“But First You Have to Go Away and Fix the Drinking Problem!

Talking to a therapist recently, I heard the same thing we hear from Counselors and Psychologists: “If the presenting problems include alcohol consumption, then that has to be fixed first before any other problems can be addressed!”

The therapist is not to blame for handing out this advice which is part of the curriculum in virtually every graduate program and medical school as well as the “advice” proffered in numerous TV series as well as books and magazines.

The problem?

This belief is just flat out wrong and comes from the myth that the self-medication is the primary problem rather than what it really is – a SYMPTOM that something is wrong in one’s life that is being avoided, or coping skills are lacking, or one has failed to mature, or there is unaddressed trauma.

I know. That’s a radical suggestion since everyone knows…

At best, the symptom and the problems are addressed together. For example, if anxiety is being medicated with alcohol (easy to do these days) there are Cognitive Behavioral Therapy (CBT) skills that can be taught and internalized to deal with that. Drinking to excess is also a common passive-aggressive response to unbalanced relationships or controlling or abusive spouses. Assertiveness training, delivered in gradual doses, can help with that.

The list continues: weight training and self-defense classes for depression and low self-esteem, for example. Communication skills that override dysfunctional, obsolete, and/or abusive family of origin patterns.
The problem? Fixing actual problems requires insight, effort, and process time. No miracles, magic, no s/he quit drinking so now everything is fine.

That of course is the familiar AA/12 Step rehab model. Drinking is the problem!

No, it’s not. As anyone who’s had a family member/spouse disappear into a world of meetings and other avoidant activities that frequently make them less available, less responsible, and less capable of normal relationships than the drinking ever did.

And while you used to be able to complain about the drinking, you don’t get to bitch about someone who retorts that they “are working their program.” Notice that “working their program” always involves hiding out in meetings to avoid the same responsibilities they used to avoid by drinking.

But again, there is a difference between those who do this and you. Steppers lack the necessary maturity to resolve problems and learn new and different coping skills. You don’t.

So, again, what’s your choice? Do the work and resolve the problems, keep on drinking to excess, join an avoidant cult? I went for the first option and we can help you do the same. Oh, you don’t have to wait for the pandemic to subside to start. Restrictions mean time – use it to get a jump start on the day we return to some sort of normalcy.


Nothing makes behavioral change easy – ask any ex-smoker – but some medical support can help. One of these aids is the benign anti-craving medication, Naltrexone. Naltrexone is not a magic bullet – it is an “opioid receptor blocker,” which means it blocks the receptors in your brain which create the “buzz” you get from drinking. No buzz = less temptation.

Of course its efficacy varies from one person to another, as is the case with any medication, but it doesn’t have adverse interactions with any other medications EXCEPT opioid pain killers. Stop taking it before any medical procedure which might involve the use of these.

No, you don’t take it forever – usually 3-6 months.

How does it help? Basically it reduces cravings which means you aren’t as distracted while you are addressing the actual underlying causes of your self-medication. It’s an aid, not a fix.


While anyone who can prescribe can give you a script for it, most providers don’t know about it even though it’s been FDA approved for 30 years. Many medical professionals, rather than admit ignorance, will hid behinds, “only an addiction specialist can prescribe this,” or “this is way too dangerous,” or “only psychiatrists can prescribe it,” and so on and on and on.

To help you with this difficulty I’ve attached a handout from Alaska’s Department of Health and Social Services to give to your provider.

Other notes? AA and 12 Step rehab hate Naltrexone because it isn’t punitive like Antabuse which makes you violently ill after any intake of alcohol. Also because it has been successfully used as a moderation and/or harm reduction support – clearly not in line with AA’s “disease” mythology.

Yes, we recommend that our clients at least try it with the following notes: do not drink for at least 72 hours before beginning it so as to eliminate the possibility of being thrown into withdrawal; start with half doses taken with a meal to reduce the chances of experiencing the occasional mild side effects, usually a bit of nausea and/or a mild sedative effect.

Finally, many of you may have read about the Sinclair Method which suggests Naltrexone is a magic bullet. We note that no one has successfully replicated Dr. Sinclair’s reported success, nor have any of our clients who’ve tried it been successful.

Truth is, you still have to make the effort and fix whatever you are escaping via alcohol.