How Science Is Unlocking the Secrets of Addiction

We’re learning more about the craving that fuels self-defeating habits—and how new discoveries can help us kick the habit.

From National Geographic

Addiction hijacks the brain’s neural pathways. Scientists are challenging the view that it’s a moral failing and researching treatments that could offer an exit from the cycle of desire, bingeing, and withdrawal that traps tens of millions of people. Janna Raine became addicted to heroin two decades ago after taking prescription pain pills for a work injury. Last year she was living in a homeless encampment under a Seattle freeway.

By analyzing brain scans of recovering cocaine addicts, clinical neuroscientist Anna Rose Childress, a professor at the University of Pennsylvania, studies how subliminal drug cues excite the brain’s reward system and contribute to relapse. When she showed images such as the one of cocaine on the left screen to patients for 33 milliseconds, their reward circuitry was stimulated. She’s trying to find medications that can prevent this activation and keep people from falling prey to “unseen” triggers.

Continue reading “How Science Is Unlocking the Secrets of Addiction”

What/why is there an emphasis on a higher power in AA? It is assumed that “higher” is understood to be of great value. What do you think?

Quora discussion – our answer:

There are many good answers here already, but we will chime in only to say that for many, the concept of “higher power” as they understand it in the context of AA can be one heck of a road block, and in many cases, it can be an “Exit Only” from AA.

To be clear – we support virtually *anything* that people can use to get past addiction, and depression. If a higher power does it for you? Great. If it does not? You can still recover.

We believe that the roots to most addictions run much deeper than the addiction itself. Psychotherapy can be the saving grace for so many of us.

Just know that if AA is not working for you, you still have options. And if it is working for you? Congrats! Whatever works… 🙂

Why Alcoholics Anonymous Works

For NYMag

In a story in the April issue of The Atlantic that was posted online earlier today, journalist Gabrielle Glaser harshly criticizes Alcoholics Anonymous. AA and similar 12-step programs, she argues, simply don’t offer the benefits they claim to for those struggling with addiction, and they have become entrenched in both our culture and legal system — judges frequently refer defendants to 12-step programs as an alternative to jail time — as a result of faddishness and cultural appeal rather than sound science.

As with any story about a complicated social-science issue, there are aspects of Glaser’s argument with which one could easily quibble. For one thing, she repeatedly conflates and switches between discussing AA, a program that, whatever one thinks about it, is clearly defined and has been studied, in one form or another, for decades, and the broader world of for-profit addiction-recovery programs, which is indeed an underregulated Wild West of snake-oil salesman offering treatments that haven’t been sufficiently tested in clinical settings. Her argument also leans too heavily on the work of Lance Dodes, a former Harvard Medical School psychiatrist. He has estimated, as Glaser puts it, that “AA’s actual success rate [is] somewhere between 5 and 8 percent,” but this is a very controversial figure among addiction researchers. (I should admit here that I recently passed along this number much too credulously.)

But on Glaser’s central claim that there’s no rigorous scientific evidence that AA and other 12-step programs work, there’s no quibbling: It’s wrong.

She makes her strongest version of the argument in two places near the beginning of the piece. First, she writes that “Unlike Alcoholics Anonymous, [other methods for treating alcohol dependence] are based on modern science and have been proved, in randomized, controlled studies, to work.” In other words, “modern science” hasn’t shown AA to work. A little while later, she writes:

Alcoholics Anonymous is famously difficult to study. By necessity, it keeps no records of who attends meetings; members come and go and are, of course, anonymous. No conclusive data exist on how well it works. In 2006, the Cochrane Collaboration, a health-care research group, reviewed studies going back to the 1960s and found that “no experimental studies unequivocally demonstrated the effectiveness of AA or [12-step] approaches for reducing alcohol dependence or problems.”

Here and throughout the piece, Glaser is simply ignoring a decade’s worth of science.

No, that’s not true,” said Dr. John Kelly, a clinical psychologist and addiction specialist at Massachusetts General Hospital and Harvard Medical School, when I ran Glaser’s argument by him. “There’s quite a bit of evidence now, actually, that’s shown that AA works.” Kelly has a front-row view of the current generation of research: Alongside Dr. Marica Ferri, the original report’s lead author, and Dr. Keith Humphreys of Stanford, he’s currently at work updating the Cochrane Collaboration guidelines (he said they expect to publish their results in August).

Kelly said that in recent years, researchers have begun ramping up rigorous research on what are known as “12-step facilitation” (TSF) programs, which are “clinical interventions designed to link people with AA.” Dr. Lee Ann Kaskutas, a senior scientist at the Alcohol Research Group who has conducted TSF studies, explained that while these programs take on different forms, they’re generally oriented toward preparing participants for the (potentially weird-seeming, especially at first) culture and philosophy of 12-step programs like AA. By randomly assigning a group of study participants to either TSF programs or standard treatment, researchers can overcome some of the self-selection issues inherent to studying AA “in the wild” (that is, it could be that people who choose to go to AA are simply more motivated to kick their addiction).

The data from these sorts of studies, argued Kelly, Kaskutas, and other researchers with whom I spoke, suggest that it outperforms many alternatives. “They show about a 10 to 20 percent advantage over more standard treatment like cognitive behavioral therapy in terms of days abstinent, and typically also what we find is that when people are engaged in a 12-step-oriented treatment and go to AA, they have about 30 percent to 50 percent higher rates of continuous abstinence,” said Kelly.

The original Cochrane paper that Glaser cites came out before the latest round of studies did, so that research wasn’t factored into the conclusion that there’s a lack of evidence for AA’s efficacy. In a followup email, Kelly said he expects the next round of recommendations to be significantly different:

Although we cannot as yet say definitively what the final results will bring in the updated Cochrane Review, as it is still in progress, we are seeing positive results in favor of Twelve-Step Facilitation treatments that have emerged from the numerous NIH-sponsored randomized clinical trials completed since the original review published in 2006. We can confirm that TSF is an empirically-supported treatment, showing clinical efficacy, and is likely to result also in lowered health care costs relative to alternative treatments that do not link patients with these freely available recovery peer support services. Another emerging finding is that a central reason why TSF shows benefit is because it helps patients become actively involved with groups like AA and NA, which in turn, have been shown to enhance addiction recovery coping skills, confidence, and motivation, similar to professional interventions, but AA and NA are able to do this in the communities in which people live for free, and over the long-term.

In other words, the most comprehensive piece of research Glaser is using to support her argument will, once it takes into account the latest findings, likely reverse itself.

In an email and phone call, Glaser said that TSF programs are not the same thing as AA and the two can’t be compared. But this argument doesn’t quite hold up: For one thing, the Cochrane report she herself cites in her piece relied in part on a review of TSF studies, so it doesn’t make sense for TSF studies to be acceptable to her when they support her argument and unacceptable when they don’t. For another, Kelly, Katsukas, and Humphreys, while acknowledging that TSF programs and AA are not exactly the same thing, all said that the available evidence suggests that it’s the 12-step programs themselves that are likely the primary cause of the effects being observed (the National Institutes of Health, given the many studies into TSF programs it has sponsored, would appear to agree).

Glaser said that her broader issue is with the culture of AA. “The therapeutic alliance is so hugely important when people are trying to get better from anything,” she said. “And understanding who’s going to thrive under different settings is really, in my opinion, the key to effective treatment.” She explained that she had encountered many people turned off by AA’s atmosphere, but she also acknowledged, as she does in her piece, that it works for others.

It’s worth pointing out that while critics of AA paint it as a bit cultlike and out-there, what with its reliance on “higher powers” and such, to the researchers who believe in its efficacy, there’s actually very little mystery to the process. “We have been able to determine WHY these 12-step facilitation interventions work,” said Kaskutas in an email. “And we have also been able to determine WHY AA works.”

Simply put, “People who self-select to attend AA, or people who are randomized to a 12-step facilitation intervention, end up having people in their social network who are supportive of their abstinence,” she said. Reams of research show that social networks, and the norms contained therein, are powerful drivers of behavior, so to Kaskutas — who noted that she is an atheist — the focus on AA’s quirks and spiritual undertones misses the point. “When you think about a mechanism like supportive social networks, or the psychological benefit of helping others, well, they have nothing to do with faith, or God — they have to do with the reality of what goes on in AA, with people meeting others in the same boat as they are in, and with helping other people (for but two examples of these mechanisms of action),” she said. So it can be the case both that AA rests on overly judgmental moral language, takes the unlikely view that God himself (or “a higher power”) is what cures people’s alcoholism, and has various other flaws — and that it still works for a lot of people, simply by connecting them to others going through the same struggles.

Glaser is right to point out that it is foolish, if not harmful, to treat AA and 12-step programs as one-size-fits-all panaceas. They’re not. She’s also right to point out that other treatments, including promising pharmaceutical options, may not always get the attention they deserve. But untangling a problem as complex as addiction requires taking into account all the best, most recent research. Glaser didn’t do that, and as a result she and The Atlantic simply aren’t giving readers an accurate view of the current addiction-research landscape.

The Irrationality of Alcoholics Anonymous

Its faith-based 12-step program dominates treatment in the United States. But researchers have debunked central tenets of AA doctrine and found dozens of other treatments more effective.

By GABRIELLE GLASER for The Atlantic

j.g. is a lawyer in his early 30s. He’s a fast talker and has the lean, sinewy build of a distance runner. His choice of profession seems preordained, as he speaks in fully formed paragraphs, his thoughts organized by topic sentences. He’s also a worrier—a big one—who for years used alcohol to soothe his anxiety.

J.G. started drinking at 15, when he and a friend experimented in his parents’ liquor cabinet. He favored gin and whiskey but drank whatever he thought his parents would miss the least. He discovered beer, too, and loved the earthy, bitter taste on his tongue when he took his first cold sip.

His drinking increased through college and into law school. He could, and occasionally did, pull back, going cold turkey for weeks at a time. But nothing quieted his anxious mind like booze, and when he didn’t drink, he didn’t sleep. After four or six weeks dry, he’d be back at the liquor store.

By the time he was a practicing defense attorney, J.G. (who asked to be identified only by his initials) sometimes drank almost a liter of Jameson in a day. He often started drinking after his first morning court appearance, and he says he would have loved to drink even more, had his schedule allowed it. He defended clients who had been charged with driving while intoxicated, and he bought his own Breathalyzer to avoid landing in court on drunk-driving charges himself.

In the spring of 2012, J.G. decided to seek help. He lived in Minnesota—the Land of 10,000 Rehabs, people there like to say—and he knew what to do: check himself into a facility. He spent a month at a center where the treatment consisted of little more than attending Alcoholics Anonymous meetings. He tried to dedicate himself to the program even though, as an atheist, he was put off by the faith-based approach of the 12 steps, five of which mention God. Everyone there warned him that he had a chronic, progressive disease and that if he listened to the cunning internal whisper promising that he could have just one drink, he would be off on a bender.

J.G. says it was this message—that there were no small missteps, and one drink might as well be 100—that set him on a cycle of bingeing and abstinence. He went back to rehab once more and later sought help at an outpatient center. Each time he got sober, he’d spend months white-knuckling his days in court and his nights at home. Evening would fall and his heart would race as he thought ahead to another sleepless night. “So I’d have one drink,” he says, “and the first thing on my mind was: I feel better now, but I’m screwed. I’m going right back to where I was. I might as well drink as much as I possibly can for the next three days.”

He felt utterly defeated. And according to AA doctrine, the failure was his alone. When the 12 steps don’t work for someone like J.G., Alcoholics Anonymous says that person must be deeply flawed. The Big Book, AA’s bible, states:

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. There are such unfortunates. They are not at fault; they seem to have been born that way.

J.G.’s despair was only heightened by his seeming lack of options. “Every person I spoke with told me there was no other way,” he says.

For J.G., it took years of trying to “work the program,” pulling himself back onto the wagon only to fall off again, before he finally realized that Alcoholics Anonymous was not his only, or even his best, hope for recovery. But in a sense, he was lucky: many others never make that discovery at all.

The debate over the efficacy of 12-step programs has been quietly bubbling for decades among addiction specialists. But it has taken on new urgency with the passage of the Affordable Care Act, which requires all insurers and state Medicaid programs to pay for alcohol- and substance-abuse treatment, extending coverage to 32 million Americans who did not previously have it and providing a higher level of coverage for an additional 30 million.

Nowhere in the field of medicine is treatment less grounded in modern science. A 2012 report by the National Center on Addiction and Substance Abuse at Columbia University compared the current state of addiction medicine to general medicine in the early 1900s, when quacks worked alongside graduates of leading medical schools. The American Medical Association estimates that out of nearly 1 million doctors in the United States, only 582 identify themselves as addiction specialists. (The Columbia report notes that there may be additional doctors who have a subspecialty in addiction.) Most treatment providers carry the credential of addiction counselor or substance-abuse counselor, for which many states require little more than a high-school diploma or a GED. Many counselors are in recovery themselves. The report stated: “The vast majority of people in need of addiction treatment do not receive anything that approximates evidence-based care.”

Alcoholics Anonymous was established in 1935, when knowledge of the brain was in its infancy. It offers a single path to recovery: lifelong abstinence from alcohol. The program instructs members to surrender their ego, accept that they are “powerless” over booze, make amends to those they’ve wronged, and pray.

Alcoholics Anonymous is famously difficult to study. By necessity, it keeps no records of who attends meetings; members come and go and are, of course, anonymous. No conclusive data exist on how well it works. In 2006, the Cochrane Collaboration, a health-care research group, reviewed studies going back to the 1960s and found that “no experimental studies unequivocally demonstrated the effectiveness of AA or [12-step] approaches for reducing alcohol dependence or problems.”

The Big Book includes an assertion first made in the second edition, which was published in 1955: that AA has worked for 75 percent of people who have gone to meetings and “really tried.” It says that 50 percent got sober right away, and another 25 percent struggled for a while but eventually recovered. According to AA, these figures are based on members’ experiences.

In his recent book, The Sober Truth: Debunking the Bad Science Behind 12-Step Programs and the Rehab Industry, Lance Dodes, a retired psychiatry professor from Harvard Medical School, looked at Alcoholics Anonymous’s retention rates along with studies on sobriety and rates of active involvement (attending meetings regularly and working the program) among AA members. Based on these data, he put AA’s actual success rate somewhere between 5 and 8 percent. That is just a rough estimate, but it’s the most precise one I’ve been able to find.

I spent three years researching a book about women and alcohol, Her Best-Kept Secret: Why Women Drink—And How They Can Regain Control, which was published in 2013. During that time, I encountered disbelief from doctors and psychiatrists every time I mentioned that the Alcoholics Anonymous success rate appears to hover in the single digits. We’ve grown so accustomed to testimonials from those who say AA saved their life that we take the program’s efficacy as an article of faith. Rarely do we hear from those for whom 12-step treatment doesn’t work. But think about it: How many celebrities can you name who bounced in and out of rehab without ever getting better? Why do we assume they failed the program, rather than that the program failed them?

When my book came out, dozens of Alcoholics Anonymous members said that because I had challenged AA’s claim of a 75 percent success rate, I would hurt or even kill people by discouraging attendance at meetings. A few insisted that I must be an “alcoholic in denial.” But most of the people I heard from were desperate to tell me about their experiences in the American treatment industry. Amy Lee Coy, the author of the memoir From Death Do I Part: How I Freed Myself From Addiction, told me about her eight trips to rehab, starting at age 13. “It’s like getting the same antibiotic for a resistant infection—eight times,” she told me. “Does that make sense?”

“I honestly thought AA was the only way anyone could ever get sober, but I learned that I was wrong.”

She and countless others had put their faith in a system they had been led to believe was effective—even though finding treatment centers’ success rates is next to impossible: facilities rarely publish their data or even track their patients after discharging them. “Many will tell you that those who complete the program have a ‘great success rate,’ meaning that most are abstaining from drugs and alcohol while enrolled there,” says Bankole Johnson, an alcohol researcher and the chair of the psychiatry department at the University of Maryland School of Medicine. “Well, no kidding.”

Alcoholics Anonymous has more than 2 million members worldwide, and the structure and support it offers have helped many people. But it is not enough for everyone. The history of AA is the story of how one approach to treatment took root before other options existed, inscribing itself on the national consciousness and crowding out dozens of newer methods that have since been shown to work better.

A meticulous analysis of treatments, published more than a decade ago in The Handbook of Alcoholism Treatment Approaches but still considered one of the most comprehensive comparisons, ranks AA 38th out of 48 methods. At the top of the list are brief interventions by a medical professional; motivational enhancement, a form of counseling that aims to help people see the need to change; and acamprosate, a drug that eases cravings. (An oft-cited 1996 study found 12-step facilitation—a form of individual therapy that aims to get the patient to attend AA meetings—as effective as cognitive behavioral therapy and motivational interviewing. But that study, called Project Match, was widely criticized for scientific failings, including the lack of a control group.)

As an organization, Alcoholics Anonymous has no real central authority—each AA meeting functions more or less autonomously—and it declines to take positions on issues beyond the scope of the 12 steps. (When I asked to speak with someone from the General Service Office, AA’s administrative headquarters, regarding AA’s stance on other treatment methods, I received an e-mail stating: “Alcoholics Anonymous neither endorses nor opposes other approaches, and we cooperate widely with the medical profession.” The office also declined to comment on whether AA’s efficacy has been proved.) But many in AA and the rehab industry insist the 12 steps are the only answer and frown on using the prescription drugs that have been shown to help people reduce their drinking.

People with alcohol problems also suffer from higher-than-normal rates of mental-health issues, and research has shown that treating depression and anxiety with medication can reduce drinking. But AA is not equipped to address these issues—it is a support group whose leaders lack professional training—and some meetings are more accepting than others of the idea that members may need therapy and/or medication in addition to the group’s help.

AA truisms have so infiltrated our culture that many people believe heavy drinkers cannot recover before they “hit bottom.” Researchers I’ve talked with say that’s akin to offering antidepressants only to those who have attempted suicide, or prescribing insulin only after a patient has lapsed into a diabetic coma. “You might as well tell a guy who weighs 250 pounds and has untreated hypertension and cholesterol of 300, ‘Don’t exercise, keep eating fast food, and we’ll give you a triple bypass when you have a heart attack,’ ” Mark Willenbring, a psychiatrist in St. Paul and a former director of treatment and recovery research at the National Institute on Alcohol Abuse and Alcoholism, told me. He threw up his hands. “Absurd.”

Part of the problem is our one-size-fits-all approach. Alcoholics Anonymous was originally intended for chronic, severe drinkers—those who may, indeed, be powerless over alcohol—but its program has since been applied much more broadly. Today, for instance, judges routinely require people to attend meetings after a DUI arrest; fully 12 percent of AA members are there by court order.

Whereas AA teaches that alcoholism is a progressive disease that follows an inevitable trajectory, data from a federally funded survey called the National Epidemiological Survey on Alcohol and Related Conditions show that nearly one-fifth of those who have had alcohol dependence go on to drink at low-risk levels with no symptoms of abuse. And a recent survey of nearly 140,000 adults by the Centers for Disease Control and Prevention found that nine out of 10 heavy drinkers are not dependent on alcohol and, with the help of a medical professional’s brief intervention, can change unhealthy habits.

We once thought about drinking problems in binary terms—you either had control or you didn’t; you were an alcoholic or you weren’t—but experts now describe a spectrum. An estimated 18 million Americans suffer from alcohol-use disorder, as the DSM-5, the latest edition of the American Psychiatric Association’s diagnostic manual, calls it. (The new term replaces the older alcohol abuse and the much more dated alcoholism, which has been out of favor with researchers for decades.) Only about 15 percent of those with alcohol-use disorder are at the severe end of the spectrum. The rest fall somewhere in the mild-to-moderate range, but they have been largely ignored by researchers and clinicians. Both groups—the hard-core abusers and the more moderate overdrinkers—need more-individualized treatment options.

“We cling to this one-size-fits-all theory even when a person has a small problem.”

 

The United States already spends about $35 billion a year on alcohol- and substance-abuse treatment, yet heavy drinking causes 88,000 deaths a year—including deaths from car accidents and diseases linked to alcohol. It also costs the country hundreds of billions of dollars in expenses related to health care, criminal justice, motor-vehicle crashes, and lost workplace productivity, according to the CDC. With the Affordable Care Act’s expansion of coverage, it’s time to ask some important questions: Which treatments should we be willing to pay for? Have they been proved effective? And for whom—only those at the extreme end of the spectrum? Or also those in the vast, long-overlooked middle?

For a glimpse of how treatment works elsewhere, I traveled to Finland, a country that shares with the United States a history of prohibition (inspired by the American temperance movement, the Finns outlawed alcohol from 1919 to 1932) and a culture of heavy drinking.

Finland’s treatment model is based in large part on the work of an American neuroscientist named John David Sinclair. I met with Sinclair in Helsinki in early July. He was battling late-stage prostate cancer, and his thick white hair was cropped short in preparation for chemotherapy. Sinclair has researched alcohol’s effects on the brain since his days as an undergraduate at the University of Cincinnati, where he experimented with rats that had been given alcohol for an extended period. Sinclair expected that after several weeks without booze, the rats would lose their desire for it. Instead, when he gave them alcohol again, they went on week-long benders, drinking far more than they ever had before—more, he says, than any rat had ever been shown to drink.

Sinclair called this the alcohol-deprivation effect, and his laboratory results, which have since been confirmed by many other studies, suggested a fundamental flaw in abstinence-based treatment: going cold turkey only intensifies cravings. This discovery helped explain why relapses are common. Sinclair published his findings in a handful of journals and in the early 1970s moved to Finland, drawn by the chance to work in what he considered the best alcohol-research lab in the world, complete with special rats that had been bred to prefer alcohol to water. He spent the next decade researching alcohol and the brain.

Sinclair came to believe that people develop drinking problems through a chemical process: each time they drink, the endorphins released in the brain strengthen certain synapses. The stronger these synapses grow, the more likely the person is to think about, and eventually crave, alcohol—until almost anything can trigger a thirst for booze, and drinking becomes compulsive.

Sinclair theorized that if you could stop the endorphins from reaching their target, the brain’s opiate receptors, you could gradually weaken the synapses, and the cravings would subside. To test this hypothesis, he administered opioid antagonists—drugs that block opiate receptors—to the specially bred alcohol-loving rats. He found that if the rats took the medication each time they were given alcohol, they gradually drank less and less. He published his findings in peer-reviewed journals beginning in the 1980s.

Subsequent studies found that an opioid antagonist called naltrexone was safe and effective for humans, and Sinclair began working with clinicians in Finland. He suggested prescribing naltrexone for patients to take an hour before drinking. As their cravings subsided, they could then learn to control their consumption. Numerous clinical trials have confirmed that the method is effective, and in 2001 Sinclair published a paper in the journal Alcohol and Alcoholism reporting a 78 percent success rate in helping patients reduce their drinking to about 10 drinks a week. Some stopped drinking entirely.

I visited one of three private treatment centers, called the Contral Clinics, that Sinclair co-founded in Finland. (There’s an additional one in Spain.) In the past 18 years, more than 5,000 Finns have gone to the Contral Clinics for help with a drinking problem. Seventy-five percent of them have had success reducing their consumption to a safe level.

The Finns are famously private, so I had to go early in the morning, before any patients arrived, to meet Jukka Keski-Pukkila, the CEO. He poured coffee and showed me around the clinic, in downtown Helsinki. The most common course of treatment involves six months of cognitive behavioral therapy, a goal-oriented form of therapy, with a clinical psychologist. Treatment typically also includes a physical exam, blood work, and a prescription for naltrexone or nalmefene, a newer opioid antagonist approved in more than two dozen countries. When I asked how much all of this cost, Keski-Pukkila looked uneasy. “Well,” he told me, “it’s 2,000 euros.” That’s about $2,500—a fraction of the cost of inpatient rehab in the United States, which routinely runs in the tens of thousands of dollars for a 28-day stay.

When I told Keski-Pukkila this, his eyes grew wide. “What are they doing for that money?” he asked. I listed some of the treatments offered at top-of-the-line rehab centers: equine therapy, art therapy, mindfulness mazes in the desert. “That doesn’t sound scientific,” he said, perplexed. I didn’t mention that some bare-bones facilities charge as much as $40,000 a month and offer no treatment beyond AA sessions led by minimally qualified counselors.

As i researched this article, I wondered what it would be like to try naltrexone, which the U.S. Food and Drug Administration approved for alcohol-abuse treatment in 1994. I asked my doctor whether he would write me a prescription. Not surprisingly, he shook his head no. I don’t have a drinking problem, and he said he couldn’t offer medication for an “experiment.” So that left the Internet, which was easy enough. I ordered some naltrexone online and received a foil-wrapped package of 10 pills about a week later. The cost was $39.

The first night, I took a pill at 6:30. An hour later, I sipped a glass of wine and felt almost nothing—no calming effect, none of the warm contentment that usually signals the end of my workday and the beginning of a relaxing evening. I finished the glass and poured a second. By the end of dinner, I looked up to see that I had barely touched it. I had never found wine so uninteresting. Was this a placebo effect? Possibly. But so it went. On the third night, at a restaurant where my husband and I split a bottle of wine, the waitress came to refill his glass twice; mine, not once. That had never happened before, except when I was pregnant. At the end of 10 days, I found I no longer looked forward to a glass of wine with dinner. (Interestingly, I also found myself feeling full much quicker than normal, and I lost two pounds. In Europe, an opioid antagonist is being tested on binge eaters.)

Patients on naltrexone have to be motivated to keep taking the pill. But Sari Castrén, a psychologist at the Contral Clinic I visited in Helsinki, told me that when patients come in for treatment, they’re desperate to change the role alcohol has assumed in their lives. They’ve tried not drinking, and controlling their drinking, without success—their cravings are too strong. But with naltrexone or nalmefene, they’re able to drink less, and the benefits soon become apparent: They sleep better. They have more energy and less guilt. They feel proud. They’re able to read or watch movies or play with their children during the time they would have been drinking.

In therapy sessions, Castrén asks patients to weigh the pleasure of drinking against their enjoyment of these new activities, helping them to see the value of change. Still, the combination of naltrexone and therapy doesn’t work for everyone. Some clients opt to take Antabuse, a medication that triggers nausea, dizziness, and other uncomfortable reactions when combined with drinking. And some patients are unable to learn how to drink without losing control. In those cases (about 10 percent of patients), Castrén recommends total abstinence from alcohol, but she leaves that choice to patients. “Sobriety is their decision, based on their own discovery,” she told me.

Claudia Christian, an actress who lives in Los Angeles (she’s best known for appearing in the 1990s science-fiction TV show Babylon 5), discovered naltrexone when she came across a flier for Vivitrol, an injectable form of the drug, at a detox center in California in 2009. She had tried Alcoholics Anonymous and traditional rehab without success. She researched the medication online, got a doctor to prescribe it, and began taking a dose about an hour before she planned to drink, as Sinclair recommends. She says the effect was like flipping a switch. For the first time in many years, she was able to have a single drink and then stop. She plans to keep taking naltrexone indefinitely, and has become an advocate for Sinclair’s method: she set up a nonprofit organization for people seeking information about it and made a documentary called One Little Pill.

In the United States, doctors generally prescribe naltrexone for daily use and tell patients to avoid alcohol, instead of instructing them to take the drug anytime they plan to drink, as Sinclair would advise. There is disagreement among experts about which approach is better—Sinclair is adamant that American doctors are missing the drug’s full potential—but both seem to work: naltrexone has been found to reduce drinking in more than a dozen clinical trials, including a large-scale one funded by the National Institute on Alcohol Abuse and Alcoholism that was published in jama in 2006. The results have been largely overlooked. Less than 1 percent of people treated for alcohol problems in the United States are prescribed naltrexone or any other drug shown to help control drinking.

To understand why, you have to first understand the history.

The american approach to treatment for drinking problems has roots in the country’s long-standing love-hate relationship with booze. The first settlers arrived with a great thirst for whiskey and hard cider, and in the early days of the republic, alcohol was one of the few beverages that was reliably safe from contamination. (It was also cheaper than coffee or tea.) The historian W. J. Rorabaugh has estimated that between the 1770s and 1830s, the average American over age 15 consumed at least five gallons of pure alcohol a year—the rough equivalent of three shots of hard liquor a day.

Religious fervor, aided by the introduction of public water-filtration systems, helped galvanize the temperance movement, which culminated in 1920 with Prohibition. That experiment ended after 14 years, but the drinking culture it fostered—secrecy and frenzied bingeing—persists.

In 1934, just after Prohibition’s repeal, a failed stockbroker named Bill Wilson staggered into a Manhattan hospital. Wilson was known to drink two quarts of whiskey a day, a habit he’d attempted to kick many times. He was given the hallucinogen belladonna, an experimental treatment for addictions, and from his hospital bed he called out to God to loosen alcohol’s grip. He reported seeing a flash of light and feeling a serenity he had never before experienced. He quit booze for good. The next year, he co-founded Alcoholics Anonymous. He based its principles on the beliefs of the evangelical Oxford Group, which taught that people were sinners who, through confession and God’s help, could right their paths.

AA filled a vacuum in the medical world, which at the time had few answers for heavy drinkers. In 1956, the American Medical Association named alcoholism a disease, but doctors continued to offer little beyond the standard treatment that had been around for decades: detoxification in state psychiatric wards or private sanatoriums. As Alcoholics Anonymous grew, hospitals began creating “alcoholism wards,” where patients detoxed but were given no other medical treatment. Instead, AA members—who, as part of the 12 steps, pledge to help other alcoholics—appeared at bedsides and invited the newly sober to meetings.

A public-relations specialist and early AA member named Marty Mann worked to disseminate the group’s main tenet: that alcoholics had an illness that rendered them powerless over booze. Their drinking was a disease, in other words, not a moral failing. Paradoxically, the prescription for this medical condition was a set of spiritual steps that required accepting a higher power, taking a “fearless moral inventory,” admitting “the exact nature of our wrongs,” and asking God to remove all character defects.

Mann helped ensure that these ideas made their way to Hollywood. In 1945’s The Lost Weekend, a struggling novelist tries to loosen his writer’s block with booze, to devastating effect. In Days of Wine and Roses, released in 1962, Jack Lemmon slides into alcoholism along with his wife, played by Lee Remick. He finds help through AA, but she rejects the group and loses her family.

Mann also collaborated with a physiologist named E. M. Jellinek. Mann was eager to bolster the scientific claims behind AA, and Jellinek wanted to make a name for himself in the growing field of alcohol research. In 1946, Jellinek published the results of a survey mailed to 1,600 AA members. Only 158 were returned. Jellinek and Mann jettisoned 45 that had been improperly completed and another 15 filled out by women, whose responses were so unlike the men’s that they risked complicating the results. From this small sample—98 men—Jellinek drew sweeping conclusions about the “phases of alcoholism,” which included an unavoidable succession of binges that led to blackouts, “indefinable fears,” and hitting bottom. Though the paper was filled with caveats about its lack of scientific rigor, it became AA gospel.

Jellinek, however, later tried to distance himself from this work, and from Alcoholics Anonymous. His ideas came to be illustrated by a chart showing how alcoholics progressed from occasionally drinking for relief, to sneaking drinks, to guilt, and so on until they hit bottom (“complete defeat admitted”) and then recovered. If you could locate yourself even early in the downward trajectory on that curve, you could see where your drinking was headed. In 1952, Jellinek noted that the word alcoholic had been adopted to describe anyone who drank excessively. He warned that overuse of that word would undermine the disease concept. He later beseeched AA to stay out of the way of scientists trying to do objective research.

But AA supporters worked to make sure their approach remained central. Marty Mann joined prominent Americans including Susan Anthony, the grandniece of Susan B. Anthony; Jan Clayton, the mom from Lassie; and decorated military officers in testifying before Congress. John D. Rockefeller Jr., a lifelong teetotaler, was an early booster of the group.

In 1970, Senator Harold Hughes of Iowa, a member of AA, persuaded Congress to pass the Comprehensive Alcohol Abuse and Alcoholism Prevention, Treatment, and Rehabilitation Act. It called for the establishment of the National Institute on Alcohol Abuse and Alcoholism, and dedicated funding for the study and treatment of alcoholism. The NIAAA, in turn, funded Marty Mann’s nonprofit advocacy group, the National Council on Alcoholism, to educate the public. The nonprofit became a mouthpiece for AA’s beliefs, especially the importance of abstinence, and has at times worked to quash research that challenges those beliefs.

In 1976, for instance, the Rand Corporation released a study of more than 2,000 men who had been patients at 44 different NIAAA-funded treatment centers. The report noted that 18 months after treatment, 22 percent of the men were drinking moderately. The authors concluded that it was possible for some alcohol-dependent men to return to controlled drinking. Researchers at the National Council on Alcoholism charged that the news would lead alcoholics to falsely believe they could drink safely. The NIAAA, which had funded the research, repudiated it. Rand repeated the study, this time looking over a four-year period. The results were similar.

After the Hughes Act was passed, insurers began to recognize alcoholism as a disease and pay for treatment. For-profit rehab facilities sprouted across the country, the beginnings of what would become a multibillion-dollar industry. (Hughes became a treatment entrepreneur himself, after retiring from the Senate.) If Betty Ford and Elizabeth Taylor could declare that they were alcoholics and seek help, so too could ordinary people who struggled with drinking. Today there are more than 13,000 rehab facilities in the United States, and 70 to 80 percent of them hew to the 12 steps, according to Anne M. Fletcher, the author of Inside Rehab, a 2013 book investigating the treatment industry.

The problem is that nothing about the 12-step approach draws on modern science: not the character building, not the tough love, not even the standard 28-day rehab stay.

Marvin D. Seppala, the chief medical officer at the Hazelden Betty Ford Foundation in Minnesota, one of the oldest inpatient rehab facilities in the country, described for me how 28 days became the norm: “In 1949, the founders found that it took about a week to get detoxed, another week to come around so [the patients] knew what they were up to, and after a couple of weeks they were doing well, and stable. That’s how it turned out to be 28 days. There’s no magic in it.”

Tom McLellan, a psychology professor at the University of Pennsylvania School of Medicine who has served as a deputy U.S. drug czar and is an adviser to the World Health Organization, says that while AA and other programs that focus on behavioral change have value, they don’t address what we now know about the biology of drinking.

Alcohol acts on many parts of the brain, making it in some ways more complex than drugs like cocaine and heroin, which target just one area of the brain. Among other effects, alcohol increases the amount of gaba (gamma-aminobutyric acid), a chemical that slows down activity in the nervous system, and decreases the flow of glutamate, which activates the nervous system. (This is why drinking can make you relax, shed inhibitions, and forget your worries.) Alcohol also prompts the brain to release dopamine, a chemical associated with pleasure.

Over time, though, the brain of a heavy drinker adjusts to the steady flow of alcohol by producing less gaba and more glutamate, resulting in anxiety and irritability. Dopamine production also slows, and the person gets less pleasure out of everyday things. Combined, these changes gradually bring about a crucial shift: instead of drinking to feel good, the person ends up drinking to avoid feeling bad. Alcohol also damages the prefrontal cortex, which is responsible for judging risks and regulating behavior—one reason some people keep drinking even as they realize that the habit is destroying their lives. The good news is that the damage can be undone if they’re able to get their consumption under control.

Studies of twins and adopted children suggest that about half of a person’s vulnerability to alcohol-use disorder is hereditary, and that anxiety, depression, and environment—all considered “outside issues” by many in Alcoholics Anonymous and the rehab industry—also play a role. Still, science can’t yet fully explain why some heavy drinkers become physiologically dependent on alcohol and others don’t, or why some recover while others founder. We don’t know how much drinking it takes to cause major changes in the brain, or whether the brains of alcohol-dependent people are in some ways different from “normal” brains to begin with. What we do know, McLellan says, is that “the brains of the alcohol-addicted aren’t like those of the non-alcohol-dependent.”

Bill Wilson, AA’s founding father, was right when he insisted, 80 years ago, that alcohol dependence is an illness, not a moral failing. Why, then, do we so rarely treat it medically? It’s a question I’ve heard many times from researchers and clinicians. “Alcohol- and substance-use disorders are the realm of medicine,” McLellan says. “This is not the realm of priests.”

When the hazelden treatment center opened in 1949, it espoused five goals for its patients: behave responsibly, attend lectures on the 12 steps, make your bed, stay sober, and talk with other patients. Even today, Hazelden’s Web site states:

People addicted to alcohol can be secretive, self-centered, and filled with resentment. In response, Hazelden’s founders insisted that patients attend to the details of daily life, tell their stories, and listen to each other … This led to a heartening discovery, one that’s become a cornerstone of the Minnesota Model: Alcoholics and addicts can help each other.

That may be heartening, but it’s not science. As the rehab industry began expanding in the 1970s, its profit motives dovetailed nicely with AA’s view that counseling could be delivered by people who had themselves struggled with addiction, rather than by highly trained (and highly paid) doctors and mental-health professionals. No other area of medicine or counseling makes such allowances.

There is no mandatory national certification exam for addiction counselors. The 2012 Columbia University report on addiction medicine found that only six states required alcohol- and substance-abuse counselors to have at least a bachelor’s degree and that only one state, Vermont, required a master’s degree. Fourteen states had no license requirements whatsoever—not even a GED or an introductory training course was necessary—and yet counselors are often called on by the judicial system and medical boards to give expert opinions on their clients’ prospects for recovery.

Fourteen states had no license requirements for addiction counselors—not even a GED or an introductory course.

Mark Willenbring, the St. Paul psychiatrist, winced when I mentioned this. “What’s wrong,” he asked me rhetorically, “with people with no qualifications or talents—other than being recovering alcoholics—being licensed as professionals with decision-making authority over whether you are imprisoned or lose your medical license?

“The history—and current state—is really, really dismal,” Willenbring said.

Perhaps even worse is the pace of research on drugs to treat alcohol-use disorder. The FDA has approved just three: Antabuse, the drug that induces nausea and dizziness when taken with alcohol; acamprosate, which has been shown to be helpful in quelling cravings; and naltrexone. (There is also Vivitrol, the injectable form of naltrexone.)

Reid K. Hester, a psychologist and the director of research at Behavior Therapy Associates, an organization of psychologists in Albuquerque, says there has long been resistance in the United States to the idea that alcohol-use disorder can be treated with drugs. For a brief period, DuPont, which held the patent for naltrexone when the FDA approved it for alcohol-abuse treatment in 1994, paid Hester to speak about the drug at medical conferences. “The reaction was always ‘How can you be giving alcoholics drugs?’ ” he recalls.

Hester says this attitude dates to the 1950s and ’60s, when psychiatrists regularly prescribed heavy drinkers Valium and other sedatives with great potential for abuse. Many patients wound up dependent on both booze and benzodiazepines. “They’d look at me like I was promoting Valley of the Dolls 2.0,” Hester says.

There has been some progress: the Hazelden center began prescribing naltrexone and acamprosate to patients in 2003. But this makes Hazelden a pioneer among rehab centers. “Everyone has a bias,” Marvin Seppala, the chief medical officer, told me. “I honestly thought AA was the only way anyone could ever get sober, but I learned that I was wrong.”

Stephanie O’Malley, a clinical researcher in psychiatry at Yale who has studied the use of naltrexone and other drugs for alcohol-use disorder for more than two decades, says naltrexone’s limited use is “baffling.”

“There was never any campaign for this medication that said, ‘Ask your doctor,’ ” she says. “There was never any attempt to reach consumers.” Few doctors accepted that it was possible to treat alcohol-use disorder with a pill. And now that naltrexone is available in an inexpensive generic form, pharmaceutical companies have little incentive to promote it.

In one recent study, O’Malley found naltrexone to be effective in limiting consumption among college-age drinkers. The drug helped subjects keep from going over the legal threshold for intoxication, a blood alcohol content of 0.08 percent. Naltrexone is not a silver bullet, though. We don’t yet know for whom it works best. Other drugs could help fill in the gaps. O’Malley and other researchers have found, for example, that the smoking-cessation medication varenicline has shown promise in reducing drinking. So, too, have topirimate, a seizure medication, and baclofen, a muscle relaxant. “Some of these drugs should be considered in primary-care offices,” O’Malley says. “And they’re just not.”

In late august, I visited Alltyr, a clinic that Willenbring founded in St. Paul. It was here that J.G. finally found help.

After his stays in rehab, J.G. kept searching for alternatives to 12-step programs. He read about baclofen and how it might ease both anxiety and cravings for alcohol, but his doctor wouldn’t prescribe it. In his desperation, J.G. turned to a Chicago psychiatrist who wrote him a prescription for baclofen without ever meeting him in person and eventually had his license suspended. Then, in late 2013, J.G.’s wife came across Alltyr’s Web site and discovered, 20 minutes from his law office, a nationally known expert in treating alcohol- and substance-use disorders.

J.G. now sees Willenbring once every 12 weeks. During those sessions, Willenbring checks on J.G.’s sleep patterns and refills his prescription for baclofen (Willenbring was familiar with the studies on baclofen and alcohol, and agreed it was a viable treatment option), and occasionally prescribes Valium for his anxiety. J.G. doesn’t drink at all these days, though he doesn’t rule out the possibility of having a beer every now and then in the future.

I also talked with another Alltyr patient, Jean, a Minnesota floral designer in her late 50s who at the time was seeing Willenbring three or four times a month but has since cut back to once every few months. “I actually look forward to going,” she told me. At age 50, Jean (who asked to be identified by her middle name) went through a difficult move and a career change, and she began soothing her regrets with a bottle of red wine a day. When Jean confessed her habit to her doctor last year, she was referred to an addiction counselor. At the end of the first session, the counselor gave Jean a diagnosis: “You’re a drunk,” he told her, and suggested she attend AA.

The whole idea made Jean uncomfortable. How did people get better by recounting the worst moments of their lives to strangers? Still, she went. Each member’s story seemed worse than the last: One man had crashed his car into a telephone pole. Another described his abusive blackouts. One woman carried the guilt of having a child with fetal alcohol syndrome. “Everybody talked about their ‘alcoholic brain’ and how their ‘disease’ made them act,” Jean told me. She couldn’t relate. She didn’t believe her affection for pinot noir was a disease, and she bristled at the lines people read from the Big Book: “We thought we could find a softer, easier way,” they recited. “But we could not.”

Surely, Jean thought, modern medicine had to offer a more current form of help.

Then she found Willenbring. During her sessions with him, she talks about troubling memories that she believes helped ratchet up her drinking. She has occasionally had a drink; Willenbring calls this “research,” not “a relapse.” “There’s no belittling, no labels, no judgment, no book to carry around, no taking away your ‘medal,’ ” Jean says, a reference to the chips that AA members earn when they reach certain sobriety milestones.

In his treatment, Willenbring uses a mix of behavioral approaches and medication. Moderate drinking is not a possibility for every patient, and he weighs many factors when deciding whether to recommend lifelong abstinence. He is unlikely to consider moderation as a goal for patients with severe alcohol-use disorder. (According to the DSM‑5, patients in the severe range have six or more symptoms of the disorder, such as frequently drinking more than intended, increased tolerance, unsuccessful attempts to cut back, cravings, missing obligations due to drinking, and continuing to drink despite negative personal or social consequences.) Nor is he apt to suggest moderation for patients who have mood, anxiety, or personality disorders; chronic pain; or a lack of social support. “We can provide treatment based on the stage where patients are,” Willenbring said. It’s a radical departure from issuing the same prescription to everyone.

The difficulty of determining which patients are good candidates for moderation is an important cautionary note. But promoting abstinence as the only valid goal of treatment likely deters people with mild or moderate alcohol-use disorder from seeking help. The prospect of never taking another sip is daunting, to say the least. It comes with social costs and may even be worse for one’s health than moderate drinking: research has found that having a drink or two a day could reduce the risk of heart disease, dementia, and diabetes.

To many, though, the idea of non-abstinent recovery is anathema.

No one knows that better than Mark and Linda Sobell, who are both psychologists. In the 1970s, the couple conducted a study with a group of 20 patients in Southern California who had been diagnosed with alcohol dependence. Over the course of 17 sessions, they taught the patients how to identify their triggers, how to refuse drinks, and other strategies to help them drink safely. In a follow-up study two years later, the patients had fewer days of heavy drinking, and more days of no drinking, than did a group of 20 alcohol-dependent patients who were told to abstain from drinking entirely. (Both groups were given a standard hospital treatment, which included group therapy, AA meetings, and medications.) The Sobells published their findings in peer-reviewed journals.

In 1980, the University of Toronto recruited the couple to conduct research at its prestigious Addiction Research Foundation. “We didn’t set out to challenge tradition,” Mark Sobell told me. “We just set out to do good research.” Not everyone saw it that way. In 1982, abstinence-only proponents attacked the Sobells in the journal Science; one of the writers, a UCLA psychologist named Irving Maltzman, later accused them of faking their results. The Science article received widespread attention, including a story in The New York Times and a segment on 60 Minutes.

Over the next several years, four panels of investigators in the United States and Canada cleared the couple of the accusations. Their studies were accurate. But the exonerations had scant impact, Mark Sobell said: “Maybe a paragraph on page 14” of the newspaper.

America spends $35 billion a year on substance-abuse treatments, yet heavy drinking causes 88,000 deaths a year.

The late G. Alan Marlatt, a respected addiction researcher at the University of Washington, commented on the controversy in a 1983 article in American Psychologist. “Despite the fact that the basic tenets of [AA’s] disease model have yet to be verified scientifically,” Marlatt wrote, “advocates of the disease model continue to insist that alcoholism is a unitary disorder, a progressive disease that can only be arrested temporarily by total abstention.”

What’s stunning, 32 years later, is how little has changed.

The Sobells returned to the United States in the mid-1990s to teach and conduct research at Nova Southeastern University, in Fort Lauderdale, Florida. They also run a clinic. Like Willenbring in Minnesota, they are among a small number of researchers and clinicians, mostly in large cities, who help some patients learn to drink in moderation.

“We cling to this one-size-fits-all theory even when a person has a small problem,” Mark Sobell told me. “The idea is ‘Well, this may be the person you are now, but this is where this is going, and there’s only one way to fix it.’ ” Sobell paused. “But we have 50 years of research saying that, chances are, that’s not the way it’s going. We can change the course.”

During my visit to finland, I interviewed P., a former Contral Clinic patient who asked me to use only his last initial in order to protect his privacy. He told me that for years he had drunk to excess, sometimes having as many as 20 drinks at a time. A 38-year-old doctor and university researcher, he describes himself as mild-mannered while sober. When drunk, though, “it was as if some primitive human took over.”

His wife found a Contral Clinic online, and P. agreed to go. From his first dose of naltrexone, he felt different—in control of his consumption for the first time. P. plans to use naltrexone for the rest of his life. He drinks two, maybe three, times a month. By American standards, these episodes count as binges, since he sometimes downs more than five drinks in one sitting. But that’s a steep decline from the 80 drinks a month he consumed before he began the treatment—and in Finnish eyes, it’s a success.

Sari Castrén, the psychologist I met at Contral, says such trajectories are the rule among her patients. “Helping them find this path is so rewarding,” she says. “This is a softer way to look at addiction. It doesn’t have to be so black and white.”

J.G. agrees. He feels much more confident and stable, he says, than he did when he was drinking. He has successfully drunk in moderation on occasion, without any loss of control or desire to consume more the next day. But for the time being, he’s content not drinking. “It feels like a big risk,” he says. And he has more at stake now—his daughter was born in June 2013, about six months before he found Willenbring.

Could the Affordable Care Act’s expansion of coverage prompt us to rethink how we treat alcohol-use disorder? That remains to be seen. The Department of Health and Human Services, the primary administrator of the act, is currently evaluating treatments. But the legislation does not specify a process for deciding which methods should be approved, so states and insurance companies are setting their own rules. How they’ll make those decisions is a matter of ongoing discussion.

Still, many leaders in the field are hopeful—including Tom McLellan, the University of Pennsylvania psychologist. His optimism is particularly poignant: in 2008, he lost a son to a drug overdose. “If I didn’t know what to do for my kid, when I know this stuff and am surrounded by experts, how the hell is a schoolteacher or a construction worker going to know?” he asks. Americans need to demand better, McLellan says, just as they did with breast cancer, HIV, and mental illness. “This is going to be a mandated benefit, and insurance companies are going to want to pay for things that work,” he says. “Change is within reach.”

 

Dear Alky: My Friend Says I’m Not Sober (Humor!)

By Alky for TheFix

I know what you’re thinking—pot never shepherded you down the path of making out with the cashier at 7-Eleven, so what’s the big deal?

A woman sitting behind a desk

How can I help you?

Q: I haven’t had a drink in four months but I still smoke pot sometimes (I have RA). My friend says this means I am not “sober” but since I am not waking up in weird dudes’ beds anymore, I kinda wanna to tell her to f**k off. Curious what you think.

A: While I am inclined to advocate for telling anyone to f**k off, in my experience it’s not usually a good idea. I will say that, according to Merriam-Webster Dictionary, “sober” is defined as not being drunk or addicted to an intoxicating drink and puts no parameters whatsoever on smoking weed. Therefore, technically speaking, you could tell your friend to go f**k herself and feel pretty self-righteous about it. But what your friend is likely proselytizing is her personal definition of “sober,” shared by many people in the recovery community. Those in active recovery (working some kind of program beyond abstinence) generally feel that using any kind of drugs (at least the kind that typically causes muchos problemas) means a person is not sober.

I know what you’re thinking—pot never shepherded you down the path of making out with the cashier at 7-Eleven, so what’s the big deal? That’s a fair question, especially if you are smoking/eating/Jolly-Ranchering the kind of cannabis that relieves pain but doesn’t get you high. Here are my thoughts: if drinking made your life unmanageable (i.e. waking up in bed with the cab driver), then it’s a good thing you stopped. Four months without a drink is nothing to shake a stick at but it’s also not long enough to really weigh in about whether just removing booze from the equation will solve your life’s problems. If you are truly using medical marijuana to deal with a real medical issue, and not just mounting a 4-foot bong every Friday night and high-dialing Little Caesars, then you are probably going to be just fine.

Q: I have been clean and sober for over five years now, but I live in the Denver area and pretty much have to walk into clouds of pot smoke half a dozen times a day. I thought I would get used to it but I’m actually getting more and more pissed off, to the point where I am worried I am going to clock someone or relapse. Any ideas on how to deal with this growing (pun intended) issue?

Bro, I feel you. My favorite 12-step meeting is in the back of this coffee shop and one day, a bunch of little a-holes just started hanging out in front, drinking café au laits and blazing up. There is nothing that will rub a clean/sober person the wrong way more than being forcefully shotgunned on their way to hand out day-count chips and hugs. But here’s the deal—other than your other friends in recovery and maybe your mom, no one else gives a rat’s ass that you are clean. Whether we realize it or not, many of us carry a proverbial chip on our shoulder about what we had to go through to get and stay sober and how much better people we are now in comparison. While all of these notions are 100% valid, you’ll have to forgive the rest of the planet for not stopping what they are doing to pat us on the back for finally becoming functioning and respectable human beings.

Now that we have the tough love part out of the way, I urge you to try and see your situation in a different way. Rather than feeling like a victim of all these stoners who get to frolic through the streets of Denver with a one-hitter and a dream, remember that getting clean was a choice you made and one you most likely made for a damn good reason. Try and put yourself in their Chacos and be grateful that you don’t have to waste anymore of your life thinking Doug Benson is funny.

In Defense of 12-Step Programs

By Helaina Hovitz for TheFix

Relying less on others, dramatically cutting back on meetings and calls to my sponsor, and actually trusting my own thinking and decisions is a sign that the program really does work.

A group of people in a circle holding hands

It feels like our world is increasingly being pushed to take a position on one side or another, pigeon-holing us into a realm of black and white thinking that, in recovery, only causes us even more pain.

“The gray” is actually a great place to live, and it’s quite relaxing if you can manage to make yourself at home; but it’s a bitch to try and settle into.

While taking on the important work of researching new approaches to treatment for alcohol and drug addiction, some reporters and scientists have, in the process, attempted to strengthen their own argument by tossing 12-step programs like AA under the bus, referring to them as dated and irrational.

I got sober in AA when I was 22 and haven’t had a drink or puffed a joint since (or lit up a cigarette, if you can believe it). That’s five and a half years so far. I was a social binge drinker, a frequent “toker,” and a high functioning reporter/college student/publishing intern. I had never been to rehab, but I did try to stop on my own until I realized that wasn’t my only option. To this day I think the only reason I ultimately even thought of AA was because I read it in Caroline Knapp’s Drinking: A Love Story six months before I hit my “high bottom” and remembered underlining it in my copy.

Some people might disagree with me when I say that relying less on others, dramatically cutting back on meetings and calls to my sponsor, and actually trusting my own thinking and decisions is a sign that the program really does work. Whether or not you agree with me is none of my business.

What I can tell you is that I think one of the reasons I was so prepared to tackle the steps was because I had a few years of Cognitive Behavioral Therapy and Dialectical Behavioral Therapy (for a Post Traumatic Stress Disorder diagnosis) under my belt, and the steps felt like the next grade level up. More learning, practicing, and finally, consistently doing things differently after a real effort to learn new ways of thinking, doing, behaving, and perceiving, literally changing the way our minds work.

Also, times are changing. We can speak to other sober people through Skype or Facebook or texts whenever we need to. We can dial into phone meetings or attend virtual ones. We live in a world where social support is available in many different forms, not just meeting rooms. What we need changes as we grow, which is why nobody stays in Kindergarten forever.

As a journalist, I have stayed on top of and researched new forms of methodology and alternative forms of treatment. Maybe I’m biased, but I think the 12-step model still holds up, despite articles featuring interviews with people who will say that the “program doesn’t work.” Newsflash: a program isn’t a thing that works or doesn’t. It’s there for you to work. There is psychology in those 12 steps, and the model has been replicated in tons of recovery programs that we call “alternative.” Where people start to get persnickety is around God, the concept of powerlessness, and having faith.

First of all, “faith” simply means you’re willing to trust something greater than yourself, willing to consider other points of view and willing to come to terms with the fact that the world doesn’t revolve around you. Anyone who pushes a specific idea of God on you is marching to their own tune, and one that is a real ear-sore to listen to at that.

Second of all, regarding the notion of God, one of the first things they tell you, especially when you’re a newcomer and believe God has left the building, is that you can be an atheist for all they care—you just have to believe in something that’s not you. You, who kind of made a mess of things. When I came in, I said, “My higher power is just the concept that everything happens for a reason.”

I also don’t believe that something is “dated” just because it’s been around for 80 years. I remember reading Living Sober and thinking, “Holy crap, how do they know? They’re in my head!” If anything, I was amazed that it was so spot-on. So make fun of all of the Big Book references to John Barleycorn and get pissed at the references to gender roles of women at the time, but outside of that, if you want data to prove efficacy: there are over two million active members in 181 countries, and nearly 118,000 groups that meet regularly.

Take that and leave the rest, if you need to.

My experience has not been sunshine and butterflies all the way through, by the way.

In my first six months, I was dumped by two sponsors who had an issue with my taking medications, and I was left doing steps 1-4 twice, holding onto my 4th step in desperation, trying to find some random woman to go over it with me.

I’ve heard horrendous stories of sponsors who talk down to grown women who have years under their belt and who try to act as their doctors or their keepers.

I’ve been in meetings that end with “Our Father” and got really pissed, and I strongly disagree with those who say we are permanently sick and can never trust our thinking.

As my current sponsor says—and she’s one of these women in the New York Circuit that everyone knows and respects—as women in recovery, we learn to rely on ourselves and become people who are capable of trusting their own thinking again because we’ve grown and changed, and learned to do that.

Just like any other community on earth—your local government, your workplace, your book club, your yoga class, your MeetUp Group—you’re going to encounter personalities you don’t like and people who are overbearing and difficult to deal with.

But when we’re talking about changing and saving lives, it’s important not to toss any one approach under the bus. Explore alternatives, do what works for you, and keep in mind that just like one medication may help someone’s depression and do nothing for the other’s, different people respond to different treatment. Ultimately, there is enough room for all of us to exist here without putting one another down.

So please play nice.

5 Ways I Stay Sober Without AA

By Beth Leipholtz for TheFix

There are many ways to recover from alcoholism without 12-step programs. Here’s how it’s worked for me.

A woman standing and smiling at the camera, fingers pointing outward.

Four years ago, I got sober through an outpatient treatment program. The rehabilitation facility I went to followed the 12-step format and stressed the importance of AA meetings and a sponsor. In a way, I owe my sobriety to this form of treatment. I’m so grateful for it. For the first year or so of recovery, this is the format I followed because it was what I knew and it was what was working. But over time I found that I wasn’t necessarily comfortable at AA meetings. Part of it was the God talk, since I’m not necessarily religious, but it was more than that, too. The way sobriety was discussed just didn’t always click for me, and I found myself leaving meetings with a frustrated feeling hanging over me. Though I occasionally still go to meetings, I’ve stayed sober for three of my four years largely without AA involvement. Here’s how:

1. I have a recovery network online. The internet is an amazing resource for those in recovery. It allows you to connect with men and women all over the world, of all ages. There are various websites, chat rooms, Facebook groups, and more which are all about sobriety and recovery. There are hundreds of bloggers who cover sobriety and recovery from numerous standpoints. There are videos and podcasts. The list goes on. The internet has been a lifesaver for my sobriety. Not only has it allowed me to begin a blog and write about recovery, but it has connected me with many men and women who are going through or have gone through the same feelings and circumstances that I have. I’ve found that it doesn’t matter if we haven’t met in real life, that connection still exists because we have been through the same struggles and we’ve all decided to change our lives for the better. The women I have met through technology have become constants in my life and are always there to offer advice and love.

2. I have an outlet for stress and fear. Like many who are in recovery, I used to use alcohol to release stress and fear. Upon getting sober, that was clearly no longer an option. I had to find new ways to cope with my emotions, which was scary at first. I didn’t know how to just sit with them and feel them without burying them. I had heard from many people that writing about recovery was a healthy way to work through this array of emotions. Because I have always been a writer/journaler, this was the outlet where I found the most comfort. Since getting sober four years ago, writing has remained a constant in my life. I write when I’m happy, sad, frustrated, confused, hysterical. There is something about putting words down on paper that makes life seem just a little more manageable. Though writing has been a good way for me to find relief from difficult emotions, I’ve found I can only solve so much through words. I recently decided I needed another healthy outlet, something I could put my all into and walk away knowing I’d done everything I could. So I started Crossfit. To be honest, I don’t know how I managed stress and anxiety before I started working out. Moving your body and pushing it to its limits has a way of making the hard things in your life seem a little less hard. I still write often, but I also move often. Sometimes the most effective solution may be a combination of outlets that allow you to lead the healthiest life possible.

3. I think back to the way life was when I was drinking. This may seem like a small tool, but it’s a powerful one. Like most people in recovery, I have off days. I have days where I wish I could drink and forget about what is happening in my life. I have days where I want to feel “normal.” Sometimes I even consider what would happen if I did allow myself to drink. However, I can usually snap out of this mindset pretty quickly when I think back to the way my life was when I was drinking. Towards the end of my drinking career, my life was headed in a quick downward spiral. I had damaged many of the closest relationships in my life. I had let myself go physically and I often felt rundown or hungover. I wasn’t happy with the person I had become. I keep some photos of myself during this period of time because all of these things are reflected in the way I looked and the way I carried myself. When I’m feeling down about recovery, I look at these photos. And then I look at photos of the person I am today. And the choice to not drink becomes an easy one, because no part of me wants to return to that person I was before.

4. I keep words of wisdom on hand. Words are powerful, and there are so many words about recovery and sobriety out there. I have a board on Pinterest dedicated to quotes about recovery, as well as bookmarked blog posts on my phone. I’ve also saved emails or texts from people telling me they are proud of the journey I have been on. For some reason, revisiting words like these has a way of grounding me and making me remember why it is that I began this journey. In difficult moments, when I am wishing I could be more like other people my age, I grab my phone and pull up these quotes or blog posts or emails. I take five minutes to read, and after doing so I usually feel refreshed and remember why I set out on this journey four years ago. It was because I wanted a better life, and for me, drinking will never be the way to a better life.

5. I talk to people about how I am feeling and why. This is perhaps the most vital tool in my sobriety. Before getting sober, I disliked talking about my emotions. I felt like it made me weak to acknowledge that I was struggling and I preferred to just bury any difficult emotions instead. This often involved drinking in order to forget why I was feeling the way I was, which just made the feelings worse upon sobering up.

But when I found myself in treatment, I had to learn how to vocalize my feelings and figure out what was at the root of them. This was something I hated at first, but as time has passed I have become wholly comfortable expressing my emotions. Today I feel comfortable reaching out to the people in my life and asking for help. I can talk through my emotions and dig to the bottom of them to figure out what the root cause is and what I can do to get myself back on track. There are still days where confronting emotions is difficult, but it always proves to be worth it.

It’s important to note that staying sober without AA isn’t the right path for everyone. For some, AA is necessary in order to get sober and maintain recovery. And that’s just fine, because everyone’s path is different. Those living a life of recovery need to know that they have every right to find what works for them in their own personal journey. There is no right or wrong way to stay sober.

My Daughter, the Addict

By John Lavitt for TheFix

An interview with a mother and daughter about their journey through addiction and recovery.

Katie Donovan and Brittany Sherfield

After getting Brittany clean, the mother-daughter team have been spreading a positive message about recovery. Photo via

When Katie Donovan found out that her daughter Brittany Sherfield — a good girl from a loving family attending a suburban high school — was addicted to heroin, it transformed her life for seven long years into utter hell. Through her popular blog, A Mother’s Journey with her Daughter’s Addiction, Katie has reached countless thousands and helped many families to face their own struggles. Luckily, and through hard work, Brittany eventually found a path of sustainable sobriety, but her recovery did not stop the family’s advocacy efforts. Katie became one of the leaders of Families Against Narcotics (FAN). Today, mother and daughter often travel across the country, spreading a positive message of recovery. Together, they told their story to The Fix.

After a seemingly idyllic upbringing, Brittany progressed within a year from experimenting with Vicodin as a party drug during her senior year in high school to being a diehard IV heroin addict. How did this happen? When did mom find out about your drug abuse and what were the first steps taken?

After almost three months of snorting this powder, I woke up really sick. It felt like the worst flu in the entire world. I didn’t know what had happened. My boyfriend sat me down and told me I had been doing heroin for three months and that I was dope sick. I called my mom immediately, and we were both in shock, crying. We literally Googled what to do because the concept of addiction was so foreign to us. We had no idea how to detox, what to do for treatment, and so on.

Katie Donovan: When I learned of the prescription drug abuse, I first thought, “Okay, we can get her into some counseling, take away her privileges, and nip this in the bud.” This was nine years ago. At that time, I was absolutely blind and completely uneducated about the dangers of prescription narcotics, not to mention heroin. We taught our kids about the dangers of alcohol, weed, and drugs. I never even thought about prescription narcotics. Once she was spiraling out of control and turned to heroin, I felt so numb. I couldn’t believe this was happening. It felt so unreal, yet so painful at the same time.

I called a treatment center and was able to get her in right away. I remember driving home and I had to pull over. I was crying so hard, I couldn’t see through the tears. My chest was heaving, so heavy with emotion, fear of the future, relief she was in a safe place, shock that we were even in this position. Then I received a call five days later that she was being released. I couldn’t believe it. Five days wasn’t enough time, but insurance wouldn’t cover the cost of the rehab anymore. They felt outpatient was a better route because “she didn’t have a history of substance abuse.” I was heartbroken because I had seen my daughter firsthand. I knew how bad it was.

Yes, and when I say that Brittany was a diehard addict, it is not blown out of proportion. Over seven years, she experienced 17 attempts to get sober in a variety of institutions, overdosed three times, and ended up being homeless in three different states. Looking back, does the extremity of what happened astonish you? Beyond the disease of addiction, what other factors were fueling it?

Brittany Sherfield: Looking back, it feels like I am talking about a totally different person because the things I experienced now seem unimaginable clean and sober. Aside from having the disease of addiction, I was extremely depressed. I could be in a room full of people, yet I still felt completely alone. The drugs made me feel part of and connected. By being high, I obliterated the loneliness for a second and nothing seemed more important at the time.

There was a reason for this: My mom and I moved around a lot when I was younger. It was always to a better area or a better school, but it was hard on me. I constantly had to make new friends. It got to the point where I was so exhausted from trying to meet new people that I became a chameleon. I would blend in with any crowd no matter where I was, so I had no real sense of personal identity. I didn’t know who Brittany was and that scared me. But when I was high, I felt nothing—no pain, no loneliness, no sense of anxiety about not fitting in or being myself. Just peace.

Katie Donovan: I look back and have no idea how we made it through the addiction. Truly. I don’t think I slept for seven years. I was running on fumes and every day there seemed to be a new fire to put out, a new twist to the turmoil. I had to be a strong mom, trying to save my daughter, but I also had a full-time job, a husband and a younger daughter to bring up and care for. I experienced things that I never in a million years expected to ever experience in my life. Watching your child slowly die in front of your eyes, well, I wouldn’t wish that upon anyone. I’ve seen her in jail and witnessed her having three grand mal seizures. I once saw my daughter shoot up in a dealer’s car and nod out. I was so frightened that she wouldn’t wake up. We felt like prisoners in our own home, locking up items and being stolen from and violated. I slept with my purse and car keys under my pillow. It was just such a feeling of helplessness, beyond awful.

During the dark years of Brittany’s addiction, why did you never let go? Al-Anon recommends that you carry the message but not the addict. Do you feel that their perspective of letting go of the addict so they can hit bottom is too extreme?

Katie Donovan: In the beginning, I thought I could save her. I felt like if I could just “fix” all of her issues and bail her out of bad situations, it would make things better. I was the Queen of Enabling. It wasn’t until our family was several years into her addiction that I reached out for help. It was humbling to me because I was usually the one fixing other people’s issues. Why can’t I fix my own daughter? Clearly, whatever I was doing wasn’t working. I had to try another way.

That was the turning point. It was when I truly became educated about addiction. I learned to become strong because the knowledge I acquired gave me more compassion as opposed to anger in relation to the disease. Personally, I’m not a fan of “letting them hit bottom.” With heroin, any day could be death. I needed to create my own healthy boundaries, but you never stop loving. She knew I would always be there for her if she wanted help. Letting go doesn’t mean you have to stop communication. For me, it meant I have to let go of the chaos, but I would never let go of my child.

Brittany Sherfield: And that still means the world to me, Mom! I might never be able to forgive myself for what I put you through, but I also will never forget how you were always there for me. Year after year, even when I was homeless, I knew I always had a way out if I needed it. I also know I terribly abused that love.

Katie Donovan: You are my daughter, and I love you more than anything in the world. I’m just so happy you are healthy and happy now. From our experience, I know we can put the past behind us and live for today.

In A Mother’s Journey with her Daughter’s Addiction, you write about enabling and codependency. Can you tell how your experiences with enabling and codependency affected what happened? Going back, what might you have done differently?

Katie Donovan: Given the last answer, that question makes a lot of sense right now. I wish I had learned about enabling earlier in her addiction. What I thought was loving her at the time was really practically killing her. I did many things wrong; things that I thought were right, but weren’t in reality. I would spend hours and days printing out lists of AA meeting locations, job searching for her, making doctor appointments, all things that she could have done herself, and she should have been doing herself. I thought she couldn’t mentally handle it, due to her addiction. I really thought I had to take over. I thought I had to find some way to save her.

Once I found help for myself, however, I started becoming very strong. Ironically, once I became strong, she did too. I think she saw the change and realized I wouldn’t do the things anymore that had been enabling the addiction. As parents, when our child is an addict, we have to completely change the way we act in the dark shadow of this vicious disease. It’s not a natural course of behavior, and it takes some time to adjust. We want to fix things for our children, not have them suffer. We want them to be happy no matter what, but happiness doesn’t come if we try to do everything for them.

My husband said something to me once that really stood out. He said, ”Katie, if anything ever happened to you, I really don’t think Brittany would be able to survive.” And I realized he was right and how wrong that was: What had I been doing? What was I teaching her by enabling her? Helplessness? Just like those struggling with addiction have to work a 12-step program, families affected by addiction need to work on our own recovery. We need to work the steps as well to see how the disease affected us.

Dr. Gabor Maté believes that behind every addiction there is a childhood trauma that needs to be addressed. Brittany has written how, “This bubbly, outgoing, beautiful girl was secretly lost and self-destructive and ran to anyone I could fit in with that day.” Can you describe how you were secretly lost and why you were so self-destructive? What was the trauma behind the addiction?

Katie Donovan: This is a hard question for me to even think about it. I know it’s a question for Brittany, but it reminds me of the part I played.

Brittany Sherfield: It wasn’t your fault, Mom, and it’s not about you. There really wasn’t necessarily any “childhood” trauma. The traumas that I’ve experienced are significant and keep me up most nights, but they all happened during my addiction. As far as my childhood goes, the only thing I can say is that I do not know my birth father. Even though now I don’t care to know him, when I was younger, it felt like something was missing. I felt like I didn’t know the other half of myself. My mom is my best friend though, and she has always been there for me. I never felt unloved or unhappy. I can honestly say that I had an amazing childhood. What’s important to understand is that addiction can take over regardless of love and support. It’s that powerful.

Can you tell us how and why you became involved in the advocacy group Families Against Narcotics (FAN)?

Katie Donovan: I stumbled upon FAN when I was looking for support. I had attended Al-Anon, but it just wasn’t for me because I couldn’t let go like that. I tried FAN, and what I found there blew me away. It’s not just a group for those who have families struggling—it’s for everyone. It’s for those who are in recovery, those who are struggling, and those who have lost loved ones. It includes people from drug court, school districts, law enforcement, truly anyone who has been affected or would like to learn more about addiction. It takes a community to come together, and that’s what I found in FAN.

I started to volunteer and dove head first into their group. FAN is so much more than just a support group because that’s only one of the facets, and FAN is a real jewel with many facets. We go into schools to educate and create awareness, bringing both recovering addicts and those affected by the disease as our speakers. Real stories. Real lives. We also work with law enforcement, community leaders, physicians, dentists, and the legislature to continue our mission. I still can’t believe I’m now the executive vice-president of the organization. It’s such an honor.

Brittany Sherfield: It’s an honor that you really deserve, Mom. You have put so much work into FAN, and they are lucky to have you. Beyond helping me, you have helped so many others. I think I learned how to be of service to others by watching you.

Katie Donovan: Thank you for saying so, darling! That means the world to me. I have tried to be of service to other families and guide them. If I can help them avoid some of the pain, that means everything.

FAN president Linda Davis has said, “Almost every addict we come across started with a legit prescription or their drug dealer was their parents’ medicine cabinet.”

It sounds a lot like what happened to Brittany. How can such pharmaceutical abuse be avoided? What steps need to be taken?

Katie Donovan: What I have found is that silence is the number one killer. The more we talk about it, the more we educate, thus raising awareness and saving lives. Getting the doctors to limit prescribing large amounts, educating the public on how to store prescription drugs securely and dispose of them safely, letting people know that it’s okay to say no when your doctor offers you painkillers. It takes strength to say to a doctor, “I don’t really need 60 Vicodin. Maybe I don’t need any at all. Advil or Tylenol should work just fine.”

Brittany Sherfield: I’m not sure I could have said that back in the day. I don’t think I would have said that when I was a teenager.

Katie Donovan: I know, but that’s why it’s also so important for parents to monitor their teenagers when they go to the doctors because of a sports injury or to dentist to get their wisdom teeth removed. Parents have to be in control of all prescription drugs, both the decision before being prescribed and when they are prescribed if truly needed, for any underage child. By underage, I don’t mean 18 by the way. Given the obvious danger, I mean 21.

As mother and daughter, what were the respective worst and best moments of this entire experience for each of you?

Brittany Sherfield: The worst moments were knowing how much I hurt my family. I did so much damage, and it still shocks me to this day. They were feeling so ashamed, and that shame hurt me because I was the cause. I couldn’t bring myself to call my family, even though all they wanted was to hear from me.

The best moments were when my mom and I started working together once I found the path of long-term recovery. They were when I could sit down at a family dinner and honestly enjoy myself. My mom, younger sister and I could sit and laugh for hours. That was something we hadn’t done as a family in seven years. I regret the time lost, but I am so happy that we have recovered those smiles.

Katie Donovan: The worst was seeing my youngest daughter actually become scared of her sister. It hurt so much to see that fear in her eyes of her big sister. They are 12 years apart. She didn’t want her around, and she just wanted it to be over. She became so tired of the drama, of the letdowns, of seeing mom and dad worry and cry, day in and night out. That was very hard.

The best moment was when Brittany was early in her recovery, this one now that has lasted and become real. One Friday night, her younger sister wanted to do a puzzle. My husband and I were working on it with her at the kitchen table when Brittany walked into the door from a meeting. She sat right down with us and jumped right in. She was really with us. It had been so long since she had been really present as a member of the family. It was so beautiful. I had to take a step back because I was overcome with emotion. I was so grateful to have my family back together again.

In “My Daughter The Addict-A Suburban Mom’s Nightmare,” you write, “If you feel like ‘it would never happen to you or anyone in your circle,’ take a look around. It’s happening. You may not even know it.” What community-based steps need to be taken to battle the rising tide of drug abuse and the opioid epidemic in the United States?

Katie Donovan: I think community education is key. Speaking in schools, in colleges, at parent groups, coaches, athletes, churches, anyone that will listen. And don’t stop; you need to keep talking. Even after your kids find recovery, it’s not over. The healing process takes a long time, and we are still going through it, but it gets better and better. At the same time, it takes a lot of work.

I’m also on the executive committee in Michigan of an organization called Operation Rx. It’s a community-wide group with key stakeholders leading individual committees such as seniors, behavioral health, court system, education and prevention, data, dental, physicians, law enforcement, and legislative. All of these groups do amazing work. It really does take a village.

Republicans have been unwilling to provide funding for the Comprehensive Addiction and Recovery Act of 2016. Although they voted for the act, Republicans seem intent on leaving the legislation toothless. Presently, only 15% of Americans seeking recovery are able to access treatment services.

Given your personal experiences, what is your take on this?

Brittany Sherfield: It scares me because I remember what happened to me, and I don’t know if I would have survived without the support of the treatment opportunities that I had. Even when they didn’t lead to long-term sobriety, they still helped me to survive and keep going. I think they even kept me alive.

Katie Donovan: Yes, it really upsets me because people are literally dying while waiting for treatment. There just aren’t enough beds available. There’s such a small window of opportunity when they reach out for help. We are failing them when we ask them to wait three weeks. Even three hours could mean death on account of an overdose. It’s a fragile situation, and it’s also life and death.

During the election, Donald Trump’s strategy for addressing the national drug epidemic was to build a wall between the United States and Mexico to stop the flow of drugs. If you were in charge in Washington, what would you do?

Brittany Sherfield: I don’t like talking politics. You can take this one, mom.

Katie Donovan: I don’t like to do it either, but I do know drugs are coming from everywhere. They are available online on that dark web, and they are coming from China, from Canada, and, yes, from Mexico as well. I’m a big supporter of any preventative measures that can be taken. Washington needs to take this seriously and make changes fast. They need to be funding recovery and making sure that treatment options are available nationwide to anyone that reaches out for help. In so many tragic cases, they don’t get a second chance.

Do you have any last words for families in crisis out there?

Brittany Sherfield: Recovery works, but you have to be willing to take the first step. I once thought I was hopeless, but I wasn’t, and that’s important for people to know. There is hope.

Katie Donovan: Don’t stay silent. Reach out for help. Don’t let the fear of judgement or shame hinder you. You are not alone. There are thousands upon thousands of people, even millions, across the country who feel the same and share the same stories. Once I opened up and began talking publicly about this, I was shocked and amazed at the outpouring of support.

9 Things To Do Besides Drink When Life Gets You Down

By Beth Leipholtz for The Fix

Something that I thought was the end of my life was really the beginning, and that’s a powerful reminder when I am going through a difficult time.

A man with a big smile.

Utilize other tools–healthier ones.

Upon getting sober, you’ll be told many times that it won’t be all sunshine and rainbows. This seems like an obvious statement, as life has ups and downs. But the reason you’ll be told this is because you need to be prepared for how you’ll handle such ups and downs when drinking is no longer an option.

Lately I’ve been dealing with some hard things in life, things that feel beyond my control. I’ve been regretting past choices I made because of the current situation those choices have put me in. I tend to dwell on things like this, and they take up all of the open space in my mind and affect every aspect of my life. The old me would probably have started drinking in order to push those overbearing, anxious thoughts aside. But the sober me doesn’t have that choice. I know that today, escaping from myself isn’t an option. Instead, I need to utilize other tools—healthier ones.

When life has me down today, in sobriety, there are a few things I will do instead of turning to alcohol:

1. Reach out to friends and family. I’ve always had this option, but when I was drinking I didn’t lean on the people who loved me as much as I should have. In fact, I sort of pushed them away so that I could continue to drink. I felt uncomfortable talking about what was wrong in my life, like it made me less of a person to admit that there were imperfections in life. That was ridiculous, because everyone struggles. Today, I reach out to friends and family to talk about what is on my mind, and I know they will be there to offer everything they can. When I’m not drinking and burning bridges, it’s much easier to reach out to someone and know they’ll be there.

2. Work out. Working out has always been a good outlet, but I tend to forget that when I am in the throes of self pity. When you’re feeling down, exercising often feels like the absolute last thing you want to do. But it’s one of the best decisions you can make. When you exercise, it literally releases happy chemicals into the brain—mainly dopamine, which is a neurotransmitter that affects feelings of pleasure and happiness. Working out is also a good stress reliever and a confidence booster. After a good, hard workout, problems have a way of seeming smaller and more manageable.

3. Write a gratitude list. I only started doing this recently, but I know many people in recovery who like to do so daily. It’s as simple as it sounds—grab a pen and paper, and write a list of all the things you are grateful for. Seeing these blessings on paper after you finish is a good reminder that life is not hopeless. Even on the days when it seems like everything is going wrong, you have sobriety to be grateful for. And my bet is that you can come up with quite a few other blessings as well.

4. Remind yourself that the only day you can do anything about is today. I’ll admit it, I am terrible about this. I tend to think about tomorrow, next year, 10 years from now. I am a planner and find it difficult to focus on only today. But in the big picture, that’s the only day we can really do anything about. Much like sobriety, it’s about taking life one day at a time. Breaking life down into small, simple pieces makes it a lot more manageable.

5. Cry. Yell. Feel. I used to hate expressing emotion this way because it made me feel weak and vulnerable. But getting sober meant going through a lot of emotions, and now these are emotions I am comfortable with. In fact, I cry all the time. I cry when I am happy, when I am sad, when I am frustrated. Letting emotion out that way may not change the situation, but it can relieve a lot of the build-up you may feel inside.

6. Get fresh air. This may not work for everyone, but for me, being in nature is calming. It makes me realize I am a small part of a big world, and that my problems are equally as small in the grand scheme of things. If you live in a city, find a park. If you live in the country, go for a long walk, or sit and watch the animals interact. Fresh air has a way of hitting the restart button on my brain and I always feel just a little more at ease after spending time outside.

7. Do what you can with what you have. I like to feel like I have control over a situation, even though this isn’t always realistic—and I know I’m not alone there. But some things are just beyond our control. Still, I feel better if I can take little actions, like writing out a list of what I need to do or change. It’s a way of at least doing something so that you feel you have some sort of control over what is going on.

8. Write—even if you are not a writer. Remember, no one has to see what you write. Grab a pen and a notebook and just put your thoughts down somewhere. Doing this is better than letting them all swirl around in your mind over and over. Journaling is therapeutic, and is recommended in many situations. Though it won’t necessarily change anything about your current situation, it may change your mindset, which can be helpful. Attitude and outlook go a long way when it comes to dealing with struggles.

9. Remind yourself of other hardships you’ve overcome. Whenever I feel like my world is crashing down around me, I like to remind myself that I also felt that way the day I got sober. I didn’t want to get sober, and I was convinced my life was over. I felt hopeless, helpless, empty. I didn’t think I could possibly feel full ever again, let alone enjoy sobriety. But in retrospect, sobriety was the best thing to ever happen to me. Something that I thought was the end of my life was really the beginning, and that’s a powerful reminder when I am going through a difficult time. Things have a way of working out as time passes, and they may even turn into blessings.

The bottom line is that problems don’t have to be solved by drinking. There are many other ways to adjust your mindset and your attitude, and even to take action when life gets tough. It’s just a matter of having the tools and knowing you have options.