Speaker 1: There’s, like, a part of my mind that compulsively drinks alcohol in near-fatal doses, and it doesn’t leave me alone, for the most part.

Next Speaker: 25-year-old Marissa has been a binge drinker for more than 5 years.

Next Speaker: What were the consequences?

Next Speaker: Mostly a loss of relationships. I usually end up, um, pretty lonely with, like, no friends and somewhere in between, like, relapse and recovery.

Next Speaker: We first met her on a spring morning in Connecticut, as she set off to start a bold treatment for her alcohol addiction.

Doctor: Are you Marissa?

Next Speaker: Yes.

Next Speaker: Hi, nice to meet you.

Next Speaker: She met her new doctor, filled a prescription, took a pill, and an hour later, on her first day of treatment, she had a drink, doctor approved.

Next Speaker: I feel like I could have another drink or not have another drink and be totally fine.

Next Speaker: If Marissa’s protocol sounds like a radical departure, that’s because it is, and it’s growing out of an awareness that much of what we do for alcoholics doesn’t work.

Next Speaker: How would you characterize the way that we’re treating alcohol use disorder in this country?

Next Speaker: It’s an abomination, and abomination, and abomination.

Next Speaker: Dr. Mark Willenbring used to run alcohol recovery research at the National Institutes of Health, the government’s top medical research agency. He spent 30 years tackling alcohol abuse which claimed some 90,000 American lives each year and is an even bigger killer than opioids.

Next Speaker: It’s a huge problem. It costs the economy about 250 billion dollars a year.

Next Speaker: Billion?

Next Speaker: Yeah.

Next Speaker: Very few of the millions of alcoholics in the United States get treatment, and Dr. Willenbring says the vast majority of rehabs don’t work anyway. Relapse rates are often estimated to run higher than 70 percent.

Next Speaker: People don’t have access to professional, dignified, scientifically-based treatment.

Next Speaker: The problem, he says, is that most rehab is based on Alcoholics Anonymous, or AA. In AA, and similar spiritual gatherings –

Next Speaker: We are people are in recovery.

Next Speaker: Those struggling with addiction share their stories and commit to abstinence through 12 steps, including embracing help from a higher power.

Next Speaker: Do you believe that’s, all that’s nonsense? So, people ask me, does AA work? I say, well, it works for the people it works for. So, it’s sort of like asking does Catholicism work? I guess it works for Catholics.

Next Speaker: He says AA helps a lot of people, but it was developed long ago when alcoholism was seen as a moral weakness, not a medical condition, and today, whether at publicly-funded facilities or centers with great views of the Pacific, he says rehabs don’t provide enough science-based medicine.

Next Speaker: And, we don’t send someone with diabetes to a spa for a month, teach them diet and exercise, and then send them to support groups, but don’t take insulin. I mean, that’s the absurdity of what we’re doing now. We’re still providing the same pseudo-treatment that we provided in 1950, and 85 percent of rehabs in the country are 12-step rehabs. People don’t’ have any choice.

Next Speaker: Marissa says besides detox and AA, she tried unconventional treatments, like body cleansing therapy and aromatherapy. Still, she continued to drink herself into oblivion.

Next Speaker: I don’t really remember how it happened, or, but, yeah, I woke up, blood all over the pillow, no sheets on the mattress, broken glass and blood on the balcony. I was throwing up into a bucket of my hair, full of my hair, ’cause I had shaved my head the night before.

Next Speaker: You were that drunk?

Next Speaker: Yeah. Those days were bad, but they weren’t the worst of it. I felt so shameful, like, work thinks I’m at home, and my boyfriend thinks I’m at work, and I’m standing outside the liquor store waiting for them to open, and I feel inside, like, I’m waiting go, like, murder them puppies.

Next Speaker: Did it ever cost you a job?

Next Speaker: Oh, yeah. Every job I’ve ever had I’ve lost, because of drinking.

Next Speaker: in a perfect world, how would we be treating alcohol use disorder in this country?

Next Speaker: The way I do, like a health care condition.

Next Speaker: Willenbring, a psychiatrist and addiction specialist, set up his own clinic in St. Paul, Minnesota. He says alcoholism is a complex, chronic disease, and though he encourages it, he doesn’t require abstinence.

Next Speaker: How have you been since the last time I saw you?

Next Speaker: He targets his patient’s accompanying conditions, like anxiety and depression and uses behavioral therapies, and he provides something most alcohol treatment programs don’t, anti-addiction medication.

Next Speaker: If you ask the average physician to name the three drugs that are approved by the FDA for the treatment of alcohol use disorders, I don’t think many could.

Next Speaker: Dr. George Koob is the top official at the NIH’s Institute on Alcoholism and Alcohol Abuse. He agrees that there’s not enough of the latest research in today’s rehab. He says the approved anti -addiction drugs are effective, but most doctors are not trained to use them.

Next Speaker:  How could it be that a, a disease so pervasive as alcoholism is, is not being treated by physicians?

Dr. Koob: Good question. It’s always kinda been the elephant in the room that nobody wants to talk about, and nobody wants to address.

Next Speaker: Do we have the tools already at our disposal to fight alcoholism in this country?

Next Speaker: We have tools at our disposal to do a lot better. We need to get those treatments out to the public. We need the public to understand that those treatments are not just rehab and AA.

Next Speaker: People die from alcohol withdrawal.

Next Speaker: Dr. Matt Divens and Dr. Victor Pinkus are two New England physicians who have been forced to take on alcoholism. They are emergency room doctors.

Next Speaker: We see people come in who are shaky and, uh, nauseated, and we get ’em into a detox program. We’re like, you know, have you ever been to rehab before? Yes. Do you wanna go to rehab? No. And then, we see ’em again, and, like, what happened? I went to detox. I came out. I started drinking again, and it feels very frustrating.

Next Speaker: Determined to find a solution, the doctors came across an unorthodox treatment called the Sinclair Method. It’s unorthodox, because patients continue drinking, as long as they take Naltrexone, one of those approved anti-addiction drugs 1 hour before the first sip. The drug blocks pleasure receptors in the brain, a buzz kill, and when combined with psychotherapy sessions, the theory goes, eventually, the cravings go away.

Next Speaker: You’re essentially telling folks that you can drink yourself sober?

Next Speaker: Yes.

Next Speaker: It sounds like somebody’s gonna get us in trouble.

Next Speaker: Yeah.

Next Speaker: I’m uncomfortable with that. Uh, the whole goal of the program is to slowly extinguish the amount that they drink over a period of 4 to 6 months. We’re not insisting on abstinence. We tell them all, zero is safest, but if the choice is between drinking 20 drinks a night or one drink a night, take one, right?

Next Speaker: What about your pledge to do no harm?

Next Speaker: That’s an excellent question –

Next Speaker: Yeah.

Next Speaker: – but I’m perfectly comfortable with that.

Next Speaker: We’re pretty pragmatic doctors. People who drank yesterday and the day before are gonna drink tomorrow.

Next Speaker: That’s something Dr. Pinkus knows all too well. His own wife, Lisa, had been struggling with alcohol. After rehab failed, her husband prescribed her the Sinclair Method treatment.

Next Speaker: There were days I wouldn’t drink at all.

Next Speaker: Know why?

Next Speaker: Right.

Next Speaker: Lisa stopped drinking completely, and her success became the inspiration for the clinic.

Next Speaker: Um, but when I would get drunk, I would get very drunk.

Next Speaker: Where Marissa is now a patient.

Next Speaker: How are you?

Next Speaker: Good, how are you?

Next Speaker: We talked to her after just a few weeks of treatment.

Next Speaker: Has the pill rewired your brain, do you think, at all? Has it changed the desire?

Next Speaker: When I take it, because I have to decide to take it, and that means I have to decide that I don’t want the feeling that alcohol gives me.

Next Speaker: While the new Boston clinic is using a medical approach, experts caution. The Sinclair Method has not been extensively tested.

Next Speaker: So, we talked to a number of, of scientists, and they are quite skeptical. It’s early. The bottom line is the current system is failing, so I don’t see anything wrong with taking something that has helped a lot of people and offering it here.

Next Speaker: But, even as medical science tries to improve treatment, some of the most respected rehab facilities are standing by 12 steps. Chris Yajern is executive director of the non-profit Hazelton Betty Ford Foundation in New York.

Next Speaker: The 12 steps are crucial, because it’s a spiritual program of recovery and a sense of the human spirit, our need for connection, our need for meaning, our need to reclaim value, and that’s what recovery’s really about.

Next Speaker: The 12-step program was, was created in the 30s, 40s.

Next Speaker: And, we’re using the same approach 80 year later?

Next Speaker: If we were using that approach exclusively I might have the same misgivings.

Next Speaker: He says Hazelton Betty Ford’s Clinics have joined the conversation. They have added a broad range of science-based medications and therapies, though he says they have a good track record of success with 12 steps.

Next Speaker: What we’re saying is, this is an extremely time-tested, proven way that people have found hope and healing, and we’re gonna build on that with the best of science.

Next Speaker: Marissa has stuck with her New England doctors and her pills.

Next Speaker: Does it?

Next Speaker: And, guess what? After 3 months, she noticed a big change.

Next Speaker: Do you still have cravings?

Next Speaker: No, and it’s so crazy. I kinda feel like I don’t even remember what they feel like anymore.

Next Speaker: That’s pretty wild.

Next Speaker: Yeah. To me, the fact that I feel safe in a room with alcohol in it is astonishing.

Next Speaker: But, it’s not all down to her pill, she says, because she has also been getting support from the 12 steps of AA, and on her path to recovery she has learned a thing or two.

Next Speaker: What would you like other people to know, other people who are battling alcohol addiction?

Next Speaker: If you have this, this disease then there’s help for you, and now I know that there’s a lot of different types of help. There’s not one type of treatment that works for everyone.