A Canadian addiction center that relies on medication and therapy to treat alcohol use disorder opened its first U.S. clinic in January with a discreet office in Santa Monica. A small group of doctors and therapists meet with patients all over California while quietly disabling a century-old tenet to recovery: that abstinence is the only way to go. In their approach, continued drinking is key to regaining control.
“Most people don’t want abstinence,” said Alavida’s medical director and co-founder Dr. Diane Rothon. “They want to be able to have a cocktail at the end of the day or a glass of wine with dinner, go to a wedding and have a few drinks. They want to be able to fit in.”
Since Alcoholics Anonymous opened its doors in 1935, the 12-step program has set the tone for addiction recovery. Most of the country’s 17 million alcoholics know the familiar trajectory: once a person hits “rock bottom,” they join AA, admit they powerless over alcohol and embrace the struggle for sobriety for the rest of their lives.
Rothon says it’s an outdated way of thinking that ignores recent medical leaps in scientific understanding of the brain and addiction. Some estimates put AA’s success rate at below 10 percent.
“It’s about the relationship you have with alcohol,” Rothon said. “Some of that is learned. Some of that is genetic.”
Doctors at Alavida treat their outpatient clients with therapy, a smartphone app to track how many drinks they’ve had and medication. Most patients get a prescription for naltrexone pills to take as needed, an hour before they drink. Because the medication blocks opiate receptors in the brain while they drink, patients gradually feel their cravings weaken.
Scientists call it “selective extinction.” Patients say the effect of the medication is subtle.
“There was a point where I was wondering if it was a placebo but at the same time I was starting to drink less,” said Mark, who asked to use his middle name to keep his recovery private. Mark, who is in his late 40s, felt his drinking was beginning to escalate before he discovered Alavida. He had begun hiding it from friends and family but never would have considered an abstinence-based program like AA.
“I have no interest in going to those meetings,” Mark said. “It sounds time-consuming and dreadful.”
Instead, Mark logs onto his computer every other week to talk to his therapist and doctor at Alavida over secure teleconferencing. He logs his drinking his drinking in an app and takes naltrexone before he goes to the bar or anywhere else he may drink.
Two weeks ago, he went out to a pub with his wife and drank two beers. He said when he got home she poured him a glass of wine and just as he was about to take a sip he changed his mind. He set down the glass and simply said ‘no thank you.’
“It’s a four to six month period where I’m building a new repertoire of habits and I hope when it’s over I’ll be a more moderate person,” Mark said. He does worry once his program ends that he may slip back into bad habits. He’ll have a prescription for the naltrexone for the rest of his life.
“That’s really the start of change,” said Alex Lee, clinical director at Alavida. “What we’re doing is creating new feedback loops.”
Without endorphins enforcing the behavior, Lee and Rothon say clients regain the self-control needed to turn down a second or third drink.
“When it works it’s a like a miracle,” Rothon said. She says naltrexone works in about four out of five patients. “For many, we’re giving them back their children, their jobs, their bank accounts, their homes. For the ones who waited too long, they’ve lost everything and now they are getting it back.”
While Alcoholics Anonymous and abstinence is free, patients at Alaveda pay about $6,500 for a four to six-month program. They can submit the treatment program to their medical insurance for reimbursement, but the total cost may not be recovered.
Rothon hopes the data from her clinic in Santa Monica will help her approach become more mainstream. She hopes more doctors and insurance companies will begin to recognize tailored approaches to addiction that use medication and therapy to allow patients control over their bad habits.
“There’s so much more to do than just hit rock bottom and quit drinking,” Rothom said. “That’s the old-fashioned way.”