There’s a lot I don’t know about addiction, but I know enough to be touchy when I hear popular news stories about it. I’m sure if you’re a meteorologist, you can’t stand listening to conversations about climate change and I can’t even imagine being knowledgeable about nutrition and constantly subjected to Five Fab Fatbusters and Eat Like a Caveman to Live Forever. Well, my burden is knowing a bit about addiction and cringing at what gets reported. (My coworker Dawn has the same problem.)

I got pretty prickly listening to a recent episode of Radiolab called The Fix. It begins with a woman who’s dating a guy with an alcohol use disorder. She becomes intrigued by the idea that a muscle relaxant called baclofen has helped other people reduce their alcohol use. In fact, she learns, there are several other medications used to treat alcohol use disorders. Hearing this, Radiolab hosts Jad Abumrad and Robert Krulwich wonder aloud if these medications might be cures for alcohol addiction. If so, how come we’ve never heard of them? From here, the whole episode turns on one question: are we experiencing a sea change in the way addictions are treated?

I began to feel frustrated. True, there are medications for alcohol addiction. But Radiolab starts breathlessly down the path of “everything you thought you knew about addiction is wrong” and the discussion turns (inevitably) to A.A. Now that we know there are medications to reduce alcohol use, A.A doesn’t look so good. It’s old-fashioned, it’s anti-science.

I wondered why it’s necessary to pit these two recovery paths against one another. Is it just for a good story? C’mon, media!

A number of folks in the comment section made the same point. Paul Reiger from Philly wrote:

It would be wonderful to hear the unedited interviews by the two scientists, especially in regards to their views on heterogeneity among people with addiction. This might help clear up the either/or debate (medical issue vs spiritual malady) that exists primarily in the media, impressed upon society. Addiction researchers know the disorder is nuanced, and each individual brings with him/her different sets of issues. One person might benefit completely from naltrexone or AA, while another needs a combination of the two. An entirely different person might need mental health treatment for anxiety or depression, while another needs something else. The key is understanding the variability between people and what will be most effective to treat each case.

Reiger’s point is illustrated by the second half of the episode, which is quite stirring. We follow Billy Webb, a thirtysomething musician from an affluent Ohio suburb, through his years-long attempts to get sober. It’s a painful story. Lots of relapses. Health problems. Despair. Eventually, he begins treatment with naltrexone, an opioid antagonist that dulls the positive effects of alcohol use. If, as the show’s hosts speculate, medications represent a cure for alcohol addiction, this would be a major turning point for Webb. It only sort of is.

After a period of moderate drinking using naltrexone, he stopped taking his medication and began heavy use again. Why? “To feel like myself again,” he said.

That’s hard to swallow. The consequences of his alcohol use were serious: in short order, he’d lost his job and his girlfriend. But alcohol use and drunkenness was so much a part of his life story, so much a part of who he felt he was, that even in the face of severe consequences, he returned to it. Where’s the pill for that?

And what ended up happening to the boyfriend from the beginning of the story? We never find out. Did he take baclofen on his girlfriend’s recommendation? What happened there? Things are looking a lot more complicated than they were at the beginning of the show.

And that’s how it ends. Complicated. Complicated and heartrending. In the final minutes of the show, the hosts play a mishmash of voicemails from listeners on the subject of addiction. A mom calls in to tell them she’d lost her son to an overdose last year.

“He was a great person. I think he just couldn’t see how to be sober in this world…That was really hard for him. How do you live your life when you have to be sober?”

 

Three Simple Ideas You Can Take To the Bank

If you’re like me, the radio show stirred up a lot of emotions. It probably raised more questions than it answered. Looking for a some clear takeaways that pertain to the show? Here are a few to choose from:

Medications to treat alcohol use disorders are available and underutilized. There are three FDA-approved medications to treat alcohol use disorders, all of which can be prescribed by your primary care doctor. While acamprosate and disulfiram are intended to help patients maintain abstinence from alcohol, naltrexone is appropriate for people who want to reduce heavy drinking. Medications are not incompatible with self-help or mutual aid groups like A.A. To learn more, please download this new guide.

Delaying the onset of substance use reduces the likelihood of later addiction. The developing adolescent brain is particularly vulnerable to the habit-forming effects of drugs and alcohol, which is one reason that the 90% of adults with substance use disorders began using substances before age 18. Billy Webb’s story–of alcohol as an intractable part of his identity–can help us understand why it’s particularly hard to stop using if you started in adolescence, if you feel you’ve become who you are with substances.

There are many paths to recovery. Just as there are a number of factors that can lead to addiction, so too are there many elements that can combine to lead to recovery. Evidence-based treatment, recovery support groups, and each person’s unique recovery capital are all ingredients that can lead an individual to a healthier relationship with drugs and alcohol.

 

Resources

Radiolab – The Fix (2015)

Medication for the Treatment of Alcohol Use Disorder: A Brief Guide (2015)

SBIRT for Adolescents – Webinar and Slideshow (2013)

The A.A. Member – Medications & Other Drugs (2011)