Discussing “The Abstinence Myth” with Dr. Adi Jaffe

How does someone go from a meth addict, to a Ph.D. in psychology, to a mental health professional intent on radically changing the way his peers treat addiction? To answer those questions and more, I spoke with Dr. Adi Jaffe, who recently published a book on bucking the “abstinence myth” in addiction treatment. You can watch our full interview below or read a transcript of it, which has been lightly edited and condensed.

Katie Lain, Ria Health Director of Community Outreach: I want to dive into some of the concepts you have in your book, The Abstinence Myth: A New Approach for Overcoming Addiction Without Shame, Judgment, or Rules. But to begin, I want to chat about your own personal story with addiction. I know your own story led you to the work that you’re doing in the field, and ultimately to writing this book. Can you just tell me a little bit about your battle with addiction, and how it led you to wanting to do work in transforming the way we treat addiction in the US?

Dr. Adi Jaffe: Absolutely. My own battle started with my discovery of alcohol, and its power to help me overcome some severe social anxiety. I didn’t feel like I fit in and belonged—especially after my family moved. And I found myself with a new social circle that I wasn’t familiar with. I felt out of sorts and out of place all the time. I thought I would have to live with that forever. At the age of 14, I went to a sleepaway camp, and somebody brought out a big bottle of vodka. I had probably three or four swigs of this vodka that tasted terrible and made me almost want to throw up. But once I waited 20-30 minutes, I felt okay for the first time in years. I remember on the bus back from camp, we were all going to Newark Airport—I was living in Chicago—and I was standing in the aisles dancing. I wasn’t drunk anymore, but I had felt like I had made such close friends because we drank that weekend. I was totally comfortable, and I hadn’t had that in a really, really long time.

That was the first moment I discovered that chemicals could give me the feeling I’d been looking for. So it started with that, and weed got introduced two years later. And then I had a really bad breakup in my first year of college, and I went to everything that I could find. Cocaine, ecstasy, mushrooms, LSD—I tried whatever I could. I learned that chemicals could change the way I felt, so that I could feel the way I wanted to. I then started this quest for finding the right chemicals, and that led all the way to meth. And by the time I ended my addiction—and by that I mean my addiction kind of came to a screeching halt—I was a meth addict. I had been using meth for five years. And the last three of those years I was a daily user—and I mean all day. I had a pipe in my glove compartment in my car, I always had meth on me. I was using about four or five hundred dollars worth of meth a day for three years straight. And I was selling drugs. My entire life had become surrounded by these chemicals that I had given so much power to.

Lain: Wow.

Jaffe: And then I got arrested. The way that ended was a full-on SWAT team arrest in my bedroom in Brentwood. The Beverly Hills Police Department was nice enough to make the trek all the way to Brentwood, and—

Lain: Oh my god!

Jaffe: 8 o’clock in the morning, guns to the head, everything. And I’m not going to lie and say that’s where my addiction ended. But it was this huge stop sign of, “You better start reconsidering what you’re doing—or else.” It still took me about a year to three years to get my stuff together. But what I learned in the process was that I had to create big enough changes in my own life so that I didn’t live the life of somebody who could be addicted to drugs anymore. So I didn’t live the life of somebody who relied on chemicals to make their life better.

Lain: Incredible. I feel like that’s the nugget of this book. And it takes me to my second question: In the book, you talk about addiction as a syndrome, meaning a set of symptoms that show themselves similarly for people, even if the underlying reason for their development is very different. Can you talk a bit more about this?

Jaffe: Absolutely. So many people have this idea that addiction is a disease, and they put so much weight on that. And yet there’s actually a pretty broad debate in the addiction treatment industry, in the general public, and among researchers, about what that actually means. Without a doubt, we see very similar patterns show up for addicts. Like cravings, or using more than they want to, losing control when they use, giving up responsibility—social, employment, and familial responsibilities. And in the face of mounting consequences—financial, psychological consequences, legal consequences—still not being able to stop. We see a lot of common symptoms of addiction. There’s no doubt that drugs and other behavioral addictions interact with the brain and the body in ways that make people more likely to use. There’s a book by Bruce Lipton called The Biology of Belief, where he writes about the idea of epigenetics, or the interaction between the environment and what happens in your body. Biology is never the only answer to anything, it’s the interaction in a place and time. So I was trying to think, how do I choose a word that still lets people understand that there’s biology involved, but it’s not all about biology? It’s not like a virus that happens in your body. And “syndrome” just popped into my head.

All “syndrome” tells you is, yes, we have these symptoms—the cravings, the overuse, the consequences. But just because people show the same symptoms, doesn’t necessarily mean they have the same underlying cause. And that’s a big piece of the Abstinence Myth book. I don’t think addiction is one thing, and it’s never been one thing. I’m a big believer in the power of language, and because we believe that addiction is a disease, we’ve imagined that there is a specific singular fix for it. You get a flu vaccine for the flu, you get the measles vaccine for the measles—one specific condition gets one specific cure. But with addiction, that hasn’t proved to be true. I think it’s part of the reason why there’s so much failure in addiction treatment. And so “syndrome” releases us a little bit from trying to figure out what the disease is. Instead, addiction can be caused by a whole different set of underlying reasons. We can’t just fix the symptom, we have to go back and fix the reason for the development of the conditions.

Lain: Absolutely. There’s a statistic out there, which I’ve seen in my own research and which you reference in your book, that 90 percent of people who struggle with alcohol addiction don’t get help.* Why do you think that is?

Jaffe: That statistic is part of the reason why I left academia and said, “Screw this, I’ve got to get out there and actually start making a difference.” It was shocking to me when I first heard it. There’s not another condition that we have these kinds of numbers for. For instance, for cancer patients, the numbers are flipped. About nine out of 10 people who are diagnosed with cancer get at least one course of treatment for it. I did research at the University of California Los Angeles on why people don’t get treatment for alcohol addiction, and I found four main reasons: cost, logistics, shame, and abstinence.

Cost is pretty obvious. In the last 10 or 15 years of addiction treatment, it’s gotten really expensive in many places. Logistics are also pretty obvious. If you have to leave your life for 30, 60, 90 days, or go report somewhere for 15-20 hours a week for treatment, it creates real barriers for normal people who have a job and a family. So those two are obvious. As for shame, addiction is still so looked down upon. Even after 100 years of conversation about it, it’s one of those things that nobody wants to tell others in their life that they struggle with. So they try to fix it by themselves, and often they dig themselves into a deeper and deeper hole. And then finally, abstinence. For a lot of people, the idea of having to commit to giving up the only thing that is making life okay for them, before getting any help, is absurd.

Lain: It sounds crazy when you say it like that.

Jaffe: I equate it to telling a quadriplegic that the only way they can get physical therapy is if they leave their wheelchair at the door. They’re relying on alcohol or opiates, or whatever it is that they’re relying on, to just get through the day. What most practitioners in the field tell them is, “You need to stop that first, and then come get help.” And they go, “I can’t stop this. If I could stop this, I wouldn’t need your help anyway.” So those are the four barriers that I see. And now I try to help people in a way that eliminates many of those barriers.

Lain: In your book you say, “Addiction, the daily grind, the pressure and judgment we face, from both inside and out wear us down and make us forget that it’s possible to truly love our life.” You articulate the vicious cycle that keeps people trapped in addiction really well. So how is it that somebody begins to get out of this cycle and start to see that glimpse of what’s possible?

Jaffe: That is a great, great question. And to be fully frank, that is something that I constantly struggle to make better and easier for the people I work with. Because it’s so individualized. And so, for most of the people that I work with, at some point earlier in life, they lost hope. They lost the internal belief that they are able to be anything but “that”—whatever it is they ended up as. I struggled with it. I thought I was a piece of you-know-what, who was never going to amount to anything, who lacked motivation and couldn’t follow through on anything, that was going to disappoint everybody in my life forever. And that was a really difficult position to start from, because you don’t see an end point. What people need, first and foremost, is the belief that it’s even possible.

That’s why, in The Abstinence Myth, I don’t start out by giving people tools, I start out by giving people stories and examples, my own and others. Other people in dire situations who found a way out. Because that is the first thing people need to understand, that there is a way out. So that’s number one. And then the second one is, once they believe it, I think people need to look inside and understand what happened in their life that created those limiting beliefs for them, and then dismantle those step by step. And it’s difficult. Some of the people that I work with one-on-one have almost given up the idea that they can be happy.

Lain: Wow, given up the idea?

Jaffe: Yeah! And I don’t think that’s that uncommon in addiction. Look, they’ve been through the system. One of these people that I was just talking to today, she’s been through dozens of therapists, a handful of treatment episodes, and nothing has made things better. You can imagine how defeating that can feel. And so I think reinstating that belief that it’s even possible is the first step. And a lot of times, that is by speaking out. That’s why I wrote the book. I called it The Abstinence Myth because of instances when a family member will call me and say, “I don’t know what to do. My loved one won’t go to therapy, they won’t go to rehab, they won’t do anything. And I know that abstinence is a really big piece of the puzzle.” I go, just show them the book. They don’t even need to read it yet, just show it to them, and when they see that somebody has written something that does not start out with, “You have to quit to get better,” they’ll at least open it up. They’ll at least consider the conversation, and then we can put in the tools that we all know work.

Lain: Definitely. And this idea of abstinence being the barrier for getting help, it’s something that’s really personal to me in my own story of alcohol addiction. I was really struggling for about 10 years, and I started naltrexone a year and a half ago to get into a healthier place with alcohol. Because abstinence was like a huge—I couldn’t even conceive of it. I tried many times and failed, and didn’t want to be abstinent. But now, a year and a half in, I am abstinent. I don’t drink anymore, because the medication really helped. I’ve done a lot of inner work, and it’s brought me to this place.

Jaffe: Awesome.

Lain: Yeah, it’s amazing! And I’m curious, how have you seen this approach—abstinence-not-required—help people overcome addiction?

Jaffe: Here’s my favorite thing that I think everybody needs to hear—and almost nobody will remember as soon as I stop saying it, because it happens to me over and over and over. Not requiring abstinence to enter treatment does not mean that people don’t end up being abstinent. It’s the biggest misconception, and I’ve been fighting it for seven years. All people will remember from the end of this is this guy doesn’t think people need to abstain. And that’s okay, it is what it is, but 40-50 percent of the people who come to me seeking not abstinence, but an improvement, decide to be abstinent in the end. Some people find completely different routes. For instance, some of the people that came to me for alcohol were daily blackout drinkers—exactly who somebody would call an alcoholic. And a lot of these people experience either a complete return to abstinence or huge reductions in their drinking. Like going from drinking every day to blackout, to drinking two to three times a month, with essentially none of those being blackouts, but sometimes drinking a little more than they want to.

The removal of abstinence as a starting point is a way to get people in the door. There is no other field that I know of where you have to commit to the success before getting help. It’s a little bit like asking an athlete who wants to learn how to play football at the age of five, to be able to throw like Tom Brady in order to be able to practice. It’s insane.

I got an email from somebody just a few days ago. I think they might have done this free online workshop that I have, and they said, “I read the example of that daily blackout drinker who drank four times in three months. Are you saying it’s okay for him to drink those four times?” How did you read about somebody going from 90 days of drinking in three months to four days of drinking in about four months, and the only thing you can focus on are the four days he drank as the mark of failure? What does the rest of your life look like, if the only measure of success is complete and utter perfection? It’s like there’s no gray area for people in this field, there’s no middle road to success.

The reason you took naltrexone in the face of all these past “failures” was that it offered a route that didn’t force abstinence as a key initial ingredient. And yet look at you now. You’re abstinent. And it doesn’t matter if you’ll be abstinent forever. The point is you’ve achieved success by removing a barrier to getting in the treatment. By putting that barrier in place, we have kept nine out of 10 people from getting help. I will do whatever I can to make the industry understand that it’s stupid, it’s counterintuitive, and it might even be unethical to be doing this on a continuous basis.

Lain: In your book you refer to your story as “The Hero’s Journey.” I feel like when I’ve applied the hero’s journey framework to my life, it’s brought about a greater sense of magic and wonder and understanding. Can you briefly explain how you define the hero’s journey? And how can people embark on their own hero’s journey when they’re deciding to fix their dependence on alcohol or another substance?

Jaffe: Yeah! The program I created online is called “The Ignited Hero Program.” And the reason I ended up there is, again, the importance of language. Addicts are told more than anything else that they’re losers. Everybody thinks they know what you have to do, right? Just stop. And everybody has told you how to do it: go to an AA meeting, quit cold turkey, or just get yourself together and become a good person. And you’ve run against this wall over and over and over, and you feel like a complete and utter failure. That’s the shame piece. I don’t know how you guys feel about swearing, but I wear this “Fuck Shame” bracelet right here, which comes from my TED talk. It’s something I have to remind myself all the time. When I start feeling embarrassed and ashamed of who I am, I need to check myself really, really quickly. Because that is, to me, a dangerous route—going back into hiding and doing things that are unhealthy, to reduce that shame. And so I didn’t think of my journey as a hero’s journey at all. There was nothing heroic about it as I was going through it. But now that I’ve told my story so many times, I really had to stop and think for a moment, why do people love hearing it? It has nothing to do with me, it just has to do with the perspective I have on my life.

Lain: Definitely.

Jaffe: The reason I called my program “The Ignited Hero Program” is because we do something very quickly, right at the beginning of the program, to get them to understand that they are their own hero already. I tell people the fact that you got here and made it through everything you’ve made it through, makes you a hero. You just haven’t gotten to the act that you want to get to, you haven’t gotten to the final piece. And you might not even think it’s possible right now, but you’re already a hero. The goal is to understand how the challenges, tribulations, and struggles that you’ve experienced in your life have formed you into the hero that you are. And just like naltrexone, just like cognitive behavioral therapy, this is not 100 percent foolproof. Sometimes people have a really hard time stepping into this role. But when you see people shift into this perspective of, “Oh my god! I’m the hero of my own story. I get to write what the next chapter is. I get to understand and select what the next challenge is going to go like,” it completely shifts the way they look at everything. Every task they have to complete, every challenge they have to undergo. It took me 12 or 13 years into my hero’s journey to get there. And then I looked back and went, “Oh!” Because look, nobody likes to hear, “Hey, I’m a meth addict, and I steal shit for a living and sell drugs.”

Lain: [Laughs]

Jaffe: That’s not a story that goes well in any party, other than among other addicts. But I used to be a meth addict, and then I went back to school, and got my PhD, and now I help other meth addicts and alcoholics and sex addicts—that story makes people feel good. But it took 12, 13, 14 years for that to happen. We lose track of the fact that we can be heroes 10 years from now, because we feel so terrible about ourselves right now, that we don’t take the steps to make ourselves those eventual heroes.

Lain: Totally! So well said. And I know you have a whole chapter in your book on the power of stories, and how we can at times get stuck in a role that we are good at playing and that others expect of us. So, can you explain how this experience of being stuck in a story that might not be serving you, how that might contribute to someone depending on alcohol or other substances for relief?

Jaffe: Sure. Do you mind if I turn this around on you for a second? I don’t know if you feel like getting personal, but…

Lain: Go for it, yeah! That’d be great.

Jaffe: I don’t know what a year and a half ago was like for you, but it was much worse than things are right now.

Lain: Mhm.

Jaffe: It sounds like maybe you started a few years beforehand, you were already trying to get some help.

Lain: Yeah.

Jaffe: At what age did alcohol start playing a role for you?

Lain: About 21, 22. I drank before—I started drinking as a teenager—but I hated it, and I hated the way it felt. But I was very insecure, and my circumstances led me to be with someone who is an alcoholic, and so it was really easy for me to lean on that to feel secure.

Jaffe: So, in my book, there are four factors; it looks like environment and psychology played the biggest role for you. Biology, that everybody focuses on, was not a big player in your case. And so now you had psychology and environment that were really huge factors. Again, we’ve never done this together, but for somebody that ended up in a relationship like that, my guess is there was a lot of self-worth issues going on there, and there was a lot of feeling trapped, almost this feeling of, “I hate my life. But if I do something other than this, it’s going to be even worse. Like, at least here, I know how to function. I know how to be relatively safe in this context.” And so whenever you try to pull yourself away from that—the feeling of I’m still worthless, and nobody’s ever going to love me, and I’m going to be stuck alone and lonely and scared the rest of my life—that’s the story, and that story was always there in the back of your head every time you tried to stop. First of all, this other person would probably pull you in, in some ways, and they probably use the same story on you. They probably told you, you’re not going to be anything, you’re never going to be anything. You’re going to be in this problem forever and ever and ever. And when you have that story in the back of your head, the tools don’t matter. Cognitive behavioral therapy doesn’t do anything, because your core belief is you’re a weak, worthless person, and weak, worthless people don’t have great lives.

Lain: Yeah!

Jaffe: And unfortunately, we live in this world where we compare ourselves to these perfect images of others all around us, that seem like they have the best life ever. We don’t celebrate struggle, we don’t celebrate transformation, we don’t celebrate challenges. We don’t talk to anyone about these things, we feel like we have to deal with them on our own. So you also felt alone. And what I tell people in terms of stories is, you have to get to a place where you can at least believe and start writing a different existence for yourself. In one of my podcasts, I talk about addiction in terms of beating it. Not curing it—because I don’t think it’s a disease—but beating it in a way that it doesn’t come back. You have to become a person who is no longer addicted, and that means wholesale changes in how you see yourself, the way you live your life, your daily rituals, and your support network. We get so trapped in the way we see ourselves that we don’t actually believe a different version is possible. Once we switch that perspective, a lot of things open up.

Lain: Definitely. And in your book, you give an example of a client of yours whose husband can only focus on her drinking and nothing else. And you say that, for the most part, everyone fixates on the visible behavior, rather than the feelings or circumstances driving it. So a loved one of someone who is addicted, how can they support someone struggling with addiction, and begin to focus more holistically, rather than just on the substance use?

Jaffe: This is a really good question, because I didn’t actually realize how relevant saying that in the book was until people started writing to me afterwards. They were writing to me like, “Hey! I want to help a loved one. How do I do it?” And one of the things I always ask is, have you ever come up to them and just said, “I see you struggling. I’d love to help, if you’re willing to let me help?” And some people say, “Yeah! Yeah! I’ve had exactly that conversation.” I say, okay, when you came to them, and said that, what were you wanting to help them with? They said, well, their drinking. And I go, “They don’t want help with their drinking, they’re using the drinking for help on something else.”

Forget the drinking for a second, just go to them and say, “You seem like you’re really suffering.” Find out what is causing them pain. And if they’re not able to talk about it, that’s okay. But at least have the conversation—that you see underneath the drinking, you see that there’s something there. This whole bullshit assumption that alcoholics are different than other people, it drives me insane. It’s as if we’ve literally created a different class of people. It’s like alcoholics live over here, and the rest of humanity lives here somewhere. And it is so dehumanizing and so demoralizing for the people we say that to, and we think we’re helping them. When another person comes back and says, “Don’t you see that if you just stop this drinking, everything will be better,” you completely alienate yourself from them. Because of course they see that the drinking is causing problems—they’re not an idiot.

The last thing I say to a client is, “You know you need to stop drinking,” because I’d just be repeating the same thing they’ve told themselves a million times. I’m not telling them anything useful. What you should do is say, “You know what, forget this drinking for a second. I’m here to hold your hand through whatever is happening in your head.” A lot of us struggle with this because the underlying issues are not easy—early childhood sexual abuse, abandonment by your parents, violence at home, struggle with alcoholic parents who were never there and were abusive psychologically, and sexually, and physically. Deep mental health struggles that have been there for decades. The answers you’re going to get are not simple. “Oh yeah, I didn’t like my outfit last week, and so I’ve really been drinking too much”—those will not be answers you will get. But if you really want to help somebody, go help them with those deeper issues.

Lain: In your book you talk about how alcohol takes the edge off, when the true purpose of the edge is to remind us that we need to develop better communication and healthy intimacy. How might people begin to get comfortable with exploring that edge alcohol-free?

Jaffe: What a great question. I think the first thing is the permission to start exploring it. Somebody saying it’s okay to talk about this pain and you don’t have to hide from it anymore, and you don’t need to tackle it on your own—that’s the first step. Now, with alcohol in particular—and this probably plays a role with opiate addictions and benzos as well—the chemicals are so good at removing the pain that, for a lot of people, they’re disconnected from the fact that the pain exists or what it even is at that point.

And secondly, because of the substance use, the problem has actually been exacerbated over time. Your body is less biologically able to produce its own break, its own stress reduction chemicals, because you’ve been using these other things as supplements for so long. So not only are you now psychologically less able to rely on your own internal mechanisms, but your body is less able to generate them.

And so the first thing you need is a lot of support. A lot of support is one of the answers that people gave in the study that I did when I was at UCLA on barriers, and why people don’t enter treatment. They said they want to do it alone—and I get it, because the shame is so overwhelming—but it’s so hard without support. And so I really recommend that people find someone to hold their hand through this, whether it’s a professional who understands you, a loved one, a friend, a parent, somebody in a support group. It doesn’t matter who it is, but somebody who doesn’t have an agenda and is just there to support you. In my courses, people have been running in one direction, away from all this pain that has been overwhelming them for years, and I ask them to stop and turn around and look at it in the face. That’s a scary proposition. And so to have a wingman or woman to be able to hold your hand, to say you’re okay and we’re going to deal with this together, is a huge step. Because the process after that is actually a difficult one.

Lain: Thank you for taking the time to talk today, Dr. Jaffe. I love the work you’re doing and excited to see you continue on the field.

Jaffe: Thank you so much for having me, and thank you for having these conversations. I know Ria is doing a lot to give people options outside of the typical addiction treatment complex. The more options people have, the more likely it is that we treat that 90 percent people who don’t get treatment. So thank you.

Dr. Adi Jaffe’s book, The Abstinence Myth, is available for purchase on Amazon or for free here (just pay shipping and handling).

Do you have trouble controlling your drinking, or know someone who does? You can find out more about how Ria Health’s at-home program works here, or get started here.

* According to the 2017 National Survey on Drug Use and Health, 14,062 survey respondents age 18 and older had an alcohol use disorder (AUD), and 2,369 respondents 18 and older received alcohol treatment. That comes out to approximately 16.8 percent of people with AUD receiving treatment, or 83.2 percent of people with AUD not receiving treatment.

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