Tuesday, December 31, 2013

My Cure

Constant Reader, you have hearkened unto the tale of my drunken misery.  List now as I tell you how I found the way out, left the cage of alcohol, and became the Unchained Mouse.

Making a Plan

The only glimmer of light was my knowledge that I had abruptly become unaddicted while pregnant.  I had once believed that we chased highs because we had nothing better in our lives, but now I knew better.  Not only did I have a great number of better things in my life, I knew for certain that biochemistry was a vital piece of the puzzle.

That clue led me to targeted naltrexone, aka the Sinclair Method.  I considered baclofen as well, but targeted naltrexone was clearly preferable in several respects:  the drug was safe, it was easy to get, and it wasn't needed forever.  There are other good methods with a strong success rate -- and the most successful ones are eerily unknown -- but the Sinclair Method was the right choice for me.

Commitment mattered.  I decided, wholeheartedly and without reservation, to follow the protocol faithfully for six months no matter what.  There were a few exceptions, such as if I had had one of the rare serious side effects, but those were both so uncommon and so obvious that there was no point in adding disclaimers to the commitment.  Six months.  No matter what.

You Never Forget Your First

On the first time of nal + al, I didn't manage the full hour.  I white-knuckled for 45 minutes before I cracked.  I expected that first beer to bring the usual rush of euphoria, that "aaahhh" feeling that I needed so badly.

Instead, that first time was indescribably frustrating. I craved alcohol desperately and I was drinking alcohol, yet the craving did not abate even slightly.

Fortunately, there's no way to untake the pill.  Once it has been swallowed, the swallower is physiologically unable to feel the euphoric effect of alcohol.  At least for that evening, the drinker is stuck -- and during that evening, the brain takes its first steps towards unlearning the idea that alcohol brings pleasure and relief.  There is no pleasure and no relief.

For that reason, some people try it once and ditch the idea.  They'd hoped that they would still be able to enjoy alcohol, and that the pill would just somehow cause them to have the early a-few-drinks experience without going overboard.  It doesn't work that way.  Drinking on naltrexone is very different from drinking without it.

The commitment mattered.

Seeing It Through

I just had to power through that first time and the next couple after it, based on the strength of my commitment. The good part is that it only requires one instant of willpower, just long enough to swallow the pill.  Well, okay, and a little more to wait for an hour.  Fortunately, no other time is as rough as the first -- extinction begins on that very first night.

Some people build constraints into their lives.  For instance, someone who habitually grabs a drink immediately after getting home from work may take the pill while still at work.  I had no such convenient pattern, but I pushed through it because I had to.  My system was simple:  On one day, take naltrexone and drink.  On the next day, don't take naltrexone and don't drink.

After that first time, which really was rather awful, it became easier.  The second wasn't so bad.  After a surprisingly short time, the drive lessened enough that waiting an hour no longer seemed so onerous.  I even found myself realizing with surprise that, gee whiz, it had already been an hour and I hadn't even been thinking of the upcoming alcohol.  Much of the extinction happened early, and the struggle was blessedly eased long before complete extinction was reached.

A six-month commitment turned out to be overkill in my case.   I'm glad I committed, though.  "Trying" the method could have led to ditching it after that first miserable experience.

I was a relatively fast responder.  I wasn't one of the fabled "three-pill cure" folks, but it was only about five weeks from out-of-control drunkenness to complete extinction of the desire to drink.  In the Sinclair Method's terms, I was cured.

Hey, Wait a Minute . . .

The real kick in the shorts was that I had this idea on my own.  Lo these many years ago, while confined in the Minnesota Model rehab and listening to them rattle on about Higher Powers and dopamine somehow affecting each other, I asked if a dopamine blocker wouldn't take care of this dopamine excess problem.  The big bad addiction rehab expert said no, not unless you took it before you drank . . . which was, of course, precisely what I was asking.  He was just too hung up on Stepping to understand the question.

The other kicker is that knowledge that TSM had been patented in 1989 and deployed clinically since 1991.  Although I would have rejected TSM in early youth, I would gladly have embraced it by my late twenties.  DUIs 3-6 did not have to happen.  The career stall did not have to happen.  The prison term did not have to happen.  The frantic internal struggles did not have to happen.  The threat to the deepest and most meaningful relationship of my life did not have to happen.  Whatever damage my drinking did to my son's preexisting problems did not have to happen.

None of it had to happen.

One pill.  Five weeks with one pill.

Three decades of struggle.  Five weeks of increasingly easy treatment.

Three decades.  Five weeks.

So . . . yeah.  I don't drink and don't want to.  I'm indifferent to it.  I'm cured.

My Drunkalogue, Part 2

Constant Reader, you have read of my sad and sorry youth.  Allow me to show you my equally sad and sorry thirties.

A Chance at a New Life, But I Blew It

I moved to Massachusetts and continued my drinking ways.  By this time I was getting plastered only three times a week or so instead of every single night, but it still wasn't good.  It wasn't so much that I had cut down as that I was no longer physically able to tolerate alcohol every night.

Sometimes I showed up to work with a hangover so bad that I could barely function.  Sometimes I didn't show up.  I wet the bed.  I kept a bucket and towel nearby when I drank, so that I could puke without having to leave the alcohol.

At around this time, I experienced a life-changing event:  I met a wonderful man, concealed the extent of my drinking from him, and knew love for the first time in my life.  True love fills a hole we don't even know we have until it's filled.

Even true love does not perform miracles.  The addiction was already ensconced.  I started practicing harm reduction, but imperfectly, and got a sixth DUI.

That's a lot of DUIs.

Again, they didn't look out-of-state and treated it as a first DUI.  I recommend that hardcore drunks move around a lot.  :(

The first-DUI stuff was quite familiar at that point, but I had to drive in an emergency situation, and I was caught.  Massachusetts is quite serious about not driving while a license is suspended for DUI.  I was sentenced to two months in prison.

My wonderful then-boyfriend stood by me through this.  He didn't realize the extent of my addiction.  He knew about one DUI in Albuquerque but thought that the Massachusetts one was my second rather than my sixth.  I did not disabuse him because I was too afraid of losing him.

I survived prison, and eventually moved in with my love.  I had a starry-eyed assumption that I could easily abstain when we lived together, since of course I would not want to put him through that or torpedo the relationship.  Both of those things were true, but unfortunately addiction does not work that way.

I tried  SMART, Down Your Drink, other stuff.  It didn't work.

[The Sinclair Method was well-established in other countries as a successful practice.]

Through some miracle, he did not leave me.  Perhaps he sensed how hard I struggled.  We eventually wed, but that did not provide a miracle cure.  I did, however, discover my own cure of sorts.

What the Heck Is This?

I got pregnant.

Suddenly, abstaining was no trouble at all.  There was no effort, no reminding myself about the fetus, no anything.  I didn't drink and didn't want to.  My brain had changed.

It stayed changed after my son's birth.  We had alcohol in the house, and I didn't want it or touch it.  I even had a drink once in a great while without resuming problem drinking.  My son was a difficult baby who grew into a problem child, but I did not drink.  I began having crippling panic attacks, but I did not drink.  This was no virtue on my part.  I didn't want to.


When my son was six or seven years old, I slid back into heavy drinking.  It's no coincidence that this is the same time that "mommy brain" wears off in other respects.

I struggled.  My husband supported me and tried to help me.  I practiced harm reduction rules with religious ferocity.  We tried to protect our son.  By dint of truly heroic effort on my part, things didn't get absolutely horrible until about a year before I sat down to write this.  At that point, the addiction won the struggle.

Drowning in Alcohol

The battle continued.  It got worse.  It got scarier.  I became desperate.  I knew that Stepping didn't help, knew that RR/SMART had not been useful before, and didn't know what else to try.  I tried LifeRing -- I liked the people, but it was no more useful than any of the other self-help programs and support groups.

Self-help programs and support groups just didn't work.    None of them broke the addiction which had me so thoroughly in thrall.

[In conventional terms,  I'd tried everything.  The most successful approaches are never even presented as options.]

My only shred of hope was that the addiction had vanished during my pregnancy and early motherhood.

You've Really Got a Hold on Me

I had to fix it.  My husband was understandably weary, my son was growing old enough that he wouldn't be oblivious much longer, and I wasn't doing so well myself.  Something had to be done.  I knew that controlled drinking was only a short-term option -- it merely excited the beast living inside me.  I had to quit.

Quitting was easy.  I did it lots of times.

Staying quit, on the other hand, proved insurmountably difficult.  I tried.  Lord, how I tried.  Just as examples, here are a couple of anecdotes:

On one occasion, I sat watching television.  Television generally requires very little concentration, but I still couldn't muster enough of it to follow whatever the show was.  Wanting alcohol consumed all my thoughts.  After some eternal-seeming time of trying to think of something else, I leapt from the couch and bolted for the kitchen, where I swallowed half a tab of valium to make my undrunken state temporarily tolerable.

On another occasion, my husband brought home a can of hard lemonade and drank it.  He left the empty can on the counter.  When I passed, I stared.  It drew me towards it.  I held it, gazed into it, inhaled the scent with deep, shuddering breaths.

I am fairly sure that these behaviors are not normal.

I had to quit, but I couldn't quit.  The hook was in too deeply.  I couldn't get it out by myself.

Don't miss the exciting conclusion of Unchained Mouse's cure!

My Drunkalogue, Part 1

Gather 'round, my children, and listen while the Unchained Mouse regales you with tales of the sad and desperate Chained Mouse of yesteryear.

My Salad Days, Apparently With Alcoholic Dressing

In early adulthood, I drank like a fish.  I loved the effect of alcohol as soon as I tasted it, and it was only two years or so until it was my only real purpose in living.  I lived to drink.  There was no distinction between daily drinking and binge drinking, because it was daily binging until unconsciousness.  Eventually a DUI and a few disorderly conduct charges shook me out of it enough to want to change, even though "change" only meant not getting arrested.

[Side note:  This was more or less about the time that David Sinclair was testing pharmacological  extinction on humans.]

I still had no real goals other than intoxication.  I sought help, but the only so-called help I found was Stepping, and even that was offered in such a smug and arrogant manner that it was clearly a poor option for someone already struggling to justify continued existence.  I just muddled along, sometimes drinking more and sometimes less.  I wanted to improve my life, but didn't really want to stop drinking.  These goals were not compatible, and the alcohol won.

[The Sinclair Method existed -- David Sinclair filed a patent in 1989 -- but I would have rejected it even if I had known about it.  I wanted to get bombed.]

After my second DUI, I was forced into "treatment" by the court.  This was the same old Minnesota Model, basically just getting Stepped on for a month.  I abstained for a while after that because I didn't want to repeat the experience of so-called treatment.

Trying to Be a Functional Addict

A few more years ticked by.  I tried abusing cold medicine, but that was not as fun.  I went back to alcohol.  Third DUI.  This time I tried to be a little more assertive, and I traveled to a mental hospital in Illinois which offered RR-based therapy as well as Stepping.  I abstained for a while after that, but again it was more to avoid repeating the experience than because the therapy had been effective.

A few more years ticked by, and I moved to Albuquerque.  I remained desperately unhappy and lonely, so guess what I did?

[The Sinclair Method not only existed, it was being used successfully in other countries.  I would have embraced it eagerly if it had been available to me.  By that point, it was clear that I was caught in a trap.  Everything past this point DID NOT HAVE TO HAPPEN.  I would have been thrilled to have a cure.]

I got a fourth DUI, although they treated it as a first because they didn't know about the others.  The charge was dismissed because the cops didn't show up in court -- I still have no idea what happened there.

I more or less had a lid on it until I lost my job (for unrelated reasons).  At that point, with no external restraint, it got quite bad again.  On one especially rotten occasion, I woke up passed out on the floor at 6:00 in the evening, a tipped-over bottle beside me, and with no memory of anything past the previous evening at maybe 9:00 or so.  That was an unusually bad night, but that was basically my life.

Sooooo, I soon acquired my fifth DUI which was also miscategorized as a first.  There was more first-time DUI preaching.  It was Step-based and as useless as ever.

Stay tuned for the next exciting episode of Unchained Mouse's drunkalogue!

Hello and Welcome

This is a blog about eliminating alcohol addiction through pharmacological extinction, a process popularly known as the Sinclair Method (TSM for short).

The idea is pretty simple.  Alcohol gets us high by causing the release of endorphins, which are then processed by the opioid receptors in our brains.  A drug, naltrexone or sometimes nalmefene, is used to block these opioid receptors.  Drinking alcohol still produces endorphins, but our brains don't receive them, and our brains gradually stop craving alcohol because the stimulus no longer produces the reward.

The cure rate is phenomenal -- 90% in studies, about 70% in the field.  For an addiction treatment, that's little short of a miracle.  It's far, far better than the success rate of support groups.

Join me as we address some things not well-covered and clear up some misinformation kicking around.  We'll make sure to have a little fun along the way.