EP 09: A Better Question with Dr. Adi Jaffe

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Dr. Adi Jaffe, Behavioral Neuroscientist and Ph.D. joins Annie Grace in discussing ‘The Abstinence Myth’. Dr. Jaffe gives his insight into prescription medications for reducing drinking and finally Dr. Jaffe and Annie decide that there is question to ask ourselves than: “Do I have to stop drinking?

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Introducing Dr. Adi Jaffe

Dr. Adi Jaffe is the person that really ignited my newest project, The Alcohol Experiment. Dr. Jaffe and I were both speaking at a conference, The Harm Reduction Conference, last November in San Diego. We sat down over coffee and some of the stuff that he told me about the landscape of just America, and drinking, and people seeking help, and all of these things just blew my mind. It launched me into the entire project that I’m now calling The Alcohol Experiment which was which was amazing.

McLellan Pyramid

Tom McLellan, is honestly probably one of the top five addiction researchers of all times. He has created the McLellan pyramid. It shows the fact that at the top of the alcohol use problem is this peak of people who struggle with drugs and alcohol. That’s where we put most of our focus. If you talk about alcohol something like 60 percent of Americans are current drinkers. The vast majority of them don’t struggle with things at all. But about 25 percent of the population fits into the area where there is some kind of struggle with their drinking.


Another 10 percent or so are what we would typically call alcoholics, the clinical term in DSM is alcohol dependent. At the peak of the peak of the peak, all the way at the end are these people that actually go to treatment, because only 10 percent of people with alcohol use disorders actually end up in treatment. So we’ve kind of been developing this entire system for lack of a better term the worst of the worst kind of alcoholics and the vast majority of people won’t engage with the kind of system that we have. What we know is typically the vast majority of people who engage with the system don’t do very well.

A Continuum

The idea that alcohol problems actually run along more of a continuum than this kind of “Yes, you’re an alcoholic”, “No, you’re not an alcoholic” has been around for a while but hasn’t changed the treatment modality at all. So people make up all these crazy, stupid names for it. Like you’re a ‘high functioning alcoholic’ or you’re a ‘high bottom drunk’ or whatever all these ridiculous terms are to essentially say you don’t look like the other people we expect you to look like. The solution is always still the same. You know, whether you’re the housewife who drinks four glasses of wine a night and is kind of saying, I want to cut down to two, or you’re a homeless, ex-executive who lost his job, his wife, and his car because of his drinking and has been homeless for 15 years, the treatment we offer you is exactly the same. And that is just insane to me.

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When you start looking at statistics in terms of recovery, you see that something like 75 percent of people who meet criteria for having an alcohol use disorder at one point in time, when you go and survey them back, don’t meet criteria later on in life. About a quarter to a half of those people don’t meet criteria, but aren’t abstinent. So somewhere between a quarter to half of people who struggle with alcohol, figure out how to drink in non-problematic ways down the line. And that’s something that nobody ever talks about. So we’re left with this system that pushes one way of doing treatment as the only solution. If you don’t buy in, you’re in denial. You don’t understand how big your problem is and you need to be coerced. On the flip side we have a lot of people who just won’t engage and a good number of them are getting better.

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Keep listening to find out more on what Dr. Adi Jaffe has to say on treating alcohol use disorders and what the better question we can ask is.

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Special music thank you to the Kevin MacLeod Funkorama (incompetech.com)
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