The Rehab That Teaches You How to Drink Safely - Page 2

By Hunter R. Slaton 06/11/13

Is moderate drinking a realistic treatment goal for drug users and heavy boozers? The Fix visits a radical Beverly Hills rehab to find out.

Seeking the middle ground. Photo via Shutterstock

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Of course there’s more to it than that. In the initial abstinence phase, Dr. Jaffe conducts “exposure work” with each client—the techniques of which come from methods used to combat anxiety or phobias. This means exposing the client to progressively more and more realistic representations of things which are troubling to them.

For Erin, who liked to smoke heroin in her car, that meant Dr. Jaffe going with her to her car, bringing tin foil with him, and sitting in the vehicle and having her handle the foil. They discussed the feelings that arose, to aid in the extinction process of associating her car with smoking dope. Later, Jaffe and Erin went to her home and repeated the exercise.

The process is similar for someone who wants to resume moderate drinking. “We walk with them to a bar, somewhere safe in Beverly Hills, and buy them one drink,” says Dr. Kern. “‘What’s that like?’ we ask them. ‘Have we triggered the desire for another?’”

I don’t believe anyone within 12-step programs is powerless. Ultimately we have to get the individual to take control of their problem. Abstinence is somewhat irrelevant if quality of life improves."

According to Jaffe, some clients do crave more, while others’ craving is zero. (Also, after their initial month of abstinence, clients are asked, before alcohol is reintroduced, whether they still want to drink moderately. “We don’t force it on them,” says Jaffe.)

Although it’s still a small sample size, about half of Alternatives' clients so far have done well with reintroduction of alcohol, while the other half have struggled, but eventually got a handle on it. Either way, though, “The level of craving is always lower than they expect,” Jaffe says. 

Patty, a 37-year-old married professional and mother of two, became a bottle-and-a-half-of-wine-a-night drinker after her brother’s unexpected death from a heart attack two years ago. Before her reintroduction event, she tells me over the phone, “I was apprehensive, because the last 30 days [when she was sober] were the best in the past two years. I was thinking it might mess up what had been going so well.”

She also was worried that after the somewhat staged process of sitting with Dr. Jaffe at a restaurant and having a glass of wine while he watched her, that she would go home and immediately want to drink to excess again. “I expected to want more,” she says.

But that didn't happen. At the restaurant, the pour of wine was larger than usual; she did not finish the glass. And over the following weekend, on a Sunday without much to do—a time when she previously would have reached for the corkscrew—she did not even think of drinking.

It’s worth noting that both Jaffe and Kern know where Patty, Erin, and the rest of their clients are coming from. Jaffe was a crystal meth addict who spent four months in jail before cleaning up in 2003 and going back to school for addiction treatment, while Kern was a daily drinker and a pill popper.

“I’m not abstinent today,” Kern tells me. “But I have not done a Quaalude in 30 years. I do drink, two to three times a month. But I no longer feel the pull that drinking used to exert on me.” Jaffe, too, reintegrated drinking in 2008, after three years of sobriety. He has not returned to crystal meth, nor has he ever felt compelled to do so.

Extinction—continued exposure to a trigger without the reward—isn’t the only way that Alternatives readies its clients to resume moderate drinking. Kern focuses on affect regulation, or learning how to change your feelings in a healthy way, while Jaffe emphasizes “structural scaffolding”: life skills, self-care, exercise and proper nutrition. Neurofeedback sessions with Dr. Andrew Hill and family work also are components of the program.

Prior to taking their clients to the bar, Kern teaches them how to ride out the drop in blood alcohol content (BAC) that results when they take a drink and then stop—a profoundly unpleasant experience for many with substance problems. “They love the going up, and magically think there’s some way to plateau the buzz,” says Kern. 

But there’s not. Everyone comes down eventually. Yet if what Alternatives has instilled in its clients works, then they may be able to weather that drop in BAC and drink successfully.

Who can potentially benefit from these methods? Apart from those who feel alienated by 12-step programs, “The people who come to us believe the notion that their use—even inappropriate use—is at least in some measure under their control,” says Jaffe. “And they want to regain that control.”

It goes without saying that 12-step philosophy, whose very foundation (aka the First Step) rests on the powerlessness of the alcoholic or addict over his or her substance of choice—and, some might argue, over anything at all—is not in agreement.

“I don’t believe anyone within 12-step programs is powerless,” says Kern. “Ultimately we have to get the individual to take control of their problem.” Some might contend that, if this works for a person, then he or she wasn’t “really” an alcoholic to begin with.

But that distinction is meaningless, in Kern and Jaffe’s opinion. And regardless, “If our system doesn’t work, we can offer them a more abstinence-based approach,” says Kern, who notes that all medicine is harm reduction. “Abstinence is somewhat irrelevant if quality of life improves,” he adds.

One early client who had been overdrinking three to four times a week, and who finished the program in February, now has “an extra glass or two of wine every couple of months,” according to Jaffe. While the woman occasionally drinks more than she intends to, it’s “a world of difference” from where she was at—and she is satisfied.

Erin’s quality of life has improved as well, without any admissions of powerlessness or turning over her will and life to the care of any higher power required. In fact, she seems like she’s on a “pink cloud,” to use a piece of AA slang.

She tells me a story about a recent interaction she had with her old drug dealer. “I had been in loose contact with him,” she says. “But I totally cut him out. He felt like I owed him, but I was like, ‘I don’t have time for negativity and drugs any more. If you wanna get off dope, hit me up.’”

Soon after this revelation, the guided meditation session begins. Rassekh intones, “Try to become the observer of your breath. Whether it’s short or erratic, your breath is absolutely perfect the way it is now.” Toward the end of the session, there is a long period of silence, with only the white noise of the air-conditioning.

Hunter R. Slaton is The Fix's Rehab Review editor.

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Hunter Slaton is the esports managing editor for Blizzard Entertainment. You can find hunter on Linkedin or follow him on Twitter.