want to get into what actually defines alcoholism, alcohol use disorder, in your mind. But one definition or part of the definition that seems intuitive to me is that it becomes a problem when it distracts from positive elements in your life and when it presents a problem when you're at an age where in college, hopefully you're actually reading these signed texts for the classes I teach and doing all kinds of other things. But obviously a lot of the culture of college, and that's part of the point of college, is to meet friends and create a social network and hang out with each other. And so, you know, if in college there's three or four nights a week where you're out of people drinking, that doesn't necessarily distract from what those years are supposed to be for, and it certainly doesn't stand out relative to your peers. Right. And so I guess the question is, as you're going from that to a different life circumstance, do you continue to engage in this behavior, to change behavior?
- [08:37]
A
I not only continued to engage in it, my drinking accelerated greatly. So drinking did get in the way of my college somewhat. I couldn't just things like the choices that I made so I could. I never took morning classes, never. And I, you know, that's something that lots of students do. But even something like that, choosing my major based on, you know, on having noon, noon lectures rather than 8am lectures, it did influence all of my choices, the places where I lived. You know, I needed to, I knew that I needed to live within walking distance of bars because otherwise, this is before Uber, right? So otherwise I would be at risk for, for drinking and driving, which I knew was going to be an issue. So it really influenced sort of large and small decisions I made in sort of the trajectory of my life. But after college, and I also dropped out of college for a while, in part because of my drinking and because of things that happened while I was drinking.
- [09:30]
B
Before we get to what, what happened next, I mean, you know, when we go back to that time and we get 21 year old Katie, who's obviously very smart and reflective and so on, and, you know, somebody says, hey, I know you pretty well, I feel like perhaps your drinking is a problem. What at the time would you have said? Was there some part of you that knew that and believed it? Was there no part of you that knew and believed that? What did you admit to yourself and what would you have admitted to a close friend at the time?
- [09:56]
A
So at 21. No, at 21, I had no idea that my drinking was anything out of the ordinary. And in fact, my drinking was not out of the ordinary. At 21, I lived in very boozy towns and very boozy communities. I was completely normal. The difference is that I just never stopped. As my friends, as we graduated and moved away and my friends got careers and families and bought homes, I was really stuck in that pattern of behavior. And even then, though, I'll say my behavior wasn't abnormal because the community that I was in was very, was still very Boozy. We weren't 21, we were 25, 27, 30, 35, 50, but still I was a bar person. I hung out in bars and everyone around me was the same.
- [10:42]
B
And so when do you think Most of your peers started to grow out of this behavior, and you didn't. And what to you were the warning signs that. Hang on a second. This thing that seemed to me to be adaptive seemed to me to be a fun part of my life, actually, perhaps is holding me back in serious ways.
- [10:59]
A
So that also was gradual. My peers from college, I think they were a little bit more ambitious. After college, most of them moved away and started jobs or went to grad school. And I lost touch with a lot of them. And I think that most of them, sort of at that point, most of them, not all, but most of them really did kind of get their shit together and start drinking norm, adultly, normally. But I didn't. I'm. So I moved after college, I moved to Oregon and lived there for a couple years and was working in coffee shops and places like that. And so, you know, my friends were musicians and artists. And so within that community, what I was doing was completely normal. My first realization that I had a problem was in my. I think I was about 24, and I was going through my first really serious breakup. And. And the sort of short version of the story is that my girlfriend at the time, who I lived with, you know, it was a serious relationship, basically, I. I treated on her. I treated her really poorly. And she found out because this was the. This was the MySpace days. And she. She read a MySpace.
- [12:08]
B
Wait, how is MySpace related to finding out?
- [12:11]
A
She read a MySpace message where I was like, confessing this behavior to a friend of mine, a drinking friend of mine, and she came to the. I had just gotten a job at a bakery, and she came to the bakery where I worked, and she said, you fucking liar. And she slapped me in the face. And then. So within the span of a day, I lost my girlfriend, my job, in my house. And that was my first sort of like, oh, there's a problem moment, because. And not just because my life had fallen apart, but because I was really confronted with the fact that I had done something truly wrong and I had done it to someone that I truly loved. And so what was the. Why did I do this? What was wrong with me? And my options were, as I saw it, I was either a bad person, a sociopath even, or I had a drinking problem because my behavior was connected to drinking. And in some ways, I would have rather had been a sociopath, because sociopaths don't have to quit drinking. And the last thing I wanted was to quit drinking. So that was my first sort of aha moment.
- [13:10]
B
Is that a kind of poignant retrospective gloss or is that something you thought at the time? Do you really think, like, it's either this or that and like, hopefully I'm a sociopath. I mean that feels, I believe I'm neither of those two things. But to think of yourself as a sociopath seems like such a radical self indictment.
- [13:33]
A
So the thing about addiction is that it's such a powerful force that I wanted to do, I wanted any excuse to continue to drink. And if. And facing the realization that I had a really serious drinking problem was absolutely devastating and destabilizing in a way that I have not, not experienced since. And this was 20 years ago almost. And so after that, so I had this realization and I actually went to a, to a psychiatrist. Like, like in that moment I knew, but I went to a psychiatrist because I wanted to, I want, I didn't want to be diagnosed with sociopathy, but I went to a psychiatrist and he diagnosed me as bipolar one. This was a complete misdiagnosis. I'm not bipolar. And bipolar one is the bad one, you know, or the fun one. However you look at it. This, I'm not bipolar. This is a complete misdiagnosis. I had a drinking problem, but my behavior from the outside looked bipolar because
- [14:27]
B
I guess you were one personality when you were sober and another when you were drunk.
- [14:30]
A
I engaged in really high risk behaviors when I was drinking and I was depressed because alcohol, it's depressant, it wreaks havoc on your brain. So I did have some of the symptoms of an actual, you know, serious mental illness. But it just, it was a complete misdiagnosis. And probably part of me was hiding what I was doing because I didn't want him to tell me, you have to quit drinking. Instead, he, he did tell me I should quit drinking, but he also prescribed me a mood stabilizer, which I took for a few months and then just stopped taking. It had, it really had no, no long term or even short term effects on me. But so after that first realization, I had this, you know, aha moment, A terrible one. And over the next decade and a half, really, I lived with the knowledge that I was an alcoholic. But there's a term that I think describes this really well. Vacillating denial. So I was, sometimes I knew I was a drunk. Like late at night when I Woke up at 3 o' clock in the morning with, you know, night sweats and my head pounding and just radiating shame. I knew I was a drunk at 5 o' clock the next day when I wanted a Drink. I'm not thinking I'm an alcoholic. I'm thinking I just want to drink. So I was able to. I was able to live with this cognitive dissonance, knowing sometimes that I had a drinking problem and knowing I needed to quit, but also being so unable to quit that I just ignored it for years. I ignored it like I had accepted this truth. But I. I was able. I continued to drink despite knowing this truth. And again, because I lived in heavy drinking communities, this was completely normal. I was surrounded by alcoholics.
- [16:09]
B
Well, one of the things that strikes me in my personal experience with friends and acquaintances that have problems with using alcohol sometimes, perhaps that have a tenuous hold on reality sometimes who have a drug abuse problem, that there are certain communities that valorize those kind of behaviors. Right. I mean, the kind of relatively straightforward one is like, oh, this is a really fun person. They're always up for going out and it's always a laugh and a good time to be around them. Right. You know, in more extreme cases, it can be artists who are valorized partially for their extreme behavior and their odd personalities, which actually are rooted in drug abuse, for example. And so then obviously I worry about the cultures of those communities because they encourage that behavior. But of course, the other way around, people who have those problems are drawn to those communities because those communities give you cover for that behavior.
- [17:03]
A
100%. Absolutely. So before we started recording, you said something about me being an introvert. I am an introvert. I admit to that fully. When I was 25 years old, nobody who knew me would have called me an introvert. I was the life of the party. I was wild. I was always down to go out. I was fun, unpredictable, completely unrecognizable to my life now. You know, I went out, I went to bars, I went to party every day. I did this every day for years of my life. I was so social and I had a lot of friends. Yeah. And all of that was connected to drinking.
- [17:43]
B
And do you think that the introversion is connected to that? I don't mean by that that it's generally connected. It would surprise me if introverts in general were more likely to be alcoholics. If anything, perhaps extroverts like, might be more likely to end up as alcoholics because you are in more social situations, it's easier to end up drinking too much, et cetera. But perhaps in your particular case, there's a kind of link between being introvert but seeking that social stimulation and friendship and the way you can get yourself to sustain it. Is that you need alcohol as a lubricant to be social in those kind of ways.
- [18:16]
A
Yeah, I think that was a huge part of it. And the thing about it is that so much of my socialization happened from a young age under this sort of cloud of alcohol, that it was when I quit drinking eventually one of the. Or when I knew that I needed to quit drinking. One of the things that was so terrifying about this was that I. I thought that it would be impossible for me to be social. I thought it would be. I genuinely thought it would be impossible to have a good time, to have any fun at all if I wasn't drinking, because I had literally never, never done it before. Drinking was such. It was. Every part of my life was connected to alcohol. And so the idea of going to a dinner party or a party or a. Anything without alcohol, it was unthinkable. I have realized now that it's actually fine. People do it every day. Not everyone needs to get loaded to have a good time. It's actually fine. But at the time, it was completely unimaginable.
- [19:11]
B
You were talking earlier about this term of vacillating denial. I think you were talking mostly about how it felt within your own brain during this period of vacillating denial. Was there times when you would admit to what you saw as a problem to confidants and family members and friends, or it was just within your own mind? You kind of had moments of, I kind of know I actually have this problem, but you would sort of refuse to acknowledge it to others. And there must have been moments when friends or family members or romantic partners told you, hey, I think you have a problem. How did you respond to that? Perhaps that never happened.
- [19:48]
A
It never happened. Not a single time. I was very good at hiding my drinking. Very good at it, to the point where a lot of people who I was close to didn't know that I had a drinking problem because I was really good at hiding it. And.
- [20:06]
B
And you are good at hiding the fact of drinking, or you were good at hiding the drinking affecting you or needing to drink or all of those things.
- [20:15]
A
All of it. All of it. And so within my. Within my. In my heaviest drinking years, I would have conversations with other friends who also, in retrospect, it was very obvious had drinking problems. A lot of them have now quit drinking. So we would have these conversations, but it was all sort of. It was all sort of cloaked in humor and no one took it seriously. And it. On the. The rare occasions when someone did get sober within My friend group, I was appalled. I thought of it as like betrayed. Yes, yes. And you know, I was very judgmental of people who didn't drink, didn't understand them, didn't want to be around them. Yeah, it was. And that was fairly normal within my, within my community.
- [21:02]
B
You know, it is interesting because we think about the stigma of alcoholism and that does exist, but there is also the stigma of being a teetotaler. And I drank a good amount when I was young. Younger I guess, but young. I have to admit, you know, at this point I really don't drink very much. But there are social situations where, you know, you're meeting somebody at 6pm, you don't really want to have a drink, but it feels a little bit rude not to have a drink because it feels like you're not committing to that social occasion. It feels like, you know, their company is not worth the investment of perhaps sleeping a little bit less well and perhaps being a tiny little bit hungover the next day. And so sometimes, you know, I find it difficult to not order drink in those circumstances purely out of this kind of social stigma against not drinking a particular situation.
- [21:53]
A
Right. And you want to do what the person next to you is doing. Right. If you go to dinner with somebody with a group of people and one person doesn't eat, it just seems strange. And alcohol is kind of that same way as well.
- [22:03]
B
If I go to dinner with somebody and they're really sanctimonious about being a vegan, then I find it annoying. But if I go to dinner with someone, I order a steak and they order the salad, I don't care where. Somehow it does feel like if I meet somebody at 6pm and they order a beer and I say, could I have a sparkling water? You know, it somehow feels like not a disrespect towards them, but a disrespect towards the social situation.
- [22:26]
A
Well, I think it can also be a little bit of a signifier that you don't drink for a reason. And so it leads to a follow up question, why don't you drink? Which, you know, most people probably aren't going to ask, but they might wonder.
- [22:39]
B
Yeah, it's funny, that's not the fear I have. I think the fear I have is a sense of sort of it communicates I want to be done with this meeting quickly or I don't think you're sufficiently important to me to I'm not
- [22:52]
A
going to waste a hangover on you.
- [22:53]
B
Yeah, exactly. Something like that. Yeah. So you're very good at not letting people notice that. And a part of that, of course, is that you have your life together in a way that some people who are dependent on alcohol don't. Right. A lot of people. I mean, perhaps they're just sneakier than everybody else and cleverer than everybody else. And it's certainly very clever. But. But it feels to me, if you're able to hide your alcoholism in a way that a lot of people are not, it's in part because you continue to be professionally successful, you do keep a relationship during that period. So, you know, you develop ways in which the alcohol dependency negatively impacted your life, but it didn't totally make your life derail. Why do you think that is? Or what's. What sort of stood between you and the people whose lives are just completely destroyed by that disease?
- [23:42]
A
So it did destroy my life for many years. So until I was about 30, I worked mostly minimum wage, entry level jobs. This was, however, you know, this was long enough ago that rent was still cheap in most American cities. So I could afford to still pay my rent even when, if I was working part time or working minimum wage jobs or I had roommates living the
- [24:08]
B
dream of the 90s in Oregon. Yeah, yes, yeah.
- [24:11]
A
Or early 2000s, but yes, yeah, still cheap. So I was still able to live. Live in a way that was pretty hedonistic and irresponsible and still manage to pay rent. And so I really. That's how I spent my twenties. I spent my. I honestly, my twenties are very much a blur. And I did that until I was really into my. I. When I was 30, I was working as a. As a copy editor at a small academic publishing house, again working part time. And I. I left my job to get an unpaid internship at the age of 30. And that was really the beginning of trying to get my. Get my shit together. So I did have a really delayed adolescence or really prolonged adolescence, I suppose. And then after, after that I did, you know, I started on a career path. I made better decisions, but I was still. And I wasn't drinking every night. I also kept moving. So I' in a bunch of different places. And that was always sort of one of my coping mechanisms, like if something got to. If my drinking accelerated to the point where it was becoming very problematic, I would leave, leave the community that I was in, leave the environment, which was. Actually worked pretty well for a while and then eventually, you know, that I would adopt the same habits in a new place. But so I Basically, until my 30s, I was. I was like, just like every Other loser at the bar. And then I started to get my shit together and then the timing.
- [25:43]
B
Got your shit together was not directly correlated with a time when you actually quit drinking. Right? That came later.
- [25:48]
A
No. So I moderated my drinking for a couple years. I got this internship, I moved to a new city. I got a job, my first job in media, working in public radio. And I would drink on the weekends. So I was very regimented about when I would allow myself to drink. So I would do it during the weekends, but not during the weekend. On the weekends I would go back to my old town and I would sleep on my friend's futon and party all weekend. And then I would leave. And then I moved across the country. I moved to Seattle. Similar. Similar patterns where I was really able to keep it to the weekends for the most part. Yeah. You know, and so I. For the book, I interviewed a ton of. A ton of problem drinkers. And, you know, we have sort of the stereotype of the alcoholic as maybe a guy living under a bridge or whatever who beats his wife and ends up getting DUIs and in prison. Although I guess most people living on under bridges these days are probably more likely fentanyl addicts than drinking wine out of a paper bag. But there's, you know, this would surprise nobody to know, but it is very possible to be an alcoholic and have a career and have a family, and it is detrimental for sure. I think especially if you start drinking young, you can kind of get emotionally and mentally stuck in your, you know, developmentally, in your 20s or teens even. That's. That definitely happens. But people manage. People manage to live these sort of bifurcated lives where you're. You're hungover at work, but you're still doing your job, and then you get off work and you. And you drink. It's. It's pretty common.
- [27:24]
B
What sort of the bad men style alcoholism rather than the fully out of control style alcoholism.
- [27:31]
A
Dysfunctional alcoholic. There's, you know, there's a term for it for a reason. Yeah.
- [27:35]
B
So, you know, there's periods when it redirects your life. There's periods when you have your life more or less together even though it continues to negatively impact you. That makes it sound like you could easily have gone through your whole life without either becoming the person drinking wine out of a bag under a bridge, or really getting the problem under control, really grappling with the fact that you have a problem. What, after these years of vacillating acceptance and denial of a problem of better years and worse Years made you confronted in. In a different kind of way.
- [28:12]
A
Covid. So I. During COVID you know, I was laid off. I was working at the Stranger, Seattle's all weekly, and I took a furlough really early on. I basically volunteered as soon as Covid hit and the newspaper was, you know, it's a free paper. It was the. All of the. All of our paychecks were paid by ads for things like events which were no longer happening. And so, and so it was pretty obvious pretty quickly that things were going to go downhill really quickly. And so I volunteered to take a furlough.
- [28:45]
B
You were also the most popular employee of a stranger for that's a different story.
- [28:50]
A
I was like, not coming into work and seeing these assholes for a few months. I'll take it. So I went on furlough. I started collecting unemployment, which I loves. It was like my. Maybe my fifth or sixth time on unemployment. I've never been, Never been afraid to take our meager social safety net, social safety net up on its offerings. And. And so I, you know, I was at home. My wife is a nurse, and I was at home by myself a lot because it was Covid. She was working a lot. And, you know, Jesse and I had started this podcast, but for the most part, at the beginning of the show, it didn't take much work. There was so much happening in the culture that we would just sort of get on the mic and talk to each other for an hour about whatever we were seeing. Now the show has really changed and there's a lot of structure, but at the time, it really didn't take much prep. And so I just had a ton of time on my hands and I just drank. I drank during the day. The time that I started drinking got early and earlier, so at some point I was drinking in the morning. And this was completely in secret. Nobody knew about it, including my wife. And I did this for two years. And so basically every time my wife went to work, I got loaded and I spent all day just sitting on my porch drinking and scrolling and sort of watching from the sidelines as it felt like the world was falling apart. Not just because of COVID but because of everything that else that was happening. And I knew. And like, I. I felt terrible, I looked terrible. Just wracked with guilt and shame constantly. And I started having health effects, right? So waking up at 3 o' clock in the morning every. Every morning, just like with the shakes, with night sweats, having a pounding headache every morning, telling myself the next day that today will Be different today. I'm not going to drink. And then, you know, around 11:00 noon, it was like this switch just flipped in my brain. And almost without even being conscious of it, I was out the door on my way to go buy booze. And I started adopt. Like there, there are things that I think many problem drinkers like lines that we tell ourselves we're not going to cross. You know, I'm not going to drink in the morning, I'm not going to drunk drive. I'm not going to hide it. And pretty soon I had crossed a lot of those, a lot of those lines for myself. And it was going to kill me at some point. Like the amount that I was drinking, not that the amount that I was drinking at the time, I was drinking basically like six tall boys, like six pints of cheap beer a day. So much less than I was in sort of my heavy drink days of my, of my 20s, when I could drink twice that in a day. But still, it's a lot of liquid, it's. It's a lot of empty calories. I look like I felt like. And I. The, the worst part about addiction for me has always been the amount of brain space it takes up. So besides all of the, all of the, the health, the like physical health effects, for me, I think the best way to, to explain it to people who haven't ever been addicted to something is the feeling that you get when you're like newly in love with someone or you have a crush on someone. And it's so overwhelming to you, especially when you're younger and it's so overwhelming to you that that's all that you can think about or maybe like, you know, your mom has a cancer diagnosis or something and that's the only thing that you can think about. That's what alcohol was for me for so long. It just took up all of my brain space. And one of the things that made it hard to get sober, and I had tried over the years to get sober. I'd done aa, I'd done group therapy, I'd done individual therapy, cbt, CBT and cbd. I tried lots of things. Nothing ever stuck.
- [32:35]
B
CBT and CBD is great.
- [32:37]
A
I tried it all. One of the things that made it so difficult to get sober long term was that the messages that I had absorbed about sobriety and recovery was that once you're an alcoholic, you have to quit drinking forever. Like they say it's one day at a time, na, but really everybody knows it's forever. And I Couldn't conceptualize a life without alcohol. And so having that in my brain and knowing that the only way out of this was to give up this thing that was absolutely destroying me, but that I also was completely dependent on and that I hated, but I also loved was such a mental barrier that it kept me drinking just for years, drinking in secret, drinking more and more all the time, to the point where it really was taking over my life in a way that was very destructive. And I was. You know, I never beat my wife, like, nothing like that, but I was just distracted all the time. I was, you know, a shitty partner. I was lying to my wife. Just small things, like, you know, my wife, we. We live an hour from Seattle. She takes a ferry if she was coming home from. And it was after a certain time of day, I couldn't pick her up at the boat. I was going to be drunk. You know, just things like that where I'm like, all right, you got to take the bus. Sorry, I've got a meeting. I don't have a meeting. I'm actually.
- [33:58]
B
Right. You're making excuses for not going to pick her up. And it's not that you didn't want to render that act of service to somebody you loved. It's just that it would have been dangerous for you to do so.
- [34:06]
A
I would have killed her if I picked her up. Yeah. Like. Like making all of my decisions around drinking, scheduling, my life around drinking. Like with Jesse with the podcast, I was. I still am a control freak, but I was very regimented about when I was willing to record, because if we record it afternoon, I'm going to be loaded, and I don't want to record the podcast drunk. So. So being completely inflexible about my routine, because my routine, I. I knew I was going to be drinking. I needed these hours to do it, and I knew nothing could be scheduled during that time. Don't tell Jesse, by the way.
- [34:41]
B
He. He never listens to any podcast, so it's fine. He certainly wouldn't listen to mine. You know, one of the really interesting things about your book is that you combine your personal story with an interesting argument about how we think about addiction, how we think about overcoming addiction. And so I just want to plant the seed at this point of this conversation because you mentioned that one of the things that kept you from seeking help, various forms of help, but to really try and overcome this problem is that you felt like if you stopped drinking money, it's forever. And you couldn't conceive of a life without Alcohol. Tell us a little bit about the kind of dominant frame for what somebody in the situation you were in during COVID should be doing and the role that aa, Alcoholics Anonymous plays in that, you know, both in terms of medical establishment, but also in terms of our culture more broadly.
- [35:32]
A
Yeah, so this is changing. But for. So I first I. The first time I went to AA and the first time I approached a professional about my drinking was I was 24. This was in, I think 2007. And at the time, and then for many years before and since there was basically, you know, a couple of modalities if you, if you. Or treatment programs for somebody who, who presents with a drinking problem, rehab and 12 step programs. And that was pretty much it. And when I was writing the book, I learned the history of aa and it's pretty fascinating. So AA was sort of an organic, organic peer support group that developed, was developed by two guys in the 1930s. But the reason that AA became so dominant in the culture was because of an early. Or one of the reasons was because of an early member, a woman, actually. Her name is Marty Mann and she was, she was a PR whiz. She was very connected in publishing in Hollywood. And she made it. AA saved her life and she made it her. And AA at the time was not hospitable to women, but she was early member and it saved her life. And so she basically made it her mission to preach the gospel of AA throughout the land and was incredibly successful at this. And AA has saved so many lives. I really don't knock aa. It really works for a lot of people.
- [36:53]
B
And what's for people who don't know as much about it? What's the basic model of aa?
- [36:57]
A
So it's a peer support group. You go to a meeting, at open meetings, anybody is welcome. But you go to a meeting and you basically listen to people. You sit in a circle around a table and in this sort of kind of regimented way, people talk about what's going on and it's not, there's not a lot of like back and forth. That's called crosstalk. That's not encouraged, not even really allowed. But you, you know, at the beginning of the meeting, you go through, you go through this sort of process. Everybody sort of speaks the same words. There's these, these traditions, these rituals. When you, when it's time to speak, you say, my name is Katie and I'm an alcoholic. So there's these, there's these norms within the group. A lot of people get a sponsor within the group and the sponsor. The sponsor is the person that you call when you're having problems. You work the steps. There are 12 steps, starting with admitting that you are powerless and ending with basically going forth and helping other alcoholics. So it's a pretty, it's a, it's a process, right? You don't, if you do it right, you don't just go and sit at the meetings, you actually work the steps and you become a part of the community. And this, there have been peer support groups for much longer than AAA was. Not the first at all, but it's certainly the most successful, at least in terms of membership. And for almost 100 years that's been the dominant paradigm for how people get sober. And that includes in rehab. So AA is free. That's one of the amazing benefits of it, right? There are AA meetings in every city and town in America and many all over the world. There are also now meetings on Zoom, largely because of COVID So anybody can go to AA who thinks they might have a problem and, and there is something very powerful about being in the company of other addict who understand what you're going through. They can also be really fun. Like a, like addicts are great storytellers. It's often, it's like an open mic, right? So you, you'll hear these great stories. Oftentimes you'll hear the same stories from the same people over and over again. But AA's, it's a community. And that I think especially for people who are face, who are in the midst of addiction, having community, accountability, support and a place to go can be really valuable. And that model has, has infiltrated. Sounds negative. That's, I don't mean it as negative. But lots of rehab programs also rely on these peer support groups, these 12 step principles within, within AA. And there's some, it is a little bit ironic because, because rehab can be incredibly expensive. But the therapy that they provide sometimes is like the, that you can get for free at your local AA meeting. But one of the, one of the sort of, there's a lot of I think, think misconceptions about aa. So people think that aa, you know, preaches that alcohol, alcoholism is a personal failure. It's more nuanced than that. Right. And the founders of aa, particularly Bill Wilson, was a pretty, he was a very open minded guy. He was experimenting with psychedelics in the 1950s. But AA has become incredibly dominant throughout the culture. So that it's not just something that everybody has heard of, it's something that courts can mandate that if you get a DUI or you get in trouble with the law that you go to aa, professional licensing organizations can mandate that somebody who has a drinking problem, like I've been to AA meetings recently where there were two pharmacists there and they weren't there because they wanted to be there. They were there because they got in trouble at work and they needed to fulfill these requirements in order to keep their license. You know, if you come out of prison and you need a place to live and you end up in a halfway house, AA can be mandated as part of, part of that sort of recovery process. So it really has become dominant. The problem is that it just doesn't work for everybody.
- [40:52]
B
And why doesn't it work for everybody? And just to draw that out, part of the assumption is that the goal is not to drink at all. Right. The goal is not get to a healthy relationship with alcohol where you can, you know, toast your partner's birthday with a glass of champagne. The idea is that people will have relapses and there's not going to be judgment about that. But the goal is to not drink at all.
- [41:14]
A
Yes. So within aa, the doctrine of aa, any slip up is considered, any drink is considered a slip. And that's. You sort of start the counter back to zero. So you could have had 12 years sober and you go and you have a sip of champagne campaign at your daughter's wedding and you got to start the clock right over. I personally find that not very helpful. It's this sort of all or nothing attitude. And anything less than perfect is considered a failure. And I think that in itself keeps people away from the program, especially people who aren't totally sure that they're ready. Like if you know that drinking is pro, causing a problem in your life, but you're not totally ready to quit, or you can't conceptualize a world without alcohol. And your one option, the one option that you've been given or that you've been told about is to never have another sip of alcohol again. It's just going to keep people drinking, some people drinking longer than they should. And that was my experience. If these were the two options, total complete abstinence or a life of drinking, even though it's causing problems in my life, I was going to choose the life of drinking.
- [42:29]
B
And so why did that not happen? You know, clearly you have ended up in a, in a situation where it's not one of those two options, it's a third option. How did you realize there could be a third option? And how were you able to escape the situation?
- [42:42]
A
So it was an article in the Atlantic. This article came out in 2015. It was by Gabrielle Glasser, and it was called the Irrationality of Alcoholics Anonymous. Now, that article is about sort of about the problems with aa, but there was a part of it that mentioned this treatment called the Sinclair method. And the Sinclair Method is medication assisted therapy. It was developed by an American researcher named John David Sinclair to sort of simplify it. He developed this protocol where a person takes an opioid blocker, typically naltrexone. In other places, it's an opioid blocker called Nalpha Mean or some other opioid blocker. And you continue to drink as normal with this opioid blocker in your system. And so that opioid blocker, naltrexone, it basically prevents your brain from getting an endorphin rush and a dopamine dump indirectly flooded with dopamine. When you drink alcohol. And the idea is you do this over time, you do this over months, maybe years even for some people. And gradually you retrain your brain not to enjoy alcohol because your brain isn't getting.
- [44:02]
B
It's not getting what it wants from it.
- [44:04]
A
Exactly, exactly. It makes drinking boring. And so I read that article, I read this, I think in 2018 or so, and I read this article. I thought, okay, this is what I've been looking for. This is the solution to my problems. And I went to my doctor and I brought this article to my doctor, and she had never heard of the Sinclair method, which is, is very common. I don't think most doctors have. Lots of them have heard of naltrexone. And that's increasingly true as medical education has, has embraced things like harm reduction and medication assisted therapy for substance use, use disorder. But my doctor had never heard of Sinclair method. So I brought her this out, this article, and I said, this is what I want to do. And she said, okay, do it. So I got the drug and I, I went home, I got a. A can of beer from the store, from the, you know, corner store on the way home. Then I took the drug and I felt like. I just felt awful. I got side effects, headache, nausea. I felt depressed. I felt I really didn't like it. And I sort of choked down this can of beer. And I thought, okay, this is. I, like, I was so hopeful. I was so hopeful that this, because this was. This seemed like a miracle cure, right? The thing that would allow me to keep drinking but. But diminish my Enjoyment of it. Because what I was afraid of for years, the thing that, that kept me drinking, one of the things that kept me drinking longer than I should was I didn't want to live in a state of unfulfilled desire for the rest of my life. And that's what I thought sobriety would be.
- [45:31]
B
Right? It would be this constant hankering for the thing you can't have and this constant self denial.
- [45:36]
A
I was so I, I still am, like, very bad at fighting cravings for anything. If I, I, if I want a cookie, I'm eating a cookie. I don't have much willpower when it comes to giving into my own impulses.
- [45:46]
B
You didn't pass a marshmallow test?
- [45:47]
A
No, no, definitely I would be eating the whole bag. And, and so I, yeah, so I was looking for a solution that would extinguish not just the drinking itself, but the desire to drink. And that's what I hoped that this would do. And then the first time I took the drug, I thought, no, this, I can't do this. This is not for me. So I, you know, I put the drug away and I, it sat in the. My medicine ca another several years until Covid. Until I sort of really needed something, anything. And I thought, you know, I, I either have, I'm going to try this one more time or I'm gonna have to fess up to my wife and probably have, I'm gonna have to go to rehab and that's gonna up the podcast because I'm gonna have to leave for 30 days and then I'm gonna have to do intensive outpatient therapy. It's going to completely derail my life. So I'll just try this one other thing before I fess up and blow my life up. And I did it.
- [46:46]
B
And why was the second time different? What is it that the first time around either physically led to the side effects or just mentally made you not prepared to deal with the side effects? And why is it the second time you were able to use this method?
- [47:01]
A
I think a big part of it is that I armed myself with information. So I read everything I could find about the Sinclair method. I prepared myself to deal with the side effects. And there are simple things to do. Like start out at a standard dose is 50 milligrams. So start out at a quarter of a pill, start out at 12 and a half milligrams and work your way up. I had a full meal the first time I ate it. I drank a full glass of water. Some people take over the counter Nausea medications. And so one thing that's interesting about this is I was not getting this information from my doctor. I was getting this information from Facebook and Reddit and YouTube. My doctor had never heard of this. Right. And so I was just prepared. I knew about the side effects. I was prepared to handle them. And I also knew that this was kind of last. Like, last chance before I have to really blow up my life. I was willing to take some discomfort if that meant that I could not that I didn't have to tell my wife, basically, and didn't have to go to rehab. I didn't have to go to AA and didn't have to quit drinking. And so that was the plan. I'm gonna. I'm gonna do this. I'm gonna try this again. I researched. I researched it so much. I talked to people. I kept a substack where I was writing about this under a pseudonym. And. And I just. I treated it sort of like a journalism project
- [48:32]
B
to ask a really simple and perhaps stupid question. You know, if your brain craves the feeling that alcohol gives you, and if you miss that feeling, what stops you from not taking that drug? I mean, why is it that you don't wake up some mornings and you're intending to continue on your road towards recovery as you intended many times during COVID and earlier to do so? But just as in those earlier instances, you wake up thinking, today I'm not going to drink. And then by noon, you say, I'm going to drink. Why in this case, is it so hard to say I'm not going to go and reach for a bottle of beer, but it's somehow easier to say, I am going to take this pill.
- [49:15]
A
Yeah. So compliance is an issue with this drug, for sure. There's a long acting form called Vivitrol. It's a shot in the butt. You get it once a month. And so for people who have trouble with compliance, that can be a sort of good alternative. For me, I knew that the other options were worse. And my life had become, as they say in aa, my life had become so unmanageable that this was the last best option. And so I was just. I was committed to it. And honestly, I think that if I had tried this at 25, I don't think I would have been able to do it. But I was not 25. You know, I was in my. In my late 30s, early 40s. I. I wasn't drinking socially at the time. This was like. All this was during COVID I was alone at. And I Had I had ceased to get much pleasure from alcohol like the first, like the anticipation and fulfilling the. The craving was pleasurable. And the first few drinks there would be elements of pleasure. But by the third drink, I was really only drinking to try to recapture the feeling of the first drink or even the feeling before the first drink. You know, the feeling of I have a craving and I'm gonna fulfill it. And that feels good. And so. And I knew that. And to me, I think I had just reached a point in my life where it was like, if I don't do this, it's eventually going to kill me and I don't want to die. But yeah, compliance is a. Compliance can absolutely be an issue for this drug. And so after talking to a lot of people who have done the Sinclair method and there's other ways to take naltrexone, but this particular, the book is about this particular modality. For the most part, it re. It can be effect. It's most effective for people who are highly motivated. You know, also people who are. Have some social support, who have work like this is not going to be a miracle cure for somebody who lives on the street, who, whose life is really unstable, who has trouble finding housing or food or alcohol for people like that. You know, I talked to a guy who works in public health and he said for his, for his patients, Vivitrol can be effective in terms of reducing drink because it's a shot, right? You get the shot. If they show up to get the shot, it can be effective. But for his clients, something that requires you to take your pill, wait an hour, set your timer, wait an hour, and then drink is just not going to work.
- [51:37]
B
I guess there is a structural difference as well. Where the structure of a problem with not drinking is you have to not drink at 10am and you have to not drink at 11am, you have to not drink at 12pm, you have to not drink at 1pm, right? You have to have perfect compliance throughout the day. And in the kind of AAM framework every day and messing up once scuppers the whole scheme with taking this medicine, you know, on the daily basis. It's just you have to have one moment of self control, right? As long as at 10am or at 11am or at 12pm or at 1pm you have a moment of self control.
- [52:12]
A
It's a little bit more complex than that because it is very possible to drink through the naltrexone. So the half life of the drug, it depends on your particular metabolism and biology, but ranges like five, six hours. And so it is very possible to drink through it. And there, it's. From anecdotally, it seems like there are, there are some drinks, some forms of alcohol that make people more likely to drink through the drug, like vodka. Vodka. People who are heavy vodka drinkers typically have a, an easier time drinking through it. And so what some people do is they redose. Right? You redose after five or six hours. Hours. That takes willpower, especially if you've been drinking for five or six hours and you're half loaded and you know, you got to make this, make the good choice. That is hard to do. But by the time people get to get to a place where they're taking naltrexone or they're doing the Sinclair method, from my experience, talking to a lot of people who have done this, they are desperate for change. They are so ready. They've tried, they mostly have tried other stuff and it hasn't worked. And so if you, if you are desperate for change and the only thing that you have to do is take your pill, people do it. Not everybody for sure. Like again, compliance is for sure an issue. And this will not work for people who are sort of half assed on compliance even. I've talked to people who, who, who. There's a. The term is called reaching extinction. It's sort of the end goal of the Sinclair method. And this is a term, it's a term in psychology, as I'm sure you know, Yasha, that just means basically re. Unlearning a behavior. And so once you have reached extinction, which under the Sinclair method basically means you lose the desire, the compulsion to drink.
- [53:58]
B
Right. You've retrained your brain so it's no longer expecting pleasure from drinking.
- [54:02]
A
Exactly. Once you reach extinction, some people like me, just stop drinking entirely. Some people continue to drink moderately. And I have talked to people who reached extinction. They felt free from the, from the, this monkey on their back and then they, so that. But they continued to drink moderately and they got lax on waiting the full hour. So they kept taking the pill, but they got lax on waiting the full hour and they very quickly slid back into alcoholism and have to start the process all over again.
- [54:32]
B
So tell us about where you at in this journey. You hinted at the fact that obviously this worked for you and that it does seem to have led to the good kind of quote unquote extinction in this case. So tell us about what that process looked like and when you decided to not just tell your wife and many of your friends and Family members. But to write a book about this and go public with this whole journey.
- [54:56]
A
Yeah, so once I started this, I was very regimented about it and it took about. And there are all sorts of. One of the reasons I wrote the books is because it seems it's sort of deceptively simple. Take the pill, you wait an hour and then you drink. But there are all sorts of kind of small changes that people can make along the way that will increase their likelihood of success. And I should say this is not, this is not a miracle pill. Like it does not work for everybody for a combination of reasons, including some that are just straight out biological that you have no, no control over. But for me, so I started taking the pill and I very regimented about it. I'm going to take the pill, I'm going to wait an hour, I'm going to drink. Over time I, and I should also say so one of the differences between the seclair method and sort of the typical way that a doctor might prescribe this drug is that you only take naltrexone when you are drinking. So you do not take it on alcohol free days. And the reason for that is because on those days, days when your endorphin receptors are unblocked, you want to fill your days, if you can, with things that bring sort of healthy pleasures. Right? So that's part of relearning, relearning life sober. You, you know, things like enjoy, you know, having a good meal or going for a jog if that brings you pleasure, or playing with your dog or your kids or whatever it is you want to, you want to find new coping mechanisms and also retrain your brain to find pleasure and non alcoholic things.
- [56:23]
B
Right.
- [56:24]
A
And so I started over that seven months I was tracking my drinking. This is another key part of the process. And at the beginning I was drinking basically just as much as I had been. The experience of drinking on naltrexone was less pleasurable. I've heard it described as like eating four day old cake or, or riding a bike with a flat tire or, or drinking with a condom on. Like you're still doing the thing, you're still doing the act. It's just not as fun. And you can still get drunk. It's just you don't get the sort of euphoric buzz that comes with alcohol or that I get from alcohol. Not everybody gets that. You know, I, I wasn't getting that sort of energetic high. I was getting kind of the body, the body effects of Alcoh, Slurry and a little sleepy, but it wasn't counterbalanced with that euphoria. So I did that for seven months and over. You know, within the first month or so, my didn't, my drinking didn't change that much. I was tracking it, you know, so I could, I could see on a chart how much I was drinking. And then I started increasing the number of alcohol free days or I actually before I started that, I started pushing back my start time. So instead of starting at noon, I would start at 3, and then later at 4 or whatever. And then I started increasing the number of alcohol free days I had every week. And that in itself was like, I had never done that before. I had never had alcohol free days when I was not. When I was like, by my, like, I had alcohol free days all the time when my wife was around, but, but when she wasn't working. But I never had alcohol free days. If I was just like left to my own devices and I could do whatever I wanted, I was gonna drink. And so I started increasing those and finding things to do that were not alcoholic, you know, going for walks with my dog in the woods, whatever it was, paddle boarding, just finding ways to fill up my time working. I started working more. And, and so I did this for seven months, sort of decreasing the amount of alcohol, increasing the number of alcohol free days. And then after seven months, I said, all right, I'm going to challenge myself to 30 days without drinking. And it was shockingly easy. Something that before had always been so
- [58:34]
B
it would have felt completely daunting and impossible.
- [58:36]
A
I think I one, you know, in, in almost 20 years, I think I had one period of having a fully alcohol free month and it was a huge challenge. And of course I celebrated it afterward with a bender. And it was easy. Like I didn't even think about alcohol. And so that took seven months. And then I just never started again. And I declared sort of myself officially extinct after nine months after starting. So two months, after seven months of, of doing the protocol, two months of sobriety, I said, okay, this is it, I'm done. This is. I've reached extinction. And then I just never started drinking again. So I no longer take the pill because I no longer drink.
- [59:15]
B
And so at this point, you're at a wedding and there's a toast with champagne. You don't toast or you toast with champagne and have, and have a couple of sips?
- [59:22]
A
No, no, I don't drink at all. And if I wanted to drink, I would need to take a pill. Like it would be. I still have all of the risk factors. My life has changed. I have new coping mechanisms and I'm in some ways a different person. Some ways I'm exactly the same. But in some ways my life is very different. But I think, I think my particular risk factors biology make me high risk candidate for alcohol use disorder no matter what. And so I think if I. It's a slippery slope, right? I could take that sip of champagne and I would be fine that day, but it would trigger something in my brain. Oh, you like this, right? And so for me, it's just easier not to drink at all, in part because I don't like taking naltrexone. For some people who don't have any sort of side effects, like naltrexone is just absolutely no big deal. And it's. They want to continue to drink moderately and that works for them. And I think that's completely fine. Just for me, like, the pleasure that I get from drinking on naltrexone is not worth the side effects. And I. The side effects were not prohibitive, but I just, I don't really like to. It, you know, it's an endorphin blocker. It doesn't feel good. Good or doesn't feel great. So I just don't drink at all now. And I, I'm. The thing that's the most surprising about this is that I actually can't have a good time without alcohol. I can like, it's like this thing that I thought was impossible because I had never done it before because I started drinking so long. It's completely fine. I enjoy it. I enjoy going to dinner parties and not drinking. I enjoy going to parties and not drinking. Whatever it is, it. It has so little mental pull on me that everybody around me can be drinking. And I don't get. I don't get jealous. I don't get resentful. I don'. Cravings. Yeah, I feel completely free of that, of that mental burden.
- [61:11]
B
Thank you so much for listening to this week's episode of Addict Fight. In the rest of this conversation, Katie and I talk about how the culture is changing in terms of medically assisted ways of quitting addiction. We talk about smoking and vaping, as well as about AA versus the Sinclair method and other areas in which the moral question seems to be, is only quitting completely cold turkey without the assistance of drugs the right way of doing it? Or can we devise other options for people who desperately need to change their lives? And Katie also gives advice to listen. Listeners of a podcast who may, for the last part of this conversation, have wondered whether they themselves could have a problem, and who perhaps have been inspired by Katie's story to think about how they themselves can improve their lives. To listen to those parts of the conversation, please go to jaschamung sapsteadtag.com in fact, if you go to yashamk.sapstek.com the good fight, you get 25% of your subscription. That makes this about the cost of $1 a week for three episodes every week of your favorite podcast. Thank you for listening.
- [62:47]
A
Sa.