#428 Abstinence or moderation? New personalised approaches to alcohol recovery, with Jonathan Hunt Glassman.

EPISODE TRANSCRIPT

___

Please note that while an effort is made to provide an accurate transcription, errors and omissions may be present. No part of this transcription can be referenced or reproduced without permission.

Jonathan Hunt Glassman 0:00

Sometimes people think it's aa or nothing, it's inpatient rehab or nothing, it's abstinence or nothing. And if those options don't feel like good fits, or they've tried one of those options and not gotten the results that they were looking for, that can be very discouraging, but the truth is that the options for help in drinking less or quitting are both more numerous and more diverse than many of us expect.

Agi Keramidas 0:37

You are listening to personal development mastery, the podcast that empowers you with the simple and consistent actions to take that will help you create a life of purpose and fulfillment. Before we dive in, if you enjoy listening and appreciate what we're doing, the quick favor I'm asking of you is to click the subscribe button. Now let's get started.

Agi Keramidas 0:59

Today. I am excited to welcome Jonathan Hunt Glassman. Jonathan, you are a healthcare entrepreneur and CEO of Oar health. You have over 15 years of experience in the healthcare industry, and you also have a personal journey of overcoming alcohol addiction. You are passionate about reshaping the approach to alcohol use disorder and its treatment while also emphasizing the importance of moderation and empathy. Jonathan, welcome to the show. It's a real pleasure to speak with you today.

Jonathan Hunt Glassman 1:40

Thank you so much for having me. As I

Agi Keramidas 1:43

was telling you just before we hit record, it is a topic that I'm very much excited to discuss. And of course, the topic of today's conversation is alcohol. The thing I wanted to start this conversation with and for me, it is an important distinction. Is when you used and I said in my introduction of you the term alcohol use disorder. So you know, generally, I'm not a big fan of the DSM, the Diagnostic and Statistical Manual of Mental Disorders. However, in this particular case, I have to say that in my ears the term alcohol use disorder sounds, can I say better, or it has a different tone anyway, to the term alcoholic or alcoholism. So I wanted to start this conversation with hearing your thoughts about these terms, these labels. And you know, some of the things that influence people when they discuss about alcohol, and of course, later on when they want to do something about it. So let's start with some definitions.

Jonathan Hunt Glassman 3:07

Always a good place to start. As you said, alcohol use disorder is the modern medical terminology that encompasses a lot of terms we used to use, things like alcoholism, alcohol abuse, alcohol dependence. AUD, for short, is defined as a condition in which one has an impaired ability to stop or control drinking despite adverse social health and or professional consequences. So we say AUD is present when alcohol use is creating negative effects in someone's life and they're struggling to cut back or quit in response to those it's what you'd find in DSM five, which I agree, imperfect document, but probably a better, broader definition of what we're talking about than alcoholism, and hopefully a definition that allows more people a way in to reevaluating their relationship with alcohol.

Agi Keramidas 4:12

Thank you. And you know, I hadn't heard the definition the way that you said it like that, the impaired ability to reduce etc. And I think it, it is very accurate, and it completely hits home with anyone listening that has ever been, let's say, concerned about her or his drinking. I think what, the way you described it, the way the definition is, is very precise for one to know whether they are in that category or not. It's very clear, I think so. Thank you for starting with that. I would like you know before we explore more about the actual alcohol use disorder. Out there. And before that, I would like to hear a bit more about your own personal journey with alcohol, so we can get a background of who, where is Jonathan coming from today, and especially how your journey led you to create all health.

Jonathan Hunt Glassman 5:19

The topic is very personal to me, and the work that we're doing at Oral Health, helping people get access to medication that can help them drink less or quit, is also personal. So let me explain, yes, I had a problematic relationship with alcohol for most of my adult life, what started as binge drinking in high school and college became a pattern of drinking to blackout in my 20s, and then, as I saw peers start to grow up and put excessive alcohol use behind them, the opposite was happening for me. I was starting to have multi day binges and experience some of the physical and mental health symptoms of withdrawal from alcohol on the back end of those and so things were pretty rough, and it was no secret to me that I had a problem with alcohol. So I sought help in a lot of the places that first come to mind, Alcoholics Anonymous, psychotherapy, emergency room, each helpful in some ways, but none really put a dent in the drinking. What was much more of a turning point for me was connecting with a primary care physician who did two things that felt brand new. One was accept my goal of moderation rather than abstinence, and the second was to suggest prescription medication as a tool in the toolkit to achieve that goal. And that all yielded great results. For me, I felt like I was able to get control over alcohol rather than vice versa. But it didn't take too much reflection to realize that it wasn't so great. It had taken 15 years of searching to find the right tool that fit me, and it didn't take too much research to confirm that I was far from alone in not having access to safe, effective medication to drink less or to quit, and that's why we started or health to make access to that medication and other evidence based tools easier to access so that people could take that first step that fit them.

Agi Keramidas 7:28

I'm actually curious, why is there not access today? I was not aware of that.

Jonathan Hunt Glassman 7:37

The statistics are pretty stunning. In just to use the US as an example, there are 30 million people with alcohol use disorder in the US. About 2% are prescribed any medication to help them drink less or quit. I think three main reasons. One, these medications have been generic for decades, which is good in that it makes them affordable, but bad in that there's no pharmaceutical company spending millions of dollars a year to make them household names two a lot of physicians and other healthcare professionals don't get enough training in treating addiction, given how often it's going to come up in their panels and don't feel as comfortable and confident treating it As they do other chronic behavioral health conditions like depression or anxiety. And then lastly, there is still a little bit of a stigma in some corners of the recovery community around using medication. You still hear the phrase don't replace one drug with another, sometimes, which I don't think is a particularly trenchant criticism of the medications that are used to treat AUD, which are not themselves addictive or subject to abuse. So plenty of reasons, none of them add up to a good explanation, in my mind, and that dissatisfaction with the status quo is part of the reason we started a place like or health.

Agi Keramidas 9:02

What I would like you already mentioned it briefly in passing, but the thing I would like to discuss next is, you know, when people feel that they they have some concerns, I'm trying to choose the words carefully, because I know and you this topic for some people, it can be sensitive, and it is never an intention for this conversation to judge anyone and put any label on them. That's why I'm trying to choose the words carefully, so when people discover or have some concerns about their alcohol drinking habit, and whether you know they have impaired ability to reduce it. As you said, my question is, what? What challenges do people face when they desire to have a change and do so? Something different about their alcohol habit.

Jonathan Hunt Glassman 10:07

There are plenty, but I think one that a lot of folks face once they've already done that work that you described, of identifying a concern, deciding that a change would be for the best is finding the help that fits them. Most people have heard of Alcoholics Anonymous and AA has helped millions of people to recover from alcohol problems, which is millions more than any of us, including me. So nothing I'm going to say is a criticism of AA, but it is not the only option that's out there. And so I think sometimes people think it's aa or nothing, it's inpatient rehab or nothing, it's abstinence or nothing. And if those options don't feel like good fits, or they've tried one of those options and not gotten the results that they were looking for. That can be very discouraging, but the truth is that the options for help in drinking less or quitting are both more numerous and more diverse than many of us expect, and so if someone is feeling that lack of an option that fits them, it really pays to do some research. You don't have to become an expert on every option under the sun, but there's probably one out there that's aligned with your goals the way your theories about how you can create change in your life, and the strengths, resources, capabilities that each of us as an individual can bring to a change project.

Agi Keramidas 11:53

If you enjoy this episode, can you think of one person that would find it useful and share it with them? I'd really appreciate it. It helps the show grow, and you will also be adding value to people you care about. Thank you. And now let's get back to the episode.

Agi Keramidas 12:11

Jonathan, thank you for this answer. I like very much how you said that it is for each individual to find there is no one method for everyone. There is no one single curse, I would say so finding the help that fits the individual you use the word align with our goals of how to change. I think that is, first of all, it sounds very liberating for someone to hear that it's not just this or that there are, I don't know. I suppose, there are numerous methods there that some include psychological methods or pharmaceutical methods or or pure self discipline methods. There are different ways. And I will, actually, since I mentioned that, I will share a little bit about, you know, my own experience, as I would say, without getting too into detail. But as I told you earlier on, alcohol is also a topic that I have personally involved with, and have had drinking alcohol on and off for many periods of my life, since I was 18, I have found that, and you mentioned the good moderation earlier in the word abstinence, the first time that I was very good at stopping or being, you know, feeling good about myself and how my alcohol habit is, was when I did a dry January. It was probably seven years ago, and I realized then that not only the that I had the whole part to do it, but also I saw the benefits. Because I think that was the first time that I had not drunk in 30 days in a row. That was very much. So the point that I want to make is that all the other times during these seven years that I was either drinking or not drinking. For me, it has never been a moderation period. I've tried it, don't get me wrong, but moderation quickly or not so quickly. Sometimes it would take longer, but it would turn to not moderation again, or perhaps how it started. So for me, the abstinence worked very, very well in the terms that there was no gray zone. It's not like, shall I have two or shall I have three or one? It was simple. I can't have it. Period. Maybe I need to do, find something else to do instead. So I'm sharing that as also my personal reflection, and in the terms of you know, as a podcast host, to share what's going on. It's not it is alcohol. Many people in the Western won't have it, and let's not even get into the conditioning you we've had for generations. So can you tell me? Then, after this long comment from me, can you tell me your thoughts about moderation versus abstinence and how realistic is for one to say, well, I can cut off to a desired, you know, frequency or amount or anything else. Well,

Jonathan Hunt Glassman 15:49

I think it's much more than a than a comment. It's, it's a really important experience. Yes, I guess my view is that neither sobriety nor moderation is the perfect goal for everybody when it comes to moderation, which has been my goal, I think it's a legitimate goal in that the harms from alcohol tend to be fairly linear with the amount consumed. So if somebody can cut back meaningfully on how much they're drinking, that is overwhelmingly likely to yield real benefits in terms of health and well being. I think what's complex about moderation is exactly what you put your finger on, which is it can be a little bit blurrier as to whether the goal is being achieved. And so one thing I found particularly helpful in my moderation journey was to have some bright line goals. In my case, no blackouts. For others, it's a certain number of drinks, maybe staying within national guidelines on moderate drinking and avoiding heavy drinking. And what was also helpful was having some specific strategies to support the goal. So no more shots, no more than one drink before eating something, relying on my wife and other supportive friends to give me a little nudge in the ribs if they thought I was approaching a danger zone. Those of course, you know specific goals and strategies will vary by individual but I do think that's pretty good advice for those pursuing moderation, is try and fill in the the the details of what moderation means. None of this is to say that sobriety is a bad goal, the safest level of alcohol consumption for any of us is almost certainly zero. So that's a terrific goal too. Sometimes what we see at or is folks who start with the goal of moderation, as about 60% of our members do, ultimately graduate to a goal of sobriety, either because moderation is not proving achievable, or they're so happy with the effects of moderation that they decide to take it one more level. I think you know, what we have to avoid is a an insistence that only moderation or only sobriety is a legitimate goal, because that is likely to turn people off from engaging in or sticking with the change project, and that is self defeating. Whether you want to get more people sober, more people moderating, or all of the above,

Agi Keramidas 18:36

that's great. I have a question, and then I will make a comment. I have a question you said earlier about you use the word strategies that you had for me, the equivalent word that I would use in your situation is rules. In a way, there are rules that you have to abide. Didn't you find that complicated? Did you not feel that your self discipline was pushed when you have these many rules, it can be easier, more and more complicated anyway, to stick to them.

Jonathan Hunt Glassman 19:13

Yes, I agree, particularly in contexts where the social cues are pushing against those rules and saying, Drink more, drink more, drink more. So a wedding or a birthday party that starts at 2pm in the afternoon and is going to go until two in the morning. So, yeah, absolutely. And you know, I think that is a something for folks to evaluate in choosing their their goal. I think whether one sets out with the goal of sobriety or moderation, whatever treatment tools one adds to the toolkit, medication, psychotherapy. It be coaching, counseling, support groups, whatever. Those first six months to a year are also going to take some real self discipline and focus. I think most people find in those first six to 12 months, this needs to be one of their top priorities. You know, I'm sure you have views on this, I've found you can only keep so many things on the front burner at a given time, and I think drinking less or quitting probably has to be one of those for at least an initial period. And then hopefully one can reach a maintenance or sustainability mode where following those rules has shifted from being an intense focus to a way of life.

Agi Keramidas 20:48

Thank you, and there was I liked again. It comes back to what you said earlier. It's about finding the kind of help and where you want to go that fits one particular person, rather than you use the word insistence on sobriety. And when you say that, you reminded me of Alan Carr, who, I'm sure that you are familiar with the easy way to stop anything really, which his basic, easy way was to eliminate it. It's, it is. And as I said, for me, it worked, because it takes away all the, you know, the bandwidth in the in the mind of, can I, can I not? Or trying to persuade your mind, and were very good to be tricked by our minds. So in a way, even though I realized that for me, it worked this absolute black and white approach that you know Alan Carr talks about, on the other hand, I really appreciate what you're telling me, that it's different for anyone, and because Aggie was not very good at moderation, and he found it easy, easier to abstain completely, that doesn't mean that Jonathan or Angela are the same. So I'm just reiterating all this in my own words to because I think it's important to realize that there are different options and different goals. It's not like everyone should stop drinking alcohol and they should ban the thing from the planet. Which are, I've heard things similar, maybe not expressed like that, but you know, to that effect,

Jonathan Hunt Glassman 22:47

well, we tried that in the in the 1920s in the United States, and it didn't go so well.

Agi Keramidas 22:53

Yeah. So thank you very much. And I don't know if you wanted to add something more to this particular element of to someone listening that wants to explore. You know, what other options or how many different options? Is there anything else you would like to add?

Jonathan Hunt Glassman 23:10

We've hit on a lot of those categories. Let me maybe try to sum up some different categories of options. Some people change their relationship with alcohol, essentially on their own, some kind of grow out of it. Others form a mindful plan to drink less. Rely on self discipline and self evident rules. Others find help through treatment. And there are really three categories there, I would encourage people to think about mutual peer support, which includes AA, but also groups like smart recovery and moderation management that may be better fits for some in terms of goals, methods, values, number two, professional Behavioral Healthcare, so that incorporates psychiatry, psychotherapy, coaching, counseling, working with someone to identify maladaptive patterns of behavior, develop solutions. And then the third which was particularly relevant to my journey, was prescription medication. There are multiple safe, effective medications that can help people drink less. And the great part about those categories is that they're complimentary rather than competitive, so individuals can mix and match across categories and ramp up and down the intensity of those supports as needed, over time, through their journey. So lot of options out there.

Agi Keramidas 24:48

Thank you. I'm glad we summed it up in such a concise way. There are, there are, there were two things with what you just said. One was the fact that you said that the medication assisted treatment is, or can be complementary, which I like very much, because it sometimes it, it takes the responsibility away from the person who wants to heal something. If this, if the doctor tells them, take this pill and do nothing else. So it is you put all your expectation on the substance anyway. That's a big topic on its own. The other thing I wanted to to ask, because, personally, I'm not familiar with the medications to stop alcohol. I mean, I have read about them at some point in the news, but I don't know many things you use the the word safe and effective, which kind of reminded me of these words were been thrown around a lot when the covid vaccine came with the safe and effective. So I leave that aside. Can you tell me when you say safe and effective? Can you quantify it so that I understand what that's that means?

Jonathan Hunt Glassman 26:17

Yeah. So that's the, you know, the those buzzwords are the the standard by which medications are evaluated for approval by the FDA in the United States. And so they've kind of permeated around the world from there, when it comes to alcohol use disorder, there are three medications indicated in the in the US, four, five, in some other countries, the frontline medication is one called naltrexone, and the way that it works is it blocks a receptor in the brain that is involved in the pleasure and reward pathways activated by alcohol. And so when we're not drinking, it can reduce cravings, because anticipation taps into those same pathways when we are drinking, it can make that first or second drink a little bit less exciting, a little bit less euphoric, and therefore make it easier to stop at one or two rather than have way too many. So it suits goals of both abstinence and moderation. When we say safe and effective, in regard to a medication like naltrexone, mean that it's more effective than a placebo in reducing days drinking, days heavy drinking, relapse to alcohol dependence. It's not a silver bullet. It may not be the only tool in the toolkit, as you were saying, and I fully cosign with that, but it is one of the more effective tools that we have on the safety side. All of the medications that are indicated to treat alcohol problems have been around for decades, and so we have, you know, really good, say, and all have good safety track records, you know, a low number of adverse events. That is, you know, in the view of the FDA, acceptable, given the effectiveness when it comes to naltrexone, the one the big safety Watch out is that it is not appropriate for people who are taking opioid based painkillers or using illegal drugs that contain opioids like heroin and fentanyl. It the receptor that it blocks is also the one activated, is also one that's activated by those sorts of medications, so it could cause withdrawal. But overall, you know, drug that's been around 30 years better than a placebo, not a silver bullet, is kind of the story great

Agi Keramidas 28:46

and how effective is it then? Because if it is something there for 30 years, I would expect that then the less people will have to worry about their drinking habits. They would say, Okay, let's get that, even though I think you mentioned it in the beginning, that there is not much, let's say, interest from the pharmaceuticals to do something like that. Yeah.

Jonathan Hunt Glassman 29:13

So you know, at or health, where we offer people access to the medication that I was describing, as well as additional

Agi Keramidas 29:19

is that a different a different one that the one that you mentioned no

Jonathan Hunt Glassman 29:24

or health is just the name of our company, right? The medication that clinicians practicing on the platform prescribe most commonly is naltrexone, the recommended frontline medication. And when we ask folks kind of how they're doing, about two thirds indicate that they are meeting their goal to drink less or to quit, and a similar number are screening as drinking at a low or moderate risk level or not at all, relative to typically finding us when they meet the criteria for Su. Your alcohol use disorder. Now that two thirds success rate can't be attributed entirely to the drug, right? It's the medication. Everything else the person is doing in their life, other resources they're finding through, or their own commitment to change and self discipline, there's a lot going on in that, in that success rate, but when it comes to these, you know, complex behavioral health conditions, it's a pretty good number.

Agi Keramidas 30:32

Thank you. And what others you mentioned that it is a complementary and you see it as a complementary treatment. So what other treatments do you advocate for, or do you offer when someone uses that?

Jonathan Hunt Glassman 30:52

I really encourage each individual to feel empowered to assemble whatever recovery toolkit fits them best. Medication can be effective with or without any form of psychosocial support, but it makes a lot of sense to me to combine medication and some form of psychosocial support. Usually, we don't. We find ourselves drinking too much if we do for a combination of biological and behavioral and social reasons, and so intuitively, it just makes sense to me to go at both of those, and the medication is going to be mainly focused on the biochemistry, of course. So engage, you know, seeing a therapist, going to a mutual support meeting, like the weekly Smart Recovery meeting that we host, that's open to both or health and non or health members, that that psychosocial support can be helpful in so many ways, identifying the people, places and things that lead us to drink too much, and coming up with new strategies or rules to avoid those situations or to act differently within them, therapy can be helpful if there are co occurring mental health conditions like anxiety and Depression pretty common to co occur with excessive alcohol use, if we have, you know, traumas in our past, working with a professional to process and aim to resolve those certainly advisable kind of, as you said earlier, Aggie, there's no one size fits all answer. So I'm not gonna say this is the particular combination of tools that every person must use if they want to recover. That is contrary to the evidence. I'm going to say each person who wants to recover has the right to assemble the toolkit that fits them.

Agi Keramidas 32:56

Definitely and appreciate, once again, your approach to this and how you're sharing it. I had one last quick question. What kind of duration of taking the medicine must someone expect to see, you know, achieving their goals? One

Jonathan Hunt Glassman 33:14

of the good things about the medications used to treat AUD is that results can be very quick. So there are folks who see a meaningful change within one to two weeks. We think, you know, if that's not the case, we think sticking with it for a few months is kind of a fair trial, and if folks are seeing improvement, we generally recommend sticking with the medication for the better part of a year. Kind of the idea being most of us didn't get into this situation overnight. So let's, you know, let's allow some time to let the new habits take hold, and then it's a very individualized decision from there as to how long to stay on on medication, naltrexone, the one that I mentioned, is considered safe and appropriate to stay on indefinitely. But there are also people who have the goal of getting off the medication, and we think that's totally appropriate too. The rule of thumb is kind of commonsensical, the more stable and secure one is feeling and having achieved their goals, the more logical it is to experiment with taking the medication out of the toolkit. And of course, there's no shame in coming back to to medication in the future. If one starts to feel they could they could benefit.

Agi Keramidas 34:39

That's great. Thank you very much, Jonathan, for someone who has listened so far and is very intrigued and want to find out more about you, what's the best place to go?

Jonathan Hunt Glassman 34:55

Best Places? Orhealth.com. O, A R, health. Dot com, a lot of resources that unpack the topics that we've talked about today. Also want to highlight that anyone can schedule 15 minutes to chat with me, just as we've been doing today. And then for people in the United States who are interested in medication assisted treatment, we can we offer that directly on on oral health for folks outside the US happy to point them in the direction of practitioners in their communities.

Agi Keramidas 35:31

That's great. Thank you so much for this. And Jonathan, before I we wrap up today's conversation, and I have a specific thing that I want to mention. There are enough. But before we go there, I have two questions that I always ask my guests after 400 and plus episodes that I have done, quick questions. And the first one is, what does personal development mean to you,

Jonathan Hunt Glassman 36:04

I think it means always trying to evolve the way that we interact with the world around us and to bring that closer to our values, which are themselves evolving in most cases.

Agi Keramidas 36:28

And a hypothetical question, if you could go back in time and meet your 18 year old self, what's one piece of advice you would give him? Well,

Jonathan Hunt Glassman 36:37

the obvious one would be drink less. But the less obvious one would be, don't let perfection be the enemy of progress. Don't let unrealistic expectations stop you from doing what, what you wish to in the world.

Agi Keramidas 37:06

That's a solid piece of advice, and I think it would apply to many 18 year. No, it doesn't matter. It's a great, solid piece of advice. Thank you, Jonathan, thank you very much for this conversation. I think the intention we had said before we started recording today to get the word out that there are options for someone who is, as I said earlier, has some concerns about their alcohol drinking habit. I think that throughout the conversation, the underlying message, and I hope that came through, was that it is about to the individual. You use the word toolkit a few times, which I liked very much as a description, you used the method that aligns with one's goal, that it is the help that fits them. So I want to reiterate that, that it is there are many options. And if someone tried something in the past and it didn't work, or doesn't want to try something else because of XYZ, it's fine. There are still many options. So thank you again for this. I think it was inspiring, and I hope that the listener right now has thought of something that they would like to do next as a result of this conversation and on the tone of that, I will leave it with you for your last part in words.

Jonathan Hunt Glassman 38:57

Well, thank you so much for having me and using your platform to help spread this message, I would love to leave people with three very simple thoughts. One is that change is possible. I am an example of that. In regard to one's relationship with alcohol, there are millions of others. Two treatment options. And I underline options exist. And third and lastly is it's never too early or too late to get started on a change project. You don't have to wait until rock bottom. But on the other side of that coin, no matter how difficult things feel at the moment, it is always possible to build a better tomorrow.

Agi Keramidas 39:50

And before I end today's episode, if you enjoy this podcast, can you think of one person that would find it useful and share it with them? I'd really appreciate. It helps the show grow, and you also add value to people you care about. Thank you, and until next time, stand out, don't fit in.