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EP 09: A Better Question with Dr. Adi Jaffee
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- Опубликовано: 12 окт 2017
- Dr. Adi Jaffe, Behavioral Neuroscientist and Ph.D. joins Annie Grace in discussing 'The Abstinence Myth'. Dr. Jaffe gives his insight into prescription medications for reducing drinking and finally Dr. Jaffe and Annie decide that there is question to ask ourselves than: "Do I have to stop drinking?"
Introducing Dr. Adi Jaffe
Dr. Adi Jaffe is the person that really ignited my newest project, The Alcohol Experiment. Dr. Jaffe and I were both speaking at a conference, The Harm Reduction Conference, last November in San Diego. We sat down over coffee and some of the stuff that he told me about the landscape of just America, and drinking, and people seeking help, and all of these things just blew my mind. It launched me into the entire project that I'm now calling The Alcohol Experiment which was which was amazing.
McLellan Pyramid
Tom McLellan, is honestly probably one of the top five addiction researchers of all times. He has created the McLellan pyramid. It shows the fact that at the top of the alcohol use problem is this peak of people who struggle with drugs and alcohol. That's where we put most of our focus. If you talk about alcohol something like 60 percent of Americans are current drinkers. The vast majority of them don't struggle with things at all. But about 25 percent of the population fits into the area where there is some kind of struggle with their drinking.
Alcoholic
Another 10 percent or so are what we would typically call alcoholics, the clinical term in DSM is alcohol dependent. At the peak of the peak of the peak, all the way at the end are these people that actually go to treatment, because only 10 percent of people with alcohol use disorders actually end up in treatment. So we've kind of been developing this entire system for lack of a better term the worst of the worst kind of alcoholics and the vast majority of people won't engage with the kind of system that we have. What we know is typically the vast majority of people who engage with the system don't do very well.
A Continuum
The idea that alcohol problems actually run along more of a continuum than this kind of "Yes, you're an alcoholic", "No, you're not an alcoholic" has been around for a while but hasn't changed the treatment modality at all. So people make up all these crazy, stupid names for it. Like you're a 'high functioning alcoholic' or you're a 'high bottom drunk' or whatever all these ridiculous terms are to essentially say you don't look like the other people we expect you to look like. The solution is always still the same. You know, whether you're the housewife who drinks four glasses of wine a night and is kind of saying, I want to cut down to two, or you're a homeless, ex-executive who lost his job, his wife, and his car because of his drinking and has been homeless for 15 years, the treatment we offer you is exactly the same. And that is just insane to me.
Recovery
When you start looking at statistics in terms of recovery, you see that something like 75 percent of people who meet criteria for having an alcohol use disorder at one point in time, when you go and survey them back, don't meet criteria later on in life. About a quarter to a half of those people don't meet criteria, but aren't abstinent. So somewhere between a quarter to half of people who struggle with alcohol, figure out how to drink in non-problematic ways down the line. And that's something that nobody ever talks about. So we're left with this system that pushes one way of doing treatment as the only solution. If you don't buy in, you're in denial. You don't understand how big your problem is and you need to be coerced. On the flip side we have a lot of people who just won't engage and a good number of them are getting better.
Find Out More
Keep listening to find out more on what Dr. Adi Jaffe has to say on treating alcohol use disorders and what the better question we can ask is.
This articulated everything I've been feeling since I quit drinking a couple years ago. My life was flipped upside down and I decided I needed to quit. After going through AA I was left even more battered then when I had walked in. I have been researching, reading books, watching documentaries, and analyzing my whole life since. My hope was to try and figure out what happened and why because my behavior at the time did not match my core personality. So many factors go into dependency and I feel like you have validated every bit of time I've spent figuring out my own truth and potential future. Thank you both so much for being progressive and open minded! I have no doubt you will touch many, many lives with this information. I applaud you!
Would love to hear how you're doing now!
Thank you for this Adi . Years of sat in the rooms . When I spoke up , people I'd known years turned against me , I said in a meeting iv been clean years and I'm depressed 😢. That silence you talk about happened . It was always the same , you need more meetings , you need to finish step 4 , I saw a close friend kill himself cos he cudnt stay clean , he felt a failure , he wasn't . The self righteousness of people cringed me . I was told if you leave ul use . And I did . I did , again going bk to rehab . Then I found Anna s naked mind it changed my life . Thank you both of you ❤️
Honored to have been able to help you!
Annie- thanks for the book and podcasts. I'd like your take on something -
There's no arguing that some progress is better than none, and that once someone has cut back from an extremely excessive intake, the drinks they "saved" can't be taken from them. They've spared their body/mind/soul the damage of those drinks-not-drunk, and that's a good thing.
However, as appealing it may sound on the surface, Dr. Jaffe's views are fundamentally different than what I understand your perspective to be on alcohol, and what my perspective has come to be since reading TNM (and now having over a year of sobriety myself- thanks!).
Dr. Jaffe's view seems to implicitly view alcohol as a fun thing that confers benefit, and for some people an inherent part of who they are. Therefore, consuming it is an activity worth dedicating real work to preserve, even if it's just a little bit, for people who don't want to abstain.
Now, I know he said a lot of stuff (some of it was fairly contradictory, to be honest), and he leaned hard on the "let's be realistic and take people as they are", and "we shouldn't make people ashamed" thing, but if you see alcohol for what it is (a poisonous, non-essential and non-nutritive substance that in any amount is detrimental to a human's mind/body/soul, and given enough exposure leads to addiction, death and any number of terrible collateral outcomes along the way), then the notion of going through a process in order to continue consuming at reduced levels is asinine.
I found it frustrating how he framed things in terms of unassailable (but empty) platitudes about shame, being who you are, progress not perfection, the dangers of an "all or nothing" approach, etc. At 38:30-39:00 he says things like "a lot of people don't agree wit the goal that abstinence as the ideal" and he asserts that it leads to judgment (who could be pro-judgment?), and that he "isn't a big supporter of telling people what to do just because we've decided its good or bad". Uhh, letting the person with the drinking problem (someone with a compromised brain) dictate the terms and goals of treatment sounds all cuddly, but makes no sense.
He then analogizes abstinence to dunking a basketball or height, as if some people are just born to drink, and asking them to abstain is the equivalent of asking someone short to dunk (i.e., to do something they naturally cannot do, therefore the demand is cruel and doomed to failure). Seriously? The alcohol just jumps into their mouth and they're powerless to resist it?
No, as laid out in TNM, abstinence is FREEDOM, and having the right mentality and paradigm is key to making the shift. This is universally true, even though some people may have less of an issue with alcohol than others based on the biology/psychology.
While cuddly and appealing on a surface level, Dr. Jaffe's more permissive view is dangerous and more often than not will not solve the underlying problem- how one's subconscious views alcohol.
Lastly, I think there's a distinction to be made between what approach he might take with a patient in a one-on-one context, vs what is preached more generally to the public. Of course, if you have a patient on the edge, bringing them back from that with the carrot of moderation could make sense to avoid near-term harm. Outside of that, giving people the option of moderation sends the wrong message to people who are trying to rationalize continuing to drink.
TNM is about not having the desire to drink. There are however those that can practice moderation and occasionally imbibe. I'm not against that. There are other non-nutritive substances that can also be indulged in occassionally. Do I need those french fries? Probably not but I'll indulge anyhow. We are all human after all.
wartimemodels I agree with you. What the book recommends and what this professor says are different. It is about being totally free, just like we did with cigarettes (I did that 21 years ago and I am so happy about it). Not everyone will be able to become totally free overnight and that is ok, but the goal needs to be crystal clear. @Annie: please don’t back pedal...the message in your book is right!
This Naked Mind I am new to TNM (have been listening to the podcast) and I am so excited to read the book and continue
Omgsh, what an awesome way to think about this. I want to see more of Dr Jaffee. I wish I could work with
you Dr Jaffee about perfection and and a bad neurological disorder plus lupus that requires opioids b/c I am unable to take any NSAIDS.
THANK YOU Annie Grace for your podcasts
He is awesome!
🤯🤯🤯🤯🤯🤯 how have I never heard anything like this before!
Glad it came when you needed it!
I remember RIP Beth Solomon said meetings were
actually harming her. “When the treatment becomes worse than the original ailment, it should be clear that it is time to move on. X
So important to find what works for you not blindly follow the status quo.
Do you recommend taking amino acid supplement to help recovery from addiction?
If you feel it helps.
Great answer
NAC, B-vitamins, protect your sleep. Naltrexone.