A Controversial New Cure for Alcohol Dependence - Katie Herzog

Talk to me about your relationship with alcohol. >> Oh gosh, it's a complicated question. So, my relationship with alcohol started very young. I started drinking or I had my first drink when I was in middle school. I don't know if this is something that 12-year-olds do these days, but uh but back in my day, 12-year-olds drank, or at least they did in my school. And I I loved it. I loved it from the very beginning. Um, even before I was sort of old enough to appreciate the the taste of a good glass of wine or a cold beer, I like the effect. And so I drank in in high school, I drank more in college. And by the time I was out of college, I was a barfly. So I spent a lot of time sitting on bar stools from 400 p.m. until late at night, oftentimes with men who were because these were the sort of people who would who would be at bars drinking during the day. Like men in their 50s and 60s. these were these were my people. Um, and I I lived like that for a really long time. I was a party girl, so I was a lot of fun back in those days. I gradually got less fun the more my drinking accelerated by the time I I quit in my late 30s, early 40s. I wasn't a party girl anymore. Most of my drinking was done solo and in secret. Um, but that was it. And this was not this was not abnormal among my my peers and my friends. I my life was lived in bars. This is what my friends and I did. And there were, of course, consequences to this. Some of them pretty terrible. Um, I went to the hospital a couple times. I uh I very memorably burned down a porch at one point. I had trouble keep I see I see your your brow is sort of furrowing here. Do you want to know how I how I burned out a porch? >> Yes. So this was actually one of the times when I was I thought I was being a good girl. So I stayed home on like a weekday night which was rare to me at this period of my life. This was in my late or my mid20s. I spent when I say I went to I was a barfly. I was at the bar almost every day. And luckily this was at a time when when Paps Blue Ribbon was a buck 50. You tipped 50 cents. So I was not didn't have my bar tabs were hefty for the amount of money that I was making. But still my drinks were cheap. And so I stayed home one night thinking I'm doing the right thing and I was also a smoker and I uh and ironically I was I was watching uh this this fantastic television show. I can't remember what it was called but it was about the the NY the New York City Fire Department. Uh Dennis Liry was in it. So I was drinking at home by myself taking regular cigarette breaks and watching this TV show. And on one of my cigarette breaks I uh failed to extinguish a cigarette. I just like left it burning outside and it lives in an apartment building. I I walked outside. I saw some smoke and like a a fairly significant hole in the wall where the vinyl siding had started to melt. I went and got a glass of water first. Tried that. Splashed it on. It didn't work. Went and got the fire extinguisher. Tried that. That didn't quite work. It was still burning. And then I called 911 and they said, you know, this is 9 this is 911. What's your emergency? And I said, "Well, I'm not really sure if this is an emergency. I'm really more looking for advice." And so, I wanted them to reassure me that I don't know what I wanted. I just didn't want to get in trouble, basically. Eventually, they did come and I had to bang on all of my neighbors doors and tell them that the apartment building was on fire. And um while the fire department was in my house dragging a hose through my carpeted living room floor out to the balcony on my bedroom, I was outside in a patch of woods drinking vodka. And the next day, all of my friends knew about this. I lived in a really small town. I woke up to a friend of mine shouting from outside, "What the [ __ ] did you do?" Um, so everybody knew about this and frankly thought it was hilarious because that's the sort of community that I lived in. And I thought it was hilarious, too. I mean, terrible, but also hilarious. So, I had lots of sort of misadventures like that. I had trouble holding on to jobs. I dropped out of college once. I dropped out of grad school once. I did finish college. I didn't finish grad school. And alcohol just really dominated my life for my teens, 20s, and well into my 30s. Um, and it got gradually it got less fun and it got kind of more depressing as the as the sort of friendships evaporated as everybody else kind of got their [ __ ] together or didn't get their [ __ ] together and and died. Frankly, a lot of people I know from those days from those days are dead. Um, and at some point I realized I was just sort of drinking alone. You know, the last one at the bar except the bar wasn't a bar. It was my house. And I was by myself scrolling on my phone during COVID drinking alone as much as I could. I don't know whether you know but the first 15 years of my adult life was spent as a club promoter. So I ran I ran nightclubs for a really long time. >> We would have gotten along really well in that period. >> You I would have made a lot of money from you. Yeah. >> Um I often think about this that the way that party culture and I'm not sure if it's the same now. I genuinely don't know if Gen Z has kind of adopted the Ly Larry drinking culture that I knew and and and you would have known as well. I mean, the British, it's kind of a national symbol for us. >> Yeah. >> Um >> I often do think about how many people >> were just in the party enjoying themselves, these events that I used to run. Um and most people you expected to kind of age out of them to sort of graduate out of the young party lifestyle. Um, but you know, I did a million or over a million lifetime entries across my career as a a club promoter. So that's a pretty big sample size. >> Yeah. >> And I do wonder, you know, how many of these people saw the thin end of the wedge, which was, well, this is fun and I'm I'm with my friends and there's a good DJ on and there's music or there's whatever. But that that is kind of this gateway that out the other side of it introduces them to a frequency of use and maybe not even just alcohol. Um, how many of those people went on to Yeah. kind of be uh more dependent? They were It was 4:00 a.m. in the nightclub and they were still there, but the club was closed and no one else was around. >> Yeah. It's probably not an insignificant number. Not that this is your fault. It's probably people were probably going to find their way to addiction uh anyway. They any you know, no matter what happened, whether you had been there or not. You know, you're right in the in the fact that most people do actually age out of problem drinking. Most people who binge drink during college don't continue to binge drink into their 40s and 50s. It's called natural recovery. This was a concept I was completely unfamiliar with until I started writing my book. But this concept, natural recovery, this is more common than not. And most of my peers from my college days did gradually sort of get their [ __ ] together. you know, they got into relationships, they got careers, they had children, and the ability to be hung over on a Wednesday morning just sort of slowly evaporated and they shifted as their lives did. I didn't. I was stuck in that pattern of behavior until well beyond the the the age when I should have been. So natural recovery is somebody who drinks heavily when they're younger and then has their ability to drink and be hung over gets constrained by real world responsibilities. That is that it in a in a nutshell? >> Yeah, that's that's basically it. People who natural recovery is people who don't take any any sort of proactive step to recover from alcohol use disorder. Alcohol use disorder, you know, what is commonly called alcoholism is a vast spectrum. And for a lot of people on that spectrum, they don't have to go talk to a therapist or go to an AA meeting. They just naturally age out of it. >> And that's the ideal. That's what I wanted. I thought that was my hope. I knew that I was a problem drinker from a very young age. But my hope was that some future me, some older, more mature me would be able to just sort of, you know, take it or leave it. This doesn't work in my life any for my lifestyle anymore. I'm done. It just never happened. I took sort of it took kind of brute force for me to actually get over my my habit. >> So you knew quite early on that this was a category of drinking that maybe was even different to some of your friends that this wasn't just party drinking. >> Yeah, I knew from my early 20s. I had my sort of uh my first come to Jesus moment. Okay. Uh I was I believe 24 and I was going through my first really serious breakup and um I had let's just say I behaved in some ways that are not optimal to a healthy relationship. I cheated on my girlfriend and when I was confronted with that fact when she discovered this because this was back in the in the MySpace days when she when she read a message that I that I wrote to a friend of mine sort of confessing to my friend what I had been doing. My girlfriend at the time, she um she came to the bakery where I worked. I had a brand new job. I was a barista at at a bakery in in Portland, Oregon. And um she walked in and she she said, "You [ __ ] cheater." And then she slapped me in the face. That was my first come to Jesus. Then she kicked me out of the house. And so it was like a you know, like a bad romcom where all of my stuff was was out on the on the on the on the lawn. And that was my first moment of being like, "Oh, something is deeply wrong with my behavior." And either I'm a bad person. Either I'm a sociopath or I'm an alcoholic. I also for a brief period I convinced myself that it wasn't the problem wasn't drinking because I didn't want drinking to be the problem because if drinking was the problem then I had to quit. I would convince myself like I convinced myself that I I went to a psychiatrist and he told me I was bipolar. Not bipolar 2 which is sort of bipolar light but like bipolar one. And I was like hell yes that's it. I'm not >> my drinking sick. My drinking actually helps my bipolar. >> Exactly. I I'm not bipolar. I kind of not that I wish that I was, but I'm like just sort of fundamentally sort of a low energy person. I'm not bipolar. Um I was, you know, I do things like, you know what, it's my astrological sign. I'm a Gemini. That's just what this is. It turns out I'm not a Gemini. I'm a Taurus. Um and astrology is also [ __ ] Um, but at the time I was sort of looking for any any plausible reason that would explain my poor behavior besides alcoholism. And I lived in there's this term, I don't remember where I read it, but this vacasillating denial. So at times I would I was very aware that alcohol was the source of my problem and then I would sort of convince myself that it was something else. Um, and I did and in in one of those moments I did start going to AA. One of those moments of of sort of realization I did start going to AA. It didn't work for me, but I went to AA at various times over the years. And so I lived like that for about 15 years about um, you know, sort of knowing that drinking was a problem, doing things to try to curb my drinking, quit drinking, moderate my drinking, but ultimately I was never able to string more than 30 sober days together. What makes me really, it's like an odd irony, you having this kind of embarrassing, potentially fatal story where you nearly burned down an entire apartment. >> Oh, that's not what even one of the embarrassing ones. >> Okay. Well, the the rabbit hole goes deep. I'm excited to learn more. Uh, but my even the point on that is what was the response from all of the people around you? And I did my master's dissertation was on the effectiveness of anti-alcohol advertising on students at Newcastle University. >> And one of the things that I learned when I did that research was >> people especially in the UK, but we can assume in the US as well, they see those crazy stories as rights of passage. They're almost like badges of honor that you wear. Um, and you know, the the movie The Hangover was an entire movie about this. That's that the whole narrative was you do stuff when you're drunk and lol that's funny because everybody does that stuff and it's a weird way of sort of um releasing inhibitions and you're kind of less culpable for what happens the next day. We know that that wasn't the real you, but there's this other version of the world that everybody can kind of step into a little bit. And uh it was basically that when you see things as a right of passage, it's very hard to have interventions because if you ask somebody, "How was your night last night?" And they said, "Dude, it was amazing. John lost an eye." And you're like, >> "Yeah, >> that's a good night." >> Really? Yeah. Is that cuz usually, you know, if that was a sports game, that wouldn't usually be that. And uh it's a just a weird upside down sort of topsyturvy world. And I suppose as well that must allow people who have problem drinking to uh couch and hide and delude themselves into well, you know, like I'm just a fun hang. Yes. >> Like I don't have a problem. I'm just a I'm a vibe. Like you know these people are just balls. >> Yes. No, that's exactly how I felt. And that was completely normal within my peer group. And the thing that it took me years to realize is that that's not actually normal. It's not. There are v there are many cultures in this world where alcohol is not a regular part of the culture. Talk to Muslims. You know what I mean? Like there are just it you do not have that does not necessarily have to be a part of your culture. It just was such a part of my culture for my entire young adult and adult life that yeah I was I was so judgmental of people who didn't drink or people who didn't drink as much as I drank. >> Part of that was because I think psychologically it was a little threatening. like anytime I knew somebody who got sober, it felt like a betrayal. How could you? How could you do this to me personally as it had anything to do with me? Um, you know, but it was also just a reminder that there are other ways to live and that life can be can be actually better with alcohol, which I generally didn't believe. And this is one of the reasons I I really bristle at AA because I would go to AA meetings and I would hear these these people who lots of them old-timers who talked about how much better their lives were sober and I I thought they were lying. I genuinely didn't believe it because I could not conceptualize that a life without alcohol would be worth living. It was as though I would it was it would be like living without food. How could you do this? I could not conceptualize it because everybody that I knew drank and that was such a part of my identity. a part of everybody's identity. >> It's woven into your lifestyle, right? Beyond just what the drug is doing to you. It's how you bond. It's the place that you hang out. It's the social group that you are around. It's the um way that you get a sense of selfworth and that you um are a part of a community. It's a ritual that you do together. You know, it's not just the thing. >> And the community is such a vital aspect of that. And I think that is, you know, I'm not I don't drink anymore, but I'm not one of these people who thinks the world needs to be tea total. In some ways, that would probably be better. But alcohol in community, it it is such a bonding experience. I feel that way about cigarettes, too. Going outside and I think this is I think the decline of smoking actually has had some negative effects. And part of that is bonding over a cigarette. going outside and asking somebody to bum a lighter from somebody, you end up in conversation with people. You know, the same thing the rise of the cell phone when I in the over the last five years, like if I went to a a bar in the early days of my drinking, I might bring a book and I would sit there and read a few pages of the book, but really the book is there as an excuse for somebody to ask you what you're reading so you can enter into conversation with somebody. Other if I just wanted to stay home and if I just wanted to read, I'd stay home and read by myself, right? Phones don't work like that. Nobody looks at you on your cell phone and says, "Hey, what are you scrolling?" You know, "What meme is that?" And so there is there's such a social aspect of that of that aspect of of American and British culture. And I think it it really does add a lot of value to people. The problem is just that for some people, it doesn't stop there. With making friends, it it leads to other things. Job loss, health effects, legal problems, death, you know, small things like that. M you talked about multiple rock bottoms throughout your 20s. >> Yeah. >> Was there something about a final one that really propelled you forward or was it a a cumulative thing over time? >> Oh, none of the rock bottoms didn't matter at all. It was really not that didn't help. There was always a lower rock bottom. And I I I saw a therapist for a while who said to me, you know, uh this ends in one of two ways or I guess maybe three ways. It ends in jail, it ends in death, or you or you recover. And I thought, well, recovery is clearly the worst option here. Jail jail sounds fine. I'll just do that. You know, and I think one thing that's common with a lot of problem drinkers is that you sort of you almost crave the rock bottom because you think, you know, if I if I go to the doctor and the doctor tells me I need a liver transplant and I get one more drink, that's the one that's the one's going to kill me. Then I'll get my [ __ ] together. Then I'll quit. I need I just need one more DUI. One more DUI and then I'll get my [ __ ] together. The problem is even even that level of consequence, people do respond to incentives. But even for me, negative consequences were never really able to make me moderate or or quit drinking. I just couldn't do it. >> What's the lesson that you take away from that? That >> if somebody loves alcohol a lot, they need to really really really really hate something else way more in order to be able to compete. And most people that are alcoholics don't hate anything as much as they love alcohol. >> No, I don't think it's that. I don't think it's I mean alcoholics do love alcohol. Yes. But like I know that I love my family and my dog especially more than I love alcohol. I know that cognitively. But no matter how many times I woke up and told myself that today would be different. Today I'm not going to drink. My brain had been hijacked by alcohol. I felt unable to make rational decisions. You know I wake up in the morning today will be different. I'm not going to drink today. By the time noon rolled around, any sort of willpower, any desire, my own, you know, sort of rational thinking desire was out the window and I was out the door on my way to get alcohol. I was completely out of control. I I mean, there's a a very well-known phrase within AA, your life has become unmanageable. You are powerless over alcohol. That's I did not get sober through AA, but that was absolutely true. It's wasn't because I love booze more than my I love my wife. was because I had no control over it. >> What have you learned about the way that uh alcohol addiction particularly sort of shows up in the brain? The the mechanism of how this works, the reward signaling, uh the different types of alcohol use disorder like what have you learned about this? >> Yeah, so I learned a ton about this while I was working on the book. So to simplify things, there are basically two types of of problem drinkers of alcoholics. An alcoholic is a term that a lot of people bristle at, but I use it because everybody sort of can can it's easy to conceptualize what an alcoholic is. And and again, alcohol use disorder is a vast spectrum. So this could be somebody who just drinks one glass of wine that she doesn't necessarily want or someone who's like fully pickled pickled her liver. And I was like somewhere not on the middle, somewhere on sort of the far side of that spectrum. Not by any means the worst though. So when I drank alcohol, I got a a euphoric buzz. It was for me it was almost taking a little bit of caffeine or a little bit of cocaine, right? Didn't make me sleepy. It made me energized. It made me talkative. Um it made me obviously make poor decisions uninhibited. You know, I'm I'm gonna go sing karaoke on a some ter some I'm gonna go like rap the water the the TLC song waterfalls in front of all of my friends and feel great about it. At one point I now this part is actually embarrassing. I was in a band and my role in the band was not to sing or to play an instrument. I wore a horse head mask and I danced around wearing pasties holding a machine gun. And I did this on stages in front of other people. That's the sort of thing that I would do when I was drinking, right? So, very very energetic, very much the life of the party. At least in the earlier days. In the later days, it was just sort of depressing and alone. But in my party days, I was very fun. So, for people like me, you get uh you get a rush of endorphins when you drink, right? And that that uh indirectly affects things like dopamine and serotonin, but you get a high for other people. And these people can still have a drinking problem, but other people get a sedating effect from alcohol. So, they're not getting that big rush of endorphins. What they get, it calms them down. Uh, for people who drink because they have like severe social anxiety. Um, alcohol can can help with things like that. So, and and to complicate things further, some people have like elements of both. Um, but so that's one thing that I learned that alcohol really does have very different effects on different people. Also, my wife, she does not have a drinking problem. She drinks, she'll drink a little like almost like a shot glass size glass of like sipping wine while she's cooking dinner. It doesn't make her energized. It's not like having a little shot of cocaine or Red Bull for her. It makes her calm. It's a chill thing. It's sedating. Um, and so for people like her, it's just I don't think she'll ever have a serious drinking problem because she doesn't she she doesn't get the the really strong effects from alcohol. She just sort of gets sleepy and slow. And >> have you got any idea what the difference is between the you bucket and the her bucket? >> I'm sure there's probably some biological response to this. And I I think this is still sort of an open question. Um the drug that I took ultimately took. Do you want to get into that now? >> Let's let's just round out the the the rest of this stuff because it's super exciting. I think the process that you went through to get sober is just so fascinating. Um, but I I would put myself in uh kind of both categories. I think when I was in my 20s, I was probably more you and in my 30s I'm probably more your wife. >> Yeah, that's interesting. And there so there are particular risk factors for people who develop alcohol use disorder. And one of those is is just gen is just genes. What is your you know is there a history is there a history of alcoholism in your family? Another one is the age at which you at which you start drinking. And a third and really important one is repeated exposure. Uh trauma can also be a risk factor. I didn't have any trauma in my background, but those three other risk factors, genetic history, uh early exposure, and repeated use, I had all three of those risk factors. And if I had had two, you know, a genetic history and I started drinking earlier, but I drank once when I was 12 and I just never did it again, I wouldn't have developed alcoholism, right? It really was all three and everybody's different. You know, there's sort of we make sort of generalizations about this because everybody's different and it's hard to make hard and fast rules. >> Why do you think the early exposure thing makes a difference? It's just habituation. It's part of your development. >> I don't know. That's a good question. >> Maybe a selection effect that if you start drinking young, that's because you like it. >> Sure. >> In some sort of a way. >> That could be part of it. But and you know when I was growing up it was not uncommon for at least in my sort of I didn't go to a like a particularly bad or good school sort of a very standard American school. So I guess I mean sort of bad and that wasn't I wasn't really an outlier within my peer group. Everybody drank and I don't think everybody developed a a you know an addiction later on. >> Yeah. That's interesting. And I think you make a distinction between uh relief drinkers and recommend reward drinkers. >> Yeah. >> Right. Right. >> Yeah. >> What would you have put yourself into? Because it seems like >> it seems like after a while anybody that's been a reward drinker ends up becoming a relief drinker. The relief from not being drunk. >> Yeah, I think you might be you might be on to something there. I was definitely a reward drinker. Um, even at the end I wasn't for me it's like the difference between the first drink and the third drink I would start to get that euphoria right that high even even I when I even though I knew that I was going to regret this later on chasing that buzz became really paramount to sort of everything that I was doing. I was looking for that it's not even a long period of time. There was maybe like a 20 minute period between the first drink and the second drink or the second drink and the third drink. That felt really, really good. And pretty quickly, you know, by the fourth drink and the fifth drink, that euphoria is gone. I kept drinking in order to chase that buzz, but you unfortunately cannot recreate it. Um, and then at that point, you know, I would get sort of slower and sloppy. Um, but yeah, a lot of my drinking was was in in the in the effort to capture this one very specific feeling where I think my endorphins and my and my dopamine is just raging in my brain. >> And that's at the very start. So yeah, interestingly, if I guess what is it the the top 10% of drinkers drink half of the alcohol, something like that. >> It's something like that. >> It might even be more than half. It's a it's a massive amount. So I wonder how many people that means that 50% of the consumption is done by 90% of the people some something in in that sort of region which means that maybe lots of people are able to just get that first drink buzz that one or two drink buzz >> and then not continue on. So it's interesting. >> I mean there is a a a survey came out recently. This was either Gallup or Pew or something like this. some survey came out recently that when you look at least this might be different in the UK but Americans the average American does not actually drink that much right so only about half of Americans drink alcohol period it might be something like 54% I'm forgetting the exact number and among that 50 something percent most people drink within the recommended you know CDC guidelines which is a very moderate amount I think at this point it's like three or four drinks a week for women, maybe seven for men a week. So, so basically one alcoholic drink a day, no more than three in one sitting ever, things like that. So, most people fall into that category. The people with I mean, one in in 10 Americans fall into the category of of uh of qualifying for alcohol use disorder. So, it's still a massive number of people. We're talking about 30 million people in the United States, but that means nine out of 10 people are basically fine when it comes to this issue. >> What did you try before the uh elusive mysterious strategy that we're about to talk about? What uh what were the different things that you did before that? >> So, I did AA uh can never really stick it out. Um, I did individual therapy, I did group therapy, I did these sort of um, cognitive behavioral therapy things like um, um, moderation management, smart recovery that have sort of less of a of a faith-based element. So, these are things like tracking your drinks, just sort of strategies to to drink less or to um, or to take more control over your alcohol consumption. drinking a glass of water in between alcoholic drinks, that stuff all went out the window for me pretty quickly because as soon like it was on as soon as I had my first drink. Like any pretense of of moderation was just on cuz like that's I drank to get [ __ ] up. I didn't drink to like enjoy the taste of Pep's Blue Ribbon, you know, the fine effrovescence of a shitty beer was never really my thing. Um, so I did stuff like that. And then I would do these like like I did the master cleanse at one point, which is this idiotic uh you you don't eat solid food for 10 days. You drink cayenne, lemon water. I lasted for like three days and then I went to the bar. Um, so I I broke my fast with with alcohol. Um, I would do stuff like that. You know, I'm gonna get really into yoga. That's going to solve my problems. I'm gonna Sam Harris's meditation app is going to save my life. I tried stuff like that. Um, outpatient therapy. So I like group therapy with other people um who had who had similar problems that was particularly I would say ineffective for me and a lot of that was also based on principles of CBT. So going to these therapy sessions and you know I I have a worksheet and I like write down the names of four people I can trust and I would write down like my mom, my dad, my sister, and my favorite bartender. So that stuff just it just never really worked for me. And a part of that was honestly probably because I didn't take it seriously enough. But I did, you know, I would show up. I I I did try things. I never did rehab. Um but I did try lots of other things. It sounds like white knuckling it with willpower isn't an option then. >> I tried that. I tried that every day. It just I'm I'm like a a weakwilled [ __ ] I just don't I don't I don't I've said this before, but for me, you know, every day at the gym is day one because there's never a day two. I've never been good at forming healthy habits and quitting bad habits. I sucked my thumb until I was nine. Like I have always had a very sort of addictive obsessive personality and a lot of people who get sober are me this seems particularly true of men are able to channel that into fitness or adventure sports. Not me. I wish I really wish I think maybe if I had a maybe if I start like micro doing testosterone I'll be like yes I'm gonna channel all of that energy into doing >> become an iron man. Yeah. >> Yes. Yes. I'm not gonna become I might like you know watch 11 hours of television in a row. I can I can binge something like that, but I've never been good at sort of the healthy habits. >> There is definitely a sense of uh the guys the sort of classic mid30s, mid-40s pivot toward endurance racing. I think I I mean it's fantastic to to put your efforts into something which is great for your health and very difficult to do and inspiring and all the rest of it. Uh but I wonder what you're running from. I wonder what And that's not everybody, but it is it is it is lots of people. And I suppose you know for me I have found a bunch of different outlets that training has been one of them, meditation's been another. Uh if you don't have the capacity to sort of build that structure together, >> then that outlet is entirely preluded to you like that that avenue. You don't get to be the guy going and doing an iron man. You don't get to be the person who I'm going to go and do a 10day silent meditation retreat. My meditation's been so great recently and I've been really loving it and that's where I've been putting all of my effort and I actually get dopamine and I get reward chemicals from the progress that I'm making in this new avenue here. I'm going to start a new business or I'm going to, you know, whatever [ __ ] crocheting, you know, pickle ball, whatever you do. Um, if that's not something that appeals to you because the bad habits are so hard to break and the good ones are so hard to instantiate, >> you're it's it's making it even more of a headwind to try and sort of fly into to get out of this thing, >> right? And and those things, you know, I don't have kids. I'm married and have a dog that I'm sort of obsessive about, but I don't have kids. I think for most people, like I have the I'm a podcaster by trade. like I would have time to get like deeply obsessed with fitness if I wanted to. I maybe don't have the sort of um fortitude to do that. I think for most people just living life like taking care of your kids, driving your kids to soccer practice, that [ __ ] takes so much time that these sort of other like having a having a hobby that you get deeply obsessed with like maybe during retirement, but I think for for the average the average person is probably just trying to you know kind of get through the day like they don't really have time um for for that kind of thing. alcohol use disorder in that way is kind of a luxury problem to have. >> Well, it it seems like such a it seems like such a silly way of putting it because it's such it's so damaging to one's life and it is not as though like there's no need to do a privilege disclaimer like I have the I had the privilege of becoming an alcoholic because I didn't have children because so many people you see who who suffer from alcoholism are are truly down and out. Although I although I think like the the stereotypical homeless person uh person living on the street now is probably alcohol might not be I I think I I live outside Seattle so we see more of like the fentanol lean than we do with like a bottle of wine in this bag these days. >> Yeah, it's uh it's unfortunate to think that there is there are sort of different levels of challenge that people can come come up against. How susceptible are you to the substance and then how nonsusceptible or limited are you in potential coping strategies or other uh modes of reward, other avenues that you can go down. >> Yeah. And alcohol, it's sort of a rest development in a lot of ways. So developing those coping strategies. If alcohol is the coping mechanism that you have used from your teenage years into adulthood when something goes wrong or something goes right, that's one thing about getting sober or recovery or even getting control over your drinking. You have to learn new coping mechanisms. And that can be hard to do when you're in your 40s or 50s and and your response to uh to trauma or tragedy or even, you know, positive news has always been to grab a bottle. M what does the history of addiction treatment philosophies look like? I from the outside it seems to me like AA was the gold standard. I I know that in every TV show that I watch it's always that and the person always usually ends up being okay because the community and their faith sort of brings them back around. >> Um but it seems evidently like it's not a panacea for everything, >> right? It's not a panacea for everything. Um, so the history of addiction treatment is pretty fascinating. So in the early days before programs like AA and obviously alcohol addiction has has I think probably existed as long as alcohol is and the first traces of of human consumption of alcohol was was found in some like pottery some clay in China from from 9,000 years ago. Some traces of rice wine or something like that. So people been drinking for a long time, right? And you can see in in early writings and the arch archaeological record that there's some there's some record of not like long-term treatment programs, but like somebody that you would you could somebody somewhere that you could go to dry out, right? And so that that was sort of the the early days of alcohol treatment were not based on long-term long-term sobriety or long-term recovery. it was just a place to go to dry out to basically survive withdrawal. Um so there were so so for instance the um the guy who who created AA his name is Bill Wilson before he created AA and this is you know uh pure he wasn't the first person to start a peer group but but certainly probably the most successful in in western history at least he went to this hospital in New York called it was called the town's hospital and he went there four different times and every time he would go they would give him the the treatment duour which was um it was a it was Belladon A which is basically a hallucinogen. It's a poison. And they would give give their patients this and and uh and they would withdraw using this substance. Apparently a pretty pretty painful pretty horrible experience. These days withdrawal can be managed with sedatives and bzzoasipams. And it's not like so I I thought going I'd never done a like formal withdrawal before I started writing this book. And my sense of what withdrawal would be would be painful, right? You have the DT, the delirium trims, the shakes, you're ill, you're sweating on a floor somewhere. I had to absorb the message of of alcohol withdrawal from literature and from from pop culture. These days it's totally different. You can go to a go to a go to a center basically sit in a recliner for a few days and they pump you full of vitamins and give you some some medication and you're fine within a few days. This could even be done at home as well. But in the early days it wasn't like that. Um and there were all sorts of of sort of uh maybe not super effective kind of miracle cures um that that were that were marketed at the time. And then and then Bill Wilson in the 1930s. So this is this is a guy who'd been a stock broker. his life had absolutely deteriorated and he uh he got he was at the at this Charles Towns hospital and he had this sort of come to Jesus moment. He had a this might have been a a a Belladon eluc hall hallucination, but he had this this moment where he saw a flash of of light and he and he was sort of reborn in that moment as a sober man. And then at some point so he stayed sober for several months and then at some point within the first I think six months maybe four months he was on a work trip in Akran, Ohio and he was fighting the urge to drink. There's um there's this concept called alcohol um excuse me what's it called? I'm forgetting now. the alcohol deprivation effect, which you might think that once you go through a period of abstinence, the desire for alcohol weakens, but that's not actually what happens for a lot of people. So this concept, the alcohol deprivation effect basically means that once you go through a period of abstinence, your cravings can return stronger than ever. And so Bill Wilson was going through that. And so he uh he had joined a b what is basically a temperance society and he called he called some like locals that he found through some kind of phone tree thing and he and he encountered this man who was a doctor in Akran Ohio. His name is Dr. Bob and they got together and they sat and they just talked about their problems for six hours and that was the beginning of Alcoholics Anonymous. And so they started doing this. They started having meetings of of people who had gone through this experience and just they would sit in a room and they would talk about it and they came up with these you know the the 12 steps the 12 traditions. They added some structure and one of the early members of this group was a woman. She was one of the first members or the first she was one of the first female members of AA. Her name was Marty Man. Good old dyke. She was a she was a lesbian although I don't know if they used that word at the time. And uh and Marty man had she had spent a lot of time in the UK. She came back, passed out on a stretcher, had to be carried off of of whatever ship like Queen Mary HMS whatever whatever had to be carried off this this boat. Came back to the US and continued to drink, right? And so she was killing herself like mo like many alcoholics do. Uh just suicide attempts, drink waking up and drinking gin every day, just life deteriorating. And so her doctor told her that she needed to go to this go to this alcoholics anonymous meeting and she was resistant but she did it and she said that she found her people and Marty man was absolutely essential to the spread of the gospel of Alcoholics Anonymous because she had a background in PR. She was very well connected. So she used her connections to get AA in Hollywood movies and on the cover of magazines and she is probably more so than even Bill Wilson or Dr. Bob, the founders of AA for spreading the gospel of AA. And she also did something else which she wanted to lower lessen the stigma of alcoholism because alcoholism at this point had was really considered a moral failing. And so she she sort of conceptualized the disease model of AA. And a lot of people have a lot of people assume that AA sort of preaches the model that preaches the idea that that alcoholism is a moral failing. They actually don't. they really rely much more heavily on this this medicalized model. I have my issues with that with that sort of framing. I actually don't think that alcoholism is I don't think it's very helpful to call it a disease because it's not like cancer. It's it's different, right? And um anyway, so so she she spread that message throughout throughout the land and that is one of the reasons that AA became as popular as it as it did because it had a really good really good PR team. um right and aa there were lots of other treatments throughout throughout history things like um there was a clinic called Shik Shadel that did aversion therapy right different societies different cultures they lots of cultures have come up with potential solutions to this program to this problem but AA at least in the United States sort of eclipsed all that for almost a hundred years and now I think what we're seeing is a broadening of the options because AA does work really well for some people. It offers, you know, community, support, accountability, a place to go, which can be really important if what you do is go to a bar or drink at home. Just getting people out of their out of their their environment is really valuable. And I know many people whose lives have been saved by AA, but it doesn't work for anyone. I'm sorry, it doesn't work for everyone. And so what we're seeing now um with the rise of of groups like Sober Curious and there are apps, there's one called Reframe that I keep getting ads for on Instagram is sort of a a broadening. I think I think the the cultural strangle hold of AA is lessening a little bit. That doesn't mean it still doesn't exist on some level. Like courts can mandate that people who get in trouble with the law go to AA. um professional licensing organizations. If you get if you're a like I went to meetings not that long ago where there was a pharmacist there and he wasn't there because he wanted to be there. He was there because he had a drinking problem and his boss found out and he was going to lose his pharmacy license if he didn't go to these meetings. Um sober houses they could mandate attendance in 12step programs. So for some people who are uh you know who are getting out of jail and need a place to live and they're they need to live at a halfway house they have to enter 12step programs. So it is really imshed within our legal and criminal justice systems at least in the United States. I don't know if that's as true in the UK and it does it it to be clear I like I don't it really does work for a lot of people. It just doesn't work for everyone including me. >> Long answer to your question. Sorry. >> It's fascinating. I I was thinking about how hilarious it would be if somebody was mandated by a judge that they needed to go and do yoga. >> Yeah. >> Or, you know, we need we need to see that you've completed a 30-day streak on Sam Harris's Waking Up. >> Yeah. Uh, ecoin therapy. You have to go swim with dolphins. Something like Whitney Cummings does that. She says it's really good. >> I'm sure she does. Uh so if is there a particular taxonomy of drinker that you think AA does and does not work for? Is there something about you given that it is for some people for many people a a great saving grace? >> What is it about you that it didn't? And what is it about other people that it does? >> I think for me it's a couple things. The primary one is that AA never address addressed the root cause of my drinking and that was that I like to drink. Right? So it's very simple but I was physically and emotionally addicted to alcohol and aa going to meetings did not curb my cravings. I needed something that would take care of my cravings and AA couldn't do that for me. So I think I think that is fundamentally it was just that my cravings overrode any sort of desire to quit. I was completely imprisoned by these cravings. Um I also am not I'm not a joiner. I'm not predisposed predisposed to um to any sort of club whatsoever. I also, you know, there's a spiritual element of AA that I found to be a turnoff. I did go to they have meetings for atheists and agnostics. I like those. I found them a little self-righteous in a way that I really appreciated. Um but it didn't it just didn't stick with me. And um and and also you know there's a level of when you work the steps there's a level of introspection that is required. I don't like introspection just to be frank with you. I'm like the one lesbian who doesn't like to process in this world. I don't like to talk about my This is why like doing these interviews and writing this book was very awkward. You ch you really chose a difficult thing to be talking about for the next couple of years. >> I did. I absolutely did. Uh I don't like emotional chow chow. I find it to be like very like uncomfortable. And so anything where I was sort of expected to take like a searing look into my soul. I don't believe in the soul. I believe that I had a drinking problem. I was physically and mentally addicted to alcohol and I just needed to needed to solve that problem. But for for a lot of people, that is exactly what they need. And I think that's especially true of people who have done sort of more damage than I have. I did damage. I hurt other people for sure. Um, but I wasn't, you know, I'm not a parent. I didn't I didn't destroy my family. I didn't I don't think I There are probably some people who think I should make amends to them. They're going to be waiting for a while. Um, not because I I don't think that's important. I do think it's important for some people, but my way of making amends is to basically remove myself from people's lives. So, if I have hurt somebody, my punishment is that I no longer deserve to their presence in my life, right? That's my way of making amends. Um, yeah, I I just I think like some combination of my personality. I'm a skeptic by nature. Um, I'm the I'm the type of person who would like go into an AA meeting and be like googling recidivism statistics during the meeting. I just I'm the sort of person AA was never going to work for. >> Highly non-hypnotizable in that regard. >> I listened to your show on on on hypnotism and I I also want to get my my genome mapped. So, >> I I fear that we are both uh built from the same sort of building blocks there. Um it I think you touch on something that's really interesting which is most people when they think about a person who's going to go and attend AAA is well this person knows that their drinking is bad but it's just out of their control and it it's uh destitute and and uh they're despondent and and and they they don't enjoy it but they there gripped by this sort of evil thing and it's at the bottom of a bottle and uh then there's other people who go, I think drinking is pretty awesome. It makes me feel pretty good. >> And uh I need to quit but don't want to stop. >> Yes, that's the fundamental problem. That's the paradox. I need to quit, but I don't want to stop. I love this thing, but I hate this thing. That's the I think that's the you you've captured the the inner monologue of many an alcoholic. >> Uh okay. If AA were invented today with all of the evidence that we know about now and it didn't have the strangle hold, do you think that meds would be its first step? >> That's a very good question. I think that if Bill Wilson himself founded it, I think yes. So, Bill Wilson was extremely open-minded in the 1950s. He experimented with psychedelics and this was very controversial within AA because the ethos of AA has always been sobbriety, full sobriety and how can you be sober if you're doing psychedelics and he sort of lost that battle. Um, but he was extremely open-minded and my my book starts with a quote from the big book which is which is the Bible of AA. It's the the sort of the big text that everybody reads and studies and the quote I'm gonna I'm going to butcher it but it's something like uh someday science might find a cure for the alcoholic but that hasn't happened yet and the thing so that was written in the 1930s. I think that science has actually found a cure or at least for some people I need to I need to couch that um in many ifs but I think for for some people there's a cure and I I it worked for me. >> Take it away. explain this super futuristic experimental successful procedure. >> Okay, so the crazy thing is that this is not futuristic. It's not experimental. So there is a drug, an opioid blocker that was first synthesized in 1963 by a company called Endolaboratory. So we are talking about this is you know before the civil rights act. This is this is this is old [ __ ] And uh this drug um it was owned by Dupoint for a long time. they uh they bought the the first laboratory that synthesized this Indo Laboratories and it's a an opioid antagonist. So an opioid blocker. It was initially developed to treat opioid addiction uh which at the time would have been like morphine and heroin less fentanyl and oxy and whatever they're selling on the streets these days. And but it also works for for alcohol use disorder. And it works like this. So because it's an opioid blocker, I'll just I'll explain how it works with alcohol specifically. So you take the drug and it blocks the your receptors from getting an endorphin rush from alcohol. So it's pretty simple. The molecules sit on your opioid receptors and they prevent you from getting that euphoric high that we talked about earlier when you drink alcohol. Now there are different ways to take Nrexone. The way that is most commonly prescribed is not the way that I did it. So the way it's most commonly prescribed is for people to take it every day whether or not they plan on drinking. So you wake up in the morning and you take this drug and it curbs your cravings and for some people that works. There's also a long acting form called Vivitrol. Um so it's a shot in the butt. It's in you for 30 days. It releases slowly over time. Oh, and I should say this has been FDA approved for alcohol, the treatment of alcohol use disorder since 1994. So, this is not actually a new treatment. This is an old treatment. The way that I took it was developed by a man called John David Sinclair. He was an American researcher who did most of his work. because he he went to grad school in the US, did his PhD here, but then he moved to Finland, and he worked for Alco Laboratories, which was a a state-owned sort of an interesting company, especially from an American perspective. So, it was a a liquor distributor that also had a lab. So tax taxpayer funded um or funded by I presumably I don't know what the what the liquor taxes were in Finland in the 1970s. But on on the bottom floors of this of this company, they would be selling and distributing alcohol and figuring out how to get more people to drink. And on the top floors where the lab was or maybe it was vice versa, maybe they put the maybe they put the researchers in the basement. I don't quite remember at the moment. Um you had people like John David Sinclair who were working on treatments for alcohol use disorder. and John Davidson Clair. So, he did most of his research on on mice. And he realized at one point that he he was one of the first people to describe the the um alcohol deprivation effect that I that I mentioned earlier where after a period of abstinence, your cravings come back stronger than ever. And he wanted to interrupt that process. So, he started out by giving lab rats opioid various drugs including this opioid blocker nrexone. And then he would give them access to alcohol. And what he found was that these lab rats who whose opioid receptors were blocked because of this drug. They would over time and these were these were a uh this was a a breed of lab rat that had been had been bred specifically to have a propensity for alcohol addiction. They they were bred to like alcohol, which is actually sort of hard to do. Rats don't and mice don't typically like they're not boozers naturally. But so these ones had been specifically not GMOed, but you know, good oldfashioned. You take two rats that like to drink. Yeah. You make them [ __ ] >> So you find the ones that are hanging at the bar late at night, get them together, put them in a room together. And so um so he started these experiments and what he found was that yes, these lab rats that uh that whose whose opioid receptors were blocked when given alcohol, they would refuse it. they no longer had any interest in drinking and this effect lasted over time and then he started um started writing about this. This was later uh later started doing human studies and he developed what is now called the Sinclair method. And so the Sinclair method is very simple. You take an opioid blocker usually nrexone and and there other ones there's one called an alphamine that's more common in Europe than it is in the US. You wait an hour, which is how long it takes for this drug to metabolize in your system, and then you drink as normal. And so that's what I did. I found out about this from an article in The Atlantic. And during COVID, my drinking accelerated to the point where it was becoming very problematic. Um, I uh my wife is a nurse, so she was, you know, a essential worker as we called them back then when we cared about them. and she was gone a lot. So, I used my recreational time. I had been laid off from my job. I was a reporter for uh for the Stranger, which was a is an alt weekly in Seattle. And when I got laid off from my job, I did what everyone else did. I started a podcast and I stayed home and I drank by myself. And uh I did this for two years. I drank basically every time I my wife left the house for two years. I didn't tell anybody. I didn't tell her. She had no idea. And then it got to the point where I knew this was I either had to come clean and confess and tell her and maybe go to rehab and probably go to AA and I didn't want to do that or I had to solve this problem on my own. And I had read about the Sinclair method in the Atlantic in an article from several years before. And I decided to do it and I did it and it worked. >> That's crazy. I I mean the >> We're still married by the way. She's going to be real shocked when she finds out about this book. I was going to say, yeah, what was the what was the reveal like when you presumably had to have that conversation and how much of it was propelled by the potential book coming up? >> None of it. I had not written the book by the time I told her. So I So to like cut a long story short, I did this for about seven months. I was very regimented about it. I planned my drinking days. I always took my pill. There was a small handful of occasions when I skipped it for whatever reason, but for the most part, I was very regimented about this. And this is one of the things about this this this treatment. You can't halfass this. It's like AA in that respect. Like you got to go you got to 100% commit because if you don't take the pill and you drink without your opioid receptors being blocked, you're the Sinclair method is basically a process of of unlearning a behavior. It's called extinction or pharmological extinction because there's a medication involved. And so if you if you drink without the drug and you get that endorphin dump and that and that dopamine rush, >> everything that you've just learned, >> it's not gonna it's not going to be undone overnight. But if you do this, if if you if you don't really stick to the protocol or if you don't wait the full hour for it to metabolize, it's just not going to work. It's going to confuse your brain and your brain will continue to seek out that high. What you're trying to do is to give your brain the message that that high no longer exists. You no longer get pleasure from alcohol. And over time, your brain will stop craving it. And for me, that took about seven months of like actively doing the Sinclair method. And over time, I I started you have to incorporate some habit change and mindfulness, which not natural for me. I'm not a mindful person, but you have to you have to do these sort of um you have to you have to make some changes in your life. It's not as simple as just taking the pill and drinking. It's pretty simple, but it's not that simple. And over time, I started like, you know, pushing my drinking my drinking start time back. So, instead of starting to drink at noon, maybe I'd start at 2 or maybe three. And I started incorporating more alcohol-free days into my week. And alcohol days are alcohol-free days are exactly what they sound like. So, that's days when you're not drinking and you're not taking the pill. And that's what's different about the Sinclair method than sort of the daily use of this drug, taking it every morning or the shot bivbitrol which is in your body for a month. You only take it when you're drinking. And on the days when you're not drinking, you don't take it because you want your endorphine receptors to be heat up. And on those days, you go out and you do things that are going to spur a sort of natural high. You know, go for a hike, um, have good convers, go eat good meals, get late if you can. you know, you just you try to try to retrain your brain into seeking pleasure elsewhere because you're no longer getting it from alcohol. So, I did this for about seven months and then I decided to try for an alcohol-free month and it was easy and this had never been easy for me before, but it was it was uncomplicated. And after that month, I just never started drinking again. And it's been three years since then. And I and I didn't tell my wife. I didn't tell her. I waited an extra I wanted to like get a year of sobriety under my belt before I told her. And then a year came and went. And honestly, I had stopped thinking about drinking. Like I think about drinking now because I'm promoting this book. I wrote the book. It's more a part of my life. But for that period of time between quitting drinking, between my last drink and and deciding I was going to write this book, I just didn't think about alcohol. And that's what I wanted because, you know, everybody sort of knows about the physical effects of alcohol, right? The headaches, the hangovers, the shakes, but for me, the killer was was mental because alcohol was on my mind 100% of the time for most of my adult life, right? And for people who haven't experienced addiction, I think the best way to sort of explain it is like when you have a crush on somebody or you're newly in love with somebody and you all you think about is that person like you're going to work, you're having conversations with your hopefully not with your spouse, but you know, you're like everything in your mind is focused on this desire. That's what addiction was like for me. So I thought about it. I spent 20 years of my life thinking about I still managed to, you know, have a career and a life and relationships, but I spent 20 years of my life thinking about alcohol almost every moment of the day. It was in the back of my mind and the Sinclair method and this drug freed me from that. So, I basically stopped thinking about it. And then I I told my wife after it was more than a year. I think it was like a year and a half after I told her. She was surprised for sure, but not mad. I like married well above my weight both physically and morally. Um, and so we're still married. My wife was like sad for me that I'd gone through this thing, but she was also I think impressed that I had solved that I had I had a problem and I fixed it on my own. And I would never advise people to be like do this without social support because in everything that you do, social support is going to make it easier, but I you know didn't do that. lone skeptic again as as on brand. >> Yeah. Um >> I mean I did talk to people because I was I was also doing a lot of research about this and so I'm a journalist and so I would when I had questions I would call people and there's a robust online community. That's sort of one of the ironies about the Sinclair method is that this is one of those cases and there aren't many of these where you can get better information typically from like Facebook groups and Reddit and YouTube than you can from your own GP. Um, so I was involved in these in these online communities and having conversations about it and interviewing people, but I wasn't talking about it with the people who mean most of my life. Why is it that doctors are still hesitant to prescribe Nrexone or or talk about it or educate about it even if it's got strong evidence? >> So there's lots of answers to that question. The first answer I think goes back to medical education. So I don't know how it is in the UK but in the US historically addiction medicine has been a very very small part of a medical of medical education. So I talked to doctors who are you know in their 40s and 50s who did four years of of medical school then four years of residency maybe did some extra training now they're GPS they're family doctors or they work in an ER. So they're seeing people every day who suffer from some kind of substance abuse disorder whether that's alcohol or anything else and they're in that you know eight years of of medical training and education the entirety of their training on addiction was maybe one hour maybe they were told to attend an AA meeting. So historically it has just not been a part of medical education in the US. This is this is changing. So there are currently three drugs that are FDA approved to treat alcohol use disorder. Nalrexone is one of them. There's also an abuse uh which has been around since the 1950s or been FDA approved for the 1950s. And there's one called um a campate. So and there's also various off label drug other drugs that are used in an off label basis. Now every med student who goes through a psych rotation is going to get education on at least those three drugs. So this is changing and it's changing really rapidly. Part of this has to do with the opioid crisis I think. So for a long time within uh the recovery industry the idea of harm reduction was sort of anathema. You know the nobody not nobody but a lot of a lot of these institutions were based on 12step program 12step principles. And in 12step principles like you don't tell people to go take suboxone or methadone. You tell them to seek help from, you know, to to confess their their to admit that they're powerless, to go to meetings every day and sort of will their way through it. But that doesn't work very well for opioid addiction. And so there has been a shift um in recent years towards principles of harm reduction and medication assisted therapy. So that's part of it. Just straight up people doctors are not educated. The Sinclair method has an extra an added barrier to uptake which is that it requires drinking. So now Trexone doesn't require drinking and lots of doctors prescribe it take it daily and don't drink with it. But the Sinclair method gives people permission to drink and that's going to be a tough cell for a lot of doctors. Not just because right and for families and you know this it sounds like >> you're going to do what? >> Right. You're gonna you're you're telling me I can cure diabetes with donuts. Like it sounds crazy. I understand that there's also legal reasons, right? So, if you're a doctor and your patient comes to you and says, "I'm having a drinking problem." And you say, "Okay, here's the deal. Take this drug and then go get a six-ack of beer. Enjoy yourself." And your patient does that and goes and kills someone in their car. You don't want to be legally liable for that. So, there are all sorts of barriers specifically to the Sinclair method that prevent this from being better known. N Tre there's also economic factors here, right? So N Trexone is a cheap generic drug. It's been cheap and generic for a long time and no drug company is going to pay to market it because they could just be undercut by the drug company down the street. So there are several factors here. Another one, um, another theory, there's a a guy named Percy Menses. He was a he was a drug rep for DuPont. Um, and so he was one of the one of the this was back in this in the in the 80s. He was one of the first people trying to sell this drug to doctors or uh I don't know if I don't know if drug reps like that term, but trying to get doctors to adopt this drug for use of um of treating heroin addiction. And Percy found when he would go talk to doctors that they were completely uninterested in it because at that point more uh methadone had sort of cornered the market. They f they thought that they had this gold standard and they weren't interested in anything else. The other thing is this is an opioid antagonist. It has the word opioid in it. And so Percy thinks that doctors could be just straight up turned off by that because it feel it's not an opioid. It's an opioid blocker. But it sort of emotionally feels like you are giving opioids to your patients. It's nobody, you know, you don't opioids are sort of a they're they're on the outs these days. >> Yes. Yeah. It's uh it's poor branding right now I would say to try and get that done. It's so >> it see it feels to me like the whole kind of alcoholic alcohol use disorder world has been overmoralized and undermedicalized. >> Yes, >> I think that that's kind of how it feels. >> I think you're completely right about that. It's it's sort of ironic because you know a lot of people will say if asked they'll say yes alcoholism is a disease but it's not a disease that we typically treat with medications and again I sort of I I have complicated feelings about that framing I don't think it's particular >> someone who's unsure that it is a disease but something that you should treat with medications >> right >> or could treat with medications >> right and and nrexone doesn't work for everyone I want to be really clear with this so earlier we talked about um there's two types of drinkers right reward drinkers and relief drinkers and this information. I learned this all from a guy named Joe Vopacelli. He's uh he's this fantastic clinician and uh researcher out of out of Penn. And Joe Joe's studies some of his he's been working with Alrexone for decades. And his some of his early studies were used for the FDA approval of this drug. And Joe explained this to me for people for reward drinkers. This typic this is this people like this tend to be binge drinkers, right? the people who are going out, going to clubs, um dancing in the town fountain, whatever. People who get energized from alcohol, nrexone can work really, really well. It's almost he actually used the term miracle pill, which is not something these are, this is like a you know, this is a this is a real doctor here. This is not a term that doctors typically use. It can almost be a miracle pill for or a miracle cure for that population. For the other types of drinkers, relief drinkers, people who get the sedating effect, it has almost no effect. >> Why? >> I think it's okay. So, part of this there, this is like sort of an open question, but the theories that I read and I heard from researchers is that it has something to do with one particular alil. So, one particular gene variant. It's called ASP 40 ASP 40 in the MOU opioid receptor for so having that having possessing that alil does not guarantee that Nraxone will work for you but it's a strong indicator that it may work if you don't have that have that alil it's a strong predictor that it will not work >> right okay and that that will uh tend you toward a particular type of alcohol use and a particular type of response to alcohol too. >> That is the theory. Yes. >> Right. That's interesting. I've just checked. Uh I checked your genetic and lab reports. The ASP 40 variant you're ask for refers to the OPRM1 and A1 AG polymorphism. D looking through your genetic reports. You do not have the ASP 40. Your OPRM1 result shows the AA genotype. ASN 40. As 40 meaning you do not carry it. So no. So I would be uh uh I would be useless. >> You might it might not. It would be interesting to uh interest. Do you drink now? >> No. Uh I it was an interesting journey I guess with regards to alcohol for me. Um I never had a problem with it. Uh in terms of a dependency uh but I I was a party drinker. You know every two weeks I would send it in club promoter fashion. And uh then it got toward the end end of my 20s. So what we're talking about now 28 I think 27 28 would have been the first time I did it. So maybe 9 years ago. And uh I know that low and no movements are kind of all the rage and morning ice plunge parties and run clubs and stuff are kind of everywhere. >> 10 years ago, 9 years ago, that really was not the case at all. It was not trendy to be against the grain with regards to uh even social drinking. And uh there was just some inclination that I had that alcohol was holding me back. Mhm. >> Uh even though I wasn't using it that frequently, uh I do get bad hangovers. I think I I tend to waddle a mood sometimes and if you do and then you crank a hangover on top of it, like that that's really going to turn it up. >> And I I just had one really bad hangover one day and I was like, I'm not going to drink for 6 months and I just had this idea in my mind. So I went six months sober um and loved it. And then I was in Bali and had a a corona. I was like, "Okay, I'm I've done my six months and I'll break it when I'm in Bali and I'll go back to Yeah, I'll see what drinking's like." I did it for three months, really didn't like it. I was like, "I'm going to do another six." Went back for one or two weeks after that. Had one or two a couple of beer nights out and did it for a thousand days. And then since then, basically, I'll drink less than five times a year and it'll be a year or a couple of years or something like that. And I'm curious, when you drink, what is the effect? Do you get high energized sort of fast or are you does it chill you out? >> It's a good question. >> It's harder. It's harder to answer than you might think. Like it it does >> Mhm. I would say I would say in the past it might have >> uh been and this is what I said earlier on in my 20ies. It reminded of being more energized and it being infusing. uh also would have been coupled up with unspeakable unpronouncable drugs from a guy in a toilet somewhere. Um which you know will supercharge anything. >> Yeah. Well, and there's also the social aspect, right? So if you're going out and your friends around and there's loud music and you're dancing, that's also going to be a natural amplifier of this sort of euphoric effect. And I think it would be hard to parse out. Is that the booze or is that the mood >> atmosphere? Yeah. setting for alcohol. Whereas now, you know, if I do have a beer or a glass of wine or something, it's as we're trying to work out why everyone's commenting on the Ukraine when they don't have any expertise in it over a good steak at dinner, you know, like that. It's it's a very different sort of atmosphere. Um, and maybe that is the sort of thing that I want. And also, I' I've generally chilled out. I'm not sending it in the same way that I used to previously. Anyway, um I made a big song and dance about this uh because it was as the show was starting and and it was a big part going sober uh or what I called at the time elective sobriety, which was like choosing to as a productivity strategy as opposed to for some sort of need. >> Yeah. >> Um sober maxing. >> Soberaxing. That's it's correct. Yes. Yes. Uh, I I was I mean I still am. I I don't think I need to kind of fly the flag for it so much anymore, but it was a huge part of my identity for the first sort of three or four years of the show. The reason I don't think I need to talk about it quite that much is it's less of a big part of my life because it's more just habituated and that's kind of the way that I exist. But also, I think the world has sort of taken that and run with it. You know what is it now? I think that the WHO says that there is no safe level of alcohol consumption. this huge meta meta meta analysis by the Lancet came back and basically said that there's no such thing as a safe level of alcohol consumption. That one glass of red wine. Oh, but the resveratrol that comes from the red grapes, it's like, yeah, but it's being offset by all of the stuff that it's housed in. >> You can just eat the grapes. >> Yeah, exactly. You And it's not good. There is no benefit. The one benefit that you could see is to go like a Warren Buffett style approach, which is the stress of trying to be perfect will kill you more quickly than your imperfections. Um, and I I can see a place for that, but if you're looking just straight up physiologically huban pill, like it's not this is not the direction to go down. Um, but it was a huge huge part of me and my life. And uh I remember even for me, right, as somebody who wasn't dependent, wasn't drinking that regularly, was around the party scene a lot, um I remember how triggering it was for all of the people that I used to party with when I'd say that I wasn't drinking. And especially if you're in your 20s and especially if you're the club promoter, you're supposed to bring the party. Yes. >> And that meant that when I said I wasn't drinking, the responses that I got from people were, as far as I could see, really outsized. I was very surprised by by how triggered other people were by it. Um, by how mean they got. Um, I was >> kind of in a fortunate position that I was the top of the tree within this industry. So, there was only so far that you could like it. It's like taking the piss out of Joe Rogan for the microphone that he's not using anymore. and you're like, "Yeah, but he's like the guy that runs it, right?" So, it's, you know, and it was kind of the same, at least a little bit in the world of club promotion for me, that it's like you could push me a little bit, but not that far. However, one of the things that did happen was people stopped inviting me out because >> you're a downer. >> They didn't want to. And the other thing which I'm sure that you've seen too and it must be a difficulty must be why it's so hard if you're friends with people who use alcohol to get sober is that your sobriety throws their drinking into sharp contrast and other people do not like the spotlight being placed on them in reflection of somebody that's making a change. And um yeah, I mean I wrote I wrote so much about this about the fact that um if the only friends that you can bear to be around are ones that you have to drink to be able to spend time with, then you don't have friends who have drinking partners. If the events that you're attending are ones that you need to consume alcohol to be able to get through, then the problem is not your alcohol use. the problem is the shitty events that you're you're going to like you know just this endless list of very obvious insights in retrospect that were all couched underneath this lifestyle that uses alcohol like in the UK I don't know whe this is the same in the US I haven't seen it here even though I fly a lot in the UK if you go to any workingclass town airport Newcastle Manchester Liverpool Birmingham something like that if you go to any of those airports between the months of March and October summer holidayish trips, 6:00 in the morning, 5:00 in the morning, the bar will be open, and people will be treating the opportunity to have a beer like it's this. It's like it's naughty. Like, it's sort of uh it shouldn't be allowed, but oh, we're going to treat ourselves to something. And I always found that so [ __ ] cringe. Like I always I always found it. I was like, "Oh my god, the the highest point >> of of >> subversive uh uh like anarchistic contribution that you can have is having a beer at 5 in the morning." And I get it like people are allowed to enjoy what they're allowed to enjoy. But I don't think that people are enjoying that. I think they're enjoying the story that they tell themselves about what that means. And I think that that's something which is much easier to change and it's something that I'm seeing. So yeah, again my long-winded way of saying um oddly enough even though alcohol was never something that was a a huge uh part of my life. Um going sober was massively formative because it allowed me to finally get a [ __ ] meditation habit and finally actually wake up and go to bed at the same time. Finally actually get some journaling done. finally start a podcast and do because I wasn't resetting these very difficult to do habits, right? going to the gym and eating well and getting up on time and doing all the rest of this stuff is hard enough to do as it is if you're not shaking the etcher sketch every two weeks to reset all the program and then day one no chance and day two still kind of not and day three okay maybe I'm sort of slowly getting back there and I always wondered like why am I just it permanently feels like I'm not making progress at the speed that I should and um the answer was kind of really subtly staring me in the face which is well you're you're choosing to kind of give yourself an illness for a couple of days twice a month, >> right? >> And and that was it. >> Yeah. I found that after I got sober, I found that it almost felt like a life hack. And this is not like like I'm not a I'm not a maximizer. I'm not anything pill. Well, I'm nrexone pill, but it did it did feel like a life hack because I lived for so many years with this mental obsession. The physical the physical effects of alcohol, but especially the mental obsession that was such a distraction from anything else in my life. I couldn't optimize [ __ ] I still can't really optimize [ __ ] >> How did you get how did you get anything done? Because I've listened I've listened to your podcast. You you seem to have a really fantastic recall. You've got great stories. You were working as a writer. The book's wonderful. I love the pods that you've done in the past that I've heard. Those do not smack to me of a person whose brain has been adultled by alcohol, who's never been able to think about anything, who's had their mind cycles captured by worrying about where the next drink's going to come from or if my wife's going to find those bottles that I hid in the back garden or whatever. Um, that doesn't smack me as that. So, are you are you the the prototypical functional alcohol use disorder person or what? >> Well, I wasn't for a long time. So until I was 30, I worked deadend entry-level jobs that I was usually fired from within a few months and spent all of my time at a bar at the bar. There was one bar I liked in particular. And then at 30, I started to get my [ __ ] together. I took an unpaid internship at a public radio station. And I did this purely out of pettiness because I had been broken up with someone who worked in public radio. And I was like, "Bitch, I'm going to I'm going to get your job and I'm going to do it better than you. I'm going to I'm going to I'm going to win. That's how petty I am." And um and so I started to get my [ __ ] together then, but it was still I was still working at a deficit because and I also I also moved a lot during this period. So I would live somewhere for a few years, maybe I think at the max at the most like four years and then I would kind of burn my bridges. I would run out of jobs and then I would leave for a new town and I would start the cycle over again. that was actually a fairly effective way of of getting clean for at least a little while, like removing myself from the environment that I was in. Um, but so I really did not start even really attempting to make career moves until I was 30 years old. And then I got I did get serious about I decided I was going to be a journalist. Um, and I did get serious about that, but I still had many many setbacks. And at that point, I had kind of aged out of like heavy like club culture and party culture because just like my friends weren't doing it as much. So I I did much more of my drinking at home by myself. So I really shifted around that period to like being the girl being like a party girl who everybody knew as a party girl to being somebody who had a much more like not like equally problematic but much more private drinking experience. Um and there are lots of people who when I was reading when I was working on the book I talked to an entrepreneur who I will not mention his name but you have heard of him who was drinking 40 drinks a day like low alcohol drinks but 40 40 beers a day who also got >> 40 low alcohol beers a day >> it's just an immense amount of liquid he probably had to wear a [ __ ] diaper. >> Yeah. Holy [ __ ] So, right. And then and also like think about the 1950s, right? When people are having three martini lunches and then going back to the office after this, you know, that has that has almost completely left the culture. So, we're just our standards really have changed. And then >> go ahead. >> No, I just we have like what is acceptable and what is considered problematic drinking has changed so much that like what I consider problematic drinking would not have registered in 1950. Yeah, I remember hearing some story about the introduction of tea houses or coffee houses I think into uh Great Britain and when that changed from being the public house where everybody would go to meet and talk during the day and that >> uh encouraged a slightly sloppier type of conversation to then oh well you you don't just need to drink the alcohol perhaps you can drink the caffeine and this was some sort of springboard boon for um idea generation and may have contributed to the Renaissance and stuff like that. >> What is I'm curious. So I did I did study abroad in the UK when I and I and I I chose it there for two reasons. One the drinking age was is what 18 and I was 20 at the time or 19 or 20 and two this is the less important reason you speak English. Um, and so I, so I did study abroad over there and I had classes on Monday all day and then Tuesday until noon. That was my entire work week. My like my school schedule ended at Tuesday at noon. And there was a pub on campus, the student union was an actual union. And there was a there was a a pub and pool tables and we drank [ __ ] snake bites. That horrific like >> half cider, half laga with a little bit of black currant juice in it. Yeah. >> And it's like worse coming out coming up the the next day. It's disgusting. >> Um, and just the drinking culture there was >> I loved it. I absolutely loved it. But I'm curious. I mean, >> yes, in the US we have definitely seen like we can see this in in polling. Gen Z is way less boozy than, you know, millennials than my generation was. They're also having less sex. They're seeing each other less. There's all sorts of downstream effects, I think, connected to the phone. But um has this has this changed in the UK at all as well or people still boozing it up there? >> I think it's it's very similar. Um my colleagues and ex- business partners uh from the industry that I spent my life in um it does feel a little bit to me like I sold Bitcoin at $120,000. Um and because the market has really hit uh quite a an aggressive downturn. Um it's it's just not the done thing. And you know it it is a confluence of all of this stuff because if the nightclubs are less busy because more people you're not just competing as a nightclub with the darts around the corner or the Huberman podcast telling you that you shouldn't be drinking alcohol. You're also competing with Netflix and HBO and Tik Tok and just the fat vegetable culture. I'm just going to veg out on the couch. and you're competing with changing dynamics in terms of what people tell. Well, weed is now more prevalent in the UK. I know it's massively maybe even to the stage where more Gen Z smoke and drink now, I think. Um, so there's a lot of competition for what your potential substance of choice is. Whether it's the environment that you're going to be in, whether it's the people that that are around you, whether it's the social norms about that, whether it's the education level that you've got and understanding of the health effects, whether it's the alternatives that you've got to get a buzz on, whether it's the screens that can stop you from going out of the house at all, whether it's the social anxiety from being, you know, arrested development during COVID. really is in many ways a a a perfect storm to stop people from from drinking. And in many ways in many ways that's good. But I mean we are already seeing how how quickly the world's turned. Only a decade ago for me it was revolutionary to say that I wasn't going to drink. And now we have I think I saw a Scott Galloway clip the other day of him saying I would way rather someone go out and get smashed than sit in the house and like stare at the screen because very quickly as with everything the pendulum has swung so quickly back the other way that well no we're worried about this thing now. We got to be concerned about the you know the isolation. Yes. >> Um, so yeah, it's >> I think that's a completely legitimate fear because it's not just that young people aren't drinking, which it's hard to argue that that's not a net positive, but they're also not socializing with each other in person. And I cannot see that as a net positive. They're not having sex, which, you know, maybe there's some net positive there as well for, you know, we want people to have to be responsible with their bodies. But if we have, you know, generations of people coming up who don't know how to interact with each other in person, I don't know. >> It was I mean that that right of passage thing that I said um it it really is. And as much as could I have could I have learned the lessons that I needed to without going out and partying? Maybe. Maybe. But given that whatever it is, you know, maybe 90% or 95% drink 50% of the alcohol, it seems that most people aren't graduating into becoming uh alcohol dependent. >> Yes. >> And if that's the case, you can there's there's probably a pretty good argument to be made that it is maybe a net positive that it does sort of expedite your learning. How many people met their partners? You know, meet your girlfriend in a nightclub. Is that the best place? I don't know. >> At least at least the girlfriend for the week or the night. >> That's true. That's true. That's true. Um, yeah, it is a it probably is. There is certainly something that's been lost from that and the sort of massive surveillance culture that we have. I think that made everybody much more >> worried about messing up or or or doing something embarrassing. Um, we used to do this bar roll called Carnage, which was a t-shirt bark roll, and you wore the t-shirt as your ticket, and then there was tasks on the back that you had to take off, like pulled a pig, swapped shoes with a random um >> pull a pig, >> pulled a pig, like got off with somebody who's really ugly and fat. >> Oh, that's terrible. That is so awful. >> It was 2006. Okay, so we were allowed to >> Makes sense. >> A different It was a different world. And um >> different means a different thing in Austin. That's a That's a a barbecue joint. >> Uh true. Um that the Larry Lowy culture would not you would not even be able to get two feet down the street with that in the modern world because this [ __ ] >> surveillance state run by gullible volunteers, this sort of starsy for the Angry Birds generation. >> Yes. >> Um would have captured everything. So you pulling the pig or you throwing up and in a bush somewhere that is immortalized on the internet for the rest of time. >> And at an even younger age when I was a kid, when I was 15, my parents left me at home for a weekend. I hope they're not listening to this. If they are, I'm sorry. I [ __ ] took their car and I drove around all weekend. I had a giant party at their house. They never found out. today they would have a tracker on me in the form of my phone and every neighbor would have a Ring camera or they would have a Ring camera >> capturing you as you go pasturing you. Yeah. So I don't know how young people today get away with [ __ ] and I do think those are valuable lessons to learn. I'm not sure what the value is, but I think it's still valuable. [Music] >> It's fascinating. So is this what is it that you're hoping to achieve with this? Are you hoping to make more people aware that this is a particular uh solution for people that drinking too much? Is it to sort of campaign to make this more widespread among doctors? >> All of the above. Yeah. Um I want the the the main message of the book is you know the book is about the Sinclair method in Nrexone and it is sort of a a step by step. This is self-help which the fact that I Katie Herszog wrote a self-help book would shock anybody who knew me 10 years ago. Um, it's it's definitely a twist. No one saw this coming. So, but part of it is to give people a guide because when I was doing this, there were YouTube videos and Facebook and Reddit and lots of you can hire coaches who are really helpful in terms of helping people know what to expect, how to deal with side effects and setbacks and things like this. Um, trying to figure out if it'll even work for you in the first place. But I wanted a book. I wanted something I could read that would tell me what to expect on day one, on month one, on year one, and that didn't exist at the time. Um, so that's part of it, just giving people a guide. But I also, you know, now Trexone isn't going to work for everybody, but there are lots of other options out there. And I just I want the conversation to shift from there's one path out of alcohol use disorder and that is abstinence only to just broadening the way that we think about this because that that option does work for a lot of people but it doesn't work for everyone. And I think the problem with the the AA or nothing narrative or the abstinence or nothing narrative is that it keeps people drinking longer. So, I thought that for years I thought that the only solution to my problem was going to be to quit drinking and to quit drinking forever. I h I did do that in the end, but it wasn't wasn't what I expected. And that that was such a mental barrier for me that it kept me drinking much longer than I should have. And had I known that there was a way to continue to drink, because that's what I wanted to do, continue to drink, but do it in a way that was safe and that would extinguish my desire for alcohol. I I I would have taken this step, I think, a lot earlier than I did and I would have saved myself some heartache uh in the process. >> And you wouldn't have had to write a personal development book, but here we are. We've done it and it's actually really good. So, congratulations. Yes. I mean, not only did I have to tell my come out and tell my parents that I had been secretly drinking, I had to tell them that I wrote a self-help book. >> Humiliating. >> The price that you pay to try and help the world become slightly better. >> My god. >> Uh Katie, you're great. Where should people go to check out all of your stuff? >> Um you can pre-order the book. It's uh on Amazon, all that stuff. You can go to my website, drinkyouways.com or or not sure. Google it. And uh I also have a podcast. It's called Blocked and Reported. We do not talk about self-help or or drinking culture. We talk mostly about the internet and culture and um a lot of talk about furries. We're been on a furry kick lately. >> Okay. I haven't seen those, but your Blocked and Reported is awesome and everyone should go and check that out and uh so are you. I really really appreciate what you've done. >> Thank you for having me. It's great to talk to you. >> Congratulations. 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