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Thursday, January 30, 2014

Flu

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.

http://www.nytimes.com/2014/01/02/opinion/cold-turkey-isnt-the-only-route.html?hpw&rref=opinion&_r=2&

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."

Magic

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.