Targeted naltrexone administration ("the Sinclair Method," our focus here) is the bee's knees for people addicted primarily to the opioid reward. For people whose addiction functions more via GABA receptors, daily high-dose baclofen has some risk but also some good results. Baclofen is still in the "early results are promising" stage, but the Sinclair Method's efficacy is well-established.
What disturbs me is that this has been well-established for some time and yet we still think people should just abstain from alcohol and join a support group. That approach pretty much doesn't work. 95% of the people who try it will fail.
Why do we most strongly promote the method which is both most difficult and least successful? I think we believe that addicts deserve to suffer.
If someone has a broken leg, we fix the problem. We don't get into a pointless argument about whether he jumped off the roof, fell by accident, or was thrown by an assailant. We fix the leg first. But if someone develops an addiction, hoo boy does the blame start flying -- and the addict should be forced to do it the hardest possible way, as penance.
If the guy jumped, he was foolish to do it. Whether he jumped or was pushed, he still deserves reasonable medical care. The guy who jumped shouldn't be denied proper medical care on the grounds that he did something foolish.
If we denied real medical care to everyone who contributed to his/her own problem, there would be no cardiac care for anyone who ever ate fast food or drank coffee. Cancer treatments would be denied to anyone who ever went near carcinogens. The entire field of sports medicine would disappear. Since none of us are perfect, most of us would die young.
It's time to stop insisting that addicts need spirituality instead of proper care. It's time to treat addicts with no more but no less respect and concern than anyone else with a health problem. It's time to let addicts have proper medical treatment.
Friday, June 27, 2014
Friday, June 20, 2014
"I Get No Pleasure From Drinking"
Interesting discussion over on www.thesinclairmethod.net -- one participant said (I'm paraphrasing) that people who drink after trauma should focus on addressing the trauma, that people who drink to relax and to deal with anxiety should try the baclofen approach first, and that the Sinclair Method was best suited for people who drink to get high. I think she has a good point and that that's a reasonable approach. However, there's a snag -- some of us are maintaining our self-respect by maintaining that we loathe drinking and everything about it.
I'm always surprised when I hear an addict or recent ex-addict say that there was no pleasure in drinking. Some people say, and probably even believe, that there was no high or enjoyment of any kind in drinking, only the illusion of pleasure from the relief of addiction. This is not true, yet many of us believe it.
If this mistaken belief is widespread, it could be bad. If we don't know what we are conditioned to seek (euphoria, in our case), then we don't know what to block (opioid receptors) to break the conditioning. I can easily imagine someone convincing himself that he drinks only due to addiction, gets no pleasure from it at all . . . and therefore is not a good candidate for a method which works by blocking pleasure.
That would blow.
Really, the majority of people conditioned to drink are conditioned to seeking the pleasure. Yes, it is no longer under our conscious control, but the presence of conditioning doesn't mean the absence of the physiological euphoria which everyone feels upon consuming alcohol.
If you think that your addiction is 100% pain and 0% pleasure, consider that you may be fooling yourself. There are a number of reasons to deny the inherent pleasure, chief among them being shame that we are (apparently) choosing this cheap temporary pleasure in the face of all reason and common sense. It's okay. You're conditioned; it's not a free choice any more. Any shame attaching must be to the earlier decisions, not to last night's bender. The thing to do now is to fix the problem.
I'm always surprised when I hear an addict or recent ex-addict say that there was no pleasure in drinking. Some people say, and probably even believe, that there was no high or enjoyment of any kind in drinking, only the illusion of pleasure from the relief of addiction. This is not true, yet many of us believe it.
If this mistaken belief is widespread, it could be bad. If we don't know what we are conditioned to seek (euphoria, in our case), then we don't know what to block (opioid receptors) to break the conditioning. I can easily imagine someone convincing himself that he drinks only due to addiction, gets no pleasure from it at all . . . and therefore is not a good candidate for a method which works by blocking pleasure.
That would blow.
Really, the majority of people conditioned to drink are conditioned to seeking the pleasure. Yes, it is no longer under our conscious control, but the presence of conditioning doesn't mean the absence of the physiological euphoria which everyone feels upon consuming alcohol.
If you think that your addiction is 100% pain and 0% pleasure, consider that you may be fooling yourself. There are a number of reasons to deny the inherent pleasure, chief among them being shame that we are (apparently) choosing this cheap temporary pleasure in the face of all reason and common sense. It's okay. You're conditioned; it's not a free choice any more. Any shame attaching must be to the earlier decisions, not to last night's bender. The thing to do now is to fix the problem.
Tuesday, June 17, 2014
Finding Support
Some have asked me where they can find support for doing the Sinclair Method. I'm happy to talk with people, but I'm not available 100% of the time, and there are an awful lot of desperate people out there.
The best place to find mutual support is TheSinclairMethod.net. It's a free message board. There are people from all over the world, so help is potentially available 24/7. It's reasonably private -- you have to register to read, although of course nothing is truly private online and pseudonyms are always suggested.
Don't leave off the "the" at the beginning or you'll find yourself at the page of a Sinclair Method inpatient/outpatient clinic.
I've heard a couple of people say that they would like live support groups. I doubt this will ever happen, because most people don't want or need it. It's simple to do and it usually works in months rather than decades, so endless meetings are just not a part of it. I suppose a really huge place like New York City might produce enough people who would like face to face meetings, but I've never heard of it happening.
Your best bet is to join the message board and find a few particular buddies. If you struggle with the temptation of skipping nal, which is the main pitfall, some folks might share texting numbers with you.
I don't mean to discourage anyone from emailing me. unchainedmouse at gmail dot com remains available to anyone who wants my help and support. We're all in this life together, you know? I just hate to be anyone's sole lifeline when I know that I won't always be available.
The best place to find mutual support is TheSinclairMethod.net. It's a free message board. There are people from all over the world, so help is potentially available 24/7. It's reasonably private -- you have to register to read, although of course nothing is truly private online and pseudonyms are always suggested.
Don't leave off the "the" at the beginning or you'll find yourself at the page of a Sinclair Method inpatient/outpatient clinic.
I've heard a couple of people say that they would like live support groups. I doubt this will ever happen, because most people don't want or need it. It's simple to do and it usually works in months rather than decades, so endless meetings are just not a part of it. I suppose a really huge place like New York City might produce enough people who would like face to face meetings, but I've never heard of it happening.
Your best bet is to join the message board and find a few particular buddies. If you struggle with the temptation of skipping nal, which is the main pitfall, some folks might share texting numbers with you.
I don't mean to discourage anyone from emailing me. unchainedmouse at gmail dot com remains available to anyone who wants my help and support. We're all in this life together, you know? I just hate to be anyone's sole lifeline when I know that I won't always be available.
Wednesday, May 28, 2014
"That's not the real me"
We seem to have an idea of our "real" selves. This real self is as pure as the driven snow. Whenever we do something wrong, we insist that that isn't like us, it's not the sort of thing we do, it's not who we really are.
A flat-out narcissist may deny that the event happened at all. "I am a good person; a good person would not do that; therefore I did not do that." The logic is flawless, even if the premises are a bit skewed. These people are not simply lying. They have actually rewritten history in their minds so that the actions which don't flatter them never occurred.
Most of us will admit that the event happened and simply insist that it doesn't reflect our true inner character. "Yes, I got a DUI, but I'm not really a drunk driver." This lets us continue to believe that we have a real self which is good and kind and honest, and that bad decisions and actions were the result of other factors outside our control. This is a large part of the appeal of the disease model.
To the sufficiently confused, the idea can go 'round and 'round forever. "That was out of character for me, so something else must have made me do it. That means I have a behavioral disease. Since I have a behavioral disease, I sometimes do things which aren't my true self. That means other bad actions (such as lying about how much I drink) can also be part of the behavioral disease." And so we end up with an idiotic paradigm in which lying is a sign of the disease of alcoholism and the person doing all this stuff can still be a virtuous person.
I first noticed this after my second DUI, lo these many years ago, while confined in a 12-Step rehab center. During one session they did a sort of reverse hotseat on me, pelting me with the idea that I wasn't a bad person (I kinda was) and didn't want to drink too much (I totally did) and wasn't the sort of person who would drive drunk. Uh, wait a minute -- I did drive drunk. If I did it, then it is something I would do. It was an odd experience, struggling to take responsibility for my actions while a roomful of people insisted that I wasn't responsible for them.
"Wait a minute, Mouse. Isn't having a defect of character part of the 12-Step model?" Sort of, but most of them don't act like it. The defect becomes another thing separate from the true self, the flawless -- but imaginary -- being who would never neglect the kids or waste the family's savings. This is how "character defect" and "disease" get all mixed up. Praying for the defects to be removed becomes rather like praying for a demon to be exorcised. Legitimate religions acknowledge that the vast majority of our bad deeds are our own fault, and ask us to mend our ways.
Unless you are a hardcore exemplar of Narcissistic Personality Disorder, you have the ability to acknowledge that you are the sum of your actions. There is only one you. Your good and bad and neutral actions are all part of that one you. There is no way to free the inner self who is 100% virtuous, because that self is imaginary.
Your mission, should you accept it, is to decrease the number of bad actions and increase the number of good ones in order to better yourself. To "better" yourself -- to make yourself a better person.
A flat-out narcissist may deny that the event happened at all. "I am a good person; a good person would not do that; therefore I did not do that." The logic is flawless, even if the premises are a bit skewed. These people are not simply lying. They have actually rewritten history in their minds so that the actions which don't flatter them never occurred.
Most of us will admit that the event happened and simply insist that it doesn't reflect our true inner character. "Yes, I got a DUI, but I'm not really a drunk driver." This lets us continue to believe that we have a real self which is good and kind and honest, and that bad decisions and actions were the result of other factors outside our control. This is a large part of the appeal of the disease model.
To the sufficiently confused, the idea can go 'round and 'round forever. "That was out of character for me, so something else must have made me do it. That means I have a behavioral disease. Since I have a behavioral disease, I sometimes do things which aren't my true self. That means other bad actions (such as lying about how much I drink) can also be part of the behavioral disease." And so we end up with an idiotic paradigm in which lying is a sign of the disease of alcoholism and the person doing all this stuff can still be a virtuous person.
I first noticed this after my second DUI, lo these many years ago, while confined in a 12-Step rehab center. During one session they did a sort of reverse hotseat on me, pelting me with the idea that I wasn't a bad person (I kinda was) and didn't want to drink too much (I totally did) and wasn't the sort of person who would drive drunk. Uh, wait a minute -- I did drive drunk. If I did it, then it is something I would do. It was an odd experience, struggling to take responsibility for my actions while a roomful of people insisted that I wasn't responsible for them.
"Wait a minute, Mouse. Isn't having a defect of character part of the 12-Step model?" Sort of, but most of them don't act like it. The defect becomes another thing separate from the true self, the flawless -- but imaginary -- being who would never neglect the kids or waste the family's savings. This is how "character defect" and "disease" get all mixed up. Praying for the defects to be removed becomes rather like praying for a demon to be exorcised. Legitimate religions acknowledge that the vast majority of our bad deeds are our own fault, and ask us to mend our ways.
Unless you are a hardcore exemplar of Narcissistic Personality Disorder, you have the ability to acknowledge that you are the sum of your actions. There is only one you. Your good and bad and neutral actions are all part of that one you. There is no way to free the inner self who is 100% virtuous, because that self is imaginary.
Your mission, should you accept it, is to decrease the number of bad actions and increase the number of good ones in order to better yourself. To "better" yourself -- to make yourself a better person.
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.
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.
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.
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