Andrew: I have the pleasure of speaking with Doctor
Al Mooney the third. The director of addiction medicine
and recovery at Willingway Hospital in Statesboro,
Georgia and in private practice in Raleigh, North Carolina.
Thank you so much for joining us Doctor Mooney.

Dr. Mooney: Thank you, Andrew. It’s great to be here.

Andrew: Well, let’s start with your background and
your family history, which is incredible. Maybe you can
give our readers a summary of what led you to where
you are today.

Dr. Mooney: Andrew it seems that getting into the
addiction field, and now doing some of the things I
do, was a natural path. I never planned on it, but it
all started when I found myself living with alcoholic
parents in the late 50s. My dad went to prison for his
drug addiction in 1959. I had known that things were
not like they should be. But like so often happens
in the family story of addiction, I was given a lot of
misinformation to make everything look like it was
okay when it really wasn’t. And when I found out that
my dad had a disease that caused a lot of behavioral
issues and that now he was getting well because he
had committed himself to a different way of approaching
the problem and addressing his disease; it actually
was a burden off my shoulders because the confusion
was immediately lifted. When I got into medical school
later in my life I realized that same confusion and misinformation
is just so prevalent in the professional and
medical community that I just found a path. That led
to me doing some things, not just clinically, but also
writing about addiction and the person and the family.
Now the reason we’re talking is because that has, over
a number of decades, evolved into a new addition of
The Recovery Book that I’m trying to get the message
about recovery, not only the message, but to guide
people to a path of recovery.

Andrew: Yes, and The Recovery Book, an incredible
publication, over 350,000 copies sold. It’s now in its
second edition, isn’t it?

Dr. Mooney: We were just so proud that we could
come out with the second edition just this past month.
And we’ve refined on the previous edition in ways that
I think are going to make it much more practical, even
though we had quite a following. And even people
that don’t get a new edition, the old ones just fine
but, you know its 2014, we had to do a lot of things
to bring it up to date, and we’ve done that. Now we’re
trying to get the message out that there is a guide for
recovery that has basically everything a person needs
to know if they even begin to think about whether
recovery is an option.

Andrew: Willingway Hospital has been around for
what 45, 46 years now?

Dr. Mooney: Yes. Well after my folks got sober my mom
came into recovery after my dad got out of prison and
got his recovery going, in the late 50s. But at the time,
in the medical world where there’s almost no help for
alcoholics, my dad started treating people privately
and that lead to people coming into our home. When
I was a teenager, we had up to 25 people living in our
home. It was like growing up in a treatment center.
And, then in 1971, the building that Willingway Hospital
is in today, was opened and it’s been running
continuously under the same ownership and management
since those doors opened in 1971. We’ve broadened
our services and we’ve gotten a lot more up to
date with some of the modern science of addiction,
but we’ve been around quite a while.

Andrew: The reputation that Willingway Hospital has
is stellar. But in many ways, people don’t know about
Willingway Hospital. So can you fill us in on why Willingway
is such an outstanding treatment program for
so many lucky individuals that find themselves coming
through those doors?

Dr. Mooney: Well, I think the results of the treatment at
Willingway speak for themselves. We’ve never done a
lot of advertising or marketing because it’s a family operation.
We’ve spread the word of Willingway through
word of mouth. We’ve never really tried to grow, but
we’ve tried to meet the need of the suffering alcoholic
that needs help. And that’s what we’ve done, it’s not
been a product of any business plan, it’s just been an
evolution. My mom never intended to have a hospital.
The idea was from my dad’s accountant, because
people came into our home and were never charged.
They were just taken into the family, living in a surrogate
family of recovery. These people found, through
some initial good medical care and orientation to
abstinence and 12 steps, they found a way to life that
they had never been able to achieve before. And often
this meant things that were counter to the common
knowledge in medicine, helping people get off of
drugs for example. You know a lot of people think that
the solution to a drug problem is another drug, which
does sound counter intuitive, but you’d be amazed at
how many people looking for that solution.
Recovery, abstinence in 12 steps were the objective.
And eventually the accountant came in and said
Doctor John, you got dozens of people living in your
home, you’re going to go bankrupt unless you can figure
out a way to deal with this. And he thought he was
doing 12 step work at the time so he told the accountant
that, and the accountant said, “Well, I don’t think
12 step programs have meals and overnight shelters
and give phenobarbital for detox.” And my dad had to
agree with that. So then they started rethinking the
issue and the whole idea of a rehab type goal that facilitates
orientation and involvement in 12 step recovery
came about, and Willingway grew out of that.

Andrew: I wanted to ask you about the strategy used
for detox and then for, pharmacotherapies after detox,
after the acute withdrawal has passed. How do you
approach that?

Dr. Mooney: Well at, Willingway we are big advocates
for medication management in the engagement
phase of addiction. As a matter of fact, before we
started using medications to help people get along
to a path of recovery, there were a lot of deaths from
withdrawal. Sometimes, in the old medical literature,
up to 30 of the people, due DTs, would die. So the
medical therapy actually started out as a legitimate
method to help keep people from dying so they could
get involved in a meaningful form of recovery. And
we still strongly advocate that medical detox to help
people safely find more meaningful recovery.
Over the years, this idea of saving lives with medical
detox and medication management has morphed into
this idea that we can find solutions to life through a
drug. And looking at the science and, there are a lot
of things both in The Recovery Book and the Willingway
program, that are cutting edge neuroscience that
says the brain can heal. The brain wraps around life
as we challenge ourselves in recovery. But that new
science, and that experience at Willingway, said that
most of these people find that a medication eventually
can create more of a fog that makes recovery more
difficult. Now there are people with mental disease
that need medications, but for addiction, the facts do
not support medications long term. Even though the
medications have been important in helping people
engage recovery. And that’s the way I look at it as a
physician, if I can help people engage recovery, in
what we call in The Recovery Book the red zone, which
is the zone where people connect with their recovery
and get involved in abstinence 12 steps. And that
engagement in recovery, even if assisted initially with
medications, can be very important, but in life-long recovery
there’s very little evidence that medicines work
lifelong, to promote recovery. Even though there are
a lot of people that would love to believe that, I can’t
find the signs.

Andrew: And you just mentioned a co-morbidity,
co-occurring disorder mental health issues which as
we both know, is very common. When it comes to the
treatment of addiction we find there are mental health
issues as well. I think SAMHSA states it’s around 45%
or so. How do you work the treatment of those mental
health issues in conjunction with the treatment of the
behavioral health issues?

Dr. Mooney: What the approach that I take when dealing
with culpability, and it doesn’t matter whether you
have a stomach ulcer, a brain tumor or depression, But
the way you, in medicine, deal with culpability is we
prioritize, based on life and death risk, the treatment
needs. And, in the field of addiction, there are deaths
from alcohol alone: around the world, six people die
every minute. That’s a death every ten seconds for
alcohol alone - around the world, and our country’s
number one health problem. Alcohol and drugs,
prescription drugs as a matter of fact, is the country’s
number one drug problem other than alcohol. So the
life and death risk of the alcohol and drug problem is
substantial. The life and death risk of mental illness,
even though it’s present, doesn’t come anywhere close
to the life and death risk of alcohol and drugs unless
there’s alcohol and drugs involved. So, in a program
like Willingway we’re able to prioritize the treatment
and deal with the deadly disease first. And, deal with
both at the same time. But clear the body of alcohol
and drugs and allow that person to begin to get a
platform for recover y and then deal with other issues,
whether it’s high blood pressure, depression, athlete’s
foot, or anxiety.
These things are dealt with in relationship to their life
and death risk. I was astounded to realize that when
most mentally ill patients died, there were alcohol and
drugs on board were involved in the case. So without
alcohol and drugs, the mortality of mental illness
drops dramatically. So by addressing alcohol and
drugs as a primary concern, we first take a large percentage
of the mortality off the table. And then once
we have a safer situation, we can address the co-morbidity
and the feelings that people have in life that
make them unconformable.
Now the good news about the science of recovery and
addiction is, and this does not fit with a lot of traditional
ideas, but the brain heals when given challenges to
push through, just like muscles. If you go to the gym,
and don’t ache the next day, you question whether
you had a good work out.
The brain science is evolving in a similar way that
challenge through emotional discomfort is where the
growth comes. There’s a whole field of what we call
positive neuro plasticity that fits very well with 12 step
philosophies that say if we want to get comfortable
with our emotions, we have to challenge and push
beyond them. It’s a kind of a variation of the no pain
- no gain theory. And that concept that recent neuroscience
fits perfectly with what we’ve seen work in a
practical way in 12 step recovery and abstinence for

Andrew: You mentioned one death every ten minutes,
which is just astounding, that statistic.

Dr. Mooney: Yeah, one death every ten seconds
around the globe. The World Health Organization’s
come out with recent reports saying there are 3.3
million deaths from alcohol alone in the world each
year. And if you do the math and take that down that’s,
that’s six deaths a minute, one every ten seconds.

Andrew: Now I know you’re involved with efforts
globally to establish recovery programs and recovery
awareness. I’m wondering, from your experience, why
do you feel that the public does not perceive addiction
as needing urgent attention?

Dr. Mooney: You’d probably better ask a sociologist
or anthropologist that, but let me give you my idea
because it baffles me as to how we can have the country’s
number one health problem essentially unattended
both clinically and scientifically, like other health
problems are. And it doesn’t make sense, but I think
that there is an phenomenon that we see in the health
world, where a problem is so prevalent that society
looks at it as normal. You look at gun violence in in
America, you look at tuberculosis in the Philippines,
you look at malaria in Africa, and you and I would be
horrified to have to deal with these situations, but
when an issue becomes prevalent enough to be perceived
as normal, it becomes somewhat transparent
and invisible in a society. I think that’s part of the problem
with addiction. You think about half the people
in our country are addicted or are family members of
the addict, and such a prevalent disease that affects
so many people in a sense we look at as normal. Just
like, when I went to Africa, I got a call and said, I can’t
see you today, I got Malaria today which is no big deal,
because that was just part of what happened in Africa.
And we normalize addiction here, whereas when we
look at the statistics, look at the data, and we look at
the years of life lost, and the money that is lost in cash
or productivity, there’s nothing really in our society
that comes close.

Andrew: And you mentioned the families just now,
and family is such an important part of treating this
illness. I know that at Willingway, there is a very unique
family program in which the spouses are invited to
stay during their time that they’re in that family program.
How did that get developed?

Dr. Mooney: Well, in the early days before there was
Willingway Hospital people would just be dropped
off. You know, some husband and wife, didn’t know
what to do with their spouse, so they would drop
them off to live with our family. And, in a sense, the
Mooney family became a surrogate family that represented
recovery to these people. The patients who
were dropped off got some detox and they got orient
ed to recovery, they got to participate in AA 12 step
recovery and, you know, it was not big at that time but
families were encouraged to get involved in Al-anon.
And then at the end of the stay, rather than just sending
those people back home, there was a need that
became evident very quickly that these people who
had been so sick, and were now getting well so rapidly,
were really having trouble connecting in their old
family. So, the family was asked to come hang out a
few days at our family home and some actually stayed
with the patient in the early days before there was
much structure. But we found that when the family
could participate together in recovery, the success
dramatically increased. So when the hospital was
built in 1971, the rooms were made are all private. The
family members stayed, and at that time it was mostly
the spouse, now we include more children because we
are more generational and other relationship factors
that we deal with. Other people come, but initially that
spouse came and lived in the hospital for five days,
and absorbed much of the program that the patient
had absorbed for nearly a month or more. And we
found that with that family involvement that the success
increased dramatically.

Andrew: I can imagine.

Dr. Mooney: We still do it, and that is a separate program
because sometimes the alcoholic one won’t
help. And we even now we’ll work with families in the
family workshop program when the alcoholic is not
even willing to go to treatment or an intervention
fails. So the family program now is available to families
whether or not the alcoholic decides to get the help.

Andrew: Fantastic. Now this goes to the philosophy of
Willingway Hospital, doesn’t it? It’s a very holistic philosophy
that you have. Treating the individual with the
addiction, treating the family system, as well. Using
all of the tools and resources accessible to attack this

Dr. Mooney: We have to understand that, you know,
society of medicine where things seem to be so reductionist.
We want to fix a balance of a brain chemicals
or something. It’s easy to lose sight that human beings
live in the context of relationships, family, and community.
Yes we want to attend to the molecules, but
unless we orient people to a method of recovery that
allows them to fit and live in the world we’re limiting
our success.

Andrew: Well thank you for the development of those
invaluable programs. Let’s shift gears just a moment.
I know that you have been involved with creating
certification standards for the American Board of
Addiction Medicine, and I know that the Affordable
Care Act is coming into play now and within that act, I
think things are going to change a bit. Particularly for
those physicians who are in private practice. How do
you see things changing with regard to the diagnosis,
or I should say the diagnostic screening for addiction,
within the family physician’s office, and how will people
be referred to treatment for addiction?

Dr. Mooney: There is a concept that in the old traditional
mental health world everything depended on
a diagnostic criteria. The DSM is a nomenclature, is a
vocabulary, that’s owned by psychiatry, and in order
to get reimbursement, people have to meet criteria
of this nomenclature. And if you don’t meet criteria,
you’re not going to get any services, and even though
its origin had a fairly noble purpose of helping identify
and classify diseases, it left little room to deal with
people that were at risk of melting down to something
much more severe. And so, one of the things that has
evolved in the last five years, that I’m very supportive
of because I’m, by training, a family physician and I
know that if we can prevent a disease often we can
save a lot of misery and money. Instead of waiting until
the disease comes so bad that a cancer has spread,
or a heart attack has happened and put somebody in
the ICU. Unfortunately, that preventative element, in
a lot of ways, is still not part of mental health because
we’re so invested in these criteria. But, there is a move
to broaden the concerns to people that have not
become flaming alcoholics and addicts yet, and that’s
what this screening idea is. And the way that I explain
the screening idea, it’s like as a primary care doctor, as
a physician in office taking care of a family, if I can look
at your skin and I see a mole, I don’t have to know it’s
melanoma, I would like to know if it’s melanoma, but I
don’t have to know it’s melanoma to act. All I have to
do as a doctor, your family doctor, is to know you have
an ugly mole, and once we both had decided you have
an ugly mole, it’s very easy to reach the conclusion it
needs to live in a bottle of formaldehyde and not on
you. So that’s the approach we take. We want to get it
biopsy and have it off of you, and if it happens to be a
melanoma, it opens a whole new can of worms as to
what treatments you need. We’re doing that same risk
management approach now, and the system has a lot
of difficulty with it because of the diagnostic nature of
mental health.
But the system is rapidly moving to a concept of risk
management so we can classify your drinking like we
would look an ugly mole. If we can tell you that this is
risky drinking, then we know it calls for an intervention.
We don’t know you’re an alcoholic if you’re a risky
drinker, but we know of all the people in America, a
third of the people in America, a third of adults, don’t
drink at all. A third of the people in America drink, I
say when they have to, at a celebration, a party, you
know once a month or so. And a third of the people in
America do all the drinking. So the social drinkers, the
people that say, I’m a social drinker, trying to say, I’m
not an alcoholic, but I’m a social drinker. That pool of
social drinking excludes two-thirds of the population.
So if a person self identifies as a social drinker, they are
in the top third risk group for being alcoholics. And the
definition of risky drinker, and this is kind of the ugly
mole idea, is if a person drinks five or more drinks, if
a man drinks five or more drinks and a woman drinks
four more drinks, that classifies them as a risky drinker.
There are also much more complicated other factors
that you can go to the NIAAA website and look for
related risky drinking. But basically, we can identify
a risky drinker, then there’s an approach that we can
help a person get oriented. What is recovery? You go
to some AA meetings, understand what getting help
is about. Break the stigma. Get aware, so that if more
than risky drinking is there and the disease of addiction
is there, you can get help. And that’s the intervention.
It’s called S-B-I-R-T, SBIRT, which is Screening
Brief Intervention and Referral to Treatment. And that
referral to treatment may not be a rehab, it could be an
AA meeting or a professional who understands addiction
or even a peer.
One of my approaches that I use if a person is a risky
drinker, is that I introduce to them to someone who is
in recovery that used to be risky drinker and crossed
that invisible line into alcoholism. So, this new concept
of identifying risk and managing that is evolving very
rapidly as a useful way to help people get help with a
drinking problem in the very early stages. I’m glad you
asked that question and I’m so glad that information is
coming out because I’m discouraged by how few addiction
professionals have ever been taught the idea
of risky drinking. And when I go to talk with people,
they’ll know a lot about DSM and mental illness, but
very few understand that continuum of drinking, risky
drinking, and addiction. Often, that leaves us in places
we can intervene very effectively, and very early if
we’re just aware that it’s happening.
Andrew: I’d like to ask you about some of the efforts
that you’ve so generously invested your time in
throughout the world in developing recovery programs,
and recovery awareness. This must be a passion
of yours.

Dr. Mooney: It evolved into what it is today, but I started
out under the umbrella of the Willingway Foundation,
which is a philanthropic arm of Willingway.
You know we don’t do treatment, but we do medical
education, we do education on campuses. One of
the most funded programs that we have in the foundation,
is campus recovery which maybe something
worth talking about in a while. But one of the projects
that had been global recovery, and it started years
ago, almost as a side line interest when the Iron Curtain
was falling in the early 1990s, it became apparent,
and we all knew that the Russian population had huge
problems with alcohol. But under communism it was
obscured enough so it was not evident, at least to us,
but we knew when the Iron Curtain fell, that all the
things to have a vibrant drug economy and alcohol
economy were left. You have a convertible currency,
disposable income and free markets for distribution
of product. And the Willingway Foundation at that
time said, you know, this is just kindling for a drug
and alcohol problem. So we got involved at that time,
and there were other people in America were getting
involved and thinking recovery to Russia, were able
to get involved and do some medical education and
had an impact on some ideas that developed in Russia
after the fall of the Iron Curtain.
And then we were given some contacts in Roma
nia, which also had a revolution to free itself from
communism, and we were involved with people in
Romania, where we started a Willingway foundation
and help promote recovery there, and it trickled into
the Balkans to Bosnia-Herzegovina, Serbia, Belgrade,
all parts of the old Yugoslavian Republic. And then,
through contact from there, we went into Egypt and
now into Ghana, West Africa and that’s our present
emphasis now. And in addition to doing some things,
there’s some exciting developments in the United
Kingdom that have the much more mature philosophy
of recovery and AA. And they all, and they also in the
United Kingdom, they have a National Health Service.
So there is a lot more organization to the delivery of
healthcare services, and a huge recovery movement
in the UK, that I’m actually trying to steal knowledge
of and bring back to America, because we’re in a lot of
ways fragmented in America, in helping the alcoholic
with our controversial and conflicting ideas. Well in the
UK, at least in one area of The National Health Service
in Durham England, there is a wonderful evolution of
a recovery philosophy that I’m trying my best to learn
more about, and cross pollinate back to America, as
well as take into Africa and other places where our
foundation works.

Andrew: And the campus recovery that you mentioned
can you speak to that?

Dr. Mooney: The campus recovery program on collegiate
campuses is one of the most exciting programs
that I’ve been involved with. The grandfather of all
these programs is at Texas Tech. They started a campus
recovery program decades ago. And in the last decade
The Willingway Foundation has looked for projects.
And the campus recovery program has emerged as
our number one funded project. We’ve actually had
donors who have been willing to contribute to this.
And the addition that Willingway’s project from Georgia
Southern University has over Texas Tech, is that
the Georgia Southern University campus recovery
program is housed in the challenge of public health,
which makes it an academic program. Most college
discovery programs are in the student health services.
But, the one in Georgia Southern is actually a scholarly
program in the College of Public Health.
So it, its structure allows it to produce an evidence
base in research, and some of the outcome is very
exciting. And now, actually the program at George
Southern is recruiting addicted students, believe it or
not. Most people want to throw those kids away, and
that’s what started our program.
People with good recovery, young people with good
recovery, their whole life ahead of them in recovery,
were having difficulty getting into educational environments,
colleges, graduate schools, medical school,
law school, and those kinds of things. And it’s sad
because these people are going to be the highest
achievers in the world. They’ve got a maturity, and
recovery allowed them to perform academically better
than anybody else on campus. But the stigma, created
barriers that were almost impossible to overcome. So
our foundation funded a campus recovery program.
So the way it basically works, and this is an over simplification,
but if you’re in good recovery, and you seek
and achieve advocacy from the department with its
Center for Addiction Recovery, and you get rejected
from the college when you apply, then that rejection
can be overturned. Technically it’s an appeal, but
nobody has ever lost their appeal. But the Center for
Addiction Recovery overturns those applications that
are rejected. And you’re admitted to the university as
a student at the undergraduate and at the graduate
level. And the results have actually been studied. It’s
kind of unbelievable, and people don’t believe me
when I describe it, but it’s out there and its hard data.
The grade point average for the university is 2.7 overall
and alcoholics, addicts, felons, the people in recovery
who’ve been given another shot at education, have
a 3.7 GPA. So now the people that were stigmatized
and refused admission are now the honor students at
Georgia Southern, and not only that, but the retention
rate is in the 90 plus percentile. The relapse rate is only
2%, and the graduation rate going to graduate schools
is higher, much-much higher, than the rest of the
campus. So now, with these achievements and these
scholarly achievements these recovery students have
made, the University is seeking people in recovery
because it’s going to boost their academic standard
around the country.
Well it’s a stigma that people just don’t want to believe
that, because we stigmatize people in recovery
and think what could they achieve, and this Georgia
Southern has shown, with hard facts, that these are
the brightest kids on campus. As long as they’re the
brightest kids, they can excel if they are given an
opportunity for their recovery to be supported. And
so we continue to actively seek resources to not only
expand the program at Georgia Southern, because unfortunately
we only have a limited number of students
that can be accepted because of the limited financial
resources, but we also are very interested in replicating
this collegiate recovery method in other universities.
Now, often it’s done in a way where people say, oh we
have a recovering dorm. But there’s no real program
or legitimizing of the program, and it becomes almost
like a symbol of addiction on campus that can be more
stigmatizing than relieving that stigma. So Georgia
Southern is, in my view, the really foremost example,
probably next to Texas Tech of any place in the country
for campus recovery.

Andrew: Dr Al J. Mooney III, I want to thank you for
time today and for your insights - It is very much appreciated.
And I hope the rest of your day is a terrific
one. Thank you so much. I hope that people will go
to read about the recovery
zone system and take to heart, in their lives and
their families, some of these things that have been
so rewarding for people over my lifetime that have
followed this philosophy.

Dr. Mooney: Thank you.

more interviews can be found here