Radiolab - The Fix

Episode Date: December 18, 2015

This episode we take a sober look at the throbbing, aching, craving desire states that return people (again and again) to the object of their addiction … and the pills that just might set them free. Reporter Amy O’Leary was fed up with her ex-boyfriend’s hard-drinking, when she discovered a French doctor’s memoir titled The End of My Addiction.  The fix that he proposed seemed too good to be true.  But her phone call with the doctor left her, and us, even more intrigued. Could this malady – so often seen as moral and spiritual - really be beaten back with a pill? We talk to addiction researcher Dr. Anna Rose Childress, addiction psychologist Dr. Mark Willenbring, journalist Gabrielle Glaser, The National Institute of Health’s Dr. Nora Volkow, and scores of people dealing with substance abuse as we try to figure out whether we're in the midst of a sea change in how we think about addiction. Produced by Andy Mills with Simon Adler If you are someone looking for help with a substance abuse problem and want to find health care services in your area, check out this map from the Substance Abuse and Mental Health Administration. For more on Dr. Mark Willenbring and the Alltyr Clinic visit their website. If you’d like to hear more from Nora Volkow you can watch her speech from this summer’s American Psychiatric Association’s annual meeting. Or watch her and other top addiction researchers at last year’s World Science Fair   

Wait, you're listening. Okay. All right. You're listening to Radio Lab. Radio Lab. From W-N-Y-S. See? See?

Yeah. 321. Hey, I'm Chad I'm Brumrod. I'm Robert Krollwich. This is Radio Lab. And for today. Yeah. We're going to begin with a conversation we had actually quite a while ago.

I would benefit from a little bit of framing about kind of what we're, like, our goal of this session. Sure. frame it. You make you blab a lot and then we edit it later. Right. That's kind of it. It's a conversation that we had with a reporter. I see, someone we used to work with. Ex-intern. One of our great interns who's gone off in the world.

Amy O'Leary is her name. Amy O'Leary is her name. She at the time was a New York Times reporter, but is now the editorial director of Upworthy. So this started actually through a personal interest. So I was in a relationship with an alcoholic and was very open about that, talked about it with all my friends,

Were you open with him about it, too? Yeah, I mean, he was in some denial. But, yeah, I was, I mean, I regularly would tell him, hey, like, you have a problem with this. And, you know, and he would be clear back and say, you know, if you're going to make me choose between me and vodka, I'm going to choose vodka. He would say that, really? He did say that once, yeah. Wow. And I was, you know, young, but every night after 11 o'clock, my life became shhty.

Without getting into a lot of detail, there were fights, arguments, a lot of rage. And I didn't know what to do and felt really out of control. and, you know, I'd been to Al-Anon meetings, and it just seemed like this, like, terrible, tragic problem that, like, a really smart, cool person would turn really awful on you. But then one day, Amy found herself in Barnes & Noble on Union Square. Union Square, I think I'm on the third floor, and there was a table of mostly self-help books,

and there was this one called The End of My Addiction. She picked it up. This book was super fascinating. It was the memoir of a French cardiologist, this French doctor who had had his life completely ruined by alcoholism, And I looked at it, and I probably stood there, like, feet glued to the floor and just, like, read 70% of the book. The book described in very vivid detail this successful doctor just sliding off the rails. He'd been in, you know, detoxes and medical treatment facilities, you know, upwards of a half dozen times.

His practice had fallen off. He was losing everything in his life. At one point, he describes this terrifying moment of waking up in the back of a taxi. He's blood all over himself. Doesn't know whose blood it is. doesn't know where he's going. He was totally desperate. He killing himself was the next option. And then at one point he says that he had read this tiny nugget.

New York Times. And this is like the early 90s, I think. Apparently he'd stumbled across this short piece about a guy who'd been addicted to cocaine, taken some muscle relaxants. And his cravings for cocaine completely ceased. It was just one guy, one guy's experience. But he saw that and he basically just felt like, well, I might as well try this. I'm just going to experiment on myself.

So he gets the drug, starts taking it. And he slowly like doses up more and more amounts of the drug. Nothing happens, nothing happens. And then at one point he says, the switch flipped. And once the switch hit, he just became absolutely indifferent to alcohol. Like, boom. Yep. Apparently this obsessive need for alcohol that had burdened him his entire life just went away.

Total indifference. What is a drug called, by the way? B-A-C-L-O-F-E-N. Baclophon. Amy says at this point, standing there in the Barnes & Noble, she was interested, skeptical, but interested. Yeah, so I found an email address, like you do as a reporter, I googled every combination of his name until I found some little dot-fr email address. And emailed him, and he wrote back right away. And they set up a time to talk.

You know, I'm already. We have it planned in advance. I confirm it with them. I'm all set up at my desk in New York. and he picked up and I was like, you know, Dr. Amisen, how are you? It's so good to speak with you. And he, he was like, Amy, Amy, I'm so sorry. I'm rescuing my girlfriend. We are in the Alps. I'm carrying her down a mountainside. Can I call you back? Did you hear wind in the background and the sound of, I heard no sound effects. No. No. But he did seem like he was exerting himself to some extent. So, you know, we schedule a second appointment and, you know, I recorded. to the phone call.

Hello? Hello, is this Dr. Amisen? Yes, it's Amy? Yes. Amy, finally. I'm like, hi, nice to talk to you. And then like... It's like, miracle it happened.

You know, the last time we spoke, I was, I was rescuing my girlfriend. My God, it was like a nightmare. We were in Switzerland. And at 10,000 feet. So he launches into the mountain story and then... It just kind of goes off. When Moses opened, the red sea, people say it was a miracle, although there is some signs.

Like Nietzsche said, become who you are. And I am who I wanted. Einstein might have been wrong, and they were wrong. Einstein was right. And, I mean, still, Rövenstein told me he's never heard a pianist like me. He's heard of Rachmane, not for Horowitz. They thought, you know, if comes the Nobel, you never know. People tell me it, you know, it may have made the discovery of the century.

I mean, there's no. He, like, literally went on for 20 minutes before I got in. Well, I wanted to ask you with a little question. You know, a little, I read your book. I think close to when it first came out in the United States. Oh, really? Yeah, it's really like the thriller. I mean, it's humor.

It's fun. I mean, I'm... Then he was off again. Sometimes read it. I can't believe. Sometimes I want to say, you know, I say that and that. I mean, a lot has happened. But, I mean, if you look at just the back, you know,

I just have it in... And then, like, literally it was 20 minutes of how important our shared mission was to, like, save the world. What I want to bring is the shame. Red flags going off left and right. And I sort of started to down to... shift my thought of doing a story. And right about this time, my reporting group got disbanded due to an internal reorganization. And so I moved to a different desk and it was just like, okay, maybe someday Radio Lab will be interested in the story. Because we'll lead anything.

No, in all fairness, Dr. Mason, who unfortunately passed away a few years ago, may have been in the middle of a manic episode, which doesn't necessarily negate his story he was telling. No, I don't know. And even after dropping the story, Amy... As a journalist and as someone who'd been personally affected by alcoholism, I was incredibly torn. As a journalist, you have to be skeptical of everything. But at the same time, like, wouldn't it be great if we lived in a world where you could deal with this problem, which, you know, tears apart so many lives, kills so many people, creates all kinds of pain and agony with, like, a medication. That just seems great.

Yeah. You know. And like the question for me is, like, we often see addiction as like this thing that you've got to morally conquer, like a spiritual calamity that you've got to somehow reorganize your entire being in order to get through. But what if it's not that way? What if it's simply a switch in your brain that got stuck in the on position and you can use a pill to just switch it right off? Oh, that would be nice. Now, we were super skeptical of this idea, but we also couldn't stop thinking about it. Yeah.

So recently, we started making some calls. Hi, it's Anna Rose Chuldris. I'm all here. Dr. Anna Rose Chuldris is an addiction researcher at the University of Pennsylvania, and Amy pointed us to her because it was her work that actually inspired Dr. Amisen. I don't know if you mentioned throbbing, pulsing, desire states, but somehow that comes to mind. That's her specialty. Throbbing pulsing desire states. That sounds great.

She spoke with producer Annie Mills and I in the studio, and for decades, she has been studying that craving state. in addiction. She's interviewed people about it. So what patients described to me is that they would sometimes describe a sort of a wave of sensation. Some enormous wave just pulsates throughout your whole body. Go from their toes up to their head and back down again. My toes to my head. Sort of a zoom, a zoom, a zoom.

And boom, a zoom. And whom, rushing pulsating. Okay, one day in 1995, she's at a conference, she bumps into a guy who tells her he has managed to get some rats addicted to cocaine, give them baclophone, and they totally lost interest in the coke. They were disinterested for several hours. So I saw this and I thought, wow. So she began to give baclophone to people who were addicted to crack, small doses. And initially, there was a lot of disappointment.

Results weren't great. Then she says one day, she was sitting in the staff lounge, just chilling, and a collie ran in. And said, you know, there's this guy over at the hospital next door. And, you know, Anerras, you've got to talk. to him. His name was Ed Coleman. He was a paraplegic. He had a drug deal gone wrong, been shot in the neck. Paralyzed from the waist down, so he was in a wheelchair, taking back, Lafin. I was having bad spasms.

Because he was having these spasms in his legs. He recounted this to me, and I actually had the tape of it. You were doing the low dose at first, and that was 10 milligrams four times a day. Yeah. And then you up the dose. Tell me why you up the dose. I up the dose because I found that the 10, 10, The 10 dose was to take care of the muscle spasmus.

I would still get up, and then my legs were still just tightening up and shape. So I said, well, maybe if I take two of these, it'll calm it down. What did you notice? What Edward found was that when he doubled his bachlophon dose... I would try to use cocaine. I couldn't feel the effects of it. Cocaine no longer had the high. And when I was taking it, I didn't have no cravings.

He then went on to tell her that when he stopped taking back of him, because he did stop for two days. I was having bad spasms. The leg spasms came back. But I was getting the full effect of the cold. He could get the high again, and the craving went through the ceiling. So Edward had been doing his own experiments. He had doubled the dose, he had halved the dose, to see what was the dose where he could still feel the cocaine high, but his spasms wouldn't be driving him crazy.

Wow, so he was like a one-man study. Yeah. Now, this was actually the specific story that inspired Dr. Mason to do his one-man study and to write that book, which held Amy glued to the floor in Barnes & Noble. Now, even though none of this was rock-solid science by any means, Amy says that since then, people have begun to quietly take this drug. And some doctors have even begun to prescribe it.

You know, I talked to a guy who runs a half-webushabye. House in Youngstown, Ohio, who was using Baclifan with people that were under his care. There was a doctor in Chicago who was prescribing it to a lot of people that... This is all off-label use? Yeah, yeah, absolutely. She told us that after Amistin's book, Message boards popped up. Hundreds of people on these boards swapping stories about how much they took, when they took it. They were crowdsourcing their own cure, in effect.

But the really surprising thing is that as we kept calling around, we realized that Baclifen was just a tip of the iceberg. Yes, yes. There's another drug, Acamprasator Camprol, and this other drug, gabapentin, is the puramator, topomax, a dyslphrine,

chantic-saboxone, naltrexone, buprenorphine. This is Dr. Mark Willembray. I'm an addiction psychiatrist here in St. Paul, Minnesota. Mark says that some of these drugs try to target the craving, they try and block the craving.

Others try to target the high that you get. The simple way to put it is this. It's a buzzkill. It's a buzz kill. Interesting. So you drink but you don't get the... You don't get the happy warm feeling. Apparently it takes all the fun out of it. According to one journalist that we talked to, Gabrielle Glazer, who does a ton of reporting about mental health and addiction. Took my 630 pill.

She tried one of these drugs during the course of reporting. And honestly, it made a second glass of wine seem about as enjoyable as a big glass of diamond tap. I mean, really, it was just... It was like drinking water. Why? What is it? the drug's supposedly doing? Well, it blocks opioid receptors in the brain, which is our pleasure system. According to Dr. Willembring, basically, if you think of, like, if you think of a good buzz as a, as like a chemical handshake, like you've got the alcohol molecules, and they need to

click in with the receptors in your brain, and that's what creates ultimately the good feeling. Right. What this category of drugs do is they get in the middle of the handshake. They sort of, like a blanket prevent the hands from shaking. Or muffled them, sort of. Right. And if you're not getting as much enjoyment out of the drinks, then the idea is you're not going to drink as much. And these are home-run drugs. These are drugs that you just don't see these kinds of effects in medicine, in hardly anything.

Mark pointed us to some studies that have been done in Finland, the Netherlands, the UK, Iran, a bunch that have been done in the U.S. that look at this one particular drug called Naltrexone and show that it has a very high success rate. Like one particular study in Finland with about 150 people showed that this drug had a 78% success rate in helping very heavy drinkers reduce their drinking to normal levels.

Right, right. So are these drugs being used? No. No. Basically, the pickup has been near zero. This is something that we heard over and over again, drugs are out there, that there is some evidence that they work, but they're kind of invisible. Yes, exactly.

That's Gabrielle Glazer again? Here, about 1% of people who suffer from alcohol use disorder are ever given the choice or an option to take any sort of medication. She says maybe one, two percent at best. Yes. Which is particularly weird, she says, because that drug nontraxone that was used in the finish study that did well, it's been out for a while. This drug was approved by the FDA in 1994.

For the purpose of treating alcohol? Yes. Wow. We never heard about it. That's so weird. Why wouldn't we've heard of that? Well, that's a very complicated question. She said it's sort of hard to pin down, but that there has basically just been this psychic

barrier that we've all had to seeing addiction as something a pill can help. I mean, just look at med schools. I think there are something around 140 medical schools in the United States. in only 14 medical schools was there a single course in addiction medicine. That number has since gone up a little bit, but not a lot. And so we asked her, why would that be? And she said, well, it's just that addiction treatment has never really been part of the rest of medicine. It has been completely segregated.

It's been its own self-contained world. And this actually goes back to how it was set up at the very beginning. And this I found fascinating. If you go back about 80 years. We had in hospitals at the time in the late 1930s and early 1940s, we had... The white plague, tuberculosis. TB wards. But then, suddenly...

After World War II... TB had a cure. You got better. You didn't have to stay in the hospital and the sanitarium just to recover. And suddenly, these TB units were empty. And she says it was just a few years earlier that a group of mostly men had got together to form alcoholic synonymous. Now, at the time, doctors had no idea what to do with alcohol-addicted people. They were called drunkards.

Innebriot was another word that was commonly used. They were basically seen as hopeless cases. And of course, the founders of A.A. knew this. So when they saw all those empty TB wards, they went to the hospitals and said, let's make those alcoholism units in your hospital. Really? Yes. Doctors thought, okay, we don't have an answer for these guys. So we'll just let them, we'll let them do it.

And thus began 80 years of separation. And that's where we are now. Out of this physical separation, according to Gabriel Glazer, you got a cultural separation, two very different ways of seeing addiction. Cultural, all right, what does that mean? Just to state it in the extremes, on one hand, you've got like someone in the medical sciences who might be inclined to see addiction as a purely biological phenomenon. You know, that's all this is.

And we'll just fix it. just fix it. On the other hand, you have the idea that there's, no, that you can't just fix this biologically. There's something deeply wrong here. There's something in the person, in the spirit, in the soul. This is a reflection of your inner broken self. Yeah, which just has to be addressed

at a higher level. In the AA curriculum, I may have my facts wrong. I believe five out of the 12 steps mention God. Actually, when we checked, it's six out of the 12, half. And the big book, which is the Bible of

of Alcoholics Anonymous, there's a mention of God or him or your higher power on almost every page. What is the recovery rate from the AA crowd? Well, what many researchers say is that the success rate of AA is in the single digits. One study showed that for every 100 people who show up in an AA meeting on January 1st, only five of those people will be sitting there on December 31st. Of the same year? In that same year. Really? So the, what do you call that? The dropout rate is 95%. Yeah. I was really surprised to find that out.

Now, to be fair. I think we should be fair. We have to say that a couple things. Like, first of all, AA is a volunteer organization. It's a support group. It doesn't claim to be a treatment. And also, when you start talking about success rates, that gets really squishy. I mean, if a person doesn't show up to an AA meeting, it doesn't necessarily mean that they're drinking again. They may be doing just fine. perhaps they've switched groups. They've moved and moved on the idea. It's really, really hard to sort of define your terms here. Clearly, AA is important to a lot of people. And that's something that actually Gabrielle Glazer found out last spring when she published an article in the Atlantic where she basically laid all this out. When that article came out, I received thousands of emails. You are a horrible person. You deserve to die.

AA saved my life. I hope your kids get killed by drunk drivers. But. So there was this article in the Atlantic in April. When we talked to Dr. Willingbury, who Glazer mentioned in the article is somebody who believes more in medication than 12th step, he said that when that article came out. Since then, our phone has rung off the hook. We get about half of our calls from out of state. Is there anybody in North Carolina or in New York or in Texas or in California or wherever it is? And they're desperate.

And the families are desperate for an alternative. And they can't find one. He says all of this makes him think back about 30 years. When I was a resident, there was this debate raging. There was this big debate about depression whether people should be treated with antidepressants. But he says the debate completely shifted. Here we go. Here comes to Prozac. When we got Prozac.

Doctors have prescribed Prozac to 2 million Americans. Suddenly he had this drug that was a massive success, spawned other drugs, and in the process changed how people fundamentally see depression. And now most people, you know, get treatment for anxiety or depression with antidepressants compared to psychotherapy. Do you think we're heading in the same place with addiction? Oh, we are. Oh, we are. We are. There's no question. I do predict in 10 or 15 years. We'll have a Prozac moment. This is Gene P. P. P. Sloane, Massachusetts. Radio Lab is supported in part by the Alfred P. Sloan Foundation, enhancing public understanding of science and technology in the modern world.

More information about Sloan at www.sloan.org. All right, welcome back. I'm Jad. Robert. And if you know this music, you already know. It's the Brian Larrow Show on WNYC. Good morning, everyone. This is the Brian Laira show at our own home station, WNYC in New York. Very, very popular show.

Yes. And to explain, we wanted a gut check because we had been hearing all of these things from experts saying that we're undergoing a sea chain. and we want to know, is that actually happening out there in the world? And the world, at least our local world, is full of Brian Lerer listeners. It's your stories of what kinds of treatment you were offered and actually used for alcohol and substance abuse. So we asked the Brian Laird team if they would help us out. Call us at 212-433. And they helped us out.

And we'll explain more now with Radio Lab host at Aberrondajad. Hey, Brian. Thank you for having me on. And you believe we're in the midst of a cultural and medicinal shift. for the way we both view and treat people with addictions, right? Yeah, so, I mean, we're not sure, to be totally honest. You know, we bumped into a reporter a couple of years ago who told us the story of a guy. So I sort of summarized Emil Larry's story about Dr. Ramieson. He described a moment where the addiction just switched off.

Then I sort of summarized what the experts had told us that maybe something is happening, but we weren't sure. We're just not sure. And so we're curious to hear from people who've struggled with substance abuse. I'm wondering what sorts of treatments they've been offered, if have they seen pills like Naltraxone or Baclophan, have they used them? Have they worked? What's been the experience? So, listeners?

Just like that. Help Jad report this story. Hi. Hi. My name is Nicole. I'm calling from New Yorkshire. I'm actually in Afghanistan. I've overdosed many times on heroin, cocaine, celebrating a year of sobriety next month.

There was an explosion of calls. Ginger and Mayo Pack. You're on WNYC. Hi, how are you? I'm an alcoholic and an addict, and I've been in recovery for 18 years. I'm sitting outside of an AA meeting listening to this. We heard from a lot of people who felt like this idea of a pill that can treat addiction was idiotic. I just don't think psychotropic is really a solution. There is no quick fix. There is no magical medication.

If it was just the physical disease, we would all be cured. But we also heard from a lot of people who had just been offered these drugs. I was prescribed handball. I have been offered nalprachshone. And it's very effective. It does help cut the craving. One guy who called? It's just so incredibly crazy that I heard this show today.

I'm about to embark upon this thing. He just got prescribed addiction medicine that morning. One way or another, I'm going to fix this. He was excited, as were a lot of the callers in this category, because... It's a huge social stigma. If these pills work for them, it kind of means that they're just sick. They're not bad people. something that people choose even though it seems that way.

DeMara in Manhattan, you're on WNYC. Hello, Tamara. Hi, yeah. One caller called in to say that her dad had had a terrible time with alcohol. It was destroying the family. And, you know, we were thinking about putting him in rehab or something, but afraid of the stigma of it. And my mom is a doctor. So she was working in the hospital.

She told me that one day, if she took matters into her own hand, and she gave him injection shots of something called bolterine. Or, you know, the way we say it is like waltarine. This actually turns out to be a muscle relax and not too dissimilar from Baclivan. And it worked. One day, like, everything was okay and he was over it. I mean, it wasn't something that was controlling our lives anymore. Well, let me ask you this.

That's producer Andy Mills again. After the Brian Laira show, we had so many calls that he set up a Google voicemail and he talked with an additional 40 or so people And he asked everyone. Do you feel that we're headed toward a sea change where we're going to start treating addictions in a new way? No. I completely do.

You know, you've got a drug problem. Find the drug that fixes the drug problem. There's no pill that will make you want to put down the drink in the trap. Hello, Billy. Hey. Will you just introduce yourself? Tell me who you are. Yeah, and you can use my full name if you want.

My name's Billy Webb. I am from Shaker Heights, Ohio, and I currently live in St. Paul, Minnesota. Hey, this is Andy. So in talking to all those people on the phone, Billy's, it was the story that I just kept thinking about over and over again. And so eventually we ended up getting him into the studio. Do you remember what it was like the first time that you had alcohol? Yeah, it was the summer that I turned 16. And I was a quieter kid. And I was kind of a nerd. You might say I was into computer games. But then the tide sort of swung and I got into music. And most of the specifically punk rock and ska. He says it was this time that he was coming out of his shell. He learned how to play the bass, started practicing all the time. He made these new friends and they started a band.

We were horrible, but we were willing to put ourselves out there and we started playing gigs. And I had gotten my first girlfriend at that time and I was very excited and nervous to see her. So I figured why not loosen myself up a little bit? So one day he breaks into his father's life. liquor cabinet takes a couple shots of Mount Gay Rum. It was euphoric, to be honest with you, and I finally felt like I was myself.

And it just felt like I was on top of the world and that I could do anything. And I had all these creative ideas that came to me. I wanted to talk to people. That's sort of when things started to take off. By the time, Billy was 24. I was becoming an entrepreneur. He was running his own business. It was a storage facility that he planned to convert into art spaces.

Where we would have shows and maybe even a little small record shop. I was in a relationship. We had a dog. He was in a new band that toured. It was fun. I can say that for sure. I could even conduct business out of the bar down the street if I wanted to because the business line forwarded to myself. But he said that it was also around this time that he started to wake up in the morning with the shakes.

And I remember drinking beer in the morning in the bathroom. How much do you think you were drinking at this point? 20 drinks a day, 25 sometimes. Wow. And usually the night before, before I passed out or went to the bathroom. sleep. I would say, you know, I'm going to turn it around in the morning. I'm going to get out of bed and work out, eat a full meal. And that never ended up happening. What eventually did end up happening is that Philly asks for help. Both his mom and his sister, they flew Billy up to

Minnesota where he checked into one of the best rehab centers in the Midwest. And when I got there, looks like a small college campus. I mean, it's very serene, sort of peaceful setting, very welcoming. He started going to group meetings, started working out, and was like, all right. was actually excited. I thought that things would turn around when I got back. But within just a day of being back in Cleveland, it was right back to where I was, 20 drinks a day, 25 sometimes. So I ended up back in treatment. We figured, you know, I just didn't do it right the first time. So if we go back, we'll get it right this time. And once again, you know, I crashed and burned. This time, not even in Cleveland. I had relapsed at the airport. I didn't even make it to Cleveland. And he said,

said this is just how things went for years. It was just the same old story of in and out, in and out. In the span of about four years' time, Billy tried seven different treatment centers and detox centers, lots of AA meetings. I went to 110 meetings in 70 days. I went to 28 in one week one time. Nothing worked. He says that his AA sponsors would tell him, you know, you can do this, she'll get it right. So we'd leave those meetings. Feeling positive. End up at a liquor store.

I just considered myself a failure at this point in time that, I was never going to get better, and that led to more and more drinking. He said that he lost his girlfriend, pretty much all his friends, got fired from his job. Due to drinking, and my days just consisted of walking to the liquor store, buying two-fifths and walking home. That's all I did. I just lay in bed and drank. It's hard to even think about without being completely horrified that that's what my life had turned into. And then I woke up one day with severe, severe pain in my abdomen, and I couldn't move or walk or keep water down. And it was really scary.

And it was pancreatitis. So I ended up checking myself into a hospital in Grand Rapids. And I saw these people and they said, wow, we don't even, we don't see this condition until people are usually in their mid-40s. Billy was only 29 years old. When I got out, I moved into a sober house in St. Paul. and that's when I got hooked up with the Altier Clinic. Now at the Altier Clinic, which I should say really quick, is run by Dr. Mark Willembring, who we talked to earlier.

There they do something that they call evidence-based treatment. So if a patient shows up looking for help, they are given a therapist to treat any underlying mental health conditions that they may have, and for everything connected to their addiction, they're given medications. In Billy's case, they gave him naltrexone. When I took the naltrexone,

I actually was able to limit my drinking to two to six drinks a night, which was, quite frankly, felt like a normal amount to me. He was able to drink moderately? Yeah, almost overnight. I was blown away. That's all I wanted

was to be like everyone else who can have a couple drinks and set it down. Well, what does that tell you then? That tells you that you are cured? I just felt like there was no compulsion to keep going and going. Like, what was different, though? Like, did it not taste as good?

It tasted as good. I can say that for sure, especially if it was a micro brew or something like that. But I didn't get that same rush in my head. And being able to drink without that rush, for a while, it made all the difference. For a couple months, I was okay. You know, now I can just have a couple. But what happened was I was taking. was taking it and then on one weekend, I just decided, you know what?

You know what? I'm not going to take it this weekend. It's a long weekend. I don't need it. Billy says that even though the urge to drink, which was something that had been nagging at him for years, even though that was now gone, he told me that there was just some part of him that missed being drunk. I wanted to be intoxicated. Even with this medication that was helping you, you missed it. Yeah. Knowing all that it cost you, what about it did you miss? I missed feeling like myself.

I didn't, I didn't. Hey guys, this is Corey the engineer. I hate to interrupt, but we have to, the studio is being booked in like the next 10 minutes. I'm sorry, guys. So with poetically bad timing, we got kicked out of the studio. And this was, this was several months back, actually. Then it took about another month. and a half before we could all get back in the studio again.

Billy? Hey. Well, yeah. So I started by asking him, so when you said that you didn't feel like yourself, what did that mean? I didn't picture life being possible without alcohol. That's the only person that I knew. And basically what he told me is that if you think back to the beginning of his story,

he came out of his shell alongside alcohol, being creative, writing music, performing music. Alcohol's there. his first girlfriend, alcohol was there. He's had drinking associated since puberty with the best parts of himself. And so, like, you know how we all have this sense of, like, who we are inside of us?

Like, you know, I have, like, your inner jad where, like, people can think what they want about you and you've got your reputation. But, like, you know who you are down deep. Well, his, it was all wrapped up in alcohol. So you take that alcohol away? What was left was an empty guy that I didn't know. Just this void.

And filling up that void, he says, was this onslaught of these terrible memories. Sequestured detox wards and punitive treatment and all the people I've alienated over the years, all the lost opportunities, and all the failed attempts. He says that's what he would think about when he was sober, and he just wanted not to. last time we talked to Billy he was doing really well I had the job I had the girl I had a band back

but he says that in the course of just this month and a half since the last time that we talked lost the girl isolated a bunch of friends and lost a good job that I wanted to keep for a while until I could get into grad school so kind of having to start over now even just listening to your voice right now you sound so different I know that I sound different because I was I was coming in here with a more of a positive spirit last time. I really was flying high last time.

People were excited for me to come in, and now they said, are you sure you want to come in today and talk to them? I mean, the people who even talk to me right now. So it's hard to do a triple backflip. I tried to, didn't want to come in here crying or anything, but, you know, It's pretty sad.

It's pretty sad. But at the same time, you know, I feel hopeful that I can beat this. Now, Billy's still seeing a therapist. He's still going down here. He's actually on this new medication now called Gabba Pitten, which he says has been helpful. And I know I was pretty staunchly against the 12 steps last time. But I am actually going back to meetings these days.

Just to be with people who are in the same boat. So he's doing both. Yeah. Huh. I hear a story like that and I think, yeah, I think we're ready to see addiction in a new way. And we're definitely, I think pills will be a big part of that, seems to me. But the pills can't get all the way down, you know? Right.

The thing that makes the addiction go is really deep. Well, right. And this reminds me of when we were talking to Nora Volkov. And I'm director of the National Institute of Drug Abuse at the NIH. She sort of pointed out at the same idea in a really interesting way. One of the questions that I've always had in my brain is, why do we become addicted? I mean, why is it that we can fall into a state where we actually become obsessed about something and compulsive despite the fact that it can have negative consequences?

And romantic love is exactly that situation. Nora says that one thing that biologists know and actually have known for a while is that drugs hijack systems in our brain that are there for other purposes. She says literally drugs will light up the same circuits in your brain that are usually engaged when you're in love, when you're hanging out with your friends, when you're being hugged by your kid. It's almost like randomness of chemistry that you have these chemical compounds that can go directly and activate these. these centers. So it hijacks the very things that make us, you know, good friends and good parents. Correct. So it's like a weakness born of a strength in a way.

Yeah, and actually, according to Anna Rose Childress, who we had talked to earlier, people with addictions. Ironically, they're the fittest of the fit in evolutionary terms, right? They're the people who would have been earliest for the food, earliest for the sexual partner. The idea here is that deep down inside of them, like we're talking at a genetic level. They have the greatest sensitivity. They would be exquisitely attuned to the promise of rewards. And most of the time, and for most of the millennia, all the priorities were on being good reward appreciators. That was our only job.

That's interesting. But now we're in a different environment where we've got huge opportunities for many sexual encounters that carry lethal violence. rather than just, you know, the possibility of survival of fittest. And we've got, you know, calorie-dense meals that we can acquire without expending a calorie. And see, in almost every circumstance that you can think of, except for the last, you know, 50 years, being on the side of being overly responsive to reward was probably mostly an advantage, you know? That's so interesting. I've never heard it said that way. And for our patients, in some sense, they're the fittest of the fit. And,

being punished for it. Yeah, it's like a terrible joke. And the terrible reality of that joke is something that just kept showing up on our voicemail over and over again. Hello, yes, this is Pat Roos. I was listening to the Brian Ler show on the way home from work today.

And I have a son who died of heroin addiction and alcohol abuse last May. And since then, I've been trying to come to terms with him. This is my son. He was a great person. I think he just couldn't see to be sober in this world

that he knew. That was really hard for him. How do you live your life when you have to be sober? This story was reported and produced by Mr. Andy Mills. Special thanks to Tim Howard. And to Lever Maitra. Leanne Donagan.

Deborah Snyder. Kelly. George Coob. And this is Andy, and I wanted to say to the dozens and dozens of people who were willing to talk to me, some of them for hours about their recovery. Thank you very much. And a very special thanks to Brian Lair and Megan Ryan and that whole team. And, of course, to Amy O'Leary, who started the whole thing off.

Exactly. I'm Chad Aboumran. I'm Robert Proovich. Thank you guys for listening. To play the message, press two. Hi, this is Billy Webb. Radio Lab is produced by Chad Abram. our staff includes Renna Farrell, David Gable, Dylan Keith, Matt Keighley, Robert Krulwich, Andy Mills, Laitish,

Laitis Nacer, Kelsey Padgett, Arienne Wack, Molly Webster, Soren Wheeler, and Jamie York. With help from Simon Adler, Alexander Lee Young, Abigail Keel, Stephanie Tam, and Michael Lohinger. Fact checkers, Ardiva Dasher, and Michelle Harris. End of mailbox.