A Controversial New Cure for Alcohol Dependence - Katie Herzog

1. 0:00 – 18:36

   How Relationships to Alcohol Can Vary

   1. CWChris Williamson0:00

      Talk to me about your relationship with alcohol.

   2. KHKatie Herzog0:02

      Oh, gosh, it's a complicated question. So my relationship with alcohol started very young. I started drinking ... or I had my first drink when I was in middle school. I don't know if this is something that 12-year-olds do these days, but, uh, but back in my day, 12-year-olds drank, or at least they did in my school. And I, I loved it. I loved it from the very beginning, um, even before I was sort of old enough to appreciate the, the taste of a good glass of wine or a cold beer. I liked the effect. And so I drank in, in high school, I drank more in college, and by the time I was out of college, I was a bar fly. So I spent a lot of time sitting on bar stools from 4:00 PM until late at night, oftentimes with men who were (laughs) ... 'cause these were the sort of people who would, who would be at bars drinking during the day, like men in their 50s and 60s. These were, these were my people. Um, and I, I lived like that for a really long time. I was a party girl, so I was a lot of fun back in those days. I gradually got less fun the more my drinking accelerated. By the time I, I quit in my late 30s/early 40s, I wasn't a party girl anymore. Most of my drinking was done solo and in secret. Um, but that was it. And this was not, this was not abnormal among my, my peers and my friends. I ... My life was lived in bars. This is what my friends and I did. And there were, of course, consequences to this, some of them pretty terrible. Um, I went to the hospital a couple times. I, uh, I very memorably burned down a porch at one point. I had trouble k- ... I see, I see your, your brow is sort of furrowing here. Do you wanna know how I, how I burned down a porch?

   3. CWChris Williamson1:41

      Yes.

   4. KHKatie Herzog1:42

      So (laughs) 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, a weekday night, which was rare to me at this period of my life. This was in my late twen- or my mid-20s. I spent e- ... When I say I went to ... I was a bar fly, I was at the bar almost every day. And luckily, this was at a time when, when Pabst Blue Ribbon was a buck 50, you tipped 50 cents, so I was not ... didn't ha- ... My bar tabs were hefty for the amount of money that I was making, but still, my drinks were cheap. And so I stayed home one night, thinking I'm doing the right thing, and I was also a smoker, and I, uh ... And ironically, I was, I was watching, uh, this, this fantastic television show. I can't remember what it was called, but it was about the, the NY ... It was the New York City Fire Department. Uh, Denis 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, uh, failed to extinguish a cigarette. I just, like, left it burning outside, and I lived in an apartment building. I, I walked outside, I saw some smoke and, like, a, a fairly significant hole in the wall where the vinyl siding had started to melt. I went and got a glass of water first, tried that, splashed it on, it didn't work. Went and got the fire extinguisher, tried that, that didn't quite work. It was still burning. And then I called 911, and they said, you know, "This is 9- this is 911, what's your emergency?" And I said, "Well, I'm not really sure if this is an emergency. I'm really more looking for advice." And so I wanted them to reassure me that ... I don't know what I wanted. I just didn't want to get in trouble, basically. Eventually, they did come, and I had to bang on all of my neighbors' doors and tell them that the apartment building was on fire, and, um, while the fire department was in my house dragging a hose through my carpeted living room floor out to the balcony out 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?" Um, so everybody knew about this, and frankly thought it was hilarious, because that's the sort of community that I lived in. And I thought it was hilarious too. I mean, terrible, but also hilarious. So I had lots of sort of misadventures like that. I had trouble holding onto jobs. I dropped out of college once, I dropped out of grad school once. I did finish college, I didn't finish grad school. And alcohol just really dominated my life for my teens, 20s, and well into my 30s. Um, and it got ... Gradually, it got less fun, and it got kind of more depressing as the, as the sort of friendships evaporated, as everybody else kind of got their shit together or didn't get their shit together and, and died. Frankly, a lot of people I know from those days, from those days are dead. Um, and at some point, I realized I was just sort of drinking alone, you know, the last one at the bar, except the bar wasn't a bar, it was my house, and I was by myself scrolling on my phone during COVID, drinking alone as much as I could.

   5. CWChris Williamson4:40

      I don't know whether you know, but m- the first 15 years of my adult life was spent as a club promoter.

   6. KHKatie Herzog4:46

      Mm-hmm.

   7. CWChris Williamson4:46

      So I ran, I ran nightclubs for a real long time. Um-

   8. KHKatie Herzog4:49

      We would've gotten along really well in that period.

   9. CWChris Williamson4:51

      You ... I would've made a lot of money from you, yeah. Um.

   10. KHKatie Herzog4:54

       (laughs)

   11. CWChris Williamson4:54

       (laughs) Um, I often think about this, that the way that party culture ... and I'm not sure if it's the same now. I genuinely don't know if Gen Z has kind of adopted the louty, lairy drinking culture that I knew and, and, and you would've known as well. I'm mean, the British, it's kind of a national sport for us.

   12. KHKatie Herzog5:12

       Yes. Yeah.

   13. CWChris Williamson5:13

       Um, I often do think about how many people were just in the party enjoying themselves, these events that I used to run, um, and most people you expected to kind of age out of them, to sort of graduate out of the young party lifestyle. Um, but, you know, I did a million ... over a million lifetime entries a- a- across my career as a, a club promoter, so that's a pretty big sample size.

   14. KHKatie Herzog5:41

       Yeah.

   15. CWChris Williamson5:41

       And I do wonder, you know, how many of these people saw the thin end of the wedge, which was, "Well, this is fun, and I'm, I am with my friends, and there's a good DJ on, and there's music, or there's whatever," but that, that is kind of this gateway that, out the other side of it introduces them to a frequency of use, and maybe not even just alcohol. Um, how many of those people went on to, yeah, kind of be ...... are more dependent. They were, it was 4:00 A.M. in the nightclub, and they were still there, but the club was closed and no one else was around.

   16. KHKatie Herzog6:13

       Yeah. I- It's probably not an insignificant number, not that this is your fault. There's probably, people were probably gonna find their way to addiction, uh, any way they, any, you know, no matter what happened, whether you had been there or not. But, you know, you're right in the, in the fact that most people do actually age out of problem drinking. Most people who binge drink during college don't continue to binge drink into their 40s and 50s. It's called natural recovery. This was a concept I was completely unfamiliar with until I started writing my book, but this concept, natural recovery, this is more common than not, and most of my peers from my college days did gradually sort of get their 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, the, the age what I should've been.

   17. CWChris Williamson7:10

       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, that, i- is that it in a c- in a nutshell?

   18. KHKatie Herzog7:23

       Yeah. That's, and that's basically it. People who... Natural recovery is people who don't take any, any sort of proactive step to recover from alcohol use disorder. Alcohol use disorder, you know, what is commonly called alcoholism, is a vast spectrum and for a lot of people on that spectrum, they don't have to go talk to a therapist or go to an AA meeting. They just naturally age out of it.

   19. CWChris Williamson7:45

       Mm.

   20. KHKatie Herzog7:47

       And that's the ideal. That's what I wanted. I thought, uh, that was my hope. I knew that I was a problem drinker from a very young age, but my hope was that some future me, some older, more mature me would be able to just sort of, you know, take it or leave it. This doesn't work in my life any, w- for my lifestyle anymore, I'm done. It just never happened. I took sort of, it took kind of brute force for me to actually get over my, my habit.

   21. CWChris Williamson8:09

       Mm. 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?

   22. KHKatie Herzog8:19

       Yeah. I knew from my early 20s, I had my sort of, uh, my first come to Jesus moment. My, uh, I was, I believe 24 and I was going through my first really serious breakup, and, um, I had... Let's just say I behaved in some ways that are not optimal to a healthy relationship. I cheated on my girlfriend, and when I was confronted with that fact when she discovered this, because this was back in the, in the MySpace days when she, when she read a message that I, that I wrote to a friend of mine sort of confessing to my friend what I had been doing, my girlfriend at the time, she, um, she came to the bakery where I worked. I had a brand new job. I was a barista at a, at a bakery in, in Portland, Oregon, and, um, she walked in and she, 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, was out on the, on the, on the lawn, and then that was my first moment of being like, "Oh, something is deeply wrong with my behavior." And either I'm a bad person, either I'm a sociopath or I'm an alcoholic. I also, for a brief period, I convinced myself that it wasn't, the problem wasn't drinking 'cause 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 II, which is sort of bipolar light, but like bipolar I, and I was like, "Hell yes. That's it. I'm not an alcoholic." Yes.

   23. CWChris Williamson9:46

       My drinking's sick. My drinking actually helps my bipolar.

   24. KHKatie Herzog9:49

       Exactly. I, I'm not bipolar. I kinda... Not that I wish that I was, but I'm, like, just fun- sort of fundamentally sort of a low energy person. I'm not bipolar. Um, I would, uh, you know, I would do things like, "You know what? It's my astrological sign. I'm a Gemini. That's just what this is." It turns out I'm not a Gemini, I'm a Taurus, um, and astrology is also bullshit, um, but at the time, I was sort of u- looking for any, any plausible reason that would explain my poor behavior besides alcoholism. And I lived in, uh, 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. Um, and I did, uh, and in one of those moments, I did start going to AA, one of those moments of, of sort of realization, I did start going to AA. It didn't work for me, but I went to AA at, at various times over the years. And so v- I lived like that for about 15 years, about, um, you know, sort of knowing that drinking was a problem, doing things to try to curb my drinking, quit drinking, moderate my drinking, but ultimately, I was never able to string more than 30 sober days together.

   25. CWChris Williamson11:03

       What makes me really t- (sighs) it's like a, an odd irony, you having this kind of embarrassing, potentially fatal story where you nearly burnt down an entire apartment complex.

   26. KHKatie Herzog11:15

       Oh, that's not even one of the embarrassing ones. (laughs)

   27. CWChris Williamson11:18

       Okay. Well, uh, the, the rabbit hole goes deep.

   28. KHKatie Herzog11:20

       (laughs)

   29. CWChris Williamson11:20

       I'm excited to learn more. Uh, but my, even the point on that is what was the response from all of the people around you? And I did... My master's dissertation was on the effectiveness of anti-alcohol advertising on students-

   30. KHKatie Herzog11:32

       Mm-hmm.
2. 18:36 – 26:58

   How Does Alcohol Addiction Manifest in the Brain?

   1. CWChris Williamson18:36

      What have you learned about the way that, uh, alcohol addiction particularly sort of shows up in the brain, the, the mechanism of how this works, the reward signaling, uh, the different types of alcohol use disorder?

   2. KHKatie Herzog18:50

      Yeah.

   3. CWChris Williamson18:50

      Like, what have you learned about this?

   4. KHKatie Herzog18:52

      Yeah, so I learned a ton about this while I was working on the book. So to simplify things, there are basically two types of, of problem drinkers, of alcoholics. And alcoholic is a term not a lot of people bristle at, but I use it, because everybody sort of can, can... It's easy to conceptualize what an alcoholic is. And, and again, alcohol use disorder is a vast spectrum, so this could be somebody who just drinks one glass of wine that she doesn't necessarily want or someone who's, like, fully pickled, pickled her liver. And I was, like, somewhere not on the middle, somewhere on sort of the far side of that spectrum. Not by any means the worst, though. So, when I drank alcohol, I got a, a euphoric buzz. It was, for me, it was almost taking a little bit of caffeine or a little bit of cocaine, right? Didn't make me sleepy, it made me energized. It made me talkative, um, it made me obviously make poor decisions, uninhibited, you know, I'm, I'm gonna go sing karaoke on a, some ter- some... I'm gonna go, like, rap the water, the, the TLC song, Waterfalls, in front of all of my friends and feel great about it. At one point, I... Now, this part is actually embarrassing. I was in a band, and my role in the band was not to sing or to play an instrument. I wore a horse head mask and I danced around wearing pasties, holding a machine gun, and I did this on stages in front of other people. That's the sort of thing that I would do when I was drinking, right? So very, very energetic, very much the life of the party, at least in the earlier days. In the later days, it was just sort of depressing and alone, but in my party days, I was very fun. So, for people like me, you get, uh, you get a rush of endorphins when you drink, right? And that, that, uh, indirectly affects things like dopamine and serotonin. But you get a high. For other people, and these people can still have a drinking problem, but other people get a sedating effect from alcohol. So they're not getting that big rush of endorphins. What they get, it calms them down. Uh, for people who drink because they have, like, severe social anxiety, um, alcohol can, can help with things like that. So in- and to complicate things further, some people have, like, elements of both. Um, but so that's one thing that I learned, that alcohol really does have very different effects on different people. 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 energized. It's not like having a little shot of cocaine or Red Bull for her. It makes her calm. It's a chill thing. It's sedating. Um, and so for people like her, it's just... I don't think she'll ever have a serious drinking problem because she doesn't, she, she doesn't get the, the really strong effects from alcohol. She just sort of gets sleepy and slow and...

   5. CWChris Williamson21:43

      Have you got any idea what the difference is between the you bucket and the her bucket?

   6. KHKatie Herzog21:48

      I'm s- 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?

   7. CWChris Williamson21:58

      Let's, let's just round out the, the, the rest of this stuff, because it's super exciting. I think the-

   8. KHKatie Herzog22:03

      Sure.

   9. CWChris Williamson22:03

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

   10. KHKatie Herzog22:06

       Sure.

   11. CWChris Williamson22:07

       Um, but I, I would put myself in, uh, kind of both categories. I think when I was in my 20s, I was probably more you, and in my 30s, I'm probably more your wife.

   12. KHKatie Herzog22:17

       Yeah, yeah.

   13. CWChris Williamson22:17

       Uh...

   14. KHKatie Herzog22:18

       It's, that's interesting. And there, so there are particular risk factors for people who develop alcohol use disorder, and one of those is, is just gen- it's 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 what you, at which you start drinking, and a third and really important one is repeated exposure. Uh, trauma can also be a risk factor. I didn't have any trauma in my background, but those three other risk factors, genetic history, uh, early exposure, and repeated use, I had all three of those risk factors. And if I had had two, you know, a genetic history and I started drinking earlier, but I drank once when I was 12 and I just never did it again-

   15. CWChris Williamson23:00

       Mm.

   16. KHKatie Herzog23:00

       ... 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.

   17. CWChris Williamson23:11

       Why do you think the early exposure thing makes a difference? I- i- it's just habituation? It's part of your development?

   18. KHKatie Herzog23:19

       I don't know. That's a good question.

   19. CWChris Williamson23:20

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

   20. KHKatie Herzog23:26

       Sure.

   21. CWChris Williamson23:26

       ... in some sort of a way?

   22. KHKatie Herzog23:27

       That could be part of it, but, and, you know, when I was growing up, it was not uncommon for, at least in my sort of... I didn't go to a, like, a particularly bad Oregon 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, a, a, you know, an addiction later on.

   23. CWChris Williamson23:52

       Yeah, that's interesting. And I think you make a distinction between, uh, relief drinkers and recreation-

   24. KHKatie Herzog23:59

       Reward.

   25. CWChris Williamson24:00

       Reward drinkers? Yeah.

   26. KHKatie Herzog24:01

       Right, right.

   27. CWChris Williamson24:02

       Yeah. (laughs) 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.

   28. KHKatie Herzog24:16

       Yeah, I think you might be, you might be onto something there. I was definitely a reward drinker. Um, even at the end, I wasn't... For me, it's like the difference between the first drink and the third drink, I would start to get that euphoria, right? That high. Even though, even I, when I, even though I knew that I was gonna regret this later on, chasing that buzz became really paramount to sort of...... everything that I was doing. I was looking for that. It's not even a long period of time, there was maybe, like, a 20-minute period between the first drink and the second drink or the s- second drink and the third drink that felt really, really good. And pretty quickly, you know, by the fourth drink and the fifth drink, that euphoria is gone. I kept drinking in order to chase that buzz, but you unfortunately cannot recreate it. Um, and then at that point, you know, I would get sort of slower and sloppy. Um, but yeah, a lot of my drinking was s- was in, in the, in the effort to capture this one very specific feeling, where I think my endorphins and my, and my dopamine is just raging in my brain.

   29. CWChris Williamson25:20

       And that's at the very start. So, yeah.

   30. KHKatie Herzog25:22

       Yes.
3. 26:58 – 33:53

   Building Good Habits to Break Bad Habits

   1. CWChris Williamson26:58

      What did you try before the, uh, elusive mysterious strategy that we're about to-

   2. KHKatie Herzog27:02

      Yeah.

   3. CWChris Williamson27:02

      ... talk about. What, uh, what were the different things that you did before that?

   4. KHKatie Herzog27:05

      So I did AA. Uh, could never really stick it out. Um, I did individual therapy, I did group therapy, I did these sort of, um, cognitive behavioral therapy things like, um, um, moderation management, smart recovery that have sort of less of a, of a faith-based element. So these are things like tracking your drinks. Uh, just sort of strategies to, to drink less or to, um, or to take more control over your alcohol consumption. Drinking a glass of water in between alcoholic drinks. That stuff all went out the window for me pretty quickly because as soon, like, it was on as soon as I had my first drink. Like, any pretense of, of, uh, moderation was just on 'cause, like, that's, I drank to get fucked up. I didn't drink to, like, enjoy the taste of Pabst Blue Ribbon. (laughs) You know, the fine effervescence of a shitty beer was never really my thing. Um, so I did stuff like that. And then I would do these, like, like, I did the master cleanse at one point, which is this idiotic, uh, you, you don't eat solid food for 10 days. You drink cayenne lemon water. I lasted for, like, three days and then I went to the bar. Um, so I, I broke my fast with, with alcohol. Um, I would do stuff like that. You know, I'm gonna get really into yoga, that's gonna solve my problems. I'm gonna... Sam Harris's meditation app is going to save my life. I tried stuff like that. Um, outpatient therapy. So I, like, group therapy with other people, um, who had, who had similar problems. That was particularly, I would say, ineffective for me. And a lot of that was also based on principles of CBT. So going to these therapy sessions and, you know, I 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 'cause I didn't take it seriously enough. But I did, you know, I'd show up. I, I, I, I did try things. I never did rehab.

   5. CWChris Williamson29:04

      Mm.

   6. KHKatie Herzog29:04

      Um, but I did try lots of other things.

   7. CWChris Williamson29:07

      It sounds like white knuckling it with willpower isn't an option then.

   8. KHKatie Herzog29:11

      I tried that. I tried that every day. It just, I'm, I'm like a w- weak willed motherfucker. I just don't. I don't, (laughs) I don't, I don't... L- 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 m- 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 l- maybe if I start, like, micro dosing testosterone, I'll be like, "Yes, I'm gonna-"

   9. CWChris Williamson29:54

      Mm.

   10. KHKatie Herzog29:54

       "... channel all of that energy into doing pull-ups."

   11. CWChris Williamson29:56

       You're gonna become an Ironman. Yeah.

   12. KHKatie Herzog29:57

       Yes, yes. I'm not gonna become... I might, like, you know, watch 11 hours of television in a row. I can, I can binge something like that, but I've never been good at sort of the healthy habits.

   13. CWChris Williamson30:07

       There is definitely a sense of, uh, the guys, the, the sort of classic mid-30s, mid-40s pivot toward endurance racing-

   14. KHKatie Herzog30:15

       Yeah.

   15. CWChris Williamson30:16

       I think. Uh, I mean, it's fantastic to, to put your efforts into something which is great for your health and very difficult to do and inspiring and all the rest of it. Uh, but I wonder what you're running from. I wonder what... And that's not everybody, but it is, it is, it is lots of people. And I suppose, you know, for me, I have found a bunch of different outlets that, uh, training has been one of them, meditation's been another. Uh, if you don't have...... the capacity to sort of build that structure together, then that outlet is entirely precluded to you.

   16. KHKatie Herzog30:49

       Mm-hmm.

   17. CWChris Williamson30:49

       Like, that, that avenue, you don't get to be the g- guy going and doing an Ironman.

   18. KHKatie Herzog30:54

       Right.

   19. CWChris Williamson30:54

       You don't get to be the person who, "I'm gonna go and do a 10-day silent meditation retreat- "

   20. KHKatie Herzog30:58

       Right.

   21. CWChris Williamson30:58

       "... because my, my meditation's been so great recently and I've been really loving it- "

   22. KHKatie Herzog31:01

       Right.

   23. CWChris Williamson31:01

       "... and that's where I've been putting all of my effort. And I actually get dopamine and I get reward chemicals from the progress that I'm making in this new avenue. Here, I'm gonna start a new business or I'm gonna," you know-

   24. KHKatie Herzog31:09

       Mm-hmm.

   25. CWChris Williamson31:09

       ... whatever, do fucking crocheting, you know-

   26. KHKatie Herzog31:11

       Mm-hmm.

   27. CWChris Williamson31:11

       ... pickleball, whatever you do. Um, if that's not something that appeals to you because the bad habits are so hard to break and the good ones are so hard to instantiate, you're-

   28. KHKatie Herzog31:23

       Yeah.

   29. CWChris Williamson31:23

       It's, it's making it even more of a headwind to try and sort of fly into to get out of this thing.

   30. KHKatie Herzog31:30

       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, for the average, the average person is probably just trying to, you know, kinda get through the day. Like, they don't really have time, um, for, for that kind of thing. And-
4. 33:53 – 47:58

   The History of Addiction Treatment

   1. CWChris Williamson33:53

      What does the history of addiction treatment philosophies look like? I, I, from, from-

   2. KHKatie Herzog34:00

      Mm.

   3. CWChris Williamson34:00

      ... the outside, it seems to me like AA was the gold standard. I, I know that in every TV show that I watch, it's always that and the person always usually ends up being okay because the community and their faith sort of brings-

   4. KHKatie Herzog34:15

      Mm-hmm.

   5. CWChris Williamson34:15

      ... them back around.

   6. KHKatie Herzog34:17

      Yeah.

   7. CWChris Williamson34:17

      Um, but it seems evidently like it's not a panacea for everything.

   8. KHKatie Herzog34:21

      Right. It's not a panacea for everything. Um, so the history of addiction treatment is pretty fascinating. So in the early days before programs like AA, and obviously alcohol addiction has, has, I think, probably existed as long as alcohol is in the, the first traces of, of human consumption of alcohol was, was found in some, like, pottery, some clay urn in China from, 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, in early writings and the archeolo- archaeological record that there's some, there's some record of not, like, long-term treatment programs, but, like, somebody that you would s- you could s- somebody, somewhere that you could go to dry out. Right? And so that, that was sort of the, the early days of alcohol treatment were not based on long-term, long-term sobriety or long-term recovery. It was just a place to go to dry out, so basically survive withdrawal. Um, so there were... So, so for instance, the, um, the guy who, who created AA, his name is Bill Wilson. Before he created AA, and this is, you know, uh, p- he wasn't the first person to start a peer group, but, but certainly probably the most successful in, in Western history at least. He went to this hospital in New York called, it was called the Towns Hospital and he went there four different times, and every time he would go, they would give him the, the treatment du jour which was, um, it was, uh, 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 (laughs) , pretty horrible experience. These days, withdrawal can be managed with sedatives and benzodiazepins and it's not... Like, so, uh, I s- I thought going, I'd never done a, like, formal withdrawal before I started writing this book and my sense of what withdrawal would be would be painful, right? You have the DT, so delirium tremens, the shakes, you're ill, you're sweating on a floor somewhere. I had absorbed the message of, of alcohol withdrawal from literature and from, from pop culture. These days it's totally different. You can go to a, go to a, go to a center, basically sit in a recliner for a few days and they pump you full of vitamins and give you some, some medication and you're fine within a few days. E- this can even be done at home as well.... but in the early days, it wasn't like that. Um, and there were all sorts of, of sort of, uh, maybe not super effective kind of miracle cures, um, that, that were, that were marketed at the time, and then, and then Bill Wilson in the 1930s, so he, this is a guy, this was a g- a guy who'd been a stockbroker. His life had absolutely deteriorated, and he, uh, he got ... He was at th- at this Charlestown hospital, and he had this sort of come to Jesus moment. He had a, it s- might have been a, a, a belladonna hallu- hallu- hallucination, but he had this, this moment where he saw a flash of, of light, and he, and he was sort of reborn in that moment as a sober man. And then at some point, and so he stayed sober for several months, and then at, 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, um, there's this concept called alcohol, um, excuse me, what's it called? I'm forgetting now. The alcohol deprivation effect, which you might think that once you go through a period of abstinence, the desire for alcohol weakens, but that's not actually what happens for a lot of people. So this concept, the alcohol deprivation e- effect basically means that once you go through a period of abstinence, your cravings can res- return stronger than ever. And so Bill Wilson was going through that, and so he, uh, he had joined a ba- 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 was Dr. Bob, and they got together, and they sat, and they just talked about their problems for six hours. And that was the beginning of Alcoholics Anonymous, and so they started doing this. They started having meetings of, of people who had gone through this experience, and just, they would sit in a room and they would talk about it, and they came up with these, you know, the, the 12 Steps, the 12 Traditions. They added some structure, and one of the early members of this group was a woman. She was one of the first member, or the first, she was one of the first female members of AA. Her name was Marty Mann, a good old dyke. She was a, she was a lesbian, although I don't know if they used that word at the time, and, uh, and Marty Mann had, she had spent a lot of time in the UK. She came back, passed out on a stretcher, had to be carried off of, of the, whatever ship, like Queen Mary, HMS Whatever, whatever, had to be carried off this, this boat, came back to the US, and continued to drink, right? And so she was killing herself, like m- like many alcoholics do, uh, just suicide attempts, dr- 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 'cause she had a background in PR. She was very well-connected, so she used her connections to get AA in Hollywood movies and on the cover of magazines, and she is probably more so than even Bill Wilson or Dr. Bob the founders of AA for spreading the gospel of AA. And she also did something else, which she wanted to lower, lessen the stigma of alcoholism, because alcoholism at this point had, was really considered a moral failing. And so she, she sort of conceptualized the disease model of AA, and a lot of people have, uh, a lot of people assume that AA sort of preaches the model that, preaches the idea that, that alcoholism is a moral failing. They actually don't. They really rely much more heavily on this, this medicalized model. I have my issues with that, with that sort of framing. I actually don't think that alcoholism is, I don't think it's very helpful to call it a disease because it's not like cancer. It's, it's different, right? And, um, anyway, so, so she, she spread that message throughout, throughout the land, and that is one of the reasons that AA became as popular as it, as it did because it had a really good, really good PR team.

   9. NANarrator40:58

      Right.

   10. KHKatie Herzog40:59

       Um, and AA, there were lots of other treatments throughout, throughout history, things like, um, there was a, a clinic called Schick Schadel that did aversion therapy, right? Different, different societies, different cultures, they, uh, lots of cultures have come up with potential solutions to this progra- 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, their environment is really valuable. And I know many people whose lives have been saved by AA, but it doesn't work for every- anyone. I'm sorry. It doesn't work for everyone. And so what we're seeing now, um, with the rise of, of groups like Sober Curious and their apps, there's one called reFrame that I keep getting ads for on Instagram, is sort of a, a, a broadening. I think, 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, um, professional licensing organizations, if you get, if you're a ph- like, I went to meetings not that long ago where there was a pharmacist there, and, 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 gonna lose his pharmacy license if he didn't go to these meetings. Um, sober houses, they can mandate attendance in 12 Step programs. So for some people who are, uh, you know, who are getting out of jail and need a place to live and they're, they need to live at a halfway house, they have to enter 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, it, it, to be clear, I, like, I don't knock AA. It really does work for a lot of people. It just doesn't work for everyone, including me.

   11. CWChris Williamson43:05

       Mm. I- I was thinking-

   12. KHKatie Herzog43:06

       That's a long answer to your question, sorry.

   13. CWChris Williamson43:08

       It's fascinating. I, I was thinking about how hilarious it would be if somebody was, uh, mandated by a judge that they needed to go and do yoga.

   14. KHKatie Herzog43:18

       Yeah.

   15. CWChris Williamson43:18

       Or, you know, "We need, we need to see that you have completed a 30-day streak on Sam Harris' Waking Up app."

   16. KHKatie Herzog43:23

       Yeah. Uh, equine therapy. "You have to go swim with dolphins," something like that.

   17. CWChris Williamson43:27

       Whitney Com- Whitney Cummings does that. She says it's really good. Um-

   18. KHKatie Herzog43:30

       I'm sure she does.

   19. CWChris Williamson43:31

       Uh, (pauses) so w- i- is there a particular taxonomy of drinker that you think AA does and does not work for? Is there something about you, given that it is, for some people, for many people, a g- a great saving grace, w- what is it about you-

   20. KHKatie Herzog43:51

       Yeah.

   21. CWChris Williamson43:51

       ... that it didn't, and what is it about other people that it does?

   22. KHKatie Herzog43:54

       I think for me it's a couple things. The primary one is that AA never adru- addressed the root cause of my drinking, and that was that I like to drink, right? So, it's very simple, but I was physically and emotionally addicted to alcohol, and AA, going to meetings did not curb my cravings. I needed something that would take care of my cravings, and AA couldn't do that for me. So I think, I think that is fundamentally it, was just that my cravings overrode any sort of desire to quit. I was completely imprisoned by these cravings. Um, I also am not ... I'm not a joiner. I'm not prediposed, predisposed to, um, to any sort of club whatsoever. I also, you know, there's a spiritual element of AA that I found to be a turnoff. I did go to ... They have meetings for atheists and agnostics. I like those. I found them a little self-righteous in a way that I really appreciated. Um ...

   23. CWChris Williamson44:53

       (laughs)

   24. KHKatie Herzog44:54

       But it didn't, it just didn't stick with me, and, um, and, and also, you know, there's a level of, when you work the steps, there's a level of introspection that is required. I don't like introspection (laughs) . Let's just ... 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 f- ... This is why I like doing these interviews and writing this book, was very off-brand.

   25. CWChris Williamson45:20

       I was gonna say, you really cho- you really chose a-

   26. KHKatie Herzog45:22

       It's tough.

   27. CWChris Williamson45:23

       ... a, a difficult thing to be talking about for the next couple of years.

   28. KHKatie Herzog45:25

       I did, I absolutely did. Uh, I don't like emotional chow-chow. I find it to be, like, very, like, uncomfortable. And so anything where I'm sort of expected to take like a searing look into my soul, I don't believe in the soul. I believe that I had a drinking problem, I was physically and mentally addicted to alcohol, and I just needed to, needed to solve that problem. But for, for a lot of people, that is exactly what they need. And I think that's especially true of people who have done sort of more damage than I have. I did damage. I hurt other people, for sure. Um, but I wasn't ... You know, I'm not a parent. I didn't, I didn't s- destroy my family. I didn't m- ... I don't think I ... There are probably some people who think I should make amends to them. They're gonna be waiting for a while. Um, not because I, I don't think that's important. I do think it's important for some people, but my way of making amends is to basically remove myself from people's lives. So if I have hurt somebody, my punishment is that I no longer deserve to, their presence in my life, right? That's my way of making amends. Um, yeah, I, I just, I think, like, some combination of my personality, I'm a skeptic by nature, um, I'm the, I'm the type of p- uh, 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 gonna work for.

   29. CWChris Williamson46:52

       Highly non-hypnotizable in that regard. Yeah, it's-

   30. KHKatie Herzog46:55

       I listened to your show on, on, on hypnotism, and I, I also wanna get my, my genome map so I (laughs) yeah.
5. 47:58 – 1:01:16

   Is Medication the Modern Cure for Alcohol Addiction?

   1. CWChris Williamson47:58

      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?

   2. KHKatie Herzog48:10

      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. Um, but he was extremely open-minded, and my, my book starts with a, a quote from The Big Book, which is, which is the bible of AA. It's the, the sort of, the big text that everybody reads and studies. And the quote, I'm gonna, I'm gonna butcher it, but it's something like, uh, "Someday science might find a cure for the alcoholic, but that hasn't happened yet." And the thing it ... So that was written in the 1930s. I think that science has actually found a cure, or at least for some people. I need to, I need to couch that, um, in many ifs. But I think for, for some people, there's a cure, and I, I ... it worked for me.

   3. CWChris Williamson49:10

      ... take it away, and-

   4. KHKatie Herzog49:11

      Okay.

   5. CWChris Williamson49:11

      ... explain this super futuristic, experimental, successful procedure.

   6. KHKatie Herzog49:17

      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 Laboratories. So we are talking about, this is, you know, before the Civil Rights Act. This is, this is, this is old shit. And, uh, this drug, um, it was owned by DewPoint for a long time. They, uh, they bought the, the first laboratory that synthesized this, Endo Laboratories. And it's a, an opioid antagonist, so an opioid blocker. It was initially developed to treat opioid addiction, uh, which at the time would have been like morphine and heroin, less fentanyl and oxy and whatever they're selling on the streets these days. And it, but it also works for, for alcohol use disorder. And it works like this. So because it's an opioid blocker, I'll just, I'll explain how it works with alcohol specifically. So you take the drug and it blocks the, your receptors from getting an endorphin rush from alcohol. So it's pretty simple. The molecules sit on your opioid receptors and they prevent you from getting that euphoric high that we talked about earlier when you drink alcohol. Now, there are different ways to take 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, um, so it's a shot in the butt, it's in you for 30 days, it releases slowly over time. Oh, and I should say, this has been FDA approved for alcohol, the treatment of alcohol use disorder since 1994. So this is not actually a new treatment. This is an old treatment. The way that I took it was developed by a man called John David Sinclair. He was an American researcher who did most of his work, his, he, he went to grad school in the US, did his PhD here, but then he moved to Finland, and he worked for Alco Laboratories, which was a, uh, a state-owned, sort of an interesting company, especially from an American's pur- perspective. So it was a liquor distributor that also had a lab. So tax- taxpayer-funded, um, or funded by a presumably, I don't know what the, what the liquor taxes were in Finland in the 1970s, but on, on the bottom floors of this, of this company, they would be selling and distributing alcohol and figuring out how to get more people to drink. And on the top floor is where the lab was, or maybe it was vice versa, maybe they put the, maybe they put the researchers in the basement, I don't quite remember at the moment. Um, you had people like John David Sinclair who were working on treatments for alcohol use disorder. And John David Sinclair, so he did most of his research on, on mice. And he realized at one point that... He w- he was one of the first people to describe the, the, um, alcohol deprivation effect that I, that I mentioned earlier, where after a period of abstinence, your cravings come back stronger than ever, and he wanted to interrupt that process. So he started out by giving lab rats opioid block-, various drugs, uh, 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, uh, this was a, a breed of lab rat that had been, that had, it had been bred specifically to have a propensity for alcohol addiction. They, they were bred to like alcohol, which is actually sort of hard to do. Rats don't, and mice don't, typically, like, they're not boozers naturally. But, so these ones had been specifically, not GMO'd, but, you know, good old fashion, you take two rats that like to drink-

   7. CWChris Williamson53:07

      Eugenics, yeah.

   8. KHKatie Herzog53:08

      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, um, so he started these experiments, and what he found was that, yes, these lab rats that, uh, that, wh- whose, whose opioid receptors were blocked when given alcohol, they would refuse it. They no longer had any interest in drinking, and this effect lasted over time. And then he started, um, started writing about this, this was later, uh, lat- later started doing human studies, and he developed what is now called the Sinclair Method. And so the Sinclair Method is very simple. You take an opioid blocker, usually naltrexone, and, and there are other ones, there's one called nalfamine that's more common in Europe than it is in the US. You wait an hour, which is how long it takes for this drug to metabolize in your system, and then you drink as normal. And so that's what I did. I found out about this from an article in The Atlantic, and during COVID, my drinking accelerated to the point where it was becoming very problematic, um, I, uh... My wife is a nurse, so she was, you know, a essential worker, as we called them back then, when we cared about them, and she was gone a lot. So I used my recreational time. I had been laid off from my job. I was a reporter for, um, for The Stranger, which was a, is an alt weekly in Seattle, and when I got, after I got laid off from my job, I did what everyone else did, I started a podcast and I stayed home and I drank by myself. And, uh, I did this for two years. I drank basically every time my li- 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.

   9. CWChris Williamson55:09

      That's crazy.

   10. KHKatie Herzog55:10

       (laughs)

   11. CWChris Williamson55:10

       I- I mean...... the, the, the answer-

   12. KHKatie Herzog55:13

       We're, we're still married, by the way.

   13. CWChris Williamson55:14

       Well-

   14. KHKatie Herzog55:14

       She's gonna be real shocked when she finds out about this book.

   15. CWChris Williamson55:17

       I was gonna say, yeah. What was the, w- what was the reveal like when you-

   16. KHKatie Herzog55:21

       Hmm. (laughs)

   17. CWChris Williamson55:22

       ... presumably had to have that conversation, and how much of it was propelled by the potential book coming out?

   18. KHKatie Herzog55:26

       None of it. I had not-

   19. CWChris Williamson55:27

       All right.

   20. KHKatie Herzog55:27

       ... 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. Uh, there was a h- small handful of occasions when I skipped it, for whatever reason. But for the most part, I was very regimented about this. And this is one of the things about this, this, this treatment, you can't half-ass this. It's like AA in that respect. Like, you gotta go, you gotta 100% commit. Because if you don't take the pill, and you drink without your opioid receptors being blocked, you're, i- i- the Sinclair Method is basically a, a process of, of unlearning a behavior. It's called extinction, or pharmalogical extinction, because there's medication involved.

   21. CWChris Williamson56:08

       Hmm.

   22. KHKatie Herzog56:08

       And so if you, if you drink without the drug, and you get that endorphin dump, and that, and that dopamine rush-

   23. CWChris Williamson56:14

       You've undone everything that you just learned. ?

   24. KHKatie Herzog56:16

       It's not gonna, it's not gonna be undone overnight, but if you do this, if, if you, if you don't really stick to the protocol, or if you don't wait the full hour for it to metabolize, it's just not gonna work. It's gonna confuse your brain, and your brain will continue to seek out that high. What you're trying to do is to give your brain the message that that high no longer exists. You no longer get pleasure from alcohol. And over time, your brain will stop craving it. And for me, that took about seven months of, like, actively doing the Sinclair Method. And over time, I, I started, you have to incorporate sort of habit change and mindfulness, which not natural for me. I'm not a mindful person. But you have to, you have to do these sort of, um, you have to, you have to make some changes in your life. It's not as simple as just taking the pill and drinking. It's pretty simple, but it's not that simple. And over time, I started, like, you know, pushing my drinking, my drinking start time back. So instead of starting to drink at noon, maybe I'd start at 2:00 or maybe 3:00. And I started incorporating more alcohol-free days into my week. And alcohol days are, alcohol-free days are exactly what they sound like. So that's days when you're not drinking, and you're not taking the pill. And that's what's different about the Sinclair Method than sort of the daily use of this drug, taking it every morning, or the shot, 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 keyed 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 convers- go eat good meals, get laid 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.

   25. CWChris Williamson58:21

       Wow.

   26. KHKatie Herzog58:22

       And I, and I didn't tell my wife. I didn't tell her. I waited an extra y- I wanted to, like, get a year of sobriety under my belt before I told her. And then a year came and went, and honestly, I had stopped thinking about drinking. Like, I think about drinking now, because I'm promoting this book, I wrote the book, it's more a part of my life, but for that period of time between quitting drinking, between my last drink, and, and deciding I was gonna write this book, I just didn't think about alcohol. And that's what I wanted, because, you know, everybody sorta knows about the physical effects of alcohol, right? The headaches, the hangovers, the shakes. But for me, the killer was, was mental, because alcohol was on my mind 100% of the time for most of my adult life, right? And for people who haven't experienced addiction, I think the best way to sort of explain it is like, when you have a crush on somebody, or you're newly in love with somebody, and you, all you think about is that person, like, you're going to work, you're having conversations with your, hopefully not with your spouse, but, you know, you're, like, everything in your mind is focused on this desire. That's what addiction was like for me. So I thought about it, I spent 20 years of my life thinking about ... I still managed to, you know, have a career and a life and relationships. But I spent 20 years of my life thinking about alcohol almost every moment of the day. It was in the back of my mind. And the Sinclair Method and this drug freed me from that. So I basically stopped thinking about it. And then I, I told my wife after, it was more than a year, I think it was, like, a year and a half after I told her. She was surprised, for sure, but not mad. I'm, like, married well above my weight, both physically and morally, um, and so we're still married. My wife was, like, sad for me that I'd gone through this thing, but she was also, I think, impressed that I had solved, that I had, I had a problem and I fixed it on my own. And I would never advise people to be like, "Do this without social support," because in everything that you do, social support is gonna make it easier. But I, you know, didn't do that. (laughs) I kept it a secret.

   27. CWChris Williamson1:00:38

       The lone skeptic, again, a- a- as is on brand.

   28. KHKatie Herzog1:00:41

       Yeah.

   29. CWChris Williamson1:00:41

       Um-

   30. KHKatie Herzog1:00:42

       I mean, I did talk to people, because I was, I was also doing a lot of research about this. And so, I'm a journalist, and so I would, when I had questions, I would call people. And there's a robust online community. That's sort of one of the ironies about the Sinclair Method, is that this is one of those cases, and there aren't many of these, where you can get better information typically from, like, Facebook groups and Reddit and YouTube than you can from your own GP. Um, so I was involved in these, in these online communities and having conversations about it and interviewing people, but I wasn't talking about it with the people who mean most to my life.

6. 1:01:16 – 1:09:27

   Why are Medical Professionals Still Hesitant About Addiction Medication?

   1. CWChris Williamson1:01:16

      Why is it that doctors are still hesitant to, uh, prescribe naltrexone or t- or talk about it or educate about i- i- even if it's got strong evidence?

   2. KHKatie Herzog1:01:29

      So there's lots of answers to that question. The first answer, I think, goes back to medical education. So I don't know how it is in the UK, but in the US, historically, addiction medicine has been a very, very small part of a medical, of medical education. So I talk to doctors who are, you know, in their 40s and 50s, who did four years of, of medical school, then four years of residency, maybe did some extra training. Now they're GPs, they're family doctors, or they work in an ER. So they're seeing people every day who suffer from some kind of substance abuse disorder, whether that's alcohol or anything else. And they're, in that, you know, eight years of, of medical training and education, the entirety of their training on addiction was maybe one hour. Maybe they were told to attend an AA meeting. So historically, it has just not been a part of medical education in the US. This is ch- 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 Antabuse, uh, which has been around since the 1950s, or been FDA approved for the 1950s, and there's one called, um, acamprosate, so s- And there's also various off-label dru- 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, uh, the recovery industry, the idea of harm reduction was sort of anathema. You know, the, uh, nobody, not nobody, but a lot of, a lot of these institutions were based on 12-step progra- uh, 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, to confess their, their, to admit that they're powerless, to go to meetings every day, and sort of will their way through it. But that doesn't work very well for opioid addiction. And so there has been a shift, um, in recent years towards principles of harm reduction and medication ass- assisted therapy. So that's part of it, just straight up, peop- 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 l- 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 gonna be a tough sell for a lot of doctors. Not just because ...

   3. CWChris Williamson1:04:13

      (laughs)

   4. KHKatie Herzog1:04:13

      Right. And for families, and for, you know, this, it sounds like a ...

   5. CWChris Williamson1:04:16

      You're gonna do what?

   6. KHKatie Herzog1:04:17

      Right. You're gonna, you're, you're telling me I can cure diabetes with donuts? Like, it sounds crazy. I understand that. There's also legal reasons, right? So if you're a doctor and your patient comes to you and says, "I'm having a drinking problem," and you say, "Okay, here's the deal, take this drug, and then go get a six pack of beer, enjoy yourself," and your patient does that, and goes and kills someone in their car, you don't wanna be legally liable for that. So there are all sorts of barriers specifically to the Sinclair Method that prevent this from being better known. Naltrec- 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, um, another theory, there's a, a guy named Percy Menzies. He was a, he was a drug rep for DuPont, um, and so he was one of the, one of the ... This is back in the, in the, in the '80s, he was one of the first people trying to sell this drug to doctors, or, uh, I don't know if, if ... I don't know if drug reps like that term, but trying to get doctors to adopt this drug for use of, um, of, of treating heroin addiction. And Percy found, when he would go talk to doctors, that they were completely uninterested in it, because at that point, more of, uh, uh, methadone had sort of cornered the market. They f- they thought that they had this gold standard, and they weren't interested in anything else. The other thing is, this is an opioid antagonist. It has the word opioid in it. And so Percy thinks that doctors could be just straight up turned off by that, because it feel- it's not an opioid, it's an opioid blocker, but it sort of emotionally feels like you are giving opioids to your patients. It's nobody wants, you know, you don't wa- or opioids are sort of a, they're, they're on the outs these days.

   7. CWChris Williamson1:06:10

      Yes. Yeah. It's, uh, it's poor branding right now ...

   8. KHKatie Herzog1:06:14

      Yes.

   9. CWChris Williamson1:06:14

      ... I would say, to try and get that done. It's so ... It s- it feels to me like the whole kind of alcoholic, you know, yeah, alcohol use disorder world has been over moralized and under medicalized.

   10. KHKatie Herzog1:06:30

       Yes.

   11. CWChris Williamson1:06:31

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

   12. KHKatie Herzog1:06:33

       I think you're completely right about that. It's, it's sort of ironic, because, you know, a lot of people will say, if asked, they'll say, "Yes, alcoholism is a disease," but it's not a disease that we typically treat with medications. And again, I sort of, I, I have complicated feelings about that framing. I don't think it's particularly helpful.

   13. CWChris Williamson1:06:49

       So, like, it was unsure that it is a disease-

   14. KHKatie Herzog1:06:50

       Right. Right.

   15. CWChris Williamson1:06:50

       ... but something that you should treat with medications.

   16. KHKatie Herzog1:06:53

       Right. Right. And, and ...

   17. CWChris Williamson1:06:53

       Or could treat with medications.

   18. KHKatie Herzog1:06:55

       Right. And, uh, and naltrexone doesn't work for everyone. I, I wanna be really clear with this. So earlier we talked about, um, there's two types of drinkers, right? Reward drinkers and relief drinkers. And this information, I learned this all from a guy named Joe Vopotici. He's a, he's this fantastic clinician and, uh, researcher, uh, out of, out of Penn, and Joe, Joe studies, some of hi- he's been working with naltrexone for decades, and his, some of his early studies were used for the FDA approval of this drug. And Joe explained this to me. For people, for reward drinkers, this typic- this is, this, people like this tend to be binge drinkers, right? The people who are going out, going to clubs, um-... uh, dancing in the town fountain, whatever. People who get energized from alcohol, naltrexone can work really, really well. It's almost a... He actually used the term "miracle pill," which is not something... These are, this is like a, you know, this is a, this is a real doctor here. This is not a term that doctors typically use. It can almost be a miracle pill for, or a miracle cure, for that population. For the other types of drinkers, relief drinkers, people who get the sedating effect, it has almost no effect.

   19. CWChris Williamson1:08:07

       Why?

   20. KHKatie Herzog1:08:08

       I think it's... Okay, so part of this... There, this is like sort of an open question, but the theories that I read and I heard from researchers is that it has something to do with one particular allele. So, one particular gene variance. It's called ASP40, A-S-P-40, in the mu opioid receptor. For... So, 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.

   21. CWChris Williamson1:08:48

       Right, okay. And that, that will, uh, tend you toward a particular type of alcohol use and a particular type of response to alcohol, too?

   22. KHKatie Herzog1:08:59

       That is the theory, yes.

   23. CWChris Williamson1:09:01

       Right. That's interesting. I've just checked. Uh, I checked-

   24. KHKatie Herzog1:09:04

       You have it?

   25. CWChris Williamson1:09:04

       ... your genetic and lab reports. The ASP40 variant you ask for refers to the OPRM1 and A11AG polymorphism. Da-da-da-da. Looking through your genetic reports, you do not have the ASP40. Your OPRM1 result shows the A A genotype, SN40, SN40, meaning you do not carry it. So, no, so I would be, uh, uh, it would be useless.

   26. KHKatie Herzog1:09:25

       You might, it might not... It would be interesting to,

7. 1:09:27 – 1:22:03

   Changing Your Relationship to Alcohol

   1. KHKatie Herzog1:09:27

      uh, interes- Do you drink now?

   2. CWChris Williamson1:09:29

      No.

   3. KHKatie Herzog1:09:29

      Okay.

   4. CWChris Williamson1:09:30

      Uh, I, it was an interesting journey, I guess, with regards to alcohol for me. Um, I never had a problem with it, uh, in terms of a dependency.

   5. KHKatie Herzog1:09:37

      Mm-hmm.

   6. CWChris Williamson1:09:37

      Uh, but I, I was a party drinker, you know?

   7. KHKatie Herzog1:09:40

      Yeah.

   8. CWChris Williamson1:09:40

      Every two weeks, I would send it in club-promoted fashion, and, uh, then it got toward the end of, end of my 20s, so what we talking about now? 28? I think 27, 28 would have been the first time I did it, so maybe nine years ago. And, uh, I know that low and no movements are kind of all the rage, and morning ice plunge parties-

   9. KHKatie Herzog1:10:01

      Mm-hmm.

   10. CWChris Williamson1:10:01

       ... and run clubs and stuff are kind of everywhere.

   11. KHKatie Herzog1:10:04

       Yeah.

   12. CWChris Williamson1:10:04

       10 years ago, 9 years ago, that really was not the case at all.

   13. KHKatie Herzog1:10:08

       Yeah.

   14. CWChris Williamson1:10:08

       It was not trendy to be against the grain with regards to, uh, even social drinking. And, uh, there was just some inclination that I had that alcohol was holding me back.

   15. KHKatie Herzog1:10:21

       Mm-hmm.

   16. CWChris Williamson1:10:21

       Uh, even though I wasn't using it that frequently. Uh, I do get bad hangovers. Uh, I think I, I, I tend toward a low mood sometimes, and if you do-

   17. KHKatie Herzog1:10:28

       Mm-hmm.

   18. CWChris Williamson1:10:28

       ... and then you crank a hangover on top of it, like, that, that's really gonna turn it up. And I, I just had one really bad hangover one day, and I was like, "I'm not gonna drink for six months." And I just had this idea in my mind, so I went six months sober, um, and loved it. And then I was in Bali and had a, a Corona. I was like, "Okay, I'm, I've done my six months and I'll break it when I'm in Bali and I'll go back to, yeah, I'll see what drinking's like." I did it for three months, really didn't like it. Was like, "I'm gonna 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 1,000 days.

   19. KHKatie Herzog1:11:06

       Mm-hmm.

   20. CWChris Williamson1:11:06

       And then, since then, basically I'll drink less than five times a year and it'll be a beer.

   21. KHKatie Herzog1:11:13

       Mm-hmm.

   22. CWChris Williamson1:11:13

       Or a couple of beers, or something like that.

   23. KHKatie Herzog1:11:15

       (laughs) And I'm curious, when you drink, what is the effect? Do you get high, energized sort of fast, or are you, does it chill you out?

   24. CWChris Williamson1:11:22

       It's a good question. Um-

   25. KHKatie Herzog1:11:23

       And it's harder, that's harder to answer than you might think. Like, it, it does...

   26. CWChris Williamson1:11:27

       Mm-hmm.

   27. KHKatie Herzog1:11:27

       Even-

   28. CWChris Williamson1:11:28

       I would say, I would say in the past it might have, uh, been, and this is what I said earlier on-

   29. KHKatie Herzog1:11:33

       Mm-hmm. Yeah.

   30. CWChris Williamson1:11:34

       ... in my 20s, it m- uh, reminded of being more energized-

Episode duration: 1:32:38