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.
For aversion therapy to work long-term, it requires ongoing maintenance, he said. And it only creates an aversion against one substance; if a drinker decides to turn to Valium, which acts on the same reward circuits in the brain as alcohol, all bets are off.
Plus, Muench said, aversion therapies run the risk of severe psychological and physical pain, particularly if electrical shocks are involved. Muench noted that similar methods have also been used to “cure” homosexuality, and that “whether it’s sexuality or any other behavior, it has very short-term effects.”
“What is needed is a recovery-supportive community and system of care that offers an approach to a better life, rather than an aversion to a previous one,” Muench said.
Another issue with Schick Shadel’s claims of success is that their studies are small, sometimes risibly so. The center has heavily promoted a 2017 study by researchers from Schick Shadel and the University of Washington that purports to show a 69% success rate and a reduction in “craving-related brain activity” observed in brain scans. The center called the study “evidence that Schick Shadel’s program works!” in promotional materials and touted the results on local TV news. What they don’t mention is that the study included just 13 people, and that the brain scans were taken right after treatment, with no follow-up to see what patients’ brains looked like after some time in the real world.
Although Woodward acknowledged that nine patients who stayed sober for one year is “not enough” to make sweeping conclusions about Schick Shadel’s effectiveness, others affiliated with the hospital have been far less cautious. Schick Shadel’s celebrity spokesman, former DJ and concert promoter Pat O’Day, told patients in a recent lecture that UW researchers “ratified” the treatment, declaring, “We’ve never seen anything like this!”
This was consistent with what I heard at a Schick Shadel speaker’s meeting, where a former patient waved a printout from the brain scan study, which showed before-and-after pictures of a brain, and claimed that a decrease in red-colored areas on the “after” scan proved that “the cravings went away.”
Schick Shadel has made efforts to improve its standing in the treatment world, obtaining accreditation through the Commission on Accreditation of Rehabilitation Facilities and requiring patients to create aftercare plans that include an appointment with a therapist. Many insurance companies will cover the treatment.
It’s possible that people who stay sober after leaving Schick Shadel do so because they stick with those plans. It’s also possible that the people who tend to end up in Schick Shadel are the kind of people more likely to stay sober in the first place. The hospital doesn’t accept Medicare of Medicaid, and insurance doesn’t always cover the $22,000 tab. Woodward said about 15% of patients pay the full price of treatment out of pocket. Studies of aversion therapy have suggested that the people who seek it out tend to be financially stable and self-motivated, which may account for their higher success rates.
The Difficulty Of Getting Sober
In several weeks of reporting on Schick Shadel, I met a lot of people who truly believe the treatment works. I sat in on a roundtable of patients and former patients back for 30- and 90-day checkups (which include one duffy and one sleepy and cost $1,800), and listened to them talk about how empowered they felt by a program that didn’t talk down to them and trusted them enough not to subject them to drug tests or restrict their access to the outside world, two components of many addiction treatment programs.
I heard a lot of people whose bad experiences at other treatment centers or in AA had led them to see treatment at Schick Shadel as an act of defiance. I got the sense that many inside the Schick Shadel community, including staffers as well as evangelists like O’Day, view the hospital’s position as a besieged island of science and rationality in a sea of woo.
“A lot of professionals were trained that 12 steps is the only way,” Woodward said. “Trying to get a professional who’s been trained this way to say that aversion therapy works is like trying to get a Republican to believe that welfare is a good thing.”
But like any treatment program, many former patients go back to drinking. In conversations with seven former patients and family members of former patients in Seattle, I found that just two had stayed sober continuously since leaving Schick Shadel. The rest had either returned to drinking, or relapsed and then gotten sober through AA or another program.
Pete, the former patient who went to Schick Shadel after finding he could no longer function in the mornings, went back to drinking almost immediately, pushing through a brief bout of nausea to return to what he considers a more moderate level of drinking. He’s still glad he went to Schick Shadel, though, calling it “a reset button” that taught him “I could be the person I wanted to be without alcohol.”
Zach Wurtz, a Seattle resident who convinced a cousin to go to Schick Shadel because it didn’t involve “30 days of praying” like other programs, said his cousin immediately began drinking again when he left and, within six months, had returned to opiates, then heroin. Eventually, he got on methadone. Wurtz said his family had emptied out bank accounts and pooled their resources to afford a discounted $15,000 stay at the center.
“If you have 15 grand and it isn’t going to hurt you to burn it, I guess it’s worth trying,” he said. “But if you don’t, do not go to Schick Shadel. Have your friend kick you in the nuts when you take a shot, because that’s basically the same thing.”
For Tara, Schick Shadel didn’t get her to stop drinking. But she said it gave her a sense of indifference toward alcohol, “an absence of craving that I had never felt before.”
But once she left the controlled environment of an inpatient hospital, “it just felt like it was possible to have a drink.”
When we spoke, Tara was 38 days sober, an achievement she attributed to AA and moving into a sober group house in Seattle, where she has to do chores, attend meetings, and take random drug and alcohol tests. “I had to acknowledge that I didn’t really try with AA the first time.”
She’s stuck with the program this time, despite her reservations, and it seems to be working for her. “In a radical, very swift fashion, things started to get a lot better.”
Need help with substance use disorder or mental health issues? In the U.S., call 800-662-HELP (4357) for the SAMHSA National Helpline.