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You know that sinking feeling when you wake up with a hangover and think: “I’m never doing this again”? We’ve all been there. But what happens when you follow through? Sonia Kahlon and Kathleen Killen can tell you, because they did it! They went from sisters-in-law, to Sisters in Sobriety.
In this podcast, Sonia and Kathleen invite you into their world, as they navigate the ups and downs of sobriety, explore stories of personal growth and share their journey of wellness and recovery.
Get ready for some real, honest conversations about sobriety, addiction, and everything in between. Episodes will cover topics such as: reaching emotional sobriety, how to make the decision to get sober, adopting a more mindful lifestyle, socializing without alcohol, and much more.
Whether you’re sober-curious, seeking inspiration and self-care through sobriety, or embracing the alcohol-free lifestyle already… Tune in for a weekly dose of vulnerability, mutual support and much needed comic relief. Together, let’s celebrate the transformative power of sisterhood in substance recovery!
Kathleen Killen is a registered psychotherapist (qualifying) and certified coach based in Ontario, Canada. Her practice is centered on relational therapy and she specializes in couples and working with individuals who are navigating their personal relationships.
Having been through many life transitions herself, Kathleen has made it her mission to help others find the support and communication they need in their closest relationships. To find out more about Kathleen’s work, check out her website.
Sonia Kahlon is a recovery coach and former addict. She grappled with high-functioning alcohol use disorder throughout her life, before getting sober in 2016.
Over the last five years, she has appeared on successful sobriety platforms, such as the Story Exchange, the Sobriety Diaries podcast and the Sober Curator, to tell her story of empowerment and addiction recovery, discuss health and midlife sobriety, and share how she is thriving without alcohol.
Your sobriety success story starts today, with Kathleen and Sonia. Just press play!
[00:00:00] Sonia: Hi, we're Kathleen and Sonia and you're listening to Sisters in Sobriety. Thanks for being here. I'm Sonia and I'm with my sister in [00:01:00] sobriety. Actually, my sister in law, Kathleen. Kathleen, how are you doing today?
[00:01:05] Kathleen: I'm good. I'm still in your kitchen. We're still together. I went for a very lovely walk this morning and I'm doing really well. How are you?
[00:01:18] Sonia: I'm really good. I love having you guys here. Cause as everyone knows, I live alone and so it is nice. I was so happy you were here because the carbon monoxide detector battery is low and the the beeping went off at 5.
[00:01:36] 30 in the morning and I had someone there to help me locate where it was coming from.
[00:01:40] Kathleen: You did, but I also think it's funny because you, at first, your thought was to blame me for the beeping. So you thought that, because I'm an early bird, it was actually like the only day I was going to sleep in was today, but I didn't. That's okay, that's okay. You were like, I thought it was you doing something weird and being up so early.
[00:01:59] I'm like, [00:02:00] why are you blaming me?
[00:02:02] Sonia: The fact that someone was in my house and the beeping went off had to be related. When in fact, they were not related at all. And so, I'm sorry that I
[00:02:15] Kathleen: Aw, that's okay. You made me laugh at 5. 30 this morning because you were like standing in front of the carbon monoxide monitor and waiting for it to beep again and you were like, Do it! Do it! You were like trying to will it, will it beep. So that's okay. I woke up the day laughing. So that's, that's good.
[00:02:34] Sonia: Okay, alright, I'm happy that was okay
[00:02:37] so joining us today is Jonathan Hunt
[00:02:39] Glassman, the founder of ORR. And ORR is providing people with the support and medical assistance they need to redefine their relationship with drinking through the use of naltrexone, which is a medication that can significantly reduce stress.
[00:02:54] The craving for alcohol and this service can be crucial for some and can help them reimagine the [00:03:00] path to recovery and our conversation today will provide some understanding on how naltrexone works, but also delve into some personal stories of transformation.
[00:03:09] Kathleen: So whether you're looking to change your own relationship with alcohol or a loved one is seeking support for someone in need or simply interested in the very innovative approaches to recovery, this episode is definitely for you. So grab a cup of tea and listen to our chat with Jonathan.
[00:03:26] Sonia: Hi Jonathan.
[00:03:27] Jonathan: Hello, it's great to be with you.
[00:03:28] Sonia: It's so good to have you here. So can you just start by sharing your journey and what inspired you to start a service focused on changing people's relationship with alcohol?
[00:03:38] Jonathan: Sure, I started Oral Health because in many ways I needed it. I struggled with alcohol misuse my entire adult life. What started as binge drinking in high school and college became a pattern of drinking to blackout in my 20s. And then as I saw peers start to grow up and put that sort of [00:04:00] excessive alcohol use behind them, The opposite was happening for me.
[00:04:04] I was starting to have multi day binges, experience the physical and mental health symptoms of withdrawal on the back end of those. And over those 15 years or so, it was no secret to me that I had a drinking problem. So I sought help in a lot of the places that first come to mind a therapy, primary care, the emergency department, um, and pretty much always heard the same thing, which was you need to stop drinking and start going to meetings, AA meetings in particular.
[00:04:35] And I gave that a shot, um, but it never quite fit and never really helped me achieve my goal to take back control over alcohol. What was much more of a turning point was connecting with a primary care physician. who suggested putting safe, effective FDA approved medication in the toolkit, specifically naltrexone, as you mentioned.
[00:04:59] And for [00:05:00] me, at that point in my life, it was exactly the tool I needed to achieve my goals.
[00:05:04] Kathleen: So can you describe what the historical approach you mentioned a few things has been to treating alcohol dependence and How it's evolved to include medications like naltrexone?
[00:05:16] Jonathan: Historically, modern medicine didn't have a lot to offer people who were drinking too much, or who we called alcoholics. And so, homegrown tools like Alcoholics Anonymous, that I'm a big fan of, and has helped millions of people recover from struggles with alcohol, kind of filled the gap. They, um, weren't necessarily evidence based in the sense that, modern medicine is, um, but they helped, and they worked, and so for a long time, those were the best tools we had, and so common practice for, Let's say a primary care physician who encountered a patient was drinking too much was to hand them a pamphlet, for mutual [00:06:00] peer support of some sort, 12 step programs, often with a religious component.
[00:06:06] And as I say, Really helpful helped millions and millions. today, those are still, uh, tools and the evidence has actually caught up and suggested that mutual peer support is helpful, to many, but today we also have a broader menu of options, including behavioral health care, whether that's therapy or coaching, um, and Prescription medication.
[00:06:28] And a lot of those tools can work together in very complimentary ways.
[00:06:32] Sonia: So, do you think that the medical community's understanding of addiction has influenced the use of these medically assisted treatments?
[00:06:42] Jonathan: Absolutely. I think the adoption of a disease model for addiction, thinking about it as a chronic brain disease. And the development and use of medication to treat addiction are tightly, tightly [00:07:00] interlinked.when we thought about addiction as a personal failing or a spiritual defect, it didn't make a lot of sense to study, develop, prescribe medications.
[00:07:12] Now that we think of addiction as a bit more of a chronic brain disease in the medical consensus, uh, it makes sense to treat it like other chronic diseases, often with a combination of behavioral healthcare interventions and prescription medications, along with lifestyle changes that people are able to make outside of the doctor's office.
[00:07:34] Um, And so those two things, yeah, very, very connected. We'vemodernized how we understand addiction and modernized how we treat it.
[00:07:42] Sonia: Yeah, so to take that moral Failing idea, which yeah, I love AA too, but I just cannot get behind the moral failing of it. . were the pivotal moments in research, that really advanced the acceptance of, medically assisted treatments for alcohol dependence?
[00:07:57] Jonathan: We could probably use all of our time [00:08:00] together tracing the history of the study of pharmacotherapy, for alcohol use disorder. But the landmark study that I think is most, important is something called the combine study, which took place in the mid two thousands. And, uh, this was a large clinical trial that, uh, tested naltrexone, a campersate.
[00:08:23] And what they called a combined behavioral intervention that kind of synthesized elements of cognitive behavioral therapy, motivational enhancement therapy, and encouragement of participation in mutual peer support. And then they tested all sorts of combinations of those interventions. So this actually ended up with.
[00:08:42] nine different arms of the trial, which is so unusual. If you follow clinical trials where normally it's pharma company a trying to prove that drug X is better than placebo. This was really interesting that they looked at multiple bonafide therapeutic approaches and the [00:09:00] findings were as such naltrexone effective in reducing how much people drank.
[00:09:07] Uh, the combined behavioral intervention effective in reducing how much people drink. Surprisingly, this particular trial did not find incremental benefit from combining, those two approaches, although there's certainly broader evidence and clinical experience to suggest that the combination can be helpful.
[00:09:26] And so this built on 20 years of research on naltrexone. But it was the loud call, at least for those who follow the evidence closely, that medication is a really effective tool in the toolkit. And if you look at the clinical guidelines, even today, they are pretty consistent with the findings of that study and the ones that have come since.
[00:09:53] Basically, when people are drinking too much, they should be offered medication. They should be offered behavioral interventions, if [00:10:00] they want to pursue a combination of them, fantastic. If they don't, feel ready or able at this moment to pursue one type of treatment, well, they shouldn't be denied, uh, the other just because of that.
[00:10:14] Sonia: So When you're talking about effective, we're not talking about abstinence, right? We're talking about reducing overall alcohol consumption, which alsodiverges from AA or otherapproaches
[00:10:24] Jonathan: yeah, there are different, endpoints, as they say, in the research and, um, certainly. Um, days, not drinking at all. Um, is an important one. but, days, heavy drinking is also important. Um, what our advisors have told us is that the harms associated with alcohol are fairly linear. in relation to the quantity consumed.
[00:10:47] So for any of us, the safest amount of alcohol consumption is almost certainly zero. but if that doesn't feel realistic, um, and somebody can move from very heavy drinking 40, [00:11:00] 50 drinks a week, to something closer. to the recommended limits for moderate drinking, that is almost certain to yield, uh, significant benefits in terms of health and well being.
[00:11:12] And for that reason, uh, or we've taken the approach of supporting, both moderation and sobriety as fantastic goals. The way I look at it is if we insist on abstinence as the only legitimate goal, that's going to serve as a deterrent to some people seeking treatment or sticking with treatment. And that ends up being self defeating.
[00:11:36] Sonia: Yeah. I totally agree with that. So okay, for people who are unfamiliar, can you just quickly explain, what naltrexone is and how it works for treating alcohol dependence? Yes.
[00:11:53] Jonathan: that with an indication for, treating alcohol dependence, uh, as you said, in other words, helping people drink [00:12:00] less or quit, the way that it works is it cools off the pleasure and reward, uh, that some feel when drinking to get a little bit more.
[00:12:10] Technical about it, it is an opioid antagonist, so it binds to a specific opioid receptor in the brain. And there are no opioids in alcohol, but what it does do is it blocks endogenous opioids produced by the body when drinking. and that's how it cools off the pleasure and reward. So alcohol may be less interesting, less appealing.
[00:12:32] If you do drink while taking naltrexone, it may get easier to stop after one or two drinks instead of feeling like you're on that runaway train. That's very familiar to me from my own experience. And then over time, as the association between alcohol and reward gets diminished, uh, cravings and time spent thinking about alcohol can diminish as well.
[00:12:55] Kathleen: Is it used for substances beyond alcohol?
[00:12:59] Jonathan: It is. [00:13:00] So it was originally developed as a treatment for opioid use disorder because of the opioid antagonist properties. It's been overtaken in clinical, practice, um, by, by other medications like Suboxone, for opioid use disorder. Those are the only two FDA indications. However, there are Suggestive limited research results that suggests it may be helpful with other sorts of compulsive behavior, and so it is sometimes prescribed by clinicians in their judgment off label, or things like overeating, um, gambling addiction.
[00:13:34] We need more, better, bigger research to. Get an FDA indication for those sorts of, uh, uses.
[00:13:42] Kathleen: How long has Naltrexone been used for alcohol use disorder?
[00:13:48] Jonathan: This is one of the most interesting things about the Naltrexone story. It was approved for treating alcohol problems in 1994, uh, 30 years ago. And despite that and the [00:14:00] evidence for its efficacy, its safety track record, its relatively benign side effects, it's still dramatically under prescribed, relative to the number of people who are struggling with alcohol problems and could likely benefit from it.
[00:14:12] Less than 2 percent of people who meet the diagnostic criteria for alcohol use disorder are prescribed any medication, intended to help them drink less or quit.
[00:14:21] Kathleen: Why is that? Is that perception? Is that stigma? Why, why is that?
[00:14:26] Jonathan: There's plenty of blame to go around. I think the, the, the big factor here is Naltrexone has been generic since after, or sorry, since before direct to consumer marketing of pharmaceuticals really became a thing. So there's no pharma company that has an economic incentive to make it a household name like Zoloft or Viagra.
[00:14:48] number two clinicians still don't get enough training in treating addiction relative to how frequently it's going to come up in their panel. And so that old practice of, Handing [00:15:00] someone an AA pamphlet, is still way too common. Uh, and then lastly, there are still pockets of the traditional recovery community that are a bit averse, to the use of medication.
[00:15:12] or may not have the capacity to prescribe. There's not a prescriber at the back of every AA meeting, as great as that would be. Even. Inpatient rehab facilities don't always have a prescriber on staff. The good news is I think we're making progress across all three of those dimensions, but the statistics show long way to go.
[00:15:31] Kathleen: Long way to go. And how is it used? Is it injected or is it taken orally?
[00:15:36] Jonathan: Naltrexone is available in both a tablet and an injection format. Um, at Oral Health, we only, prescribe the, the tablet form. That's a little bit more amenable to telemedicine. but there's also an intramuscular injection. Um, the good part about that is you only need to get the injection once every 30 days.
[00:15:55] the trickier part is it's not approved for self injection, so you need to go to a [00:16:00] doctor's office or in some states, a pharmacy.
[00:16:03] Kathleen: And so then the tablet form is that taken under medical supervision or how does that work?
[00:16:08] Jonathan: It can be if someone's in an inpatient facility, but for most folks, uh, no, it's something you can get started on, in the comfort of your home, and, certainly checking in with, uh, your prescriber on a regular basis about how things are going, side effects, response, dosage changes, administration schedule is a good practice, but this is something people can do, at home.
[00:16:30] Certainly helpful to build a medication routine, and incorporating a partner or a family member, into that if you want to enlist them in your project to drink less or quit is a great idea. Uh, but we also have members who've, you know, really done this quite independently, which takes some stick to itiveness, but is the right path for some.
[00:16:51] Kathleen: Okay.
[00:16:53] Sonia: I know the last time we spoke, Jonathan, as much as I know about alcohol and recovery, I really didn't understand the Sinclair Method. And [00:17:00] so I think there's probably a lot of people out there that also, don't, and for everyone it's about binge drinking, but, yeah, so my problem was not a, well, my problem was a daily binge drinking, not a, one off binge drinking.
[00:17:12] So what is the Sinclair Method and do you prescribe for that at work?
[00:17:18] Jonathan: The Sinclair method is a way of taking naltrexone in a targeted rather than a daily fashion. most of the large clinical trials that drove the FDA's approval of naltrexone for alcohol problems, a daily use, protocol. so that is the default, the standard. Um, in the United States in terms of how to take naltrexone.
[00:17:43] but there are many who have found success with the Sinclair method. The basics of it are take naltrexone at least one hour before drinking. and then the in parentheses after that is Don't take it at all on days that you're [00:18:00] not drinking. And those who followed the Sinclair Method, um, have reported, um, several benefits, that they have seen.
[00:18:10] Um, one, taking it an hour or so, before starting drinking means it's going to be at peak levels in your body, uh, when you're drinking. And then to what many people following the Sinclair method find is that over months, they reach something that they call extinction, meaning extinction of their desire to drink, which is incredibly powerful result.
[00:18:37] And there are, although the, weight of evidence behind daily use is, is quite strong. There is emerging, evidence to support targeted use of various forms, including the Sinclair method. There was a, a study recently, um, out of UCSF, that worked with gay men with binge drinking problems that basically instructed something very similar to the [00:19:00] Sinclair method.
[00:19:00] Take naltrexone when you know you're going to be drinking, worried that you'll binge and showed, quite effective results. My view, You know, based on the evidence available is that daily use and targeted use, including the Sinclair method are both legitimate uses of naltrexone with more in common than they have that separates them.
[00:19:21] Same basic idea. Take this medication, try to drink less. and so at or we do support members, um, who are, who are pursuing both the daily use and the Sinclair method pathway.
[00:19:33] Sonia: Okay, that actually brings my next question, which is, so what is a typical initial treatment plan at OR?
[00:19:39] Jonathan: So. It all starts kind of at oarhealth. com. Um, folks can learn more about alcohol use disorder and medication assisted treatment, including naltrexone. Uh, if they feel it might be a good fit for them, they can begin a consultation with a clinician licensed in their state right from the website. there are some questions about their drinking, their [00:20:00] general medical history, other medications they may be on.
[00:20:03] Uh, and then that's all reviewed by a clinician. There may be some follow up questions, some discussion. Uh, a typical treatment plan. typically includes two things. one is recommendations of psychosocial support that fit the members preferences. Most of those are not provided directly by or they're accessible in the members community, or in some cases online.
[00:20:29] The second component is a prescription, if medically appropriate, and we find that most people who've taken the step of coming to OR and setting up this consultation do end up, being good fits for the medication in the clinician's judgment. And then at the member's choice, they can either get that prescription filled at their local pharmacy, uh, or what a lot of folks opt for is the convenience and privacy of getting it sent directly to them.
[00:20:54] Sonia: so you just mentioned the,psychosocial support, so what is the ongoing, support [00:21:00] at OR after, the initial treatment plan, or what is the typical, time frame?
[00:21:06] Jonathan: So folks are You know, able and encouraged to come back and check in with their clinician as frequently as they as they need or want. We see that most commonly in the first few weeks as people are getting adjusted to the medication and then on a more intermittent basis over the first few months as they're gauging results, perhaps making a dosage or administration schedule change if needed.
[00:21:31] and then in most cases, a little bit. more intermittent, but kind of staying in touch over time. in addition to the interaction with the clinician, uh, we offer two forms of additional support directly. One is an optional, uh, confidential member support, group, which can be quite helpful, especially with medication like this, that as we said, just isn't, widely known just connecting with other people who are using the same tool.
[00:21:57] for similar or or different journeys. [00:22:00] And then the second is a set of digital tools, including guided reflections that can help people formulate their plan, their strategies, maybe get in touch with some of the reasons that they've been struggling with alcohol and how they might address that. Not a substitute for Psychotherapy.
[00:22:22] but we think still still helpful.
[00:22:25] Kathleen: Just because I want to ask this because I am based in Canada and I'm assuming from what you've said, that or is only us specific, is that right?
[00:22:35] Jonathan: that's correct. the laws of telemedicine and pharmacy are complex. And so we're going at a pace that allows us to make sure we're in compliance with them. for folks who are in countries or the few U. S. States where we're not available, I would recommend the C three Foundation, is a terrific resource on medication assisted treatment.
[00:22:57] Their emphasis is on the Sinclair [00:23:00] method, um, and they can recommend, both in person and telemedicine, uh, prescribers of MAT for AUD, certainly in Canada and in many other countries also.
[00:23:11] Kathleen: Okay, that's great. And how do you measure success? I know we talked about abstinence and also we talked about decreasing the amount of drinking, but how do you measure success of your members at OR? And
[00:23:26] Jonathan: test. The first is whether folks are regularly, uh, meeting their goals, whether those goals be to drink less or to achieve sobriety. And over 60 percent of our members indicate they are meeting that goal. In this realm, there's nothing that's a silver bullet. We're proud of those members.
[00:23:49] The second prong is a more objective, alcohol risk, screener. The audit see, test. And what's interesting is when we ask the same members, the [00:24:00] questions on on that test, um. It shows very similar results, about two thirds, drinking at, drinking not at all, um, or at low or moderate risk levels, uh, versus, uh, you know, the vast majority of the folks who, uh, start with us are in the severe alcohol use disorder subtype.
[00:24:20] Kathleen: what are some of the side effects that people might experience when they're using naltrexone?
[00:24:28] Jonathan: um, and some related tummy troubles, Also, um, some experience a little bit of dizziness, um, issues with sleep either on either end, either feeling sleepy or having trouble falling asleep. most side effects do tend to dissipate with one to two weeks of use. And we do try to coach people on titrating up, um, to a full dose, taking the medication with a meal.
[00:24:55] Using over the counter, medications to manage side effects, like [00:25:00] bismuth. Um, the other thing that I think is worth mentioning is the, the significant, safety watch out with naltrexone. As I mentioned, good safety track record. But because it's an opioid antagonist, It is not appropriate for people who are taking opioids, whether those be opioid based painkillers, um, whether used as prescribed or recreationally, um, nor people who are using street drugs that contain opioids.
[00:25:30] Kathleen: And has naltrexone been found to be addictive itself?
[00:25:34] Jonathan: It's not. it, it, yeah, it does not have, um, there's, it cannot get you high. Um, and so therefore, does not have a concern around abuse, um, which is of course something that people seeking treatment for an addiction, um, are justifiably concerned about. and it's, it's one of the real benefits of naltrexone is you can kind of take that worry out of the [00:26:00] equation.
[00:26:00] Kathleen: hmm. Mm
[00:26:02] Sonia: So I have a question, I don't even like using the term relapse, unless I'm communicating with people in AA, so what is considered technically like a relapse or return to use and how is that managed in your patients that are on naltrexone?
[00:26:16] Jonathan: Yeah, I think we come from a Similar philosophical place and don't spend too much time trying to classify folks into, oh, here's who's relapsed who here's who hasn't we spend a lot more time talking with members about their journeys, which may involve. Slips, lapses and setbacks. we try to encourage them to think about those moments as learning opportunities.
[00:26:46] Um, what, what went wrong? what, uh, can be changed in the future. is it a moment to recommit to a medication regimen that has kind of gotten a little loose? Is it a [00:27:00] moment to layer on, additional supports, um, working with a professional, joining a mutual peer support group? is it time to reevaluate the goal?
[00:27:09] Um, we have members who began with a goal of moderation, and Found that it was not working for them and graduated, uh, to a to a goal of abstinence. I think that's a, a success story. I think the main message we try to share people when they're feeling, um, down about their progress, whether because of a recent, uh, negative event of drinking more than intended or otherwise is this is not a What matters most is what we make of that sort of experience, no matter how painful it may be.
[00:27:45] Sonia: Yeah, we feel the exact same way at Everbloom, where we want you to come in if you feel like you've failed. It's not a failure if we learn something from it. And so there's a barrier to people seeking treatment, with group support.
[00:27:58] And I know people, before their [00:28:00] first meetings are so nervous. They're nervous they're going to have to, label themselves an alcoholic or they're nervous they're not going to fit in. So what challenges does medically assisted treatment, face in terms of public perception?
[00:28:13] Okay.
[00:28:17] Jonathan: challenges, you know, the biggest problem we all face is that less than 10 percent of people with alcohol use disorder get treatment of any sort. So there are certain common challenges. You know, is this going to work? Am I weak for seeking treatment? what will people think of me for, for saying I need help?
[00:28:36] Um, and then based on the modality, there are some specific, um, concerns and barriers. when it comes to medication, there's certainly some stigma. Um, and some, I think a very kind of old fashioned, uh, notion that, Taking medication is taking the easy way out or cheating. Um, I think using the tools that are available [00:29:00] is, is neither of those, uh, things.
[00:29:02] And then there are access problems. as we, you know, talked about, not every clinician in primary care or the emergency department practices in line with, um, the guidelines of the professional bodies that know the most about this, or the recommendations of the N I. H. And so we have, Stories that or of members who screwed up the courage to talk with their primary care physician or another health care professional, they came into contact with and we're told some variety of.
[00:29:38] Oh, your problems not that serious. Don't worry about it. you're an addict. We can't help you here. medication for addiction. I don't believe in it. Um, pretty shocking things. Um, so there's a whole host of obstacles that individuals sometimes need to navigate to get access to this. safe, effective, recommended, tool.
[00:29:59] And [00:30:00] that's a big part of the problem we're trying to solve, is private, convenient access to clinicians who are, uh, confident, comfortable, and trained in helping someone figure out whether MAT is a good fit for them.
[00:30:13] Kathleen: So you're, I wanted to ask how you're addressing that stigma so it sounds like you're going through it like a multi pronged approach. can you just speak a little bit more about that, about how like generally you're trying to address the stigma?
[00:30:26] Jonathan: Yeah, I think We have a lot of work to do on that front. I think the most powerful thing to reduce a lot of stigmas in our society is for people to hear from individuals that they care about, um, or that they can see themselves in, um, in some form. And so I've tried to be as open as I can be about how medication has been helpful to me, transformative, um, in my life.
[00:30:57] And, you know, not all of our [00:31:00] members, want to be public about their experience, nor is there any expectation, um, that they need to be. Um, but there are many, there are some, many like me who've, seen such positive results in their own life. shocked at how, uh, limited awareness and access to these tools are.
[00:31:20] And so for them, we've started, an ambassador program that helps them share their story, helps them share recent research, um, with others in their, social networks or more broadly in their communities. I think the more stories we can get out there of. The different pathways that people have taken to recovery, however they define recovery, the better.
[00:31:44] sure, the evidence, the research is an important foundation, but I think we've, the, the evidence also shows that what, as human beings, we tend to react to the most are, are [00:32:00] stories, and so I think that's the most important thing.
[00:32:02] Kathleen: So what advice would you give someone who's considering changing their relationship with alcohol but is hesitant to seek help? What would you say to them?
[00:32:12] Jonathan: Yeah, I'd say first, recovery is possible. I'm one example of that. We have millions more. The second is that the options are more diverse than you may know. And so it pays to do a little bit of research. You don't have to become an encyclopedia. of every option under th options you've heard abou they're a great fit for y some research.
[00:32:43] we've talked a lot ab There are also professional behavioral health care options like therapy. There's also group, um, support and more options than just AA. and of course the things you can do in your own [00:33:00] life and the, and the, and the resources you can rally, uh, around you and, and trust your instincts.
[00:33:06] you're the foremost expert on you. So it's likely those that kind of feel like they might be a good. that maybe resonate with the way you've solved other difficult problems in the past are a good place to start. And then that initial commitment is not a lifelong commitment. Um, you can always reassess, do more of what's working, do less of what's less helpful, and ramp up and down the intensity.
[00:33:33] of, uh, the supports and treatments that you're seeking. Um, this is a problem, that, you know, tends to ebb and increase in intensity, and it makes perfect sense that the treatment options that you're gonna put in your toolkit, um, do the same. So you have a lot of power to make the choices that fit you.
[00:33:56] I think every individual has the right to assemble that toolkit that best fits [00:34:00] them.
[00:34:00] Kathleen: Can we talk about that toolkit a little bit about how naltrexone can be used in combination with other approaches? I'm really interested to know, how medically assisted treatment is combined with counseling or psychotherapy and what are the benefits? I know you mentioned that, was it called the combine, uh, research and how the combination didn't really show.
[00:34:25] benefits, but other research has. So in your experience, leading or how is that, how is that working? what is the approach to combining it with psychotherapy, for example,
[00:34:39] Jonathan: They're a great, they're a great combination. I think that's what we see across behavioral health challenges broadly, whether we put them in the addiction and compulsion bucket or the mental health bucket. Not sure how separable those actually are, but in general, um, you know, I think that's what we see, is that having the medication go to [00:35:00] work biologically at the same time.
[00:35:03] Okay. Um, that we're working with a professional, to understand the patterns, um, thoughts, feelings, uh, behaviors that may be an aspect of the problem, devising strategies to improve them and strengthen the relationships around us, uh, is a fantastic, combination. And even if you look at that combined study and say, Oh, you know, not great evidence that the combination was better.
[00:35:31] we don't live in a world of clinical trials. We live in the real world. And it's a bit hard to predict, um, up front, which modality is going to do the most work, the patient. So in the clinical trial realm, really important to understand what are the effects isolating the medication? What are the effects isolating?
[00:35:51] the behavioral intervention. In the real world, we just want to help someone achieve their goals. And so if they're open to combining modalities, [00:36:00] A, it's the most shots on goal. And B, I think the broader experience of patients, of clinicians. is that these, these 2 things can have synergistic.
[00:36:12] Kathleen: And would you say the same as for like other holistic therapies, like yoga, mindfulness, our therapy, does that, can that enhance the impact? Of naltrexone, for example.
[00:36:25] Jonathan: Yeah, absolutely. I'll, uh, give you my personal experience there, which is, I tried yoga for, and other sorts of mindful practices, mindfulness practices for years and years and years, and, I didn't get anything out of them, and it was really only once I started taking naltrexone and drinking less, um, that I, really did find that to be a calming, yoga in particular, to be a calming, centering experience that made me feel better, uh, physically and mentally.
[00:36:57] I think the broader point [00:37:00] is, yeah, there's real evidence that things like movement
[00:37:03] Kathleen: Mm hmm. Mm
[00:37:05] Jonathan: to others, like, Dance, for example, can be quite, um, therapeutic. And more broadly, when someone is saying less or no to alcohol. it's really important to be saying yes and more to other activities that activate healthy natural reward pathways.
[00:37:28] Uh, could be yoga, um, could be meditation, could be just walking outside, could be more time with family and, and one's partner.
[00:37:39] Kathleen: Well, I, you're speaking my language because I am also a yoga teacher and meditation teacher and not Not at all periods of my life did I find it helpful. So it's nice to hear that you went back to it and that it was helpful once, once you were able to, find that stillness, be able to sit in the [00:38:00] stillness
[00:38:00] Jonathan: Yeah, I think at least for me, part of it was, turning down the volume on alcohol or, you know, any, drug of misuse, um, can maybe let you tune in to some of those other,
[00:38:14] Kathleen: for sure.
[00:38:15] Jonathan: pleasure and meaning.
[00:38:16] Kathleen: Mm hmm. I agree.
[00:38:18] Sonia: Kathleen knows the same for me, I've been sober for 7 years and I just started meditating like 2 weeks ago, and I didn't have the clarity to do it, I didn't have the space, right? My focus was well, generally, from, when I woke up to like lunch, my focus was on not feeling sick, and then, rest of the day, the focus was like, when am I going to have a drink?
[00:38:38] Kathleen: Yeah. Have you ever done yoga hungover? Cause I sure as hell have and it was horrible.
[00:38:43] Sonia: yeah, I agree. It feels just like a misery, right?
[00:38:45] Kathleen: I feel like you're gonna die.
[00:38:47] Sonia: it's not a spiritual experience. I did hot yoga hungover once. I thought I was gonna die.
[00:38:52] Kathleen: Oh my gosh! Are you kidding me? No.
[00:38:56] Ugh. We digress.
[00:38:58] Sonia: So Jonathan, what are some, I know [00:39:00] we talked a little bit about research, but is there anything new going on in this field that you find exciting?
[00:39:08] Jonathan: think probably the most exciting results in. The last year have been both anecdotal and then early, small studies suggesting that smagglotides, um, which people may know by brand names like ozempic, very well be helpful, to at least some people in significantly. curbing their desire for alcohol and how much they drink.
[00:39:36] A lot of research necessary to replicate that across a longer, uh, larger group. Um, understand what happens when people go off the medication. Um, and not yet an FDA indication, um, for that use, but I think there's a lot to be excited there. also some. Very early small studies suggesting that psilocybin, might have some [00:40:00] effects.
[00:40:00] I'm a little bit more skeptical about how you actually implement that, in practice. Uh, and then there continue to be small biotech, uh, companies pursuing traditional small molecule, research with various, Uh, theories. Um, I think it's pretty obvious from this conversation. I'm a big fan of naltrexone, but it's not a silver bullet.
[00:40:23] and so we would be a lot better off with more tools, um, even in the medication section, uh, of the toolkit so that we can offer everyone who wants to drink less or quit, kind of the right fit, uh, for them in terms of the medication that's going to help them achieve their goals.
[00:40:40] Sonia: And so are there any gaps you think still in understanding of the full potential of medically assisted treatment?
[00:40:48] Jonathan: Definitely. there's a spectrum of response to the medications that we have. naltrexone, acamprosate, disulfiram. and we don't understand well [00:41:00] enough why that is, why there are people who tell you naltrexone was a miracle drug for me. and why there are people who will tell you I didn't notice any benefit at all.
[00:41:09] and so there's much work to be done. To understand is that purely a biochemical, uh, reaction? Does it have to do with the presence or absence of common co occurring mental health, uh, struggles like anxiety and depression? or are there other environmental factors that are going on? And my hope is that if we can understand the diversity of response in the medications that will provide clues for further drug investigation and development so that we can get a little bit more precise about what medication best fits each patient.
[00:41:44] Sometimes I hear about this era of precision medication that were. allegedly entering, and when it comes to MAT for AUD, that's not where we are yet.
[00:41:55] Kathleen: Mhm. You spoke earlier, Jonathan, about [00:42:00] stories, about people's stories that helpbreak down those barriers and reduce the stigma. Besides your own, are there any stories that you feel comfortable just sharing that have really moved you, with the use of Naltrexone?
[00:42:16] Jonathan: Yeah, I would love to. one that really sticks with me is from a young man named Kevin, and I really appreciate him allowing us to, to share his story. And the way he describes it is that alcohol had become a constant companion. in his life. Uh, there to celebrate the highs and to numb the lows. And as a lot of us do in these moments of struggle, he turned to the internet to see if there was a way to break free from what felt like chains in his words and stumbled across.
[00:42:52] The idea of medication assisted treatment with naltrexone, it struck him like a ray of [00:43:00] hope in his otherwise dark world. And he was pleasantly surprised how simple and discreet it was to get started, consult with a compassionate medical professional who understand, understood the pain that alcohol had inflicted on not only him, but also his loved ones.
[00:43:20] And then once he started out on Naltrexone, he was a bit unsure what to expect. first he noticed some subtle changes. He started to feel a little more in control. Uh, like the urge to drink was less overpowering. And then a few months in, a turning point at a social gathering that he knew. In the past would have been a high risk event, but a few hours in, he looked around, found that he was engaging in conversation and enjoying the company of others without a drink in his hands.
[00:43:54] And that's really what he looks back at as the turning point towards a profound [00:44:00] transformation, no longer needing alcohol as a crutch or a confident. And while there were. challenges along the way. Moments when the old cravings resurfaced, he felt like he was able to not only, have the support of taking the medication daily, but also interact with, counselors with fellow members of the recovery community through the or, member community, learn coping mechanisms.
[00:44:28] And so a year or so later, he looks back on this journey with naltrexone as well as the other tools that he was able to rally and marvels at the, the person he's, become after this awe inspiring, uh, transformation and, and life changing treatment. I've had the chance to, to talk with Kevin and, it's, I, I would concur, that it's kind of inspirational to see how secure, happy, hopeful, he feels in his life without this [00:45:00] reliance on alcohol.
[00:45:01] Kathleen: Way to go, Kevin.
[00:45:03] Sonia: Kevin! I know, I love, I love the stories at Everbloom, they make me so emotional and I have a Kevin too, but I'm gonna call her Betty from Arkansas. and it inspires me to stay sober
[00:45:14] So thank you so much, Jonathan, for sharing your wisdom about medically assisted treatment. And if you're interested in naltrexone treatment for alcohol use disorder, we will link to oarhealth. com in our show notes. Okay, I'm
[00:45:30] Jonathan: so much for having me. It was great to connect with both of you.
[00:45:32] Kathleen: So Sonia, lots of information today in today's episode, what resonated with you the most?
[00:45:39] Sonia: I think what resonated with me the most was that, Jonathan and Orr are really seeing this grey area, drinker a lot, which is what I'm seeing a lot more in Everbloom and so that AA, abstinence model is changing slowly, and I think that is gonna help, with [00:46:00] the overall stigma.
[00:46:00] And just like he said, some people will try to moderate, and then realize it's not working, and then will end up, going towards total abstinence, but it's a choice. It's not the only way. What resonated with you?
[00:46:15] Kathleen: Well, to be honest, I, I really knew nothing about Naltrexone before I knew that he was going to be a guest, uh, on our podcast. So I learned a lot about it. And I think, you know, my initial thought was. That when I, when I first started learning about it, I thought, well, you need more tools than this one thing in your toolbox, but I really, it resonated with me was how he discussed that it's one tool in the toolbox, not the whole thing.
[00:46:47] So I think that resonated with me the most.
[00:46:50] Thank you for listening to Sisters in Sobriety and we'll see you next week where our guest will be Dr. Brooke Scheller, whose book, How to Eat to Change How You Drink [00:47:00] is all about how we can use nutrition as a tool in sobriety.