Dec 17, 2015

The Fix

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 

 

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Speaker 3: Wait, you're listening-

Speaker 4: Okay.

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Speaker 4: Okay?

Speaker 3: All right.

Speaker 5: You're listening to Radiolab. From WNYC.

Jad Abumrad: 3-2-1. Hey, I'm Jad Abumrad.

Robert Krulwich: I am Robert Krulwich.

Jad Abumrad: This is Radiolab.

Robert Krulwich: And for today-

Jad Abumrad: do, do, do-

Amy O'Leary: yeah.

Robert Krulwich: We're going to begin with a conversation that we had actually quite a while ago.

Amy O'Leary: I would benefit from a little bit of framing about what we're-

Jad Abumrad: Yes.

Amy O'Leary: ... our goal of this session.

Jad Abumrad: Sure, we can frame it.

Robert Krulwich: We make you blab a lot, and then we edit it later.

Amy O'Leary: Right.

Jad Abumrad: That's kind of it. It's really what we do.

Jad Abumrad: It's a conversation that we had with a reporter ... Actually, who we used to work with.

Robert Krulwich: Yeah.

Jad Abumrad: Ex intern.

Robert Krulwich: Yeah.

Jad Abumrad: One of our great interns has gone off in the world.

Robert Krulwich: Amy O'Leary is her name.

Jad Abumrad: Amy O'Leary is her name. She at the time was a New York Times reporter, but is now the editorial director of Upworthy.

Amy O'Leary: So this started actually through a personal interest. I was in a relationship with an alcoholic, and was very open about that. Talked about it with all my friends and-

Jad Abumrad: Were you open with him about it too?

Amy O'Leary: Yeah. I mean I would ... He was in some denial, but yeah I was. I mean, I regularly would tell him, "Hey, you have a problem with this." 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."

Jad Abumrad: He would say that really?

Amy O'Leary: He did say that once. Yeah.

Jad Abumrad: Wow.

Amy O'Leary: I was young, but every night after 11 o'clock my life became shitty.

Jad Abumrad: Without getting into a lot of detail there were fights, arguments, a lot of rage.

Amy O'Leary: I didn't know what to do, and felt really out of control. You know, I'd been to Al Anon meetings. It just seemed like this terrible tragic problem that a really smart, cool person would turn really awful on you.

Robert Krulwich: Then one day Amy found herself in Barnes & Noble on Union Square.

Amy O'Leary: 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.

Jad Abumrad: She picked it up.

Amy O'Leary: This book was super fascinating. It was the memoir of a French Cardiologist. This French doctor who had his life completely ruined by alcoholism. I looked at it, and I probably stood there, feet glued to the floor, and just like read 70% of the book.

Jad Abumrad: The book described in very vivid detail this successful doctor just sliding off the rails.

Amy O'Leary: He'd been in detox's and medical treatment facilities upwards of a half dozen times. His practice had fallen off. He was losing everything in his life.

Jad Abumrad: At one point he describes this terrifying moment of waking up in the back of a taxi, blood all over himself. Doesn't know whose blood it is, doesn't know where he's going.

Amy O'Leary: He was totally desperate. Killing himself was the next option. Then at one point he says that he had read this tiny nugget-

Jad Abumrad: New York Times.

Amy O'Leary: This is like the early '90s, I think.

Jad Abumrad: Apparently he'd stumbled across this short piece about a guy who'd been addicted to cocaine, taken some muscle relaxants-

Amy O'Leary: His cravings for cocaine completely ceased.

Jad Abumrad: It was just one guy. One guys experience.

Amy O'Leary: He saw that and he basically just felt like, well I might as well try this. I'm just going to experiment on myself.

Jad Abumrad: So he gets the drug, starts taking it.

Amy O'Leary: He slowly doses up more and more amounts of the drug.

Jad Abumrad: Nothing happens, nothing happens.

Amy O'Leary: Then at one point he says the switch flipped. Once the switch hit he just became absolutely indifferent to alcohol.

Jad Abumrad: Like, boom?

Amy O'Leary: Yep.

Robert Krulwich: Apparently this obsessive need for alcohol that had burdened him his entire life just went away.

Amy O'Leary: Total indifference.

Jad Abumrad: What is the drug called by the way?

Amy O'Leary: Baclofen.

Jad Abumrad: Baclofen.

Amy O'Leary: Mm-hmm (affirmative).

Jad Abumrad: Amy says at this point standing there in the Barnes & Noble she was interested, skeptical, but interested.

Amy O'Leary: Yeah. 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. He wrote back right away.

Jad Abumrad: They set up a time to talk.

Amy O'Leary: I'm all ready. We have it planned in advance. I confirm it with him. I'm all set up at my desk in New York, and he picked up and I was like Dr. Amesin how are you? It's so good to speak with you. He immediately was like, "Amy, Amy I am so sorry I am rescuing my girlfriend. We are in the Alps. I'm carrying her down a mountain side. Can I call you back?"

Robert Krulwich: Did you hear wind in the background? The sound of the birds and-

Amy O'Leary: I heard no sound effects, no.

Robert Krulwich: I know.

Amy O'Leary: He did seem like he was exerting himself to some extent. You know, we scheduled a second appointment, and I recorded the phone call.

Dr. Amisin: Hello?

Amy O'Leary: Hello is this Dr. Amesin?

Dr. Amisin: Yes. It's Amy?

Amy O'Leary: Yes.

Dr. Amisin: Amy, finally.

Amy O'Leary: I'm like, "Hi, nice to talk to you." And then like-

Dr. Amisin: It's like miracles happen you know. Last time we spoke I was rescuing my girlfriend. My God, it was like a nightmare. We were in Switzerland, at 10,000 feet.

Jad Abumrad: So he launches into the mountain story and then-

Dr. Amisin: Strong and the-

Jad Abumrad: Just kind of goes off.

Dr. Amisin: When Moses opened the Red Sea people say it was a miracle. Well though there is some science, like nature said, "Become who you are." I am who I wanted ... I might have been wrong in the were wrong but Einstein is right. Rubinstein told me he'd never heard of candidates like me. He's heard Rachmaninoff or Harroway too. If comes the Nobel you never know. People tell me it made have made the discovery of the century. I mean there's no-

Amy O'Leary: He literally went on for 20 minutes before I got in with a little question.

Amy O'Leary: You know, I read your book, I think close to when it first came out in the United States.

Dr. Amisin: Oh really, yeah it's really like a thriller. It's humorous and it's fun. I mean-

Jad Abumrad: Then he was off again.

Dr. Amisin: Sometimes reading I can't believe I ... Sometimes I want to say ... I say that, and that personally a lot has happened, but I mean if you look at just the back-

Amy O'Leary: Then literally it was 20 minutes of how important our shared mission was to like save the world.

Dr. Amisin: When I want to break the machine.

Amy O'Leary: Red flags going off left and right, and I sort of started to down shift my thought of doing a story. Right about this time my reporting group got disbanded due to an internal reorganization. I moved to a different desk, and it was just like pshh okay. Maybe some day Radio Lab will be interested in the story.

Jad Abumrad: Because we'll eat anything. No, in all fairness Dr. Amisin, who unfortunately passed away a few years ago, may have been in the middle of a manic episode. Which doesn't necessarily negate the story he was telling.

Robert Krulwich: No, not at all.

Jad Abumrad: Even after dropping the story Amy-

Amy O'Leary: 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. At the same time, wouldn't it be great if we lived in a world where you could deal with this problem which tears apart so many lives, kills so many people, creates all kinds of pain and agony with a medication. That just seems great.

Robert Krulwich: Yeah.

Amy O'Leary: You know?

Jad Abumrad: The question for me is ... We often see addiction as 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.

Robert Krulwich: Oh, that would be nice.

Jad Abumrad: Now, we were super skeptical of this idea, but we also couldn't stop thinking about it.

Robert Krulwich: Yeah.

Jad Abumrad: Recently, we started making some calls.

Anna Rose Childress: Hi, it's Anna Rose Childress. I'm all here.

Jad Abumrad: Dr. Anna Rose Childress is an addiction researcher at the University of Pennsylvania, and Amy pointed us to her because it was her work that actually inspired Dr. Amisin.

Anna Rose Childress: I don't know if you mentioned throbbing, pulsing desire states, but somehow that comes to mind.

Jad Abumrad: That's her specialty.

Robert Krulwich: Throbbing pulsing desire states.

Jad Abumrad: Yeah that sounds great.

Jad Abumrad: She spoke with producer Andy Mills and I in the studio. For decades, she's been studying that craving state in addiction. She's interviewed people about it.

Anna Rose Childress: What patients described to me is that they would sometimes describe a sort of a wave of sensation.

Speaker 10: Some enormous wave just pulsates throughout your whole body.

Anna Rose Childress: Would go from their toes up to their head, and back down again.

Speaker 10: From my toes to my head, to my toes to my head.

Anna Rose Childress: Sort of a zoom, a zoom, a zoom.

Speaker 10: Room, room, rushing, pulsing.

Jad Abumrad: 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 Baclofen, and they totally lost interest in the coke.

Anna Rose Childress: They were disinterested for several hours. I saw this and I thought, wow.

Jad Abumrad: She began to give Baclofen to people who were addicted to crack. Small doses, and initially-

Anna Rose Childress: There was a lot of disappointment.

Jad Abumrad: Results weren't great. Then she says one day she was sitting in the staff lounge, just chilling, and a colleague ran in.

Anna Rose Childress: Said, "You know there's this guy over at the hospital next door and Anna you've got to talk to him"

Ed Coleman: Acute episode when the desire was strong-

Jad Abumrad: His name was Ed Coleman. He's a paraplegic.

Anna Rose Childress: He had had a drug deal gone wrong, been shot in the neck-

Jad Abumrad: Paralyzed from the waist down. He was in a wheelchair, taking Baclofen.

Ed Coleman: I was having bad spasms.

Jad Abumrad: He was having these spasms in his legs.

Anna Rose Childress: He recounted this to me, and I actually have the tape of it.

Anna Rose Childress: So you were doing the low dose at first, and that was 10mg four times a day?

Ed Coleman: Yeah, and-

Anna Rose Childress: And then you upped the dose. Tell me why you upped the dose?

Ed Coleman: I upped the dose because I found that the 10 dose wasn't taking care of the muscle spasms.

Anna Rose Childress: Right.

Ed Coleman: But I still lit up, and my legs were still just tightening up in shape. I said, well maybe if I take two of these it will calm it down.

Anna Rose Childress: What did you notice?

Ed Coleman: Well-

Anna Rose Childress: What Edward found was that when he doubled his Baclofen dose-

Ed Coleman: I would try to use cocaine, I couldn't feel the effects of it.

Anna Rose Childress: The cocaine no longer had the high.

Ed Coleman: When I was taking it, I didn't have any cravings, you know.

Jad Abumrad: He then went on to tell her that when he stopped taking Baclofen, because he did stop for two days.

Ed Coleman: I was having bad spasms.

Jad Abumrad: The leg spasms came back.

Ed Coleman: But, I was getting the full effect of the coke.

Anna Rose Childress: He could get the high again, and the craving went through the ceiling. 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.

Jad Abumrad: Wow. So he was like a one man study.

Anna Rose Childress: Yeah.

Jad Abumrad: Now this was actually the specific story that inspired Dr. Amisin to do his one man study, and to write that book, which held Amy glued to the floor in Barnes & Noble. 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. Some doctors have even begun to prescribe it.

Amy O'Leary: I talked to a guy who runs a half way house in Youngstown, Ohio who was using Baclofen with people that were under his care. There was a doctor in Chicago who was prescribing it to a lot of people that-

Jad Abumrad: This is all off label use?

Amy O'Leary: Yeah, yeah absolutely.

Jad Abumrad: She told us that after Amisin's book message boards popped up.

Amy O'Leary: 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.

Jad Abumrad: The really surprising thing is that as we kept calling around we realized that Baclofen was just the tip of the iceberg.

Mark Willenbring: Yes, yes. Well, there's another drug Acamprosate, or Campral, and this other drug Gabapentin ... Is too Disopyramide, or Topamax. A disulfiram, Chantixx, Suboxone, Naltrexone, Epinephrine.

Jad Abumrad: This is Dr. Mark Willenbring.

Mark Willenbring: I'm an addiction psychiatrist here in Saint Paul, Minnesota.

Jad Abumrad: Mark says that some of these drugs try to target the craving. They try to block the craving. Others, tried to target the high that you get.

Mark Willenbring: The simple way to put it is this. It's a buzz kill.

Jad Abumrad: It's a buzz kill, interesting.

Mark Willenbring: Yeah.

Jad Abumrad: You drink but you don't get the-

Mark Willenbring: You don't get the happy warm feeling.

Jad Abumrad: Apparently it takes all the fun out of it. According to one journalist that we talked to, Gabrielle Glaser, who does a ton of reporting about mental health and addiction.

Gabrielle Glaser: Took my 6:30 pill-

Jad Abumrad: She tried one of these drugs during the course of reporting.

Gabrielle Glaser: It honestly, it made a second glass of wine seem about as enjoyable as a big glass of Dimetapp. I mean really, it was just ... It was like drinking water.

Jad Abumrad: Why? What is the drug supposedly doing?

Mark Willenbring: Well, it blocks opiod receptors in the brain which is our pleasure system.

Jad Abumrad: According Dr. Wellenbring basically if you think of a good buzz as like a chemical handshake. 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.

Robert Krulwich: Right.

Jad Abumrad: What this category of drugs do is they get in the middle of the handshake. Sort of like a blanket prevent the hands from shaking.

Robert Krulwich: Or muffle them, sort of.

Jad Abumrad: Right.

Robert Krulwich: Yeah.

Jad Abumrad: If you're not getting as much enjoyment out of the drinks then the idea is you're not going to drink as much.

Robert Krulwich: These are home run drugs. These are drugs that you just don't see these kinds of effects in medicine, in hardly anything.

Jad Abumrad: 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. 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.

Robert Krulwich: Right, right.

Jad Abumrad: Are these drugs being used?

Robert Krulwich: No. Oh no. Basically the pick up has been near zero.

Jad Abumrad: This is something that we heard over and over again. These drugs are out there. That there is some evidence that they work, but they're kind of invisible.

Gabrielle Glaser: Yes. Exactly.

Jad Abumrad: That's Gabrielle Glaser again.

Gabrielle Glaser: 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.

Jad Abumrad: Says maybe one, 2% at best.

Gabrielle Glaser: Yes.

Jad Abumrad: Which is particularly weird, she says, because that drug Naltrexone that was used in the Finnish study that did well, it's been out for a while.

Gabrielle Glaser: This drug was approved by the FDA in 1994. By the-

Robert Krulwich: For the purpose of treating alcoholics?

Gabrielle Glaser: Yes.

Robert Krulwich: Huh wow.

Jad Abumrad: Wow.

Gabrielle Glaser: We never heard about it.

Jad Abumrad: That's so weird.

Robert Krulwich: Why wouldn't we have heard of that?

Gabrielle Glaser: Well, that's a very complicated question.

Jad Abumrad: 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.

Gabrielle Glaser: 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.

Jad Abumrad: 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."

Gabrielle Glaser: It has been completely segregated.

Jad Abumrad: It's been its own self contained world, and this actually goes back to how it was set up at the very beginning. This I found fascinating. If you go back about 80 years.

Gabrielle Glaser: We had in hospitals at the time, in the late 1930s and early 1940s we had-

Speaker 14: The white plague, tuberculosis.

Gabrielle Glaser: TB wards, but then suddenly-

Jad Abumrad: After World War II.

Gabrielle Glaser: TB had a cure, you got better. You didn't have to stay in the hospital in the sanitarium just to recover. Suddenly these TB units were empty.

Jad Abumrad: She says it was just a few years earlier that a group of mostly men had got together to form Alcoholics Anonymous. Now, at the time doctors had no idea what to do with alcohol addicted people. They were called drunkards.

Gabrielle Glaser: Inebriate was another word that was commonly used.

Jad Abumrad: They were basically seen as hopeless cases. Of course, the founders of AA knew this. When they saw all those empty TB wards they went to the hospitals-

Gabrielle Glaser: And said let's make those alcoholism units in your hospital.

Robert Krulwich: Really?

Gabrielle Glaser: Yes. Doctors thought okay we don't have an answer for these guys, so we'll just let them do it. Thus began 80 years-

Jad Abumrad: Of separation.

Gabrielle Glaser: That's where we are now.

Jad Abumrad: Out of this physical separation, according to Gabrielle Glaser, you got a cultural separation. Two very different ways of seeing addiction.

Robert Krulwich: Cultural, all right. What does that mean?

Jad Abumrad: Just to say that in the extremes. On one hand you've got someone in the medical sciences who might be inclined to see addiction as a purely biological phenomenon. You know, that's all this is-

Robert Krulwich: And we'll just fix it.

Jad Abumrad: We'll just fix it.

Robert Krulwich: Yeah.

Jad Abumrad: On the other hand you have the idea that no, you can't just fix this biologically. There is something deeply wrong here. There's something in the person, in the spirit, in the soul.

Robert Krulwich: This is a reflection of your inner broken self.

Jad Abumrad: Yeah, which just has to be addressed at a higher level.

Gabrielle Glaser: In the AA curriculum, I may have my facts wrong, I believe five out of the 12 steps mention God.

Jad Abumrad: Actually when we checked it's six out of the 12, half.

Gabrielle Glaser: The big book, which is the Bible of Alcoholics Anonymous, there is a mention of God, or him, or your higher power on almost every page.

Robert Krulwich: What is the recovery rate from the AA crap.

Gabrielle Glaser: 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 5 of those people will be sitting there on December 31st.

Robert Krulwich: Of the same year?

Gabrielle Glaser: In that same year.

Jad Abumrad: Really, so the-

Gabrielle Glaser: Yeah.

Jad Abumrad: ... the what do you call that? The drop out rate is 95%?

Gabrielle Glaser: Yeah. I was really surprised to find that out.

Jad Abumrad: Now, to be fair-

Robert Krulwich: Hmm. I think we should be fair.

Jad Abumrad: We have to say that ... A couple things. First of all AA is a volunteer organization. It's a support group, it doesn't claim to be a treatment.

Robert Krulwich: Mm-hmm (affirmative).

Jad Abumrad: 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 are drinking again. They may be doing just fine.

Robert Krulwich: Or perhaps they've switched groups.

Jad Abumrad: Exactly.

Robert Krulwich: They've moved and moved on another-

Jad Abumrad: It's really-

Robert Krulwich: Yeah.

Jad Abumrad: ... really hard to sort of define your terms here. Clearly AA is important to a lot of people. That's something that actually Gabrielle Glaser found out last spring when she published an article in the Atlantic where she basically laid all this out.

Gabrielle Glaser: 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.

Jad Abumrad: But-

Robert Krulwich: So there was this article in the Atlantic in April.

Jad Abumrad: We talked to Dr. Willenbring, who Glaser mentioned in the Article as somebody who believes more in medication than 12 step. He said that when that article came out-

Mark Willenbring: Since then our phone is 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. Their desperate, and the families are desperate for an alternative, and they can't find one.

Jad Abumrad: He says all of this makes him think back about 30 years.

Mark Willenbring: When I was a resident there was this debate raging. There was this big debate about depression, whether people should be treated with anti-depressants.

Jad Abumrad: He says the debate completely shifted.

Speaker 15: Here we go. Here comes the Prozac.

Jad Abumrad: When we got Prozac.

Speaker 16: Doctors have prescribed Prozac to two million Americans.

Jad Abumrad: Suddenly you had this drug that was a massive success, spawned other drugs, and in the process changed how people fundamentally see depression.

Mark Willenbring: Now, most people get treatment for anxiety or depression with anti-depressants, compared to psychotherapy.

Jad Abumrad: Do you think we're heading in the same place with addiction?

Mark Willenbring: 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.

Gene Pelletier: This is Gene Pelletier in Boston, 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.

Robert Krulwich: Hi I'm Robert Krulwich. Radio Lab is supported by Royal Caribbean. Look, if you knew what was going to happen in this Radio Lab episode would you keep listening to us? Of course, you wouldn't, because the point is not knowing is the fun. Not expecting is even better. That's what Royal Caribbean has promising. Each day, they say, gives you an unexpected adventure. Sometimes it's surfing an endless wave on the Flo Rider 16 stories above the sea. Sometimes visiting an island that's totally different from the one you went to yesterday, all in the same trip. Why just vacation in the Caribbean when you can go on an adventure on Royal Caribbean. Come seek, at RoyalCaribbean.com ships registry Bahamas.

Alec Baldwin: I'm Alec Baldwin. Join me for a live taping of Here's the Thing with my special guest Itzhak Perlman. I'll be talking with the legendary violinist about his life and his music. We'll hear live performances from some of the talented students in the Perlman music program. Monday, February 18th at NYU's Skirball Center, tickets a WNYC.org/events.

Jad Abumrad: All right. Welcome back. I'm Jad.

Robert Krulwich: Robert.

Jad Abumrad: If you know this music you already know-

Brian Lehrer: It's the Brian Lehrer show on WNYC. Good morning everyone.

Robert Krulwich: This is the Brian Lehrer show at our own home station WNYC in New York. Very, very popular show.

Jad Abumrad: Yes. 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 change. We wanted to know is that actually happening out there in the world?

Robert Krulwich: The world, at least our local world is full of Brian Lehrer listeners.

Brian Lehrer: It's your stories of what kinds of treatment you were offered and actually used for alcohol and substance abuse.

Jad Abumrad: We asked the Brian Lehrer team if they would help us out.

Brian Lehrer: Call us at 212-433-WNYC.

Jad Abumrad: They helped us out.

Robert Krulwich: Big time.

Brian Lehrer: We'll explain more now with Radio Lab host Jad Abumrad. Hi Jad.

Jad Abumrad: Hey Brian. Thank you for having me on.

Brian Lehrer: 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?

Jad Abumrad: Yeah. We're not sure, to be totally honest. We bumped into a reporter a couple years ago who told us the story of a guy ... I sort of summarized Amy O'Leary's story about Dr. Amisin.

Jad Abumrad: He described a moment where the addiction just switched off.

Jad Abumrad: Then I sort of summarized what the experts had told us. That maybe something is happening, but we weren't sure.

Jad Abumrad: We're just not sure. We're curious to hear from people who've struggled with substance abuse. I'm wondering what sorts of treatments they've been offered. Have they seen pills like Naltrexone or Baclofen. Have they used them? Have they worked? What's been the experience.

Brian Lehrer: Listeners-

Jad Abumrad: Just like that-

Brian Lehrer: Help Jad report this story.

Speaker 20: Hi.

Speaker 21: Hi.

Speaker 22: Hi.

Speaker 20: My name is Paul.

Speaker 22: My name is Nicole.

Speaker 21: I'm calling from New Hampshire.

Speaker 22: I'm actually in Afghanistan.

Speaker 23: I've overdosed many times on heroin, cocaine.

Speaker 22: Celebrating a year of sobriety next month.

Jad Abumrad: There was an explosion of calls.

Brian Lehrer: Ginger in Mahopac you're on WNYC.

Ginger.: Hi how are you? I'm an alcoholic and an addict. I've been in recovery for 18 years.

Speaker 22: I was sitting up at an AA meeting, listening to this.

Jad Abumrad: We heard from a lot of people who felt like this idea of a pill that can treat addiction was idiotic.

Speaker 25: I just don't see psychotropics is really a solution.

Ginger.: There is no quick fix. There is no magical medication. If it was just a physical disease we would all be cured.

Jad Abumrad: But we also heard from a lot of people who had just been offered these drugs.

Speaker 26: I was prescribed Cambal.

Speaker 27: I have been offered Naltrexone, and-

Speaker 28: Naltrexone.

Speaker 29: And it's very effective. It does help cut the cravings.

Jad Abumrad: One guy who called-

Speaker 30: This is so incredibly crazy that I heard this show today, as I'm about to embark upon this thing.

Jad Abumrad: He just got prescribed addiction medicine that morning.

Speaker 30: One way or another I'm going to fix this.

Jad Abumrad: He was excited, as were a lot of the callers in this category, because-

Speaker 31: It's a huge social stigma.

Jad Abumrad: If these pills work for them, it kind of means that their just sick. They're not bad people.

Speaker 32: It's not something that people choose even though it seems that way.

Brian Lehrer: Damara in Manhattan you're on WNYC. Hello Damara.

Damara: Hi yeah.

Jad Abumrad: One caller called in to say that her dad had had a terrible time with alcohol. It was destroying the family.

Damara: We were thinking about putting him in rehab, or something, but afraid of the stigma of it. My mom is a doctor so she was working in the hospital. She told me that one day she took matters into her own hands and she gave him injection shots of something called Volteran. The way we say is like Voltareen.

Jad Abumrad: It's actually turns out to be a muscle relaxant, not too dissimilar from Baclofen.

Damara: It's worked. One day everything was okay and he was over it. I mean it wasn't something that was controlling our lives any more.

Andy Mills: Well let me ask you this because I-

Jad Abumrad: That's producer Andy Mills again. After the Brian Lehrer show we had so many calls that he set up a Google voicemail and he talked with an additional 40 or so people. He asked everyone-

Andy Mills: Do you feel that we're headed toward a sea change. Where we're going to start treating addictions in a new way?

Speaker 35: No.

Speaker 36: I completely do. You've got a drug problem, find a drug that fixes the drug problem.

Speaker 37: There's no pill that will make you want to put down the drink, and the drugs.

Robert Krulwich: Hello Billy?

Jad Abumrad: Hey will you just introduce yourself, tell me who you are.

Billy Webb: Yeah and you can use my full name if you want. My name is Billy Webb. I am from Shaker heights Ohio, and I currently live in Saint Paul, Minnesota.

Andy Mills: Hey this is Andy. In talking to all those people on the phone Billy's it was a story that I just kept thinking about over and over again. Eventually we ended up getting him into the studio.

Andy Mills: Do you remember what it was like that first time that you had alcohol?

Billy Webb: Yeah. It was the summer that I turned 16. I was a quieter kid, and I was kind of a nerd. You might say I was into computer games. The tide sort of swung and I got into music, and most specifically punk rock and ska.

Andy Mills: 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.

Billy Webb: We were horrible, but we were willing to put ourselves out there, and we started playing gigs. I had gotten my first girlfriend at that time. I was very excited, and nervous to see her so I figured why not loosen myself up a little bit.

Andy Mills: One day he breaks into his fathers liquor cabinet, takes a couple shots of Mount Gay Rum.

Billy Webb: It was euphoric to be honest with you. I finally felt like I was myself.

Andy Mills: Huh.

Billy Webb: It just felt like I was on top of the world, and that I could do anything. 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.

Andy Mills: By the time Billy was 24-

Billy Webb: I was becoming an entrepreneur.

Andy Mills: He was running his own business. It was a storage facility that he planned to convert into art spaces.

Billy Webb: Where we would have shows, and maybe even a little small record shop. I was in a relationship. We had a dog.

Andy Mills: He was in a new band that toured.

Billy Webb: 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 my cell.

Andy Mills: He said that it was also around this time that he started to wake up in morning with the shakes.

Billy Webb: I remember drinking beer in the morning in the bathroom.

Andy Mills: How much do you think you were drinking at this point?

Billy Webb: 20 drinks a day, 25 sometimes.

Andy Mills: Wow.

Billy Webb: Usually the night before I passed out or went to sleep I would say you know what 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.

Andy Mills: What eventually did end up happening is that Billy asked for help. Both his mom and his sister they flew Billy up to Minnesota where he checked in to one of the best rehab centers in the Midwest.

Billy Webb: When I got there it looks like a small college campus. It was very serene, peaceful setting. Very welcoming.

Andy Mills: He started going to group meetings, started working out, and was like all right.

Billy Webb: I was actually excited. I thought that things would turn around when I got back but-

Andy Mills: Within just a day of being back in Cleveland-

Billy Webb: It was right back to where I was 20 drinks a day, 25 sometimes. I ended up back in treatment. We figured I just didn't do it right the first time, so if we go back we'll get it right this time. Once again, I crashed and burned.

Andy Mills: This time not even in Cleveland.

Billy Webb: I had relapsed at the airport. I didn't even make it to Cleveland.

Andy Mills: He said this is just how things went for years.

Billy Webb: It was just this same old story of in and out, in and out.

Andy Mills: In the span of about four years time Billy tried seven different treatment centers and detox centers. Lots of AA meetings.

Billy Webb: I went to 110 meetings in 70 days. I went to 28 in one week one time.

Andy Mills: Nothing worked. He says that his AA sponsors would tell him-

Billy Webb: You can do this. You'll get it right.

Andy Mills: He'd leave those meetings-

Billy Webb: Feeling positive.

Andy Mills: End up at a liquor store.

Billy Webb: I just considered myself a failure at this point and time. That I was never going to get better. That led to more, and more drinking.

Andy Mills: He said that he lost his girlfriend, pretty much all of his friends, got fired from his job.

Billy Webb: 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 laid in bed and drank. It's hard to even think about without being completely horrified that that's what my life had turned into. Then I woke up one day with severe, severe pain in my abdomen, and I couldn't move or walk, or keep water down. It was really scary, and it was pancreatitis. 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."

Andy Mills: Billy was only 29 years-old.

Billy Webb: When I got out I moved into a sober house in Saint Paul. That's when I got hooked up with the Alltyr Clinic.

Andy Mills: At the Alltyr clinic, which I should say really quick, is run by Dr. Mark Willenbring who we talked to earlier. There they do something that they call evidence based treatment. 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.

Billy Webb: 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.

Jad Abumrad: He was able to drink moderately?

Andy Mills: Yeah, almost overnight.

Billy Webb: I was blown away. That's all I wanted was to be like everyone else who can-

Andy Mills: Right.

Billy Webb: ... have a couple drinks and set it down.

Robert Krulwich: Well what does that tell you. That tells you that you are cured or ...

Billy Webb: I just felt like there was no compulsion to keep going and going.

Jad Abumrad: What was different though? Did it not taste as good? Did it not-

Billy Webb: It tasted as good. I can say that for sure.

Jad Abumrad: Oh okay.

Billy Webb: Especially if it was a micro brew or something like that, but I didn't get that same rush in my head.

Andy Mills: Being able to drink without that rush, for a while that made all the difference.

Billy Webb: For a couple months I was okay. Now I can just have a couple, but what happened was I was taking it and then on one weekend I just decided you know what I'm not going to take it this weekend. It's a long weekend. I don't need it.

Andy Mills: 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 there was just some part of him that missed being drunk.

Billy Webb: I wanted to be intoxicated.

Andy Mills: Even with this medication that was helping you, you missed it?

Billy Webb: Yeah.

Andy Mills: Knowing all that it cost you, what about it did you miss?

Billy Webb: I missed feeling like myself. I didn't ...

Cory: Hey guys this is Cory the engineer. I hate to interrupt but we have to ... The studio is being booked in like the next ten minutes. I'm sorry guys.

Andy Mills: No, no I understand.

Andy Mills: So with poetically bad timing, we got kicked out of the studio. 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.

Andy Mills: Billy?

Billy Webb: Hey.

Andy Mills: I started by asking him when you said that you didn't feel like yourself what did that mean?

Billy Webb: I didn't picture life being possible without alcohol. That's the only person that I knew.

Andy Mills: 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. You know how we all have this sense of who we are inside of us. You have your inner Jad where people can think what they want about you, and you've got your reputation, but you know who you are down deep. Well his it was all wrapped up in alcohol. You take that alcohol away-

Billy Webb: What was left was an empty guy that I didn't know.

Andy Mills: Just this void. Filling up that void, he says, was this onslaught of these terrible memories.

Billy Webb: Sequestered detox wards, and punitive treatment, and all the people I've alienated over the years, all the lost opportunities, and all the failed attempts.

Andy Mills: He says that's what he would think about when he was sober, and he just wanted not to.

Andy Mills: Last time we talked to Billy he was doing really well.

Billy Webb: I have the job. I have the girl. I have the band back.

Andy Mills: But he says that in the course of just this month and a half, since the last time that we talked-

Billy Webb: 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.

Andy Mills: Even just listening to your voice right now, you sound so different.

Billy Webb: I know that I sound different, because I was coming in here with 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 would even talk to me right now. It's hard to do a triple back flip, you know. 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 I feel hopeful that I can beat this.

Andy Mills: Now Billy is still seeing a therapist. He's still going to Alltyr. He's actually on this new medication now called Gabapentin, which he says has been helpful.

Billy Webb: I know I was pretty staunchly against the 12 steps last time but I am actually going back to meetings these days.

Andy Mills: Just to be with people who are in the same boat.

Jad Abumrad: He's doing both?

Andy Mills: Yeah.

Jad Abumrad: Huh. I hear a story like that and I think, yeah I think we're ready to see addiction in a new way. We're definitely, I think, pills will be a big part of that.

Robert Krulwich: Mm-hmm (affirmative).

Jad Abumrad: Seems to me, but the pills can't get all the way down, you know.

Robert Krulwich: Right.

Jad Abumrad: The thing that makes the addiction go is really deep.

Andy Mills: Right, and this reminds me of when we were talking to Nora Volkow.

Nora Volkow: I'm director of the National Institute of Drug Abuse at the NIH.

Andy Mills: She sort of pointed at the same idea in a really interesting way.

Nora Volkow: 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. Romantic love is exactly that situation.

Andy Mills: Nora says that one thing that biologist know, and actually have known for a while is that-

Nora Volkow: Drugs hijack systems in our brain that are there for other purposes.

Andy Mills: 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.

Nora Volkow: It's almost like randomness of chemistry that you have these chemical compounds that can go directly and activate these centers.

Jad Abumrad: So it hijacks the very things that make us good friends, and good parents.

Nora Volkow: Correct.

Jad Abumrad: It's like a weakness born of a strength in a way.

Andy Mills: Yeah and actually according to Anna Rose Childress who we had talked to earlier people with addictions-

Anna Rose Childress: 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.

Jad Abumrad: The idea here is that deep down inside of them, we're talking at like a genetic level-

Anna Rose Childress: They have the greatest sensitivity. They would be exquisitely attuned to the promise of rewards. Most of the time, and for most of the millennia all the priorities were on being good reward appreciators. That was our only job.

Andy Mills: That's interesting.

Anna Rose Childress: But now we're in a different environment where we've got huge opportunities for many sexual encounters that carry-

Andy Mills: Yeah.

Anna Rose Childress: ... lethal viruses rather than just the possibility of survival of the fittest. We've got calorie dense meals that we can acquire without expending a calorie.

Andy Mills: Mm-hmm (affirmative).

Anna Rose Childress: See in almost every circumstance that you can think of, except for the last 50 years being on the side of being overly responsive to reward was probably mostly an advantage, you know?

Jad Abumrad: That's so interesting. I've never heard it said that way.

Anna Rose Childress: For our patients, in some sense, they're the fittest of the fit and being punished for it.

Jad Abumrad: Yeah that's like a terrible joke.

Andy Mills: The terrible reality of that joke is something that just kept showing up on our voicemail over and over again.

Pat Rousse: Hello, yes this is Pat Rousse. I was listening to the Bryan Lehrer show on the way home from work today, and I have a son who died of heroin addiction, and alcohol abuse last May. Since then, I've been trying to come to terms with it. This is my son. He was a great person. I think he just couldn't see how 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?

Jad Abumrad: This story was reported and produce by Mr. Andy Mills. Special thanks to Tim Howard.

Robert Krulwich: And to Avir Meetra.

Jad Abumrad: Lianne Donagon.

Robert Krulwich: Deborah Snider.

Jad Abumrad: John Kelly.

Robert Krulwich: George Kuub.

Andy Mills: 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.

Jad Abumrad: A very special thanks to Brian Lehrer and Megan Ryan, and that whole team.

Robert Krulwich: Of course, to Amy O'Leary who started the whole thing off.

Jad Abumrad: Exactly. I'm Jad Abumrad.

Robert Krulwich: I'm Robert Krulwich.

Jad Abumrad: Thank you guys for listening.

Speaker 42: To play the message press 2.

Billy Webb: Hi, this is Billy Webb. Radio Lab is produced by Jad Abumrad. Our staff includes Brenna Phil, David Gabel, Dylan Keith, Matt Kitely, Robert Krulwich, Andy Mills, Latif Nasar, Chelsey Pagent, Aryan Wax, Molly Webster, Soren Wheeler, and Jamie York. With help from Simon Adler, Alexandra Lee-Young, Abigail Keele, Stephanie Tam, and Michael Loanger. Our fact checkers are Eva Dasher and Michelle Harris.

Speaker 42: End of mailbox.

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