One Pill or Twelve Steps?

By Jodi Sh. Doff 04/15/15

Who needs AA when you've got naltrexone? Anyone with a screaming void in their core that they've filled with alcohol, of course.


People have strong feelings about Alcoholics Anonymous—it’s that program we love or hate, it’s everything or it’s nothing. A recent Atlantic article that lauded the drug naltrexone while denigrating 12-step recovery is part of the growing firestorm of anti-Alcoholics Anonymousism.

 When people of like purpose gather together, they’re stronger. That’s simply a fact. 

Naltrexone was developed 20 years ago to treat drug addiction because of the way it competed with opium, heroin, and morphine for the opioid receptors in the brain—those tiny little receptors that can bring you oh-so-much pleasure, or so much pain. Based on the theory that if it could also stop the endorphins released by alcohol from reaching those same opiate receptors, it would reduce your urge to drink and gradually your cravings would subside. You’d learn to control your consumption and be free of your alcoholism, right?

But craving Georgi or Jameson isn’t the problem. Stopping is not the problem. And really, even drinking is not the problem. Drinking, as every alcoholic knows, was the solution. Alcohol helped us feel whatever it was we didn’t: brave, beautiful, handsome, smart, funny, enough, attractive, older, younger, bigger…better. Even those of us who wound up vomiting it all up on ourselves remembered the part where it made us feel better for a while. When it worked, booze made the pain go away. It made us more of who we wanted to be.

Most alcoholics don’t even start thinking about rehab, or detox, or AA until the day comes when they drink and it doesn’t work. When that happens, if you’re an alcoholic, you’ll take another drink, and another, and another because if the booze has really stopped working, it’s just you and that overflowing barge of shame and garbage and fear floating around inside you. When the booze stops working, you are left with no way to quell that screaming void in your core. That, my friend, is a problem.  

Naltrexone stops the booze from working—it speeds up the inevitable.  

You can’t take away a person’s solution—even one that doesn’t work anymore—without offering them something else, some other way to handle whatever the problem was that left booze as the solution. Alcoholics Anonymous doesn’t claim to be the only way to stop drinking for everyone, but for millions of alcoholics AA has been that something else that has made the post-booze difference between a life worth living and one that is not. The spiritual aspect of AA—what detractors label religious or cultish—the part that all the finger-pointing always seems to focus on, is not necessarily religion or prayer. Some recovering alcoholics are active in organized religion, attending services at their church, temple, mosque, or synagogue. Others find they’re more comfortable with something smaller or more intimate such as private prayer, a regular yoga practice, nature walks, meditation, or music.

It can be as simple as being part of a recovery community—a gathering together with people who are alike in one essential way: they understand what it feels like to need a drink, several drinks, something, anything, to get through, sometimes, something as simple as putting on your makeup. When people of like purpose gather together, they’re stronger. That’s simply a fact. You see it in the success of everything from cancer support groups and bereavement groups to armies. Recovering alcoholics in AA come together in that place where no matter what our outside circumstances, our inner lives intersect. This is the place in our lives where we need support, we learn to accept someone else’s experience and advice, where we come to know for sure that we’re not the only one out there struggling with fear, darkness, alcohol, self-loathing or self-doubt. 

You’d better believe if we could do it alone, we would. If we could take a pill, or an injection, or slap on a patch and be done with it, we would. What’s missing from most medical equations is that “bridge back to life” part those AAers are always going on about. What the alcoholic needs help with more than putting down the drink is living life without the drink. Sans buffer between ourselves and the outside world, and even more so, between ourselves and our inner world. The inability to be in one’s own skin is a hallmark of the stories you hear repeated when you listen to alcoholics talk about life without a drink. The drink enabled us to do that, wear our own skin out in the world.

In general, alcoholics haven't a single clue how to just be in a social situation without booze, or pot, or Valium or something; how to be comfortable in their own skin and not drown in self-hate or shame. Alcoholics Anonymous is a set of instructions for how to get through the process, heal, and then pass the knowledge on by helping someone else going through the same thing. Those instructions are best passed on through the community—the fellowship—of recovering alcoholics who have already done the work. More than a century before Bill Wilson met Dr. Bob Smith, before either of them were even born, Native Americans had “sobriety circles” and encouraged recovering alcoholics to come together and get in touch with their ancestral heritage and beliefs. They understood that the alcoholic needs something bigger to believe in to stay sober, and bigger is only defined as bigger than the alcoholic themselves. The “we” part of the equation.

The program of AA as written down in the Big Book was the culmination of centuries of trial and error. There have always been cures and solutions—and what the right answer is depends on who you ask, and when. 

  • Ancient Greeks crafted wine glasses from amethysts believing that the gemstone would keep them from getting drunk. #AncientGreekFail
  • Inebriate asylums combined forced abstinence with opium, morphine, cocaine, ether, and chloroform to treat alcoholics and addicts in the 1860s. #BetterLivingThruChemistry #Fail
  • The option of pre-frontal lobotomies as a cure began in 1935. Think: Jack Nicholson at the end of One Flew Over the Cuckoo’s Nest. #RandallMcMurphyFail
  • The mid-1900s gave birth to Hazelden, the Minnesota Model, and the introduction of barbiturates, amphetamines, and hallucinogenics to treat alcoholism, as well as aversion therapy with Antabuse. The Hazelden model has worked for a lot of people, but better living through the wonders of LSD? #TimothyLearyFail 

Designed to take you one step at a time, like babies learning to walk for the first time, each step builds on the one before, to a life worth living. Only the very first of those steps even mentions alcohol. That’s where we admit we’re screwed, we’ve fucked it all up, possibly beyond repair and redemption. We know we can’t fix it, can’t fix ourselves, and quickly, or slowly, we take a second step and begin to believe that someone or something outside of us can fix our crazy.

And then, that giant third step, saying okay to that someone or something. Allowing ourselves a little bit of trust for maybe the first time in years and meaning it, even if hesitantly, we let go of having to engineer every little goddamned thing in the world, in our lives. We stop fighting—we know we’ve lost the war. Like Chinese handcuffs, the harder we fought, the harder it was to escape, but once we start to loosen our grip, everything around us relaxed. We surrender and we begin to be free. 

That freedom is found not in conquering our alcoholism, but in discovering a way to be right-sized in the world, the willingness to be a worker among workers, being neither above nor below anyone—being humble rather than humiliated. Getting comfortable in our own skin is a result of helping others and being of service in the world. Practicing being honest with ourselves and others to the best of our ability. We are reminded constantly—in meetings, by our sponsors, by the literature, and our community—to live in the now, neither obsessing about past mistakes nor living in some imagined future glory or destruction. Being right here, where we are. Look down. See those feet? That’s where you are. We reach out to hold someone’s hand, and we let them hold ours. Share a laugh, a story, our trepidation, or confusion, over a cup of coffee with someone we just met and feel like we’ve known forever. 

We come together to learn how to be together. 

Putting down the drink? Hell, we’d put down that drink every time we passed out. Don’t Drink. Go to Meetings. Help Another Alcoholic. Drugs like naltrexone can probably help with the first part of that standard AA chant, but it’s also where the help ends. Unless “combined with counseling or interventions like Alcoholics Anonymous,” medical treatments only offer short-term crisis intervention for the alcoholic.

With nothing else in his arsenal, the alcoholic will do one of three options: Go right back to drinking; pick up something else; or lose his mind. 

Jodi Sh. Doff has written for Bust, Cosmopolitan, xoJane and Penthouse among many other publications. Her last pieces for The Fix were about non-celebrity overdoses, the Hangover Club and powdered booze.

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Jodi Sh. Doff is a self-described scribbler, shutterbug, and succulent cactus. She writes about booze, sex, crime, and righteous feminist indignation. She is also an editor, script doctor and a ghostwriter for non-native english speakers. You can find Jodi on Linkedin or follow her on Twitter.