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.
Doesn't work. admit it, we need a new model.
ReplyDeleteOh, come on. Five out of ten is 50%, aka half, aka "lots better than other options." Obviously it works (for many).
ReplyDelete"Not a cure-all" is not the same thing as "doesn't work."
I've been meaning to comment on this for a few days. I think TSM is most effective in a fairly narrow band of alcoholics--people who have acknowledged that they have a serious problem and are willing to do whatever it takes to address it, but who are still functional enough to comply with a routine. Marginal alcoholics who start TSM grudgingly might like the diminished drinking, but they'll balk when they realize how much less pleasurable drinking is. And later-stage alcoholics aren't going to wait an hour for their first drink of the day (which may come only a few hours after their last one of the day before). That's still a lot of people who can be helped by naltrexone (I'm one of them), but not by any stretch the entire alcoholic population.
ReplyDeleteI agree that the overselling of TSM is a problem, as it has the result of downplaying both the cost (we will never quite be normal drinkers, and anyone who expects that result will likely be disappointed) and the required commitment (because if you're "cured," there's no need to harsh your buzz with this pill anymore, right?). My fear is that TSM will begin to get some recognition only to be flattened by a backlash from people who haven't had the promised results.
I agree about the band, but I'm not sure it's that narrow. I believe there are a fair number of people who want very much to break their addictions and aren't yet at the "lives to drink and drinks to live" stage where alcohol is sought immediately upon awakening. Those late-stage people probably need some sort of inpatient therapy, if they have any hope left at all.
ReplyDeleteAs for the people who ditch the bill because it interferes with their buzz -- yeah, it's an issue, but not an issue with the protocol. These are mostly your younger folks, or at least people in the earlier stages of addiction. Most such people could probably back out of the trap and learn moderation, if that's what they want to do. Contrary to popular belief, that's quite common.
So, basically, I agree with everything you said except the idea that the band is narrow. I think there are quite a few people who are outwardly functional and inwardly desperate.
I probably overstated it. There are indeed quite a few people between the extremes I described, and if they could be provided with naltrexone and crystal-clear instructions on how to use it, it would totally change the complexion of the disease of alcoholism. But there are enough people unwilling/unable to comply with TSM to make it hard for us to get there.
ReplyDelete