Wasted: An Alcoholic Therapist's Fight for Recovery in a Tragically Flawed Treatment System (41 page)

He did something rare in research. He followed 450 families of alcoholics and a comparison group of families of non-alcoholics over thirty-five years.
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“We were able to document their low response to alcohol and then study how it interacts with the environment.” Among Dr. Schuckit’s discoveries: Heavy drinkers
tend to choose friends who also drink heavily, since light drinkers don’t want to spend as much time consuming alcohol.

Dr. Schuckit documented this effect, even in drinkers who had not been raised by an alcoholic parent. “We studied children of alcoholics who were not raised by the alcoholic and found that they still had a high rate of alcoholism. So it’s genetically influenced.”

Dr. Schuckit used this knowledge to design an intervention to help college students right now. Four out of five college kids drink, and half of them consume their booze through binge drinking, which is the kind of drinking that helps low responders develop alcohol use disorder. So what if you could prevent a class of freshmen from ever building up their tolerance to alcohol?

Dr. Schuckit’s
study looked at 454 freshmen at the University of California, San Diego.
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“We sent out a questionnaire about a variety of things,” he said. It included questions about how many drinks students were consuming, defined what a standard drink was, and asked how many drinks it usually takes to achieve an effect. “Then what we did is we put together three intervention groups that used educational
videos about the risks of drinking, and one of the groups had no videos at all.”

Each group saw four videos over four weeks, but the group identified by the questionnaire as “low responders”—young, heavy drinkers—watched videos with additional information targeting their s
pecific
risk. The results?

“Those individuals who were placed in the low response education-based group [the
group with the special videos], they decreased their level of drinking over the subsequent year
twice
as much than if they had been in the general education group [the group with the videos outlining the general risks of drinking]. There are important things that you can teach people at risk points in their life, such as when they’re transitioning from high school to university. If you not only
educate them in general, but you speak their language, and if you focus on a risk factor they can identify with, it makes sense that they would respond more strongly,” said Dr. Schuckit.

While the search for genes associated with characteristics that predispose people to addiction might continue for decades, Dr. Schuckit’s freshman study proves identifying a predisposition early on can
truly help in the long run.

I’m predisposed. I know I’m impulsive. I now know I’m a low responder, and there’s a sixty per cent chance I’ll pass both traits down to my three sons, leaving them at risk for a substance use disorder too. I asked Dr. Schuckit what he would say to my sons if he were in my shoes.

“If you decide to drink, then my next bit of advice for you is to always
remember you can’t compare your risk for serious troubles to the man or woman sitting next to you who may not be carrying a risk for alcohol-related problems. And my best advice to you if you decide to be a drinker is to be a drink-counter. That is, to say, ‘I can’t get as intoxicated as I would like to, but I’m going to limit myself to three drinks.’”

It also turns out there is a blessing
tucked in my genetic curse.

When we were filming in Charleston with Dr. Raymond Anton, his team of researchers at the Medical University of South Carolina took a sample of my blood to extract a
DNA
sample. They wanted to see whether I have a certain genetic feature that some early research suggests would make me respond better than average to the medication naltrexone, or its injectable
form, Vivitrol. I’ve now had three monthly shots since my recurrence.

There’s a one-in-four chance I’ll do particularly well on those drugs if I’m part of a genetic sub-group. I sure hope so, because this treatment is pricey. Determining which treatment is best according to one’s genetics is part of an evolving science called pharmacogenetics.

If researchers can identify who are
those most like to respond to a certain treatment, they can then target them more accurately.

I’ve felt buoyant, almost like a better version of myself ever since receiving the Vivitrol shot.

We had just wrapped up filming when Dr. Anton literally appeared at the door. Anton’s contribution to evidence-based addiction treatment is overwhelming. He is a professor of psychiatry and
behavioural science, director of the Center for Drug and Alcohol Programs at Charleston, and scientific director of an
NIAAA
-funded alcohol research centre, just to name a few of his many titles. When he arrived, his excitement was palpable. He briefly explained how the
DNA
testing worked, then revealed that I have the genetic variant characteristic that research suggests responds best to naltrexone.

My first reaction was relief: relief that my genome may have finally cut me a break. I had guessed from my profound sense of wellbeing that Vivitrol was working for me. And that it works for me because my biology is different, not because I’m working any harder at sobriety. Then anger: anger because for so long, I’ve felt the burden of being “constitutionally incapable of being honest”
as the reason I was unable to successfully work the Alcoholics Anonymous program, and as the reason my alcohol use disorder became intractable. Naltrexone, the pill form of Vivitrol, has been around for two decades. At the worst of my addiction, no one offered me this medication.

That’s partially because doctors receive woefully inadequate training on treating addiction.

In my
experience, it’s also because the few addiction specialists available are also deeply biased in favour of
AA
and the twelve-step approach. My specialist believed in the power of the program so much that he would begin each visit by asking my sobriety date and how many meetings I attended that week. But like someone with Crohn’s disease gets relief from a weekly or monthly injection, I get relief
from Vivitrol. My substance use disorder is a medical condition. And should be treated as such. I’m not suggesting
AA
isn’t valuable. I am suggesting it is now one of many options in a toolkit for treating a devastating disorder.

• 50 •

LAST WEEK, A
client came into my office very ill, his substance use disorder dangerously advanced. He was so sick that I sent him to the hospital. He needed medications. That night he called me, his voice shaking, and told me had been sent home, with no treatment. The doctor who saw him said, “We’re not a babysitting service.”

We’re not a babysitting service.
Think about that for a moment. With what other life-threatening disorder would it be okay to talk to patients like that?

The lack of compassion they showed my client is not unique. I was the keynote speaker for the British Columbia Health Sciences Association Annual General Meeting. They invited me to speak in part because they were the union that
essentially saved my life by going to bat for me when I returned to work at Surrey Memorial Hospital as a psychiatric nurse and relapsed. I credited them with progressive thinking. My talk was about the stigma and bias many health care professionals still feel toward those battling substance use disorders and how those attitudes ultimately cost all taxpayers more in failed treatment. We estimated
my substance use disorder resulted in thirty-one visits to the
ER
. In most of those visits, I was treated with disdain. “Don’t you know there are real sick people here,” “You again,” “When are you going to get with the program,” and “I don’t want to see you in my
ER
again” were all things I heard. Some nights I walked out without ever being seen by a doctor. Other nights, I was given two Ativan
and a bus pass.

Leaders in addiction research see an urgent need to educate the next generation of doctors, and they make it part of their business to do so. The 2012 Columbia University report, “Addiction Medicine: Closing the Gap Between Science and Practice,” is damning. “The medical system, which is dedicated to alleviating suffering and treating disease, largely has been disengaged
from these serious health care problems. The consequences of this inattention are profound. America’s failure to prevent risky use and effectively treat addiction results in an enormous array of health and social problems such as accidents, homicides and suicides, child neglect and abuse, family dysfunction and unplanned pregnancies.”
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Center on Addiction and Substance Abuse (
CASA
) Columbia, an
addiction research non-profit, estimates that risky substance use and addiction are the U.S.’s largest preventable and most costly health problems, accounting for one-third of hospital inpatient costs, driving crime and lowering productivity, and resulting in total costs to government alone of at least $468 billion each year. Canada’s cost would be an estimated ten per cent of that.

It
makes sense, then, that leaders in addiction medicine are trying to change that. Betty Ford’s medical director, Dr. Eickelberg, told us, “I’m the president of a non-profit organization called
MERF
—Medical Education and Research Foundation—for the treatment of addiction. Our mission statement is to prevent the harm being done to patients by physicians who lack the knowledge, training and skill
to recognize and treat addiction. And so, what we do is provide forums to mentor residents and faculty at medical schools, and at teaching institutions, on how to recognize and treat addiction.”

To prevent the harm being done to patients.
First, I’m blown away a doctor would actually admit his colleagues hurt people through ignorance. Second, when a non-profit run by a group of doctors
has a mission statement like that, it underscores the desperate need for change.

Dr. Eickelberg believes all family doctors should screen for substance use disorder, just like they do for high blood pressure. “We know that eighty per cent of Americans in any given year see a health care provider. We also know that most people with substance use disorders want the health care provider to
ask. Contrary to what we might think, that they would fight and deny and argue, they actually want to be asked. So it’s very disappointing to read these statistics that come out of the Center on Addiction and Substance Abuse at Columbia University—and see that the majority of patients in treatment identify that their doctor knew they had a substance use disorder and said nothing, or they didn’t
recognize it, and they prescribed substances that actually promoted their addiction or prevented them getting into recovery.”

The lack of evidence-based medical care hurts not only the addict, but his or her whole family, too. The substance user’s loved ones, with no medical understanding, must navigate a complex system in search of solutions. Imagine a world where your father has cancer
and you must search online, without medical guidance, for treatment. There are government-approved programs, but those have waiting lists. There are hundreds of private treatment options, but you are overwhelmed by all the claims programs make—and there’s no national licensing or regulating body, so you have no way of discerning what’s credible. In desperation, you pick one and pay tens of thousands
of dollars out of your own pocket, with no guarantee your dad will get well. When he comes home and the cancer reoccurs, you are forced to do this all over again. People may even blame your dad for the return of his cancer.

In reality, no one would dream of treating a cancer patient and his family this way. Yet this is considered completely acceptable in the world of addiction rehab. Some
of you reading this might still say, “Yeah, but the guy with cancer didn’t bring it on himself!”

To that I say, there are many illnesses in which lifestyle is a factor, but blaming people doesn’t help them get better. Investing in evidence-based, regulated, compassionate treatment is the only way to stop bleeding away billions of taxpayer dollars unnecessarily.

• 51 •

WHEN I BEGAN
my recovery some six-and-a-half years ago, I was angry with Alcoholics Anonymous and twelve-step facilitation. Everywhere I turned for help, it was all that was offered. It didn’t work for me. I’m not alone in my dissatisfaction with the status quo. While we were writing this book, many high profile stories in popular mainstream
publications slammed Alcoholics Anonymous, like “The Irrationality of Alcoholics Anonymous,” which appeared in the
Atlantic
in April, 2015.
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Good, I thought.

But through my experience filming the
CBC
documentary on addiction, I’ve had a bit of an awakening. As I sat down with some of the world’s leaders in addiction research, I was humbled by their open-mindedness and goodwill toward the
fellowship of Alcoholics Anonymous.

Dr. Bill Miller has spent a lifetime studying addiction and he believes many contemporary psychological treatment tools parallel what was originally intended by Bill W. Despite the movement’s many critics, Dr. Miller doesn’t believe Alcoholics Anonymous should change.

“It’s really not up to me to say what
AA
should be doing. The traditions of
AA
are very permissive. That’s at the heart of the program. In a way, it’s what we do with motivational interviewing. We offer it, it’s available, but we don’t police it and make people do it a certain way.
AA
just doesn’t take stands on controversial issues.” Upon reflection, I do agree with Dr. Miller that
AA
shouldn’t be drawn into the fray. But with respect, I suggest the fellowship could consider
amending the Big Book. Those of us who do not succeed at
AA
are not “constitutionally incapable of being honest,” as Bill W. originally wrote. We just need another approach. A different treatment. Like there have been many updates, edits and revisions of the bible, none of which I’d argue diminished its power, so too could there be an update to the Big Book.