Katie Herzog is the co-host of the podcast Blocked and Reported and the author of Drink Your Way Sober: The Science-Based Method to Break Free from Alcohol.
In this week’s conversation, Yascha Mounk and Katie Herzog discuss Katie’s experience of alcoholism, the weaknesses of Alcoholics Anonymous, and why quitting cold turkey may not be the only way to overcome alcoholism.
This conversation has been condensed and lightly edited for clarity.
Yascha Mounk: I’ve known your writing for a long time. I listen to your podcast with Jesse Singal often. You have a new book out that is personal in a different kind of way. It tells the story of you becoming an alcoholic and managing to move beyond that in a way that’s perhaps somewhat surprising to people. How, in your case, do you think the alcoholism started? How do you go from drinking socially, hanging out with friends, to suddenly it becoming a problem?
Herzog: It happened gradually. I started drinking young. I’m not a Gen Z-er, so it was normal in my milieu to start drinking in high school, or younger. I had my first drinks when I was in middle school. It was normal. You were weaned on wine. Starting young is one of the risk factors for developing alcohol use disorder or alcoholism. People sometimes bristle at the term, but I don’t have a problem with it. Another factor is a family history of alcohol abuse.
I come from Irish Catholic people, so there’s some alcoholism in my blood. There are other risk factors. Trauma is one of them. I don’t have any trauma, at least that I’m willing to admit in public. Although I go with the old-school definition of the term trauma. I’m not talking about people yelling at me online and things like that.
Basically these three risk factors, I hit each one of those. While I drank a lot in college, it was very social, but it was also somewhat anti-social. When I was 19 or 20 years old, I loved nothing more than to sit on my porch by myself, reading The New Yorker and drinking alone. I loved it. If I could spend my life doing that without the negative side effects, I probably would still be doing that. It was a fantastic way to live.
My subscription has lapsed. I also no longer drink. Losing The New Yorker might have been more painful. As I aged, I really aged into bar culture. By the time I was in my early 20s, I was drinking at four o’clock in the afternoon at a bar with mostly older men, like retired and out-of-work men and some women as well. Alcoholism is not really sex-based.
As my friends, my peers who were my own age, naturally aged out of that pattern of behavior, I never did. I was hoping that I would. Most people do. There’s a phenomenon you don’t hear about much in recovery centers or in AA meetings, but it’s called natural recovery. Most people who binge drink in college just age out of it as life changes. Life gets in the way of their drinking, and so they stop.
Mounk: I want to get into what actually defines alcoholism, or alcohol use disorder, in your mind. One definition, or part of the definition, that seems intuitive to me is that it becomes a problem when it distracts from positive elements in your life. When you’re in college, hopefully you’re reading your assigned texts and doing other things.
A lot of the culture of college, and part of the point of college, is to meet friends, create a social network, and hang out with each other. If in college there are three or four nights a week where you’re out with people drinking, that doesn’t necessarily distract from what those years are supposed to be for. It certainly doesn’t stand out relative to your peers. So I guess the question is, as you’re going from that to a different life circumstance, do you continue to engage in this behavior or change behavior?
Herzog: I not only continued to engage in it, my drinking accelerated greatly. Drinking did get in the way of my college experience somewhat, in the choices that I made. I never took morning classes. I know that’s something many students do, but even something like that—choosing my major based on having noon lectures rather than 8 a.m. lectures—shows how it influenced all of my choices.
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It also affected where I lived. I knew that I needed to live within walking distance of bars because otherwise—this was before Uber—I would be at risk of drinking and driving, which I knew was going to be an issue. So it really influenced both large and small decisions I made in the trajectory of my life.
After college, I also dropped out for a while, in part because of my drinking and because of things that happened while I was drinking.
Mounk: Before we get to what happened next, when we go back to that time and we look at 21-year-old Katie, who’s obviously very smart and reflective, suppose somebody says, hey, I know you pretty well. I feel like perhaps your drinking is a problem. What, at the time, would you have said?
Was there some part of you that knew that and believed it? Was there no part that knew and believed it? What did you admit to yourself, and what would you have admitted to a close friend at the time?
Herzog: At 21, no. At 21, I had no idea that my drinking was anything out of the ordinary. In fact, my drinking was not out of the ordinary at 21. I lived in very boozy towns and very boozy communities. I was completely normal. The difference is that I just never stopped. As we graduated and moved away and my friends got careers, families, and homes, I was stuck in that pattern of behavior.
Even then, my behavior wasn’t abnormal because the community I was in was still very boozy. We weren’t 21; we were 25, 27, 30, 35, 50. Still, I was a bar person. I hung out in bars. Everyone around me was the same.
Mounk: When do you think most of your peers started to grow out of this behavior while you didn’t? What, to you, were the warning signs that this thing which seemed adaptive and fun was actually holding you back in serious ways?
Herzog: That also was gradual. My peers from college were a little more ambitious. After college, most of them moved away and started jobs or went to grad school. I lost touch with many of them, and most really did get their lives together and started drinking normally, in an adult way. I didn’t.
After college, I moved to Oregon and lived there for a couple of years, working in coffee shops and places like that. My friends were musicians and artists, and within that community what I was doing was completely normal.
My first realization that I had a problem was when I was about 24 and going through my first really serious breakup. The short version is that I cheated on my girlfriend at the time, who I lived with in a serious relationship, and treated her very poorly. She found out because this was the MySpace era, and she saw a MySpace message.
Mounk: Wait, how is MySpace related to finding out?
Herzog: She read a MySpace message where I was confessing this behavior to a drinking friend of mine. She came to the bakery where I had just started working, and she said, you fucking liar, and slapped me in the face. Within the span of a day, I lost my girlfriend, my job, and my house. That was my first “there’s a problem” moment, not just because my life had fallen apart, but because I was confronted with the fact that I had done something truly wrong to someone I truly loved.
So I asked myself: why did I do this? What was wrong with me? As I saw it, my options were that I was either a bad person, even a sociopath, or I had a drinking problem, because my behavior was connected to drinking. In some ways, I would rather have been a sociopath, because sociopaths don’t have to quit drinking, and the last thing I wanted was to quit drinking. That was my first real “aha” moment.
Mounk: Wait, is that a kind of poignant retrospective gloss, or is that something you thought of at the time? Did you really think, it’s either this or that, and hopefully I’m a sociopath? I believe I’m neither of those two things, but to think of yourself as a sociopath seems like such a radical self-indictment.
Herzog: The thing about addiction is that it’s such a powerful force that I wanted any excuse to continue to drink. Facing the realization that I had a really serious drinking problem was absolutely devastating and destabilizing in a way I have not experienced since. This was almost 20 years ago.
After that realization, I went to a psychiatrist. At that moment, I knew, but I wanted confirmation. I didn’t want to be diagnosed with sociopathy, so I went to a psychiatrist, and he diagnosed me as bipolar I. This was a complete misdiagnosis. I’m not bipolar. Bipolar I is the severe form—or the “fun” one, however you look at it. It was a misdiagnosis. I had a drinking problem, but from the outside my behavior looked bipolar.
Mounk: Because you had one personality when you were sober and another when you were drunk?
Herzog: I engaged in really high-risk behaviors when I was drinking, and I was depressed because alcohol is a depressant. It wreaks havoc on your brain. I did have some of the symptoms of a serious mental illness, but it was a complete misdiagnosis. Probably part of me was also hiding what I was doing because I didn’t want him to tell me, you have to quit drinking.
Instead, he did tell me I should quit drinking, but he also prescribed me a mood stabilizer, which I took for a few months and then stopped. It had no long-term or even short-term effects on me.
After that first realization, that terrible “aha” moment, I lived for the next decade and a half with the knowledge that I was an alcoholic. There’s a term that describes this really well: vacillating denial. Sometimes I knew I was a drunk—like late at night when I woke up at three o’clock in the morning with night sweats, my head pounding, and radiating shame. At five o’clock the next day, when I wanted to drink, I wasn’t thinking, I’m an alcoholic. I was thinking, I just want to drink.
I was able to live with this cognitive dissonance—knowing sometimes that I had a drinking problem and needed to quit, but also being so unable to quit that I ignored it for years. I accepted the truth, but I continued to drink despite it. Because I lived in heavy-drinking communities, this was completely normal. I was surrounded by alcoholics.
Mounk: One of the things that strikes me in my personal experience with friends and acquaintances who have problems with alcohol or drug abuse is that there are certain communities that valorize those kinds of behaviors. The straightforward example is that this is a really fun person—always up for going out, always a laugh, always a good time to be around.
In more extreme cases, it can be artists who are valorized partly for their extreme behavior and their personalities, which are actually rooted in drug abuse. I worry about the cultures of those communities because they encourage that behavior. Of course, it also works the other way around: people with those problems are drawn to those communities because the communities give cover for that behavior.
Herzog: Absolutely. Before we started recording, you said something about me being an introvert. I am an introvert; I admit that fully. When I was 25 years old, nobody who knew me would have called me an introvert. I was the life of the party. I was wild, always ready to go out, fun, unpredictable, and completely unrecognizable compared to my life now.
I went out, I went to bars, I partied every day. I did this for years of my life. I was very social and had a lot of friends, and all of that was connected to drinking.
Mounk: Do you think that introversion is connected to that? I don’t mean in general, because it would surprise me if introverts were more likely to be alcoholics. If anything, perhaps extroverts like me might be more likely to end up as alcoholics because being in more social situations makes it easier to drink too much.
But in your particular case, perhaps there’s a link between being introverted while seeking social stimulation and friendship, and alcohol serving as a lubricant to help you sustain that social life.
Herzog: Yeah, I think that was a huge part of it. The thing about it is that so much of my socialization happened from a young age under this cloud of alcohol that, when I eventually quit drinking—or even when I first knew I needed to quit—one of the most terrifying things was the belief that it would be impossible for me to be social.
I genuinely thought it would be impossible to have a good time or any fun at all if I wasn’t drinking, because I had literally never done it before. Every part of my life was connected to alcohol. The idea of going to a dinner party, a party, a show, or anything without alcohol was unthinkable.
I have realized now that it’s fine. People do it every day. Not everyone needs to get loaded to have a good time. It’s actually fine. But at the time it was completely unimaginable.
Mounk: You were talking earlier about this term vacillating denial. I think you were describing mostly how it felt within your own mind. During this period of vacillating denial, were there times when you admitted what you saw as a problem to confidants, family members, or friends, or was it just within your own mind? Did you have moments of thinking, I actually have this problem, but refusing to say it to others?
There must have been moments when friends, family members, or romantic partners told you, I think you have a problem. How did you respond to that?
Herzog: It never happened. Not a single time. I was very good at hiding my drinking—so good that many people I was close to didn’t know I had a drinking problem.
Mounk: Were you good at hiding the fact of drinking, at hiding how the drinking affected you, at hiding the need to drink—or all of those things?
Herzog: All of it. During my heaviest drinking years, I had conversations with friends who, in retrospect, obviously had drinking problems. Many of them have since quit drinking. We would have these conversations, but they were always cloaked in humor, and no one took them seriously.
On the rare occasions when someone in my friend group did get sober, I was appalled. I thought of it as a betrayal. I was very judgmental of people who didn’t drink, didn’t understand them, and didn’t want to be around them. That attitude was fairly normal within my community.
Mounk: It is interesting because we think about the stigma of alcoholism, and that does exist. But there is also the stigma of being a teetotaler. I drank a good amount when I was younger, I have to admit. At this point, I really don’t drink very much.
There are social situations where you’re meeting somebody at 6 p.m., and you don’t really want to have a drink, but it feels a little rude not to. It can feel like you’re not committing to that social occasion, as if their company is not worth the small cost of perhaps sleeping a little less well or being slightly hungover the next day. Sometimes I find it difficult not to order a drink in those circumstances purely because of this social stigma against not drinking.
Herzog: You want to do what the person next to you is doing. If you go to dinner with a group of people and one person doesn’t eat, it seems strange. Alcohol works in that same way as well.
Mounk: It’s weird because, if I go to dinner with somebody and they’re sanctimonious about being a vegan, I find it annoying. But if I go to dinner with someone, I order steak, and they order a salad, I don’t care.
Somehow it does feel different if I meet somebody at 6 p.m., they order a beer, and I say, could I have sparkling water? It doesn’t feel like disrespect toward them, but it does feel like disrespect toward the social situation.
Herzog: I think it can also be a signifier that you don’t drink for a reason, which can lead to a follow-up question: Why don’t you drink? Most people probably aren’t going to ask, but they might wonder.
Mounk: Yeah, it’s funny. That’s not the fear I have. I think the fear I have is that it communicates, I want to be done with this meeting quickly, or, I don’t think you’re sufficiently important to me. Something like that.
You were very good at not letting people notice. Part of that, of course, is that you had your life together in a way that some people who are dependent on alcohol don’t. Many people aren’t able to hide it, but you were. It seems that in part this was because you continued to be professionally successful and kept a relationship during that period.
Alcohol dependency negatively impacted your life, but it didn’t completely derail it. Why do you think that is? What stood between you and the people whose lives were completely destroyed by the disease?
Herzog: Well, yes. It did destroy my life for many years. Until I was about 30, I worked mostly minimum-wage, entry-level jobs. This was long enough ago that rent was still cheap in most American cities, so I could still pay my rent even if I was working part-time or minimum-wage jobs, or if I had roommates. In the early 2000s, rent was cheap enough that I could live in a hedonistic and irresponsible way and still manage to pay rent. That’s how I spent my 20s. Honestly, my 20s are very much a blur.
When I was 30, I was working as a copy editor at a small academic publishing house, again part-time. I left that job to get an unpaid internship, and that was really the beginning of trying to get my life together. I did have a prolonged adolescence, but after that I started on a career path. I made better decisions, and I wasn’t drinking every night. I also kept moving. I lived in a number of different places, and that became one of my coping mechanisms. If my drinking accelerated to the point where it became very problematic, I would leave—leave the community, leave the environment. That actually worked fairly well for a while, until eventually I would adopt the same habits in a new place. So until my 30s, I was just like every other loser at the bar. Then I started to get my life together.
Mounk: The time you got your shit together was not directly correlated with the time when you actually quit drinking, right? That came later.
Herzog: No. I moderated my drinking for a couple of years. I got this internship, moved to a new city, and got my first job in media working in public radio. I would drink only on the weekends. I was very regimented about when I allowed myself to drink. On weekends I would go back to my old town, sleep on my friend’s futon, and party all weekend. Then I would leave.
Later I moved across the country to Seattle, and similar patterns developed. For the most part, I kept it to weekends.
For the book, I interviewed many problem drinkers. We often have the stereotype of the alcoholic as someone living under a bridge who beats his wife and ends up getting DUIs and going to prison. Although these days, most people living under bridges are probably more likely fentanyl addicts than drinking wine out of a paper bag.
It may surprise nobody, but it is very possible to be an alcoholic and still have a career and a family. It is still detrimental. Especially if you start drinking young, you can become emotionally and mentally stuck in your teens or twenties. That definitely happens. But people manage to live bifurcated lives: hungover at work but still doing the job, then drinking again after work. It’s common.
Mounk: It’s more the Mad Men-style alcoholism rather than the fully out-of-control kind.
Herzog: Yeah. Functional alcoholic. There’s a term for it for a reason.
Mounk: There are periods when it redirects your life and periods when you have your life more or less together, even though it continues to negatively impact you. That makes it sound like you could easily have gone through your whole life without either becoming the person drinking wine out of a bag under a bridge or really getting the problem under control and grappling with the fact that you have a problem.
After these years of vacillating acceptance and denial—of better years and worse years—what made you confront it in a different way?
Herzog: During COVID I was laid off. I was working at The Stranger, Seattle’s alt-weekly, and I took a furlough really early on. I basically volunteered as soon as COVID hit. The newspaper was a free paper, funded entirely by ads for events that were no longer happening. It was obvious pretty quickly that things were going to go downhill. I volunteered to take a furlough, thinking, not coming into work and seeing these assholes for a few months? I’ll take it.
I went on furlough and started collecting unemployment, which I loved. It was maybe my fifth or sixth time on unemployment. I’ve never been afraid to take our meager social safety net up on its offerings. My wife is a nurse, so I was home alone a lot while she was working.
Jesse and I had started our podcast, but at the beginning it didn’t take much work. There was so much happening in the culture that we would just get on the mic and talk for an hour about whatever we were seeing. Now the show has structure, but at the time it required little prep. I had a ton of time on my hands, and I drank.
I started drinking during the day. The time I started drinking got earlier and earlier, until eventually I was drinking in the morning. This was completely in secret. Nobody knew about it, including my wife. I did this for two years. Every time my wife went to work, I got loaded and spent the day sitting on my porch, drinking and scrolling, watching from the sidelines as it felt like the world was falling apart—not just because of COVID, but because of everything happening.
I felt terrible, looked terrible, and was wracked with guilt and shame constantly. I started having health effects: waking up at three in the morning with the shakes and night sweats, a pounding headache every morning, telling myself the next day would be different, that I wouldn’t drink. By 11 a.m. or noon, a switch flipped in my brain and, almost without being conscious of it, I was out the door to buy booze.
I crossed lines I had once promised myself I never would. I told myself I wouldn’t drink in the morning, wouldn’t drink and drive, wouldn’t hide it. Pretty soon I had crossed all of those lines. The amount I was drinking would have killed me eventually. At the time, I was drinking about six Tall Boys—six pints of cheap beer—a day. That was less than in my heaviest drinking days in my 20s, when I could drink twice that, but still a lot. It was a huge amount of liquid and empty calories. I looked awful, felt awful, and the worst part was the amount of brain space it took up.
The best way I can explain it to people who haven’t been addicted to something is this: the feeling when you’re newly in love or have a crush, especially when you’re young, and it’s so overwhelming that it’s all you can think about. Or when your mom has a cancer diagnosis and that’s all you can think about. That’s what alcohol was for me for so long. It consumed my mind.
I had tried to get sober over the years—AA, group therapy, individual therapy, CBT, even CBD. Nothing stuck long-term. One of the hardest things was the message I absorbed about sobriety: once you’re an alcoholic, you have to quit forever. They say one day at a time, but everyone knows it means forever. I couldn’t conceptualize a life without alcohol.
That was the mental barrier: knowing the only way out was to give up the thing that was destroying me, but also the thing I was completely dependent on, that I hated but also loved. That kept me drinking for years, in secret, more and more, until it really was taking over my life in destructive ways.
I never beat my wife or anything like that, but I was distracted all the time, a lousy partner, lying to her. Small things, like if she was coming home from work on the ferry, I couldn’t pick her up because I was drunk. I’d say, sorry, I’ve got a meeting, when the truth was I was drunk. She had to take the bus.
Mounk: You were making excuses for not going to pick her up. It wasn’t that you didn’t want to do that act of service for someone you loved; it was that it would have been dangerous for you to do so.
Herzog: I would have killed her if I had picked her up. I was making all of my decisions around drinking, scheduling my life around drinking—for example, with Jesse and the podcast. I still am a control freak, but I was very regimented about when I was willing to record, because if we recorded in the afternoon I would be loaded and I didn’t want to record the podcast drunk. I was completely inflexible about my routine because I knew I was going to be drinking; I needed those hours to do it. I knew nothing could be scheduled during that time. Don’t tell Jesse, by the way.
Mounk: He never listens to any podcasts, so it’s fine. He certainly wouldn’t listen to mine. One of the interesting things about your book is that you combine your personal story with an argument about how we think about addiction and overcoming addiction.
I want to plant the seed for this part of the conversation. You mentioned that one of the things that kept you from seeking help was the belief that if you stopped drinking, it would be forever, and you couldn’t conceive of a life without alcohol. Tell us a little about the dominant framework for what somebody in your situation during COVID should be doing, and the role that AA—Alcoholics Anonymous—plays in that, both in terms of the medical establishment and in our culture more broadly.
Herzog: Yeah, this is changing. The first time I went to AA and approached a professional about my drinking, I was 24. This was in 2007. At the time, and for many years before and since, there were basically only a couple of treatment modalities for somebody presenting with a drinking problem: rehab and 12-step programs. That was pretty much it.
When I was writing the book, I learned the history of AA, and it’s fascinating. AA developed in the 1930s as an organic peer-support group created by two men. One reason AA became so dominant in the culture was an early member, a woman named Marty Mann. She was a PR expert, very connected in publishing and Hollywood. AA saved her life, and she made it her mission to preach its gospel throughout the country. At the time, AA was not hospitable to women, but she became an early member and was instrumental in spreading it. She was incredibly successful. AA has saved many lives. I don’t knock it—it really works for a lot of people.
Mounk: For people who don’t know much about it, what’s the basic model of AA?
Herzog: It’s a peer-support group. You go to a meeting—at open meetings anyone is welcome—and you basically listen. People sit in a circle around a table, and in a regimented way each person talks about what’s going on. There isn’t much back-and-forth; that’s called crosstalk, and it isn’t encouraged or even allowed.
At the beginning of the meeting, there’s a process: everyone speaks the same words, following traditions and rituals. When it’s time to speak, you say, my name is Katie, and I’m an alcoholic. There are norms within the group. Many people get a sponsor, the person you call when you’re having problems. You work the 12 steps, starting with admitting that you are powerless and ending with helping other alcoholics. If you do it right, you don’t just sit at meetings; you work the steps and become part of the community.
Peer-support groups existed long before AA, but AA is the most successful in terms of membership. For nearly a century, it has been the dominant paradigm for getting sober, including within rehab. One of its great benefits is that it’s free. There are meetings in every city and town in America and many around the world, with Zoom meetings now common since COVID. Anyone who thinks they might have a problem can go, and there is power in being with other addicts who understand what you’re going through.
AA meetings can also be fun. Addicts are often great storytellers. It can feel like an open mic—you’ll hear great stories, sometimes the same ones repeated. But it’s a community, and for people in the midst of addiction, having accountability, support, and a place to go can be valuable. This model has spread widely, and many rehab programs rely on 12-step principles. The irony is that while rehab can be incredibly expensive, the therapy provided is sometimes the same thing you could get for free at your local AA meeting.
There are misconceptions about AA. Some think it preaches that alcoholism is a personal failure, but it’s more nuanced. Bill Wilson, one of the founders, was open-minded; he even experimented with psychedelics in the 1950s. Still, AA has become so dominant that courts can mandate it for DUIs, professional licensing boards can require it, and halfway houses often include it in recovery. I’ve been to meetings recently where pharmacists were there not voluntarily but because they had to fulfill requirements to keep their licenses. AA has become the dominant framework for recovery. The problem is, it doesn’t work for everybody.
Mounk: Why doesn’t it work for everybody? Part of the assumption in AA is that the goal is not to drink at all, not to get to a healthy relationship with alcohol where you can toast your partner’s birthday with a glass of champagne. The idea is that people will have relapses and there’s not going to be judgment about that, but the goal is not to drink at all.
Herzog: Yes. Within AA, any drink is considered a slip, and you start the counter back to zero. You could have been 12 years sober, and if you have a sip of champagne at your daughter’s wedding, you start the clock over. I personally find that not very helpful.
It’s an all-or-nothing attitude, and anything less than perfect is considered a failure. I think that keeps people away from the program, especially people who aren’t totally sure they’re ready. If you know drinking is causing a problem in your life but you’re not ready to quit or can’t conceptualize a world without alcohol, and the one option you’ve been told about is to never have another sip of alcohol again, it’s going to keep some people drinking longer than they should. That was my experience. If the two options were total abstinence or a life of drinking, even though it was causing problems, I was going to choose the life of drinking.
Mounk: Why did that not happen? Clearly you ended up in a situation where it’s not one of those two options, it’s a third option. How did you realize there could be a third option, and how were you able to escape that situation?
Herzog: It was an article in The Atlantic. This article came out in 2015. It was by Gabrielle Glaser and called “The Irrationality of Alcoholics Anonymous.” The article was about the problems with AA, but there was a part that mentioned a treatment called the Sinclair Method.
The Sinclair Method is medication-assisted therapy. It was developed by an American researcher named John David Sinclair. To simplify, he developed a protocol where a person takes an opioid blocker, typically naltrexone. In other places, it might be nalmefene or another opioid blocker. You continue to drink as normal with this opioid blocker in your system. The blocker prevents your brain from getting the endorphin rush and dopamine dump that comes with alcohol.
The idea is that over months, maybe years, you retrain your brain not to enjoy alcohol because your brain isn’t getting the reward. It makes drinking boring.
I read that article in 2018 or so, and I thought, okay, this is what I’ve been looking for. This is the solution to my problems. I went to my doctor and brought the article to her. She had never heard of the Sinclair Method, which is common. Many doctors have heard of naltrexone, and that’s increasingly true as medical education embraces harm reduction and medication-assisted therapy for substance use disorder. But my doctor had not heard of the Sinclair Method.
I said, this is what I want to do. She said, okay, do it. I got the drug and went home. I bought a can of beer from the corner store, took the drug, and felt awful. I had side effects: headache, nausea, depression. I didn’t like it. I choked down the can of beer and thought, okay.
I was so hopeful. This seemed like a miracle cure—the thing that would allow me to keep drinking but diminish my enjoyment of it. For years, one of the things that kept me drinking longer than I should have was the fear of living in a state of unfulfilled desire for the rest of my life. That’s what I thought sobriety would be.
Mounk: Interesting. It would be this constant hankering for the thing you can’t have and this constant self-denial.
Herzog: I was, and still am, very bad at fighting cravings for anything. If I want a cookie, I’m eating a cookie. I don’t have much willpower when it comes to giving in to my own impulses. Definitely, I would be eating the whole bag. So I was looking for a solution that would extinguish not just the drinking itself, but the desire to drink.
That’s what I hoped this would do. The first time I took the drug, I thought, no, I can’t do this. This is not for me. So I put the drug away, and it sat in my medicine cabinet for several years until COVID. Then I really needed something, anything. I thought, I’m going to try this one more time, or I’ll have to fess up to my wife and probably go to rehab. That’s going to fuck up the podcast because I’ll have to leave for 30 days and then do intensive outpatient therapy. It’s going to completely derail my life. So I’ll try this one other thing before I fess up and blow my life up. I did it.
Mounk: Why was the second time different? What was it that the first time around either physically led to the side effects or mentally made you not prepared to deal with them? Why was it that the second time you were able to use this method?
Herzog: I think a big part of it is that I armed myself with information. I read everything I could find about the Sinclair Method. I prepared myself to deal with the side effects. There are simple things to do, like starting out at a quarter of a pill instead of the standard 50 milligrams. Start at 12.5 milligrams and work your way up. I ate a full meal the first time I took it, and I drank a full glass of water. Some people take over-the-counter nausea medications.
One thing that’s interesting about this is that I wasn’t getting this information from my doctor. I was getting it from Facebook, Reddit, and YouTube. My doctor had never heard of this. I was prepared. I knew about the side effects and I was ready to handle them. I also knew this was basically my last chance before I really blew up my life.
I was willing to take some discomfort if it meant I didn’t have to tell my wife, go to rehab, go to AA, and quit drinking. That was the plan. I was going to try this again. I researched it extensively. I talked to people. I kept a Substack where I was writing about this under a pseudonym. I treated it like a journalism project.
Mounk: To ask a simple and perhaps stupid question: if your brain craves the feeling that alcohol gives you, and if you miss that feeling, what stops you from not taking that drug? Why don’t you wake up some mornings intending to continue your recovery, as you intended many times during COVID and earlier, but just as in those earlier instances you wake up thinking, today I’m not going to drink, and then by noon you say, I’m going to drink?
Why in this case is it so hard to say, I’m not going to reach for a bottle of beer, but somehow easier to say, I am going to take this pill?
Herzog: Yeah, compliance is an issue with this drug for sure. There’s a long-acting form called Vivitrol. It’s a shot in the butt you get once a month. For people who have trouble with compliance, that can be a good alternative. For me, I knew the other options were worse, and my life had become, as they say in AA, so unmanageable that this was the last best option.
I was committed to it. Honestly, if I had tried this at 25, I don’t think I would have been able to do it. But I was not 25. I was in my late 30s, early 40s. I wasn’t drinking socially at the time. This was during COVID. I was alone at home, and I had ceased to get much pleasure from alcohol.
The anticipation and fulfilling of the craving were pleasurable, and the first few drinks had elements of pleasure. But by the third drink I was drinking only to try to recapture the feeling of the first drink, or even the feeling before the first drink—the feeling of craving and knowing I was going to fulfill it. That felt good. I knew that if I didn’t stop, it would eventually kill me, and I didn’t want to die.
Compliance can absolutely be an issue with this drug. After talking to a lot of people who have done the Sinclair Method, I learned there are other ways to take naltrexone, but the book is mostly about this particular modality. It is most effective for people who are highly motivated and who also have some social support, who have work. This is not a miracle cure for someone who lives on the streets, whose life is unstable, and who has trouble finding housing, food, or alcohol.
I talked to a guy who works in public health. He said for his patients Vivitrol can be effective in reducing drinking because it’s a shot—if they show up to get the shot, it can work. But for his clients, something that requires you to take a pill, set a timer, wait an hour, and then drink, is not going to work.
Mounk: I guess there is a structural difference as well. The structure of a problem with not drinking is that you have to not drink at 10 a.m., not drink at 11 a.m., not drink at 12 p.m., not drink at 1 p.m. You have to have perfect compliance throughout the day. In the AA framework, every day, messing up once scuppers the whole scheme. With taking this medicine, on a daily basis, you just have to have one moment of self-control.
Herzog: It’s a little more complex than that because it is possible to drink through the naltrexone. The half-life of the drug depends on your metabolism and biology but ranges around five or six hours. It is possible to drink through it. Anecdotally, some forms of alcohol seem to make people more likely to do so, like vodka. Heavy vodka drinkers typically have an easier time drinking through it.
Some people redose after five or six hours. That takes willpower, especially if you’ve been drinking for that long and you’re half loaded. Making the right choice then is hard. By the time people get to a place where they are taking naltrexone and doing the Sinclair Method, in my experience talking to many of them, they are desperate for change. They are ready. They have mostly tried other things and they haven’t worked. If you are desperate for change and the only thing you have to do is take your pill, people do it.
Not everybody. Compliance is an issue. This will not work for people who are half-assed on compliance. The end goal of the Sinclair Method is called “reaching extinction.” This is a term in psychology that means unlearning a behavior. Under the Sinclair Method, it means losing the compulsion to drink. Once you reach extinction, some people, like me, stop drinking entirely. Some people continue to drink moderately. I have talked to people who reached extinction, felt free from the monkey on their back, but continued drinking moderately. They got lax on waiting the full hour. They kept taking the pill but got lax about the timing, and they quickly slid back into alcoholism and had to start the process all over again.
Mounk: Tell us about where you’re at in this journey. You hinted that this worked for you and that it led to the good kind of “extinction” in this case. What did that process look like, and when did you decide not just to tell your wife and many of your friends and family members, but to write a book about it and go public with the whole journey?
Herzog: Yeah, once I started this, I was very regimented about it. One of the reasons I wrote the book is because it’s deceptively simple: you take the pill, wait an hour, and then drink. But there are small changes people can make along the way that increase the likelihood of success. This is not a miracle pill. It does not work for everybody, for a combination of reasons, including biological ones beyond your control.
I started taking the pill. I was regimented about it: take the pill, wait an hour, then drink. One difference between the Sinclair Method and the typical way a doctor might prescribe this drug is that you only take naltrexone when you are drinking. You don’t take it on alcohol-free days. On those days, when your endorphin receptors are unblocked, you want to fill your time with healthy pleasures—eating a good meal, going for a jog, playing with your dog or kids. You want to find new coping mechanisms and retrain your brain to find pleasure in non-alcoholic things.
Over seven months, I tracked my drinking. At the beginning, I was drinking just as much as before. Drinking on naltrexone was less pleasurable. I’ve heard it described as eating four-day-old cake, riding a bike with a flat tire, or drinking with a condom on. You’re still doing the act, but it’s not as fun. You can still get drunk, but you don’t get the euphoric buzz. I wasn’t getting that energetic high. I got the body effects—feeling slurry and sleepy—without the euphoria.
Within the first month, my drinking didn’t change much, but I tracked it and could see it on a chart. Then I started pushing back my start time: instead of noon, I’d start at three, then four. After that I began increasing the number of alcohol-free days each week. That was something I had never done before. I had alcohol-free days when my wife was around, but never when I was left to my own devices.
I started finding things to do that weren’t alcoholic—walking my dog in the woods, paddle boarding, working more. Over seven months I decreased the amount I drank and increased alcohol-free days. Then I challenged myself to 30 days without drinking. It was shockingly easy. Something that had always been difficult suddenly wasn’t. In almost 20 years, I think I had one period of a fully alcohol-free month, and it was a huge challenge. I celebrated it afterward with a bender. This time it was easy—I didn’t even think about alcohol. After seven months I took 30 days off. After two more months I declared myself officially extinct. I reached extinction and never started drinking again. I no longer take the pill because I no longer drink.
Mounk: At this point, if you are at a wedding and there’s a toast with champagne, do you not toast, or do you toast with champagne and have a couple of sips?
Herzog: No, I don’t drink at all. If I wanted to drink, I would need to take a pill. I still have all the risk factors. My life has changed. I have new coping mechanisms, and in some ways I’m a different person. In some ways I’m exactly the same, but my life is very different.
I think my particular biological risk factors make me a high-risk candidate for alcohol use disorder no matter what. I could take a sip of champagne and be fine that day, but it would trigger something in my brain: you like this, right? For me, it’s easier not to drink at all, in part because I don’t like taking naltrexone.
For some people who don’t have side effects, naltrexone is no big deal. They want to continue drinking moderately, and that works for them. I think that’s completely fine. For me, the pleasure I get from drinking on naltrexone is not worth the side effects. The side effects weren’t prohibitive, but I didn’t like them. It’s an endorphin blocker. It doesn’t feel good. So I just don’t drink at all now.
The most surprising thing is that I actually can have a good time without alcohol. I thought that was impossible because I had never done it before, since I started drinking so young. It’s completely fine. I enjoy going to dinner parties and not drinking. I enjoy going to parties and not drinking. It has so little mental pull on me that everybody around me can be drinking and I don’t get jealous, resentful, or cravings. I feel completely free of that mental burden.
In the rest of this week’s conversation, Yascha and Katie discuss cultural attitudes to alcoholism, what to do if you’re concerned about your relationship with drinking, and reaching out to friends and family for support. This part of the conversation is reserved for paying subscribers…
