Wasted: An Alcoholic Therapist's Fight for Recovery in a Tragically Flawed Treatment System (36 page)

Mike smiles limply and says, “Maureen, booze is always everywhere. I want to keep filming. It’s my way of getting out of my head and to a place where maybe I can do some good.”

THE NEXT MORNING,
something is different.

Mike looks up from his laptop and smiles. “I’m not hungry,” he says. “I’m not
at all interested in food. But more importantly... I’m not at all interested in booze.” Relief floods his face.

I call
F.M.
Morrison, my editor at the
CBC
science program
The Nature of Things
, to tell her what has happened. Now that Mike is battling a relapse, perhaps they’ll fear we no longer have the credibility “five years sober” lends to the film.
F.M.
immediately recognizes the value
of the recurrence to the story arc, but is more concerned about Mike. She’s not at all worried about his relapse. She’s done her homework and is up on the science. She knows it’s part of the disorder and insists we continue, if Mike is up for it.

Mike is more than up for it. As the month progresses, Mike loses weight, but gains confidence in his ability to withstand cravings. In fact,
he doesn’t have any. He wants people to know about Vivitrol and all the other treatments in the works.

That shot is the best thousand bucks we’ve ever spent.

• 38 •

EVEN BEFORE MIKE
was in my life, I’d been curious about addiction. My Bountiful Films partner Helen Slinger and I had actually pitched films on addiction several times to Canadian Broadcasting Corporation documentary commissioning editors. We’d propose titles like, “Alcoholism: Chronic Illness or Character Flaw?” Our attempts were unsuccessful,
for various reasons. After the first edition of Mike’s memoir came out, Helen and I sent our pitch yet again, and
this time
we knew we had a great story. While researching Mike’s book, I had discovered there has been a revolution in addiction research, but that revolution hadn’t translated into treatment. Because the medical profession is woefully ignorant about treating addiction—or as it’s called
now, substance use disorder—often defaulting to prescribing
AA
, people like Mike do not get the treatment they need. Alcoholics Anonymous does work for some of those who try it, especially those who work the program diligently. But it does not work for the majority, like Mike. In fact, nothing works best for everyone. But the reality is there are now many more options than
AA
, but so few people
know about them. An exploration of evidence-based addiction treatment combined with Mike’s personal experience made for a compelling and potentially very powerful film.
This time,
the
CBC
agreed.

Now, I realize, our theoretical exercise will become an urgent, real-life search for something that works for Mike; a search that will force me to confront my own beliefs in the very myths we
sought to shatter in the film.

• 39 •

MY SEARCH FOR
help begins the very night of Mike’s relapse. In the post-party quiet, I click on the thumbnail versions of recent interviews from the first filming road trip, when we spoke to Dr. Keith Humphreys. We had travelled to Stanford University in California, where Dr. Humphreys is a professor of psychiatry
and a world leader in addiction research. He has spent much of his professional life studying how to improve treatments and public policy on substance use disorder and mental illness. He also served as Senior Policy Advisor to the White House Office of National Drug Control Policy under the Obama administration.

The idea that we can shame someone into sobriety is pervasive, and I have
to admit that tonight, I do feel like giving Mike a blast. And while that might make me feel good in the short term, doing so hurts Mike’s chances of getting back on track. When it comes to addiction, Dr. Humphreys thinks we need a national attitude adjustment. “You know how punishing [addiction] is. It’s remarkable that people believe that what’s needed is more punishment,” he told us. “If punishment
worked, nobody would be addicted.”

Intuitively, I know this to be true. The evidence is all around us. Addiction would not be our number one public health problem if making people feel bad would make them quit. Several years ago, when Mike was trapped in the worst of his addiction cycle, he relapsed repeatedly and was subjected to ever-deeper humiliation as he returned, tail between his
legs, to the only place left for people like him: rundown recovery homes where the only treatment was a harsh, bastardized version of
AA
. With insults flung his way day and night his anxiety, sleeplessness, psychosis, depression and suicidal thoughts became further entrenched, and drinking again to diminish the pain felt like a realistic option. Punishment made his condition much worse.

When Mike described his treatment at these recovery homes to Dr. Humphreys, the doctor recoiled. “The nastiness, the hierarchy, none of that, of course, is
AA
. That’s people who are ill-trained... And unfortunately, [mistreatment] is not rare when you have a stigmatized condition that is not adequately resourced in terms of care and training.”

Listening to Dr. Humphreys’s wisdom, I’m chagrined.
I know tomorrow Mike will feel bad enough for the both of us.

Next, I click on the video file of Dr. Bill Miller. We travelled to his home in Albuquerque, New Mexico, to speak to him. Dr. Miller, a distinguished professor emeritus of psychology and psychiatry now retired from the University of New Mexico, specializes in the psychology of change, especially as it pertains to addiction.
Over four decades, he’s published fifty books and over four hundred articles and chapters in scholarly journals. You’d be hard pressed to find
anyone
who has more wisdom and compassion on the subject of substance use disorders. I smile as I recall Mike’s anticipation of that interview. “You don’t understand, honey,” he said with excitement. “Dr. Bill Miller is the Wayne Gretzky of psychology.”
Oh,
now
I get it.

Dr. Miller brings an otherworldly calm, quiet passion and sage wisdom to a subject dominated by vitriol, hyperbole and catastrophe. “I mean, there really isn’t any other diagnosis in the
DSM
where it would be okay to get in a person’s face and scream at them and shame them and make them feel terrible about themselves,” he explains. “We reserve that one for people with
substance use disorders, where it’s supposedly the only language they understand. There never was any science behind that. But for some reason, in America in particular, it was okay for several decades to treat people in a very inhumane way.”

In fact, Dr. Miller would like to ban the word “relapse” because of all the shame associated with it. “It definitely has a moralistic feel to it.
It also implies something that just isn’t true. The idea that if you have one drink then invariably you’re going to drink a huge amount of alcohol is not how treatment outcome data look. You can find individuals who look that way, but in general, what you see over time is longer and longer periods going by in between episodes of drinking. And the episodes of drinking get shorter and less severe over
time, and then eventually fade away. In a way, it’s approximation to abstinence that looks more normal.” I rewind that particular piece of video and play it again. “It’s approximation to abstinence that looks more normal.” That “approximation” sounds way less catastrophic than the disaster movie that is Mike’s relapse, replaying in my mind. I have to admit I approached Mike’s five-and-a-half years
without a drink with a certain amount of arrogance. “Drinking was in his past,” was my smug belief. I went through life blithely ignoring the fact
relapse is a symptom of the disorder.
But in Mike’s experience, relapse was never treated like a symptom of the disorder. It was treated as failure.

Several years ago, Mike got kicked out of the Phoenix Centre, a government-run rehab facility
in Surrey, after he relapsed. The “group conscience,” meaning other patients, made the decision. Not a medical professional. To Mike, kicking someone out of treatment precisely when they need it most never made any sense. Worse, it left a serious medical disorder to spiral out of control.

Fortunately, the rehab industry is changing. At the Betty Ford Center in Palm Springs, no one gets
kicked out of treatment for relapsing anymore. When we walked in to film at Betty Ford, Mike stopped in the brilliant sunlight, visibly shaken. “I think back to all the places I ended up, with no treatment, a decade ago—I’d have killed to spend a month here.”

When Mike explained getting kicked out of rehab to Dr. Steve Eickelberg, the medical director of Betty Ford Palm Springs, Dr. Eickelberg
was sympathetic. “Mike, first of all, isn’t it horrible that you have a chronic disease, and you exemplify it while out on pass, and then you’re told you can’t get any more treatment
because
you have a chronic disease?” Dr. Eickelberg described Betty Ford’s approach. “People are re-evaluated. The relapse is re-evaluated. What was missing? What were we not providing? So then, treatment is redesigned
to address those particular issues.”

Treatment at Betty Ford is designed to counter probably the most devastating belief about addiction: that anyone should have to hit rock bottom
.
Who among us hasn’t uttered a variation of that statement when referring to a friend or loved one’s out-of-control drinking? Mike lost track of the number of times people told him this; friends, family, even
Emergency Department doctors. Without any real treatment, Mike
did
hit a devastating rock bottom. In light of Mike’s drinking tonight, that spectre looms large for me now, even though I know better. When someone is caught in the grips of a life-threatening disorder, in pretty well every other area of medicine, we intervene early and aggressively. We throw every treatment option we have at them,
hoping to save their life. So why do we accept that some people must drink or drug themselves to death? A growing and progressive body of medical professionals and addictions experts reject rock bottom completely.

I recall our interview with Stanford’s Dr. Humphreys: “You’re saying to people, ‘You’re not ready for treatment... go suffer some more.’ That’s not, to me, what health care’s
about. I have an obligation to try to help them, as opposed to waiting until they’re absolutely one hundred per cent desperate. It could be they go out and then they’re in an automobile accident and that’s the end. That’s just not compassionate to me.”

And rock bottom is just not an option to me. We need to figure out how to ensure Mike gets well again and stays that way.

• 40 •

THE LONGER I
spend looking at our shot footage from our recent filming road trip, the more my fears about Mike’s relapse diminish. Those fears are in part real, borne of the knowledge of just how devastating Mike’s alcohol use disorder became, and part bogus, borne of broadly held, outdated cultural myth. I’m blessed to have the
wisdom of some the world’s best addiction researchers literally at my fingertips, their shot interviews for the documentary on my laptop.

Tomorrow morning when Mike wakes, he’ll say he’s blown five-and-a-half years of abstinence. That’s success based on the Alcoholics Anonymous model of total abstinence, which in the minds of many is the only standard. That standard was established eighty
years ago.
AA
was founded in 1935 by Bill Wilson (widely known as Bill W.) and Dr. Bob Smith, partly in response to the widespread misuse of alcohol and the social ills that accompanied it at the end of Prohibition.

The only requirement for membership in
AA
is a desire to stop drinking. With
AA
boasting some two million members worldwide, their abstinence model is deeply rooted in our
consciousness. But that’s not the measure used by contemporary science. I return to Dr. Humphreys’s interview. “I measure success in terms of the person’s health and the health of the people around them. It could be the person never uses again, and that resolves the problem, and that’s great. But it could be, for another person, they learn how to consume in a different way, a less risky fashion. If
someone’s able to go back to be being a moderate drinker, that’s great. By what standard would I judge and say that’s no good?”

But from the public’s perspective, the notion that any problem drinker could learn to drink in moderation is ludicrous. Dr. Humphreys says that idea is rooted in the experience of
AA
founders.

“They only saw really severe alcoholics whose lives had been
deeply damaged, and they concluded—correctly, I think—that this was a group of people who were never going to become moderate drinkers. They really needed to stop. But that was only a slice of the world. If you look more broadly, when you do surveys of populations, you see for every person like that, there are two, three, four, five people who have a drinking problem and they need to do something
about it, but they are not [severe] alcoholics and they can become moderate drinkers.” In fact, Dr. Humphreys told us, even one of
AA
’s founders acknowledged this quaintly in
AA
’s Big Book. “There are people who can return to drinking like a ‘gent,’ is the expression he used. That’s not what
AA
’s for, but [they advised that if] you can do that, then go ahead. And somewhere along the way, that
got forgotten, so people felt to be a good
AA
member, you had to deny the existence of that population [who can learn to drink in moderation]. That’s not true.”

Dr. Bill Miller’s work makes a powerful argument for losing “abstinence” as the only measure of success. “I did one study combining huge data sets just to see the outcomes of alcoholism treatment in America. About one in four people
stayed abstinent for a year after treatment. So that’s twenty-five per cent. So let’s take them out of the picture and look at the other seventy-five per cent who drank during the year. Their alcohol consumption was down by eighty-seven per cent, on average, over the year after treatment.”