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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.