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.
Saturday, April 26, 2014
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.
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.
Yep.
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.
Yep.
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.
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.
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.
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.
- It's not instant. It's a process, not a miracle pill.
- Drinking alcohol is not just "allowed," it's vital to unlearning.
- 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.
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