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The Cure for Alcoholism: The Medically Proven Way to Eliminate Alcohol Addiction Paperback – October 23, 2012
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About the Author
David Sinclair, PhD, is an American alcohol researcher who has worked for the Finnish National Health Institute (formally Alko Labs) in Helsinki, Finland.
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I found this book after my doctor gave me a prescription for Naltrexone. We were running out of time, so she just gave me an information sheet on the medication and told me to read it. There wasn’t a lot of information there, so I decided to use Google and found an article from Psychology Today titled “Drink Your Way Sober With Naltrexone.” You can find this article if you google the title. From there I found the link to this Amazon page, and I was very encouraged by the reviews, but I still had a lot of questions. I’m writing this review in the hope that perhaps it might help clarify some concepts for those who are new to TSM. I should make it clear that I’m not in the health field, and nothing in this review constitutes medical advice. I’m simply sharing my early experiences as someone following the advice in the book.
Let’ step back and look at the big picture first. The common view in the recovery industry (and trust me, it is a money making industry), is that alcoholism is a physiological disease, and once a person is addicted to alcohol, they can never get better unless they completely abstain from alcohol. The problem is that the treatment options based on this view only seem to work for a small percentage of people. The cravings are still there, and may return even after a person has been sober for years.
If I understand this book correctly, the method is based on the premise that alcoholism is a learned behavior, acquired by the effect of endorphins on the brain. Whenever we engage in certain behaviors, e.g., sex, intense exercise, eating a spicy meal, getting a massage, drinking or taking certain drugs (to mention a few), our bodies produce endorphins that attach to opioid receptors in the brain. We experience this as pleasure. As we repeat these behaviors, these endorphins “rewards” are reinforced, and powerful neural pathways (or highways) are established in our brains, and this can lead to addiction. Once established, these neurological pathways are so powerful that a person may feel like they have no choice in whether or not to engage in the behavior. In the case of drinking alcohol, one can say that there now there really is a physical dependence. The TSM approach is that this is only partly true, that before the physical dependency, there was a learned behavior involved reinforced by endorphins. Since alcoholism is originally a learned behavior, it can be “unlearned” through something called pharmaceutical extinction. Most of us remember the example of Pavlov’s dog, who learned to salivate when the bell rang, and then “unlearned” this behavior when it was no longer rewarded when the bell rang. This is a very simplistic example of how TSM works.
Pharmacological extinction is achieved by using a drug called Naltrexone, which attaches to the opioid receptors in the brain, and “blocks” the endorphins produced when the person drinks alcohol. For a person starting out on TSM, they will still be able to drink, there is no withdrawal, but the endorphin “high” they might have felt while drinking disappears. Over time, 3-4 months at a minimum (it can take up to a year), the person will crave alcohol less and less, and after a while simply loose interest in drinking. At first this may not seem like a credible claim, but I’ve spent some time on a couple of web forums reading the testimonials of people who have successfully completed the treatment, and it appears to be real. I also have very little desire to drink after I started on the method, but I’m told that this is due to something called the “honeymoon effect,” which is when someone following TSM experience an aversion to alcohol during the first few weeks. This can be seen as a good sign, but not everyone experiences it, and it’s important not to be alarmed if the cravings re-appear after some time. To completely erase the cravings takes months.
When I first started out on TSM, there were some important pieces of information that were not clear to me and which people in the TSM forums helped me straighten out:
First, it's important to understand that according to numerous scientific studies (referenced in the book), Naltrexone taken by itself will not permanently take away the cravings for alcohol. Initially, this was hard for me to understand. If a person takes Naltrexone for a period of time and they are not drinking, it may help with cravings short term. However, the neural pathways will not have been erased, and the cravings will most likely reappear. For those of us who have been told to abstain, it might be difficult to understand that TSM will not work unless we continue to drink while on the medication. While on TSM you’re “retraining” your brain to respond to alcohol in a new way, and for this to happen there has to be Naltrexone + Drinking over several months. When the method has been completed, that's where it's OK to completly abstain, and my understanding is that many people do so.Bottom line is that until you have completed TSM, you cannot and should not just take the medication and “not drink.” This is according to the rules laid out in the book, but unfortunately many doctors are not aware of this.
Second, it’s extremely important to follow the TSM Golden Rule: Always take the Naltrexone at least one hour before drinking. Never drink without having taken Naltrexone. This is actually all I knew when I started out, but it was enough to get me started. I filled in my knowledge gaps by doing more research over the following days and weeks.
Third, realize that when someone starts on the method, there is a likelihood that they might actually be drinking more than usual after a few days or weeks. Within reason, don't be alarmed; this is supposedly very common. It might be that the person misses the endorphin “high” and is subconsciously trying to overcome the effect of the Naltrexone. The information sheets that came with my prescription warns against this. Obviously this is something to be aware of, because a person could consume dangerous amounts of alcohol if they don’t pay attention.
It is also important to stay away from all medications containing opiods. They won't work anyway, and there is the danger of cross addiction. Personally I’ve not experienced any increase in cravings (at least not yet), and I’m drinking far less than before I started the TSM. The important thing is to be aware of the possibility of this “rebound” effect, to not feel guilty about it, not take it as a sign that TSM is not working, and to pay attention and be safe.
Fourth, your regular doctor may not have heard about The Sinclair Method, but may know it under the name “Pharmacological Extinction.” Most doctors will tell you to take Naltrexone and not to drink. Some doctors across the US are catching on, and starting to tell their patients to take the medication only before drinking. There are certain people who should not take Naltrexone, and you should consult with your doctor if you’re in this category. Like most medications, Naltrexone affects the liver negatively. This was of great concern to me, so I asked my pharmacist about it. She explained that while it’s true that Naltrexone affects the liver, the negative impact is far less than the damage caused by regular or heavy drinking. Also, since I will be taking the drug only while drinking, which for me is 3-4 times per week, the negative affect on my liver will be less than if I took the drug every day.
Fifth, some people may have questions about taking Naltrexone while participating in a 12 Step Program, or Alcoholics Anonymous (AA). I was a dedicated member of AA for six years, but left for personal reasons. If you’re in AA and you’re sober, then congratulations! There is currently no need for you to do TSM, as you don’t have a problem with drinking. However, if you’re among the majority of people who have “failed” with the AA method, I encourage you to take a closer look at TSM. From personal experience I know there are people in AA who will tell you that medications are contrary to the AA program. This is simply not true. The AA literature clearly states that “we’re not doctors and scientists.” And Naltrexone does not make you high or euphoric, so there’s no argument there. We all choose who we want to listen to, but far too often people condemn different recovery approaches without knowing what they’re talking about. That being said, I’ve got mostly good things to say about AA, and it’s helped a lot of people, including myself.
Let me in all honestly say that I don’t know for sure if this will work for me personally. However, from what I’ve experienced in the first few weeks, I’m feeling very hopeful. I like the freedom of choice that the method offers, and in a sense I feel that I have a stronger sense of freedom from alcohol than when I was totally abstaining. If you decide to give this a try, I strongly suggest that you google the phrase “The Sinclair Method Forum.” There are a couple of them, and they’re great for learning more and reading about people’s experiences with this method.
Finally, I also liked what the top reviewer on this page said about finding out what made you addicted to drinking in the first place. I believe that’s key to long term success with this method, and that’s also mentioned in the book. Combining this method with other therapies like Mindfulness-Based Cognitive Therapy (MBCT), talk therapy and other healing modalities will most definitely lead to greater probability of lasting results.
I hope you’ve found this review helpful, and I wish you all the best on your journey!
Thanks to this medication, I was able to have a glass of wine with family at Christmas dinner, and it was nice to be able to do that. However, the way I'm doing this is by cutting back slowly, which is working because my cravings have drastically reduced. My plan (and my doctor's) is to slowly move away from drinking. Everyone is different, so some may want to continue drinking a little and some may want to stop altogether.
The book is interesting as it explains how this medication works (which is very fascinating). For the first time in years, I am feeling hope and am very optimistic. I've been on it about 2 mos. and can now drive by the liquor store without getting that "pull" that always led me in to get a bottle. It's so nice not to wake up feeling sick and ashamed, with a blinding headache and swearing I wouldn't do it again .... until that evening when the obsession took over. And one of the best parts ... no more having to sneak around hiding bottles, lighting scented candles to mask the odor, and chewing lots peppermint gum (not to mention the pain we put our loved ones through) ! I feel like a heavy weight has been lifted off my shoulders and am getting my energy back. Yay! If you relate to any of my experience, read this book and talk to your doctor. It's definitely worth a try. :)