I arrived, half hungover and half drunk, to my doctor appointment; my skin felt hot and dry from the long shower I’d taken to rid myself of the stale smell of a days long binge. During that appointment, near the beginning of 2021—on the 21st of January—my primary care physician prescribed me Naltrexone, a drug meant to help me stay sober. I’d scheduled that appointment with the sole purpose of asking him for that prescription. Yet a few months prior, I’d scoffed at the idea of “sobriety drugs.”
Me and Alcohol
I experienced my first “drunk” at age 15. My brother and I found a plastic bottle of vodka in the cabinet above the refrigerator. Our father and stepmother rarely drank, and when they did drink, they rarely chose hard liquor; my brother and I assumed a small amount of the vodka would not be missed. We made ourselves a drink. We measured out two ounces in one glass for him, another two ounces in a glass for me—we topped off the glasses with cranberry juice. The moment I felt the initial warming effect, I thought that erroneous thought, which is so familiar to a substance abuser: “My euphoria will increase exponentially based on the number of drinks I have; limitless drinks = limitless euphoria!”
As I let the last of the liquid from my first drink drip onto my tongue, I tried not to notice my brother’s glass, clasped comfortably in his hands, still half-full. I told my brother I wanted to make “just one more” drink, acting as if the idea were modest and mundane. My brother nodded only half interested. Completely content without a second drink, he left me to head off to the kitchen alone. I measured out another two ounces into my cup—a third ounce directly down my throat. That second drink was technically my last drink that night, because I found enough excuses to sneak into the kitchen and take swigs straight from the bottle; A nip from the bottle doesn’t really count, right? Or so my thinking went.
When my brother and I first discovered the bottle, it was an unopened pint. Save for the two ounces my brother poured into his own drink, I consumed the whole bottle. I ruined my mattress by vomiting on it, and learned that pancakes are actually a terrible hangover breakfast.
In hindsight, my alcohol abuse started with those first two ounces. When I drink, I never willingly stop at one or two drinks. Either the alcohol runs out or I black out—no in-between exists. I did not have the opportunity to fully realize this until I turned 21 (the legal drinking age in the U.S.). I’d like to say that, once I recognized a problem, my willpower gave me the strength to simply say no to a first drink—which is the only way to say no to all drinks—but that is not my sobriety story, and it never will be.
I thrice tried Alcoholics Anonymous (A.A.), went off on my own with Rational Recovery*, and even found myself in a few mental health programs. I found some respite from my drinking through these programs, but none of them could quell the inexhaustible siren of my alcoholic brain, tempting me with the song of “just one last binge; and this time, I’ll do it right.” The longest I white-knuckled through sobriety, while participating in these programs, was barely over three months. As of the day this blog entry is posted, I am 272 days alcohol free—just over nine months. What’s different now?
I take prescribed Naltrexone.
Yes, You Can Take Drugs to Stay Sober
I assume it’s obvious, but I’d be remiss not to mention that Naltrexone, and other anti-substance abuse medications, do not and cannot get you high. Naltrexone works primarily by decreasing a person’s cravings for alcohol and vastly reducing a person’s ability to experience euphoric effects while consuming alcohol or opiates. This medication does not completely block the body from processing alcohol; you can still get impaired. And this “all the impairment with none of the euphoria” effect makes the drug, for me personally, even more helpful.
Image getting drunk, but you don’t feel relaxed, or elated, or friendly, or like your singing voice is leagues better than you know it actually is, but you’ve still lost your ability to drive a car—pointless, yes? And pointlessness is the point of Naltrexone. Knowing you cannot get drunk forces you to cope with life through other avenues, helping to break the habit of turning to alcohol for every celebration, disappointment, and prosaic life event in-between. For this reason, along with the non-addictive properties of the drug itself, Naltrexone is a common prescription meant to help those dealing with substance abuse problems. But it’s not the only medication of its kind.
If you’ve heard of any of the sobriety assistance medications, you’ve likely heard of Antabuse (disulfiram). Different from Naltrexone, this drug transforms alcohol into more of a poison than it already is. To put it crudely: to take disulfiram is to ingest a serious toxin, one which happens to be missing the key ingredient to activate the poisonous effects. That key ingredient is, of course, ethanol (the chemical name for the type of alcohol that’s otherwise safe for human consumption). Those who drink—even trace amounts—with disulfiram in their system may experience vomiting, mental confusion, blurred vision, hyperventilation, tachycardia, and a slew of other agonizing symptoms.
A negative critique of disulfiram is not my intention. The fact that disulfiram can send you to the ER after half a drink is why and how the medication works. It takes the long term dangers of alcohol abuse and turns them into an immediate, physical concern. Disulfiram, and others like it, are serious medications—but serious conditions must be addressed with serious treatment options. If transforming alcohol into a pointless and/or imminently dangerous pastime is the most helpful option for any one individual, why allow any potential stigma to prevent that individual from accepting that life saving help?
Sobriety Over Stigma
Years before I received my prescription, I’d learned about drugs that helped with sobriety. I’d never considered researching more about such medications, primarily because I judged being on drugs for the purpose of sobriety to be hypocritical. Undoubtedly, people would and do hold such views, and understandably so. However, after I failed dozens of initial attempts to quite drinking, I cannot ignore that sobriety medication was, and so far is, the only external help that has kept me sober.
This is painful to say, but losing friends, losing jobs, A.A., Rational Recovery, two intensive out-patient programs, and a host of experiences I’ll leave out to avoid the need for trigger warnings, did not keep me sober. At best, I have only ever been able to achieve a vague, “half-sobriety”, in which relapse (I see in hindsight) was practically inevitable. I say, without hyperbole, that my “rock bottom” is death. It’s critical that I embrace whatever best helps me to live clean—and this medication is what’s kept me fully sober.
Perhaps some readers were unaware such medications existed, or perhaps (like me) have avoided exploring these medications further, because of perceived stigma around “taking drugs to stay clean.” I’m not a physician and will not claim to know what options are best for others, but Naltrexone offered me the ability to avoid consuming alcohol. Perhaps you’re repelled by the idea of being unable to manage your substance abuse problem under anything other than your own willpower. But Naltrexone did not replace my willpower; it’s supplemented it. I do get cravings, but I have the power to proactively say “no.” I have the option to drink if I want to, but Naltrexone helps me say “that’s not the path I’m taking today.” I have the opportunity to strengthen my own willpower.
If you’ve avoided considering a sobriety assistance medication, I encourage you to rethink that avoidance. People say the only method of dealing with a substance abuse problem is to “just quit.” Others say “A.A. is the only way” (pardon the excessive rhyming). These work for some individuals, but those people are not heroes, and you are not any weaker because “just quit” or A.A. haven’t worked for you. Whatever works for you is what’s right for you.
Sobriety is a wonderful reality, and it’s worth considering any option that might help you live that reality.
*My intention is not to disparage A.A., Rational Recovery, or any sobriety focused program. People find long term sobriety through these programs, and that’s always worthy of recognition.