Why a promising treatment for alcohol abuse is barely used (PBS News Hour Dec. 18, 2024)

It's estimated that nearly 29 million Americans suffer from alcohol use disorder, but less than 2 percent receive medication to treat it. Naltrexone is one of three drugs approved to help people manage their alcohol use. It blocks the receptors in the body where alcohol attaches, so the pleasurable, rewarding sensations are reduced.
posted by Brian B. at 11:16 AM on December 21

Hold up. Having a glass of wine or two every day makes you an alcoholic?
posted by Keith Talent at 11:42 AM on December 21

If you feel like you *have* to have it, even if you don't otherwise want it, which is what he described IIRC, then yeah.
posted by tavella at 11:48 AM on December 21 [20 favorites]

(The Alcohol Use Disorders Identification Test (AUDIT) is a self-test that was created by the WHO, and seems to be pretty widely respected.)
posted by box at 12:04 PM on December 21 [4 favorites]

Interestingly, Wegovy is being prescribed for alcohol use disorders, now, too. It appears to be effective.
posted by constraint at 12:09 PM on December 21 [1 favorite]

(The Alcohol Use Disorders Identification Test (AUDIT) is a self-test that was created by the WHO, and seems to be pretty widely respected.)

So something positive came out of Keith Moon's death.
posted by Kibbutz at 12:10 PM on December 21 [9 favorites]

Hold up. Having a glass of wine or two every day makes you an alcoholic?

I had a similar reaction to that early quote, but Kenji later describes signs that go beyond just daily drinking—things like blackouts, low-energy days caused by drinking, and hiding his behavior.

Being vulnerable in this way takes a lot of courage, and I admire his willingness to share. I hope this is a step toward a more positive future for him.
posted by minedev at 12:15 PM on December 21 [16 favorites]

Al-Anon stole my mom for decades and encouraged her to make all of her relationships, but especially her close familial relationships, about my grandfather's alcohol abuse. There was a long stretch when she wouldn't stop talking to me about God and pressured me to join, and it seemed like every conversation we had was about her meetings. This was someone who never drank more than one small glass of Manischewitz Concorde Grape at occasional holidays. Recent research shows that AA is in fact slightly more effective than some non-relgious strategies, but it comes with a lot of baggage, as one might expect from a movement that sprang out of Great Depression-era Christian revivals.
posted by 1adam12 at 12:21 PM on December 21 [15 favorites]

The text of his letter and his preamble are quite different.
posted by Keith Talent at 12:28 PM on December 21 [1 favorite]

>> It's estimated that nearly 29 million Americans suffer from alcohol use disorder, but less than 2 percent receive medication to treat it.

> Interestingly, Wegovy is being prescribed for alcohol use disorders, now, too. It appears to be effective.

Here's the wild thing -- since more than 10% of Americans are taking GLP-1s, that means five times as many people are now taking medicine for AUD accidentally as on purpose. Weight loss drugs have become a far more prevalent (and hopefully therefore effective?) AUD drug than AUD drugs ever were.
posted by john hadron collider at 12:33 PM on December 21 [2 favorites]

Sorry to hear he's having a problem, happy to hear he's confronting it in what seems like a typically direct way.

Without diverting into details or definitions about what counts as alcoholism, I'm quite ready to wish Kenji success in gaining control over his drinking. That's something I would wish for anyone, regardless, but in Kenji's case I have a selfish motive as well, in that I have enjoyed and benefited from the work he has done to develop and share his knowledge with the world. Good luck to him!
posted by Nerd of the North at 12:48 PM on December 21 [7 favorites]

(More background on that 10% figure)
posted by box at 12:51 PM on December 21

Give the ads I see on instagram, this type of drinking is quite common. Affecting mood and energy (made worse if someone is not in their 20s and drinking) but not enough to be typical toad behavior like drunk driving and passing out in public places. My guess is that this is how that stuff starts.
posted by MisantropicPainforest at 1:02 PM on December 21 [1 favorite]

As someone who will celebrate her 6 year sobriety milestone in a couple of months, there is a lot of disconnect between what people think alcoholics are like (see: The Lost Weekend, When a Man Loves a Woman, etc) and what it is. Rock bottom, I have found out, looks different for everybody. And right now, all of us who are in recovery, this is an awful time of year. Everything revolves around drinks and if it can be real shaky for those who can't safely drink anymore. (I don't do parties anymore. Not because of tempation, though it can be, but because people can't let a sober person alone without poking as to why you don't drink.)

Congrats to Kenji. A sober life is very different than one with alcohol in it, and I am glad I didn't kill myself before finding out which I prefer.
posted by Kitteh at 1:15 PM on December 21 [39 favorites]

As someone who struggles with this (and a long time fan), I laud him for being open. However, I will add my voice to those who are critical of the cults that are AA and Al Anon. If it works for you, fine. If not, do not denigrate anyone who seeks to manage their lives otherwise. It is surprising how controversial a statement this is.
posted by hankmajor at 1:37 PM on December 21 [10 favorites]

>
Interestingly, Wegovy is being prescribed for alcohol use disorders, now, too. It appears to be effective.

I work in this field and I'm low key obsessed with the research around substance use disorders and GLP-1s. If I get it together I may do a FPP on it. Fascinating stuff.
posted by gingerbeer at 2:25 PM on December 21 [32 favorites]

However, I will add my voice to those who are critical of the cults that are AA and Al Anon. If it works for you, fine. If not, do not denigrate anyone who seeks to manage their lives otherwise. It is surprising how controversial a statement this is.

It's also surprising how controversial a statement it is to say that if AA and Al Anon are working for people, there's no need to denigrate it to them, or their involvement in it.
posted by NotMyselfRightNow at 2:43 PM on December 21 [7 favorites]

This Patreon post is really meaningful, I'm glad he has shared it more widely with a video.
posted by Nelson at 2:45 PM on December 21

I got off alcohol during the same time period I was taking Rybelsus. I had forgotten that may have played a factor.

At various points I drank 1.5 liters of vodka/day (the worst period) and then "normalized" to about 450 ml/day before I hit rock bottom and quit about 3 years ago.

But yeah I'm pretty sure Rybelsus helped reduce the craving. Good on Kenji for discussing this. Growing up in WI it's taboo. and everyone seems to be a drunk (well, I know that's not nearly as bad as it used to be but there's far more binge-drinking here, and people who drink more, IMO, than they should, and it's just "part of the culture").
posted by symbioid at 3:02 PM on December 21 [3 favorites]

If you read the transcript, as I did, there is at least one description of passing out in a public place (an aeroplane). Dude is not just having a couple glasses with dinner.
posted by i_am_joe's_spleen at 3:14 PM on December 21 [1 favorite]

However, I will add my voice to those who are critical of the cults that are AA and Al Anon. If it works for you, fine. If not, do not denigrate anyone who seeks to manage their lives otherwise. It is surprising how controversial a statement this is.

I empathize a lot with this statement, as a 6-year sober person. There is a lot to not like about AA. Where I run into difficulty is a deficit of better options. When I quit drinking I was referred to SMART meetings, which were touted as a non-religious, evidence-based alternative. My wife went to a very nice residential rehab, which offered SMART as a kind of elective on top of 12 Step programming. As I’ve mentioned elsewhere, a friend is working on stopping drinking and AA is, quite literally, the only game in town. There simply aren’t alternatives to refer him to in our rural area, and access to medical supervision etc is very challenging.

I’ve been encouraging him to focus on getting heat he can out of AA and trying to ignore the religious aspects. I really wish AA was better, and I really wish they’d change and evolve and leave the revivalist baggage behind, but I am glad they exist when they are the only thing that exists everywhere, and often the only thing that exists somewhere.
posted by skookumsaurus rex at 3:24 PM on December 21 [4 favorites]

It's also surprising how controversial a statement it is to say that if AA and Al Anon are working for people, there's no need to denigrate it to them, or their involvement in it.

This is why I explicitly said that it is great for anyone for whom that approach works. However, their dominant place in the culture surrounding this issue dwarves the dissenting voices who point out that there is no one-size-fits all.

A de-escalation in the conversation surrounding this most pressing of issues is needed, and that can only happen if everyone approaches the issue with open-mindedness and empathy, rather than digging one's heels into any given position.
posted by hankmajor at 3:47 PM on December 21 [3 favorites]

It's estimated that nearly 29 million Americans suffer from alcohol use disorder, but less than 2 percent receive medication to treat it. Naltrexone is one of three drugs approved to help people manage their alcohol use. It blocks the receptors in the body where alcohol attaches, so the pleasurable, rewarding sensations are reduced.

I have officially been diagnosed with a substance use disorder(alcohol), and at one point in my time quitting after my last binge I was prescribed this. It works very well, but it also took away all other pleasure in life, such as the art I make, food, film, whatever other media I enjoy engaging with, and and replaced everything with a greyness that was over whelming and unbearable. I ended up quitting it because I felt so horrible on it. I don't know if that's a common experience for people but it was certainly mine.

Because of booze I have been around AA on and off for decades. After AA rehab(forced) I came back to my first thought about AA, that it works for who it works for, and that it is very problematic for people who's issues with substance use are not suitable for AA's kind of treatment. I have to run, perhaps more elater.
posted by Phlegmco(tm) at 5:22 PM on December 21 [3 favorites]

I really wish AA was better, and I really wish they’d change and evolve and leave the revivalist baggage behind, but I am glad they exist when they are the only thing that exists everywhere, and often the only thing that exists somewhere.

Thank you for replying. I fully agree. I have been in an odd situation. I realised I needed to do something and went for a rehab program. It was (predictably) based around the twelve steps, but there was also an affiliated psychiatrist (an MD), who suggested that I should use Naltrexone (the so-called "Sinclair method").

Even though it was recommended to me by someone within the framework of the same institution, the twelve-step absolutists told me that this was some kind of heresy. There is a real disconnect between (as you and others have put it) the "revivalist" spirit of AA and modern evidence-based approaches.

For the moment it seems "never the twain shall meet." It is very unfortunate and I struggle to think of any other area of healthcare where you have the same perfect storm of moralism/dogmatism and people who are trying to look at a problem empirically.
posted by hankmajor at 5:58 PM on December 21 [1 favorite]

(I don't do parties anymore. Not because of tempation, though it can be, but because people can't let a sober person alone without poking as to why you don't drink.)

Kitteh, and anyone else who's had that experience - I'm sorry people have acted badly toward you. I personally am happy you are doing whatever things are good for you, for whatever reasons, and I congratulate you on your 6 years.

I don't do parties anymore either (covid), but I am hereby kicking off an imaginary virtual MeFite party and this is your official invitation. Come if you want, stay however long you like, enjoy whatever refreshments you'd enjoy, dig the music and feel free to pick some songs you like, enjoy the company. There are some great people here (even if you end up being the only person who stops by).


I'm with Nerd of the North - I love J. Kenji Lopez-Alt's stuff, and I wish him good health and good days ahead.

Thank you so much for posting this, splitpeasoup.
posted by kristi at 6:10 PM on December 21 [5 favorites]

Well, I still do parties, and I don't give anyone a hard time about anything because people should be free to dance and have fun however they please. It's so uncool that anyone would feel free to interrogate a near-stranger about their most personal life choices, yuck.
posted by 1adam12 at 8:12 AM on December 22 [2 favorites]

I go to Secular AA Zoom meetings for a while now. One nice consequence of COVID was a lot of meetings became online and have continued being so.

After 10+ years doing regular AA, and still identifying as an Agnostic; secular AA has been a 'godsend'!
posted by indianbadger1 at 9:39 AM on December 22 [1 favorite]

For the moment it seems "never the twain shall meet." It is very unfortunate and I struggle to think of any other area of healthcare where you have the same perfect storm of moralism/dogmatism and people who are trying to look at a problem empirically.

Alcoholics Anonymous has a self-perpetuating bias towards orthodoxy that is, ironically enough, rather different than the constantly shifting Christianity it came from. AA’s leadership, from the meeting to the conference level, is inherently made out of people for whom AA, in its orthodox form, works. You don’t get influential in AA if you don’t believe in the program and at least your form of a higher power. And AA dogma is built on stasis: what worked for Bill W. and Dr. Bob is known to work for the AA leadership, so there is a strong urge not to change anything. Meanwhile people who succeed in sobriety who don’t like AA, like me, don’t stay involved. Coupled with a culture of distrust of outsiders and researchers, you have a system that is very effective at not adapting changing as the science becomes more developed.

Unfortunately you also have the reality that addiction treatment is severely underfunded in the US and many other places. AA is free or cheap for the legal system and the medical system to draw on, so it’s understandable that they do so. And if AA exists, there is little incentive to policymakers to change the landscape. After all, if it works for someone, it it’s probably down to a moral failure for the people it doesn’t work for, right?
posted by skookumsaurus rex at 9:58 AM on December 22 [2 favorites]

I don’t want to dominate the thread, but on the topic of parties: yup, that’s a thing and it SUCKS. Some people are really uncomfortable with other people being sober, and you see it all the time from the other side of the curtain. Armchair psychologist me says these people are uncomfortable with their own drinking and think your efforts to stop are a commentary on them, but it’s super awkward no matter the reason. If you’re newly in recovery there’s a good chance you haven’t been partying with a lot of sober people, and you definitely haven’t built up your own self-confidence in being sober. You definitely haven’t built your new routines of “here’s what I do with my hands and my thoughts and my mouth when I’m at a party instead of just inserting alcohol into all of them”.

It goes away eventually and I like a good party now, but it took shifts in my thought patterns and my social circle and my definition of a good party to feel really comfortable again.
posted by skookumsaurus rex at 10:33 AM on December 22 [2 favorites]

I don't have/go to much in the way of parties anymore but I found that in my social circles leading up to the pandemic was a LOT more emphasis on "yes we will have good stuff other than alcohol" or "btw the restaurant has amazing specialty mocktails" in invitations and plans-making, which was great. I hope that starts happening more for other people.

I do drink, but also I'm just a dehydrated person and hate being stuck in places where my only real choices are alcohol or water. I really only want one alcoholic drink, maybe two for a longer event, and I'd rather have something to walk around with that isn't plain water. NORMALIZE HYDRATION!

It does feel like we're finally tiptoeing past AA supremacy and starting to more fully acknowledge that addiction is (perhaps among other things) a medical condition that needs medical support along with evidence-based behavioral support and then-and-only-then should any kind of support group come into play. We do know, from evidence, that group environments very much do strengthen recovery, but it feels like a dirty secret that that's actually all AA is offering - a group environment. The steps, the religion, some of the cultier vibes that often get magnified by the personalities of people who tend to get addicted to things, the evidence suggests you could replace that with absolutely any sort of sobriety-focused group interaction and get the same level of benefit.

But I get it: right now it's one of the few ports available in a storm of shitty healthcare options, and it's free. Nobody else is really offering this for free on the reputational scale AA offers.

Anyway, I'm certainly glad Kenji is able to achieve the lifestyle he wants for himself and his family. I'd like everyone to have that.
posted by Lyn Never at 11:43 AM on December 22 [1 favorite]

Some people are really uncomfortable with other people being sober, and you see it all the time from the other side of the curtain. Armchair psychologist me says these people are uncomfortable with their own drinking and think your efforts to stop are a commentary on them, but it’s super awkward no matter the reason.

For me, it's not too different than when I am offered something with meat or dairy, I just say, "No, thank you, I don't eat meat/dairy." Mind you, I have made no comment defining my diet, just that I don't eat either things. And then it becomes a lot of like the not drinking thing: people feel like they are entitled to your reasons as to why not, or they make shitty jokes about it.
posted by Kitteh at 11:52 AM on December 22 [1 favorite]

I’m all for more non alcoholic options out and about. I drink, but 2-3 over a 2 1/2 hour period with food is the most I want, and I love mocktails and the like. Also, every bar should have root beer on draft because it rules.

Proud of him for facing his problems.
posted by caviar2d2 at 3:23 PM on December 22

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