[RADIOLAB INTRO]

JAD ABUMRAD: Three, two, one. Hey, I'm Jad Abumrad.

ROBERT KRULWICH: I'm Robert Krulwich.

JAD: This is Radiolab.

ROBERT: And for today ...

JAD: Doo, doo, doo.

AMY O'LEARY: Yeah.

ROBERT: ... we're gonna 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 kind of what we're—like, our goal of this session.

JAD: Sure, we can frame it.

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

AMY O'LEARY: Right.

JAD: [laughs] That's kind of it. It's really what we do.

JAD: It's a conversation that we had with a reporter, actually, someone we used to work with.

ROBERT: Yeah.

JAD: An ex-intern.

ROBERT: Yeah.

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

ROBERT: Amy O'Leary is her name.

JAD: 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. So I was in a relationship with an alcoholic, and was very open about that. Talked about it with all my friends and ...

JAD: Were you open with him about it too?

AMY O'LEARY: Yeah. I mean I would—he was in some denial, and—but yeah, I was—I mean, I regularly would tell him, "Hey, like, you have a problem with this." And, you know, he would be clear back and say, "You know, if you're gonna make me choose between me and vodka I'm gonna choose vodka." So ...

JAD: He would say that really?

AMY O'LEARY: He did say that once, yeah.

JAD: Wow!

AMY O'LEARY: And I was, you know, young, but every night after 11:00 my life became shitty.

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

AMY O'LEARY: And I didn't know what to do, and—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.

ROBERT: But 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: 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 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 percent of the book.

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

AMY O'LEARY: He'd been in 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.

JAD: 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. And then at one point he says that he had read this tiny nugget.

JAD: In the New York Times.

AMY O'LEARY: And this is like the early '90s, I think.

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

AMY O'LEARY: And his cravings for cocaine completely ceased.

JAD: It was just one guy. One guy's experience.

AMY O'LEARY: But he saw that and he basically just felt like, "Well I might as well try this. I'm just gonna experiment on myself."

JAD: So he gets the drug, starts taking it.

AMY O'LEARY: And he slowly, like, doses up more and more amounts of the drug.

JAD: Nothing happens, nothing happens.

AMY O'LEARY: And then at one point, he says, the switch flipped. And once the switch hit, he just became absolutely indifferent to alcohol.

JAD: Like, boom?

AMY O'LEARY: Yep.

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

AMY O'LEARY: Total indifference.

JAD: What is the drug called, by the way?

AMY O'LEARY: Baclofen. B-A-C-L-O-F-E-N.

JAD: Baclofen.

AMY O'LEARY: Mm-hmm.

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

AMY O'LEARY: 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.

JAD: And they set up a time to talk.

AMY O'LEARY: You know, 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. Ameisen, how are you? It's so good to speak with you." And 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 mountainside. Can I call you back?"

JAD: [laughs]

ROBERT: [laughs] Did you hear wind in the background? And the sound of the birds above him?

AMY O'LEARY: I heard no sound effects, no.

ROBERT: No.

AMY O'LEARY: 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 the phone call.

[ARCHIVE CLIP, Olivier Ameisen: Hello?]

[ARCHIVE CLIP, Amy O'Leary: Hello is this Dr. Ameisen?]

[ARCHIVE CLIP, Olivier Ameisen: Yes. It's Amy?]

[ARCHIVE CLIP, Amy O'Leary: Yes.]

[ARCHIVE CLIP, Olivier Ameisen: Amy, finally!]

AMY O'LEARY: I'm like, "Hi, it's nice to talk to you." And then, like ...

[ARCHIVE CLIP, Olivier Ameisen: It's like miracles happen, you know? The last time we spoke, I was rescuing my girlfriend. My God, it was like a nightmare. We were in Switzerland in the—at 10,000 feet.]

JAD: So he launches into the mountain story, and then ...

[ARCHIVE CLIP, Olivier Ameisen: Strong, and the ...]

JAD: ... just kind of goes off.

[ARCHIVE CLIP, Olivier Ameisen: When Moses opened the Red Sea, people say it was a miracle, although there is some science. Like Nietzsche said, "Become who you are." And I am who I wanted to be. Einstein might have been wrong, and they were wrong, but Einstein was right. And I mean, Rubinstein told me he's never heard a pianist like me. He's heard Rachmaninoff or Horowitz too. If comes the Nobel, you never know. People tell me I may have made the discovery of the century. I mean, there's no ...]

AMY O'LEARY: He, like, literally went on for 20 minutes before I got in ...

[ARCHIVE CLIP, Amy O'Leary: Well, I wanted to ask you ...]

AMY O'LEARY: ... with a little question.

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

[ARCHIVE CLIP, Olivier Ameisen: Oh, really? Yeah, it's really like a thriller. I mean, it's humorous and it's fun. I mean ...]

JAD: And then he was off again.

[ARCHIVE CLIP, Olivier Ameisen: Sometimes I read it and I can't believe I—sometimes I want to say—you know, I say that, and that personally a lot has happened, but I mean if you look at just the back ...]

AMY O'LEARY: And then, like, literally it was 20 minutes of how important our shared mission was to, like, save the world.

[ARCHIVE CLIP, Olivier Ameisen: What I want to break is the shame.]

AMY O'LEARY: Red flags going off left and right, and I sort of started to downshift 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 pshh okay. Maybe someday Radiolab will be interested in this story. [laughs]

JAD: [laughs]

JAD: Because we'll eat anything! No, in all fairness, Dr. Ameisen, 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: No, not at all.

JAD: And 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, 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.

JAD: Yeah.

AMY O'LEARY: You know?

JAD: 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—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: Oh, that would be nice.

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

ROBERT: Yeah.

JAD: So recently, we started making some calls.

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

JAD: 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. Ameisen.

ANNA ROSE CHILDRESS: I don't know if you mentioned throbbing, pulsing desire states, but somehow that comes to mind.

JAD: That's her specialty.

ANDY MILLS: Throbbing, pulsing desire states.

ANNA ROSE CHILDRESS: [laughs]

ANDY: Yeah, that sounds great.

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

ANNA ROSE CHILDRESS: So what patients described to me is that they would sometimes describe a sort of a wave of sensation.

[ARCHIVE CLIP, patient: 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.

[ARCHIVE CLIP, patient: From my toes to my head, to my toes to my head.]

ANNA ROSE CHILDRESS: Sort of a zoom, a zoom, a zoom.

[ARCHIVE CLIP, patient: Vroom, vroom, rushing, pulsing.]

JAD: 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. So I saw this and I thought, "Wow!"

JAD: So 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: 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: And said, "You know, there's this—this guy over at the hospital next door and, you know, Anna you've got to talk to him!"

[ARCHIVE CLIP, Anna Rose Childress: Acute episode when the desire was strong.]

JAD: His name was Ed Coleman. He was a paraplegic.

ANNA ROSE CHILDRESS: He had had a drug deal gone wrong, been shot in the neck.

JAD: Paralyzed from the waist down. So he was in a wheelchair, taking Baclofen.

[ARCHIVE CLIP, Ed Coleman: I was having bad spasms.]

JAD: Because he was having these spasms in his legs.

ANNA ROSE CHILDRESS: He recounted this to me, and I actually have the tape of it.

[ARCHIVE CLIP, Anna Rose Childress: So you were doing the low dose at first, and that was 10 milligrams four times a day?]

[ARCHIVE CLIP, Ed Coleman: Yeah, and ...]

[ARCHIVE CLIP, Anna Rose Childress: And then you upped the dose. Tell me why you upped the dose.]

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

[ARCHIVE CLIP, Anna Rose Childress: Right.]

[ARCHIVE CLIP, Ed Coleman: But I still lit up, and my legs were still just tightening up and shaking. So I said, "Well maybe if I take two of these it will calm them down."]

[ARCHIVE CLIP, Anna Rose Childress: And what did you notice?]

[ARCHIVE CLIP, Ed Coleman: Well ...]

ANNA ROSE CHILDRESS: What Edward found was that when he doubled his Baclofen dose ...

[ARCHIVE CLIP, 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.

[ARCHIVE CLIP, Ed Coleman: And when I was taking it, I didn't have any cravings, you know?]

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

[ARCHIVE CLIP, Ed Coleman: I was having bad spasms.]

JAD: ... the leg spasms came back.

[ARCHIVE CLIP, 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. 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.

JAD: Wow! So he was like a one-man study.

ANNA ROSE CHILDRESS: Yeah.

JAD: Now this was actually the specific story that inspired Dr. Ameisen 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.

AMY O'LEARY: You know, I talked to a guy who runs a halfway 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: This is all off label use?

AMY O'LEARY: Yeah. Yeah, absolutely.

JAD: She told us that after Ameisen'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: But 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. There's Topiramate or Topamax. A Disulfiram, Chantix, Suboxone, Naltrexone, Epinephrine.

JAD: This is Dr. Mark Willenbring.

MARK WILLENBRING: I'm an addiction psychiatrist here in Saint Paul, Minnesota.

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

MARK WILLENBRING: The simple way to put it is this: it's a buzz kill.

JAD: It's a buzz kill. Interesting.

MARK WILLENBRING: Yeah.

JAD: So you drink, but you don't get the ...

MARK WILLENBRING: You don't get the happy warm feeling.

JAD: 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: ... she tried one of these drugs during the course of reporting.

GABRIELLE GLASER: And 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: Why? What is the drug supposedly doing?

MARK WILLENBRING: Well, it blocks opioid receptors in the brain which is our pleasure system.

JAD: According to Dr. Willenbring, basically if you think of, like—if you think of a good buzz as like a chemical handshake.

ROBERT: Mm-hmm.

JAD: 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.

ROBERT: Right.

JAD: 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.

ROBERT: Or muffle them, sort of.

JAD: Right.

ROBERT: Yeah.

JAD: And if you're not getting as much enjoyment out of the drinks, then the idea is you're not gonna drink as much.

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

JAD: Mark pointed us to some studies that had been done in Finland, the Netherlands, the UK, Iran, a bunch that have been done in the US, 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 percent success rate in helping very heavy drinkers reduce their drinking to normal levels.

MARK WILLENBRING: Right, right.

JAD: So are these drugs being used?

MARK WILLENBRING: No. Oh, no. Basically, the pick up has been near zero.

JAD: 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: That's Gabrielle Glaser again.

GABRIELLE GLASER: Here, about one percent of people who suffer from alcohol use disorder are ever given the choice or an option to take any sort of medication.

JAD: She says maybe one, two percent at best.

GABRIELLE GLASER: Yes.

JAD: 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: For the purpose of treating alcoholics?

GABRIELLE GLASER: Yes.

ROBERT: Huh. Wow.

JAD: Wow!

GABRIELLE GLASER: And we never heard about it.

JAD: That's so weird!

ROBERT: Why wouldn't we have heard of it?

GABRIELLE GLASER: Well, that's a very complicated question.

JAD: She said it's sort of hard to pin down, but that there had 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: 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: 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 ...

GABRIELLE GLASER: We had in hospitals at the time, in the late 1930s and early 1940s, we had ...

[ARCHIVE CLIP: The white plague, tuberculosis.]

GABRIELLE GLASER: ... TB wards. But then suddenly ...

JAD: 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. And suddenly these TB units were empty.

JAD: And 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: They were basically seen as hopeless cases. Of course, the founders of AA knew this, so 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: Really?

GABRIELLE GLASER: Yes. Doctors thought, "Okay, we don't have an answer for these guys, so we'll just let them do it." And thus began 80 years ...*

JAD: Of separation.

GABRIELLE GLASER: And that's where we are now.

JAD: Out of this physical separation, according to Gabrielle Glaser, you got a cultural separation—two very different ways of seeing addiction.

ROBERT: Cultural—all right. What does that mean?

JAD: 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.

ROBERT: And we'll just fix it.

JAD: We'll just fix it.

ROBERT: Yeah.

JAD: On the other hand, you have the idea that no, that 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: This is a reflection of your inner broken self.

JAD: 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: Actually, when we checked it's six out of the 12. Half.

GABRIELLE GLASER: And 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: What is the recovery rate from the AA crowd?

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 1, only five of those people will be sitting there on December 31.

ROBERT: Of the same year?

GABRIELLE GLASER: In that same year.

JAD: Really, so the ...

GABRIELLE GLASER: Yeah.

JAD: ... so the—what do you call that? The drop out rate is—is 95 percent?

GABRIELLE GLASER: Yeah. I was really surprised to find that out.

JAD: Now to be fair ...

ROBERT: Hmm. I think we should be fair.

JAD: ... 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.

ROBERT: Mm-hmm.

JAD: 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.

ROBERT: Or perhaps they've switched groups.

JAD: Exactly.

ROBERT: They've moved—moved on to another ...

JAD: So 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 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: But ...

MARK WILLENBRING: So there was this article in The Atlantic in April.

JAD: ... when 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 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.

JAD: 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 antidepressants.

JAD: But he said the debate completely shifted ...

[ARCHIVE CLIP: Here we go. Here comes the Prozac.]

JAD: ... when we got Prozac.

[ARCHIVE CLIP: Doctors have prescribed Prozac to two million Americans.]

JAD: 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: And now most people, you know, get treatment for anxiety or depression with antidepressants, compared to psychotherapy.

JAD: 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.

[LISTENER: This is Jean Pelletier in Boston, Massachusetts. Radiolab 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.]

JAD: All right, welcome back. I'm Jad.

ROBERT: Robert.

JAD: And if you know this music you already know ...

[ARCHIVE CLIP, Brian Lehrer: It's The Brian Lehrer Show on WNYC. Good morning everyone.]

ROBERT: This is The Brian Lehrer Show at our own home station WNYC in New York. Very, very popular show.

JAD: 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 change, and we wanted to know is that actually happening out there in the world?

ROBERT: And the world, at least our local world, is full of Brian Lehrer listeners.

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

JAD: So we asked the Brian Lehrer team if they would help us out.

[ARCHIVE CLIP, Brian Lehrer: Call us at 212-433-WNYC.]

JAD: And they helped us out.

ROBERT: Big time.

[ARCHIVE CLIP, Brian Lehrer: And we'll explain more now with Radiolab host, Jad Abumrad. Hi Jad.]

[ARCHIVE CLIP, Jad: Hey, Brian. Thank you for having me on.]

[ARCHIVE CLIP, Brian Lehrer: 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?]

[ARCHIVE CLIP, Jad: Yeah. So I mean, we—we're not sure, to be totally honest. You know, we—we bumped into a reporter a couple years ago who told us the story of a guy ...]

JAD: So I sort of summarized Amy O'Leary's story about Dr. Ameisen.

[ARCHIVE CLIP, Jad: He described a moment where the addiction just switched off.]

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

[ARCHIVE CLIP, Jad: And 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. Have they seen pills like Naltrexone or Baclofen? Have they used them? Have they worked? What's been the experience?]

[ARCHIVE CLIP, Brian Lehrer: So listeners ...]

JAD: And just like that ...

[ARCHIVE CLIP, Brian Lehrer: ... help Jad report this story.]

[ARCHIVE CLIP, listener: Hi.]

[ARCHIVE CLIP, listener: Hi.]

[ARCHIVE CLIP, listener: Hi.]

[ARCHIVE CLIP, listener: My name is Paul.]

[ARCHIVE CLIP, listener: My name is Nicole.]

[ARCHIVE CLIP, listener: I'm calling from New Hampshire.]

[ARCHIVE CLIP, listener: I'm actually in Afghanistan.]

[ARCHIVE CLIP, listener: I've overdosed many times on heroin, cocaine.]

[ARCHIVE CLIP, listener: Celebrating a year of sobriety next month.]

JAD: ... there was an explosion of calls.

[ARCHIVE CLIP, Brian Lehrer: Ginger in Mahopac, you're on WNYC.]

[ARCHIVE CLIP, listener: Hi, how are you? I'm an alcoholic and an addict, and I've been in recovery for 18 years.]

[ARCHIVE CLIP, listener: I was setting up at an AA meeting listening to this.]

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

[ARCHIVE CLIP, listener: I just don't see psychotropics as really a solution.]

[ARCHIVE CLIP, listener: There is no quick fix. There is no magical medication. If it was just a physical disease, they would all be cured.]

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

[ARCHIVE CLIP, listener: I was prescribed Campral.]

[ARCHIVE CLIP, listener: I had been offered Naltrexone, and ...]

[ARCHIVE CLIP, listener: Naltrexone ...]

[ARCHIVE CLIP, listener: And it's very effective. It does help cut the cravings.]

JAD: One guy who called ...

[ARCHIVE CLIP, listener: This is so incredibly crazy that I heard this show today as I'm about to embark upon this thing.]

JAD: ... he'd just got prescribed addiction medicine that morning.

[ARCHIVE CLIP, listener: One way or another, I'm gonna fix this.]

JAD: He was excited, as were a lot of the callers in this category, because ...

[ARCHIVE CLIP, listener: It's a huge social stigma.]

JAD: ... if these pills work for them, it kind of means that they're just sick, they're not bad people.]

[ARCHIVE CLIP, listener: It's not something that people choose, even though it seems that way.]

[ARCHIVE CLIP, Brian Lehrer: Tamara in Manhattan, you're on WNYC. Hello Tamara.]

[ARCHIVE CLIP, listener: Hi, yeah.]

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

[ARCHIVE CLIP, listener: 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 a hospital. She told me that one day she took matters into her own hands, and she gave him injection shots of something called Voltaren, or the way we say is, like, Voltareen.]

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

[ARCHIVE CLIP, listener: And it worked. One day everything, like, was okay and he was over it. I mean, it wasn't something that was controlling our lives any more.]

[ARCHIVE CLIP, Andy Mills: Well, let me ask you this because I ...]

JAD: 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. And he asked everyone ...

[ARCHIVE CLIP, Andy Mills: Do you feel that we're headed toward a sea change where we're gonna start treating addictions in a new way?]

[ARCHIVE CLIP, caller: No.]

[ARCHIVE CLIP, caller: I completely do. You know, you got a drug problem, find a drug that fixes the drug problem.]

[ARCHIVE CLIP, caller: There's no pill that will make you want to put down the drink and the drugs.]

ANDY: Hello, Billy?

BILLY WEBB: Hey.

ANDY: Will you just introduce yourself, tell me who you are?

BILLY WEBB: Yeah, and you can use my—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 Saint Paul, Minnesota.

ANDY: Hey, this is Andy. So 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. And so eventually, we ended up getting him into the studio.

ANDY: Do you remember what it was like the first time that you had alcohol?

BILLY WEBB: 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 specifically punk rock and ska.

ANDY: 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. 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—why not loosen myself up a little bit?

ANDY: So 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, and I finally felt like I was myself.

ANDY: Huh.

BILLY WEBB: 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.

ANDY: By the time Billy was 24 ...

BILLY WEBB: I was becoming an entrepreneur.

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

BILLY WEBB: And I remember drinking beer in the morning in the bathroom.

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

BILLY WEBB: 20 drinks a day, 25 sometimes.

ANDY: Wow!

BILLY WEBB: And usually the night before, before I passed out or went to sleep, I would say, "You know, I'm gonna turn it around in the morning. I'm gonna—I'm gonna get out of bed and work out, eat a full meal." And that never ended up happening.

ANDY: 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 into one of the best rehab centers in the Midwest.

BILLY WEBB: And when I got there, it looks like a small college campus. I mean, it was very serene, sort of peaceful setting. Very welcoming.

ANDY: 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: 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. 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.

ANDY: This time not even in Cleveland.

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

ANDY: And 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: 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: Nothing worked. He says that his AA sponsors would tell him ...

BILLY WEBB: You know, you can do this. You'll get it right.

ANDY: So he'd leave those meetings ...

BILLY WEBB: Feeling positive.

ANDY: ... end up at a liquor store.

BILLY WEBB: I just considered myself a failure at this point in time, that I was never gonna get better. And that led to more and more drinking.

ANDY: He said that he lost his girlfriend, pretty much all 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.

ANDY: Hmm.

BILLY WEBB: 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."

ANDY: Billy was only 29 years old.

BILLY WEBB: When I got out, I moved into a sober house in Saint Paul, and that's when I got hooked up with the Alltyr Clinic.

ANDY: Now 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. 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.

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: He was able to drink moderately?

ANDY: Yeah, almost overnight.

BILLY WEBB: I was blown away. That's all I wanted was to be like everyone else who can ...

ANDY: Right.

BILLY WEBB: ... have a couple drinks and set it down.

ROBERT: Well, what does that tell you? That tells you that you are cured? Or ...

BILLY WEBB: I just felt like there was—there was no compulsion to keep going and going.

ANDY: Like, what was different though? Like, did it not taste as good? Did it not ...

BILLY WEBB: It tasted as good. I can say that for sure.

ANDY: Okay.

BILLY WEBB: Especially if it was a microbrew or something like that, but I didn't get that same rush in my head.

ANDY: And being able to drink without that rush, for a while that made all the difference.

BILLY WEBB: For a couple months, I was okay. You know, 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? You know what? I'm not gonna take it this weekend. It's a long weekend. I don't need it.

ANDY: 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.

BILLY WEBB: I wanted to be intoxicated.

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

BILLY WEBB: Yeah.

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

BILLY WEBB: I missed feeling like myself. I didn't ...

ENGINEER: Hey guys, this is Cory 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!

ANDY: No, no. I understand.

ANDY: So with poetically bad timing, we got kicked out of the studio—and 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: Billy?

BILLY WEBB: Hey.

ANDY: So I started by asking him, so 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: 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 have your inner Jad where, like, people can think what they want about you, and you've got your reputation, but you—you know who you are down deep. Well, his? It was all wrapped up in alcohol. So you take that alcohol away ...

BILLY WEBB: What was left was an empty guy that I didn't know.

ANDY: Just this void. And 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: 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.

BILLY WEBB: I had the job. I had the girl. I had the band back.

ANDY: 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: 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. So 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, you know, I feel hopeful that I can beat this.

ANDY: Now Billy's 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: And I know I was pretty staunchly against the 12 steps last time, but I am actually going back to meetings these days.

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

JAD: So he's doing both?

ANDY: Yeah.

JAD: 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.

ANDY: Mm-hmm.

JAD: Seems to me. But the pills can't get all the way down, you know?

ANDY: Right.

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

ANDY: 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: 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? And romantic love is exactly that situation.

ANDY: Nora says that one thing that biologists 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: 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: So it hijacks the very things that make us, you know, good friends and good parents.

NORA VOLKOW: Correct.

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

ANDY: 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.

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

ANNA ROSE CHILDRESS: 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—that was our only job.

ANDY: 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: Yeah.

ANNA ROSE CHILDRESS: ... lethal viruses, rather than just the possibility of survival of the fittest. And we've got, you know, calorie-dense meals that we can acquire without expending a calorie.

ANDY: Mm-hmm.

ANNA ROSE CHILDRESS: 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?

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

ANNA ROSE CHILDRESS: And for our patients, in some sense, they're the fittest of the fit and being punished for it.

JAD: Yeah, it's like a terrible joke.

ANDY: And the terrible reality of that joke is something that just kept showing up on our voicemail over and over again.

[ARCHIVE CLIP, caller: Hello. Yes, this is Pat Rousse. I was listening to The Brian Lehrer Show on the way home from work today, and I had a son who died of heroin addiction and alcohol abuse last May. And 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: This story was reported and produced by Mr. Andy Mills. Special thanks to Tim Howard.

ROBERT: And to Avir Mitra.

JAD: Lianne Donagan.

ROBERT: Deborah Snider.

JAD: John Kelly.

ROBERT: George Kuub.

ANDY: 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.

JAD: And a very special thanks to Brian Lehrer and Megan Ryan and that whole team.

ROBERT: And of course to Amy O'Leary, who started the whole thing off.

JAD: Exactly. I'm Jad Abumrad.

ROBERT: I'm Robert Krulwich.

JAD: Thank you guys for listening.

[ANSWERING MACHINE: To play the message press 2.]

[BILLY WEBB: Hi, this is Billy Webb. Radiolab is produced by Jad Abumrad. Our staff includes Brenna Farrell, David Gebel, Dylan Keefe, Matt Kielty, Robert Krulwich, Andy Mills, Latif Nasser, Kelsey Padgett, Arianne Wack, Molly Webster, Soren Wheeler and Jamie York. With help from Simon Adler, Alexandra Leigh Young, Abigail Keele, Stephanie Tam and Micah Loewinger. Our fact checkers are Eva Dasher and Michelle Harris.]

[ANSWERING MACHINE: End of mailbox.]

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