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Friday, June 27, 2014

Treatment or Penance?

Targeted naltrexone administration ("the Sinclair Method," our focus here) is the bee's knees for people addicted primarily to the opioid reward.  For people whose addiction functions more via GABA receptors, daily high-dose baclofen has some risk but also some good results.  Baclofen is still in the "early results are promising" stage, but the Sinclair Method's efficacy is well-established.

What disturbs me is that this has been well-established for some time and yet we still think people should just abstain from alcohol and join a support group.  That approach pretty much doesn't work.  95% of the people who try it will fail.

Why do we most strongly promote the method which is both most difficult and least successful?  I think we believe that addicts deserve to suffer.

If someone has a broken leg, we fix the problem.  We don't get into a pointless argument about whether he jumped off the roof, fell by accident, or was thrown by an assailant.  We fix the leg first.  But if someone develops an addiction, hoo boy does the blame start flying -- and the addict should be forced to do it the hardest possible way, as penance.

If the guy jumped, he was foolish to do it.  Whether he jumped or was pushed, he still deserves reasonable medical care.  The guy who jumped shouldn't be denied proper medical care on the grounds that he did something foolish.

If we denied real medical care to everyone who contributed to his/her own problem, there would be no cardiac care for anyone who ever ate fast food or drank coffee.  Cancer treatments would be denied to anyone who ever went near carcinogens.  The entire field of sports medicine would disappear.  Since none of us are perfect, most of us would die young.

It's time to stop insisting that addicts need spirituality instead of proper care.  It's time to treat addicts with no more but no less respect and concern than anyone else with a health problem.  It's time to let addicts have proper medical treatment.

Friday, June 20, 2014

"I Get No Pleasure From Drinking"

Interesting discussion over on -- one participant said (I'm paraphrasing) that people who drink after trauma should focus on addressing the trauma, that people who drink to relax and to deal with anxiety should try the baclofen approach first, and that the Sinclair Method was best suited for people who drink to get high.  I think she has a good point and that that's a reasonable approach.  However, there's a snag -- some of us are maintaining our self-respect by maintaining that we loathe drinking and everything about it.

I'm always surprised when I hear an addict or recent ex-addict say that there was no pleasure in drinking.  Some people say, and probably even believe, that there was no high or enjoyment of any kind in drinking, only the illusion of pleasure from the relief of addiction.  This is not true, yet many of us believe it.

If this mistaken belief is widespread, it could be bad.  If we don't know what we are conditioned to seek (euphoria, in our case), then we don't know what to block (opioid receptors) to break the conditioning.  I can easily imagine someone convincing himself that he drinks only due to addiction, gets no pleasure from it at all . . . and therefore is not a good candidate for a method which works by blocking pleasure.

That would blow.

Really, the majority of people conditioned to drink are conditioned to seeking the pleasure. Yes, it is no longer under our conscious control, but the presence of conditioning doesn't mean the absence of the physiological euphoria which everyone feels upon consuming alcohol.

If you think that your addiction is 100% pain and 0% pleasure, consider that you may be fooling yourself.  There are a number of reasons to deny the inherent pleasure, chief among them being shame that we are (apparently) choosing this cheap temporary pleasure in the face of all reason and common sense.  It's okay.  You're conditioned; it's not a free choice any more.  Any shame attaching must be to the earlier decisions, not to last night's bender.  The thing to do now is to fix the problem.

Tuesday, June 17, 2014

Finding Support

Some have asked me where they can find support for doing the Sinclair Method.  I'm happy to talk with people, but I'm not available 100% of the time, and there are an awful lot of desperate people out there.

The best place to find mutual support is  It's a free message board. There are people from all over the world, so help is potentially available 24/7.  It's reasonably private -- you have to register to read, although of course nothing is truly private online and pseudonyms are always suggested.

Don't leave off the "the" at the beginning or you'll find yourself at the page of a Sinclair Method inpatient/outpatient clinic.

I've heard a couple of people say that they would like live support groups.  I doubt this will ever happen, because most people don't want or need it.  It's simple to do and it usually works in months rather than decades, so endless meetings are just not a part of it.  I suppose a really huge place like New York City might produce enough people who would like face to face meetings, but I've never heard of it happening.

Your best bet is to join the message board and find a few particular buddies.  If you struggle with the temptation of skipping nal, which is the main pitfall, some folks might share texting numbers with you.

I don't mean to discourage anyone from emailing me.  unchainedmouse at gmail dot com remains available to anyone who wants my help and support.  We're all in this life together, you know?  I just hate to be anyone's sole lifeline when I know that I won't always be available.

Wednesday, May 28, 2014

"That's not the real me"

We seem to have an idea of our "real" selves.  This real self is as pure as the driven snow.  Whenever we do something wrong, we insist that that isn't like us, it's not the sort of thing we do, it's not who we really are.

A flat-out narcissist may deny that the event happened at all.  "I am a good person; a good person would not do that; therefore I did not do that."  The logic is flawless, even if the premises are a bit skewed.  These people are not simply lying.  They have actually rewritten history in their minds so that the actions which don't flatter them never occurred.

Most of us will admit that the event happened and simply insist that it doesn't reflect our true inner character.  "Yes, I got a DUI, but I'm not really a drunk driver."   This lets us continue to believe that we have a real self which is good and kind and honest, and that bad decisions and actions were the result of other factors outside our control.  This is a large part of the appeal of the disease model.

To the sufficiently confused, the idea can go 'round and 'round forever.  "That was out of character for me, so something else must have made me do it.  That means I have a behavioral disease.  Since I have a behavioral disease, I sometimes do things which aren't my true self.  That means other bad actions (such as lying about how much I drink) can also be part of the behavioral disease."  And so we end up with an idiotic paradigm in which lying is a sign of the disease of alcoholism and the person doing all this stuff can still be a virtuous person.

I first noticed this after my second DUI, lo these many years ago, while confined in a 12-Step rehab center.  During one session they did a sort of reverse hotseat on me, pelting me with the idea that I wasn't a bad person (I kinda was) and didn't want to drink too much (I totally did) and wasn't the sort of person who would drive drunk.  Uh, wait a minute -- I did drive drunk.  If I did it, then it is something I would do.  It was an odd experience, struggling to take responsibility for my actions while a roomful of people insisted that I wasn't responsible for them.

"Wait a minute, Mouse.  Isn't having a defect of character part of the 12-Step model?"  Sort of, but most of them don't act like it.  The defect becomes another thing separate from the true self, the flawless -- but imaginary -- being who would never neglect the kids or waste the family's savings.  This is how "character defect" and "disease" get all mixed up.  Praying for the defects to be removed becomes rather like praying for a demon to be exorcised.  Legitimate religions acknowledge that the vast majority of our bad deeds are our own fault, and ask us to mend our ways.

Unless you are a hardcore exemplar of Narcissistic Personality Disorder, you have the ability to acknowledge that you are the sum of your actions.  There is only one you.  Your good and bad and neutral actions are all part of that one you.  There is no way to free the inner self who is 100% virtuous, because that self is imaginary.

Your mission, should you accept it, is to decrease the number of bad actions and increase the number of good ones in order to better yourself.  To "better" yourself -- to make yourself a better person.

Saturday, April 26, 2014

More on the De-Cured

Lately I've met a few of the de-cured, the folks who were once cured but then went back to alcohol.  Some have concluded that the Sinclair Method is overhyped and is not a good long-term solution.  It's true that, out of ten who start, only five will be cured at the three-year mark.

This may seem like a coin-flip, but consider how much better that is than with most other approaches.  Seven of ten are cured at one year, five of those seven are still cured at three years -- that's much, much better than most other things out there.  Yet it does mean that two out of our starting ten will be fully cured and then choose to go back to alcohol and re-develop addiction.

What does this mean?

For me, at least, it means that I should be careful about evangelizing too enthusiastically.  Even if we consider only cured people, we should be aware that about two in seven will walk back into the trap.  That's not a negligible number.

For me, this came up today when I read someone saying that, two years after quitting drinking (the AA way), he still had strong cravings for alcohol and still had to be careful to avoid triggers.  I would have liked to tell him and others that I know a better way, that I have no cravings and ignore things which once were triggers . . . but I thought better of it.

I've met too many de-cured people, and it's bothering me.

I've also met quite a few permanently cured people, of course.  More of them, in fact.  This highly successful method should be more widely known and practiced, absolutely.  But it should be presented realistically, without excessive hype about "88% cured" and "you'll be a happy social drinker."

I haven't fully sorted out my thoughts and feelings on this.  I know that the Sinclair Method works very well.  I also know that it's sometimes oversold.  Perhaps overselling is necessary in order to get it into the marketplace of ideas at all, but that's just not my nature.

I'm sure my ideas will continue to evolve.  I'll have a great game plan a year from now.  Right now, though, I've taken a step back from spreading the word.

Thursday, April 24, 2014

In the Realm of Hungry Ghosts, pt 5

Mate now delves into the neuroscience of addiction.  The opioid and dopamine systems are both vitally involved.  We TSM advocates know the role of the opioid system, but the dopamine aspects add new wrinkles.

The dopamine reward system is triggered by anticipation of the pleasurable act, or even by simply thinking about it.  We read earlier, in The Heart of Addiction, that relief from the pressure of addiction comes from the moment when we say "screw it" and decide to go ahead with it.  Mate is explaining the neuroscience of that bit of psychology.

This, I believe, explains why TSM often takes a while to work.  Although the opioid system is disrupted by the naltrexone, the dopamine system is still in place and giving us some satisfaction from the addiction.  It's about association, and we've spent a long time associating alcohol with the endorphin rush, thereby making alcohol into its own dopamine reward system.

An approach which disrupted both systems might make us all into those lucky three-pill cure folks.

Addicts are deficient in both opioid and dopamine receptors when compared to non-addicted people.  It's not totally clear whether this is the cause of or the result of addiction.  Of course, there's no reason why it couldn't be both -- some people are especially vulnerable, they fall prey, and the addiction seems to help while making the underlying neurological problem worse.  We often see a downward spiral in addiction.

Wednesday, April 23, 2014

In the Realm of Hungry Ghosts, pt 4

“It's hard to get enough of something that almost works.” Vincent Felitti MD as quoted by Gabor Mate.


What we really crave is the state of not craving.  We get that only momentarily, while we're in the act of indulging the craving.  Many of us find that there's no such thing as "enough" of whatever we crave, at least not all of the time.  Many of us also find that even giving in to the craving doesn't work completely.  Even while in the act of indulging, we want more because it only almost worked.

It's good, very good indeed, that we have the Sinclair Method to squelch that craving.

Mate talks here about his own problem with compulsively purchasing music.  Some of the Amazon reviews scorned him for seeing parallels between this and drug addiction, but it sure sounds to me like the guy has a problem.  If he blew thousands at the racetrack instead of the record store, would we still accuse him of self-important whining?

Mate attends an AA meeting, and climbs on board with the notion that "sobriety" is an inner state rather than simply the condition of not being drunk.  The 12-Step programs have rather hijacked this term.  Aren't they now using this to mean what they used to call "serenity"?  Or is "serenity" a higher state along the same path?  Perhaps a Stepper reading this will explain how these terms are used in modern AA.  Regardless, Mate seemed to find something of value in AA, and states that he plans to attend more open meetings.

Mate believes that addiction is a whole-life condition with many parts -- biological, mental, emotional, social, spiritual, and a dozen others.  He deliberately avoids the "disease" term because it simplifies something complex.

He's probably right.  Addiction isn't measles.

The Sinclair Method terminology says that we'll be "cured" of alcoholism and that we've reached this cure when the alcohol-seeking behavior is completely extinguished.  Many of us don't like that term and don't find it accurate.  We will never be people with no history of addiction.  Alcohol will always be in our minds, somewhere, as an option.

Sunday, April 20, 2014

In the Realm of Hungry Ghosts, pt 3

Mate finishes the first section by talking about how some of his clients feels a void he describes as spiritual, while others have a deep and aching sense of isolation.  For some, the community of heavy drug users is the only place they have ever known a sense of community.  For Mate these two drives are not unrelated, since he believes that each of us have a spark of the divine struggling to connect with the spark of the divine in others.  This doesn't necessarily have to be a literal piece of holy spirit, although it might be.  Depending on the person's own paradigm, the desire for connection could be a desire for God or for community or for any number of other things.

We've begun to see a few stories in which the people had what looked from the outside to be decent lives, until addiction brought them low.

This is good stuff, although much more philosophical than some would prefer.  It speaks to me.

Friday, April 18, 2014

In the Realm of Hungry Ghosts, pt 2

Mate tells more of his pointed and poignant tales.  I was particularly struck by the tale of Celia and Rick -- Celia actively addicted, Rick white-knuckle abstinent -- and their determination to have and love their child.  If life worked the way it should, they would have overcome their demons and showered the baby with love.  In this life, the baby was placed in a foster home and the parents were left to mourn the child and their failure.

We've already seen the horrible childhoods of many addicts.  Now we're seeing the other side.  Celia and Rick had the best of intentions, but could not control their addictions (that's what addiction means, after all), and created a bad environment in spite of good intentions.    Vows to change just aren't enough.

This story was so deeply sad that I stopped reading early.  I think I'll get to more linkage soon, though, since Mate has already mentioned that he sees lesser versions of these dreadful patterns in his own life.

Thursday, April 17, 2014

In the Realm of Hungry Ghosts, pt 1

I just started reading this, and I'll take you through it with me as I did with The Heart of Addiction.  Again, I'm reading in small chunks to digest it more thoroughly.

The author uses an unusual organizational style.  Each chapter's point is summarized by delving into one real-life story.

The opening stories are those of some truly unhappy people, the "junkies" who live on the streets or in government housing.  Their lives often began, and then continued, with some truly horrific abuse.  This isn't "my mother belittled me."  This is "my mother shut me in the dryer for hours at a time."

No one with an ounce of compassion would deny that these stories are horrible.  Mate's gift, such as it is, is in linking those wounded people to the addicts they currently are.  It's easy to understand their unbearable inner state, their endless, bottomless, need for something to dull the pain and make them happy.

These people aren't the so-called functional addicts, and so probably aren't the ones who buy and read these books.  I expect he'll get to that later.  Amazon reviews indicated that Mate was able to make the leap needed to tie these more dramatic tales in with the more common compulsions hidden among the functional addicts.

It's quickly apparent that he rejects the falsified "disease" hypothesis.  Indeed, "rejects" isn't quite the right word since he never brings it up -- it's quite cheering, really, to see that a dumb idea which has been mucking things up since the late 70's is finally going into the dustbin of history.  People are seeing less and less need to pretend that behavior can be a disease.  We'll gradually revise the taxonomy to be more accurate, and some day addictions won't be treated differently from other compulsions (and none of them will be "diseases").

Anyway, back to the book.

Aside from talking about early experiences which left addicts as vulnerable people, he talks about the role drugs play in their lives.  They may, for example, make isolation bearable or make it easier to overcome.  For one woman, drugs were the only thing she shared with her mother.

It's sad reading.

Monday, April 14, 2014

Unchained Mouse on the Radio

I've been invited to talk about the Sinclair Method on an hour-long radio show, broadcast in the Boston area and podcast elsewhere.  It's not until July, but I'm already thinking of what ducks I want to get in a row.

  1. It's not instant.  It's a process, not a miracle pill.
  2. Drinking alcohol is not just "allowed," it's vital to unlearning.
  3. It's not a 100% surefire cure -- just much better than almost all others.

Any thoughts on what else I should be sure to include?

I'll post you on the time and URL as it draws nigher.

Thursday, April 10, 2014

"The first TSM clinic" isn't the first

Recently, the C3 Foundation claimed that Claudia Christian had opened "the first TSM clinic" in California.

It is really, really easy to learn that that is not the first TSM clinic.

In fact, it's so stupefyingly easy to learn this that I can't help wonder why anyone would say otherwise.  I mentioned this to the new owner of Naltrexone Confidential, and she replied that she thought the other clinics were about making money instead of helping people.

The new clinic isn't significantly cheaper.  It's $3500 for the typical five months of outpatient, vs. $3800 for the best-known clinic.  What's different about this that would justify billing it as "the first"?

EDIT:  the page has been edited to the narrower statement that it's the first clinic "sponsored and approved by Dr. Sinclair himself."  That's more accurate.

In other news, the C3 Foundation is also endorsing a particular online pharmacy in exchange for a cut of that pharmacy's profits, and is even selling gewgaws like an official C3 pillfob.

I guess there's no real harm to it, and it may increase public awareness.  Heck, if Jenny McCarthy can convince people that vaccines are bad, maybe Claudia Christian can convince people of something that's actually supported by medical literature.

Something about all this leaves a bad taste in my mouth, though.

Wednesday, April 9, 2014

The Heart of Addiction, part 3

Well, I've finished The Heart of Addiction and am now reading Breaking Addiction by the same author.  You may not need both; a lot of the information is the same, but the first is more informative and the second more practical.

The gist is that addiction is a result of displaced helplessness over some issue which is very important to us.  This could date back to childhood, but doesn't have to -- adults can also have powerful experiences.  When we first have thoughts of drinking (or whatever), that's the time to look at what's going on with us.  When we get to the "fuck it" point where we decide to drink, we're doing something even though it's not the right thing.

The Sinclair Method broke my addiction to alcohol, but I still have a propensity to addictive behavior.  Exploring this may keep me from being one of the 20% who are cured at the one-year mark but readdicted at the three-year mark.

For those keeping score at home, I'll go over the breakdown again:

10% not helped by the method at all
20% ditch the method or do it so improperly that it doesn't have its effect
20% are cured at the one-year mark but choose to return to the addiction
50% are cured at the three-year mark

I want to be in that 50%.  I want to be aware of thoughts of drinking without naltrexone and deal with them instead of giving into them.  At this point it seems impossible that I would ever drink without naltrexone again -- why on Earth would I want to do that? -- and yet a fair number of people do exactly that.

I want to be prepared in advance for that "fuck it" moment which leads people to drink off of naltrexone.

Wednesday, April 2, 2014

The Heart of Addiction, part 2

This is a bit rambly.  Perhaps I'll edit it into better shape later, but I wanted to get my thoughts out there while they're fresh.

As I mentioned in part one, HoA's first good point is that the relief begins when we decide to drink, not only at the first drink.  That's not relief from withdrawal.  It's also not the innate euphoria, of course -- everyone feels that, most don't become addicted, and we addicts felt something much, much stronger.  It's more than that.  HoA says that it's a "fuck it" to our problems and a decisions to do something.  It could also relate to giving up the struggle against the Deprivation Effect.

HoA suggests using the urge to drink (or whatever) as a signal to deploy another strategy instead.  One example was an overworked guy who felt the "fuck it" and did ignore his work, but went for a run instead of drinking.  That worked for him because he liked running.  HoA didn't go into this, but presumably that wouldn't work for someone who saw running as an obligation (e.g., "I need to lose weight and exercise more").  Another was a woman who didn't exactly do something for herself but did dodge a request -- her "fuck it" response to a last-minute dinner party order was to order Chinese takeout instead of cooking a fancy meal, and this allowed her not to take Percodan.

Three common threads are rage, shame, and helplessness.  Helplessness is probably the easiest to pin down.  The overworked guy felt helpless to keep the work from piling on.  His addictive response was to "fuck it" and ignore the work in order to drink.  I feel for him.  Drinking is great for that; nobody can expect us to work while drunk, and it's certainly a big F-U to the expectations.  The overworked wife felt helpless in the face of the high expectations of husband, children, and mother.  She wasn't truly helpless, and in fact solved her problem fairly neatly once she was able to do so.  One wonders about the overworked man who bailed entirely by going for a run -- did his necessary work ever get done?  If not, what happened?

I've paused reading to integrate this book's paradigm with my own thoughts, so I don't yet know how the author will incorporate old struggles, but I can't help observing that "helplessness" is a definite characteristic of anything in the past.  None of us can change the past.  Even if we had full control at the time, we can't go back and change it now . . . and yet, even knowing that, I find myself realizing that the most damaging situations were ones in which I was helpless at the time.  I've made some bad choices and regretted some bad decisions, but none of them trigger the same helpless fury as being victimized does.

This, in its turn, leads me to wonder what to do with these old hurts.  Since we can't change the past, we can't react differently to them.

I expect the book will get to this.  The author has begun talking about a man whose need to be a "winner" (leading to gambling) ties back to being ignored in a crowd of children.

HoA doesn't focus on compulsion.  One of its main points is that addiction can transfer from one object to another -- from pot to alcohol to gambling, new addiction targets popping up as old ones are shed.  This is certainly true for many things.  One thing HoA hasn't really addressed, at least not yet, is how we condition ourselves to one particular addiction.  If my alcohol addiction were still present, a night at a casino could not just be swapped right in.  We target one thing and focus on it, getting conditioned just as the lab rats do.

However, one thing TSM never addresses is how we get addicted in the first place.  Eskapa's book handwaves it as "a disease" and gets right to the conditioning process, never exploring why some people condition themselves and others do not.

Neither TSM nor HoA models addiction as primarily a pleasure-seeking behavior.

TSM tries to eliminate shame by treating it solely as a behavioral process.  HoA accepts the shame issue but treats it more gently, saying that we're all pretty screwed up and that addicts simply have a more obvious and socially-disapproved coping mechanism.

This ties in indirectly to my own musings that we now disapprove of behavior which was once normal.  Five drinks is a binge; it used to be a dinner party.  More direly -- a weekend bender was once a fun spree of irresponsibility for a young man or a sign of great stress in a mature man; now it's a sure sign of alcoholism.  In looking for early warning signs of problem behaviors, we've problemized behaviors which were once within the range of normal.

Are today's open acknowledgements of drunkenness (e.g., "the best part of waking up is vodka in your cup," a shower-mountable wine glass holder) a swing away from this?  Or are they just silly attempts to be edgy?

Again, HoA says that we all have psychological defects and flawed strategies -- the strategy of the addictive behavior is just a little splashier, making it more noticeable.  It's not inherently worse, nor is it a sign of a weaker person.

The Heart of Addiction, part 1

For more than a few people, breaking the active addiction is all that's needed.  The original creator of Naltrexone Confidential is a great example of this.  Whatever originally led to the addiction, at this point the addiction itself is all that's wrong.  Breaking that single, powerful chain is all that's required to be content and satisfied.

For others, the things which led us into addiction are still in place once that horrible chain is snapped.  Some find that the addiction simply moves to a different focus -- for example, an alcoholic who becomes a non-alcoholic may one day realize that he is gambling to excess.

I'm currently reading The Heart of Addiction.  Although I regard myself as cured in TSM terms, I've noticed some displacement of addictive behavior to a different focus (junk food in my case), and I also just like reading about different paradigms.  I'm a curious gal.

I haven't finished the book, but one of the things that struck me quickly was the author's (correct) observation that the pressure eases as soon as we decide to engage in the addiction, not when we actually begin.  In my case, e.g., there was no alcohol in the house and I had a bad craving, and the craving eased once I'd made the decision to head to the convenience store.  I didn't actually have to have beer in hand and bottle top off.

This doesn't contradict TSM.  Once I had made the decision to drink, I was no longer struggling against the Alcohol Deprivation Effect.  We all know that physiological addiction is the least of it, so in a very real sense I was engaging in the addiction as soon as I had decided to do so.

This guy has a somewhat different theoretical model, though -- he thinks the real relief comes from the "fuck it" decision because it's an expression of power.  In his view, the addiction is a sort of ill-advised compromise between what we really want to do but can't (e.g., punch the boss) and doing nothing at all.

This reminds me of the "life process" theory of ending addiction.  Most people emerge from addictions quite naturally, over time (unless of course we shove them into AA to learn powerlessness and the rest).  And it's the young who so often have little real power, isn't it?  Even when they are legally adults, they're often stuck in the role of a helpless child -- they may be financially dependent on their parents, socially treated as a child . . . in fact, typing this sentence reminded me how my family treated me when I was newly fledged, and bam -- rage.

I think he may be on to something here.  Being stuck in bad situations we can't change may lead us to lash out, and addiction may be one way of lashing out.  It's that "fuck it" decision which, in this paradigm, is vital.  The addiction is not a good choice as a coping mechanism, but it is a coping mechanism.  It keeps us from curling into a whimpering ball of helplessness.

I haven't finished the book.  I'll probably keep writing up observations on my blog.

Wednesday, March 12, 2014

It's Too Easy

Well, it's been a while since I posted.  Am I running out of things to say?  No, not exactly.  I've just had my attention on other things.  It's amazing how quickly our attention turns to our real lives when we're recovered instead of just "in recovery."

Still, I continue to think about some things.  I read the forum and Naltrexone Confidential.  I recently noticed a post on NC which lists nine steps to success.

None of these ideas are bad ideas, but it's really not as complicated as that makes it sound.  It's dead simple, in fact.  You don't have to buy the book.  You don't need a fob on your keychain.  You don't have to go jogging on days when you don't drink.  You're certainly free to do any or all of those things, but it isn't necessary.

The only thing you must do to succeed is to take a large-enough dose of naltrexone or nalmefene one hour before drinking alcohol.  That's it.  That's the extent of the grand plan.

The drink diary is useful for some people, so that they can see the numbers dropping even if their progress is relatively slow.  For others, it's a hassle which puts far too much emphasis on alcohol.  It's probably a good idea to note your pre-TSM consumption and to check in with the numbers occasionally, but you don't necessarily have to write in a drink diary every day.

These extraneous steps may be useful in that they raise the barrier to entry.  People who just drink too much, who aren't really addicted, may be turned off by the work which seems required.  That's probably a good thing, but why are these people coming to TSM in the first place?

I think the answer is the "You can still drink!" line.  People get the impression, largely from the book, that naltrexone is a "normality pill" and that they will become normal, non-addicted drinkers.  Because it is so very easy to take a pill before drinking, lots of people try TSM who aren't really good candidates for it.  When they realize that they won't get a buzz any more, they eliminate the buzz blocker.

Essentially, it's too easy.  People who don't need it try it, and they bail out because it's working too well.

Friday, February 28, 2014

Disease vs. Choice -- Neither Is Correct

I was recently struck by part of this entry at Naltrexone Confidential:

I’m talking specifically about the determinism vs. free will argument here -  or, to simplify it,  the “disease vs. choice debate” and The Sinclair Method’s place in it… hence why I’ve found myself being harangued by a number of different individuals about how I shouldn’t be “advocating pills” because alcoholism is just “a choice” and blah, blah, blah.

Yeah.  Some of the "it's a choice" folks are almost as militant as the Steppers.

I can see where they're coming from.  Addiction isn't a disease.  Nobody is literally born an addict.  Some people think they were because they fastened on to alcohol immediately after discovering it, but that's not the same thing.  The only way to develop an addiction is through practice.  Even thought I sought alcohol with great determination almost as soon as I discovered it, that was an immature way of coping with pain rather than a true addiction.  The true addiction came later, gradually, as I trained myself into alcohol-seeking behavior.

If addiction isn't a disease, then what is it?  Some conclude that it must be a choice.  Addicts must be choosing their addiction out of a misguided belief that it's their best option for happiness at that time.  This fits some people's experience in that they either matured out of their addictions or stopped through willpower, but (again) it's not the whole story.  I admire people who decide to ditch an addiction and plow through the cravings and deprivation effect by sheer willpower, but that doesn't mean everyone can do it.  For people whose addictions have progressed far enough, changed lives and determination are often not enough.

Put simply, addiction is conditioned behavior.  We humans are different from rats in many ways, but some things are universal, and that's one of them.  Once we're conditioned to drink heavily on a regular basis, we'll keep doing it until something changes.

That something may be as simple as a realization that this life sucks and we'll do whatever's needed to change it.  For most of us, it isn't.

You know how 6% of ex-smokers quit cold turkey and never go back?  You know how the other 94% point out that they're lucky jerks, and the 6% keep insisting that anyone can do it since they did it themselves?  It's sort of like that.  Anyone who passes through youthful smoking and becomes a "real" smoker is likely to have great difficulty quitting.  That doesn't mean that smoking is a disease, but it sure as heck isn't a simple preference, or even a considered choice for personal happiness.

Alcohol addiction is similar in some ways.  No, it's not a disease.  Yes, it's possible to quit just by knocking it off.  That doesn't mean that everyone will be able to do it.  Many won't.

For those people, the thoroughly conditioned who can't just knock it off because they've decided they want a better life, deconditioning is a rather obvious approach which is too often overlooked.

Wednesday, February 19, 2014

Why We Drank: Old Wounds

While doing more thinking about the roots of addiction, I naturally did some research as well.  One of the factors most commonly discussed is unresolved childhood issues.  Certainly there's a strong correlation between abusive childhoods and addiction; that much is well established.  However, there's no really good therapy for resolving unresolved issues from childhood and adolescence.  Some say one thing helped and some say another thing helped, but those people are usually reporting from a time immediately after the therapy.  There's a noticeable shortage of people saying that they used a given therapy ten years ago and have been more content ever since.

I do believe that some of us are wired differently from others in this respect.  Some people seem to recover naturally, and they often don't understand those of us who don't.  They offer advice like "let it go" and "the past is past" without understanding that it just doesn't work that way for some.  It doesn't "go" despite our active attempts to drive it away, and our lives are not the past.

So -- we are all of our ages at once?  That reminds me of the paradigm of the inner child.

While reading about these therapies, I noticed that many of them are about loving our inner child.  We imagine cuddling our infant selves, whispering how we're so glad they're here and how we accept and love them exactly as they are, that they are unique and special and irreplaceable.

I tried this a couple of times, and found it to be just as silly and pointless as it sounded.  I can't help thinking that taking this seriously sounds like a recipe for narcissism.

"Expects to be recognized as superior and special, without superior accomplishments."
"Expects constant attention, admiration and positive reinforcement from others."

Hmm.  Narcissism is a popular diagnosis these days.  Maybe it's just the latest diagnostic fad, but is it possible that the massive self-acceptance and self-praise which became popular in the mid-80s led to an actual increase in narcissism?  I think it might be.

I was one of many who were struck by an article pointing out that our accomplishments are much more important than simply existing.  Slapping on generically positive labels like "nice" doesn't actually make us better people.

Reading the comments on that article is time-consuming but instructive.  Those who took it to heart in 2012 found themselves with better and happier lives in 2013.  Those who disagreed with it . . . no news.  Not a single person reported that self-esteem enhancement, sans accomplishment, resulted in a better life.

This is really just common sense.  We all know, in our heart of hearts, that chanting "I am unique and special" a thousand times has less impact than one single other person saying, "Wow, you are really something special."  So how do we get them to say it?  It's pointless to expect to be "recognized as superior and special, without superior accomplishments" a la narcissism.  We have to do something which merits hearing it.

Your father shamed you, your mother belittled you, your schoolmates bullied you.  So did mine.  I'm not going to tell you to "let it go," because we both know that doesn't work.  I am going to tell you that I, at least, feel a stronger sense of self-worth when I'm doing something to increase my worth than when I offer imaginary comfort to my wounded past self.  Increasing my fluency in Spanish is better therapy than trying to convince myself that I am lovable no matter what.

Tuesday, February 18, 2014

"How Are You Doing? Want to Talk?"

Some people don't like the "cured" term.  They'd rather use "in remission," or use a non-disease paradigm and go with "problem solved" or such.  There are a lot of good arguments against "cured," but I have to call this state something, so I'll go with the c-word for now.

Many, many people don't understand what it means to be cured of an addiction.  Perhaps they're used to the more dramatic paradigm of struggling with inner demons every day, and have trouble believing that those demons can simply be cured.  Perhaps they've heard too much 12-Step stuff and are used to people being endlessly "in recovery" and never recovered.  Perhaps they can't understand how a cure could exist without quickly becoming famous, or don't see how alcohol could be such a big part of our lives and then rather suddenly become unimportant.

One of these people, no doubt meaning well, may ask you if you want to talk about it.  How are you doing?  How's the recovery?  How are you managing a post-addiction life?  "Fine, done, and fine" is true, but doesn't seem to satisfy them.  Explaining that you're truly cured and are no longer an addict may lead to a lot of fireworks if the person is accustomed to the model of endless one-day-at-a-time recovery, but may be the best way to go for the long term. The truth of your words will become evident as you keep living your life.

We cured folks generally just want to get on with our lives, not waste time wallowing in the past.  I personally have to remind myself to come back to this blog -- I have other things I'd rather be doing.  We should realize that this isn't how most people think of addiction, though.  They've been trained to think that people must be "in a program" (as they say on TV) and fighting a bartending inner demon.  It's worthwhile to take a few minutes to explain that the addiction is completely over and that there's really, truly nothing to discuss.

Friday, February 14, 2014

Alcohol Shovelers

I've had the misfortune of knowing multiple people whom I think of as "food pushers" or "food shovelers."  These are folks who want other people to eat more and more and more.

They're not to be confused with people who inadvertently push food once in a while.  I think some of those are honestly ignorant about varieties of normal food consumption.  Consider a man on a date who's surprised that she "didn't eat very much" when in fact she ate a perfectly normal amount of food for a woman, or someone who offers a huge spread for lunch because her family ate dinner at noon, or a cultural difference where one person feels required to offer as long as the other accepts (while the other feels required to accept whatever the other offers, leading to mutual misery).  The common thread is that at least one party truly doesn't know the norms of the other, so that they can differ without either being wrong.

Honest ignorance of others' norms will clear up with time, but some people never seem to get it cleared up.  Indeed, some people plainly just don't care.  I believe these people have some sort of problem.

They monitor you at dinner gatherings, demanding that you eat double helpings of every dish.  When you have finished eating, they bellow repeated offers to hand you more food, any food, as long as you eat more.  If you decline a second brownie they will offer it six more times, then ignore all your refusals to hand you the brownie plate with a knowing smile.  They may even scoop food directly onto your plate, ignoring the fact that this is a gross violation of personal space.  They aren't necessarily prodigious eaters themselves, but they are bound and determined that their target will consume huge quantities of food.

They drive me nuts.

I've long wondered about people who worry about how to explain that they no longer drink or no longer drink heavily.  Why do they think that others will even notice?  Don't they know how to decline?  Why don't they just say that they're fine, thanks, and get on with the business at hand?  Don't they know the common convention of saying that they're "fine" or "okay" to indicate that no further offers are needed?

As I've heard more stories from people using the Sinclair Method, I've come to understand that there really are people out there who closely monitor other people's alcohol consumption and press them -- sometimes quite hard -- to overdrink.  I don't know if these people are alcohol addicts seeking company or are in the grip of some very strange notions about hosting or are just crazy.  Alcohol shoveling makes no more sense to me than does food shoveling, but apparently it exists.

How to handle it?  I know of no way to get these people to stop; the best we can do is to just manage the situation without being forced into overconsumption by them.  Essentially, this means declining all verbal offers and ignoring forced food/drink completely.  If someone offers you a beer twelve times, you decline twelve times.  If he then holds a glass of beer out to you, you ignore the proffered glass and speak of something else.  If he grabs your water cup, dumps out the water, and fills the cup with beer, you ignore the beer and get yourself a new cup of water.

There is no point in trying to reform these people.  If you decline three times and then refuse to decline a fourth because the shoveler is being rude, your silence will be taken as consent and you'll end up with item X.  If you give a reason, even an inarguable one like "I'm full," they will find a way to argue.  Even if you get completely fed up and dump the unwanted item into the sink while repeating that you don't want it, they'll just hand you another portion along with some absurd reason why you should consume it.

These people are infuriating, but fortunately they're not very common.  Most civilized human beings will accept "no, thanks" as answer either upon first hearing or after you've assured them that "I'm fine, thanks."  The shovelers are . . . odd.

Even if you're facing a contingent of several of them, so that they seem to normalize each other, remember -- they're the ones with the problem, not you.  You're not weird or rude for declining.  They're weird and rude for insisting so forcefully.

Wednesday, February 5, 2014

Stepping Is Harmful

Whenever effective new therapies for alcohol addiction are developed, they're presented with an odd timidity.  Most writeups begin by saying that they have absolutely nothing against AA, they know many people recovering in AA, it's a wonderful program which has saved millions of lives, etc.  Even The Cure For Alcoholism, written specifically to tell more people about an actual medical therapy that actually works, opens with the traditional kowtow to AA.

AA is not a wonderful program, and it has not saved millions of lives.  AA itself claims to have about two million members worldwide.  Even if zero of those people were coerced (unlikely) and even if every one of them were abstinent (ha!), we still could not say that "AA has saved millions of lives" because the great majority would not die if they left AA.  It did not save their lives.  They may say it did, and may even believe it did since they are threatened with "jails, institutions, or death" if they leave, but in fact it is one of the least successful recovery methods.

AA is actually harmful.  Every time its success rate has been examined by an objective party, it has proved to be no better than the natural history -- that is, the number of people who become abstinent in AA is the same as the number who become abstinent with no therapy or formal action at all.

But at least it doesn't hurt, right?

Well, actually, it does.  People exposed to AA are more likely to binge-drink.  Not only are AA members nine times more likely to binge-drink than people who receive real therapy, they're five times more likely to binge-drink than a control group who receives no intervention at all  (Outpatient Treatment of Alcoholism, by Jeffrey Brandsma, Maxie Maultsby, and Richard J. Welsh. University Park Press, Baltimore, MD., page 105).

AA causes binge-drinking, and it's binges which generally lead to arrests, DUI accidents, accidental deaths, and the other worst consequences of heavy drinking.

How does AA do so much damage?

The biggest problem is its insistence that we are, in AA's words, "powerless over alcohol."  People feeling the strong compulsion of conditioning may actually believe this.  Even those who know it's nonsense intellectually will be subconsciously affected after hearing it repeated daily for years -- that's just how humans are made.

And now for the big question:  Why am I talking about AA's bait-and-switch failure on a blog focused on the Sinclair Method?

It's because I recently encountered a sad case of someone trying to combine AA and TSM.  The poor guy has been taught that alcohol is too much for him to manage, and even though the conditioning is now broken, he continues to drink too much.

He is not one of the 10% who are not helped by the method.  He's drinking much less than the truly prodigious quantities he used to consume, which would not be true if he were one of the unfortunate 10%.  Yet he says, "I'm pretty sure that I am powerless over alcohol," even though his own direct experience contradicts that assertion.  He's back in the driver's seat, but continues to drive his life where AA told him he inevitably must.

If you've had Step experience that lasted for any length of time, you may need to get 12-Step dogma out of your head before you can accept your own cure.  You are not a helpless person who needs a miracle from a Higher Power.  You're simply a conditioned individual who can break the conditioning and resume life.

Sunday, February 2, 2014

Yes, You Must Drink Alcohol

Some people don't seem to quite get the gist of pharmacological extinction.  If taking naltrexone before drinking is good, taking naltrexone as often as possible must be even better, right?  If naltrexone is an anti-addiction drug, we should take it as often as possible, right?

No, actually.  Taking naltrexone daily is better than nothing -- it was originally marketed as an anti-craving drug, and it's not completely useless in that respect -- but it's most effective when taken an hour before drinking alcohol.

Imagine a rat who has learned to press a lever to get peanut butter.  His life in a cage is pretty boring, so he presses the lever all day long.  At some point he will be thoroughly conditioned to press the lever, and will keep pressing it even if moved to a better environment with lots of climbing and rat toys and such.  He's addicted.

The rat will keep seeking that lever, because he's addicted to it.  He can unlearn the addiction, but the lever must be available for him to do that.  If he presses the lever and nothing happens, he'll gradually turn his attention to other things.  

That lever must be there, though.  If the lever is simply removed then he may do other things, but he'll be back pushing that lever as soon as the lever is reintroduced.

He can't unlearn his addiction to the lever without pressing the lever futilely.  The lever -- in our case, the alcohol -- must be present in order for him to learn that the lever no longer produces peanut butter.

If he presses the lever without getting peanut butter, his addiction will be extinguished over time.  If he doesn't have the lever at all, the addiction will simply lie dormant.

Thursday, January 30, 2014


I have the flu, so haven't blogged for a few days and probably won't for another few days.  I'll see you all when I'm healthy again.

Friday, January 24, 2014

Why Did We Drink?

We started drinking for a reason.  We, all of us, addicted or not, drink to get the endorphin rush.  It's happiness on tap.

Something in our pasts or our presents made us chronically unhappy.  We drank too much, and rewired ourselves into addicts.  At that point the addiction itself became our main problem, but once we extinguish the addiction, we're back where we started.

For a lucky few, our lives actually improved in other respects during our drinking years.  If we drank to deal with a temporary source of unhappiness, and that source is now gone, we're golden.

The rest of us have some work to do.  If we don't address those original causes, we're likely to swap in some other source of temporary happiness.

I don't have any sage advice.  If I knew how to get over trauma and be content, I probably would never have become addicted and you wouldn't be reading this now.

With less time lost to drinking, there's more time available for solving problems.  Finding the solutions can be the tricky part.

I suppose a good first step would be to identify the issues.

Tuesday, January 21, 2014

Filling the Post-Alcohol Void

For many of us, alcohol was at the center of our lives.  When we remove it, there's a huge, sucking void where it used to be.  Even for those of us who still had family or work at the center, alcohol was important and the hole will cry out for something to fill it.

I believe this is how some people get mired in endless "recovery."  The meetings and reading and home exercises -- and, in AA, the additional practices of working Steps and carrying the message -- take time, and these new practices can work their way into the hole which was once filled by alcohol.

When we extinguish the addiction, though, we have nothing to fill the hole.  The addiction is gone, but it wasn't replaced with so-called recovery work.  So now what?

Exercise is the obvious choice.  It releases endorphins, improves our health, and makes most of us happier about ourselves.  Unfortunately, it doesn't take up that much time.  By all means start exercising, but think about how else you want to fill that time.

Going on a self-improvement binge may not be wise.  Research shows that we only have a certain amount of willpower, and we're using some of it to form that new exercise habit.  Some research contradicts this, suggesting that it's really our own belief in limited willpower which causes the willpower exhaustion effect, but since most of us do hold that belief we may as well treat it as true for our purposes right now.

If you have a family and you were previously neglecting them, family can fill that void beautifully.  If you were neglecting your job and you have a career-style job, work can also be a good core for life.

If you have neither a family nor an interesting job, or if you were handling both of those things despite your addiction, you've got a void where the addiction used to be.

How are you filling that void?  If the answer is "eating junk food" or "watching TV" or "screwing around on Facebook," you might want to think about that.  Whatever you put into that void early on is likely to get firmly ensconced there.

So, no self-improvement binges and no useless screwing around?  Where am I going with this exactly?

It depends on the individual, really.  Maybe we can start by bettering the things which are our first instincts.  The man who munches junk food to fill time might learn better cooking skills and even take a class.  The woman staring at daytime television might record and watch better shows with active fandoms.  The kid who spends all day on Facebook might find a less inane forum and converse on subjects of real interest.

Most of us want our time to be filled with things we regard as admirable.  In the early days, though, I think the most important thing is not to fill it with garbage.

Thursday, January 16, 2014

Competition vs. cooperation

Well, today we're all talking about an article in Slate.  You can skip the comments in that one, BTW.  It's just a bunch of "AA sux!!! / AA rulez!!!"

We're talking about it because it mentions the Sinclair Method as "a slightly more radical approach" to medication-assisted addiction therapy.  The writer sums it up thusly:  it "encourages patients on naltrexone to continue normal social drinking. The idea is that the alcoholic will become deconditioned to the formerly pleasurable effects of drinking."

This is not a terrible summary, given that the writer had only a few lines to work with.  The trouble is that the writer then proceeds to ignore the targeted-naltrexone method and to talk only about daily naltrexone therapy (daily dose) and how well that translates to traditional goals (days of abstinence).  When success is measured that way, naltrexone is indeed only "sort of" effective.  There's no way for the casual reader to realize that the patients who "achieved" fewer days of abstinence may have actually made more progress in getting rid of their addictions.  

It's often said that alcohol is a problem if it causes problems.  If that's the case, wouldn't it make more sense to measure efficacy by looking for a decrease in alcohol-related problems?  Which group had fewer legal troubles, fewer missed work days, fewer spousal complaints?

Wouldn't the Slate writer be surprised to learn that the nonabstinent naltrexone users improved most of all?  Certainly a great number of the readers would be.  That's precisely what the research shows, and yet it isn't communicated.

No sensible person could disagree with the article's final conclusion, though:
Today, the most vocal critics on either side of the debate are stuck in the bad old days, when medical treatments were untested and mutual-help groups demanded immunity from evidence. The prescription is now collaboration, not confrontation.

I do this in my own little way.  I sometimes attend LifeRing meetings -- I find them useful in learning how to couple with my troubles and my past, now that I'm no longer addicted.  I'm always fully honest about having used the Sinclair Method, despite LifeRing's official abstinence-only policy.  Their information on how to live without alcohol is useful to me, and my information on how to extinguish addiction is useful to them.

Sure, there are hidebound folks who just can't wrap their heads around it.  There are also people, especially online, who'd rather argue than move forward.  The rest of us, though, can progress further when we cooperate.

Even AA says that "someday there may be a cure."  If the entrenched establishment insists that someday cannot have come, they will be replaced in their turn by others who've grown up seeing the impressive results from fresh approaches.

We must keep Steps-only people from continuing to dominate, since thousands of people would die before they gave up control voluntarily, but we should remember that some of them are Steps-only through honest ignorance rather than conscious control-freaking.  The truth speaks for itself, and it's often better demonstrated than argued.

Are De-Cured People TSM Failures?

Question:  What do we conclude about TSM when someone says he/she was cured by TSM but is then observed to be drunk?

Answer:  Nothing at all.

We know that pharmacological extinction with naltrexone doesn't cure everyone.  There are 10% whose addiction works by some means other than opioid receptors and 20% who don't follow the protocol to a cure.  Such people don't usually claim to be cured, though, so that's not what we're talking about here.

There are also people who do completely extinguish the addiction but later drink without naltrexone and relearn the addiction.  There's no easy way to count that number, but we know they exist.  There are no statistics, but there are enough reliable anecdotes that we know there must be some.

There are also plenty of former AA members drinking away, either after leaving AA or in secret.  The existence of some such people, in unknown numbers, shouldn't lead us to conclude anything about TSM or about AA.

We should all realize that it's much, much easier to relearn a once-learned behavior than it was to learn it in the first place.  The "cured" term can be misleading.  Some people think that they took care of the problem and are now able to drink without an opioid blocker, that they are like other people.

Intuition tells me that people who became addicted during adulthood (that is, who didn't drink addictively from the beginning) may be more prone to this error, because they will want to be the way they used to be.  They don't enjoy drinking on naltrexone, they once enjoyed drinking without problems, they have cured the addiction which was causing problems, so why not go back to old habits?

It may be a tempting line of thought, but it's not sound.  Once the opioid reinforcement reappears, the addiction will probably reappear as well.  Obvious though it may seem when considered dispassionately, there are those who do slide back into addiction this way.

This is not the fault of behavioral conditioning.  Behavioral conditioning is just a thing; it can't be at fault or not at fault.  Becoming addicted again is entirely the responsibility of the person who chose to take that risk.

Were these people ever cured?  Yes, if at one point the behavior was completely extinguished.  That's not a failure of the Sinclair Method.  That's a bad decision on the part of the cured person.  Being cured puts us back in control, but it doesn't rescue us if we make bad decisions.  If we use our control to put ourselves back in a position to lose control, that's entirely on us.

Back to our original question . . . .

Question:  What do we conclude about TSM when someone says he/she was cured by TSM but is then observed to be drunk?
Answer:  Nothing at all.

Anyone, lifelong normal drinker or cured TSM graduate, may drink too much on a particular occasion.  If a TSM graduate is observed to be drunk often, or in an inappropriate situation such as at work, then that person is probably no longer cured . . . but that doesn't mean the person was never cured in the first place.  It simply means that that person has made bad choices which led back to addiction.

Saturday, January 11, 2014

Alcohol, Naltrexone, and Pleasure

Some people say there is zero pleasure in addiction.  Is puking fun?  Are hangovers fun?  Is a spouse's fury fun?  Is waking up on the floor fun?

No, of course these things are not fun.  It's quite obvious that the disadvantages of an addiction outweigh the advantages.  That's why we want to quit.

Some people would have us believe that there is no real pleasure in alcohol at all, that any pleasure we think we feel is actually just relief from the pressure of the addiction.  The writer of Naltrexone Confidential has compared it to scratching an itch and to the "aaaahhhhh" feeling of releasing our bladders after being forced to hold them for a long time -- yes, it's a good feeling, but it doesn't mean that scratching or urinating are fun in themselves.

There is a fair bit of truth to this.  There is relief in ending withdrawal, whether withdrawal is consciously experienced or not.  There is relief in ending the Alcohol Deprivation Effect (a topic for another day).  Unfortunately, it isn't the whole story.  Drinking alcohol really does create pleasure, which is why it's addicting in the first place.  If there were no pleasure, who would ever drink it?  We don't drink it because we're thirsty.

When people say that naltrexone removes the pleasure of drinking alcohol, they aren't talking about some blissful cloud of joy.  They mean the simple physical pleasure.  In all people, alcohol causes the release of endorphins which create that warm glow.  That's what normal drinkers enjoy.  That's what addicted drinkers enjoy during the first few drinks.

That's what is described in scientific literature as "euphoria," which does not have to mean some sort of orgasmic ecstasy.  It simply means a good feeling.

That's what naltrexone blocks.

That's why naltrexone works.  If there were no pleasure in drinking alcohol, blocking opioid receptors would not work to let us unlearn the conditioning that alcohol gives pleasure.

Consider cocaine.  It doesn't stimulate the same receptors as alcohol.  Accordingly, naltrexone doesn't do a darn thing for cocaine addiction.

For the non-addicts reading this, I want to reassure you that your loved one isn't simply choosing a temporary pleasure over you.  If that were so, everyone who ever drank alcohol would be an instant addict.  If that were so, nasty consequences like hangovers would rapidly teach your loved one not to overdrink.  Alcohol addiction is a conditioned behavior learned over time, and at this point is pretty much out of your loved one's control.

We do need to be aware of this natural pleasure response, though.  When we drink alcohol after taking naltrexone, that response will be gone.  Our experience of drinking alcohol will be vastly different.  This is exactly how it's supposed to work; if it weren't different, it wouldn't undo the years of learning that alcohol brings pleasure.

The first time I drank alcohol after taking naltrexone was a shock.  Apparently I have fewer opioid receptors than average, because the 25mg starter dose created a stone wall of 100% coverage around them.  The inner beast was frantic, desperate for that reward, leaping madly towards it but running into that stone wall.

Fortunately, there's no way to untake the pill.  Also fortunately, extinction begins on that first occasion and the second time was softened.

Most people won't have such a dramatic experience.  The starter dose doesn't cover all receptors, and so the response isn't blocked so abruptly.

You must reach that point, though.  Your addiction won't be extinguished unless 100% of the reward is being blocked.  Blocking only part of it will strengthen the addiction, not weaken it.

The "You can still drink!" line works to attract people to the Sinclair Method, but it's misleading to some.  Yes, you can still drink, but you won't enjoy it either as you used to in the early days or as a normal drinker does.

Naltrexone is not a normality pill.  You may feel a bit relaxed and mellow, and you may even like that feeling (most people say they just get sleepy).  You won't feel the warm glow.

Not to worry, though.  Once your addiction is extinguished, you won't miss it.  It may seem unthinkable now, but once your addiction is extinguished, you truly won't care whether or not you ever drink alcohol.

Don't worry.  Just be aware.  If you ditch the method when you realize that you can't have the warm glow, you'll never have the chance to reach indifference.

Thursday, January 9, 2014

Good Candidates for the Sinclair Method

Last time I talked about a group of people for whom the Sinclair Method (or any other alcoholism therapy) is not appropriate -- the young, who can learn better life habits via conventional means.

That raises some questions.  One is simply this:  Who is a good candidate for pharmacological extinction of the desire to drink?

If you want to get totally blasted, you're probably not a good candidate.  If you don't want to get totally blasted but it seems to just keep happening anyway, maybe so.

If you make a conscious choice to start drinking, that's one thing.  If you feel compelled against your will, almost as if your body were moving by itself in spite of your mind's wishes, that's another thing entirely.

If you quit or cut down when external pressures (family, job) require you to do so, and you can maintain that for more than a few weeks, your conscious mind is likely still the main showrunner.  If you drink even in the face of dire consequences and are baffled by your own behavior, you may well be conditioned.

That's the common thread among all of those dichotomies -- conditioning.  We humans have more freedom of choice than other animals in many respects, but we're still subject to conditioning.  Those of us who merit the label of "alcoholic" have spent years conditioning ourselves to seek alcohol, and now we're finding that it's not as easy to back out as it was to walk in.

The Sinclair Method provides an intervention which lets us unlearn this conditioning.  The behavior (drinking alcohol) has been producing rewards (endorphins -> opioids) which we've conditioned ourselves to seek.  By blocking the rewards, we interrupt that system and gradually unlearn the behavior.

That's the whole point of this method -- unlearning the conditioned behavior.  It's not well suited to someone who is still in the driver's seat of drinking but is choosing to drink.  It's perfectly suited to people who want very much to stop but feel like they simply can't, feel trapped, feel as if they can't control their own actions.

Tuesday, January 7, 2014

Young Heavy Drinkers

When a young person drinks too much, this is what we generally do:  We funnel that person into therapy, heavily AA-based, in which the kids are provided with a deluge of information about hardcore alcoholism and how it develops from early heavy drinking.  We tell him that they are not necessarily alcoholics, but we do it in such a smug and knowing manner that the message is clear.  We reinforce it with stories from hardcore alcoholics talking about how in their young days they were heavy drinkers just like the youths are now.  Professionals tell them that lifelong abstinence is the only way, and loved ones sob over their futures while telling tales of others who died drunk in a gutter.

You know what would make a lot more sense?  Advising them to cut back and modeling responsible drinking behavior.  Instead of ordering them to abstain and screaming when they don't, share a few beers with them and then stop.

A young adult's brain is fungible.  We'd all like to believe that we think for ourselves and are immune to social pressure, but none of us really are, and the young are less resistant than we more ossified older folks.  Their open minds are actually a minus when they're flooded with propaganda telling them that they must cease drinking alcohol forever or else they will surely become drunkards.

Nobody is literally born an alcoholic.  Some are born with a predisposition, but the overdrinking itself is learned.  If that were not so, it could not be unlearned.

These people have 50+ years still ahead of them.  Virtually all of them will, at some point, drink alcohol again.  Priming them to overdrink is insane.

Contrary to popular belief, most overdrinkers can and do cut down on their own.  Moderation is a more common outcome than either abstinence or continually worsening addiction.  Unless, of course, we catch people at vulnerable times, knock them off balance, and work hard to convince them that they can never drink normally.

Our zeal for abstinence creates alcoholics.

Monday, January 6, 2014

Established, Successful -- Why Not Overwhelmingly Popular?

The Sinclair Method of curing alcoholism through pharmacological extinction has been getting some buzz recently.  That has led some people to assume it's new.

It's not.  This method has been used since the 1980's, with great success.

If it's three decades old and pretty darn successful, why is it relatively obscure instead of being shouted from the rooftops?  It's a good question, and one which leads many to wonder if it isn't really as successful as claimed.

Long story short, it is successful.  It's one of several successful methods which are not widely used.  The common thread of these methods is that they all involve continued consumption of alcohol, and in the USA (as in several other countries) this has come to be seen as anathema.  We're all convinced that immediate and permanent abstinence is the only way.

The first port of call will be Alcoholics Anonymous.  If that proves unacceptable, as it usually does, then addiction specialist who are open-minded may suggest other support groups -- Women For Sobriety, SOS, LifeRing, SMART, any number of others.  Each of these groups offers mutual support and a toolkit of tips and tricks for avoiding that fatal first drink.  Each has some happy members as well as many dropouts.

None is especially successful.

You see, there's a fundamental flaw in the approach -- if we never drink alcohol, we can't learn to dislike it.

All of the most successful methods involve some consumption of alcohol.  This blog is about the Sinclair Method, which simply blocks any enjoyment of alcohol.  That's a gentle approach which generally takes months to work fully, but it does work.  On the other side of the spectrum is Schick Shadel, a method which uses extreme aversion therapy (it's been described as "controlled torture") to achieve a really spiffy success rate of around 70% in only ten days.  In both cases, the unnatural attraction to alcohol is unlearned rather than denied.

How did we end up in this situation?  Why do we first recommend methods which are least likely to be successful?

There are a lot of things going awry.  One is simple inertia -- hospitals and courts have been pushing AA so hard for so long that any change will take far longer than common sense says it should.  Another is that addicts who successfully abstain sometimes develop a sort of addiction to abstinence, endlessly hanging around "recovery" groups instead of just getting on with their lives.  Since these people are always available to talk about addiction recovery, they're much easier to find than the people who cured their addictions and got started living.

Zealots are also a problem.  With AA in particular, the hardcore boosters are sure that nothing else can work and so push hard on what they believe to be the only successful method.  Some of the doctors and judges coercing people into AA meetings are themselves members of 12-Step programs.  Others know one or two people who got sober in AA, hear a lot from them and much less from that other guy who used to drink heavily and no longer does, and so only really know about AA.  The successful therapies have former patients rather than lifelong members who cheerlead.

Some believe that the hugely profitable addiction treatment industry relies on repeat business and so avoids therapies which actually work long-term.  I don't believe that such a conspiracy is necessarily in place.  If it is, it should soon crumble as the few clinics which use successful therapies start taking all their business.

The Sinclair Method is gradually coming into wider use.  It should eventually displace abstinence-via-threats simply by virtue of being better.  If that never happens, then it'll be time to discuss any possible deliberate suppression.

*Still other doctors and judges have no idea what actually goes on at 12-Step meetings, and would be startled to learn what they're really like.  The average person has a grossly inaccurate idea of 12-Step programs, but that's a topic for another day.

Saturday, January 4, 2014

NYT says: "Cold Turkey Isn’t the Only Route;" panic ensues

This week we're all talking about an article in the New York Times.

The actual article wasn't that interesting to me.  It's worth reading if you're unaware that anything other than AA exists, but that has never been me.

The article mentions the Sinclair Method along with other options other than immediate and permanent abstinence.  It's only a mention, which may lead to some of the confusion in the comments, but I suspect the confusion would be there regardless.

There are some who know whereof they speak.  I didn't see a single Sinclair Method failure in that huge comment thread; the only people who are familiar with it are affirming that it works.  Many commenters, though, are peddling the same old stuff.

"AA is most often recommended because it is the most successful approach, saving millions of lives."  No, that's just not so.  AA's success rate is absolutely dismal, proven so whenever it has been tested.  There are several reasons why AA remains predominant in the USA (it's different elsewhere), but great success is not one of them.  Research it for yourself.

"Now you're just dependent on a different drug."  There is no naltrexone dependence, because alcohol consumption is not required once the addiction has been broken.  If no naltrexone is available, the former drinker will simply abstain.  In fairness, the article didn't make it clear that the blocker wasn't a daily drug to be taken forever.  A clearer and more detailed treatment of the method might have helped some of these people understand.

"If your drinking is out of control, don't struggle for control.  Just quit."  Gee, really?  Something which is out of control can't be just quit, because quitting is a kind of control.

"Sounds like yet another way for Big Pharma to get rich off of other people's misery!"  It would be so, so easy to learn that naltrexone has been out of patent for ages and isn't a moneymaker for any drug company.  It's just a product, is priced accordingly, and is of no interest to Big Pharma.

And then there's that all-time favorite . . . .

"This article is dangerous because it may lure people away from AA, the One True Way and the only thing that really works."

Hmm.  Does the therapy involve powerful electric shocks?  Highly invasive inpatient surgery?  Gargling with gasoline?  Those things are dangerous.  A pill which has been around for fifty years with only rare and minimal side effects is not dangerous.  These people want us to believe that it's "dangerous" not in itself but because alcohol might leap out and kill us at any moment.  They use fear to keep newbies in thrall.

Anyone who "goes out" (leaves AA, temporarily or permanently) is only a hairsbreadth away from jails, institutions, or death.  Only "the rooms" (AA meetings) can keep anyone away from these terrors.  After they hear it enough times, they begin to believe it.  I can't count the number of times that I've heard an AA booster say:  "I knew that if I drank again I would die."

It's bunkum, of course.  In fact most of the people who leave AA do drink again, and do not die.  Everyone dies eventually, of course, but most people who leave AA don't die as soon as they drink again.

If you would like to try the Sinclair Method or any other method in this article, but are afraid that you might die, relax.  Nobody ever died from leaving a support group.  Some might decide to go back to the group someday, but nobody ever died from leaving.

Thursday, January 2, 2014

What Naltrexone Is and Isn't

What Naltrexone Is

It's an opioid blocker.  It blocks the opioid receptors in your brain, so that you no longer feel the warm glow we associate with drinking alcohol.

Your lower brain learns that drinking alcohol is no fun, and so cravings and compulsion disappear over time.  Eventually, usually between three and twelve months, the desire to drink is completely extinguished.  You really and truly won't care whether or not you drink alcohol.

What Naltrexone Isn't

A Normality Pill

You will not turn into a normal drinker who enjoys a few and knows when to quit.  The "You can still drink!" line has led some people into thinking that this is so, but it isn't.  You won't feel the happy-making effect of alcohol.

A New Dependence

Some people think they've come up with incisive criticisms when they deliver lines like "What will you do if you can't get naltrexone?" or "You're trading one drug dependence for another."  This is not so.  With targeted used of naltrexone, we take naltrexone before drinking alcohol.  When no naltrexone is available, we don't drink alcohol -- this is possible because the desire to drink has been diminished or (eventually) extinguished.  I no longer take naltrexone because I no longer drink, and I'm certainly not the only one.

A Sobriety Pill

You'll still feel relaxed and mellow.  You'll also still be unable to operate heavy machinery safely.  Some people think that they aren't drunk because they aren't feeling it the way they used to, but you still aren't safe to drive and you may still have bad reactions (such as throwing up) after ingesting too much.

A Sure-Fire Cure

About 10% of people are not helped by targeted opioid blockers because their addiction works via another mechanism (hypothesized to be GABA receptors).  Another 20% don't comply with the protocol -- once they realize that they're no longer enjoying the drinking, they ditch or screw around with the pill which blocks their chemical pleasure.  The remaining 70% are cured of the desire to drink, which is a pretty awesome success rate, but we need to be aware that "most" isn't "all."


Targeted naltrexone will not make you drink less.  Nothing will or can do that.  Most people find that they quite naturally begin drinking less because there's no longer any pleasure in it, but some don't, and those people still need to put the glass down once they're able to do it.  Habit and social pressure may need to be addressed separately from the actual addiction.

Overblown Hype

No, it's definitely not overblown hype.  It works.  Very well.