The Rehab That Teaches You How to Drink Safely

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

“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.

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.