The Rehab That Teaches You How to Drink Safely
Is moderate drinking a realistic treatment goal for drug users and heavy boozers? The Fix visits a radical Beverly Hills rehab to find out.
“Notice where the door is,” says Koorosh Rassekh, in a soothing tone, as Erin, a 26-year-old woman in a red hoodie and skinny black jeans, settles her rangy body into a brown leather armchair. “Begin to allow your attention to wander inside. You have no task or goal at all, for just a few moments.”
With that, Rassekh—director of mindfulness for Alternatives, a new outpatient rehab in Beverly Hills—rings a singing bowl three times. Erin, a recovering heroin addict who’s been in and out of treatment, stills herself as the bowl’s chime fades out into the sound of the whooshing air-conditioning.
This isn’t a traditional rehab. If it were, Erin wouldn’t be here. After picking up heroin at age 22, she went to detox two years ago, and then checked into an abstinence-only rehab in Lancaster, California. While in treatment, she was 13th-stepped by a 44-year-old married woman.
“Our hope is that by making a service like ours available, people who are struggling with substance abuse won’t have to go down the road so far. Why wait until someone hits rock bottom?"
“This woman was sponsoring all of my friends’ sponsors, and she had clout and the trust of the house manager,” Erin says. “It was a real shitshow. There was a lot of hypocrisy. It was common knowledge that staff were loaded.”
Nevertheless, Erin did all right for a while, living in a sober house for three months and then moving back home. But three weeks prior to our meeting she relapsed on heroin. “My mom walked into my room and found some dope,” Erin says. “She was like, ‘You have six hours; pack your shit and get out.’”
After two nights out of the house, Erin had had enough. She called her mom and told her she wanted to come home. Her mom said OK, but only if she re-entered treatment, which Erin was opposed to. Then Erin’s mom found Alternatives.
“At our first meeting I was like, ‘Fuck this,’” Erin says. “‘I don’t need to go back to treatment. I just used one time.’”
But after speaking for about a half-hour with Dr. Adi Jaffe, Alternatives’ 36-year-old executive director, Erin started to come around, as she saw that they weren’t going to use humiliation or shaming to “motivate” her, as she felt other treatment programs had done.
“What they in rehab were using to try to help me in my recovery was pushing me to the brink of relapse,” Erin says. Those methods might help some, but they didn’t work for her. That’s where Alternatives and Dr. Jaffe’s approach comes in.
“We don’t believe a single course of action is ultimately the kind of thing that works for everybody,” Jaffe tells me. Alternatives allows its clients to choose alcohol-based moderation as a treatment goal, as part of a two- to six-month program. Half of the 10 clients the rehab has had since opening in Februrary have come in for drug and alcohol abuse, while the other half struggled only with booze.
If a person wants to stop using cocaine, for example, but to moderate their alcohol use, Jaffe says, “We’ll work very hard with them on seeing if they can indeed moderate. If they can, everybody’s happy. If not, we adjust goals as we move forward.”
One thing Alternatives does not do is help people who want to use cocaine, heroin, or other illegal drugs moderately. The main reason is that the exposure piece of the program—the supervised reintroduction of alcohol—can’t be done with illegal drugs. “I don’t want to promote breaking the law,” Jaffe says.
Still, Alternatives has helped one client who said he wanted to learn how to use alcohol, Xanax and cocaine moderately. Although they couldn’t help him with the latter two chemicals, “We teach our clients to cope with life in a way that doesn’t rely on substances,” Jaffe says. “We followed our usual program, and only did reintroduction of alcohol.”
This is a highly controversial approach. But Jaffe and Alternatives’ clinical director, Dr. Marc Kern, a garrulous gray-haired man wearing a polka-dotted tie, who speaks to me in his office, don't see it that way. “We’re just another path,” Kern says.
Kern graduated with a doctorate in clinical psychology in 1982 from the California School of Professional Psychology (now Alliant University), and began interviewing at various addiction treatment centers. In those interviews, he said he believed addiction was a coping mechanism gone awry. At the time—during the 1980s, when the addiction treatment field was in its infancy—this did not go over well. “They said I was going to murder people with this diagnosis.”
It’s a common criticism leveled at moderation-based treatment programs—which, according to Kern, are offered by only three or four other clinics in the US—and Alternatives has in fact received “a lot of hate calls,” says Jaffe. But he and Kern see their approach, and Alternatives’ mission, as simple common sense.
“Our hope is that by making a service like ours available, [people who are struggling with substance abuse] won’t have to go down the road so far,” says Kern. “Why wait until someone hits rock bottom?"
The mental-health field is beginning to see it this way, with the new edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), aka the “psychiatrist’s bible,” for the first time grouping substance abuse and dependence into one category, “substance use disorder.” Individuals will now be diagnosed, according to their symptoms, on a spectrum from “mild” to “moderate” to “severe.”
Jaffe cites numbers which suggest that only 15% of people who meet the criteria for substance use disorder seek treatment—and only 10% enter treatment. That leaves 80% to 85% of people who struggle to some degree with substances who are not being served by the system. Says Kern, “There are millions of people who need an incremental education with respect to addiction and use problems.”
At Alternatives, the way this education begins for everyone—whether or not they desire to return to moderate drinking—is with abstinence. A successful client will abstain from not only drug use but also drinking during their first month of treatment. Those who can’t make a month, or who later go back to unhealthy drinking, are returned to the initial, abstinence-only treatment phase—which is where Erin is now.
“I never had a problem with alcohol,” she tells me. “I’ll have a beer or two at dinner, but I hate the feeling of being drunk.” Erin also reveals she was a long-time pot smoker. While she grants that she “probably will” smoke weed again in the future, she doesn’t think she’ll ever be a “stoner” again. “I like not feeling cloudy,” she says.
So how does an Alternatives client move from abstinence to moderate drinking? The answer might shock abstinence advocates: They take you to a bar, and sit with you while you have a drink.