The Sinclair Method

By life-j

One of the things we AAs read from the Big Book as if it were an ever-lasting truth, though it was written in 1939:

“Physicians who are familiar with alcoholism agree there is no such thing as making a normal drinker out of an alcoholic. Science may one day accomplish this, but it hasn’t done so yet.”

And it has been a well kept secret that science began to do just that around 1978.

There is still general agreement that it is way preferable for alcoholics to stop drinking altogether, but to the extent this cannot seem to be accomplished, moderated drinking would be preferable to continued out-of-control drinking. However, in this article we will not be talking about “Moderation Management”, the program that claims that people can moderate their drinking by sensible application of willpower, but moderation with medications which have been around for decades called Naltrexone and Nalmefene.

When used according to Dr. Sinclair’s method there appears to be some extent of success with 80% of those who take it, such that half of those wind up stopping drinking altogether, and half cut their drinking in half, or better.

Naltrexone and Nalmefene are opioid antagonists.

In our brain chemistry when we take a drink or do something else with which we associate pleasure, endorphins are released. There are neural receptors that fire when endorphins attach to them, or when an opiate does, and this completes the experience of pleasure. Naltrexone is designed such that it will attach to those receptors, but not fit properly, and therefore the receptors will not fire, and no sense of pleasure occurs. Thus, when Naltrexone is taken, say, an hour before drinking or taking a drug, it has time to block all receptors in this manner so that alcohol or drugs will give no pleasurable effect, though they will still both get a person drunk/high, and will result in the usual incapacitating physical effects of alcohol such as impaired coordination when drunk, etc.

Dr. John David Sinclair was an American doctor (died earlier this year) who started studying alcoholic behavior in both laboratory animals, and people in the late 70s. He has mostly worked in Finland where he received support for his research. He has formed the theory that alcoholism is a learned behavior much along the lines of Pavlovian conditioning. Drinking initially causes pleasure, even when, as is the case with many of us, in reality it just takes discomfort, social and otherwise, away, and that is experienced as pleasurable. Then every time this person takes a drink the pleasure principle is reinforced. Later in a person’s drinking career, when physical dependency on alcohol is developed, a similar phenomenon asserts itself. The anticipation of pleasure still reigns. Drinking takes away the jitters, and that is experienced as pleasurable, even though there is no genuine pleasure, and we know very well that it only feeds into a vicious circle.

One of the reasons why Naltrexone has not found more use is that, according to Dr. Sinclair, it has been used wrong.

Naltrexone is an odd sort of medication. It appears to modify behavior. Actually any pleasurable behavior which releases endorphins is liable to get modified by it. Thus when taken in the wrong manner, it can lead to loss of pleasure in sex, eating, exercise or any other activity perceived as pleasurable, and thus a decrease in such activities.

Dr. Sinclair’s assertion which is slowly gaining acceptance is that Naltrexone must be taken an hour before a person with reasonable certainty expects to drink, and only on days when he expects to drink. It will then, after a few months’ use generally result in greatly decreased drinking, or stopping altogether. The medication, when taken according to this recommendation will allow the brain to recondition itself, and the craving for alcohol, and the pleasure from drinking will fade away. This process is called pharmacological extinction.

The officially recommended use since Naltrexone was authorized by the FDA in the mid-90s has been that the alcoholic takes it every day, and abstains from drinking. In clinical trials this had even less success than the placebo control group. However, there were some in the abstaining group who had success with this treatment. Turned out those had been cheating, and drinking anyway. Those who actually abstained were more likely to go drinking with a vengeance after the trial.

Dr. Sinclair reasoned that the medication needed to interact with actual drinking behavior to be successful. In order for the person to experience decreasing pleasure in drinking he had to actually drink. By abstaining all he would do is to increase his craving, and as we know, for some the craving can be horribly persistent. Worse yet, by abstaining from drinking and taking the medication, the medication would instead likely affect the experience of any other pleasurable, endorphine releasing activities, and make the person loose interest in those, rather than in drinking, thus making life seem ever more bland.

The benefits from taking naltrexone with drinking vs. abstinent is shown in the following figure:

Sinclair-png-image

This bar graph is from a 32 week study, so the expression “never relapsing” should be taken with a grain of salt. However the comparison is otherwise clear. Inserts with the Naltrexone medication still recommend abstinence, something that would need to be changed if this medication is to ever be used effectively.

There are factors that work against this. First of all, drinking is dangerous for an alcoholic. 10% of those who took the medication showed no positive response at all, and another 10% were not able to follow directions sufficiently to have any benefit from it. Of the 80% that would eventually show significant results, the initial phase of the program still poses significant risks. In the very early phase the medication does not yet have much effect, and the drinking behavior is as risky or even more risky than it would be without the medication. Even once the medication starts having an effect, but while a person’s drinking is still rather on the heavy side, it is only the pleasurable effects of alcohol that are lessened. The impairment of motor skills, reaction time, social interaction, and judgment remains as strong as without the medication, so there is still significant risk of problematic outcomes during the first few weeks of treatment. It is small comfort that someone was on his way to sobriety if he manages to cut the hopes short with a fatal car crash or some other unfortunate event during those first couple of weeks.

Thus many doctors will be reluctant to recommend that a patient should “drink himself into sobriety”, and insurance companies will be reluctant to accept such a treatment, none the least because during the last half century AA’s assertion that only complete abstinence works, has been a major guiding force on alcohol policy.

Of course AA itself will be very reluctant to embrace the Sinclair Method, mostly out of contempt prior to investigation.

And while some sober alcoholics who have not quite embraced their sobriety may fantasize that here is an opportunity to go drink just one more time in order to get sober, psychologist Roy Eskapa cautions that it would be both dangerous and pointless to let an already abstinent person go through the Sinclair Process.

In Roy Eskapa’s book Cure for Alcoholism we read:

David Sinclair reported on the lasting benefits of naltrexone three years after the start of treatment, in which patients continued to take naltrexone an hour before drinking.

The patients did not take the medication on days when they were not drinking. The patients’ craving, drinking levels, and liver damage markers were all way down. Indeed, these patients were drinking and craving alcohol less after three years than they had been after the first five months of treatment.

Traditional abstinence-based alcoholism treatments had always found that the results were best at the beginning of treatment, and then gradually, week after week, the patients would relapse and the drinking would increase to the level it had been before treatment. Pharmacological extinction produces exactly the opposite pattern, as shown by this three-year follow-up study. The drinking and craving is highest in the first weeks of treatment, but becomes progressively lower as the weeks on treatment progress because each intervening episode of drinking while on naltrexone was one more extinction trial. In other words, the more often people drink while on naltrexone, the less they will want to drink.

I contacted Dr. Roy Eskapa, and he informed me that no other studies have yet been performed on the long term results, but that one problem associated with long term treatment is that patients eventually get too lax about taking the medication before drinking. If people ever drink without first taking Naltrexone they will relearn the drinking behavior.

Patients need to keep Naltrexone with them at all times for the rest of their lives to the extent there is likelihood they will drink, so that they can take a pill an hour before drinking, if they should do so. This may seem burdensome, and is one major reason why people who have undergone the Sinclair Method relapse into their old patterns of drinking, but it is not really any more burdensome than going to AA meetings for the rest of our lives, something many alcoholics in AA similarly fail to do, and while this does not automatically make them relapse it does put them at greater risk of doing so.

Nalmefene is not yet entirely approved by the FDA as a treatment for alcoholism, but has been approved by the EU and in use in Great Britain for a couple of years. Though also metabolized by the liver it is not as hard on it. Nalmefene absorbs better when taken orally, has longer duration of antagonist action, and more competitive binding with opioid receptor subtypes that are thought to reinforce drinking. However, it is still under manufacturing patent, and therefore relatively expensive.

Naltrexone patents have expired, so it is now available as a generic. However, there are more side effects from its use than from Nalmefene, though rarely severe, including some nausea, and in large doses it can be hard on the liver, though in the doses prescribes for alcoholism, 25 mg the first two days and 50 thereafter, it is typically not an issue since the benefit of not drinking large amounts of liver damaging alcohol will soon outweigh the slight tendency toward liver damage from naltrexone.

A webpage by National Institute of Health describes a major recent study with Nalmefene, named ESENSE. Here are some of its conclusions:

…. This approach, better adapted to patients who do not wish (or cannot) remain totally abstinent is able to considerably reduce the damage related to alcohol consumption. This objective, which is more accessible and better accepted because it more closely corresponds to the patient’s preference, can enable the patient to modify his/her attitude in relation to alcohol dependence. This approach would encourage the patient to seek medical attention and would increase the percentage of patients accessing care….

… Patients are more likely to achieve their objective that they have chosen themselves as opposed to an objective imposed by the physician. Patients who choose abstinence more often achieve abstinence, while patients who choose reduction of consumption more often achieve this objective. As-needed treatment gives patients a more active role in management of their disease by making them more attentive to the quantity of alcohol consumed and the situations in which they drink. General practitioners, who often feel relatively impotent when the only objective is abstinence, could feel more confident about helping their patients. Reduction of consumption can be either an intermediate objective until the patient understands and accepts the need for abstinence, or, in less severely dependent patients, a realistic long-term objective.

National Institute of Health

I looked at length for negative reviews of these medications, and did not find much other than where it was associated with treatment in combination with abstinence.

Of course this sort of treatment is quite contrary to AA’s central principle that only total abstinence will work for an alcoholic. And for me, personally, anything else is indeed hard to imagine. I know how addictive my personality is. My obsessive need to drink alcohol is long gone, but I just devoured a box of cookies in the same manner I used to drink. The thought of the need to drink simply disappearing from taking a pill is quite foreign. And there is an element of AA’s philosophy which is so, eh, what should I call it, “protestant”? – that taking a pill would be cheating. Sobriety must come through suffering, self-flagellation with the 4th step, and making amends, AA is full of the Christian virtues of guilt, shame, remorse, confession, asking for forgiveness and help becoming a better person, not from just taking a pill.

I’m not here to put AA down, only to take a fair look at all the options. After all, our primary purpose is to help the still suffering alcoholic. Personally I have gained a lot from working the 12 steps, and even more from the fellowship of AA. But it is a religion. Every approach which leans more toward a scientific approach is worth investigating.

In other parts of the world good results have been achieved for alcoholics with Cognitive Behavioral Therapy, and I can imagine that if that were paired up with opioid antagonists we’d have a very powerful tool for stopping out of control drinking, but if all we could accomplish in many of the cases would be moderated drinking, that would still be way better than the alternative which is out of control drinking. I know AA says that moderated drinking is not possible except as a strenuous interlude. The results from opioid antagonist use seem to suggest that AA may not have it all right.

However, most of us started drinking for a reason. Low self-esteem, childhood traumas, whatever – those reasons are still there, buried inside. And the pills won’t address those underlying reasons. Therapy can work for that. We know that using the 12 steps can work for that. Having a tribe of like-minded people for mutual support can work for that, it’s probably the most important of all.

But it all starts with putting the plug in the jug. Keep your hats on. Opioid antagonists probably won’t help any alcoholic drink like a gentleman, whether man or woman. But they do indeed seem promising. If they can help him cut way back or even quit entirely, he may get clearheaded enough to have a look at his options. They may help save his life long enough to where he can do more with it, and rebuild an enjoyable life, whether in the long run he will find a reason to come to AA or not.


Postscript, Additional Reading and References

It has been a while since I wrote this article, here is some further information, contacts with the people involved and links to various resources: Postscript, Additional Reading, and Resources


 About the Author

life-j got sober in Oakland in 1988. He’s been involved in service work of every kind ever since, but now thinks the most important work is to help atheists and agnostics feel safe and welcome in AA. He’s spent parts of his life as a building contractor, part as a technical translator, and has dabbled a bit in art work and writing. life-j is now semi-retired and since 2002 has lived – along with his sweetie, and his dog, chickens, garden and apple trees – on a five acre homestead in a Northern California mountain village.

He has written a number of articles for AA Agnostica, including:

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  1. Cptkrk September 11, 2017 at 12:26 am - Reply

    It strikes me there are a lot of really tough logjams between TSM and AA. For instance, the whole admission thing about admitting you have alcoholism and that you are an alcoholic. I can definitely say with complete confidence that I am not an alcoholic and I do not have alcoholism, thanks to TSM. Yes, I do have viking heritage and I do have a genetic, inherited predisposition for entrenched opiodergic habituation. And I take the pill before I drink to protect from developing that entrenchment. I have zero appetite for beer now and I honestly don’t care about it. I can go to parties or social events and just drink club sodas. The labeling seems to me to be a bad trap.

  2. Cptkrk September 11, 2017 at 12:17 am - Reply

    In Iskapa’s book he states, and I’m para phrasing from mem, that if Bill (the AA writer/developer) would have known about naltrexone he would have tried it. He tried everything else under the sun, as I understand it. But naltrexone was not synthesized in a lab until the 1960s, so it was not available at the time that AA was being developed and formalized. You can say whatever you want and be skeptical all you want, but TSM has been found to be 80 percent effective in human studies and 100 percent effective in animal studies. I’m an animal. I knew it was going to work for me when I first ran across Claudia Christian’s TedX YouTube video. I can and will drink all I want whenever I want, and I haven’t had a drink in 2 months now. So that shows you how much I want a beer. Extinguishment complete, and I’m glad. 100 percent satisfied.

    • life-j September 11, 2017 at 12:29 am Reply

      Cpthrtpt

      My point with writing this article was to tell the AA community that there is TSM, and that it looks like it works. I appreciate you coming in here and letting us know that indeed it does. Especially since I am not speaking from first hand experience myself. And so I’m not telling you anything, since you already know, though of course here, like with everything else, you’re sharing your own experience, and I’m (usually) sharing my own. Thanks again

  3. Cptkrk September 11, 2017 at 12:04 am - Reply

    The article states that people drink for an underlying reason which a pill will not remedy. I disagree. Some people are socialized into it. The Sinclair Method states the basic problem is a basic two parter- one has a genetic predisposition for entrenched opiodergic habituation, and two, the person engaged in repeated ingestion over time. That’s it. That’s whole deal. It has nothing to do with adverse childhood experience or traumatic loss. Worked like a charm for me. I’m fully committed to TSM for life. I think it’s fantastic. No shame or guilt trips necessary. No meetings, no therapy, just loving life.

    • life-j September 11, 2017 at 12:20 am Reply

      Cpthrthrjt,

      Undoubtedly you are right that some people do not have underlying issues. My perspective is colored from being around AA for a long time. People who respond to AA, whether well or moderately, typically have issues. Of the people who do not respond to AA at all, there are undoubtedly a lot of people without issues who will respond to TSM with nothing further needed. Looking back on writing this article was walking a fine line, including expecting getting some rather irate responses from people, as indeed I did, that TSM will not fix the underlying issues that some people think that’s what it’s all about, underlying issues.

      So again we’re looking at that alcoholism has several root causes, and combinations thereof, or not. I think it is good you’re pointing out that some people do not have issues at all. AA needs to hear that.

  4. Curt June 19, 2017 at 3:43 pm - Reply

    I have been doing TSM for almost a month and it is working! I used to drink a pint of vodka every day, now I just drink beer once in a while. I went to the bar last Saturday to sing karaoke and my bar tab after being there for 5 hours was $10. That is how normal people drink. Never thought I could be normal again!

  5. Brandy October 23, 2016 at 10:41 am - Reply

    I have been on the sinclair method for more than seven months.    I used to drink 14-20 bottles of beer or more friday  and saturday  every weekend, would start after work on friday and pretty much drink until sunday noon.  By taking Naltrexone before drinking I immediately went to 5-7 bottles each time and some months after I was typically only drinking once a week these 5 bottles.  The last months the frequency has gone down to every other weekend.  My goal has not been to force things or necessarily stop drinking but my experience is that the craving and the binge drinking goes away and then the desire to drink gives in, leaving space for personal growth and maturity.

    • Chris February 18, 2017 at 11:24 pm Reply

      Is it possible to use AA and TSM in tandem? Use AA as your first line of defense. If you have an uncontrolable desire for a drink take Naltrexone one hour prior, have the drink. The Naltrexone will prevent a full blown binge. You can then go back to AA and continue to get support. You can attend AA meetings whether you drink or not. There’s no requirement that you have to be completely sober to atttend.

      • life-j February 19, 2017 at 2:09 am Reply

        Chris, it seems that the greatest obstacle to that approach would be AA itself. Technically it sahould be possible, and it is good to see the testimony from Brandy above, but as one can see in a couple of the comments below, even among atheist and agnostic AA members – and we should have gone through enough ostrazising to become more openminded than the rest – there can be great orthodoxy around the concept of not stopping fully, there is a stigma to having “gone out”, you “loose your time”, and have to crawl to the cross over it – enough to make a person go back out and drink with a vengeance, one should think, and indeed it should go a long way toward explaining why, when people have a slip, they wind up staying out for 5 years – it is simply too hard to face the subtle judgment coming back after a slip.

        Now I’m sitting here writing about slips as if i knew what i was talking about, I have never had one, but back to the subject at hand.

        Supposedly what yopu have to have in AA is a desire to stop drinking, and the idea of cutting back goes completely contrary to AA philosophy, as much as being an agnostic goes against it’s god-philosophy.

        There has been pretty good evidence up till now that the only way to manage alcoholism is to not drink at all – but that of course is/was without these new opioid blockers.

        So if you have a relapse and use naltrexone to fend off the worst of it, keep from killing yourself,  and return to AA and pick up where you left off you will have to face judgment from everyone. And that’s really a shame.

        We have Mike, below, who can’t understand how we can call AA a religion.

        It is in more ways than one. With respect to god stuff, of course, but a hallmark of religion is intolerance to new ideas that run contrary to any of the dogmas in the whole philosophical system. I’m broadening the term ‘religion’ a bit more than it can really bear here, but a system of thought which wasn’t would more likely say “Hmmm, maybe we are wrong?”

        AA isn’t only clinging to its god, but to all its tenets.

        I don’t know how I would have handled getting sober if it had been today. definitely seems like naltrexone would have been a way to come in for a softer landing. nothing wrong with that, except of course that in a christian oriented mode of thought the suffering associated with a hard landing is good for you. builds character.

        Ofcourse withoutnaltrexone or similar medication it is true that our experience seems to show that only total abstinence works for by far the greatest majority, if not practically all. But we must not cling too hard to our convictions in the face of new evidence. AA has a lot of opening up to do.

        If only Bill hadn’t written thedamn book with three years sober we might have had something more sensible. nowadays it seems that oldtimers aren’t even willing to listen to any independent thought from anyone with less than 10 years sober, and even then only up to a point, but they gladly accept everything bill wrote with 3 years sober as everlasting truth.

        • Chris February 20, 2017 at 3:22 pm Reply

          Yes, I’ve heard of the “Dirty Chip” concept. If you accept a chip and you’ve had a drink it’s considered a “Dirty Chip”

          Maybe it’s wrong but I use my own interpretations. If I’ve been 6 months sober and controlled a binge with Naltrexone, I would still considered that sobriety.

          Likewise, I know agnostics who call the group or the program their “Higher Power”.

           

  6. Mike July 18, 2016 at 8:17 am - Reply

    It is beyond me how you can make a general sweeping statement that AA ” is a religion ” .

    I’m 3 and a half years sober ( in Scotland ) and attend on average 2-3 meetings a week these days and that hasn’t been my experience at all . In fact , if it in any way resembled a religion I would’ve run a mile . AA is whatever you want it to be and whatever keeps you sober , including the above , then power to your elbow .

  7. Jenny November 30, 2015 at 12:58 pm - Reply

    RE:  your postscript “They’re in England, but are beginning to set up in the US, too.”

    The C Three Foundation began in the US in 2013 when Claudia founded the nonprofit organization to do what doctors and other addiction treatment services did not do for her…explain that there were other options available for treating alcohol use disorder. C Three Europe came along about a year later. C Three Foundation and C Three Europe also collaborate to run a forum: http://optionssavelives.freeforums.net/

    • John S November 30, 2015 at 1:05 pm Reply

      Thank you for the clarification and for the additional information. It’s much appreciated.

  8. Bob c November 24, 2015 at 6:47 am - Reply

    I have also come to see the steps as descriptive, as much as prescriptive and I believe that’s what was also originally intended. In other words, this is what tends to happen when someone stops being addicted to alcohol.

  9. Laurie A November 24, 2015 at 6:11 am - Reply

    Fair enough. But the BB is not the Koran and does not contain the 10 Commandments. The caveats are there: it is meant to be ‘suggestive only‘, ‘we realise we know but little’, more will be revealed’. Why treat it as set in stone dogma when the authors didn’t.

  10. life-j November 24, 2015 at 12:40 am - Reply

    Thanks to all.

    My point with writing this article was two-fold: For one, to bring to everyone’s attention this apparently very successful way of helping other alcoholics medically, the other to bring attention to just one more way the BB suffers from being 75 years old.

    Last year I had liver cancer. So I went to one of the 10 best hospitals in the country, and said: “Can you please do the surgery the way they would have done it in 1939?”

    No, jus kidding, of course. My chance of survival would have been no better than my chance of staying sober in AA was. Not good. I was just lucky. But allow me to wrap this up with the dated quote I started with:

    “Physicians who are familiar with alcoholism agree there is no such thing as making a normal drinker out of an alcoholic. Science may one day accomplish this, but it hasn’t done so yet.” (1939)

  11. Fred S November 23, 2015 at 10:04 am - Reply

    Thanks, life-j, that was very interesting to me.  I have had a prescription for Naltrexone, and yes, the instructions were to take it daily and to abstain.  I really wish I had had this information then; perhaps it would have helped.

    As it was, I took the pills for a few days and when my craving had become intense enough, I decided to drink.  It wasn’t an out-of-control moment where all the time that I’m driving to the liquor store I’m mentally begging myself, “Don’t do this. Stop the car. Turn around now.  You don’t have to do this.”  No, it was a conscious, calmly considered decision to go get a bottle and get drunk.

    And because I was doing it for the effect it would produce, I reasoned that it would be defeating my purpose to take the pill which would nullify its effects.  So I quit taking the Naltrexone, and never started back up again.  After a few years of having them sitting in the back of the medicine cabinet, I finally disposed of them some time back when we had a city-wide campaign to get rid of unwanted prescription drugs in the proper manner (which is not by flushing them into the sewer).

    Had I been able to reason with myself, “Go ahead, cave in, get the bottle.  But take the pill, too; this whole episode will serve a useful purpose,” then I likely would have done it that way, and just possibly would have quit drinking sooner than I did.

  12. John L. November 22, 2015 at 7:54 pm - Reply

    I completely agree with Bob K..  AA is abstinence based, and has been so from the very beginning.  It is equivalent to common law.  In the “Akron Manual”, written within the year after the first meeting of an Alcoholics Anonymous group in May 1939, is stated:

    Definition of an Alcoholic Anonymous:

    “An Alcoholic Anonymous is an alcoholic who through application of and adherence to rules laid down by the organization, has completely forsworn the use of any and all alcoholic beverages. The moment he wittingly drinks so much as a drop of beer, wine, spirits, or any other alcoholic drink he automatically loses all status as a member of Alcoholics Anonymous.

    “One of the easiest, most practical ways of keeping sober ever devised is the day by day plan — the 24-hour plan. You know that it is possible to stay sober for 24 hours. You have done it many times. All right. Stay sober for one day at a time. When you get up in the morning make up your mind that you will not take a drink for the entire day.

    “Bear constantly in mind that you are only one drink away from trouble. Whether you have been sober a day, a month, a year or a decade, one single drink is a certain way to go off on a binge or a series of binges. It is the first drink – not the second, fifth or twentieth, that causes the trouble.”
    Non-alcoholics — who may sometimes drink too much, even for long periods of time — may possibly, and perhaps temporarily, go back to “moderate drinking”.  For true alcoholics, only total and life-long abstinence can arrest an inevitably fatal addiction.  And only with total abstinence can the body and all its organs, including the brain, heal themselves from the damage done by alcoholic drinking.

    I am more than skeptical of Naltrexone, a recent panacea from the therapy-pharmaceutical complex.  Many ostensibly scientific studies published in medical journals have been exposed as invalid or even fraudulent — e.g., by writings of Marcia Angell, a former editor of the New England Journal of Medicine.  Most “news” stories touting pharmaceutical drugs are concocted by public relations firms serving Big Pharma.

    There’s nothing good about “moderate drinking”.  Alcohol is not a nutrient; it doesn’t make life better.  As I was told hundreds of time in my first year of sobriety: “You don’t have to drink!”

    • John S November 22, 2015 at 9:37 pm Reply

      That’s true and I agree. AA is about not drinking and should remain so. This drug is not part of AA and it was a bit of a risk to run the story here, but it was meant to report on something that has been studied and is being discussed. I thought it was interesting and I know it’s been used to help people maintain abstinence. That seems to be how it’s mostly used in the US. The people who I’ve known who have taken it, says it helps with that but it has bad side effects.

      My heart and passion is definitely with AA and helping make AA more accessible and comfortable for the secular person, and that will be the overall direction of this site. I do think this is an interesting story worthy of discussion, but it’s definitely not the AA program, and this was and is in my opinion an outside issue. It’s something we might talk about over coffee after the meeting, but not during the meeting.

  13. Mike U November 22, 2015 at 7:15 pm - Reply

    I agree with you on this count, and really enjoyed your article, though I’ve never tried a pharmacological approach myself, I’d imagine there’s help on it for some others who may well need it. I find that people who argue that “everything else is perfect” in the BB clearly aren’t reading it. Considering that the BB concedes that “we have no monopoly” on the treatment of alcoholics, and that “we know only a little.” Just a small-minded kind of response I think.

  14. life-j November 22, 2015 at 5:35 pm - Reply

    Rob, please read the Postscript readings at the bottom, and listen to some of the testimony. Yes, you would start out drinking every day. and if you had no interest in doing things different, you would probably not take naltrexone in the first place, but if you were interested in reducing your drinking, or quitting altogether, by taking it as directed you feel like drinking less, and progressively so.

    I understand you’re trying to be funny, but if you wanted to keep drinking, then you’d just keep drinking, nothing would work, I doubt that AA would work either, you probably would realize that AA was interfering with your drinking and stop going –  only way anything is going to work is if you want change, and then take some kind of action to change, right?

  15. Rob McC November 22, 2015 at 3:52 pm - Reply

    Interesting concept, but since I intended to drink just about every day, I would have had to take the pill every day as well, thus damping out quite a lot of the rest of enjoyable life, like ice cream and sex!  And then, not being a total dummy, I would have realized that I WANTED to feel good getting drunk, and in order to achieve my stated goal, I would have rationalized some reason for not taking the pill.  Hhhmmmm…

    It seems that this system may work well for some sub-set of alcoholics, but I wonder how it would work in the general population of drunks.  As a physician, I am all for exploring the science of recovery, so GO SCIENCE!  SHOW US WHAT IS IN THE REALM OF POSSIBILITY!

  16. John S November 22, 2015 at 3:45 pm - Reply

    I first learned about the Sinclair Method and the film “One Little Pill” in September of 2014. This was a month after I helped start an agnostic AA group, and I was still coming to terms with being an atheist in AA. It was an interesting and exciting time in my life because every idea that I previously held dear was on the table subject to review, and if I had evidence that another idea was better, then out with old and in with the new!

    However, it was also during this time that I became gripped with thoughts of drinking, which scared the hell out of me. Here’s an article that I wrote about that:

    http://www.weagnosticsaa.com/thoughts-of-drinking-and-fear/

    It may be that learning about this put those thoughts in my head, but as I continued to examine and study, I knew that this wasn’t for me. I have been happily abstinent from alcohol for 27 years thanks to AA, and I don’t plan on changing that. As our group started taking hold, those drinking thoughts vanished and I was more interested in the new friends that I was meeting and all the people who were coming to our group for support.

    The information about naltrexone stayed with me and I once told someone about it so he could discuss it with his doctor. Again, not giving medical advice, but just relaying information so he could look into it on his own and talk to his doctor.

    I appreciate the effort that life-j put into the article. I thought it was well done and this is good information.

  17. life-j November 22, 2015 at 2:51 pm - Reply

    nice podcast! lots of good detail. thanks

  18. Roger C November 22, 2015 at 1:43 pm - Reply

    A well written and well researched article, life, as usual. Thank you very much.

    As Bill Wilson put it in 1965, “Research has already come up with significant and helpful findings. And research will do far more.” We should welcome scientific research and its findings. That, to me, is an integral part of AA and helping the suffering alcoholic.

    Encore une fois, merci beaucoup !

  19. life-j November 22, 2015 at 1:15 pm - Reply

    Thanks for all the responses.

    Well, this program started out as one alcoholic helping another. Then they decided to write a book about it. Then it was all over. Maybe there was no way around writing the book, if the movement was to grow,  but from then on the way in which one alcoholic could help another was proscribed. I’m all for keeping it simple and helping any other suffering alcoholic any way I can, the BB be damned. That’s what I’m here for, helping the next alcoholic quit drinking. Even if quitting means cutting down from 5 cases of beer a week to a sixpack, helped by one little pill. Whatever works. We have already questioned the god stuff. Before we’re done we may find ourselves questioning many more things about the BB and our program. We may eventually adopt a concept of spectrum based abstinence, even if the concept seems as foreign as an AA without god did just a few years ago.

    What gives us genuine reason to say “the god stuff in bunk, but everything else about the program is right”? I’m hopeful to soon write an article about the BB and just how illogical, manipulative it really is. It did rally all those who had been raised to base their lives on that other illogical, manipulative book – they responded well, and then a few of us who didn’t buy the god stuff stuck around anyway, we got helped by the one true and only really workable part of this program: One alcoholic helping another.

  20. Lovinglife52 November 22, 2015 at 12:13 pm - Reply

    Thanks for writing about the Sinclair method as I think it could help so many people. I have met many who have used it sucessfully after not responding well to other support groups including AA. I have met Dr Eskapa on several occasions and really think his book is important, as we do need medical ways of treating alcoholism. I really wish I had done more research on this when I was having problems stopping a decade or so ago. It could have saved me a lot of pain, before reaching the rock bottom point that I would not wish on anyone.

    Claudia Christian has done a great film on the subject called “One Little Pill” which explains how it works in a practical way and also shows how backward many are in the treatment industry. I have a small section on my own site about it with many links for anyone interested, including a long podcast with Dr Roy Eskapa.

    http://www.recoveringfromrecovery.com/category/sinclair-method/

    This looks like an interesting site. I made use of AA for about 18 months, then moved on. The support really helped me in the early days, but I wish there had been more people like you in the meetings I attended and less religious “thumpers”!

    • John S November 22, 2015 at 6:55 pm Reply

      Lovinglife52,

      Thank you for visiting. Your site looks great and I am especially interested in listening to the podcast episodes. I appreciate your comment.

  21. Neil F November 22, 2015 at 12:10 pm - Reply

    Thanks for the interesting article.

    I don’t know if this would have brought me to abstinence and at this point I’m not about to go back out to conduct an experiment but I am happy that the option is there for others. If it helps someone recover from alcoholism I will be happy for them just as I am happy when someone finds success with SMART, MFS or any other approach.  It’s not up to me to tell someone which approach they must use.  I’m happy to share my AA experience but I’m also happy to let newcomers know about the options.

    Thanks again.

  22. Bob K. November 22, 2015 at 11:45 am - Reply

    Although Life’s article is balanced and cautionary, I’m at a loss as to why it’s being aired on a website promoting AA. The AA prescription has NOTHING to do with attempts to find a solution of moderate drinking.

    I see a lot of danger in this to the reader with an alcoholic mind who may see only the parts he wants to see,  perceive and pursue an easier softer way solution, not involving total abstinence. The great fantasy of abnormal drinkers is to control their drinking. AA views that as a HUGE part of the problem.

    I get the attempt at open-mindedness, but Weight Watchers has no obligation to report Jenny Craig’s successes. Essays like this supply ammunition for those who claim that WE are not AA. Here’s a few extra arrows for your quiver, Fundies.

    My “BOOM” comment was about Laurie’s remarks.

  23. Bob K. November 22, 2015 at 11:05 am - Reply

    ^^^BOOM!!^^^

  24. Joe C November 22, 2015 at 10:23 am - Reply

    hey life-j,

    I saw a documentary on this practice in Europe and I find your article to be far more comprehensive-maybe it’s because you and I share the same interests and cautions around this sort of thing. We are all going to hear more about “evidence based treatment” and spin-doctors are going to massage data to improve their outcomes because of the cash that will flow their way from having superior “evidence” of recovery.

    The best way to stack the deck is to change the definition of recovery. Many have already done so, especially compared to our standards. We look at uninterrupted abstainence as the only successful recovery and some models look for any improvement in life and call that success. So we would see someone who binged every weekend  and now binges three times a year as an NA or AA failure. Some clinicians would count this as a success. Her or his life has improved and the impact on her or his health has improved – congrats for graduating treatment.

    Maybe we are rigid about what we call recovery, I’m not sure. But one thing is for sure; any organization that is rewarded by positive data will use the loosest definitions available.

    BTW, I don’t think articles like this are controversial at all (by Twelve Tradition definition of controversy). This is the type of thing one would expect to find in the grey pages of Grapevine.

  25. Jon S November 22, 2015 at 10:22 am - Reply

    Excellent article. Thanks for taking the trouble to write this. I’ve been trying to get the word out about TSM for some time. There’s a very interesting documentary by Claudia Christian, “One Little Pill” available on Vimeo I strongly recommend. C3 Foundation (Google for web site address) also offer help with prescriptions and free counselling. I’ve been sober via AA for some time, but feel this is an important addition to the tools of recovery. Know three people using TSM, two very successfully thus far. One is three years abstinent as a result.

    JS

  26. Mekratrig November 22, 2015 at 10:04 am - Reply

    Life-j, thanks for another excellent article.  I would much rather read such information about the more recent discoveries in addiction treatment, such as pharmacological extinction, CBT, Harm reduction, etc. — than to endlessly go over an 80 year old book Bill Wilson wrote detailing a religious 12 step ‘program’ of recovery filled with concepts and principles he cribbed from the Christian fundamentalist, evangelical, Oxford Group that AA was born in the midst of.

  27. Bob C November 22, 2015 at 9:35 am - Reply

    Hey Life-J. Thanks so much. Really enjoyed this.

    It’s as much because it changed my own rigid thinking a little on the subject of legitimacy in treatment for alcoholism.

     I mean effectiveness or even potential effectiveness clearly must be the guide, but I am also prejudiced from my own abstinence based lens.

    Also, it seems the Europeans are further ahead on this stuff as almost always. Its likely that strict abstinence ides about recovery have morphed into a kind of support for north america’s “tough guy management” approach to addiction.

  28. Bob C November 22, 2015 at 9:24 am - Reply

    Hey Laurie,

    Great points. I especially enjoy the reference to the “types” of alcoholic in the bb. Its not even written definitively! “There appears,” “it seems” and this sort of thing. But 80 year later when this section reads like some medical relic manual on civil war battlefield surgery techniques, hardcore AA’s quote this stuff like it’s just been written. Hilarious.

  29. Thomas B. November 22, 2015 at 8:45 am - Reply

    Thanks, life-j, for this article excellently researched and written. Though it has no relevance to my continued secular recovery through AA, you make cogent and important points about how many  in  AA ideally would be open to consider this as a legitimate tool for some alcoholics instead of knee-jerk dismissing due to adherence to their pure ideological preferences for AA in which they exercise “contempt prior to investigation.”

  30. John J. November 22, 2015 at 8:26 am - Reply

    Thanks for the article.  I have read Dr. Eskarpa’s  book.  Although I have been sober and abstinent just over a year and don’t have any plans to try the Sinclair Method, I have no doubt that it would be successful in controlling alcoholic craving and abuse of alcohol. The main reason I believe this is because about 8 years ago I quit smoking using a drug called “Chantix” which much in the same way “Naltrexone” must be taken while drinking for it to have positive Pharmacological Extinction results, Chantix is taken while you continue to smoke and the desire to smoke just goes away.

    Apparently Chantix attaches to similar receptors in the brain, the ones that Nicotine attach to and the pleasurable and stimulant effects of the nicotine are disrupted. For me, after taking Chantix as directed for about 10 days, I found I was putting out cigarettes after one or two puffs and just stopped. The pamphlet that comes with the drug says to continue taking the drug for 3 months. I stopped after about 6 weeks and never filled the last months prescription.  I have not smoked since and to this day have no desire to do so.

    Had I known about the Sinclair Method 20 or 30 years ago I would have tried it.  It would likely have made my life much different without the obsession and abuse of alcohol that affected almost every area of my life.  At this point, with over a year of sobriety and since “I” decided to stop and am not having any issues with cravings or desires to drink, starting to drink just to prove that the method works seems pointless and too risky for me personally.  I have recommended the program to other folks that I think could benefit from it. If any of them try it out I will forward the results.

  31. Laurie A November 22, 2015 at 8:25 am - Reply

    Tremendous stuff, very learned yet easy on the eye. Individual members can take any attitude they wish on controlled drinking – it’s a free country; but to AA as such controlled drinking is a Tradition 10 outside issue on which we do not take sides. Insofar as there is a collective view it is expressed in the Big Book which encourages those who can do it to ‘try some controlled drinking…’ advice which could amount to a death warrant for some problem drinkers! 

    Elsewhere the book refers to ‘people whose reactions are very different from ours’ (i.e. those of us who recognise we are powerless over alcohol); it acknowledges moderate drinkers who can ‘take it or leave it’, and ‘hard drinkers’ who also may be able to stop or moderate their drinking. AA’s primary purpose is to help drinkers who decide for themselves that they can’t stop or moderate their drinking.

    Let’s not mis-represent AA. To become involved in trying to help others with less life-threatening conditions would dilute our message and damage our effectiveness, which our critics point out endlessly and vociferously is infinitesimal anyway! No doubt if the Book were to be written today allowance would be made for the scientific advances referenced by life-j. For myself, I threatened to resign as trustee of a charity providing accommodation for homeless drunks if they were forced to go to AA as a condition of their tenancy and insisted that other ‘therapies’ were provided for those who did not want to attend AA meetings. As a result they were referred to organisations like SMART that offered controlled drinking as an alternative to abstinence.

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