International uptake and clinical hesitancy

If you’re listening to this, you probably know someone who has struggled with alcohol addiction, or maybe you’re an alcoholic yourself. It’s one of the most universal human experiences. In 2023, 10 percent of the U.S. population met the criteria for alcoholism. That’s 30 million people.

And throughout the past hundred or so years, there’s basically been one solution: total sobriety, talk therapy, and Alcoholics Anonymous. And yes, there are countless people ready and eager to say, “AA saved my life.” We know and love many of those people.

But as Katie Herzog writes: “The dominance of AA obscures the fact that other options exist too.” Okay, so what are these other options? One of them is a drug called naltrexone that can let alcoholics keep drinking—yes, you heard me right. Katie describes it as a chemical safety net that makes you want to drink less.

And in order for the drug to work, you actually have to drink—at least at the beginning. The goal with this method is not necessarily abstinence. It’s reformed, moderate, responsible drinking.

Is this all starting to sound like snake oil—or worse, even dangerous? We understand. Over 175,000 Americans die each year from excessive drinking. It causes heart disease, cancer, domestic violence, and suicide. It costs the U.S. economy nearly $250 billion in healthcare expenses. There’s loss of productivity, criminal justice fees, vehicle wrecks—I could go on. And living with alcoholism, or being close to someone who struggles with addiction, can be devastating.

So when someone comes along and says, “Your alcoholic loved one can actually drink with naltrexone,” the knee-jerk reaction is to say: “Hell no.”

But Katie Herzog, in her new book Drink Your Way Sober, argues that AA—and our traditional thinking—has not worked, and will not work, for everyone. And she makes the case that we should be more open to alternative forms of treatment like naltrexone.

You’ll know Katie from her hit podcast Blocked and Reported, which she co-hosts with Free Press contributor Jesse Singal—though she likes to say she is “the only host of the only podcast.”

And today, Bari asks her how she got sober using naltrexone—and a program called the Sinclair Method—how the drug actually works, why it’s been shunned by the medical community, and whether she thinks society will buy into it.

This episode of Honestly is presented by Wonderful Pistachios.

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