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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.

2 comments:

  1. Excellent, well thought out piece. I've used TSM and have had success to a point. Trying baclofen now, and think I'll add naltrexone back into the mix and use both. Great site, good luck with it.

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    1. Baclofen has helped a lot of people. I decided against it because I didn't want to take a high dose of a drug forever, but some say it's a lifesaver. You're not the first to combine a craving muter with pharmacological extinction; sounds like a winning plan to me. :)

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