At this LA rehab center, cannabis is an exit drug
Hayley FoxAugust 16, 2017
By Mac Kirk’s own count, he’s already attended more than 30 drug rehabilitation programs. With a propensity for heroin, Xanax, and “pretty much everything under the sun,” the 20-year-old musician moved from New York to the West Coast in April to get clean. Bouncing between recovery facilities and sober living centers, Kirk overdosed twice this year.
Then he found High Sobriety.
The concept behind the Los Angeles-based recovery center is relatively simple: Instead of demanding complete drug abstinence—which has been the reigning method of treatment in Alcoholics Anonymous and offshoot programs based on the 12-step model—High Sobriety promotes a “cannabis-inclusive” model that uses marijuana as a means to smooth withdrawal’s rough edges and replace other, more life threatening drugs. Cannabis isn’t just tolerated, it’s provided as part of the program.
“This is the only reason I went to treatment, is because of the cannabis.”Vince Sercia, High Sobriety resident
High Sobriety opened its doors in January and has so far housed about 30 patients. From the sidewalk on Venice Boulevard, it looks like a block of newly renovated condos. On a recent morning, on the large deck of one of the residential units, a group of tired-eyed young men lounged in the mild morning sunshine. One resident, Vince Sercia, took puffs of pot from a pocket-sized vape pen.
Sercia, 21, has used everything from black tar heroin to designer benzodiazepines, he tells me. High Sobriety is his third rehab facility, and after the “worst 30 days” of his life detoxing through another program, Sercia was reluctant to give recovery another shot.
“I just wouldn’t have gone to treatment if it wasn’t for this place,” he says. “This is the only reason I went to treatment, is because of the cannabis.”
High Sobriety co-founder Joe Schrank is himself 20 years sober and successfully used Alcoholics Anonymous to quit drinking. But while it worked for him, he said he’s learned that AA’s strict parameters, emphasis on complete abstinence, and faith-based curriculum aren’t a good fit for everybody.
“One of the dark secrets about rehab that nobody wants to say is there are some people who should not be totally abstinent,” he says. “They’re not pleasant people if they are. They don’t function well—if they do.”
To that end, High Sobriety employs an unconventional approach. As Schrank puts it, “We’re trading drugs that will kill people for a drug that will not kill people.”
As a clinical social worker, Schrank has spent decades in the recovery community. He’s worked as a residential therapist at the swanky Promises facility in Malibu, CA; established a plush sober-living facility in Williamsburg, NY, called Loft 107; and launched a website, The Fix, focused on addiction and rehabilitation. After years of working within the 12-step system—and witnessing its shortcomings, he says—he decided to build a recovery facility of his own. If all goes well, he’ll open a second center, in Las Vegas, later this year.
Substituting cannabis for drugs like heroin, alcohol, and prescription opioids is a type of “harm reduction,” Schrank explains, a recovery paradigm that prioritizes reducing the negative consequences of drug use rather than stopping patients from using completely. High Sobriety is aimed at patients who haven’t responded to traditional rehab programs—and there are a lot of them. According to recent estimates, AA is only successful for 5% to 10% of people. Some experts even say it can even be detrimental for a number of reasons.
“One of them is that everyone believes that AA is the right treatment,” Dr. Lance Dodes, a psychiatrist and addiction specialist, told NPR after writing a book debunking the science behind 12-step programs. “AA is never wrong, according to AA,” Dodes said. “If you fail in AA, it’s you that’s failed.”
On top of that, despite AA’s emphasis on full abstinence, program participants often falls short of that goal. Many who do successfully stop using alcohol or other drugs end up dependent on coffee and cigarettes.
While the 12-step formula is the most commonly used approach to addiction treatment, it has a growing number of critics. Dr. Mark Willenbring is one of them. Willenbring, an addiction psychiatrist with decades of experience treating drug and alcohol disorders in combination with mental and physical disorders, says programs like AA are hardly scientific.
“There’s no reason for us to be treating substance abuse with prayer,” he said. “That’s what you do when you don’t have a treatment, you use prayer.”
He’s referring to AA’s many mentions of a higher power. Though the organization says it’s not a religious group and is open to all comers, seven of its 12 steps refer either overtly or by thick insinuation to God. Four name God directly. Step 3, for example, says, “We made a decision to turn our will and our lives over to the care of God as we understood Him;” Step 11: “We seek through prayer and meditation to improve our conscious contact with God as we understand Him, praying only for knowledge of His will for us and the power to carry that out.”
AA is more support group than actual treatment option, Willenbring said. And while its abstinence-only model is often the right one in his eyes—in fact, for alcoholics who can relapse with just one drink, he says these types of absolutes are necessary—the program’s God-laden rhetoric is unhelpful for many, he said.
After working for the National Institutes of Health, Willenbring in 2013 founded the Alltyr Clinic in Minnesota as an alternative to traditional rehab models. Patients there receive customized care that addresses their particular mental health diagnosis alongside their substance abuse issues. Treating those simultaneously proves to be “absolutely critical,” he said.
“We don’t just call addiction a disease, we treat it like one,” he said. “People ask me what my model is, I tell them it’s health care.”
Yet while Willenbring said he’s all for new alternatives to the 12-step model, he scoffed at High Sobriety’s use of cannabis as a treatment method, which he called “asinine” and a “marketing ploy.”
“It’s a really stupid idea,” he said. “I’m not going to mince words on this one.”
The effects of cannabis on the body are complex, and the concept that cannabis can be used as a “replacement drug” is illogical, Willenbring said. If you’re going to use one drug to treat another, it has to have similar effects on the body as the patient’s drug of choice, he said, which is why methadone is used to treat heroin—it tickles the same opioid receptors. If marijuana were in fact a treatment for drug abuse, Willenbring wouldn’t be in business, he quipped, because so many patients who come to see him are already smoking cannabis regularly.
Schrank is used to this type of reaction. Since launching High Sobriety, he’s been called a “drug dealer” and accused of orchestrating a “money-making” scheme to sell “snake oil.” Cannabis isn’t a silver bullet or a cure-all, he acknowledges, and he says he doesn’t use it himself. But he urged skeptics to consider the growing body of evidence that shows cannabis has huge potential.
The experience of detoxing from a drug like heroin mirrors chemotherapy in a lot of ways, Schrank explained. Among other symptoms, both cause bone pain, insomnia, and nausea. Cannabis has been effective in dramatically alleviating those symptoms, Schrank said. With the pain and discomfort of withdrawal being one of the largest deterrents to recovery, cannabis could help entice more patients to start down—and stay on—the road to recovery.
Cannabis remains a Schedule I controlled substance, which makes it extremely difficult for researchers to get approval to use it in a clinical study. But the emerging patterns are promising: According to a report released in January by the National Academies of Sciences, Engineering, and Medicine, cannabis has been demonstrated to help treat chronic pain, and certain oral cannabinoids have been effective in preventing and treating adults with “chemotherapy-induced nausea and vomiting.” And the National Institutes of Health recently awarded a five-year, $3.8 million grant to researchers for the first long-term investigation to see if medical marijuana reduces opioid use among adults with chronic pain.
There’s less hard science around marijuana’s effects on addiction. The National Academy report “found no evidence to support or refute the conclusion that cannabinoids are an effective treatment for achieving abstinence in the use of addictive substances,” Dr. Marie McCormick, chairwoman of the report committee, told the New York Times.
Nevertheless, a large body of observational research has emerged around cannabis, said Leo Beletsky, a drug policy expert and professor of law and health sciences at Northeastern University. That means scientists have observed real-world data and then formed hypotheses as a result, he explained. “Most of the research that we have on the impact of cannabis in the pain and chronic pain world is from these kinds of observational research.”
This is what High Sobriety’s formula is based on.
What the findings have shown, Beletsky said, is that cannabis, like opioids, behaves as a “broad spectrum drug” and that both not only have a “euphoric effect” but may also help relieve pain, emotional distress, and depression. To the extent cannabis can address the same needs as other, more dangerous drugs a patient may be using, he said, it could function as a less-risky replacement, he said. “You’re going to be drastically reducing people’s risk of addiction and overdose.”
Amanda Reiman, a former manager of marijuana law and policy at the Drug Policy Alliance who acts as an unpaid advisor to High Sobriety, said the program has the chance to reinforce existing evidence of cannabis for treatment.
People have been using cannabis as an “under the radar” harm reduction tool for years, and as a replacement drug for opioids for even longer, she said. “This is not something new. I think that High Sobriety is an opportunity to formalize it.”
As far back as the late 1800s, hemp was denoted as a cure for opium sickness, she said. And in recent years, the role of cannabis has become so prevalent that some marijuana dispensaries have begun hosting AA meetings, she said, so people using cannabis in their recovery can convene outside the abstinence-only confines of a 12-step program.
Research on the function of cannabis as a painkiller also continues to evolve. A 2011 study out of the University of California, San Francisco, concluded that patients with chronic pain may see more relief when doctors add cannabinoids to an opiates-only treatment. This combined therapy may also allow for lower opiate dosages, according to the same study. In 2014, a report from JAMA Internal Medicine found that states with legal medical marijuana saw a 25% reduction in opioid-overdose deaths.
“Cannabis really fits into this arsenal of what can we give someone when they don’t want to go back to opioids, but they aren’t able to function the way they want in complete sobriety,” Reiman said.
Amid the nation’s overdose epidemic, US spending on addiction treatment will surpass $42 billion by 2020, according estimates from the National Institutes for Health. And like most recovery facilities, High Sobriety isn’t cheap. One of the biggest hurdles for the organization, Schrank said, is that unable to accept insurance, so treatment is open only to patients wealthy enough to afford it.
An alcoholic man with a propensity for scotch has replaced his booze with pre-rolled joints. A woman with a dependence on Valium and wine now uses edibles for anxiety.
The first month at the center costs $42,500, which includes housing, food, doctor and therapist visits, clinical services, and recreational activities. When clients first enter the facility and enter the detox period, they are monitored 24/7 and are under constant supervision of a doctor, Schrank said. Afterward, patients transition to a schedule that typically includes three to five individual therapy sessions per week, community meetings, doctors appointments, and an exercise component. Clients receive medical and dental treatment if needed, said Schrank, and often receive trauma therapy, legal or marital counseling, or other services. Most guests end up staying longer than a month, and costs decrease as they need less individual care, Schrank said.
How does that price tag compare? Inpatient rehab facilities vary significantly in cost depending on location and luxury level. Some estimates range from $10,000 to $20,000 per month on the low end to up to more than $100,000 at luxury facilities. At Promises—the rehab clinic to the stars, in Malibu—a 31-day program costs around $60,000 to $90,000, depending on requests.
High Sobriety currently hosts five residential clients and has about 10 former residents who still frequent the center for meetings and regular check-ins, Schrank said. In an attempt to avoid making patients feel imprisoned at the facility, there are gates but no imposing fences, patients are allowed to keep their phones, and they’re even permitted to leave the facility and venture into neighboring Culver City (although they are randomly breathalyzed and subjected to urine testing).
“It keeps me responsible and accountable but I still have the freedom of being a human,” says Mac Kirk, the musician who counts High Sobriety as his most recent treatment facility of dozens. “I want to be able to make this an investment and make it my last fucking treatment center.”
For many of High Sobriety’s success stories, cannabis remains an integral part of their life well past treatment. Schrank cites one in particular—an alcoholic with a propensity for scotch—who has replaced his booze with pre-rolled joints. Another woman, who entered the program with a dependence on Valium and wine, now uses edibles for anxiety and a cannabis spray under the tongue for sleep.
There have been some relapses, he acknowledges, which isn’t unusual in the addiction community. Other patients are conflicted about whether to continue cannabis use in the long run.
Leland Kulok, 26, has been at High Sobriety for just over two weeks, part of his effort to end nearly eight years of heavy opioid use. He had already cycled through a handful of rehab programs when his parents discovered Schrank online. At the time Kulok was living in New York, he recalls, smoking heroin nearly every day and never leaving his apartment.
Now in treatment at High Sobriety, Kulok said that while cannabis helped his initial transition in recovery, it actually makes him paranoid. He’d eventually like to stop using it completely.
“A lot of 12-steppers and a lot of the recovery community sees marijuana as a gateway drug or as something that should be avoided,” he says, “but I think it can also be helpful to people who’ve been using for a long time and are sort of on the path to full abstinence.”