Dr. Sarah Wakeman
speaker
484 appearances
2 recordings
2 series
first heard Jan 2025
last heard May 2025
Dr. Sarah Wakeman’s voice in public audio — every appearance, attributed to the second.
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So if you decide like I want to cut back on how much I'm drinking but I'm going to go to happy hour every night with my friends and just try to like not drink while I'm there, you're probably not going to be very successful because you're going to be in a situation that's constantly like reminding you of alcohol use and everyone around you is using alcohol.
So try to make some different sort of structural changes in how you set up your life and your week and your day. And you may find that actually you don't miss it that much, that you could cut out three or four days of drinking and still get that social pleasure two days out of the week, and your overall health risk is going to go down significantly.
Generally, no. So, you know, rehab is this idea that you go away somewhere for a week, a couple weeks, and then you're kind of cured, right? It's almost like people have thought of addiction as an infection where you need like two weeks of antibiotics and then you're done.
What we really understand is that for many people, addiction is more like a chronic illness or even like cancer where you need a lot of treatment up front for the first few years. And then over time, you get into stability and remission and you're almost like a cancer survivor. You're in long-term recovery.
And so this idea that you go somewhere for a couple weeks and then you come out and you're all better really doesn't match what we know of addiction. The other problem is that much of what happens in rehab is not all that therapeutic most of the time. So the things that we know are most effective for addiction, one are medications, which there's a lot of stigma and misunderstanding about.
And then two are, like, evidence-based psychotherapies. So things like cognitive behavioral therapy, motivational enhancement therapy. you know, working on your underlying trauma. Often in rehabs, the model is really built around this idea of like you remove yourself from this environment. You do some groups while you're there. Sometimes often they're based on more of like a peer support model.
Sometimes the therapies that are offered are frankly not very evidence-based. Like we actually did this study. It was a secret shopper study where we called rehab programs across the country to like ask about what they offered. And many of them offer things like, you know, horse therapy or like dolphin assisted therapy, which like I'm sure it's
very nice to swim with dolphins and to work with horses, but it's not something that's been studied and effective, and many places don't offer the things that we know are actually effective, which are trained clinicians doing evidence-based treatments or medication treatments. So it's a combination of this short-term fix for a long-term problem
And not actually getting the treatment that you need. So what does work, like for alcohol use disorder, most people don't know we have very effective medications that can help you. Even if you just want to not drink as much. So there's this medication I mentioned at the beginning that actually blocks your opioid receptors.
Which seems kind of funny that it works on alcohol. But the reason it does is that for people who part of the thing that drives them to drink is that they drink, they feel this like pain relief pleasure sensation from the release of opioids in their brain. And that makes them want to drink more. That if you block that, people don't get sick if they drink, but they just don't find it as rewarding.
And so someone named Sinclair actually in Europe did some fascinating experiments of even just using it as needed. So rather than taking it as an everyday medication, if you know that when you go to like a holiday event, you're going to drink way more than you want to drink. You take it like 30 minutes before you go. And then what people find is they have like one drink and they're like, I'm good.
I don't have that same urge to want to drink more and more because I didn't get the same sort of tickle of feeling better and feeling relief.
Yeah, one of the most like groundbreaking trials in the last couple of years for alcohol use disorder was psilocybin. So there's a big study of psilocybin-assisted psychotherapy for alcohol use disorder, which showed really remarkable effects.
So people took psilocybin, actually compared it, folks came in and they either got a big dose of Benadryl or psilocybin, and then they sat with the therapist for like eight hours for this guided psilocybin journey. And they found that people drank much less after it. So it does seem to have some effect. And the thought is that
Part of the way psychedelics work is they increase neuroplasticity, meaning the ability for the brain to form new pathways and kind of retrain itself. And so it does seem to be a potential therapeutic for alcohol use disorder.
Yes, exactly.
I have, yeah.
Yes. People have looked at Ibogaine for opioid use disorder. Those studies have been less promising than psilocybin, although it hasn't been tested in the same kind of rigorous ways recently. Partly for opioid use disorder, we have really effective medications that have been shown to improve recovery and reduce death. And so it's sort of hard to be better than that.
One really interesting, like, new whole class of medications for alcohol is medications that are being used for weight loss that people have probably heard of. So, like, Wagovi, Ozempic, that whole class of GLP-1 medication seems to also reduce alcohol use, which is kind of interesting.
Yeah.
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