This piece originally appeared at HuffPost.
By the time Tara wound up at Schick Shadel Hospital, a 10-day inpatient rehab facility just south of Seattle, she had hit a personal low. She’d always been a drinker — alcoholism runs in her family — but things had spiraled over the past few years. More than once, she found herself sobering up in jail, trying to remember what made her husband call the cops the night before.
She had already tried traditional rehab at an inpatient facility in Eastern Washington, as well as Antabuse, the drug meant to help patients stay sober by making them violently ill when they drink. Neither kept her sober for more than a few days. Alcoholics Anonymous was a bust, too: “I went to my first meeting, cried all the way through it, then went out and proceeded to get massively wasted.”
Tara, who is being referenced by a pseudonym to protect her privacy, realized that if she didn’t do something, she was going to lose her family. It was her husband who pushed her to try Schick Shadel, a treatment center in Burien, Washington, that promises to eliminate cravings within 10 days and claims a success rate of nearly 70%.
There, Tara found a type of treatment altogether different than the spiritual transformation emphasized in most 12-step-based programs. Schick Shadel treated addiction with brute force, like a physical foe. “It was nice to have permission to reject AA,” Tara said.
But Schick Shadel’s treatment involves some strategies experts consider fringe, even borderline unethical. The center administers high doses of alcohol combined with a nausea-inducing drug or mild electric shocks‚ a method called “aversion therapy.” It also involves interviews with counselors when the patient is under sedation. A 10-day stay at the center costs roughly $22,000.
And although Tara and others say they have benefited from the program, Schick Shadel’s unconventional methods don’t appear to be any more effective than other kinds of treatment. The most comprehensive long-term study of Schick Shadel’s success over time showed that 77% of former patients had returned to drinking after 10 years.
Drinking — And Puking — At ‘Duffy’s Tavern’
Dr. Charles Shadel founded Shadel Hospital outside Seattle in 1935 offering aversion therapy in a “homelike setting” — the same year Bill Wilson started Alcoholics Anonymous in Akron, Ohio.
Decades later, a stay at Schick Shadel includes mandatory counseling, aftercare planning and other trappings of traditional treatment. But its most distinctive feature remains aversion therapy, which is based on the idea that if you associate a substance with an unpleasant experience, you’ll want to avoid it.
Schick Shadel patients are given a nausea-inducing drug followed by a cup filled with their drink of choice, which is repeated over and over again, and again, and again. If a patient’s body can’t handle vomiting, they can opt to swirl alcohol in their mouths while getting a series of mild electric shocks; if a patient is a drug user, Schick Shadel offers authentic-looking simulacra to snort or smoke.
The treatment room is like a bar from a nightmare — fluorescent lighting turned up to 11, a rolling cart stocked with warm gallon jugs of Fireball and vodka, and a giant mirror over a stark steel basin that is easy to imagine brimming with 85 years’ worth of vomit.
Although other former patients say the process of repeatedly drinking and throwing up was miserable, Tara was willing to try anything. “I was a serious bulimic for like 10 years, and they asked, ‘Is that going to be a concern?’ and I was like, ‘I don’t care about throwing up,’” she said. “I had done enough unsavory things that I never thought I would do that I said, ‘Fuck it, [my husband] really wants me to do this; maybe it’ll work.’”
Schick Shadel refers to these vomiting sessions as “duffies” — a reference to a fictitious bar that doubles as an in-joke among people in the program. On days when patients aren’t doing “duffies,” they have “sleepies” — interviews under sedation that are supposed to give counselors direct contact with a patient’s subconscious mind.
Until fairly recently, Schick Shadel used sodium pentothal, the so-called “truth serum,” for these sessions, but that drug became unavailable in the U.S. after European suppliers objected to its use in executions. Schick Shadel switched to propofol, a drug commonly used in general anesthesia.
“There’s a reason that they don’t put in the advertisements that you’re going to be given a duffy or an electric shock,” said Pete, another former patient using a pseudonym who went to Schick Shadel after his 12-drink-a-day habit started giving him morning shakes. “They know that if you knew that going in, you probably wouldn’t go.”
In the hospital, the aversion sessions are treated like a kind of shared trauma. Many wear navy “I had my last drink at Duffy’s Tavern” hoodies, which are available for $30 near the reception desk, over their green hospital scrubs.
“People say they need something more physical,” said Mark Woodward, Schick Shadel’s director of business development and marketing. People come here because of the promise behind all that suffering: that they will lose the compulsion to drink by permanently turning off brain receptors that lead to cravings.
“We are confident that we can help a patient lose their cravings in 10 days,” Woodward said.
Does Aversion Therapy Work?
The research on aversion therapy for addiction is sparse, and much of it has been funded or conducted by people associated with Schick Shadel, including its longtime medical director, the late James Smith, and Schick Razor Company founder Patrick Frawley, a onetime Shadel Hospital patient who purchased the hospital through a spinoff company in 1965.
Like most studies that treatment centers conduct, the results are limited to self-reporting from former patients who responded to surveys, and rarely include results beyond one year after treatment. The most comprehensive modern study of Schick Shadel’s method was in 1993, and suggested that about 65% of former patients surveyed said they were still sober after a year; however, 29% of the patients contacted did not respond to researchers at all, so the real “success” rate was likely much lower. Studies show that reported one-year relapse rates vary from 30 to 70% for all kinds of treatment, including one-on-one therapy. A more meaningful number would be the number of people who manage to get and stay sober over a longer period, but treatment centers, for various reasons, don’t typically track patients long-term.
Fred Muench, the president of the nonprofit Center on Addiction in New York, considers aversion therapy “outdated” and said it only works as long as the negative reinforcement is present. “When you’re in treatment, almost anything works, because you’re in a controlled environment,” Muench said.