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We have guest Dr. Fred Muench joining us on the show today. Fred is the President of the Center on Addiction and the Partnership for Drug-Free Kids. Following research that’s shown short-term text intervention has a positive effect on changing drinking habits, The Partnership has partnered with the Feinstein Institutes for Medical Research to launch Project TAMMI, which stands for Text Assessment and Mobile Messaging Intervention. Fred will be explaining how TAMMI works and who can benefit from the program. Following Fred, we have guest Dr. Theodora Saddoris. Dr. Saddorisis will be speaking to the science behind addiction and where there is the existence of an “alcoholism gene”.

 

Welcome to Recovery Radio by Landmark Recovery with your host, Zach Crouch. In this program we’ll discuss the root causes and treatments of alcohol and substance addiction, speak with experts in related fields, and help navigate the road to recovery.

 

Now, here’s the host of Recovery Radio, Zach Crouch.

 

Zach: Hi. I’m Zach Crouch and you’re listening to Landmark Recovery Radio, your source for addiction and recovery news and knowledge. You can find us online wherever you get your podcasts and don’t forget to subscribe to get the most up-to-date information from leading experts.

 

We have guest Fred Meunch joining us on the show today. Fred is the President of Center on Addiction and the Partnership for Drug-Free Kids. Following research that’s shown short-term text intervention has a positive effect on changing drinking habits, the Partnership has partnered with the Feinstein Institutes for Medical Research to launch Project TAMMI which stands for the Text Assessment and Mobile Messaging Intervention. Fred will be explaining how TAMMI works and who can benefit from the program.

 

Fred, thanks a lot. I appreciate you coming on the show with us today. It really means a lot.

 

Fred: Zach, thanks so much for having me on and for doing the work you do.

 

Zach: Tell us about TAMMI. How does TAMMI actually work?

 

Fred: Sure. TAMMI is a text messaging intervention for people who are interested in moderating their drinking. There’s a number of ways to sign up. Essentially anybody can text MODERATE to 55753 and they can start to process; because it’s a study we have to do consent and there are some forms that people fill out before they get started. They do get reimbursed for that.

 

They’re randomized into one of three groups. Based on the group they’re in, they’ll get different kinds of text messages. Over the period of time what we’re looking at it is whether text messages over time which can range from drink tracking which has shown to be very effective for people who want to moderate to more intensive interventions and messaging will change people’s drinking.

 

Our initial results, we did a short-term study of three months and it was shown that all groups actually did quite well in reducing their drinking in some ways similar to in-person therapy, not necessarily formal treatment but in-person therapy.

 

Zach: That’s pretty impressive. I’m curious to know just in terms of your study here with moderation, is abstinence also part of this as well? Is that something that you guys are tracking and it has that play in to your project?

 

Fred: Yes. It’s a great question. The reason we started with moderation was because of safety. We know that based on the severity of alcohol or substance use problem the more severe, the more likely you need more intervention and particularly more in-person intervention. Our intervention is very low lift and it’s not an intensive therapy. We purposely excluded individuals who may need more care.

 

We were also worried about individuals with high problem drinking so with greater severity because this is a remote automated intervention there’s no in-person contact, the potential for withdrawal, for example is significant and we didn’t want to encourage non-drinking when someone might go into withdrawal. It’s part of our study. We’re very intentional about making sure that those with more severe problems are referred out in our outputting study.

 

If you’re seeking abstinence, what we do is we provide other solutions because there are other online solutions for people who are looking at abstinence, whether it’s 12-Step meetings online which are exploding now because of COVID, SMART Recovery. There are a lot of great self-help resources online. What we do make sure of is if someone in the study and they’re deemed safe to be in the study and if they do want to try abstinence that they’re willing and able, we’ll help them achieve that goal.

 

Zach: Got it. With this project it brings up a question for me then, who is the prime candidate for this particular project?

 

Fred: Yes. It’s a great question. It’s people who are drinking, it’s almost like a classic. If we look at our initial study, it’s probably the best way to frame it is people who are drinking maybe a little less than a bottle of wine at dinner or at night or four or five beers. What we’re seeing is people, the average number of drinks per week was around 22; so we let people in who want to moderate their drinking so they could be binge-drinking one night a week. They’re going out Friday night and they’re drinking 12 drinks and they want to stop that.

 

We let people in the study who are drinking 30 drinks a week but are not at risk for alcohol withdrawal. What we do is we exclude those who have more severe problems.

 

Zach: Okay.

 

Fred: The best candidates for moderation are individuals who fall in that middle range who don’t want abstinence. That’s an important point.

 

Zach: Sure it is.

 

Fred: There is research to show that forcing abstinence or an abstinence goal on someone who’s not ready for it will backfire, but if you work with someone who wants to moderate and you work with them where they are that if they’re not able to do it that’s a great indicator that moderation’s probably not a good take for them and they should buy abstinence.

 

Zach: Absolutely. Got it. Wow. These folks that you’re…how many people have come through this particular study so far?

 

Fred: Right now we’re in the initial phase; about 70 people are in the study. We’re excited. We’re trying to get as many people as we can.

 

Zach: Awesome. I mentioned during the intro at least, the Feinstein Institute for Medical Research. What do they do?

 

Fred: The Feinstein Institutes is a great research institution. They’ll do everything from behavioral interventions like the study we are conducting with addiction, with mental health issues, anything on psychotherapy, remote-based digital interventions to basic science research in understanding inflammatory responses in humans and ensuring to increase immune functions. It’s a state-of-the-art research institution with capabilities from psychotherapy to basic biology.

 

Zach: Got it. I’m curious, too just within your study here, the Project TAMMI study, is there a particular age group that you’re focusing on or is this just all over the board?

 

Fred: It’s all over the board. What we found is sometimes depending on the recruitment source, but overall we’re finding that more women are engaging in this type of remote-based intervention than men.

 

Zach: Interesting.

 

Fred: The age varies from 24 to 40, but everyone, we have about 25 percent of our sample were over 50 for example. We’re seeing a large increase in the number of people who want to moderate their drinking after they retire, for example which is a big problem because people have all this free time and no responsibility.

 

Zach: Yes.

 

Fred: They start drinking heavily. They don’t necessarily have a genetic disposition but want to figure out a way to moderate. We’re really targeting that more than social drinker, that person who they’re not too worried about but…

 

Zach: They could be on the edge. Yes.

 

Fred: Yes.

 

Zach: Yes, yes, yes, for sure. That’s interesting that you bring up there’s more women engaged in the study. I find that interesting because typically, certainly within our facility here in Louisville, Kentucky at Landmark Recovery there is anywhere from I’d say 60 to 70 percent, probably 60 percent are men in the facility at any given time. Do you have any thoughts on that why more women are engaged in this study?

 

Fred: Yes, few thoughts. It is a juxtaposition to the traditional treatment centers. One reason is because of child care fewer women enter treatment. Let’s start with that fewer women have significantly more severe problems. Men typically have more severe substance use problems in terms of severity.

 

Also that we’ve seen a significant rise in alcohol use amongst women in the past 15 years so there are more women who are struggling with alcohol use. Women are typically the ones who are caring for the family and there’s a lot of shame and stigma particularly with women around substance misuse. Confidential care where they can go on with their lives and focus on this and get support remotely is attractive.

 

Zach: Huge thing.

 

Fred: It’s a huge thing. With that is understanding that sometimes people need more and that’s one of the things about our intervention with…as we target, for example we’re not asking people to go in to treatment. In fact, in the study if you’re going in to treatment we don’t think you should be in this study because you want to focus on your treatment.

 

What we do find is that as the women or anybody in this study, as they start to think and they start to get messages, some of them make decisions to go seek more formal treatment. That’s one of the unique things is we’re really meeting them where they are and help guide them on a journey.

 

For women, it very often comes in to play is understanding some of the risk factors they might not have thought about as well as understanding that they should take care of themselves, not just their family members or those around them which many women tend to do.

 

Zach: That’s just tough, man. That’s like a culturally ingrained message. We’re in the 21st century today but still if you pull people today and households where there’s kids and spouses and partners that…your traditional marriage of a man and woman together, you’re going to find the women are the one taking care of the kids.

 

Fred: Yes and even in the most progressive households you typically see a divide there, even when men think they’re doing less it’s the women who are really carrying the burden of the household responsibilities.

 

Zach: Most women are working today.

 

Fred: That’s right so they’re doing both.

 

Zach: They absolutely are. Let me ask a question. If you find someone who’s at that edge where this study is not being helpful for them, in other words they’re not moderating their drinking, they’re using excessively more and more; is there a conversation that your folks have with them or someone else?

 

Fred: We do. We have a research team. If they’re not doing well, our research team will reach out to them.

 

Zach: Okay.

 

Fred: We do say to them, “If you’re having trouble or need to reach out, reach out to us.” If after a certain period of time we’re concerned, we will also reach out. We haven’t had that because we are enrolling people without serious problems to begin with so we’re not getting that as much, but sure people need help. One of the things we say is “If you ever want to talk to somebody in the study, you can type in TALK and chat with a research assistant.”

 

We mark it down because that could have an effect on the outcome. One of the things we’re doing is because we’re testing all these various types of different interventions all of which seem to have an effect or do have an effect but we know that once you start to connect with someone it throws things off.

 

Zach: Yes. Let’s talk a little bit about the intervention because I’m curious about what a science-tested text message is. What is it?

 

Fred: Yes. As I mentioned, there’s a number of different components to the intervention. I will be purposely slightly vague if that’s okay.

 

Zach: Sure. Yes, I get it.

 

Fred: I certainly don’t want to give away the study knowing that in previous studies all components of the intervention were shown to reduce drinking. Going back there are three things that strike me in terms of how we approach this and what the fact are these messages.

 

The first thing we did was we just asked people, “What would you want to hear in this situation? What would you want to hear in this situation? What would you want to hear when you go out to a bar and you’re worried about drinking too much? What about when you’re lonely and you’re at home with a bottle of vodka sitting there? What would you like to do?”

 

Zach: It’s a great question.

 

Fred: We ask people to write themselves messages. What would you say to yourself in this situation? We tried to understand what those messages were. We rewrote them and thought about opportunities to make sure. What we did was we looked at themes amongst the messages that people write themselves. That was the first step.

 

The second step was we created a list of about 50 different types of messages and we juxtaposed them. We do a gain frame and a loss frame, for example; the pros of drinking versus the cons of drinking. I know the pros of not drinking, excuse me so you’ll feel healthier versus the con, you’re worse and understanding. We looked at messages with “I” in them versus “we” in them. We took a systematic approach and we asked people to choose the type of messages they thought were most effective for them.

 

Lastly what we did was we dove into the literature. We looked at the in-person literature and we looked at the constructs that are most important in why people drink and why people change and we built the intervention around those three components. Most importantly is if you look at the literature, probably one of the most important things is drink tracking. There are studies that show, and a study we even did that drink tracking, just tracking your drinks weekly, that can make a huge difference in reducing your drinking.

 

Zach: Just like tracking your weight or tracking a fitness schedule of some kind.

 

Fred: Exactly.

 

Zach: If you start seeing…you’re doing it right, absolutely.

 

Fred: Exactly. We looked at these different components just really trying to understand. The interventions in the study will really range. We focused on all types of messaging that would have an effect.

 

As we understand what’s working, the goal is to after the study’s over is to build sort of like a super intervention that is completely personalized because some persons might really just benefit and want drink tracking and not really thrive with whereas someone might want something that’s a little more tailored and personalized format.

 

Zach: Is this kind of getting into a little bit, so to speak at least as you mentioned you’ve taken all this data, you’re crunching it, you’re trying to create something that’s really personalized, is this sort of algorithmic in nature?

 

Fred: Right now it’s not too much but it will be. That’s typical. That’s the goal is to give people an intervention over time that will meet their individual needs and goals. One of the things we’ve learned is that…

 

Zach: Just on that topic, real quick, Fred. Just how many people do you guys want to have come through this?

 

Fred: We’d love to have up to a thousand.

 

Zach: Okay.

 

Fred: We’re trying to get as many people as we can in this intervention. We really want to optimize remote-based care because the beautiful thing about this is we can make it free. We don’t want to compete with treatment. We in fact recommend to people if they’re not doing well to go to treatment. We want to provide a guide for people and we’re keeping track of everything people do outside the intervention as well. We’d like to get as many people.

 

We think the opportunity for this particularly if we have a combined moderation program and abstinence program for people who are currently getting care under supervision is the way to go to be a self-guided program that’s personalized to an individual goal.

 

Zach: Sure.

 

Fred: That’s ultimately where we want to go.

 

Zach: Curious to know, too with that in mind especially when you have this data and you’re helping people, if they need treatment as an example here, are you guys forming relationships with different treatment facilities and programs across the US as well?

Fred: We don’t. What we do is we use…because we’re a non-profit organization we use just geolocation. We have the SAMHSA Treatment Finder for individuals who are looking for therapy. We’ll use a local treatment finder. We use Psychology Today. What we do is we provide geolocated state data. We’re in New York State, just an example we would be working with the New York State Office of Substance Services.

 

Zach: Got it.

 

Fred: We find them care in their area.

 

Zach: I see. Okay. As we’re mentioning earlier just about this idea of themes that you’re looking at among those top three, are you able to talk about any of those themes that you’ve come across or is that something that will be discussed further on?

 

Fred: Yes. Zach, I’m worried I’m going to give away too much.

 

Zach: No, no, no. Sure.

 

Fred: I think ultimately the main thing to know is that different people respond to different interventions. What we’re really trying to understand is who responds to what and how we can optimize care. Just like in the in-person literature with people who want to moderate their drinking, what you see is a four-session intervention is very often just as good as a 20-session intervention.

 

Getting this is very different from abstinence where you do see like a dose response that more treatment is good and whether that treatment is out-patient, in-patient, whether that’s mutual support like 12-Step groups, the more people are engaged in the change process, the better. With moderated drinking it’s a little different because it’s not an all or nothing but it’s sort of a shift in mindset and there are certain things that people do.

 

When people start tracking their drinking, for example, their drinks, they start to engage in all of these different [Inaudible][21:39] they’re like, “You know what? I’m already at eight drinks this week. I want to stay under 14 drinks. I’m only going to have two drinks.” They started going to this narrative in their head just based on that number.

 

Zach: Which is good because it’s making their thought process more conscious at that point.

 

Fred: Exactly, exactly.

 

Zach: That’s great, man. Very, very cool. Does this cost anything to the person that’s participating in it?

 

Fred: No, it’s entirely free. In fact we pay people because they do the study.

 

Zach: Yes.

 

Fred: The first assessment in terms of how it’s set up is you sign up. The sign up takes, including what we call our baseline interview, that intake interview, all of that takes about an hour. We give you 20 bucks, but then you’re just getting text messages and then filling out questionnaires every few months and you get $20 for about half-an-hour.

 

We appreciate the data. We want people to take the time to fill out the surveys because it means so much about what we’re going to be able to do with that data and how we’re going to be able to help people and then eventually the goal is to make this free.

 

We know we manage alcoholscreening.org that gives people feedback on their drinking. If you’re drinking X number of drinks you get feedback on whether you’re a risk and what you can do. We’re going to make that available on the side at one point once this study is over and we’re able to offer it free to everyone in the United States.

 

Zach: That’s fantastic, man. If you have 70 people who have already gone through your project here, how long are they participating for these people still participating, how long will they participate for?

 

Fred: Most people are still participating. People get messages for six months.

 

Zach: Okay.

 

Fred: It’s a long-term study. This will be the longest term text messaging study ever done.

 

Zach: Wow.

 

Fred: Yes.

 

Zach: You began this project, when was it?

 

Fred: We began this project a couple of years ago. We focused on the first year was message development.

 

Zach: Okay.

 

Fred: Last year was really starting with recruitment. What’s fascinating about this is it was a lot easier to recruit before. We are looking at different strategies and ways to engage people in this study because demographics shift, changes. I mentioned we’re realizing we need to target older adults more because there’s a huge need there. That’s rapidly changing demographics. It’s going to go for another couple of years. We’re excited to get as many people as we can during this time.

 

Zach: Very, very cool. It’ll be interesting especially to see what’s going on with the baby boomer generation and…

 

Fred: Yes.

 

Zach: Generations before that. As far as the data that’s on the phone though, our phones are it seems like just a hotbed for everything because everything’s on the phone now. How is the data stored and protected?

 

Fred: Yes. It’s a great question. These are just text messages. We don’t have an app. You sign up and you get text messages. It stores like any other text message. What we do when we sign up, we get people a one-page on how to protect your phone. Do you want to turn off the message preview feature if you’re worried in terms of the number you can make a contact that put a name on it if you’re worried?

 

One of the things we found out that women with kids who look at their phone were worried about it so they put on message preview, for example so making sure that you’re taking precautions to protect the messages if you’re worried about it. Most people weren’t but some people are.

 

The other is unlike Facebook, for example the data on your phone is, AT&T for example even though a text message goes through AT&T for example they’re not allowed to look at that individual data and then sell that data.

 

Zach: Okay.

 

Fred: Although it’s not secure and we let people know it goes through their phone company server and all that, there are strict privacy rules from those companies to look at the content.

 

Zach: Got it. That’s reassuring to know that. Talk to me a little bit more about your hopes for this project now and in the future. You touched on some of it.

 

Fred: Yes. I have a few hopes. One is that we can make this available nationwide, that we can meet people where they are, and particularly in the person that is just starting to struggle a little bit and they’re seeing they’re having a problem but they’re saying to themselves, “Oh, I don’t need much. I’m good. I’ll be good. I’ll be good,” to stop that process at that time, to say, “Here’s something that is effortless. You don’t really have to do very much. You just have to sign up and then you get messages.”

 

Zach: Yes.

 

Fred: That was one of the things that was most surprising to us. In our previous study which we asked everybody after the study, we said, “You can continue to get messages for another three months.”

 

Zach: Yes.

 

Fred: Usually in these crowds you always offer people the ability to continue and very people continue after they get the study intervention, for example. 80 percent of people opted in to continue getting messages.

 

Zach: Wow.

 

Fred: You already sort of got most of these messages. They’re going to repeat. The response was, “You know it’s a reminder of who I want to be.”

 

Zach: Yes.

 

Fred: It’s a reminder and depending on certain things that when you get the messages or whatever it might be, it’s a reminder of who I want to be at the moment or it’s a reminder of who I want to be when I’m reaching about my day and I start to track my drinking.

 

Zach: Sure.

 

Fred: That is something that is so powerful about simple text messages in that it’s effortless, it’s salient so it’s right on your phone. You don’t have to do anything. You don’t have to open an app. You don’t have to do anything else. It reminds you of the goals you have.

 

Zach: Like a personal trainer or something, right.

 

Fred: It’s like a personal trainer and I don’t want to pretend that this is a panacea because I know it’s not.

 

Zach: Sure.

 

Fred: We think of this as sort of like a mild motivational nudge. We’re hoping when we look at the data of text messages is that it is an ongoing salient reminder that allowed rather than sort of in a big dose of like, I’ll compare it to in-patient treatment. That has its effect. It’s so intense. It’s an emotional experience. You’re all in. You’re learning and then you need to carry that out into the community.

 

Zach: Sure do.

 

Fred: You need follow up and you do after-care or recovery. This is a little bit like almost like the exact opposite of that, a little bit every day but it never ends. You’re getting it every day or once a week or twice a week or whatever that might be.

 

Zach: Yes.

 

Fred: What effect does that have on someone, particularly someone who might not need that intense emotional experience and transformational experience of an in-patient or intensive out-patient program?

 

Zach: Would you say, Fred that most of the folks who go through this are going to talk to someone from the TAMMI project at some point throughout their time like I guess getting these text messages? What’s your sort of set you get your text messages and at that point if you need help then great but for those…how does it…yes.

 

Fred: Yes. Very few people actually reached out to us even in our previous study.

 

Zach: Okay.

 

Fred: Even this time and part of that is the expectation we set up which is this is an automated messaging program. It doesn’t include talking to people to take part. Yes.

 

Zach: Yes.

 

Fred: There is research to show that text message reminders with counselling also help. That’s the wonderful thing is that you can completely adapt it. For example at the Partnership, we have programs for family members who have loved ones struggling with addiction problems. Our primary focus is only on the family member, usually a parent or caregiver to the others but a parent or caregiver.

 

What we do is we have a range of programs where we’re providing people with the opportunity to get these automated messages based on that their child is struggling with heroin, they’re using IV, and they’re at risk for overdose, for example. They’ll get specific messages in that program at any time because it’s not a study. We allow them to type in CHAT and to chat and chat with a specialist. Only about 14 percent of people do it.

 

14 percent of people seem to do that. There’s a sub-group of people who just want these automated reminders and then maybe they’ll reach out to a friend or maybe they’ll get therapy elsewhere.

 

Zach: Right.

 

Fred: That’s okay.

 

Zach: Yes. Got it. Gosh, man there are so many questions I want to ask you right now but I can’t. We talked about the themes piece. I’m sure that those are things that will certainly come out in your research that you’re doing especially around the concept of why people change. I’ll be curious to know; yes more about that as the data kind of comes in.

 

In our treatment center, at least we hear a lot from females that kind of nailed on it at the beginning, large piece about change is for the children. For men a lot of times it’s for family and especially their job. There are a lot of guys who come in to treatment who are on the verge of getting fired or whatever it is.

 

Fred: In general, I don’t think it’s giving away any of the intervention that some of the moderators of why people change. We see the same thing. There’s a combination of factors. Usually it’s some discrepancy between the consequences of use and some goal or desire they have and that can be a job, that’s family, that’s repeated consequences.

 

In many ways with moderation usually people have not had the same consequences as someone who should be abstaining, but that’s not always true particularly with binge drinkers. For example, we know many women struggle because they’ll drink and they can be sexually assaulted or they’ll wake up and not remember what happened.

 

Zach: Right.

 

Fred: There are a lot of issues that go into these older individuals are experiencing health problems. There are interactions with medicines. When we look at what’s sort of happening, it’s this discrepancy between their current drinking and their life and how that’s interfering with it and particularly once people become longer-term abusers and we know this from the addiction space is the addiction is a short-term and substance use is a short-term relief that creates problems in the long-term.

 

Once they shift that mindset to be a long-term thinker and is focused on regulating in that moment, that’s a huge shift for everybody in our program.

 

Zach: Got it. Do you guys do an extensive, so to speak mental health assessment on the front-end with these folks?

 

Fred: Yes. I wouldn’t call it extensive but we do ask about mental health problems.

 

Zach: Okay.

 

Fred: We ask about triggers. We ask about craving. We do ask them about depression and emotions. We ask about their social networks. Do you drink alone? Do you drink with others? When do you drink? Getting in all these things. There are a number of patterns that emerge. You have people who are drinking 25 drinks in the span of two or three days and the people who are drinking 25 drinks over but they’re drinking every day. Those are very different types of people.

 

There are people who drink because they’re triggered by negative emotion. There are people who drink because they are triggered by positive emotion. That’s one of the things that I think we rarely see in the treatment literature because once someone gets the treatment they’re already in a state where it’s a habit. It’s addiction. They’re drinking to cope with…

 

Zach: Usually with some physical impressions, right.

 

Fred: Exactly, withdrawal. A lot of the drinkers we have is they go out with their friends and…

 

Zach: It’s problematic, right?

 

Fred: Yes, exactly. Exactly.

 

Zach: Yes. In your questionnaire, do you guys bring up any issues around trauma? Do you guys talk about any past history of trauma?

 

Fred: We do ask the trauma question but we don’t go into detail about it.

 

Zach: Okay.

 

Fred: The reason that we do is just making sure we get here because we know, just like you know only 20 minutes the overwhelming majority of people with substance abuse, not overwhelming but about half of people have some history of trauma.

 

Zach: Yes. Good deal. I am really excited to learn more about this. I’ve visited and kind of looked over your website. It looks like you guys are well on your way of getting this. Is there a completion date on this? Have you guys set any sort of timeline?

 

Fred: While we’d love to finish recruiting in a year so we can focus on data analysis and get this out. The faster, the better. The wonderful thing about this is it’s completely scalable which is if 500 people came in next week, yes we’d be overwhelmed with our staff but we could get people up and running. We don’t have to schedule an appointment the way an in-patient or a clinic would. We have this opportunity to bring in lots of people and we’re excited about it. The goal is to finish as soon as we can.

 

Zach: That’s fantastic.

 

Fred: Just one last thing, this is so low lift that the benefits of the time, first benefit equation and it’s effortless. It’s easy, effortless. The first appointment is about an hour but after that there’s very little people have to do.

 

Zach: It doesn’t disrupt your daily life at all, really at all.

 

Fred: Yes.

 

Zach: It does, I mean if you’re drinking and you want to moderate. That’s not bad. That’s good. If people are interested and want to learn more about Project TAMMI online they would go to drugfree.org/tammi, correct?

 

Fred: That’s right. They also very simply can text the word MODERATE to 55753 and then we’ll engage them right there. If you’re listening, you want to text MODERATE to 55753. You can do that. If you’re a family member who has a loved one struggling, you could also just text JOIN to 55753 and get text messages for that, too and that’s separate. That’s all free and completely separate. That’s not for the individual but that’s for family members. That’s something that we make available for free. It’s not a study. It’s just a service.

 

Zach: I’m so glad to hear that. When you guys get this published or this research done, how will we know about the Project TAMMI’s sort of forward momentum? Can you tell us what it will look like, next steps after this?

 

Fred: Yes. We certainly want to publish a paper. When the study’s over, even prior to publishing the paper because very often that takes a while, we’re going to make this intervention available and we’ll certainly do a press release. What we’ll do is we’re going to have this available as part of our larger seat of offerings for free for family members. We’re going to make this available for individuals who want to moderate their drinking themselves.

 

Zach: Great. Fred, again, sir I really do appreciate you coming on the program today.

 

Fred: Thank you, Zach.

 

Zach: Yes.

 

Fred: Thank you so much for having me on.

 

Zach: It’s been very informative.

 

Fred: Yes.

 

Fred: It’s been very informative so thank you so much.

 

Listen, if you know someone struggling with an addiction and are searching for answers, visit us at landmarkrecovery.com to learn more about substance abuse programs that are both saving lives and empowering families.

 

Until next week, I’m Zach Crouch with Landmark Recovery Radio wishing you well.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Zach: Hi. I’m Zach Crouch and you’re listening to Landmark Recovery Radio, your source for addiction and recovery news and knowledge. You can find us online wherever you get your podcasts and don’t forget to subscribe to get the most up-to-date information from leading experts.

 

We have guest Dr. Theodora Saddoris joining us on the show today. Dr. Saddoris is board certified in Addiction Medicine through the American Board of Preventive Medicine and she is a Fellow of the American Society of Addiction Medicine. She’s been providing addiction treatment in Columbus, Indiana since January of 2014.

 

She’s very active in her community from providing weekly therapy sessions to the public to helping people find recovery housing options for those in need. She’s currently writing a book on addiction recovery and she’s joining us today to talk about the family ties of alcoholism.

 

Dr. Saddoris, thank you so much for coming on the show with us today.

 

Dr. Saddoris: Oh, I really appreciate being here. Thank you.

 

Zach: Absolutely. In your practice there in Columbus, do you have people coming to you knowing they have a problem or do you have a lot of people who have some ambivalence even about being able to control their drinking?

 

Dr. Saddoris: Yes. I think that’s a great question. Currently because I’m only treating addiction [Inaudible][41:46]admitting they have a problem, but before that when I was treating both internal medicine and also addiction I had a lot of people that were having struggles even thinking they didn’t have a problem. I think anything in medicine, you have to learn from your mistakes and believe me I’ve made my share of them.

 

Zach: Right, right, we all have.

 

Dr. Saddoris: Yes, that’s true. I think my biggest mistake that I’ve made is I would ask a patient and say, “Are you an alcoholic?” or “Do you drink too much?” Immediately that puts a person defensive. They felt I was judging them. Naturally they didn’t think they drank that much because all their drinking buddies drank about the same. It wasn’t helpful for anybody. I’ve been fortunate to say, “You can come back and see me” after that encounter.

 

What I did find that was so helpful is that I tried to focus on health. What I ask them is “How many do you drink at the most in one day? How much do you typically drink in a week’s time?” Again, another big mistake I had to learn is what size is a drink. I had a relative who asked me, “Oh, is it okay if I have just a glass of wine every night to help reduce risk heart problem?” Yes. Alcohol has been proven to have some benefit with that. I said, “Sure.”

 

When I went to visit him I saw that he got one of those bottles of wine and poured it into one of those 64-ounce, Big Gulp Styrofoam cups and that was his glass.

 

Zach: You said a drink, right?

 

Fred: Yes, it was a drink. Right. We have to standardize what is a drink. We’re all on the same boat on that.

 

Zach: That’s funny.

 

Dr. Saddoris: A standard drink is conserved 14 grams of alcohol which is equal to 12 ounces of regular beer. If it’s four to five that’s about one-and-a-half drinks and it’s like five ounces of wine but if it’s four to five again, it’s about one-an-a-half drinks and then 1.5 ounces of brandy or 80-proof alcohol. Once I clarified what that drink is then I ask them “How much are you drinking?” That helped so much because then I can explain to them the amount of their drinking how it’s affecting their body.

 

Zach: Yes.

 

Dr. Saddoris: I usually tell them if you’re drinking about 60 grams a day, which is a little about four drinks a day that in ten years’ time in men and about eight years’ time in women that they have an increased risk of liver cirrhosis and five times increased risk of liver cancer. For those who drink about two drinks a day they have an increased risk of cancer of the esophagus. This is something that’s just recently been found out is that women who drink one drink a day they have an increased risk of breast cancer.

 

The current recommendation is that they want to keep people at is to help them to reduce the potential risks. For like women and for men that are over 65 they should never drink more than three drinks in one day and no more than seven in a week. For men, they shouldn’t drink more than four in one day and no more than 14 in a week.

 

When we focus on that, reduces the sensitiveness; we’re working on trying to improve health. I always state to them and say having struggles of reducing the intake and I said this is a common problem because your brain is used to a certain amount and it can make it difficult to reduce that we have medication to help you with that.

 

Zach: I have a question just to follow-up on that. I’m curious to know how you’re patients when they hear that information about increased risk of you said cancer, cirrhosis, number one, how do they take it?

 

Number two, I want to mention something. I was doing a recent just sort of search on vaping and cigarettes because vaping and cigarettes are pretty common here in the State of Kentucky and the thing that’s interesting about nicotine is that it hits the part of the brain when you smoke it, snuff it or whatever you do with it, dip or whatever nicotine has the effect of telling the brain when you ingest it that there’s nothing wrong. It turns that part of the brain off so it’s just like, “Yes, I know these are bad for me but the minute that I light up it’s like that stuff gets forgotten.” That’s amazing.

 

I’m curious to hear from you how do your patients react or do they take it in when they hear that and do they change when they hear the increased risk?

 

Dr. Saddoris: I find that they seem to be a little bit alarmed about it. We’re not so much pushing to ask them since we are health. A lot of times I also have liver enzymes showing that there’s been some liver enzyme elevations and maybe showing some abnormalities and showing that it’s affecting their health. It’s kind of like the person who doesn’t want to quit smoking but once they have a heart attack, it’s like whoa.

 

Zach: Wake up call.

 

Dr. Saddoris: Yes. They can see that there is definitely a problem happening to them then it seems like I get more cooperation. We have it in a non-judgemental way, in a way that helps them realize that I’m here to help them improve their health.

 

Zach: Sure.

 

Dr. Saddoris: I’m not judging them that you’re a bad person, you’re an alcoholic or put a label on them because all labels do is just make people feel worse and not wanting to change.

 

In terms of the smoking, that’s just part of the addiction process regardless of what it is. The cravings intense and once you have what you want, you know that that’s going to relieve it and so it doesn’t matter what’s going on or how bad it’s for you, you just want to relieve whatever the withdrawal symptoms are giving you. That’s common with any drug.

 

Zach: I also want to come back to, you mentioned you tried to treat addiction full-time. You did some work as an internist. An interesting thing for me I’ve come across in my time with doctors, internal medicine doctors, PCP folk is that many of those providers don’t know how or don’t feel comfortable having a conversation about substance use disorder maybe because they aren’t trained on it, etc. What’s been your experience?

 

Dr. Saddoris: Oh, that is very true. I think it’s a hard topic to bring up just out of the blue like that. I think what I find to be very helpful sometimes I might have like the staff give them a questionnaire and ask if they don’t mind filling it out. It’s usually just an audit questionnaire that talks about how many drinks you drink in a day or a week or do you find that you’re having problems with it or are you having trouble with relationships; basically giving you an idea of how is alcohol affecting them.

 

When I see them, I always ask their permission. Is it okay if I go over this questionnaire with you? I haven’t had anybody tell me no. We go over it and that’s a great stepping stone into discussion for their health because I can tell right off the bat how much they’re drinking right there.

 

Zach: Yes. When you work with people, do you often connect that there’s an issue that runs in their family pretty often?

 

Dr. Saddoris: Oh, definitely. The general statistics for alcohol use is anywhere genetically between 40 to 60 percent, but what I find to be amazing is that when you have a father that is an alcoholic and you’re their son it seems to be more inherited on the male side, there’s a 70 percent chance of developing alcoholism. That is a huge potential. I always tell people there’s a family history. Don’t touch the alcohol because your brain is not going to respond like other people’s brain to it.

 

Zach: When you come across these folks that you’re seeing who have alcoholism run in their family, how far back have you seen it go? Is this two generation, too?

 

Dr. Saddoris: They’re multiple. I see uncles and I see grandfathers and great-grandfathers. Yes, it can go far. Brothers, cousins, yes it can be in multiple people.

 

Zach: Go ahead. I’m sorry.

 

Dr. Saddoris: Usually there’s an outlier where somebody doesn’t have an alcohol problem but instead they have an opiate problem instead. Sometimes what we’re finding it’s not necessarily specifically to one drug. It can cross other drugs.

 

Zach: Sure.

 

Dr. Saddoris: There’s tendency.

 

Zach: There are other processes, too I’m sure. There are multiple ways that the addictive brain can get it satisfied. It’s interesting. I go back to one of my first…I’m a licensed Marriage and Family therapist. One of my first supervisors told me something like marijuana. Marijuana is a very interesting drug, substance because it affects people in such different ways.

 

Some people get a lot of energy. Some people feel lethargic. Some people feel paranoid. It depends on when you started. It depends on how long, etc. like many drugs. It’s interesting because marijuana is becoming more mainstream now. It’s becoming a lot more accepted like alcohol was after prohibition. What do you see as some of the risks with THC being more mainstream?

 

Dr. Saddoris: I think the biggest problem that we have with it is that there isn’t any clinical trial with that. A lot of people say it helps with pain. It does this or that. I think a lot of the claims are bogus claims. There are a few types of pain that has shown to be helpful.

 

Zach: There are no clinical trials for that either?

 

Dr. Saddoris: No. There are some studies found but they’re not very large. It’s more anecdotal.

 

Zach: Okay.

 

Dr. Saddoris: We really need to get into large studies. I think the biggest problem is that because it’s legalized in a lot of states, we’re going to start seeing some huge problems. One of them is that there are some people that have a tendency if they smoke marijuana that they can then go and develop schizophrenia. I have personally seen that with a lot of patients. There’s that increased risk. I know the mental hospitals in Colorado have dramatically increased. My sister lives in Colorado and there’s a big problem.

 

I think the other big problem is mixing alcohol and marijuana together. The alcohol impairs judgment and the marijuana impairs your ability to tell distance and things like that and they have a slow reaction. Sometimes they can overcome that by concentrating really hard but if they drink alcohol it impairs concentration.

 

Even at low doses of alcohol they can have severe impairment of their driving. There are a lot more accidents, a lot more fatalities, injuries that they’ve encountered. I think that it’s sad that they legalized something that hasn’t been studied to see its long-term effects.

 

Zach: Yes. It definitely gives me some pause.

 

Dr. Saddoris: It’s just like vaping. They only find all this lung people and dying. Yes. We approve things and then we later regret some.

 

Zach: I’m curious to know. Do you also see people, Dr. Saddoris who are younger, teenage, even the 17, 18-year olds?

 

Dr. Saddoris: It gets a little challenging. 18-year old is not an issue. When you get younger than that then there’s parental…how do we handle parental consent? How much do we release information? It comes to if you’re doing something that’s dangerous I have to let your mother or father know. Danger is when they tell me they’re drinking and driving. I have to let them know because that’s a very dangerous combination.

 

I don’t have a lot of patients that are younger although I don’t restrict them. I think part of it is that most treatments are more mental health type treatments which is bad because a lot of them need medication. They don’t want to give medicines to a younger person but at the same time the younger the person has the addiction, the longer it takes for them to recover than you see developed at an older age.

 

I think they have a failed knowledge that when you start young you’re going to have a severe problem for a long time. That’s when you need to be aggressive and not fiddle around with like let’s go talk about it. As a teenager they’re not going to talk to you. As a therapist you understand that.

 

Zach: That’s part of the reason I asked the question about if you do treat younger folks is they keep it at 18. Let’s just say 20 because they are certainly still in that range. I think they’re probably more versed in the ability to argue for marijuana’s validity.

 

Dr Saddoris: Oh, yes.

 

Zach: For parents out there and people who have those folks in their family, how do you have a conversation with those folks, those younger people who are really making strong arguments and they sound really valid for marijuana use?

 

Dr. Saddoris: I think when it comes to marijuana unfortunately it’s not been studied so a lot of their arguments are they’ll see one little claim that’s on YouTube saying that this is great. It helps reduce my PTSD. There’s not really been any real study showing improvement in any kind of stress-induced problems. I think we have to recognize that do we believe everything that’s on the internet that people claim.

 

I think clinical studies would really help tremendously. People forget that marijuana especially now is not the same as it was even 40 years ago. Now the THC is so concentrated and when it’s so concentrated the cannabidiol which is the part that helps offset some of the hazards of THC is significantly reduced. We’re seeing so much psychosis and so many other negative effects. It’s almost like a stimulant now. It’s just not the same drug as what it was even back in the 1960’s from people who smoked marijuana.

 

Some would say it’s in the Bible, yes but what is the dose of THC back then versus now?

 

Zach: There are a lot of things in the Bible that we probably shouldn’t do today, too.

 

Dr. Saddoris: Yes. Even if it was it’s just not the same. When we genetically engineer a plant it’s just no longer the same properties as what it was before.

 

Zach: Yes. It kind of begs the question from when we talked a little about alcoholism running in multi-generations of families, in your research, in your studies, is there an alcoholism or substance use gene, so to speak?

 

Dr. Saddoris: No. There is not one specific gene that causes alcoholism or any type of addiction, but what we’re finding is that there are different segments on multiple genes that have an effect in making a person more susceptible to addiction. Some of the things specific to alcoholism is that they some genes that affects how the alcohol is broke down and eliminate it from the body. There are also areas that affect how alcohol…

 

Zach: Which Native Americans have that gene, is that correct?

 

Dr. Saddoris: Yes. Asians have trouble with breaking it down so they don’t tend to have an alcohol problem. Americans don’t have that issue. The biggest thing is that a lot of people that have a family history of alcoholism that when they first take their alcoholic drink, they’re not getting drunk like their fellow people.

 

Zach: Right.

 

Dr. Saddoris: They don’t seem to have the effects. They already have an automatic tolerance. They have to drink a whole lot more to get that tolerance and because they’re drinking a whole lot more they’re getting much quicker dependent on it than their fellow people. There are some definite changes there.

 

There are also some genes that affect stress reduction. We call that rehabber receptors because they’re the ones that help relax you. I find that there are changes in that like people that have a family history of alcoholism like the women they seem to when they take a benzodiazepine or an Ativan instead of relaxing them it actually gives them increased energy so they kind of have a reverse effect and it makes them more susceptible to addiction to benzos.

 

The more recent one that I find to be rather exciting is the serotonin receptor changes. Serotonin causes something that’s called impulsivity which means a person is always doing things and not thinking of the consequences. I kind of liken it to a person driving a hundred miles an hour and they have no brakes.

 

Zach: Right.

 

Dr. Saddoris: They’re always taking risks. They’re always getting into trouble. They have found that blocking that serotonin receptor that has significantly improved reduction of alcohol use in those that have genetic tendency. I think what’s exciting about this is because there are multiple areas we might get to the point that we can actually map out a patient to find out where their genetics are and what specific treatment would be for those specific problems of changes in their brain.

 

I think that is going to be coming in the future and I think that sounds to be an exciting new form of treatment that can be very effective for those who have those issues.

 

Zach: Sort of genome-based treatment?

 

Dr. Saddoris: Yes, genome-based treatment. Exactly right.

 

Zach: I’m curious to know as well from you if in your experience, the study of the genetic piece if you’ve seen…can you explain a little bit about the epigenetics factors and how those, I was thinking about trauma and how that can also catapult some into it?

 

Dr. Saddoris: Definitely, definitely. I think a lot of people have struggled with epigenetics. I think even as a physician who has studied epigenetics was like, “Wow so that makes sense,” because epigenetics is that the gene sequence is the same. Nothing has changed on that, but what we seldom realize is the body has built-in ways to have us adapt to the environment. They do that by adding certain proteins to the gene sequences.

 

It hasn’t changed its sequence but it changes the way it twists or configures itself. When it twists it can have certain areas of the gene transcribe certain proteins or prevent certain proteins from being produced. When someone has had a lot of trauma in their life or a lot of what they call adverse childhood experiences these changes can be permanently in their life but it can also be passed on to future generations.

 

I think that part is like wow. We used to think is it environment or is it our genes and what we’re finding is both are inherited. Your great-grandfather who maybe has suffered severe problems is now affecting you and how you respond to stress and how you respond to problems and how you cope with things. I always remember a statement; every generation seems to be worse than the previous one. Now you kind of know why because we carry our baggage with us genetically.

 

Zach: Thank God for the things that we have now today in the clinical world to help with dealing some of those traumatic experiences, EMBR being the first comes to mind. That wasn’t the case a hundred years ago certainly.

 

Dr. Saddoris: No, no, how do we handle those changes and find better coping mechanisms and that takes time and practice and a skilled therapist who understands how to do those.

 

Zach: In your practice what would you say the two types of alcohol use disorders you see are in patients? How does treatment differ between the two of them?

 

Dr. Saddoris: Yes, definitely. I think that when we treat alcoholism, getting through the acute withdrawal part I don’t really stress because there are so many protocols out. The big thing is the time you stay off that alcohol and I think assessing how do the alcohol use pattern helps me determine a potential treatment.

 

They have type one which is type one or class A. That typically is a later onset at starting alcohol and later problems. You see after age 25 they start drinking more heavily and around 30’s or 40’s they really start having some issues, relationship problems, work-related problems. This is more slow progression. They don’t tend to be novelty-seeking and they have less fighting.

 

We find that in women and then also in older men seem to respond to what we call SSRI which is Selective Serotonin Reuptake Inhibitor such Paxil, Zoloft, Prozac, Celexa, those class of medication seem to be very helpful in a fair number of people suggesting maybe there’s a component of depression that might be contributing to that.

 

The type two is the one that is inherited. They start at a very young age with very heavy drinking. A lot of times they’re also taking other multiple drugs with it. They’re really impulsive, risk-taking. They always want to seek something, to do something new and exciting. There might be a lot of violence involved.

 

This is the serotonin blocker that really helps that. They’ve done a lot of studies on Zofran and IVIG Zofran a lot and has had great success in reducing the cravings. I have a lot of people say yes. One guy said, “Oh I didn’t think it was helping me that much because I was doing great. I didn’t think I needed it.” A week or two later he started drinking again. He said, “I need to be back on it.” It does definitely have a big influence on people to help them with that.

 

I think most importantly is that we also need to assess what other treatments that we need to help them reduce their cravings. The FDA has three approved treatments out, the disulfiram which is Antabuse. I don’t personally use that.

 

The only studies that I have really seen as being beneficial and you probably have encountered this being a family therapist, if you have a couple and they’re undergoing family therapy and they have written abstinence agreement and the one member that doesn’t drink is making sure that that person who’s taking the Antabuse every day, that has shown to be successful, but just writing them a prescription for Antabuse most likely they don’t take it or they do take it they get severely ill from it and they don’t want to take it again.

Zach: To your point, it comes back to this idea of addiction being a family disease where the people who maybe weren’t drinking are also, I’m going to use maybe some controversial vernacular here, but they’ve been infected by the disease, so to speak. They’ve been around the user, the person who’s been abusing, using for weeks, months, years at this point.

 

Their way of dealing with the dysfunction has been dysfunctional so they have to now learn a different way of living which tips and off balances the entire dynamic of the family. Readjusting, recalibrating that dynamic does take time and it takes work. To your point, it’s not just the addict or the alcoholic, the substance user who’s in recovery.

 

Dr. Saddoris: Oh definitely. I think the family a lot of times struggles. They say it’s their problem and they don’t realize how they’re contributing to that problem.

 

Zach: Absolutely.

 

Dr. Saddoris: They have to relearn how to communicate with each other in an effective way without judgement and all the other things. Yes, I think family therapy in that setting is very helpful; but otherwise, I don’t find the Antabuse has been helpful. Campral acamprosate is also an FDA-approved drug and that has been shown in European studies to help reduce the recurrence…increases abstinence.

 

They have not seen that to be so in the United States. They did a huge study and it didn’t really show to be any more benefit than 12-Steps or something like that. I think part of it is that you take it three times a day. To be honest with you, anytime you’re told to take something more than once a day is really a struggle for people to be consistent.

 

Zach: Sure it is.

 

Dr. Saddoris: Of course Naltrexone which has been proven to be superior to all the treatments. They did a big study called the Combined Study and I love that name because it means that they truly did combine all kinds of modalities. They combined a lot of motivational enhancement therapy. They combined kinds of behavioral therapy which is kind of associating how your thoughts affect your emotions and how those things can affect your behavior.

 

They’ve also done a lot of assessments with that and also in combination with the Antabuse, the acamprosate, and Naltrexone in different combinations. What they found is Naltrexone alone with medical management, just seeing your doctor seeing how you’re doing, show an interest has been superior to any of the other combinations. The acamprosate was found to be no different than going to 12-Steps.

 

I think that the biggest problem with Naltrexone though is that for a person who’s taking opioids that is an opioid blocker so you’re going to throw them to severe withdrawals. You can’t use it in that population.

 

Zach: If they can get past the withdrawal part though, the ten days or so that they need to be opiate-free right?

 

Dr. Saddoris: Sometimes they need a lot longer than that depending on the opioid that they’re taking.

 

Zach: Yes

 

Dr. Saddoris: Maybe heroin which is short-acting but some long-acting ones they might be a lot longer and so that makes it a real struggle.

 

Zach: Sure.

 

Dr. Saddoris: It does definitely reduce cravings and increase frequency and reduce heavy-drinking days but it kind of uncouples the pleasure that you get from drinking from the actual act.

 

Zach: I like that word “uncouple.” That’s a great way to put it. Yes, yes.

 

Dr. Saddoris: It’s a learned behavior in part so you’re kind of unlearning that behavior on an unconscious level.

 

I’d like to address the protracted withdrawal syndrome. I think we get people off the alcohol. They’re doing relatively okay for a couple of months. They’re still struggling a lot. They’re having restless sleep, getting a couple hours of sleep. They’re having nightmares because they’re trying to catch up on REM that they lost with the drinking.

 

They’re very irritable. They’re very anxious. They have a lot of mood swings. They can’t stand being around themselves. Nobody can stand being around them either. Sometimes they get to a point they just can’t stand any longer and drink just so they can get some sleep.

 

For those people that are having that protracted withdrawal because the sleep disturbance can last a year. That’s a long time to go without sleeping. They found Gavitamton has been very beneficial in significantly reducing that. I’ve had a lot of people that have done phenomenally well by giving them Gavitamton. Usually you need 300 milligrams three times a day or 400 milligrams three times a day trying to get them a high enough dose. A lot of people tend to lower the dose. It doesn’t really help them at that level.

 

Zach: Got it.

 

Dr. Saddoris: That helps.

 

There’s all this atypicals that are not FDA-approved but have been beneficial – a lot of certain anticonvulsants but the biggest one we mentioned was that Zofran, that blocker and the anti-depressants.

 

I do want to talk about one treatment that I have found to be very helpful and it’s called the Sinclair Method. This is where we have people that they want to reduce their alcohol intake and they maybe like to get more control of their alcohol intake but they don’t really want to go through the withdrawal because the biggest problem with withdrawal with people constantly wanting to get off and then restarting, want to get off, restarting is every time the withdrawal becomes worse and worse and worse.

 

It can get to a point where they can start having seizures and what we call DT’s and actually ten percent die from it. I think a good 80 percent of alcohol incidents are in the state of I really don’t want to stop but I would like to have less intake for health.

 

What the Sinclair Method is that you give them Naltrexone but not in the morning. You have to take it like an hour before they normally would start drinking and usually it’s either 50 to a hundred milligrams and what it is is they take it in the morning, by the time the evening happens it’s too weak so when you’re giving it to them so it gives them the maximum blocking of the pleasure that they get from it.

 

What they find is in about three months they have about a ten percent reduction of alcohol intake which it doesn’t sound that impressive but in three years they’ve had 80 percent abstinence and the other 20 percent significant reduction. I have one guy. He was drinking three-fifths of alcohol every night.

 

Zach: Oh my God.

 

Dr. Saddoris: Yes. Right now he’s down to one-fifth of alcohol a night after about three months. What we do is we just gradually start reducing the amount. He has no protracted withdrawal because he’s not going cold turkey.

 

Zach: Sure.

 

Dr. Saddoris: He’s not having any withdrawal symptoms. Sometimes as we get lower if they have a family member that can just put out this is how much you can have drink for a night, you can only have six beers and they just leave that out; we work on their state of thinking like just because one night you didn’t drink all six, you can’t then decide you can save those two and drink the extra the next day. This is your maximum that you can have per day.

 

Every month and as we get closer to lower doses we prolong it out to a couple of months, three months of slowly declining the amount that they consume. A lot of times they’re cutting back themselves, but what they’re seeing is success. When I said “Wow. That is fantastic,” he will drop from two of those fifths a night down to just one, from three to one. He says, “Wow. That really made a difference. Someone mentioned that to me.” I said “Yes. This is progress. You should be very happy with yourself.”

 

I think the biggest problem is that a lot of treatment providers have “This is the way it is. It’s my way or the highway,” and naturally they’re going to leave because you’re not meeting them where they’re at and where they want their goals to be. Even if this person never drops down less than that, he’s just definitely in better health than if he was with the other dosage.

 

That’s why in seek treatment is that they have to be individualized. We have to have shared goals that we kind of communicate and we discuss and we negotiate. I had one guy that said, “I think I’m going to go from the 45 beer down to the regular beer because I’m drinking five drinks and I start to drop down to four.” I said, “I don’t think that’s a good idea because you’re dropping down significant amount of alcohol intake per beer. Why don’t we keep the same amount of five but at a lower strength?” I explained why.

 

We’re in kind of contract negotiation every time we see and it’s mutually discussed and so that we’re both on the same page. In that way I’m just trying to slow them down so that he doesn’t have a failure and then give up.

 

Zach: Yes. It sounds like the patient is more bought in I think to the process.

 

Dr. Saddoris: Yes. They are bought in to the treatment because they are. They are actively engaging what I think I can do. They say, “Doc, I don’t think I’m ready to cut back.” I say, “That’s perfectly okay. Let’s go ahead and see about it in another month and see how things are going.”

 

Zach: Are there instances where you think that method wouldn’t be effective like if certain substances or rates of use, things like that, anything like that?

 

Dr. Saddoris: I don’t recommend that for somebody who’s already successful with abstinence. I wouldn’t say, “You can go back and drink and we’ll go do this.” No. That’s never good.

 

Zach: No.

 

Dr. Saddoris: If you’re doing fine with what you are and where you’re at, do that. For somebody who just doesn’t want to really stop or had such failures that they’re so discouraged, this is a way of getting them to try, that we try it in a gradual way and they can see success and they start building confidence and they start seeing hope because hope is so critical in recovery.

 

That’s what I always try to instill in people — hope. We can do this. We can adjust it. It’s no big deal. If it’s going slower than you think, we’ll eventually get there. It doesn’t matter if it takes us a year or five years, we’re going to be there. Okay? Little steps build up to big steps.

 

Zach: Absolutely. I can see also how it cuts back on some of the ambivalence. A lot of people who have problems in substances come in with like, “I kind of want to change. I should. Maybe I can. Maybe I can’t.” That’s interesting. I have to take a further look at that, Dr. Saddoris. That’s great.

 

Dr. Saddoris: Yes, the Sinclair Method. Yes. For a lot of people that are “Abstinence this is the only way to treat alcoholism,” they hate that. They’re missing 80 percent of people. We take things where they’re at and we just try to improve them for health, to make them so that their health wise is doing better and their life is better and they have less struggles in their relationships.

 

Zach: I can’t thank you enough for coming on the show with us today. I really do appreciate this.

 

Dr. Saddoris: Oh, it was such a pleasure. If you ever need me again, I’ll be more than happy to go on other topics. Like I said I treat all kinds of addiction.

 

Zach: Absolutely. Thank you.

 

Dr. Saddoris: You’re welcome.

 

Zach: If you know someone struggling with an addiction and are searching for answers, visit us at landmarkrecovery.com to learn more about substance abuse programs that are both saving lives and empowering families.

 

Until next week, I’m Zach Crouch with Landmark Recovery Radio.

 

Thank you for tuning in to Recovery Radio. New content for this program is available every Tuesday at 12 NN Eastern Time and 9:00 AM Pacific Time with all episodes available on demand on the Voice America Health and Wellness Channel and through our content partners: iTunes, Stitcher, TuneIn, and Google Play podcast. Please remember to subscribe, rate, and review so we can continue to create quality content to help save one million lives in the next 100 years. You don’t need to struggle through addiction alone. Live the life you’ve dreamed on the road to recovery.

 

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