#993 - Katie Herzog - A Controversial New Cure for Alcohol Dependence

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 back in my day, 12-year-olds drank, or at least they did in my school.

And I loved it.

I loved it from the very beginning.

Even before I was sort of old enough to appreciate the taste of a good glass of wine or a cold beer, I liked the effect.

And so I drank 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 4 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 my people.

And 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 quit in my late 30s, early 40s, I wasn't a party girl anymore.

Most of my drinking was done solo and in secret.

But that was it.

And

this was not abnormal among my peers and my friends.

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.

I went to the hospital a couple times.

I very memorably burned out a porch at one point.

I had trouble keeping.

I see your brow is sort of furrowing here.

Do you want to know 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 mid-20s.

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 fifty, 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 this this fantastic television show.

I can't remember what it was called, but it was about the NY, the New York City Fire Department.

Dennis Leary 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 failed to extinguish a cigarette.

I just like left it burning outside.

And it lives in an apartment building.

I walked outside.

I saw some smoke and like 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.

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 nine,

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 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 fuck did you do?

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.

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 shit together or didn't get their shit together and died.

Frankly, a lot of people I know from those days, from those days are dead.

And at some point, I realized I was just sort of drinking alone, you you know, the last one at the bar, except the bar, it 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 nightclubs for a real long time.

We would have gotten along really well in that period.

I would have made a lot of money from you.

Yeah.

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 louty, Lairy drinking culture that I knew and you would have known as well.

I mean, the British, it's kind of a national style for us.

Yeah.

I often do think about how many people

were just in the party enjoying themselves, these events that I used to run.

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 club promoter.

So that's all 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 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 not even just alcohol,

how many of those people went on to, yeah, kind of be more dependent?

They were, it was 4 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.

That's probably, people were probably going to find their way to addiction anyway they, any, you know, no matter what happened, whether you had been there or not.

But, you know, you're right in the fact that most people do actually age out a 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 shit together.

You know, they got into relationships, they got careers, they had children, and the ability to be hungover 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 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 hungover, gets constrained by real-world responsibilities.

Is that it in a nutshell?

Yeah.

That's basically it.

People who, natural recovery is people who don't take 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 take it or leave it.

This doesn't work in my life anymore 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 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 my first come to Jesus moment.

My, I was, I believe, 24, and I was going through my first really serious breakup.

And 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 wrote to a friend of mine, sort of confessing to my friend what I had been doing.

My girlfriend at the time,

she came to the bakery where I worked.

I had a brand new job.

I was a barista at a bakery in Portland, Oregon.

And she walked in and she said, you fucking 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 rom-com where all of my stuff 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 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 two, which is sort of bipolar light, but like bipolar one.

And I was like, hell, yes, that's it.

I'm not an alcoholic.

That's sick.

My drinking actually helps my bipolar.

Exactly.

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.

I would, you know, I would do things like, you know

It's my astrological side.

I'm a Gemini.

That's just what this is.

It turns out I'm not a Gemini.

I'm a Taurus.

And astrology is also bullshit.

But at the time, I was sort of looking for 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 vacillating 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.

And I did, and in one of those moments, I did start going to AA, one of those moments 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, 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 even one of the embarrassing ones.

Okay, well, the rabbit hole goes deep.

I'm excited to learn more.

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 rites of passage.

They're almost like badges of honor that you wear.

And, you know, the movie, The Hangover, was an entire movie about this.

That's 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

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 it was basically that

when you see things as a rite of passage, it's very hard to have interventions because if you ask somebody, how was your night last night?

And they say, dude, it was amazing.

John lost an eye.

And you're like, yeah.

That's a good night.

Really?

Yeah.

Is that because usually, you know, if that was a sports game, that wouldn't usually be that.

And

it's just a weird upside-down sort of topsy-turby world.

And I suppose, as well, that must allow people who have problem drinking to

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 bores.

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 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, 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 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 though 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 really bristle at AA because I would go to AA meetings and I would hear these

people who

lots of them old-timers who talked about how much better their lives were sober.

And 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 would be like living without food.

How could you do this?

I could not conceptualize it because everybody that I knew drank.

And it was such a part of my identity and 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

way that you get a sense of self-worth and that you are a part of a community.

It's a ritual that you do to get, 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 teetotal.

In some ways, that would probably be better.

But alcohol in community, 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 look in the over the last five years, like if I went to 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 American and British culture.

And I think 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 leads to other things, job loss, health effects, legal problems, death, you know, small things like that.

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 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 saw a therapist for a while who said to me, you know, 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.

Death,

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 shit together.

Then I'll quit.

I need, I just need one more DUI, one more DUI, and then I'll get my shit 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 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 mean, there's 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 wasn't because I love Booze more than I love my wife.

It's because I had no control over it.

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What have you learned about the way that alcohol addiction particularly sort of shows up in the brain?

The mechanism of how this works, the reward signaling, are the different types of alcohol use disorder.

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 problem drinkers, of alcoholics.

And alcoholic is a term that a lot of people bristle at, but I use it because everybody sort of can, it's easy to conceptualize what an alcoholic is.

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 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 euphoric buzz.

It was, for me, it was almost taking a little bit bit of caffeine or a little bit of cocaine, right?

It didn't make me sleepy.

It made me energized.

It made me talkative.

It made me obviously make poor decisions.

Uninhibited, you know, I'm going to go sing karaoke on a, some terror, some, I'm going to 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 horsehead 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 a rush of endorphins when you drink, right?

And that 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.

For people who drink because they have like severe social anxiety, alcohol can help with things like that.

So, and to complicate things further, some people have like elements of both.

But so that's one thing that I learned that alcohol really does have very different effects on different people.

So 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 energize.

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.

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 rest of this stuff because it's super exciting.

I think the process that you went through to get sober is just so fascinating.

Sure.

But I would put myself in

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 are, so there are particular risk factors for people who develop alcohol use disorder.

And one of those 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 start drinking.

And a third and really important one is repeated exposure.

Trauma can also be a risk factor.

I didn't have any trauma in my background, but those three other risk factors, genetic history,

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 it's a selection effect that if you start drinking young, that's because you like it

in some sort of a way.

That could be part of it.

But, 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 I wasn't, I wasn't really an outlier within my peer group.

Everybody drank.

And I don't think everybody developed a,

you know, an addiction later on.

Yeah, that's interesting.

And I think you make a distinction between

relief drinkers and

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 onto something there.

I was definitely a reward drinker.

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 I, when I, even though I knew that I was going to regret this 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.

And then at that point, you know, I would get sort of slower and sloppy.

But yeah, a lot of my drinking was

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, I guess,

what is it?

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 massive amount.

So

I wonder how many people, that means that 50% of the consumption is done by 90% of the people, something 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 survey came out recently.

This was either Gallup or Pew or something like this.

Some survey came out recently that

when you look at Lisa, 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 10 Americans fall into the category 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 elusive, mysterious strategy that we're about to talk about?

What were the different things that you did before that?

So, I did AA.

I could never really stick it out.

I did individual therapy.

I did group therapy.

I did these sort of cognitive behavioral therapy things like

moderation management, smart recovery that have sort of less of a faith-based element.

So these are things like tracking your drinks, just sort of strategies to drink less or to 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 pretty quickly because as soon as it was on as soon as I had my first drink, like any pretense of

moderation was just on because like that's, I drank to get fucked up.

I didn't drink to like enjoy the taste of Pap's blue ribbon.

You know, the fine effervescence of a shitty beer was never really my thing.

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.

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.

So I broke my fast with alcohol.

I would do stuff like that.

You know, I'm going to get really into yoga.

That's going to solve my problems.

I'm going to, Sam Harris's meditation app is going to save my life.

I tried stuff like that.

Outpatient therapy.

So I like group therapy with other people

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

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 did try things.

I never did rehab,

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 weak-willed motherfucker.

I just don't, I 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 men, 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-dosing testosterone, I'll be like, yes, I'm going to channel all of that energy into doing that.

You're going to become an Iron Man.

Yes.

Yes.

I'm not going to 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

the guys, the sort of classic mid-30s, mid-40s pivot toward endurance racing.

Yeah.

I think, I mean, it's fantastic 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.

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.

If you don't have

the capacity to sort of build that structure together, then that outlet is entirely precluded 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 10-day 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 making in this new avenue here.

I'm going to start a new business or I'm going to, you know, whatever, fucking crocheting, you know, pickleball, whatever you do.

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 shit 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 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 for it for that kind of thing.

Alcohol use disorder in that way is kind of a luxury problem to have.

Well, 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 had the privilege of becoming an alcoholic because we didn't have children.

Because so many people you see who suffer from alcoholism are truly down and out.

Although, although I think like the stereotypical homeless person, person living on the street now is probably alcohol might not be.

I think I live outside Seattle, so we see more of like the fentanyl lean than we did 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 up against.

How susceptible are you to the substance?

And then how

non-susceptible or limited are you in potential coping strategies or other

modes of reward, other avenues that you can go down?

Yeah.

And alcohol, it sort of arrests 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 your response to

trauma or tragedy, or even

positive news has always been to grab a bottle.

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What does the

history of addiction treatment philosophies look like?

From the outside, it seems to me like AA was the gold standard.

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 round.

But it seems evidently like it's not a panacea for everything.

Right.

It's not a panacea for everything.

So the history of addiction treatment is pretty fascinating.

So in the early days before programs like AA, and obviously alcohol addiction has, I think, probably

existed as long as alcohol is.

And the first traces of human consumption of alcohol was found in some like pottery, some clay urn in China from 9,000 years ago, some traces of rice wine or something like that.

So, people have been drinking for a long time, right?

And you can see in early writings and the archaeological record that

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

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.

So there were, so, so, for instance, the

guy who created AA, his name is Bill Wilson.

Before he created AA, and this is, you know, peer, he wasn't the first person to start a peer group, but, but certainly probably the most successful in Western history, at least.

He went to this hospital in New York called it was called the Towns Hospital.

And he went there four different times.

And every time he would go, they would give him the treatment du jour, which was, um, it was a, it was belladonna, 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 benzodiazepams.

And it's not like, so

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 DTs, the delirium tremens, the shakes, you're ill, you're sweating on a floor somewhere.

I had to absorb the message of alcohol withdrawal from literature and from pop culture.

These days, it's totally different.

You can

go to a center, basically sit in a recliner for a few days and they pump you full of vitamins and give you some medication and you're fine within a few days.

This can even be done at home as well.

But in the early days, it wasn't like that.

And there were all sorts of sort of

maybe not super effective kind of miracle cures

that were marketed at the time.

And then Bill Wilson in the 1930s.

So

this is a guy who'd been a stockbroker.

His life had absolutely deteriorated.

And

he was at this Charlestowns hospital and he had this sort of come to Jesus moment.

He had a, it might have been a Belladonna

hallucination, but he had this

moment where he saw a flash of light 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 Akron, Ohio, and he was fighting the urge to drink.

There's this concept called alcohol,

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 had joined 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 Akron, 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

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 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 Mann.

Good old dyke.

She was a lesbian, although I don't know if they used that word at the time.

And

Marty Mann had, she had spent a lot of time in the UK.

She She came back, passed out on a stretcher, had to be carried off of whatever ship, the Queen Mary, HMS, whatever, whatever, had to be carried off this boat, came back to the US and continued to drink, right?

And so she was killing herself like many alcoholics do, just...

suicide attempts, 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 Mann 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 was really considered a moral failing.

And so 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 alcoholism is a moral failing.

They actually don't.

They really rely much more heavily on this medicalized model.

I have my issues 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 different, right?

And

anyway, so she spread that message

throughout the land.

And that is one of the reasons that AA became as popular as it did, because it had a really good, really good PR team.

And AA, there were lots of other treatments

throughout history.

Things like

There was a clinic called Shikshadel that did aversion therapy, right?

Different

societies, different cultures.

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 100 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 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

with the rise of groups like Sober Curious and their apps, there's one called Reframe that I keep getting ads for on Instagram is sort of a broadening.

I think the the cultural stranglehold 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.

Professional licensing organizations.

If you get, if you're 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.

Sober houses, they could mandate attendance in 12-step programs.

So for some people who are,

you know, who are getting out of jail and need a place to live and they need to live at a halfway house, they have to enter 12-step programs.

So it is really enmeshed 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, to be clear, like I don't know, not KA, it really does work for a lot of people.

It just doesn't work for everyone, including me.

That's a long answer to your question.

Sorry.

It's fascinating.

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 to see that you have completed a 30-day streak on Sam Harris's waking up.

Yeah.

Equine therapy.

You have to go swim at dolphins.

Someone else.

Whitney Cummings does that.

She says it's really good.

I'm sure she does.

So

is there a particular taxonomy of drinker that you think AA does and does not work for?

Is there something something about you, given that it is for some people, for many people, 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

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.

I also am not, I'm not a joiner.

I'm not

predisposed 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.

But it didn't, it just didn't stick with me.

And,

and, and also, you know,

there's that 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 I'd like doing these interviews and writing this book was very off-brand.

You really chose a difficult thing to be talking about for the next couple of years.

I did.

I absolutely did.

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 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.

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 some people who think I should make amends to them.

They're going to be waiting for a while.

Not because 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.

Yeah, I just, I think like some combination of my personality, I'm a skeptic by nature.

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 hypnotism, and I also want to get my genome mapped.

So

I fear that we are both built from the same sort of building blocks there.

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 AA,

is,

well, this person knows that their drinking is bad, but it's just out of their control.

And

it's destitute and

they're despondent and

they don't enjoy it, but they're gripped by this sort of evil thing and it's at the bottom of a bottle.

And then there's other people who go, I think drinking is pretty awesome.

It makes me feel pretty good.

And 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.

I think that's the thing you've captured the inner monologue of many an alcoholic.

Okay.

If AA were invented today

with all of the evidence that we know about now and it didn't have the stranglehold, 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 sobriety, full sobriety.

And how can you be sober if you're doing psychedelics?

And he sort of lost that battle.

But he was extremely open-minded.

And my book starts with a quote from the big book,

which is the Bible of AA.

It's the sort of the big text that everybody reads and studies.

And the quote, I'm going to butcher it, but it's something like:

someday science might find a cure for the alcoholic, but that hasn't happened yet.

And the thing is, 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 couch that in many ifs.

But I think for some people,

there's a cure.

And

it worked for me.

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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 Endo Laboratory.

So we are talking about, this is, you know, before the Civil Rights Act.

This is, this is, this is old shit.

And this drug,

it was owned by DuPont for a long time.

They bought the first laboratory that synthesized this, IndoLaboratories.

And it's an opioid antagonist, so an opioid blocker.

It was initially developed to treat opioid addiction, 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 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

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 naltrexone.

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.

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.

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 state-owned,

sort of an interesting company, especially from an American perspective.

So it was a liquor distributor.

that also had a lab.

So taxpayer funded,

or funded by, I presumably, I don't know what the liquor taxes were in Finland in the 1970s, but 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 researchers in the basement.

I don't quite remember at the moment.

You had people like John David Sinclair who were working on treatments for alcohol use disorder.

And John David Sinclair, so he did most of his research on mice.

And he realized at one point that he was one of the first people to describe the alcohol deprivation effect 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 blocks, various drugs, including this opioid blocker, naltrexone.

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,

this was a, a breed of lab rat that had been, and had, it had been bred specifically to have a propensity for alcohol addiction.

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 GMO'd, but you know, good old-fashioned.

You take two rats that like to drink.

Yeah, you make them fuck.

So you find the ones that are hanging out the bar late at night, get them together, put them in a room together.

And so

he started these experiments.

And what he found was that, yes, these lab rats that

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 writing about this.

This was later, uh, later started doing human studies, and he developed what is now called the Sinclaira method.

And so, the Sinclair method is very simple.

You take an opioid blocker, usually naltrexone, and there are other ones.

There's one called nalfamine that's more common in Europe than it is in the U.S.

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.

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

The Stranger, which was 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 I did this for two years.

I drank basically every time 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 mean,

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 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 treatment.

You can't half-ass 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,

the Sinclair method is basically a process of unlearning a behavior.

It's called extinction or pharmacology extinction because there's a medication involved.

And so 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 going to be undone overnight.

But if you do this,

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 started, you have to incorporate some habit change and mindfulness, which is not natural for me.

I'm not a mindful person.

But you have to, you have to do these sort of

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 two or maybe three.

And I started incorporating more alcohol-free days into my week.

And alcohol days or 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, Vivitrol, 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 endorphin receptors to be key up and on those days you go out and you do things that are gonna spur a sort of natural high you know go for a hike um have good conversation 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 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 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 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, 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.

The loan skeptic again of his own brand.

Yeah.

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.

So I was involved 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 naltrexone 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 U.S., historically, addiction medicine has been a very, very small part of

medical education.

So I talk to doctors who are, you know, in their 40s and 50s, who did four years 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 eight years 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 U.S.

This is this is changing.

So there are currently three drugs that are FDA approved to treat alcohol use disorder.

Naltrexone is one of them.

There's also an abuse, which has been around since the 1950s or been FDA approved for the 1950s.

And there's one called a camprosate.

And there's also various off-label drug other drugs that are used on 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 the recovery industry, the idea of harm reduction was sort of anathema.

You know,

nobody, not nobody, but a lot of a lot of these institutions were based on 12-step programs, 12-step principles.

And in 12-step principles, like you don't tell people to go take Suboxone or methadone.

You tell them to seek help from, you know, to confess 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

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 naltrexone 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 sell for a lot of doctors, not just because,

you know, this, it sounds like

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 pack of beer, enjoy yourself.

And your patient 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.

There's also economic factors here, right?

So naltrexone 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, another theory, there's a guy named Percy Menzies.

He was a drug rep for DuPont.

And so he was one of the, one of the, this is back in this, in the, in the 80s, he was one of the first people trying to sell this drug to doctors, or

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

and 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,

methadone had sort of cornered the market.

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'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 no anyone, you know, you know, opioids are sort of a, they're, they're on 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's, it feels to me like the whole kind of alcoholic,

alcohol use disorder world has been

over-moralized and undermedicalized.

Yes.

I think that that's kind of how it feels.

I think you're completely right about that.

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 have complicated feelings about that framing.

I don't think it's particularly.

Somebody who's unsure that it is a disease, but something that you should treat with medications.

Right, right.

Could treat with medications.

Right.

And naltrexone doesn't work for everyone.

I want to be really clear with this.

So earlier we talked about those two types of drinkers, right?

Reward drinkers and relief drinkers.

And this information, I learned this all from a guy named Joe Vopicelli.

He's this fantastic clinician and researcher

out of Penn.

And Joe's studies, some of his, he's been working with naltrexone for decades, and some of his early studies were used for the FDA approval of this drug.

And Joe explained this to me.

For reward drinkers,

people like this tend to be binge drinkers, right?

The people who are going out, going to clubs,

dancing in the town fountain, whatever, people who get energized from alcohol, naltrexone 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, reliefs drinkers, people who get the sedating effect, it has almost no effect.

Why?

I think it's.

Okay, so part of this, 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 allele.

So one particular gene variant.

It's called ASPS40, ASP40, and the Mu opioid receptor.

Having that, having possessing that allele does not guarantee that naltrexone will work for you, but it's a strong indicator that it may work.

If you don't have that, have that allele, it's a strong predictor that it will not work.

Right, okay.

And that, that

will

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.

I checked your genetic and lab reports.

The ASP40 variant you're asked for refers to the OPRM1 and A118G polymorphism.

Looking through your genetic reports, you do not have the ASP40.

Your OPRM1 result shows the AA genotype, ASN40, SN40, meaning you do not carry it.

So no, so I would be

useless.

You might, it might not.

It would be interesting to interest.

Do you drink now?

No.

It was an interesting journey, I guess, with regards to alcohol for me.

I never had a problem with it in terms of a dependency, but I was a party drinker.

Every two weeks, I would send it in club promoter fashion.

And

then it got toward the end of my 20s.

So, what are we talking about now?

28, I think 27, 28 would have been the first time I did it.

So, maybe nine years ago.

And 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, nine years ago, that really was not the case at all.

It It was not trendy to be against the grain with regards to even social drinking.

And

there was just some inclination that I had

that

alcohol was holding me back,

even though I wasn't using it that frequently.

I do get bad hangovers.

I think I tend toward low moods 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 just had one really bad hangover one day, and I was like, I'm not going to drink for six months.

And I just had this idea in my mind.

So I went six months sober

and loved it.

And then I was in Bali and had a corona.

I was like, okay, 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 will be a beer or a couple of beers or something like that.

And I'm curious, when you drink, what is the effect?

Do you get high energized sort of fast or does it chill you out?

It's a good question.

And it's harder.

It's harder to answer than you might think.

Like it does.

I would say in the past, it might have...

been and this is what i said earlier on in my 20s it reminded of being more energized energized and it being enthusing.

Also, would have been coupled up with unspeakable, unpronounceable drugs from a guy in a toilet somewhere,

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 are 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, the collective effort, or it's set and setting for alcohol.

Um, that

but 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, yes.

Um, and maybe that is the sort of thing that I want.

And also, I've generally chilled out.

I mean, 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 it was a big part going sober 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.

Sober maxing.

Sober maxing.

That's it.

It's correct.

Yes, yes.

I was, I mean, I still am.

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.

And I can see a place for that.

But if you're looking just straight up physiologically huberman-pilled, like it's not, this is not the direction to go down.

But it was a huge, huge part of me and my life.

And 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.

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 how triggered other people were by it, by how mean they got.

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'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.

Yeah.

Because

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.

Yes.

And other people do not like the spotlight being placed on them in.

reflection of somebody that's making a change.

And yeah, I mean, I wrote, God, I wrote so much about this, about the fact that if the only friends that 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 are 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 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 whether 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

working-class 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 holiday-ish trips, six in the morning, five 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

it shouldn't be allowed, but oh, we're going to treat ourselves to something.

And I always found that so fucking cringe.

Like, I always, I always found it.

I was like, oh my God, that the highest point

of

subversive

anarchistic contribution that you can have is having a beer at five 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, oddly enough, even though alcohol was never something that was a huge

part of my life.

Going sober was massively formative because it allowed me to finally get a fucking 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?

You're 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, oh,

okay, maybe I'm sort of slowly getting back there.

And I'd always wondered, like, why am I just, it permanently feels like I'm not making progress at the speed that I should.

And

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

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 pilled.

Well, I'm naltrexone pilled, 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 shit.

I still can't really optimize shit.

How did you get anything done?

Because I've listened to your podcast.

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 addled 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.

That doesn't smack me as that.

So are you the prototypical functional alcohol use disorder person or what?

Well, I wasn't for a long time.

So until I was 30, I worked dead-end 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 shit 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

i'm gonna i'm gonna get your job and i'm gonna do it better than you i'm gonna i'm gonna i'm gonna 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 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 to cycle over again.

That was actually a fairly effective way of

getting clean for at least a little while, like removing myself from the environment that I was in.

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.

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 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

40 low alcohol beers a day.

It's just an immense amount of liquid.

He probably had to wear a fucking diaper.

Yeah.

Holy shit.

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.

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

Great Britain.

And when that changed from being the public house where everybody would go to meet and talk during the day, and that

encouraged a slightly sloppier type of conversation to then, oh, well,

you don't just need to drink the alcohol.

Perhaps you can drink the caffeine.

And this was some sort of springboard boon for idea generation and may have contributed to the Renaissance and stuff like that.

What is I'm curious?

So 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 pub and pool tables.

And we drank fucking snake bites, that horrific, like half cider, half lager with a little bit of black currant juices.

And it's like worse coming out, coming up the next day.

It's disgusting.

And just the drinking culture there was,

I loved it.

I absolutely loved it.

But I'm curious.

I mean, yes, in the U.S.,

we have definitely seen, like, we can see this in polling.

Gen Z is way less boozy than you know, millennials and 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

has this changed in the UK at all, as well?

Or are people still boozing it up there?

I think it's very similar.

My colleagues and ex-business partners from the industry that I spent my life in,

it does feel a little bit to me like I sold Bitcoin at $120,000

because the market has really hit quite

an aggressive downturn.

It's just not the done thing.

And, you know,

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 TikTok and just the fat vegetable culture.

I'm just going 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 than drink now, I think.

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 are around you, whether it's the social norms about that, whether it's the education level that you've got and the 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, it really is, in many ways, a

perfect storm to stop people from drinking.

And in many ways, in many ways, that's good.

But I mean, we are already seeing 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.

They're like, oh no, we're worried about this thing now.

We're very concerned about the, you know, the isolation.

Yes.

So it's, it's, I mean, 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 rite of passage thing that I said,

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 alcohol dependent.

Yes.

And if that's the case, you can, 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?

At least the girlfriend for the week week or the night.

That's true.

That's true.

That's true.

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

doing something embarrassing.

We used to do this bark 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 tick off, like pulled a pig, swapped shoes with a random

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 make sense.

It was a different world.

And

different

means a different thing in Austin.

That's a barbecue joint.

True.

That

Larry Louty culture would not, you would not even be able to get two feet down the street with that in the modern world because this fucking surveillance state run by gullible volunteers, this sort of stasi for the angry birds generation,

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 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.

Yeah, so I don't know how young people today get away with shit.

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.

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 solution for people that are drinking too much?

Is it to sort of campaign to make this more widespread among doctors?

All of the above, yeah.

I want the main message of the book is, you know, the book is about the Sinclair method in naltrexone, and it is sort of a step-by-step.

This is self-help, which the fact that i katie herzog 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.

Trying to figure out if it'll even work for you in the first place.

But I 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.

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 option does work for a lot of people, but it doesn't work for everyone.

And I think the problem

with 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 did do that in the end, but it wasn't what I expected.

And 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 would have taken this step, I think, a lot earlier than I did.

And I would have saved myself some heartache 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

very good.

So

yes.

Yes.

I mean, not only did I have to

come out and tell my parents that I had been secretly drinking, I had to tell them that I wrote a self-help book.

It's humiliating experience.

It's the price that you pay to try and help the world become slightly better.

Katie, you're great.

Where should people go to check out all of your stuff?

You can pre-order the book.

It's

on Amazon, all that stuff.

You can go to my website, drinkyourwaysober.com or org, not sure, Google it.

And I also have a podcast.

It's called Blocked and Reported.

We do not talk about self-help or drinking culture.

We talk mostly about the internet and culture.

And a lot of talk about furries.

We've been on a furry kick lately.

Okay.

I haven't seen those, but your Blocked and Reported is awesome, and everyone should go check that out.

So are you.

I really, really appreciate what you've done.

Thank you for having me.

It's great to talk to you.