I set out to remedy this when I founded the nonprofit HAMS in 2007. HAMS—an acronym for Harm reduction, Abstinence, and Moderation Support—is a lay-led, free-of-charge support group for alcohol harm reduction, which today has over 13,000 online participants. 

HAMS supports any positive change in regard to alcohol use, and supports members in goals they choose for themselves, ranging from safer drinking to reduced drinking to quitting altogether. What does success look like for HAMS members? The answer is different for every individual. Below are 10 stories by way of example—told in the person’s own words, edited for length, and shared with consent. All names are pseudonyms.

Wally

My HAMS story began around 2012. At the time I was drinking about a fifth of tequila and snorting about 2 grams of cocaine on a daily basis. I had been in and out of AA meetings for about 25 years, with mixed results. I quit trying the AA approach because of the toxic personalities there. 

It was at about this time that I came across a HAMS video online and it caught my attention. I’ve been following HAMS articles and using the HAMS Facebook group for support/education ever since. Over time I have been able to drastically reduce the amount of alcohol and cocaine that I drink/use. 

Some of the harm reduction techniques that I use are: counting the number of drinks that I have daily and recording them in the HAMS online drink tracker; only drinking at home by myself; drinking only after 4 pm; never driving while intoxicated; skipping drinking days; cost-benefit analysis, eating food when drinking; and smoking cannabis. I use the HAMS Facebook group for support/friendship daily, and find it highly useful. 

Most days I drink about eight shots of bourbon and use cocaine about twice a month. I’m happy with this number of drinks but have to abstain from coke ASAP. Trying to get there. Overall, my drinking/using is much much lower, and causes me far less trouble than they did before I started trying to change my habits with HAMS techniques.

“One of the biggest shifts for me is that I no longer see drinking as all-or-nothing. If I choose to have a drink, I do not see that as failure.”

Rachel

Before HAMS, I had been drinking daily for approximately three years. I never drank in the mornings and continued to maintain my professional responsibilities, so for a long time I did not see my drinking as problematic. During the height of my drinking, I would start drinking after seeing my last therapy client, and drank both socially and at home. Although I was not drinking heavily every day, there were periods where I drank to blackout. Over time, I realized alcohol had become automatic and something I relied on socially. It negatively affected my mood, social life and overall well-being. 

I first learned about HAMS while taking a drug and alcohol class where we discussed alternatives to traditional abstinence-based programs. What appealed to me was the focus on harm reduction, personal choice, and reducing shame rather than labels or perfection. 

Today, I am mostly abstinent. In the past seven months, I have only had a couple of cocktails. One of the biggest shifts for me is that I no longer see drinking as all-or-nothing. If I choose to have a drink, I do not see that as failure. Alcohol does not control me—it had simply become too important in my life, and I changed that relationship. 

The most helpful tools for me were the cost benefit analysis and the accountability culture within HAMS. Kenneth’s drink count posts were especially meaningful because everyone reported honestly—whether they had zero drinks or 10—without judgment. I also tried naltrexone, but it was not the right fit for me because I felt like it reduced enjoyment overall. I read the HAMS book and found it insightful (although I’m still hoping for an audiobook someday). 

Joe

My drinking before HAMS was excessive, especially around 2021 when I joined the group. I blacked out in Las Vegas, was denied access to my flight home and had to stay another night. That’s when I realized I had to change. 

My drinking now is more controlled, most of the time. I still go on benders when I’m stressed, but I’ve been leaning more into the A in HAMS, spending time alcohol-free so I can focus on fixing the problems in my life. HAMS gave me a community of like-minded people who don’t judge and don’t believe in “tough love,” but will also offer rational, logical advice. Also, HAMS, and especially How to Change Your Drinking, helped me understand what is going on with my brain and my behavior around alcohol, giving actual insights based on scientific studies and a more modern understanding of addictions and use disorders. 

My main tools for supporting my plan are definitely charting my drinks—I still notice a huge difference in the amount consumed if I don’t track and keep that number at the forefront of my mind while drinking—timing my drinks to better pace myself; not relying 100 percent on shots when drinking; taking regular alcohol-free periods of at least two weeks (usually longer at this point); and I create a cost-benefit analysis and written plan about every month, taking into account how I want my drinking to change. 

I am a huge fan of the HAMS book, and I read it about twice a year to keep myself accountable. I also am very active on the Facebook group, and I’ve found helping others has assisted in my own recovery journey. I didn’t join the Zoom meetings for my first few years in HAMS, but now they are something I look forward to, getting to share what’s been going on, and being able to connect with others about their struggles and wins. All in all I’ve struggled with life since around COVID, adding kids, losing jobs with long-term unemployment, and general mental health issues, but one thing that has remained constant is HAMS. I’ve tried a lot of the other groups and books […] but nothing I’ve experienced has gotten to the core of the apple like HAMS, and I’m eternally grateful.

Mary

I’m just about to hit four years abstinent from alcohol with my partner. We did it together after he puked blood from a day-long binge, and I lost a very dear friend from alcohol-related suicide and feared I might follow him. I’d come very close to checking out myself in 2021, and ended up in hospital three times in one week. We’d tried moderation but always failed miserably. 

We ran a harm reduction charity in the UK for 10 years, but when we lost our funding in 2014 we slowly slipped into a pattern of binge drinking ourselves, which soon became a nightmare for me due to the kindling effect, which I learned about in the HAMS group. 

HAMS helped me ground myself and not feel guilty or embarrassed about messing up, even though I knew all the dangers and pitfalls of drinking again inside out. It’s easy to help and advise others, but hard to apply that same compassion to yourself sometimes. HAMS was a safe space for me to vent and share without judgment. I’d had terrible experiences with AA in the past, so it’s wonderful that alternatives like HAMS exist now. 

“Being amongst others who shared similar struggles helped me understand that I am not alone and I am not the monster I was acting like.”

 

Martha

Before HAMS I was drinking two-to-three fifths of liquor a day. Drinking would make me act paranoid and erratically. My partner at the time was not helpful, and I was also struggling with my mental health. I’d cause bodily harm to myself and property damage around me when I’d have my paranoid fits. I ended up in the psych ward three different times in the first half of 2025. 

I found HAMS looking for a secular support group for drinking, because I knew my relationship with alcohol was not healthy and needed to change. I started scrolling HAMS, and being amongst others who shared similar struggles helped me understand that I am not alone and I am not the monster I was acting like. Reading other people’s success stories gave me hope I could also get out of this rut I found myself in. 

I met someone who was nice and kind, who didn’t drink, and didn’t enable that behavior. I moved in with him in September 2025. And now, almost a year later in August, I will be one year sober. I didn’t use any medications or tools to help with quitting. For me, it was about leaving behind the environment I was in. Not wanting to be in that survival mode state anymore… And surrounding myself with people who share my value of wanting to not drink. And willpower. 

I never experienced any withdrawal symptoms other than the hangxiety. I simply went to the psych hospital one final time and never took another sip after that. I took a Greyhound out of state and away from that environment. Drinking isn’t for me. I don’t know if there will ever be a day where I can casually enjoy a drink again. But if not, I’ve accepted that reality. 

Naomi

I became active in HAMS after suffering a life-threatening bout with alcohol last year. I was drinking vodka 24/7 and ended up in the ICU in critical condition. I had to call an ambulance for myself. 

Since then, I’ve joined HAMS Zoom meetings multiple times per week and have made real friends. Through support of my goals of not necessarily full sobriety, they’ve met me where I’m at. Today, I’m drinking far less, have regained partial custody of my kids and wouldn’t be here without my HAMS support network. They mean the world to me. The vodka is gone. The 24/7 drinking is gone. HAMS got me there, due to group accountability and work on my own. I have my life back with my children, and that’s a gift from HAMS I can never overstate. The Zoom calls are life-altering for me, and I’d recommend them to anyone struggling. 

Esther

I am one that chooses to be alcohol-free. Before I detoxed, I was in a cycle of blackout drinking, being sick throughout the workday until I could have a drink on the way home from work. Weekends were just a blur. I medically detoxed three times within a year. It was a never-ending cycle. 

I choose to be abstinent because I have too much to lose, as a single mother whose children lost their father to alcohol. I found the HAMS Facebook page after my last detox, and felt a sense of relief. HAMS has been immensely helpful to me because there is no judgment. I’m not flawed, I’m human. There is nothing wrong with me. My current plan that works for me has been bi-weekly therapy to deal with my trauma from my ex husband. I do utilize legal THC/CBD edibles at night, which helps with sleep and anxiety. I interact on the HAMS Facebook page. 

Grace

I stumbled across HAMS one night when I was completely wasted. I wanted to do something about my drinking, and I was like messing around on Facebook and that’s how I found it. At that time I was drinking about a handle (1.75 liters) of booze a night. 

I did the HAMS taper, and just having the support from other people who knew where I had been and being able to talk to people and communicate with people who had been there was so helpful. Now, I drink alcohol maybe once a month, about two drinks. Instead, I drink THC beverages, and that helps to curb my, you know, craving for alcohol. Actually, I’d rather drink those than alcohol now. I tried AA and that didn’t work for me. And I tried Antabuse and that was god-awful. I find the HAMS Facebook group and the Zoom meetings really helpful; in fact, I facilitate the Zoom meeting once a week. I’m totally happy that I’m not drinking like I was before, because it was going nowhere good, if you know what I mean. 

“I think one of the main things that HAMS taught me is that I’m not powerless. I’m in control.”

 

Theresa

I was in HAMS before there was even a Facebook group, back when we did a text-based chat. Someone sent me the link to the HAMS taper, and I tapered off of a half gallon of vodka a day. 

Now, that didn’t last and I ended up going back to AA. I was sober in AA for six years and I was miserable, and then I decided to try controlled drinking again and that’s when I found the HAMS Facebook group and I joined. So, both times that I went to HAMS, my drinking was out of control. 

What is it like now? It is non-existent now. I have been alcohol-free for over three years. I’m on daily naltrexone. I never have cravings. I don’t think about it. Alcohol is not a part of my life, but I’ve also rejected all of the AA norms and stigmas and slogans and bullshit that they taught me over the years. For example, the AA saying that “non-alcoholic beers are for non-alcoholics,” and you shouldn’t go to concerts alone. I go anywhere that I damn well please—because I’m not powerless, and I think one of the main things that HAMS taught me, even though I’m one of the people that are abstinent, is that I’m not powerless. I’m in control. I’m in control of my choices, and when I got away from AA my life actually began.

Samantha

I was going through alcohol withdrawal and searching the web for information because I thought I was going to die, and the HAMS website popped up. I learned about tapering with beer, and ordered a case of beer. It took me eight months to taper down to zero. 

I find the Zoom groups very helpful. It’s a sense of community. It’s like a family within a family, and there’s a lot of support—whether you’re going to moderate your drinking, or if you’re going to quit drinking or if you’re just going to be an active drinker. Everybody supports you where you’re at, and I’ve gotten a lot of support over the last six years and it’s definitely the way to go. 

I don’t drink at home anymore, so basically if I go out to dinner, I’ll have two cocktails. If I’m at a dinner party, I’ll have no more than four drinks. I’m only drinking once or twice a month now. I’m also on the Mounjaro shot, and they say that actually can help curtail some of the cravings. I’ve lost 81 pounds and my diabetes is well under control now. I don’t know if the Mounjaro is helping the alcohol, but like I said, I’m basically doing weeks on end without anything and no cravings or anything like that, and keeping it to a maximum of four drinks when I do partake. 

Photograph by Edward Howell on Unsplash

The post “No Judgment”—Ten Personal Stories of Alcohol Harm Reduction appeared first on Filter.

Aversion therapy—often involving pairing an alcoholic drink with an emetic, to condition an association with nausea—had proved highly effective for many patients who were voluntarily seeking abstinence, as Filter described in March 2023. By the 1980s, dozens of hospitals were offering it. 

The complete erasure of aversion therapy is disempowering, because it narrows people’s choices.

However, the advent of managed care led to ever-increasing competition for an ever-declining pool of patients whose insurance would pay for treatment. This led to the treatment wars of the 1980s, where each treatment modality claimed to be the best and denigrated the others as worthless. The Raleigh Hills chain of aversion therapy hospitals fell victim to political chicanery in that period and went out of business. Schick Shadel Hospital suffered a similar fate decades later, through a combination of mismanagement and COVID-19.

It is increasingly accepted today that there are multiple pathways to recovery. It’s not a one-size-fits-all proposition. Rather, different things work for different people. The complete erasure of aversion therapy is disempowering, because it narrows people’s choices. 

Richard St. Peter, who benefited from aversion therapy himself, is the former CEO of Schick Shadel Hospital. He’s also in the early stages of working to reopen it. Filter’s interview has been lightly edited for length and clarity.

Kenneth Anderson: How did you first get involved with aversion therapy for alcohol use disorder?

Richard St. Peter: I realized that I had a problem with alcohol by the 1970s. I tried AA, but it wasn’t really helpful for me because it did nothing for my cravings. Then a friend of mine took the aversion treatment at Raleigh Hills, which operated a chain of 28 aversion treatment hospitals, mainly on the West Coast. 

I was afraid that if he quit drinking, he wouldn’t be any fun anymore, but quite the opposite was true. He out-hunted, out-fished and out-dived all of us who were still drinking, and took our money playing poker. So in 1982, I decided to take the aversion treatment at Raleigh Hills myself.

KA: And how did that work out?

RSP: It was amazing! The aversion therapy took away all my cravings for alcohol completely! I stayed abstinent from alcohol for 11 years until 1993. My training is in finance, and during that time I served as CFO and executive vice president for a number of companies.

KA: What happened in 1993?

RSP: I was at a casino in Las Vegas playing poker, and I ordered a virgin bloody mary. It took a very long time for the drink to come, and when it finally did, I gulped it down because I was thirsty. But it didn’t taste right, and I told the waitress, “I think this tomato juice is rotten.” 

And she said, “No, that’s a bloody mary.” And I said, “A real bloody mary with alcohol?” And she said, “Yeah.” And I said, “I wanted a virgin bloody mary.” And she said, “Okay, I’ll bring you a virgin bloody mary.” 

A short while after that, for the first time in 11 years, I felt the buzz, and I said to myself, Well, that was stupid drinking that. And, the next day, for the first time in 11 years, I felt the cravings come back. And I thought since my career was going so good, my family was doing so good, everything was going so good, that I could become a social drinker.

“The Schick Shadel treatment worked for me when nothing else did … I believe in multiple pathways; different things work for different people.”

KA: How did that work out?

RSP: Badly. In less than a month, my drinking spiraled out of control. I woke up one morning in a pool of vomit with no idea where I was, and that’s when I realized that I had retriggered uncontrollable alcoholic drinking.

KA: What did you do then?

RSP: Well, I tried contacting Raleigh Hills, but I found out that they had gone out of business due to some rehab politicking. But then I found out that Shick Shadel in Seattle was in business and offering the same kind of aversion treatment. It was actually Schick Shadel that had first pioneered the aversion treatment for alcohol use disorder. So, I took two days of the conditioning treatment at Schick Shadel, and have never drank since.

KA: How did your connection with aversion treatment continue?

RSP: I did well in business; I got lucky and I retired in 1998, and I started joining pay-it-forward types of activities, like alumni associations for my schools, hospitals, and businesses that put me on their boards because they thought I would help them out. That’s when I was contacted by the Schick Shadel Hospital Foundation. 

They called me up and asked me if I would join. I said, Sure, I’d love to. I went to Seattle, and I was at a foundation meeting, and afterwards the hospital administrator got me and said, “I hear you’re a finance guy. We have a controller here, and we’re bouncing checks and I can’t understand his explanations. Could you come and talk to him?” I said, Sure. And we went to his office. 

His office had a front door and a back door, and when he saw me come in the front door, he went out the back door, and we never saw him again.

The hospital administrator asked me if I could just stay on for a little bit and kind of get things sorted out until we could get a replacement. I said I would do that, and I looked at their financial statements and saw that they were indeed in deep trouble. I figured out what their problem was and got them a positive cash flow within a month. A month later, the partners that owned Schick Shadel asked me if I would like to buy in. They had some shares left, and I said yes. After that, I started buying up any shares that anyone wanted to sell. That’s when they asked me to be their CEO. I stayed on as CEO until 2011.

“We could reopen as a nonprofit. I would like to make the Schick Shadel program available to anyone who could benefit from it.”

KA: Why did you leave?

RSP: Well, the Great Recession of 2008 hit, and the majority of the stockholders decided to sell Schick Shadel to Ascend Health Corporation in 2011 because Ascend Health was willing to pay them 14 times their original investment. Then, in 2012, a hospital mega-corporation named Universal Health Services, Inc. bought Ascend Health Corporation and replaced experienced addiction management with big corporate managers. 

When COVID-19 hit, the new management, unlike other hospitals, allowed medical staff to remain employed but not come to work. The census dropped, and that’s why Schick Shadel closed on June 30, 2022.

KA: And why do you want to reopen Schick Shadel?

RSP: The Schick Shadel treatment worked for me when nothing else did. My kids went through some of the best-known rehabs in the country without being helped, and then they tried the Schick Shadel program, and that’s worked for them. And now I’ve got grandkids, and I’d like the Schick Shadel program to be there for them, too, if they need it. 

I believe in multiple pathways; different things work for different people. Some people do great with AA, but others need a different kind of a program. 

KA: And what do you need to do to reopen Schick Shadel?

RSP: Well, I have money to invest, but not enough to do it all on my own. So I need to find some investors who are interested in a solid, steady return on their investment. Schick Shadel was a very profitable business for over 80 years, until these problems with COVID and management that I mentioned.

Or, if we could find a foundation to back us, we could reopen as a nonprofit. I would like to make the Schick Shadel program available to anyone who could benefit from it.

Photograph (cropped) via GetArchive/Public Domain

The post Could Aversion Therapy for Alcohol Use Disorder Make a Comeback? appeared first on Filter.

The study, a full version of which was obtained by Marijuana Moment in a pre-proof form, found that “for some individuals who drink heavily, cannabis may serve as a substitute for alcohol,” adding that “craving reduction is a potential mechanism through which this could occur.”

The authors, affiliated with Colorado State University, the University of Colorado Boulder and the University of Colorado Anschutz Medical Campus, say the project is the “first study to test effects of legal-market cannabis on alcohol intake.”

They found that, on average, participants drank about 25 percent fewer alcoholic beverages after using cannabis compared to when alcohol was consumed alone. Noting the importance of the finding, they wrote that marijuana “continues to rank as the most widely used substance among people who drink alcohol.”

For the clinical trial, scientists recruited 61 heavy drinkers who also use cannabis several times a week. Each participant completed two sessions in a mobile laboratory parked outside their homes—a workaround to federal restrictions on handling legal marijuana in campus labs. In one lab, they drank alcohol alone. In the other lab, they first used their own legal-market cannabis before drinking. In both sessions, participants received a standard “priming” drink and then had the opportunity to consume up to four more.

The researchers concluded that “cannabis self-administration was associated with a significant reduction in number of drinks” participants consumed.

When the researchers broke the group down further, they found that 23 participants, called “substituters,” drank significantly less after cannabis use and reported a consistent drop in alcohol craving. Another 23 “non-substituters” drank the same amount or more, showing little change in craving. Fifteen abstained from drinking altogether during both sessions.

“Findings from this novel human laboratory study provide initial support for the idea that legal-market cannabis can serve as substitute for alcohol among some individuals who engage in heavy drinking,” the researchers concluded, adding that “cannabis self-administration was associated with a significant reduction in number of drinks” participants consumed.

While the results are promising, the authors warn about limitations to the study’s parameters. They note that marijuana was always consumed before alcohol, meaning the reverse order was not tested. The mobile lab, while an innovative way to avoid threatening federal funds for the universities, may not mimic real-world drinking settings. They also note that the sample was not broadly representative, comprising mostly white and male subjects.

The authors call for “future work to explore additional individual and contextual factors that may predict whether cannabis can serve as a substitute for alcohol,” noting the importance of studying clinical implications for recovery approaches among those who are not abstinent. With problematic alcohol use remaining a leading cause of preventable death, researchers say this line of work could eventually inform harm reduction strategies.

In a study earlier in 2025, scientists found that “CBD represents a promising candidate to reduce voluntary alcohol consumption.”

This study preprint, submitted to the Drug and Alcohol Dependence journal and funded by the National Institutes on Health’s National Institute of Alcohol Abuse and Alcoholism, is part of a flurry of recent scientific studies on the effects of marijuana use as a way to curb or reduce drinking.

In a study earlier in 2025, scientists at the University of Sydney published a paper investigating the theory that non-intoxicating cannabidiol could mitigate problematic drinking issues. The research, published in the British Journal of Pharmacology with funding from the Australian National Health and Medical Research Council, found that “CBD represents a promising candidate to reduce voluntary alcohol consumption.”

According to a federally funded study published in the Nature journal earlier in 2025, CBD has potential to treat alcohol use disorder by reducing withdrawal symptoms and lowering the risk of resuming problematic use, while also providing neuroprotective effects. The results of that study “underscore CBD’s potential therapeutic utility for alcohol use disorder (AUD) and provide mechanistic insights into its actions,” they noted.

This also comes at a time when younger Americans are increasingly using cannabis-infused beverages as a substitute for alcohol—with one in three millennials and Gen Z workers choosing THC drinks over booze for after-work activities like happy hours, according to a new poll of 1,000 young professionals.

Photograph by waferboard via Flickr/Creative Commons 2.0

This story was originally published by Marijuana Moment, which tracks the politics and policy of cannabis and drugs. Follow Marijuana Moment on X and Facebook, and sign up for its newsletter.

The post Federally Funded Study Links Marijuana Use to Reduced Heavy Drinking appeared first on Filter.

While nearly half of full-time college students drink, according to 2023 survey data from the Substance Abuse and Mental Health Services Administration, nearly 30 percent binge drink. Binge drinking—which SAMHSA defines as five or more drinks in a sitting for men, or four for women—is linked to a slew of health problems, including injuries from accidents and alcohol poisoning.

Universities often respond to alcohol use by imposing zero-tolerance policies, or requiring alcohol prevention education in an effort to curb student drinking. But a student-led club at Rice University in Texas is taking a different approach. Through a campaign called “Balance Your Buzz,” it gives students the chance to learn how alcohol affects them in real time—encouraging more thoughtful alcohol use and informed decisions, without judgment.

The club’s president is Rice student Doug Calvillo. Our interview about the campaign has been edited for length and clarity.

“In a future setting, they can drink and then check their BAC, and be like, ‘Ok, this is about where I felt good before.’

Emma James: What is “Balance Your Buzz”?

Doug Calvillo: Balance your Buzz is a party—but it’s also an alcohol education and harm reduction campaign put on by our club, the Rice Coalition on Substance Use. We provide students with resources and education to learn more about their alcohol limits in a safe and welcoming environment.

EJ: What do your parties look like?

DC: We hold these events in real-world party settings within our residential colleges, which is Rice’s dorm system. We offer free alcohol in a designated area. After students drink enough to feel good, they can walk to a different space, which has snacks and non-alcoholic beverages, to socialize and mingle.

Then, we give students blood alcohol content (BAC) monitors to track how they’re feeling over the course of a night of drinking. We’re not as concerned about the number they’re blowing into the monitor, but that they have these dedicated BAC check-in points throughout the night to correlate how they feel with how much they’re drinking: “Ok, I’ve had about this many drinks. I feel this way.”

There’s one brand we found that has disposable BAC monitors. So when students leave, we’re giving them those and we’re like, “Hey, look, you can use this at your next whatever.” Our club also offers these for students whenever they want; they can come to us and collect them. Then, in a future setting, they can drink and then check their BAC, and be like, “Ok, this is about where I felt good before, and this is about where I’ll feel good right now.”

Disposable BAC monitors

EJ: Where did this idea originate?

DC: Alcohol on college campuses is a big concern, and Rice is no exception to that. We had some significant alcohol-related incidents on our campus last year that received public attention. Initially, our administration responded with a focus on limiting consumption and getting rid of the party culture. The Balance Your Buzz intervention was part of several efforts to help shift the culture to one of mutual trust between administration and students.

Another big motivator was just a general need for more innovative and effective drinking interventions. Many of the methods out there, such as slideshows during orientation week, infographics, or even drunk goggles, are just not supported by evidence to reduce alcohol-related harms.

“We also collected preliminary data from participants; 95 percent reported pacing their drinking more effectively.”

 

EJ: So how is this different from other college drinking interventions?

DC: Our program fosters a genuine curiosity and engagement to participate, unlike some of those other programs that might feel like a requirement. Our event is something that people are choosing to engage in, and the skills and messaging that we’re teaching are immediate, tangible and transferable to future settings.

EJ: How was the program received by students?

DC: It’s been incredibly well received. There was excitement and curiosity from students about checking their BAC levels. And we’ve found that providing alcohol education in a nonjudgmental way attracts a wide range of students—from people who frequently attend parties to students who are just starting to learn their alcohol limits.

For example, at one event, we had two students comment that they’ve never really drunk before, but they came out to our event because they felt like it was controlled and a safe space to learn about how alcohol affects them.

We also collected preliminary data from 22 participants on the impact and acceptability of the intervention. The results are promising: 100 percent of students reported that they gained a better understanding of how much alcohol it takes to feel “tipsy,” 95 percent reported pacing their drinking more effectively, and 100 percent reported that they enjoyed the event.

Detail from event flyer

EJ: And how was it received by faculty?

Faculty shared similar interest. Because of the challenges the university faced with alcohol last year, there were some barriers at first. Fortunately, by the time we decided to implement this, Rice was looking for these alternative measures and they were shifting toward a more harm reductionist view. So we kind of came in at the right time.

We worked closely with Associate Dean Allison Vogt and Erin Timmerberg at Rice’s Student Wellbeing Office, among other key campus stakeholders. I think a few people were concerned about how things would look, if the university provided alcohol and something went wrong. But Associate Dean Vogt was there to quell their fears and help share that this initiative isn’t causing more harm; it’s actually reducing harm from alcohol.

“Importantly, we centered trust: We communicated that we were trusting these students with the alcohol that we were providing.”

EJ: Have you experienced any challenges?

DC: We had to register it as a public party, which is this huge process at Rice. But other than just being time-consuming and adding some logistical hurdles, it wasn’t necessarily a challenge—in the end, it helped the event run more safely and smoothly.

For the first event, it was challenging to get university buy-in to pay for alcohol. Instead, we collaborated with other student groups who host social events to cover those costs. Once we had data to show our pilot event was successful, we were then able to secure more funding, ensuring future events ran smoothly.

EJ: Could this be replicated by other schools?

DC: Absolutely. All you need is a venue where students are used to going—we hold events in well-known party settings to engage the participants and make them feel comfortable. If you’re at a larger university, you might want to limit participants per event; around 200 students was manageable for us.

More importantly, we centered trust: We communicated that we were trusting these students with the alcohol that we were providing.

Top photograph (adapted) by cottonbro studio via Pexels. Inset images courtesy of Doug Calvillo.

The post “Balance Your Buzz”—A Student-Led Alcohol Harm Reduction Initiative appeared first on Filter.

The first ever placebo-controlled randomized trial of Ozempic for AUD was published in February by JAMA Psychiatry. The study was carried out by the University of North Carolina at Chapel Hill, in cooperation with the National Institute on Alcohol Abuse and Alcoholism. The lead investigator was Christian Hendershot, PhD.

There were 48 subjects in the study: 21 were categorized as overweight (BMI of 23 or more but less than 30) and 27 as obese (BMI of 30 or more). All subjects met criteria for AUD according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). 

On average, the participants had moderate AUD (meeting an average of 4.2 DSM-5 criteria). They consumed an average of 4.2 US standard drinks on drinking days, and drank an average of 20.2 days per month. When drinking and non-drinking days were combined, they consumed an average of 2.9 drinks per calendar day, with an average of 9.1 heavy drinking days per month and an average alcohol craving score of 12.0. None of them were previously seeking AUD treatment. 

The Ozempic group showed significantly greater reductions than the placebo group in number of drinks per drinking day, number of heavy drinking days and alcohol craving scores.

The treatment consisted of injections of either a standard dose of Ozempic or a placebo, given once a week. Both the Ozempic group and the placebo group showed reductions in all alcohol-related variables over the nine-week experiment. However, there were significant differences between the Ozempic group and the placebo group on the amount of change shown for some of these variables. 

The Ozempic group showed significantly greater reductions than the placebo group in number of drinks per drinking day, number of heavy drinking days and alcohol craving scores. Differences in number of drinks per calendar day and number of drinking days were not significant, however. As a side note, the Ozempic group showed weight loss but the placebo group did not.

Ozempic is a member of a class of drugs known as glucagon-like peptide-1 receptor agonists (GLP-1 receptor agonists). GLP-1 receptors are found in the pancreas, the brain, the nerves that control the digestive system, and a few other places. In nature, GLP-1 receptors can be activated by the hormone glucagon and by glucagon-like peptide-1 (GLP-1). GLP-1 receptors can also be activated by synthetic drugs such as Ozempic. 

When the GLP-1 receptors in the pancreas are activated, they tell the pancreas to release more insulin. When the GLP-1 receptors in the brain are activated, they tell the brain that the stomach is full and that the person should stop eating. When the GLP-1 receptors in the nerves of the digestive system are activated, they tell the valve between the stomach and the intestine to close, among other things (the brain is also involved in issuing that instruction).

It is believed that Ozempic’s effects in the brain may cause it to reduce alcohol intake. Just as Ozempic tells the brain to be satisfied with smaller amounts of food, it seems to tell the brain to be satisfied with less alcohol. Ozempic’s effect on the valve between the stomach and the intestine might also be involved, because when this valve is closed, alcohol enters the bloodstream more slowly and people attain a lower BAC.

Although that recent study was the first ever placebo-controlled randomized trial of Ozempic for AUD, it was not the first such trial of any GLP-1 receptor agonist; the first concerned a drug named Bydureon (exenatide). 

Overall, Bydureon did not significantly reduce heavy drinking days compared with placebo. However, when the results were analyzed by weight category, there were some significant findings.

The Bydureon trial, conducted in Sweden with 127 subjects and reported in JCI Insight in September 2022, was not a success. When the results of the entire group were examined, it was found that Bydureon did not significantly reduce the number of heavy drinking days compared with placebo. 

However, when the drinking results were analyzed by weight category, there were some significant findings. Among 30 patients classed as obese, the Bydureon group did significantly better than the placebo group. For 45 patients classed as overweight, there was no significant difference between groups. And among 52 patients considered to have “normal” weight, the Bydureon group did significantly worse than the placebo group. 

It is unclear whether the contrasting outcomes of the Ozempic and Bydureon trials were due to differences in the sample of subjects tested or to differences in the efficacy of the two drugs. Ozempic has been reported to be more effective than Bydureon for weight loss and control of diabetes.

More research is clearly required, and several further trials of diabetes drugs for AUD treatment have been registered with clinicaltrials.gov. 

A Danish study is currently investigating whether Ozempic reduces alcohol intake in obese patients with AUD. A multisite trial with 86 locations is investigating the effects of Ozempic and other drugs on people with alcohol-related liver disease. And both a National Institute on Drug Abuse (NIDA) study and an Oklahoma State University study are currently recruiting subjects to investigate whether Ozempic reduces alcohol intake in patients with AUD.

The raft of upcoming studies, should enhance our understanding of how effective GLP-1 agonists are in treating AUD, and for whom.

Meanwhile, a University of Colorado study is recruiting subjects to look into whether Rybelsus (semaglutide in pill form) reduces alcohol consumption in treatment-seeking individuals with AUD. And a Swiss study, which is not yet recruiting, will investigate whether Ozempic increases alcohol abstinence in patients with obesity and fatty liver disease.

Other FDA approved GLP-1 agonists are dulaglutide (Trulicity), liraglutide (Victoza), lixisenatide (Adlyxin), and tirzepatide (Mounjaro). Of these four, only Mounjaro currently has registered clinical trials for AUD treatment—three of them, in fact. 

A Danish study is currently recruiting patients to study the effects of Mounjaro on alcohol intake in patients diagnosed with schizophrenia and AUD. A University of Southern California study, not yet recruiting, will investigate whether it reduces the number of heavy drinking days in patients with moderate-to-severe AUD. And a study at Brigham and Women’s Hospital in Boston, also not yet recruiting, will investigate whether Mounjaro decreases cue-induced cravings for alcohol in people with AUD.

At the moment, then, there’s promise but not enough evidence to go on. The raft of upcoming studies, however, should enhance our understanding of how effective GLP-1 agonists are in treating alcohol use disorder, and for whom they are effective.

Photograph via PublicDomainPictures.net

The post How Hopeful Should We Be About Ozempic for Alcohol Use Disorder? appeared first on Filter.

It’s therefore instructive to look back on an often-forgotten history of LSD, one of the most famous psychedelics, being used to treat veterans—specifically for alcohol issues—in the United States.

The first report of the use of LSD as a therapeutic drug was published in Switzerland in 1947—11 years after Swiss chemist Albert Hoffman had first synthesized the substance.  Six patients with schizophrenia were given low doses of LSD, and reportedly showed temporary improvements in their emotional states, such as reductions in depression.

In the 1950s, two forms of LSD-assisted psychotherapy were developed: Psycholytic (mind loosening) therapy involved giving patients a low dose of LSD prior to the therapy session in order to allow them to talk more freely about past traumas, which could be integrated in later sessions. Psycholytic therapy was essentially a variant of narcoanalysis (aka narcosynthesis)—a method invented by J. S. Horsley in the 1930s using sodium amytal or pentothal (“truth serum”) to put the patients into an altered state and release the subconscious. Narcoanalysis has been nicknamed “short-cut psychotherapy,” since it could be done in a matter of days.

The first paper describing the use of LSD for psycholytic therapy was published in 1950. Psycholytic therapy was used for psychiatric disorders rather than for addictions.

After Osmond and Hoffer published their results in the 1950s, a number of other facilities began experimenting with psychedelic therapy for alcohol or other drug addictions.

Psychedelic therapy, under that name, was invented in 1953 at Weyburn Mental Hospital in Saskatchewan, Canada, by psychiatrists Humphry Osmond and Abram Hoffer. 

During the 1950s, the myth that “alcoholics” had to “hit bottom” in order to recover was dominant. Osmond and Hoffer interpreted “hitting bottom” to mean experiencing delirium tremens (DTs). Moreover, in the 1950s, it was believed that LSD was a psychotomimetic drug—that it mimicked symptoms of psychosis found in patients with schizophrenia. 

Osmond and Hoffer hypothesized that delirium tremens, which included unpleasant hallucinations, was essentially similar to schizophrenia. They further hypothesized that giving an “alcoholic” a high dose of LSD (500 micrograms) would duplicate the experience of DTs, thus helping the person to “hit bottom” and recover. (I use the historical, stigmatizing terms “alcoholic” and “alcoholism” in this article because they are conceptually different to the contemporary “alcohol use disorder.”)

Much to their surprise, Osmond and Hoffer found that high-dose LSD gave their alcoholic patients a mystical, transcendental experience rather than DTs. Moreover, their patients who had these experiences lost interest in alcohol and began abstaining. 

Osmond and Hoffer dubbed this psychedelic therapy. They found a certain setting—including music, flowers, a trip guide, etc.—to be essential to consistently inducing the required psychedelic experience. 

After Osmond and Hoffer published their results, a number of other facilities began experimenting with psychedelic therapy for alcohol or other drug addictions. In the US, these included Spring Grove State Mental Hospital in Maryland, Mendota State Mental Hospital in Wisconsin, Mendocino State Hospital in California, the Lexington Narcotic Farm, UCLA and five Department of Veterans Affairs (VA) hospitals. 

VA hospitals had a long history of refusing admission for a primary diagnosis of alcoholism. Service members who were labeled alcoholics were given less-than-honorable discharges. 

It is worth noting that prior to 1962, the only drugs strictly regulated by the federal government were opioids, cocaine and marijuana; regulation of other drugs was much looser, and any therapist could easily and legally obtain LSD for use in their office. After Congress passed the Drug Efficacy Amendment in October 1962, however, LSD research was strictly limited to facilities with FDA approval.

VA hospitals had a long history of refusing admission for a primary diagnosis of alcoholism, although a few alcoholic veterans were sometimes admitted under a false diagnosis. The military rejected the idea that alcoholism was a disease, and service members who were labeled alcoholics were given less than honorable discharges. 

The Winter VA Hospital in Topeka, Kansas, was the exception to the rule, however, and had operated an alcoholism treatment program from the time it opened in 1946. What made the Winter VA Hospital different was that it operated in partnership with the famous Topeka Menninger Clinic and served as the training institute for all VA psychiatrists. Karl Menninger was the director of the hospital’s neuropsychiatric unit.

In August 1960, Samuel Kaim was appointed chief of psychiatric and neurological research for the VA Central Office, putting him in charge of psychiatric and neurological research for all VA hospitals. 

Kaim had noted that about one third of patients admitted to the VA had a secondary diagnosis of alcoholism. He began funding research into alcoholism and drug addiction at VA hospitals, and by 1965, 30 VA facilities were conducting alcoholism research. In August 1964, organic disablement due to alcohol consumption was removed from the category of misconduct. From January 1967, new regulations allowed veterans to be admitted to any VA hospital for alcoholism treatment. 

In the spring of 1963, VA psychiatrist Kenneth Eugene Godfrey initiated a trial of LSD for treating alcoholism at the Winter VA Hospital. At first, the researchers attempted a version of psycholytic therapy by giving patients small doses of LSD prior to group therapy; however, this just led to chaos in the groups.

At this point, Godfrey’s patients began having psychedelic insights—and success at quitting alcohol. 

Next, the researchers attempted giving the patients a single dose of 300-400 micrograms of LSD during the sixth week of treatment and subjecting them to psychological tests; this also proved to be a failure. Godfrey finally consulted with Hoffer, Osmond and Sanford Unger, another psychedelics expert, and learned the importance of setting for the LSD experience. 

The dose was upped to 500 mcg, and administered to patients with flowers, pleasant music and a trip guide. Psychological testing during the trip was eliminated. At this point, Godfrey’s patients began having psychedelic insights—and success at quitting alcohol. 

At least, Godfrey considered the treatment to be a success; however, he was excluded from the final write up of the experiment, which was published in 1970, and which declared the LSD treatment to be a failure. 

This paper has since been justly criticized for comparing the LSD group to an unmatched control group, and its findings may have been significantly influenced by the moral panic surrounding LSD in the late 1960s.

Around 1963 or 1964, VA psychopharmacologist Leo Hollister began conducting a trial of LSD treatment for alcoholism at the VA hospital in Palo Alto, California. Yet Hollister omitted all the setting elements that had been found necessary for inducing a suitable psychedelic experience; he simply compared a high dose of LSD (600 mcg) to a dose of amphetamine (60 mg), a common alcoholism treatment of the time. Hollister published his results in 1969; not surprisingly, there was no significant difference between the two groups.

VA psychologist Milam Tomsovic and VA psychiatrist Robert V. Edwards conducted a study of the LSD treatment of alcoholism between September 1965 and April 1968 at the VA Hospital in Sheridan, Wyoming. Results were published in 1970. There were 75 subjects in the LSD group, 75 in control group I, and 183 in control group II. Control group I consisted of patients who had volunteered for the LSD study but not been given LSD. Control group II consisted of patients who had not volunteered for the LSD study. 

Control group I did the worst, probably because they had been denied the treatment which they had volunteered to take. Nonschizophrenic subjects in the LSD group showed significantly better outcomes than the other groups at one-year follow-up.

In the Highlights of the Twelfth Annual Conference Veterans Administration Cooperative Studies in Psychiatry (1967), VA psychiatrist Murray F. Ables and VA psychologist Erling W. Eng reported on an LSD alcoholism treatment trial which had been initiated at the VA hospital in Lexington, Kentucky in August of 1965. By the time of the report, 122 patients had participated (63 LSD treated patients and 59 controls); preliminary results indicated significantly more improvement for the LSD-treated patients than for the controls in both alcoholism (67 percent vs. 13 percent) and social adjustment (67 percent vs. 25 percent). A follow-up study was published in May 1970. The Lexington study was terminated in 1971.

VA psychiatrist Isham Kimbell also conducted a trial of LSD treatment for alcoholism at the VA Hospital in Houston, Texas. This was a collaborative project with Hollister of the Palo Alto VA Hospital, but I have found few details about this trial.

1966 was the year that kicked off the LSD moral panic. Scare stories appeared in the January 1966 issue of a national Sunday supplement titled This Week Magazine; in a March 1966 issue of Life Magazine; in May and June 1966 issues of the Saturday Evening Post; and many more. 

If the future prospects of treating substance use disorders with psychedelics are as bright as they appear, we can blame moral panic for several wasted decades.

Producer Jack Webb also decided to revive the popular 1950s TV series Dragnet and use it as a propaganda weapon against drugs and the counterculture. The first episode of the new Dragnet, premiering in January 1967, was titled “The LSD Story,” and gave a lurid account of a teenage boy deranged by LSD, who painted his face blue and died of an overdose of barbiturates. The Dragnet episodes, which I remember watching as a pre-teen, hit the public between the eyes like a sledgehammer. 

Later in 1967, Paul McCartney’s public confirmation that the Beatles had used the drug only added to the attention.

Meanwhile, the March 17, 1967 issue of Science reported that LSD caused chromosome damage—a major scare when the thalidomide tragedy was still fresh in the public’s mind. Although this claim would be debunked in the April 30, 1971 issue of Science, the damage to LSD research was already done. 

Research on LSD for any usage at the VA largely ended in the early 1970s, although a few projects continued as late as 1975. 

The federal government criminalized possession of LSD in October 1968, and when it created drug scheduling two years later, LSD was placed on Schedule I.

In recent years, there has been a resurgence of research on the treatment of addictions and other conditions with psychedelics. If the future prospects of treating substance use disorders with psychedelics are as bright as they appear, we can blame moral panic for several wasted decades.

Image (cropped) of the VA hospital in Topeka, Kansas, via US Department of Veterans Affairs

The post A Brief History of LSD Treatment for Alcohol Addiction at the VA appeared first on Filter.

In the ’90s when I began my sentence, I mostly saw the kind of hooch that’s more like wine than clear liquor. A very weak wine, which everyone knew tasted like shit. It was usually made by mixing fruit scraps with a little liquid and sugar inside a garbage bag and leaving it to ferment. The “wine” is no longer a feature here, at least in my experience. If you start with the fermentation process and keep going, you can instead cook off the alcohol to make actual moonshine. That’s all anyone here drinks now.

Owen* and Charlie*, like myself, are incarcerated at South Central Correctional Facility, a private prison operated by Core Civic. Both are moonshiners.

Owen learned the trade from his grandfather. As a boy he would fill mason jars with fresh moonshine from his grandfather’s liquor stills in the woods in Southeast Tennessee, load them into the old Chevy truck and make deliveries around the outskirts of town.

“Grandpop taught me early on … if the po-po caught me, I was to say nothing,” Owen told Filter. “But I never got caught.”

Charlie is from a rural, mountainous part of the state where it was rare to see a doctor, or even go into town.

“If your leg hurt, or you had some rheumatism in your back, you took a dose of moonshine,” he told Filter.

There seems to be a growing demand for prison moonshine these days. Both Owen and Charlie said that more customers are seeking it out for a specific purpose: pain management.

Chronic pain is increasing, as access to medical care is being pared away.

One compelling reason is that opioid analgesics are rarely prescribed in prison. In limited cases, for example if someone has terminal cancer, they may be allowed small doses of morphine that they have to report to a nurse three times a day to take under supervision. But for almost everyone here living with chronic pain, the most they’ll be prescribed is acetaminophen.

Ced* never drank much alcohol before he came to prison. But he has two herniated disks, and one night the pain was so crippling he couldn’t get up off the floor. Medical staff advised him to exercise and stretch more.

“I can’t sleep at night, I have such bad back pain,” Ced told Filter. “But then I’ll get a bottle of liquor, mix it in a soda can and get the best sleep without pain.”

The cost of alcohol—here at least—is about on par with marijuana, and while many people would prefer the latter it’s often much more of a hassle. Marijuana will show up on random drug tests. It also requires a flame of some sort to light it. And like many other parts of prison life, access is controlled by gangs. Alcohol doesn’t require dealing with any of these; unlike the sale of other contraband substances, this is a side hustle that people with no gang affiliation are permitted to pick up.

In addition to the reduced risk of ending up in solitary, the product itself is safer.

Alcohol is less of a risk than it used to be. Back when the fermented liquor was more common, the smell of rotting food scraps was often a giveaway. Folks who were caught with alcohol would be taken to solitary confinement for a while. Today, it’s more likely they’ll just be told to pour it out. The understaffing crisis means that, even when they catch people manufacturing, corrections officers are not looking to give themselves the extra paperwork for a substance they don’t perceive as life-threatening. Charlie said that for years, one officer who knew he was a moonshiner would stop by every afternoon for a shot.

The more fear is stoked around fentanyl and methamphetamine, the more willing officers are to look the other way when they find contraband substances that are legal, and thus less stigmatized, in the free world. To a certain extent this includes marijuana, but mainly alcohol and tobacco.

When I began my sentence, tobacco wasn’t even considered contraband yet. Over the years prison cigarettes have become more dangerous, and smoking-related harms have quietly increased. Moonshine, on the other hand, has become safer.

Tennessee prisons no longer serve fruits or vegetables, so the fermentation process now usually involves corn product, rice or grits. Sugar is usually sourced from the dry cocoa mix sold at commissary; the chocolate can be shaken out, and the sugar remains. Tang or caramels will do the job, too.

Once the mix is in the garbage bags with a little soda pop, or water if that’s all that’s available, a tube from a toothbrush holder will be taped into the opening to allow the bag to burp—and not explode—as the alcohol develops. Shaved soap or baby powder inside a soap box makes a handy deodorizer to help avoid detection. After a few days when the bag stops expanding, the mash is ready to cook off—but not the way it used to be done.

Years ago, the small hot plates used to heat the mash, or “stingers,” were cut from brass covers pulled off drainage pipes. But the brass would often poison the liquor, and folks would end up in the hospital. These days, everyone seems to have found ways to upgrade their stingers to stainless steel, which does not have the same problem. As a result, more people are willing to give the product a try.

The prison moonshine market includes many people who aren’t involved with the rest of the contraband market. The biggest factor in why alcohol is becoming more popular for managing chronic pain is just that there is more chronic pain. The prison population, here and across the country, is getting older.

Charlie’s customers pay him in commissary items. Owen’s send the money to his family on the outside.

Owen and Charlie each said that in a given batch, about four out of five 16-ounce bottles make it to market. The fifth is usually discovered and poured out, or contaminated during the production process. Each batch requires an investment of around $75, and yields around $240—which means a lot, in a facility where there aren’t nearly enough jobs to go around.

“Ain’t got any outside help,” Charlie said. “So this feeds me and keeps my ass washed with soap.”

Charlie’s customers pay him in commissary items. Owen’s send the money to his family on the outside.

“I make enough to pay my momma’s trailer payment or car payment each month,” Owen said. “They depend on me to help them; they are too old to work anymore.”

*Names have been changed for sources’ protection

Photograph of alcohol production inside a Georgia state prison, Anonymous

The post Given Few Options for Chronic Pain, Prisoners Are Making Safer Moonshine appeared first on Filter.

Tourists and foreign students have a reputation for getting intoxicated and climbing into the priceless antique fountains here, something that is illegal and of course frowned upon. I can’t say how often this happens, but the papers cover such incidents with gusto. The Trevi Fountain tends to get hit particularly hard in the hot summer months.

Naturally, we were all warned not to do this under any circumstances. Getting drunk at all, even far from fountains, was sternly advised against.

Most of my classmates—and especially study-abroads—don’t exactly heed this advice. As yet, none of us have gone skinny-dipping in the Fontana di Trevi, but many go to the local student watering hole almost nightly, and show up to class hungover. Some sip mimosas or down shots at lunchtime, at the bars across the street from campus.  

The ease of access to alcohol here—at low cost, outdoors and in family spaces—takes some getting used to.

Here in Italy, un bar is a cafe-like space, open to all ages, where food and coffee are served in addition to alcohol. Many function as cafes in the morning, cheap eateries around noon, and places to sip a glass of wine in the evening. This is helpful for those of us who don’t drink, because it feels natural and easy to order other options in this environment, even while our friends enjoy wine or Peroni. The awkward questions I’ve been asked in American bars—“Are you, like, a recovering alcoholic?”—don’t tend to crop up.   

The ease of access to alcohol here—at low cost, outdoors and in family spaces—takes some getting used to. And it can be perilous for Americans who are not accustomed to self-moderating their drinking—particularly those who are too young to buy liquor in the United States, and therefore lack experience. 

Here, the drinking age is 18—in line with much of the world, when the US age of 21 is something of an outlier. In practice, younger teenagers tasting wine with their parents seems widely tolerated in Italy. 

In the school garden, meanwhile, I often hear tales of horrendous drunken adventures told with glee, pride even. I personally don’t understand the appeal of getting smashed and embarrassing yourself, but to each his own. 

It’s noticeable, though, that the Italian students’ attitude to drinking seems much more restrained than that of their American counterparts. In my limited experience at least, our Italian friends generally appear to drink not to get blackout drunk, but simply to enhance meals and other social interactions. Their approach reminds me of my various Italian-American relatives, who routinely take wine with meals but abhor getting messy-drunk.

Wine is integrated into Italian life, yet the rate of problematic drinking is low.

People have been observing such cultural drinking differences since long before I was born, and far more rigorously. A large body of research has documented how, while alcohol appears fairly ubiquitous in southern European cultures like Italy and Portugal, binge drinking is much rarer than it is in northern European countries. 

Wine is integrated into Italian life, with a strong culture of drinking a glass or two at mealtimes. Yet the rate of problematic drinking is low.  

“People who live in countries where drinking occasions often lead to intoxication—for example, Sweden and the Baltic countries—more often experience alcohol-related problems when they increase their alcohol consumption when compared to people who live in Italy, where the drinking primarily takes place with meals and less often leads to intoxication,” explained Jonas Landberg, a research at Stockholm University’s Centre for Social Research on Alcohol and Drugs. 

According to the World Health Organization, the prevalence of alcohol use disorder in the Italian population is only 1.3 percent; it’s 11 percent in Sweden, and 13.9 percent in the US.  

One theory around this is that it has to do with how people learn to drink—wine sipped at the dinner table with older family members, versus booze sneaked and chugged alongside equally inexperienced teenage peers. Parents who model moderation have been found to be more likely to raise teens who drink without problems, compared with parents who either drink to excess or abstain.

Another, related line is that alcohol restrictions, far stiffer in places like the US and northern Europe, foster riskier behavior—“crescebat ex prohibitione cupiditas [from prohibition grew desire],” as Petrarch expressed the lure of forbidden fruit. 

As a non-drinker, I can’t claim to have deep personal insight. So I asked some of my classmates about their experiences.

“The fact that they didn’t want me drinkin’ probably made me want to do it a good bit more.” 

John* is a friendly resident student from Georgia in the US. He told me that he began drinking occasionally as a “kid,” which he attributed to his coming from the Deep South. That’s when he first tried moonshine and absinthe. 

However, “I really started drinking when I was 19,” he said, “during my first semester.” He then discovered “the joys of drinking with friends.” In this period, he said, he “got blackout at least three times a  month, two sometimes. I was doing quite the blackout nights. Really blackout weekends. I did a good couple of benders.”

John’s parents, he said, gave him permission to start drinking when he left home to study, but they personally “don’t believe in drinking,” and don’t drink themselves “except maybe a glass of wine twice a year.”

To this day, they still don’t know John drank as a child. He now thinks their attitude made it more appealing. “The fact that they didn’t want me drinkin’ probably made me want to do it a good bit more.” 

John holding his favorite drink

He’s calmed down this semester, he told me, and is currently more of a social drinker. He does think there’s a major drinking culture at our school: “Especially with the study-abroads, they’re getting wasted every  weekend and doing massive, massive rallies every single day.” 

John claimed that the Florida students are the worst. Having roomed with two heavy-drinking Miami students in my first semester, and spent time clearing up their half-eaten plates of chicken nuggets, I was probably not a neutral audience.  

Katie* is a resident student from Florida who doesn’t fit that stereotype. Her relatives make fun of her “all the time” for not drinking as much as they do. But, “I would say the large majority of my family were alcoholics,” she told me. 

She first tried a beer, with her sister and without her parents’ permission, when she was 9, she said, but didn’t start drinking casually until she was 18. “We would go to, like, family-owned restaurants, and I would have a glass of wine and it would be fine.” She never got “super-wasted or drunk” on these occasions. 

These days, Katie really isn’t into drinking. “I just don’t like the idea of it, I don’t like how it makes me feel, and I just don’t like the idea of not being in control of your actions and your emotions.” She feels that “getting wasted or blacking out” places an unfair burden on the friends you’re with. At the same time, “a lot of people [here] drink very socially and if you don’t drink, you’re seen as more of an outcast.” 

Her college-aged friends back in the States drink all the time, she added. “It’s just seen as completely  normal.” Katie’s manner suddenly became more intense, as she told me: “I don’t like the drinking culture the US has, and the idea behind it [of] getting wasted every day.” In Italy, she thinks, “people know how to control their alcohol [intake] a lot more.”  

“It’s seen as normal to give tiny amounts of prosecco, wine or beer during family gatherings, even to the smaller kids.” 

Andrea*, who comes from Rome, more or less concurred with this assessment. They recalled first trying alcohol independently at 14, when they took some drinks from a cabinet while sleeping over at a friend’s place. “Although technically I had already tasted alcohol,” Andrea said, “seeing as it’s seen as normal to give tiny amounts of prosecco, wine or beer during family gatherings, even to the smaller kids.” 

Teen drinking is normalized in Italy, said Andrea, who began drinking regularly at 15. Still, “even as a teenager or college student, I have never seen alcohol as simply something you have to drink to feel inebriated … but rather as something you share with friends.”

When Andrea turned 18, their parents told them to “drink with moderation and stay safe.” However, Andrea said that US drinking culture has been increasingly glorified by Italian youth due to media, including shows like Euphoria. “The impression is that of American students throwing immense parties, with giant crates of beer, and overall doing insane stunts while under the effect of alcohol, although not many Italian teenagers and college students can afford to do such.” 

Andrea knows of a couple Italians who drink heavily, but said this is still outside of the norm. At 19, Andrea feels, “I have achieved a good balance and know my limits.” 

I was able to continue the conversation with Andrea’s father. Lorenzo*, a police officer, is emphatically not in favor of introducing more alcohol restrictions in Italy. He recognizes that there are serious drinking-related harms, and even regrets that alcohol will always be “well liked” because of its “immediate benefits.” But he said that age restrictions, for example, are easy to circumvent when adults will often buy alcohol for minors. 

“The case of the US demonstrates how prohibitionism, or generally speaking secrecy … is not an efficient reduction method,” Lorenzo said. “An eventual approach similar to the American one will not affect the statistics positively. There needs to be a cultural and educational approach.”

Whatever the reasons behind it, the Italian tendency toward moderate drinking appears to me, at least, to be healthier and safer, as well as less likely to get you fined for ending up in the Trevi Fountain.  

*Names changed to protect sources’ privacy.

Top photograph by Lefteris kallergis on Unsplash. Inset photograph by M.L. Lanzillotta.

The post A Clash of Drinking Cultures for US Students in Italy appeared first on Filter.

It is worth noting that the term “therapeutic community” was originally coined by South African psychiatrist Maxwell Jones, who created a gentle and caring environment for people with mental health conditions to support each other. 

Yet a number of programs described by this term, operating in the United States from the mid-20th century, were characterized by inflicting humiliating punishments on people with addictions, in a direct reflection of the contempt society has held for them. 

The central activity of these therapeutic communities consisted of marathon sessions of what was known as “the game.” 

In such programs, minor infractions of the rules might bring penalties such as having one’s head shaved, or being forced to dress in a diaper and wear a sign proclaiming, “I am a big baby.” If a man in the community said hello to a woman, he might be made to wear women’s clothing. Failure to empty an ashtray with even a single cigarette butt in it might result in wearing said ashtray around one’s neck for a week. 

However, the central activity of these therapeutic communities consisted of marathon sessions of what was known as “the game.” 

The game generally lasted 40 hours, with a four-hour break for sleep. It consisted of members of the group, one by one, being verbally humiliated and insulted by all the other members, in an attempt to destroy the ego. In the course of the game, you’d be targeted by any number of belittling, sexist or stigmatizing slurs—“junkie” was the least of them. Once the victim of these verbal attacks was considered sufficiently cowed, the group moved on to the next person.

The first therapeutic community of this kind for drug users was Synanon. It is unclear how it was first labeled a “therapeutic community,” despite the fact that it was quite the opposite of the community created by Maxwell Jones.

Synanon was founded in 1958 by Chuck Dederich (1913-1997), a member of Alcoholics Anonymous in Santa Monica, California, who had no training in psychology, or anything else. 

The media fell in love with Dederich and Synanon, painting him as having a magic cure for addiction.

When Dederich had joined AA a few years previously, he was homeless and isolated, as well as addicted to alcohol. He flourished in the program, however, where he soon achieved the status of a guru. After meetings, Dederich would hold hours-long bull sessions in his home, and from these the game was born.  

At a time when very little treatment was available, Dederich claimed success in addressing addictions to alcohol and other drugs via the game. He then rented a storefront and dubbed it Synanon. Tradition has it that the name was the result of one of Dederich’s followers attempting to say “seminar” and “symposium” and slurring the two together.

The media fell in love with Dederich and Synanon, painting him as having a magic cure for addiction. Synanon boasted a good success rate, attributable to the fact that only the most motivated individuals were allowed to join. 

Soon, a number of other therapeutic communities for drug users sprang up, such as Daytop Village, Phoenix House, Odyssey House and others, which originally resembled Synanon to greater or lesser degrees, though they later changed. 

Synanon’s attack therapy spread into alcoholism treatment through two principal sources.

Moreover, Synanon and the game began to attract “squares”—people who had never used drugs—who sought a personality transformation. In the early 1960s, comparable encounter groups such as those at the Esalen Institute sprang up, where well-to-do Americans paid good money to be sworn at and humiliated.  

Synanon’s attack therapy spread into alcoholism treatment through two principal sources. (I will use the stigmatizing term “alcoholism” in this article both to reflect historical usage and because it is not an exact synonym for alcohol use disorder.)  

The first of these sources was the Johnson Institute in Minneapolis, Minnesota. It was the brainchild of Episcopal priest Vernon Edwin Johnson (1920-1999). According to Forrest Richeson, Rev. Johnson underwent treatment for alcoholism at the Hazelden rehab in 1962 and decided to dedicate his own life to such work. 

From 1962 to 1966, Johnson was assigned to the Action Program at St. Martin’s by-the-Lake Episcopal Church in Minnetonka Beach, Minnesota. Johnson also served as a consultant to Hazelden during this period. It was during this time that Johnson developed what would become known as the Johnson Institute Intervention—essentially the same practice that can be seen on the television show Intervention today. Although Johnson claimed an 85 percent success rate for his family interventions, independent researchers put the rate at 30 percent, far below CRAFT, at 64 percent.

It was Johnson’s contention that an “alcoholic” had developed a complex psychic defense system, and that only by breaking this down could the person be changed, else they were doomed to death.

Johnson also established an AA “slipper’s group” at St. Martin’s, for members who were constantly “relapsing.” This group added hard confrontation methods, borrowed from the encounter groups of the era, to the 12 Steps. 

It was Johnson’s contention that an “alcoholic” had developed a complex psychic defense system consisting of denial, rationalization and delusions, and that only by breaking this down could the person be changed, else they were doomed to death.

In 1964, Johnson staged an intervention for Irene Copeland Whitney. Her husband, wealthy businessman Wheelock Whitney Jr., was so grateful that he decided to fund Johnson to create an institute to conduct interventions.

The Johnson Institute was incorporated in 1966. Its mission was threefold: to help families stage interventions; to establish confrontational treatment programs in hospitals and other facilities; and to train alcoholism counselors in confrontational counseling.

The institute established its first confrontational treatment program in St. Mary’s Hospital, in Minneapolis. It was the first time St. Mary’s had offered alcoholism treatment. The pilot program had 16 beds, expanded to 44 beds in 1970 and later to over 100 beds. Under Medical Director George Adam Mann, MD, the program became notorious for verbal abuse of patients, à la Synanon.

In 1973, Johnson published I’ll Quit Tomorrow. This book detailed his theories on alcoholism and alcoholic defense mechanisms, and gave a detailed blueprint for setting up a treatment program based on confrontational counseling. Johnson reported that he had set up programs at Miller Dwan Hospital in Duluth, Minnesota, and Lincoln General Hospital in Lincoln, Nebraska, as well as St. Mary’s. 

In the 1980 edition, he reported having established confrontational treatment programs at over three dozen facilities, including Scripps Hospital in La Jolla, California; Baton Rouge General Hospital in Louisiana; Bethesda Hospital in Cincinnati, Ohio; and Flower Hospital in Toledo, Ohio. 

This, of course, does not include programs which may have adopted confrontational counseling as a result of Johnson’s book.

The second main source of confrontational alcoholism counseling was Eagleville Hospital and Rehabilitation Center in Eagleville, Pennsylvania. The facility had been converted from a tuberculosis sanatorium to an alcoholism treatment hospital in 1966. Donald Jay Ottenberg, MD (1919-2004), was the medical director. According to Ottenberg, Eagleville initially tried treating alcoholics using conventional group therapy and broad-band behavior therapy; however, this was not successful. 

As a result, Hazelden instituted the “hot seat” as a part of its treatment regimen.

In 1967, some of the Eagleville staff visited Daytop Village in New York City and took part in a marathon. Thereafter, confrontational “marathon therapy” was adopted as the standard treatment for alcoholism at Eagleville. In 1968, it admitted its first patients with addictions to drugs other than alcohol, making it the first facility to offer combined treatment since pre-Prohibition days.

By 1970, the demographics of patients admitted to Hazelden had changed, and many were addicted to both alcohol and other drugs. Since Hazelden staff were unfamiliar with the non-alcohol addictions, they made a visit to Eagleville that year to see how its system worked. 

As a result, Hazelden instituted the “hot seat” as a part of its treatment regimen. Patients would undergo one hot seat session during their 28-day stay (originally between the 10th and 14th days but later moved up to the fifth). 

The chair of the subject would be placed in the center of a circle; all other participating patients were given a list of 23 items to use in evaluating the person in the hot seat. Twenty-two of the 23 items were “character defects.” 

In the early 1980s, the hot seat was replaced by peer evaluation, aka the “love seat.” The only change was that now the people in the circle listed both the subject’s assets and their character defects. 

In 1985, Hazelden made a statement denouncing confrontational counseling. Peer evaluation appears to have been discontinued at Hazelden in 1987.

Hazelden and the Johnson Institute, together with Willmar State Hospital in Minnesota, dominated alcoholism counselor training in the 1960 and ‘70s. Willmar’s training program was established in 1962, Hazelden’s in 1966, and the Johnson Institute’s in 1967. Their preeminence ensured that what became known as the Minnesota Model would dominate treatment nationwide.

Alternatives to the Minnesota Model did exist, however, such as the Baltimore City Health Department counselor training program, established in 1967. The VA had also begun large-scale alcoholism counselor training by 1969.

Whenever a new treatment program opened, the director was frequently a counselor trained at Hazelden or the Johnson Institute, which spread use of the hot seat and hard confrontation.

The 1970s were a period of huge growth in the number of alcoholism treatment facilities in operation in general hospitals, residential facilities, and VA hospitals (together with a major decline in the number of state mental health hospitals). A handful of programs operating in 1970 had increased to several hundred by 1980. 

And whenever a new treatment program opened, the director was frequently a counselor trained at Hazelden or the Johnson Institute, which spread the use of the hot seat and hard confrontation far and wide.

The biggest competitors to the Minnesota Model promoted by Hazelden and the Johnson Institute were CompCare Corporation, which offered hospital inpatient 12-step programs without confrontation, and Raleigh Hills, which offered aversion therapy. By 1980, CompCare operated CareUnits in 53 hospitals, operated three psychiatric hospitals specializing in treatment of addictions to alcohol and other drugs, and one alcoholism hospital. Raleigh Hills was meanwhile operating 17 aversion therapy hospitals. 

The number of Minnesota Model programs in 1980 likely numbered over 100, and all of them offered some form of confrontational counseling.

Confrontational counseling began to fall into disrepute in the late 1970s, however. On December 2, 1978, Synanon founder Chuck Dederich was arrested for attempted murder. 

Dederich was accused of ordering two Synanon members to place a rattlesnake with its rattles cut off in the mailbox of lawyer Paul Morantz, in an act of revenge after Morantz had won a $300,000 lawsuit against Synanon. Morantz was bitten when he opened his mailbox. 

The story was juicy enough to make the national news and was broadcast by all the television networks. When Dederich was arrested, he had to be carried out of Synanon on a stretcher because he was dead drunk. He was ultimately sentenced to five years’ probation after pleading no contest to a conspiracy charge.

As researchers William White and William Miller described, confrontation has no therapeutic value.

The May 25, 1979 issue of the Minneapolis Tribune ran an article exposing confrontational treatments at St. Mary’s, Chanhassen Center and other Minnesota Model alcohol programs. The article stated:

At Chanhassen Center, Robert Turpin took over as program director three years ago and promptly fired 45 counselors and therapists trained in the confrontive style. “When I came in here the patients were kicking walls and pounding pillows,” Turpin said contemptuously. “They reinforced that here. The staff wasn’t happy until people came out crying. They called it anger therapy.

“I call it destructive behavior. Alcoholics punish themselves. Why should they pay to go to a treatment center and be punished some more?” In place of the stereotype of alcoholics that was the focus of treatment by his predecessor, Turpin installed a working policy that each patient “is not only fallible but unique, deserves respect and is responsible for his or her own feelings and behavior.”

Confrontation gradually fell out of favor in alcohol treatment programs. The 1988 book Rehab: A Comprehensive Guide to Recommended Drug-Alcohol Treatment Centers in the United States lists 146 alcohol treatment programs; only 19 reported still using the hot seat or other forms of confrontation.

Therapeutic communities for adult drug users also toned down some of their abusive approaches in the 1980s, although, as Maia Szalavitz pointed out in Help at Any Cost (2006), many of the worst abuses continued to be practiced in adolescent treatment programs.

Confrontational counseling was an abhorrent practice to use against vulnerable people. And as researchers William White and William Miller described in their 2007 article “The Use of Confrontation in Addiction Treatment,” it has no therapeutic value. They found that “the more the counselor confronted, the more the client drank.”

Photograph by Andrew Kimmel via Flickr/Creative Commons 2.0

The post The Rise and Fall of Confrontational Alcohol Addiction “Treatment” appeared first on Filter.

What’s more, the research appeared to contradict prohibitionist arguments about the potential impact of legalization, as the data also revealed no significant increase in marijuana use among young adults who were still not of age to access retail dispensaries—though there were interesting changes in certain modes of consuming cannabis following the policy change.

The study, published in the Journal of Psychoactive Drugs on November 24, involved surveys of people aged 18-20 living in Los Angeles before and after the state implemented adult-use legalization (AUL) of marijuana under a 2016 voter initiative. One cohort of 172 pre-legalization subjects were interviewed between 2014 and 2015, and the other 139 post-legalization subjects were surveyed between 2019 and 2020.

Researchers said that, “despite the possibilities of increased access to cannabis via diversion from the adult use market and increased normalization of cannabis use,” legalization “did not lead to increased frequency of cannabis use” among the subjects. They did notice a shift toward the use of edibles post-AUL, however.

“Some critics predicted that adult-use legalization would lead to increased other drug use” via the so-called “gateway theory.”

“Regarding other licit substance use, we observed significantly fewer days of alcohol and cigarette use among the [post-legalization] cohort compared to the [pre-legalization] cohort,” the study says. This suggests the “possibility of a protective effect offered by cannabis, including edibles, or potentially ongoing changes in norms and attitudes toward these substances within this socio-historical context.”

“Lower frequency of alcohol and tobacco use coupled with increase in edibles use post-AUL may suggest a substitution effect, which could result from increasing access to cannabis through a medical cannabis recommendation or diversion of cannabis from medical or adult use cannabis dispensaries,” the researchers state.

The study, which was funded by the National Institute on Drug Abuse, also found that changes in the use of illicit and nonprescribed drugs “did not significantly differ” between pre-legalization and post-legalization cohorts, which the researchers said is “notable since some critics predicted that AUL would lead to increased other drug use” via the so-called “gateway theory.”

“Future studies should monitor whether stable rates of cannabis use and declines in alcohol and cigarette use will be sustained as some participants reach legal age to access these substances for adult use, and how these trends continue or alter as participants enter later emerging adulthood,” the study concludes.

While one of the limitations of the study is the fact that people under 21 cannot legally purchase alcohol or tobacco, the findings regarding a possible substitution effect have been echoed in numerous studies covering different jurisdictions across the country, at least when it comes to other substances such as opioids.

Legalizing medical marijuana has been associated with a “lower frequency” of nonprescribed opioid use.

For example, legalizing medical marijuana is associated with a “lower frequency” of nonprescribed pharmaceutical opioid use, according to a November study published in the International Journal of Mental Health and Addiction.

In August, a federally funded study found that marijuana was significantly associated with reduced opioid cravings for people using them without a prescription, suggesting that expanding access to legal cannabis could provide more people with more options.

A separate study published in October found that legal access to CBD products led to significant reductions in opioid prescribing, with state-level drops of between 6.6 percent and 8.1 percent fewer prescriptions.

A report from July, meanwhile, linked medical marijuana use to lower pain levels and reduced dependence on opioids and other controlled substances.

Photograph by SBC9 via Flickr/Creative Commons 2.0

This story was originally published by Marijuana Moment, which tracks the politics and policy of cannabis and drugs. Follow Marijuana Moment on Twitter and Facebook, and sign up for its newsletter.

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