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Sometimes I miss it. Not all of it, but some of it. The part of it that made me feel like nothing. Not nothing in an empty way, but nothing in a weightless way, as if the physical properties that guided the rest of existence no longer applied to me. For a brief few hours, I was impervious to my own thoughts. I could sit in quiet and not be forced to listen to the whirring drone of my own dysfunction. Whether it was drink or drugs, the only thing I was looking for was a respite from myself. I wanted that click. I had wanted it before I even knew what it was that I was wanting. I wanted to feel all of the atoms in my body being slowed to a turgid crawl, blocking up my veins and capillaries until the blood coursing through me moved at the pace of a lazy river. I wanted the same thing that my grandmother did. The grandmother I never met. The grandmother whose liver gave out before I was born. The grandmother who left me her Big Books as heirlooms. I wanted it all to stop.

When I got sober I was 22 years old. Luckily for me, my path through alcoholism and addiction involved jumping out of the blocks quick and falling flat on my face almost immediately thereafter. I am what you might call a “dysfunctional alcoholic.” A dysfunctional alcoholic is not someone who is particularly bad at being an alcoholic—I think I was pretty solid on that front, at least if speed is any indicator—but rather someone who is bad at being a functional member of society whilst drinking. My using history is really a series of uninteresting 1 to 2 months spurts in which I would give up most of my earthly responsibilities in lieu of getting fucked up, only to realize that I'd turned my entire world into a shambles and needed to jump back on the wagon for a spell. At the time, it was infuriating how often my life would cave in on itself and force me to adopt a temporary guise of sober responsibility. In retrospect, it was actually a gigantic blessing that I turned out to be constitutionally incapable of contemporaneously drinking and even pretending to be a productive member of society, as it got me into treatment sooner.

Another reason why I may be so ineffective a drunk is the fact that I, like roughly 43% of all Americans with a substance use disorder, also suffer from a co-occuring mental illness. When I was still in high school my psychiatrist diagnosed me with Bipolar disorder because, apparently, it isn't normal for a 17-year old to sneak out of his parents house at 10 o' clock on a Friday night and, without telling anyone, drive 6 hours to Chicago in order to sell a manuscript that he hasn't written to publishers he's never met. This same psychiatrist also told me I suffered from Generalized Anxiety Disorder and Panic Attacks, for which he gave me a prescription for these delicious little blue pills called Klonopin that were supposed to even me out and stop me from shaking like a chihuahua in a walk-in freezer. What this psychiatrist did not tell me was that Klonopin was a benzodiazepine and, like its pharmaceutical brethren Xanax and Valium, is ridiculously addictive and only meant to be used for short periods of time on account of the likelihood of developing an emotional and physical addiction to the drug after prolonged use.

She's so happy because she just popped 4 mg of Klonopin and can't feel feelings for the next 6 hours

The way I had the clinical efficacy of Klonopin explained to me by a competent psychiatrist is that drugs like Klonopin are essentially band aids. If a client comes into his office with debilitating panic attacks and crippling anxiety, he may prescribe a month's supply of a benzodiazepine to help stop the proverbial bleeding for a second while the two of them work out some of the underlying issues of the client's mental illness and find a non-addictive drug regimen for use over the long term. Essentially, you take away the band aid and replace it with a surgical suture and some thread. What my psychiatrist decided to do was to prescribe me band aid after band aid after band aid until the wound had become infected and gangrenous.  Every day, for nearly 6 years, I took 2 mg of Klonopin while cultivating a burgeoning addiction to alcohol, turning me into a living, breathing black out machine. You see, alcohol and benzodiazepines are both Central Nervous System depressants, which is just a fancy way of saying that they slow down your brain function. If you've ever put back a few adult beverages or popped a Xanax and felt a little lightheaded or relaxed afterwards, it's because the chemicals in the drink or drug are manipulating neurotransmitters in your brain that decrease brain activity. That guy over in the bathroom who is so drunk that he's unable to button his pants is having so much trouble doing such a simple activity because the electrical activity in his brain has literally slowed down.

Now, the reason that I could black out faster than local coverage of a Jacksonville Jaguars home game is because my brain was already operating under the influence of 2 mg of Klonopin a day before I even started drinking. I didn't feel anything because I had long since grown a tolerance to the daily dosage of benzos I was on, but that didn't mean that those chemicals didn't interact with the river of liquor that was going into my bloodstream. My repeated experiences with the combination of these two drugs in my system led me to create what I call the Theorem of 1 + 1 = 3. Basically, what it says is that if a man begins to drink while under the influence of benzodiazepines, his brain will feel the effects of a “bonus drink” for every two drinks he actually imbibes. For instance, if a guy on Xanax and guy not on Xanax go out to a bar and drink 4 rum and cokes, then the guy on Xanax with be two drinks drunker when they leave, even though they both had the same number of rum and cokes. Of course, the reaction of the two men would vary based on the amount of Xanax taken and the tolerances of those involved, but you get the gist of it. I'm an alcoholic who spent his entire drinking life getting 3 drinks for the price of 2.

Not surprisingly, my drug and alcohol abuse quickly escalated to the point that I ended up having to take a “psychiatric leave of absence” during my senior year of college so that I could check myself into rehab. Since I was still on their insurance at the time, my parents were able to send me off to the frigid confines of Minnesota to attend an inpatient rehab clinic run by the Hazelden Foundation. For the uninitiated, Hazelden is essentially The Mothership of all 12-Step-Based treatment. Outside of Alcoholics Anonymous itself, there aren't many organizations in America that have been fighting alcoholism and addiction longer than Hazelden has. In fact, they have been around so long that, when they first opened up shop in 1949, the first Diagnostic and Statistical Manual of Mental Illness had yet to be published and Narcotics Anonymous had yet to be founded.

Hazelden were the originators of what has come to be known asThe Minnesota Model of drug and alcohol treatment, which emphasizes the goal of complete abstinence for its clients and provides them with a host of therapeutic tools with which to achieve it in the short and long term. Despite being the most widely used substance abuse treatment modality in America, the Minnesota Model is controversial for it's focus on the use of the 12 Steps of Alcoholics/Narcotics Anonymous as a the bedrock of their program. In addition to the 12-Step work, Minnesota Model programs place a high emphasis on the BioPsychoSocial-Spiritual approach to patient care, employing a full range of physicians, psychiatrists, psychologists, substance abuse counselors, spiritual advisors and support staff to work on the development of the entire person during the beginning of their recovery.

When I first spoke with the intake counselor at The Hazelden Center for Youth & Families, I was told I would only be there for 28 days. At least, I think they said that the program was 28 days. I don't know for certain because I was blacked out when I did my intake interview and have no idea what actually happened beyond the fact that I woke up the next morning and was informed by my parents that I had agreed to fly to Minneapolis for substance abuse treatment. I mean, I assumed I'd be there for 28 days, because who has ever seen a movie or a “very special episode” of a TV show where the rehab wasn't for that length of time? To my great relief, Hazelden held to form and provided a 28 day inpatient program...for most patients. There was an extended program for a lucky, hyper-dysfunctional few where patients were sent to a separate wing of the building for an additional 3 months of therapeutic incubation before being sent out to a halfway house situated somewhere in the big, bad, drug-infested world. Naturally, despite my most ardent attempts to present myself as an emotionally stable member of society, I was placed in the extended care program, where I would stay for 90 additional days before being sent to a halfway house in Washington state for 4 more months.

I left for treatment a week before St. Patrick's Day and returned home the day before Thanksgiving. 8 months of rehabs and halfway houses. It might seem like overkill, and for many people in active addiction or alcoholism, it would have been. But not for me. It took the bulk of my first 28 days at Hazelden for me to simply stop compulsively shaking and sweating from the benzodiazepine withdrawals. Had I been let out then, I probably would've convinced a psychiatrist to give a me a script for Klonopin within a week. For the better part of my adolescence and adult life, I had been self-medicating my problems away with booze, bowls and benzos. When those things stopped working like they always had, I was out of options. Outside of putting a foreign and often illicit substance in my body, I had nothing resembling an effective coping skill. What I needed more than anything else was time. I needed time to sort through emotional issues I'd buried under a mountain of pills and liquor my whole life. I needed a safe environment to find the medications that would help treat my mental illness; a place where I could taper off my current psychotropic meds and enter the trough-level neurotransmitter hellscape that would allow me to switch to new ones. I needed people around me who could help me learn to deal with life as it happened, not as I wished it would be.

My aim in telling you a much abridged version of my story is not to present myself as a paragon of recovery or someone who has all of the answers regarding how to fix our nation's woeful treatment of addiction and alcoholism as legitimate medical conditions. On the contrary, my success in getting sober young and, more importantly, staying sober has little to do with my own personal actions. If it weren't for the staff and residents of The Hazelden Center for Youth & Families and Gray Wolf Ranch, I'd say it's fairly safe to assume that I would not have gotten sober when I did, and if it weren't for my serendipitous birth into an upper-middle class family, I wouldn't have been able to afford either of those programs in the first place. According to the National Survey of Drug Use and Health, only 1 out of every 10 Americans suffering from active addiction and alcoholism are receiving the treatment they need and nearly half of those who did receive care say that they had to pay for it out of pocket. Despite nominal victories like the Wellstone and Domenici Mental Health Parity and Addiction Equity Act, a piece of legislation which was passed in 2008 to prevent health insurance companies from providing inadequate care for mental health issues in relation to medical issues, there is still nothing resembling equity for mental health and addiction services in practice. Without any appropriate enforcement measures from federal and state governments, there have been no real ramifications for health insurance companies who fail to provide addiction services that are equal to other chronic diseases like Diabetes or Rheumatoid Arthritis. Until the insurance companies are taken to court for their negligence, it looks like mental health and substance abuse issues will continue to be treated as second tier disorders.

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Enter Schick Shadel Hospital. Like Hazelden, Schick Shadel is one of the oldest private alcoholism and addiction centers in the country. Beyond that, pretty much every aspect of the Schick Shadel program is the diametric opposite of Hazelden's. In 1935, while Bill Wilson and Dr. Bob were in Akron forming the nucleus of what would come to be known as Alcoholics Anonymous, two men in Seattle were setting up a sanitarium for alcoholics that would address the problem much differently. Whereas Bill W. and Dr. Bob founded their organization based on the principles of mutual aid espoused by the non-denominational Christian movement known as The Oxford Group and the premise that one alcoholic could stay sober by talking to another alcoholic, Schick Shadel founders Thomas A. Shadel and William Voegtlin based their program around principles of Pavlovian conditioning.

The two men developed a mode of treating alcoholism using chemical aversion that focused on the body of the patient rather than his mind. Voegtlin, a gastroenterologist from Seattle, had no prior experience working with alcoholics, but did possess a wealth of knowledge considering Pavlovian conditioned reflex aversion. Using this and his gastroenterological background, Voegtlin developed a treatment based on Pavlovian principles that involved the use of Emetine Hydrochloride, a highly toxic chemical that causes intense gastrointestinal distress minutes after being injected into the bloodstream. The process, which is still used with little deviation over 70 years later, consists of giving an alcoholic an injection of Emetine Hydrochloride and creating for him or her a setting that replicates what their drinking environment would be in the real world. Then, at the moment the patient begins exhibiting sign that he or she might be about to vomit or void their bowels, the patient is given several sips of their drink of choice, at which point they begin violently puking and (oftentimes) shitting for about half an hour. After this initial bout of nausea and diarrhea is over, the patient is taken back to his or her room and given another alcoholic drink and a dose of oral emetine, which they will proceed to vomit up over the course of the next couple hours.(1) The point and purpose of this gruesome enterprise is to produce a physical revulsion or taste aversion in the patient to alcohol. Over the course of 5 sessions, which the people at Schick Shadel inexplicably call “Duffies”, the patient is supposed to develop such an awful association in their mind between alcohol and copious retching that they lose the compulsion to drink.

A screen capture from a wonderfully cheesy Schick Shadel ad from the 1980s.

If the whole process sound horribly primitive, it's because it is. Natural forms of the primary drug used by Schick Shadel in their treatments have been used by European/“Western” nations since the mid 17th century and by indigenous South American cultures for long before that. Ipecacuanha, a root plant native to Brazil, was used for centuries by indigenous peoples as a medication to fight diarrhea and after its “discovery” by European explorers, was brought back to France where is was actually given to Louis XIV to cure a bout of dysentery. After falling out of favor with the medical community for a while, Ipecacuanha experienced a revival around the turn of the 20th century as physicians began to extract the plant's primary active ingredient, the alkaloid emetine, and formulated diluted solutions that could be injected intramuscularly. It proved to be extremely effective in treating severe cases of amoebic dysentery, but as early as 1912 it was noted that, “the principal cause of the vicissitudes of Ipecacuanha is the production of very disagreeable and exhausting nausea and vomiting by the large doses that are essential to obtaining its full curative effects.” There is no more efficient method for emptying the contents of someone's stomach outside of slicing them open like livestock in an abattoir.

A quick download of A Clockwork Orange on Netflix should give you a good idea of what the therapy looks like in practice. Take out the theatricality of Malcolm McDowell sitting in an empty movie with a straightjacket on and what you have is a very legitimate representation of chemical aversion therapy. In the film, a young man with a predilection towards violence and sexual abuse is injected with a chemical that, causes the subject to experience, “a death like paralysis, together with deep feelings of terror and helplessness.” Then, he is restrained, strapped into a chair and shown films featuring gratuitous amounts of sex and violence with his eyelids pried open so that he can't look away from the screen. As he's watching the films, the chemical he was injected with begins to take action and make him feel paralyzed with fear and nausea, with the end goal being for him to develop an association between acts of depravity like the ones he saw in the films and the physical discomfort he felt while watching them. It's the same thing with emetic aversion therapy for alcoholism, except there's less internal paralysis and more projectile vomiting.

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Tucked away behind a barricade of pines and scrub brush in suburban Seattle, it's easy to miss the Schick Shadel Hospital. In fact, I missed it twice. Despite my navigational incompetence, I still managed to arrive at the hospital a few minutes before the tour I had scheduled was set to begin. I had called the hospital up a week earlier and told them that I had a friend who was very much in active alcoholism and that I'd love to see their facility while I was passing through town to figure out if it was right for him. Technically, everything I said was true. Having been in either active addiction or recovery since I graduated from high school, I have a disproportionately large number of friends with drug and alcohol problems. That being said, all of the stories that I had heard about Schick Shadel from friends of mine who had gone through the program sounded mildly horrifying and I had no real desire to advise any of my friends to buy a plane ticket to Seattle so that they could aggressively lose control of their bodily functions for 10 days. In truth, the main reason I was at Schick Shadel was that I had a hard time believing that such a place actually existed in 21st Century America and needed to see it for myself.

Everything about Schick Shadel's appearance was really quite nice. Nestled in the sanitized Pacific Northwest suburban-wilderness, the facility looks less like a hospital and more like the sort of motels you see outside of national park grounds. When I walked into the lobby, I was greeted by a perky young receptionist who told me to have a seat in one of the cushiony leather chairs on either side of the room while she called the woman who was going to give me the tour. Compared to practically every other treatment center lobby I'd ever been in, this one felt pretty plush. Instead of the usual faded green carpeting and walls painted the color of watery custard, this place was covered in gorgeous wood flooring and paneling, with a big, High Def flatscreen staring me in the face. The fact that the TV was playing an episode of Law and Order: SVU struck me as a tad inappropriate, what with the chances of a sexual trauma survivor coming in for her intake and seeing a 12-year old actress being fictitiously tortured by a sadistic pedophile, but I didn't say anything about it.

While I was sitting in the lobby, a woman did in fact come in from the outside to begin treatment and sat down in the chair opposite me, with her rolly-wheel suitcase by her side and a Vera Bradley bag in her lap. She was probably in her mid-to-late forties and, judging by her sleek black pinstripe skirtsuit, a woman who knew her way around a boardroom as well as she did a barroom. She typifies the type of, “socially competent, upper-class clients” that facilities like Schick Shadel normally serve. The hospital's attraction of this type of client to is due to a number of factors, but the principle one is cost. Today, a 10-day stint at Schick Shadel will run you $16,500, or roughly $67 an hour, a price that would normally be paid out of pocket due to the poor nature of addiction services coverage from health insurers in general and the fact that the US government does not formally endorse aversion therapy. Considering the fact that the mean household income for the bottom three quintiles of the US population is a only a hair above $30,000, you can pretty well scratch 60% of the country off Schick Shadel's list of potential clients straight away.

After a few minutes of waiting, the woman who is scheduled to give me the tour comes in and leads me across the threshold separating the posh lobby from the more spartan environs of the rest of the facility. As an alcoholic who has spent a large chunk of his adult life living and working in rehabs, I've always found a strange pleasure in being able step into that world again. For a man in his mid-twenties with no mooring to speak of, the insides of treatment centers and the backrooms of churches holding AA meetings are as much a home as anything else. That being said, surroundings at Schick Shadel felt less and less familiar the more fully I was acquainted with them.

For starters, all of the patients I saw while walking around the facility were wearing these greenish scrubs like they were at a proper medical hospital, which I suppose was the point. If you're going to go about the business of convincing outsiders and the patients themselves that your clinic is a principally medical setting, having them dress the part isn't a bad idea. Another big difference at Schick Shadel was that I saw the patients. In fact, I never stopped seeing them. Except for when my guide took me downstairs to see their group rooms and library, both of which were undisturbed by human activity, I was running into clients the whole time I was there. Some of them were in their rooms playing cards or wandering the halls with a decided lack of purpose, but the bulk of them were outside in the smoking lounge, just chilling. Let me add that this was at 1:30 in the afternoon...on a Friday.

This might not seem odd to those of you who aren't familiar with drug and alcohol treatment, but I can assure you, it's mighty odd. At the bulk of rehabs across this great land of ours, there is an emphasis placed on structure and routine and responsibility. There is a set time to get up and a set time to go to bed. When you get up, you are expected to make your bed and clean your room and you normally have some sort of minor chore to do around the facility like vacuuming a hallway or wiping down some windows. You get your three squares at the same time every day and you have a series of groups and educational classes at specific times. If you're lucky, you'll get to pile into a rackety 15-passenger van and drive to an outside AA meeting where you try to drink as much hi-test coffee and eat as many store brand chocolate chip cookies as you can before heading back home. Outside of the weekends, which are still often partially filled with pre-scheduled therapeutic activities, most rehabs do their damnedest to limit the free time of their clients, what with idle hands doing their due diligence and all that.

Not so at Schick Shadel. Contrary to standard rehab practice, the folks at Schick Shadel pretty much let their patients do whatever they want, whenever they want. Aside from the five chemical aversion treatments, or “duffies”, that patients undergo over their 10-day stay, there doesn't appear to much in the way of mandatory activities.Each morning they wake up at around 6 in the morning, grab some breakfast, have one or two lecture and discussion based meetings concerning alcoholism and addiction, and that's about it. By 8:30 or 9:00 in the morning, the patients have pretty well exhausted half of the day's scheduled programming. The rest of the the morning and afternoon is generally spent chain smoking in the smoking lounge or otherwise relaxing while waiting for either your duffy or what is known among the patients as a “sleepy” to begin.

The sleepies, which occur on days following a duffy, are narcotherapy sessions in which a patient is given a shot of sodium pentothal by an anesthesiologist and, after they have been chemically induced to tell the truth, asked a series of questions related to their substance use history. I couldn't help but find it ironic that a program designed to treat alcohol abuse would go about doing so by regularly injecting their clients with a barbiturate that works by binding to the same types of brain receptors that alcohol does. But, then again, I'd never considered the idea of treating a mental health issue through projectile vomiting and chronic mud butt, so maybe I'm the outlier here. Regardless, it seems that the bulk of a patient's typical day is spent waiting for or recovering from their trip to the puke room or the anesthesiologist's chair.

Not that the patients seem to mind the clinic's purgatorial baseline. Every patient I talked to had nothing but praise to heap upon the program. In the short time I was allowed to speak to patients in the smoking lounge, I was inundated with an equal amount of testimonials for Schick Shadel and condemnations of its 12-step-based counterparts. Apparently, most of the men and women who come to Schick have tried at least one 12-step rehab prior to arrival and either left the programs early or completed them and relapsed. Several of the guys I talk to still harbor considerable ill will towards the traditional treatment centers they were sent to, generally characterizing them as phony and overly moralistic shams. One patient makes a point of repeatedly claiming that a counselor at one of the 28-day programs in Seattle had to come to Schick Shadel to kick alcohol, with the insinuation being that even the 12-step gatekeepers know their program's are full of shit and go elsewhere for their treatment.

A look at one of the Duffy rooms at Schick Shadel

Building upon the irony that seemed to ooze from the very pores of the place, the most vocal champion of Schick Shadel turned out to be a client who highlighted one of the program's most glaring weaknesses.  As my tour guide was beckoning me to come back into the building, I ended up getting into a conversation with the elder statesman of the smoking lounge about his experience at the hospital and discovered that he had in fact been to Schick Shadel just a year before. This fact, which on the surface would seem to indicate a failure on the program's part to produce prolonged sobriety for one of his clients, was held up by this guy as proof positive that the program worked. As the gentleman explained it to me, he had been to Schick Shadel a year earlier for Oxycontin and had not so much as touched the stuff since. However, in the year that had passed since his first go 'round, he had manage to develop an addiction to alcohol and was coming back to get that sorted out. I was tempted to ask him what drug he'd be back at Schick for next year, but figured that'd be poor form, especially after I discovered he was paying for the entirety of his second 10-day treatment out of pocket. Yet, despite this big financial hit, the man seemed to think his second treatment was a sound investment. Or, to put it in his words, “Would I be paying that much fucking money for something that doesn't work?”

Accompanying the older man's verbal endorsement of Schick Shadel was an impromptu bit of show and tell. Before I had been dragged back into the hospital proper, the guy clenched both of his hands into pantomime claws and thrust his wrists towards me. On each of his forearms was a well-defined set of burn marks, the result of the electric shock treatment he had undergone the previous day. In certain circumstances, usually when the more effective chemical aversion therapy can't be used on a patient for health and safety reasons, Schick Shadel will perform faradic treatments. For some of you, the idea of shocking someone into behavior change with electrical current brings up images of Jack Nicholson wildly convulsing on an operating table with a giant hunk of plastic clenched between his teeth to keep him from biting his own tongue off. Thankfully, that's not the type of procedure we're talking about here.

The faradic aversion treatments that are occasionally given by the folks at Schick Shadel are not the electroconvulsive therapies commonly depicted in popular culture, but are in fact a type of aversion therapy that was often used in the mid-20th Century psychiatric practice of treating people who suffered from what were then referred to as “sexual deviations,” namely homosexuality, cross dressing and the predilection of certain fetishes. The homosexual men in these studies, men who were often in treatment of their own volition, would have electrodes affixed to either their arms or their legs and would be presented with an assortment of homoerotic pictures in an effort to give them a hard-on. When the patient's penis had reached a certain level of erection, painful electric shocks were sent his way in short bursts that would be repeated every 15 seconds until he had gone soft.

I do not bring this up to suggest that the motivations behind aversion therapy for homosexuality and alcoholism are the same. Whereas gay conversion therapies are almost entirely moralistic in their impetus, the work that is done at Schick Shadel was created to provide an alternative to what the hospital's founders considered a biased and overbearing 12-step model. In regard to intent, they could hardly be farther apart from one another. However, when it comes to actual execution of the therapy, the aversion treatments for homosexuality and alcoholism are essentially the same.

Schick Shadel markets itself as one of the few inpatient facilities in the country that provides “a researched, medical alternative” to the traditional 12-step model of drug and alcohol treatment, and they have every right to do so. They were the pioneers in the treatment of alcoholism as a physical ailment rather than a mental malady, developing the specifics of their program at the same time that the original members of AA were doing the same to theirs. In the 70 or so years that have passed since then, little in either program has changed. There have been 4 editions of the AA Big Book, but all that really changes is the inclusion of some new stories to identify with neglected groups within AA's membership and a new preface. At its core, the counter conditioning techniques used at Schick Shadel have remained fairly constant, with revisions coming in as needed when the use of certain drugs become more prevalent. AA can afford to stay the same. Schick Shadel cannot.

Alcoholics Anonymous is at its core a spiritual organization. Over time, that spiritual orientation has shifted from a predominantly Protestant one in its infancy to one comprised of a vast amalgam of religious faiths and personal beliefs that speak to the idea of perceiving god as you understand him or her or it to be, even if your perception leads you to the seemingly contradictory belief that there is no god. Stripped of its spiritual verbiage, the purpose of a person's “higher power” in AA and NA is really to get that addict or alcoholic to re-center their life's focus from the self to their fellows. If you want to keep what you have, give it those who need it more than you, because, the thinking goes, eventually one of them will be in a position to give it back. Do unto others as you would have them do unto you; the concept is as old as dirt itself, but it sticks around and crops up in every pocket of humanity because it is the truth, and spiritual truisms such as that are timeless.

Medicine, for the most part, is not timeless. What was cutting edge theory at the beginning of a physician's career often becomes archaic by the time he or she retires.It was only 130 years ago that doctors were calling antisepsis nonsense and attending to their patients' wounds by shoving their unsterilized fingers inside of them while wearing aprons caked in blood from previous operations because it was seen as proof of their pedigree. When Thomas A. Shadel and William Voegtlin were constructing their medically-based treatment of alcoholism in the 1930s, prefrontal lobotomies were considered an exciting new mental health procedure and people suffering from Down Syndrome were referred to as“Mongolian Imbeciles.”(2) What was medically and ethically valid 75 years ago often isn't today because modern medicine is constantly sloughing off the advances of the past for the breakthroughs of the present. If I was suffering from renal failure and my physician suggested a procedure that was developed in 1935, my response would be something along the lines of, Oh, hell no! Dialysis hadn't even been invented yet in 1935. Get the fuck away from me and don't come back until you're back in the 21st century.

In the past quarter century there have been terrific medical advances in the treatment of alcoholism and addiction. FDA approved and clinically vetted drugs like acamprosate and naltrexone have proven effective in treating alcoholism, albeit in different ways. Acamprosate has been shown to greatly increase a patient's likelihood of remaining abstinent from alcohol use, while naltrexone has been more effective in promoting controlled consumption of alcohol and reducing heavy drinking patterns. For those addicted to opiates, newer partial opioid agonists like buprenorphine provide a less addictive alternative to methadone, while drugs like Naloxone routinely save lives by counteracting the effects of opiate overdoses.

None of these drugs is a silver bullet and their efficacy is in large part determined by the non-pharmacological, psychosocial treatments that patients receive and the utility of their continuing care plans after their discharge. Alcoholism and addiction are complex mental health issues that are often cultivated within a person's mind and body for the majority of their adult life. What took a lifetime to construct isn't going to come tumbling down in 28 days, much less 10. You can't puke positive coping skills into existence and training yourself to feel nauseous around a vodka tonic isn't going to stop you from going through Valium like they're M&M's. Getting sober is like coming back to your home after it's been decimated by a hurricane or a tornado. The skies have cleared and you're back where you belong, but all you can see for miles around you just debris and devastation. All chemical aversion therapy does is bring you back home again. It doesn't help you clean up a damn thing.

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After I had left the smoking lounge, my tour guide promptly informed me that the tour was over and asked if I had any more questions. Of course, the one question that I wanted to ask was if I could see the rooms where they conducted the chemical aversion therapies, but I held it in on account of the fact that I think I had already asked her on 3 separate occasions and in 3 different ways if I could see it and I was rebuffed every time. Apparently, they really didn't want me getting a good idea of what the treatment was actually like there and I can't say that I blame them. Better to use euphemism and understatement when trying to sell your $1,600 a day services to someone than it would be to give them the grand tour of the puke room.

My guide led me back to the lobby and asked me to wait there for a few moments while she rustled up some literature for me to take home. As I was waiting there, I saw one of the patients I had been talking to outside come to the receptionist's window to ask for something. She was cute little thing; nothing but blonde hair and bronzed skin and probably young enough to have never taken a legal drink in her life. Almost as soon as she had arrived at he window she was gone again, so I asked the receptionist what it was that she had wanted. She told me that the girl had just wanted to know if one of her friends had arrived yet. Apparently, unlike every other rehab I'd ever been to in my life, there were no set visitation days for when family and friends could visit the clinic. At Schick Shadel, every day is a visitation day. From nine in the morning to nine at night, residents can have friends or family come in and hang with them. The receptionist also told me that patients were allowed to keep their cell phones with them throughout treatment and that they could order take our food to be delivered to them with those phones whenever they felt like it. In her words, “it's pretty much a party around here most of the time.”

Ultimately, the defining characteristic of Schick Shadel it that it asks its patients to do absolutely nothing. Every part of the process is passive, from intake to discharge. The emetine hydrochloride and the patient's gag reflexes are doing all of the work during the chemical aversion therapy and their drugged up subconscious is doing the talking during the pentothol interviews. From the moment they arrive at their doorstep, Schick Shadel treats its patients more like hotel guests than people suffering from a potentially fatal disease and, as a result, most of them will leave the hospital with nothing more than a nice surface clean. There is no emetic strong enough to purge a person of the psychological and emotional ravages of alcoholism and addiction. All of the hurt and the fear that you have masked for the bulk of your life with booze and pills is now naked to the world. If you can't cover it up with alcohol because it makes you physically ill, then what will take its place? When you find yourself waist deep in that paralyzing pain and panic that led you to drink in the first place, what will you use to soothe it?
Well, it would appear that the blonde ingenue I alluded to earlier has her answer. As I was about to leave, she popped her head into the lobby and began excitedly telling me all about how great the program was and how she didn't want leave and how she learned to love the pain of the the aversion therapies because it was a good pain. I thought for a moment that she'd talk my ear off for the next hour, but she had to cut her spiel short because she had an appointment that she needed to get to immediately. Apparently, she was late for her massage.

----------------

(1) The description of the emetic aversion therapy used here was taken from a study conducted at the Raleigh Hills Hospital in Portland, OR, a facility which has, “a common professional ancestry and use of a similar aversive counter-conditioning treatment procedure.”

(2) Dr. Adrien Bleyer, a St. Louis Pediatrician who was one of the more respected researchers in the 1930s concerning what is now known as Down Syndrome, published an article in The American Journal of The Diseases of Children in which he actually wrote, “Looking at Mongoloid Imbeciles is like looking at the stars; the more one looks, the more one sees.” And, lest you write off Dr. Bleyer as a backwards thinking moron, he was in fact one of the first two people to correctly speculate that Down Syndrome was the result of a chromosomal abnormality. This type of rhetoric was not the outlier; it was standard practice.

Originally posted to Virally Suppressed on Mon Mar 24, 2014 at 03:57 PM PDT.

Also republished by Mental Health Awareness.

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Comment Preferences

  •  Congrats and My Thanks (6+ / 0-)

    Precious few people can write about addiction with the clarity that you have shown here.  This is really a wonderful diary, and deserve mucho kudos for sharing it with us.

    Getting over a benzo addiction is really hard, and the withdrawal period can be painfully long.  You deserve kudos for climbing that very high hurdle.

    Thank Goodness for AA, NA, and self-help 12 step programs.  I'm not religious, but the existence and longevity of AA and related programs seems to me to be divinely inspired and heaven sent.  It seems too bad to me that non-addicts rarely get exposed to the wisdom of AA.

    Thank you again for your story.

    "The fool doth think he is wise: the wise man knows himself to be a fool" - W. Shakespeare

    by Hugh Jim Bissell on Mon Mar 24, 2014 at 04:21:45 PM PDT

    •  Any Idea on the Success Rate at Shick Shadel? (1+ / 0-)
      Recommended by:
      Ojibwa

      Do you have any idea of the percentage of patients who achieve long-term abstinence after treatment at the Schick Shadel Hospital?

      For most 12-step type treatment programs, something around 10-20% of patients are able to be abstinent for 1 year.

      "The fool doth think he is wise: the wise man knows himself to be a fool" - W. Shakespeare

      by Hugh Jim Bissell on Mon Mar 24, 2014 at 06:30:45 PM PDT

      [ Parent ]

      •  Sadly, there's not much data out there... (2+ / 0-)
        Recommended by:
        sfbob, Oh Mary Oh

        Most of the original aversive conditioning experiments took place during the 40s, 50s and 60s when the ethical standards for researchers were more lax than they are today, and many of them (as I alluded to in the article) had to deal with other issues like homosexuality, which, if memory serves, was in the first two editions Diagnostic and Statistical Manual of Mental Disorders. Needless to say, aversion therapy has worn out its welcome due to its barbaric nature and I honestly don't know if the lack of research comes from a lack of interest, ethical/legal prohibitions, or medical obsolescence.

        Most of the aversion therapy research since the 60s has been done by employees of Schick Shadel, with one study I found from 1990 touting a success rate of over 70%, a result that I believe about as much as North Korea's claim that Kim Jong Il scored 18 hole in ones during a round of golf.

        Their primary measure of success was a telephone survey to see if the clients were still abstinent from alcohol after 1 and 2 years, which is flawed on so many levels. In addition to being entirely based on client self-reporting, it doesn't take into account switching addictions from drinking in drug use, gambling or sex addiction and it doesn't even attempt to ascertain the relative mental health of their clients, mainly since the entire point and purpose of Schick Shadel is to show that alcoholism is a disease of the body and not the mind.

  •  The photo (4+ / 0-)

    The picture is actually of Dr Christian Jessen, an openly gay doctor and presenter of medical programmes on British TV. It is from his documentary on "cures" for homosexuality shown last week on Channel 4.

    “I suddenly went from being how you usually see me on telly, which is as a fairly calm, in-control doctor not flustered by anything, to, I think, being an abused patient”, Jessen said. “It’s not particularly nice being made to vomit, especially not being made to vomit like that. I was upset for all the people who had to go through this, sometimes enforced, sometimes voluntarily, because they were so miserable and life was so difficult.”

    "Come to Sochi, visit the gay clubs and play with the bears" - NOT a Russian advertising slogan.

    by Lib Dem FoP on Mon Mar 24, 2014 at 04:34:06 PM PDT

    •  I did not do my due diligence on the photo... (4+ / 0-)

      To avoid any confusion or conflict on interest with Jessen's work, I've removed the picture and replaced it with one of Schick Shadel's chemical aversion therapy rooms. Thanks for the heads up.

      •  Not too serious (1+ / 0-)
        Recommended by:
        northsylvania

        It was from the section where he went through a shortened session of aversion therapy where they used the same drugs to induce vomiting and excretion on the spot while showing the victim erotic pictures. In the original "treatment" this would have mean hours of sitting in your own "output".

        Incidentally, another "therapist" he visited purported to be able to identify childhood traumas causing homosexuality from the way a line picture of a brain was colored in - real "paint by numbers" type action! He then found out the guy had to ask him what colors he had used in different parts because the "therapist" was color blind!

        "Come to Sochi, visit the gay clubs and play with the bears" - NOT a Russian advertising slogan.

        by Lib Dem FoP on Mon Mar 24, 2014 at 06:05:38 PM PDT

        [ Parent ]

  •  Thank you. Honest, informative, meaningful. (4+ / 0-)

    A perfect diary.

    ". . .as singularly embarrassing a public address as any allegedly sentient primate ever has delivered." - Charles P. Pierce

    by Rikon Snow on Mon Mar 24, 2014 at 04:58:44 PM PDT

  •  What a compelling story. (2+ / 0-)
    Recommended by:
    high uintas, Ojibwa

    Thanks.

    It's the Supreme Court, stupid!

    by Radiowalla on Mon Mar 24, 2014 at 05:34:50 PM PDT

  •  Always thought I was fortunate (2+ / 0-)

    And you've confirmed my thinking. While missing much of what you had to go through at the beginning I've managed to stay clean and sober nearly 26 years. I walked into my first meeting quite voluntarily and there I stayed. A couple of years later my then-partner put himself into his final inpatient program, a local one that focused heavily on AA and NA. He stayed sober for the final three years of his life and meanwhile I got to experience through him what going through treatment and aftercare was like. His experience was fairly similar to yours though since it was at an in-town facility, run by a non-profit, there was a good deal more interaction with the outside world except for the first few days. Some of his peers went to downtown jobs during the day, as he did. And then back to their facility in the evening for meetings both 12-step and facilitated. As benign a program as it was, the thought of having to surrender my autonomy even as little as he had to has kept me sober on more than one occasion. Though of course better to work with others than to have to resort to that threat of "if you go out you might need to put yourself into treatment" thinking.

    I'm quite glad you mentioned benzos; after all the drinking and using I did, it was a dependency on them (mainly emotional to be sure but in a way that is quite similar to what you described in terms of how long I took them) are what finally got me to surrender.

    Thank you for the expose on Shick Shadel. I suppose that theoretically there are people who would do better in such an environment than by means of the Minnesota Approach but I know you'll forgive me for saying I'm not terribly impressed. It sounds utterly barbaric. And really somewhat beside the point. I've heard many people in AA say that the problem is not how to handle alcohol, the problem is how to handle sobriety. Even if one were to credit it with some level of efficacy at a purely physical level it's tough to see how aversion therapy in and of itself could take care of that other, much greater need.

    Even after all these years there are things about AA I find quite cheesy (and as a Jewish agnostic I am truly grateful not only that I didn't need to hit AA in its early days but that I also entered it in a major city) but I do find that it works.

  •  Great Great Post (1+ / 0-)
    Recommended by:
    Virally Suppressed

    Thank you for that, and being so open and honest. Very insightful and informative. I have always wondered what went on at that mysterious "hospital" while I was "stationed" at the nearby Nut Hut as a teenager and adult.

    "Nothing says 'I'm sorry' like a tuna casserole" ~ Unknown

    by francinefishpaw on Sat Mar 29, 2014 at 10:25:54 AM PDT

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