Episode 89: The Sinclair Method

Transcript

00:00 John S.: This is Episode 89 of AA Beyond Belief the podcast, and I’m your host, John S. 

[music]

00:27 John: In today’s episode, I will be speaking with Gary Bell from Hartlepool, England. Gary and I will be discussing a promising treatment for alcohol use disorder, known as The Sinclair Method. The Sinclair Method utilizes the prescription naltrexone to eliminate addiction to alcohol, through the process of pharmacological extinction. Gary, who participated in the documentary film One Little Pill, is well-versed on the subject, from firsthand experience. And I’ll think you’ll find this an interesting discussion.

01:02 John: Hello, I’m here with Gary, and he is from Hartlepool, England. I hope I pronounced that right, Gary. How you doing?

01:09 Gary Bell: I’m doing very well, John. 

01:11 John: Well, it’s nice to have you here. We’re going to talk today about The Sinclair Method. And on AA Beyond Belief, we published an article about The Sinclair Method shortly after we started the site, and it’s been one of our more popular articles. It’s had like 27,000 views. Also, we have that same article on our YouTube channel, and it’s gotten like 4,000 views or whatever. So, it’s a topic that a lot of people are interested in. And Gary, are you actually practicing and following the regimen of The Sinclair Method yourself?

01:43 Gary: Not at the moment. I first went on to The Sinclair Method, it was actually five years ago. Well, it’s going to be five years come the 2nd of April, that it’s going to be my TSM anniversary. So, it’s coming up for five years. But what happened was was that using naltrexone, I was able to cut down my drinking through a process of pharmacological extinction, to the point where I just didn’t physically crave alcohol anymore. And what’s happened is I’ve been able to abstain. So…

02:21 John: That’s really interesting.

02:21 Gary: I am abstinent. There are some people who use The Sinclair Method to moderate, to socially drink, but I pretty much had such a bad time with alcohol for most of my adult life that I was actually quite keen to become abstinent. So, I don’t really mourn the drink. That’s why I actually I don’t take naltrexone myself now. You only take naltrexone one hour before you drink, you see.

02:49 John: Right. And one of our mutual friends, Jon Stewart, he told me that there was a certain percentage of people who use The Sinclair Method that actually do just become abstinent, I think he said it was 20% of ’em or something like that. I don’t know if that statistic is right or not, but he told me a good percentage of people actually do. There’s a lot to talk about here, it’s going to be an interesting topic. Why don’t we start, if you could describe the problem that you experienced with alcohol, and we’ll just go from your problem and when you started seeking help and how you discovered The Sinclair Method.

03:21 Gary: Okay, yeah. I first started to have problems with alcohol in my early to mid-20s. And it was during a period when I was suffering a lot of work-related stress, and I was turning to the booze because I wasn’t happy in my job, and it was quite a confrontational job working in the civil service. I had a lot of anxiety and a lot of insomnia, so, what I was doing was I was having a can of Carlsberg Special Brew, which is a popular drink here in England, once a night to help myself to sleep. So I was self-medicating, essentially. But what happened was that as I started doing this more often, my tolerance increased. So, rather than it being one strong can of lager a night, it became two and then it became three. And it ended up really affecting my job performance and making me feel quite ill.

04:26 Gary: And what happened was I reached a bit of a crisis point with it where I realized that I needed to knock the booze on the head. But much to my dismay, I found that when I actually tried to stop, I found it very, very hard. I found I could stop, stopping wasn’t the problem; it was staying stopped. I would come off a binge and then I would swear off the booze completely, saying, “That’s it, never again,” et cetera, et cetera. And then something would creep in one, two, maybe three days later, this little sort of… This voice in my head, saying that it wanted booze. I would find that I would have beer commercials running in my mind. So, at some point, I sort of crossed over into actual addiction without realizing it. And what happened was… This was back in the late 1990s, and there wasn’t much in the way of treatment services here in Hartlepool. There was an addictive behaviors service, but that was a service that catered more towards opiate addicts. What they did offer in the way of treatment for people with alcohol addiction was quite scant.

05:48 Gary: I found myself gravitating towards Alcoholics Anonymous because of course, whenever you switch on the TV or watch a movie, you’ve always got pretty much adverts for it on air.

06:03 John: Sure.

06:03 Gary: And it wasn’t like I expected it to be, not going on what I had seen in movies.

06:10 John: Right.

06:12 Gary: I was quite shocked, actually. But because there wasn’t really anything much in the way of an alcohol service, nothing that they could really offer me there, and there was just AA, it was a little bit like Hobson’s choice. So, I stuck with AA for a while. And I had problems with it, John, basically because I am an atheist and there were certain aspects of the language of Alcoholics Anonymous and also the 12 Steps which were like trying to fit in a square socket into a round hole for me, which I found very difficult to reconcile. But I did meet some lovely people there. And some of the people that I did meet there are still friends, and they do get a lot out of Alcoholics Anonymous. And it has, I believe, genuinely helped them. So, from that point of view, even though I had difficulty with it, and even though I couldn’t stay sober in AA, I’m not… Looking back on it now, aside from some resentments which I had when I left AA because I had a falling out with my former sponsor, a few years on, I look back at it and I think when it comes to people in AA, I think who it is working for, I think, good for them. So, I’m not anti-AA…

07:50 John: No.

07:51 Gary: Though I’ve gone on to use The Sinclair Method, a different treatment method. I’m not one of these people who you might see on the Internet who write all these angry things all the time.

08:04 John: Yeah. It’s ridiculous to be in camps when it comes to recovery, because there isn’t, in my opinion, and there shouldn’t be maybe, one solution that fits all people. What helps a person is what that person should do, in my opinion. And we’re fortunate, now, in this day and age, that there are more options available to people. And I’ll tell you, you are not the only one who is put off by the religiosity of Alcoholics Anonymous, [chuckle] there are a lot of us. And that is just going to becoming more and more common as we become more secular in North America, Europe, and everywhere else. So, yeah, very understandable. So, when you were going to these meetings, was it helping you at all? Were you still struggling with staying off?

08:55 Gary: Yes, I was still very much struggling. I mean, I did take some good things from AA. I thought that the acronym HALT was a very good acronym. I think we should explain for some people, it stands for Hungry, Angry…

09:11 John: Lonely, Tired

09:12 Gary: The four things which you should avoid being because they’re really bad triggers for someone who has this addiction. And I also got a lot out of the community aspect of AA. At its most basic, it’s about two or more alcoholics getting together to help each other, which is a brilliant thing…

09:41 John: Sure.

09:42 Gary: It’s just a lot of the other stuff.

09:45 John: Yeah, I agree. I think if there’s any great value to it, it’s that if a person is having a lot of life problems as a result of their addiction, whether it be legal or work or relationship problems, it’s nice to have a group of people that have had similar problems that they’ve been able to come out of, and talk with those people and be comforted by those people. That was my case, I think, was just having people who would listen to me in an understanding way, I think, was a value. But that was just my experience at that time. I’m like you, though, I was also surprised by the religious nature of it. When I went in there, I had no idea. I knew about Alcoholics Anonymous only what I would see in the movies and so forth, and they don’t really show people in the movies gathering around at the end of the meeting to say the Lord’s Prayer or all the other prayers and so forth. So, I was really surprised by that.

10:40 John: And I was not… At the time when I was first going to meetings, I wasn’t an atheist, but I became an atheist, or realized, rather, I was an atheist, decades later. And upon having that realization, it was  a difficult thing for me to figure out, “Am I going to stay or leave?” Or “How am I going to make this work?” And then ultimately, we can talk about this later, I found the Secular AA community where I feel at home. But can we go into a little bit about… Let’s start about what The Sinclair Method is. You mentioned pharmacological extinction, and from what I understand of this, is the theory behind this is that alcohol use disorders, which is the proper name for this, is actually caused by our reward system, so that when we drink alcohol, endorphins are released that make us feel good. So we’re being conditioned that a drink makes us feel good, and that is what sets up the addiction. Am I getting that right? And can you expand upon this a little bit?

Dr. David Sinclair

11:38 Gary: You’ve got the essence of it right. Yeah, what happens is that endorphins are released, and then the neural pathways which develop become super highways in the brain. So, what start out as little, small pathways become super highways, super reinforced. And it’s a bit like all the learning of behavior. You know how when you learn something to the point where it becomes ingrained and it becomes rote, like muscle memory? Well, something similar happens with alcohol addiction. And this is what it is, it’s all the learning. And what Dr. Sinclair, the inventor of this treatment, discovered when he was doing studies with rats, was that there was an actual way to potentially reverse that by using opiate blockers, which… They’re often used in medicine these days to bring someone who’s overdosed on heroin into recovery, to bring them out of that overdose. But it also works upon the endogenous opioidergic system, which is the endorphin system to actually block that. And what happens is when you take the medication an hour before you would normally drink, the reward system is actually blocked and no reinforcement takes place. And the more you actually drink with the endorphin system blocked, what happens is that these super highways actually start to shrink down again. So, it’s like nature’s delete button.

13:40 John: We actually restructure our brain. We rewire our brain.

13:43 Gary: Yeah.

13:45 John: I was… Oh, a few months ago, I had a podcast with Dr. Nicole Labor. She’s in addiction medicine, and she was talking about how the problem is a dopamine problem. And I guess it’s kind of similar, but maybe both things happen. Do you know anything about that theory of addiction, and if naltrexone also works with that part of the problem? The dopamine levels being raised through the consumption of alcohol?

14:19 Gary: Well, it’s interesting that you should ask that, because although I don’t really know much about the dopamine system, a good friend of mine, a guy called Robert Rapplean, who did some very early podcast with Dr. Sinclair when he was still alive, did actually mention to me that what happens is that as these neural pathways are actually altered, our dopamine actually decreases. So that’s something that Robert happened to mention. But it’s something that incidentally happens as a result of the process.

15:00 John: Got it.

15:01 Gary: So, that’s what Robert mentioned to me, which seems to make some sense. But I’m not really an authority on it.

15:12 John: Right. No, that seems to make sense. As I was reading on this a little bit, I thought, “Well, there’s a lot of things that are going on here. There’s probably multiple parts of our brain that are affected by this.” But this method has a 80% effective rate. How do they measure that, by the way? What is the successful outcome of The Sinclair Method?

15:34 Gary: It’s whether someone can get below… Whether they can get below the WHO’s recommended safety level. Whether they can get within that umbrella, so, I forget how many units it is a week, but if… Whether you can get within that safe range, that is a success. So it’s not necessarily abstinence; it’s whether someone can actually get within that range.

16:03 John: Right. To where you basically are drinking normally without developing the craving, going on binges, et cetera. I get it. Can you talk a little bit about your personal experience with this method? And if you could also just start from the beginning, how did you learn about it, and can you tell us about your experience when you first started doing it?

16:26 Gary: Yeah. How I first learned about The Sinclair Method is a little bit of a strange story insofar as that I actually learned about it from quite an unlikely place. I learned about it from the Orange Papers of all places, which [chuckle] is quite a famous anti-AA website.

16:48 John: Right, right.

16:49 Gary: And this was when I was going through my angry sort of phase against AA, after having just left. That’s why I was reading that website, because I was feeling a little bit disgruntled.

17:05 John: Sure.

17:07 Gary: I just happened to read references to The Sinclair Method on Orange’s site. And I believe it was in a couple of readers’ letters, in fact. I don’t think he’d actually written an article on it at that point. It was just that I’d noticed in the letter section that there’d been a couple of letters around it and a few people mentioning Roy Eskapa’s book, The Cure for Alcoholism. And when I first heard about this, I thought that it was a load of horse manure, to be honest with you. I was very skeptical about it, because… I think basically because I didn’t really have that much insight about how my own addiction worked, and I had all these sort of different ideas and different theories around how alcohol addiction works, with different models of addiction and stuff. And I’d always thought that it was like a mental health thing or some sort of psychological weakness. I didn’t really think of it in terms of a biological model, to be truthful. Not so much.

18:29 Gary: But when I did a little bit of reading around this, when I did a little bit of further reading, after looking at the Wikipedia page and eventually getting the book, it was a little bit like a light bulb moment as I read through Eskapa’s explanation of how the addiction actually works. And that, in combination with a lot of the studies which have been done. There’s been something like, I believe, it’s now over 120 double-blind placebo studies on this method, and a lot of them have been quite successful. They’ve shown some nice results, a lot of people either being able to reduce their alcohol intake quite substantially or being able to abstain from it. So there was a lot of evidence which was quite helpful, because it was quite convincing.

19:31 Gary: Anyway, what happened was that I was going through quite a bad spell around about 2012. My health was getting worse, I had really bad blood pressure. It was something like 165 over 105, my typical blood pressure readings. And I had cholesterol through the roof, and also my liver function tests was starting to look not good. And I was just starting to feel quite ill and not really very well, both mentally and physically. So, I wanted to stop, but I had this problem where I just couldn’t seem to abstain for any length of time. And this is what I think came to push me into investigating The Sinclair Method a bit more and also getting in touch with Claudia Christian, who I sent a message to on Facebook. And Claudia got in touch with me the same night, which is amazing…

20:44 John: Her TED Talk, by the way, on this is really excellent. I’m going to post a link to that with the podcast. She did a really good job with that TED Talk. In a very concise way, explains this and how… And her battles with alcoholism and her frustration with not being able to stop, and discovering this and what it meant to her. It was pretty powerful.

21:07 Gary: Yeah, yeah. One of the reasons why I got so involved with the campaign and why I agreed to take part in the documentary was as a result of my own frustration of not being able to access this treatment. Once I heard about it and then did my homework, and then once I went to visit my doctor and showed him loads of stuff which I printed out and showed him the book, I was just met with absolute derision. And it was horrible because I was met with derision when I tried to show him this stuff on this method which is supposed to be really successful. And it was just horrible, not being able to access it yet knowing that it could really potentially greatly help me. I felt a little bit like… It’s a little bit like someone with a terrible illness such as diabetes or some form of cancer or something discovering a treatment that could potentially really help them and being denied it, you’d feel quite angry.

22:26 John: Yeah. It’s really weird, isn’t it, that it wouldn’t be more well-known. You would think that doctors would be up on science and they would be reading these studies and would want to try it with their patients, especially when so many of them are not being helped through the entire abstinence model. It’s interesting, when I was reading about all of this, that the entire abstinence model, I guess it’s great for me because I’m abstinent now, but they always say in AA that if you go back to drinking, it’s going to be as if you had never stopped that entire time. And it seems like the science kind of bears that out, that when you… If you are abstinent, it just makes your next relapse all the worse.

23:11 Gary: Yeah, it’s interesting that you should mention that because this is exactly what Dr. Sinclair found from his studies, was that once someone gone through rehab and they’d become detoxed and got past the physical stages, it didn’t actually end there. There was a psychological element of craving that still existed even after physical dependence ended. The name that he used for it was the alcohol deprivation effect…

23:46 John: Yes. Right. I’ve heard that

23:48 Gary: Yeah. And what he wrote was that this actually increases with abstinence, which is what he found, was that the longer you would actually deprive yourself of alcohol, having become addicted to it, the worse the craving would get it. And it would actually go up like a gradient. And so it’s quite interesting that you should point that out because I think that there is a lot of truth in it. The longest I ever was sober whilst I was in AA was six months. I think it was actually just under six months. And I can tell you, it was horrible. It was white-knuckle city trying to stay sober. It was awful. Even though it wasn’t an issue of physical dependence so many months in because of course the alcohol was out of my system, so…

24:56 John: Right. 

24:57 Gary: I didn’t needed to stop me having a seizure or anything like that, still, there was something wrong. There was something there that was a constant craving, and it was like… What would happen is I would have to step on eggshells around my triggers, because if I felt… It goes back to the HALT thing again, if I felt hungry, angry, lonely, tired, anxious, whatever, straight away, I’d be getting these beer adverts in my head.

25:33 John: Sure. Yeah, the first six months was hell. But even after that, it was… Even into my second year, the closest I ever came to drinking was during my second year. In AA, especially the group I used to go to, I used to hear people say all the time that their desire to drink was lifted. Now, these were all people who believed in God and so forth. I’ve never had it lifted. I don’t know. To this day, if I could drink, I would. I just love it. And that’s kind of an odd thing. I’ve been sober now for… I’ll be coming up on 30 years in July. And it’s not like I think about drinking very often; I don’t. Hardly ever do I even think about it. But I could at times. And I’ll tell you, one time when I actually… [chuckle] It was fairly recently, a couple years ago, when I first heard about The Sinclair Method, I thought, “Damn! That is what I want to do,” [chuckle] “exactly what I want to do.”

26:27 John: But obviously, I’ve learned that that’s not… This is not for someone like me, who has been abstinent for a long period of time. It’s not something that they would recommend for someone like me. But I do find it interesting that there’s still a part of me that does long for it. And I guess I just have to… I guess the more I think about it, the more I could exacerbate that, I guess. But I just kind of focus on what I’m doing, and I guess I’ve got to the point where I’m more rational about it, so that even though there’s a part of me that would love to drink, there’s the rational side of me that does take over now, that says, “No, my past experience tells me clearly I cannot drink normally.” So, that, and then all the support that I get from people as well I guess helps me out. But enough about me. So can you tell me about when you started The Sinclair Method? How did you finally get a doctor to prescribe it? And can you go into what it was like for you as you started using this method?

27:31 Gary: Yeah, sure. Yeah. Unfortunately I didn’t go the route of actually getting the medication from a doctor. I was very naughty and I actually imported it from Canada, which, strictly speaking, is illegal. But I simply couldn’t get it from anywhere here in the UK. There was a possibility that I could get it prescribed privately, but money was an issue for me as well at the time. So, given that I felt a little bit like Oliver Twist begging for his bowl of gruel…

[chuckle]

28:09 Gary: Going to the medical services and getting doors slammed in my face, I sort of pressed the ethic button and just said, “Right. You know what? That’s it. I’m going to import the damn stuff from an online pharmaceutical vendor.” And that’s what I did. And it was around about Easter 2013 that I actually got my package. I believe that it was 60 tablets that I ordered. And even though I ordered it through Canada, it was actually delivered from a factory in India, which was quite interesting. But in any case, there I was, armed with my copy of Roy Eskapa’s book, The Cure for Alcoholism. That sort of became my equivalent of AA’s Big Book…

29:01 John: Right.

Gary and Claudia

29:02 Gary: I was doing this. So I sat there, with this book and with a stopwatch, and I got the first pill out and I already had my alcohol there which I bought from an off-licence in my town. And I set the stopwatch for one hour, and then I took the pill. And quite truthfully, I wasn’t that impressed from the first session with it. There’s no bolt of lightning, I didn’t feel really much in the way of any sort of dramatic difference. It is interesting, though, because looking at… Because I kept a drink diary, which… I’ve actually kept my drink diaries and they’re on my blog, by the way, if anyone wanted to look at them. But what’s interesting is that with that first drink diary, something I did note was the fact that for some reason, my first drink tasted a bit less sugary. But after that first can, I didn’t notice any perceptible difference.

30:08 Gary: It depends upon who you ask, really, when it comes to using naltrexone. Some people say that it has a very big numbing effect on them. But other people, such as myself, don’t feel that much in the way of any difference. Also, another thing is that like any medication, there are side effects there as well, and again, I didn’t really have any issues with side effects. So, really, going through this process, I was very lucky. It was very much without incident. And as I found that I got through the first week and then the second week using these pills with each drinking session, I found that quite quickly, there was a decline in the amount that I was drinking. It was interesting because I’d have my can of Carlsberg Special Brew on the coffee table as I was listening to music or watching TV, and I would forget that it was there, which never happened to me.

31:20 John: No.

31:21 Gary: But I’d be sitting for an hour or so, my TV program would end… I love loads of American cop shows, I’m..

[chuckle]

31:32 Gary: Things like Law and Order. So something like that would end, and then I’d idly glance at the coffee table and I’d think, “Ooh. Hold on, I haven’t drank the rest of my can.”

31:44 John: Interesting.

31:45 Gary: Yeah. And in any case, that went on for 13 weeks, and what I found was that I was drinking less and less. And another interesting thing happened was that, as I mentioned about this specific brand of alcohol, this really strong stuff that’s 9%, Carlsberg Special Brew, I found that a few weeks in, I felt quite sickly… I felt quite sickly, it felt too strong for me, and that’s because I was gradually reducing. So as I was gradually reducing, my craving was reducing, and as I was drinking less, my tolerance was reducing as well. So this stuff, which I was absolutely in love with, now suddenly tasted like muck, and…

32:44 John: Did you have any pleasurable effects at all from the alcohol?

32:48 Gary: Oh, yeah, sure, I did, initially, as I was going through the process. But as I said, what happened was that it started to be very strong for me. And I imagine that the Carlsberg Special Brew became a little bit like how it is for a civilian to drink it, because most average people who drink it want to spit it out.

[laughter

33:16 Gary: So, it wasn’t a sign that I was becoming abnormal…

[laughter]

33:21 Gary: It was a sign that I was actually becoming a civilian again.

[chuckle]

33:27 Gary: “Civilian,” by the way, is my term for normal people.

33:31 John: Right. [chuckle]

33:33 Gary: So, what happened was I started… I went to the off-license and I bought some Newcastle Brown Ale, which is a substantially weaker drink, it has a much lesser alcohol content. And I started drinking that as well for… Instead for the final few weeks, and I just tapered off with that. And I reached a point where… Because they’re not very big, these bottles of Newcastle Brown Ale, I reached a point where I was just drinking maybe like half a bottle of that a night, which isn’t very much quantity-wise. And then I just stopped. And that was what we call our extinction point.

34:20 John: That is so interesting. And so you just stop, you’re just abstinent from… You don’t drink at all.

34:25 Gary: I have drank on a couple of occasions, a couple of special occasions over the convening years. The last time was two years ago, but I’ve always drank with the naltrexone in my system since then. So on these two occasions, I did have some naltrexone in my actual flat. So, I was able to take it and basically vaccinate myself against becoming re-addicted.

34:56 John: Right. Gosh, that’s wonderful. I thought it was interesting, when I was watching the documentary, Claudia seems to use this… She carries the pills with her all the time. So that she drinks regularly and she’ll just take the naltrexone, if I understood that right. So some people will do that for the rest of their lives, I suppose. And then other people, a good percentage of them, might just go on and say, “Oh, I don’t really care for it.” They might not hardly ever drink, I guess.

35:28 Gary: Interesting question. I think that what happened to myself was that I just wanted it to end, pretty much. I felt as if over the course of my adult life, I drank more than enough for a lifetime. I just wanted it to simply end. I think that also what’s happened is that… You know what? I thought that becoming abstinent was going to be really boring.

[chuckle]

35:57 Gary: I did. I thought that it was going to be boring as hell.

36:00 John: Yeah.

36:01 Gary: I absolutely love it. I love having that freedom again. And also that extra bandwidth in my head now that I’m not addicted, that I can use to concentrate on other hobbies, and…

36:15 John: Absolutely.

36:16 Gary: I mean, there’s so much which I do nowadays which I wasn’t able to do when I was still drinking, that I’m so grateful for. One thing which I’ve got into in a big way is weight training.

36:34 John: Oh, okay.

36:35 Gary: A hobby of mine is powerlifting. And I go out to the gym three or four times a week, and I’m up to over 110, 120 bench press now.

36:48 John: Oh, goodness.

36:48 Gary: Yeah, yeah. And it’s great, it’s like a new lease of life. It’s a little bit like having a second mid-life crisis. [laughter]

37:00 John: Yeah, it’s funny. It seems like I’m lately speaking with people who love to exercise. [chuckle] I used to. I used to, but after I got into podcasting, all exercising stopped. And I need to find some balance, as they say. So, I think that this is a very promising thing. I don’t know if there’s a human being alive that hasn’t have been affected in some way by alcohol use disorder, whether it be someone in their family, a good friend, or themselves personally. Of course I’ve been in AA for a long time, so I’ve known countless numbers of people who have died from this. I have been with them when they have gone through the agony of withdrawal. I’ve had people in my family, I have currently a brother who’s struggling. I’ve seen people come in and out of AA struggling. In fact, there was one time, after I learned about The Sinclair Method, there was a guy who… I really liked him, and he was just struggling with it, not being able to stay sober, and I said, “Have you ever heard of naltrexone?” He had never even had heard of it. I said, “You should talk to your doctor about it.”

38:09 John: But of course, over here, they don’t prescribe it the way that Dr. Sinclair would ask that it be prescribed. They do it, I guess, as a way that you take it every single day and then you don’t have a craving. I don’t know how they came up with that. But anyway, I thought it was appropriate for me, at the end of the meeting, to let him know that this exists. I think if my brother-in-law had known about it and had tried it, it could have saved his life. I watched him go through withdrawal, and it was the most horrifying thing I’ve ever seen in my life. And when he got out of the hospital, they sent him to the Salvation Army. And he didn’t… He’s somebody who had been abused by religion. And he couldn’t stand it, so he left. He’d said if this is the cure for alcoholism, he didn’t have anything to do with it. So he ended up dying. And how wonderful it would have been to be able to say, “Hey, look, here’s an option, try this. Try taking this and see if it works for you.” It could have made all the difference in the world.

39:11 Gary: Something else which I do think is, why not combine the best of both worlds? Why does everything always have to be so binary, reduced to the option of either or or? Why not actually combine something like a 12-Step format, a Secular AA group, and TSM? Because even though the protocol of The Sinclair Method goes against The Doctor’s Opinion, it goes against what Dr. William Silkworth wrote about abstinence being the only way, the fact of the matter is…

39:52 John: Of course he practiced medicine in the 1930s, by the way.

[laughter]

39:56 Gary: He did. But the fact of the matter is that the only requirement for membership of the AA is a desire to stop drinking.

40:05 John: Right.

40:06 Gary: So, if someone has that genuine desire to stop drinking and they’re using The Sinclair Method for that goal, then could they not say that… Could they not qualify for AA membership?

40:25 John: I think they would, quite frankly. I see room for that. Yeah, if someone is going… And this might be the future, too. Doctors may prescribe this for people, they might say, “I’ll tell you what. Here’s a method where we can cure your alcohol use disorder. You’re going to take this pill one hour before you drink. And I know you have all these other life issues going on associated with your drinking. And you’ve got these various support groups you can attend. AA, you have Refuge Recovery, you have SMART. You have all kinds of different resources that can be used along with the medication.” Heck, I did the same thing for depression. I take an antidepressant medication, but I also benefit from therapy. So, yeah, I see room for that.

41:18 John: Now, the problem with AA is that it’s stuck in the past. But I think there’s a growing movement within the fellowship of trying to bring us more into the 21st century, hopefully prepare us for the 22nd century. But even within our Secular AA community, and we’re pretty open-minded, it’s kind of a controversial topic. A lot of people believe that, “Oh, it’s not our job to let people know of other alternative solutions and so forth.” I disagree. I guess it’s not AA official responsibility, but I think as a human being, I have a responsibility to let people know of different avenues of recovery, in my opinion. Yeah, there’s definitely resistance now. We have a battle just trying to get modern literature written that addresses the program of recovery of AA and the language of the 21st century. [chuckle] So, updating The Doctor’s Opinion, by the way. Yeah, Dr. Silkworth who practiced medicine in the 1920s and 1930s, how relevant is he in the 21st century?

42:27 Gary: Yeah, yeah. It’s interesting because the way Bill W actually looked at the disease of alcoholism was he saw it as a threefold illness: Physical, mental, spiritual. He saw the program of alcoholics as a way to actually combat the mental and the physical aspect, and what he looked at with niacin, something which he wrote three pamphlets on, very famously, was to try to find a way to help people to combat the biological component.

43:07 John: Sure.

43:08 Gary: And it just really interests me, because I wish that there was a time machine. You know what I mean? A time machine to actually bring Bill Wilson into the here and now and actually show him The Sinclair Method, because I don’t necessarily think he would be averse at all.

43:29 John: Oh, he would’ve tried it. He tried LSD.

43:32 Gary: Yeah, yeah. It just seems quite strange when I speak to some AA members and they seem to be very anti-medication, and it sort of makes me think, “Well, you don’t really know your own history because of course your own founder was quite pro-science.”

43:52 John: Within AA, like within the rest of society I guess, there’s a bit of a divide. You’ve got a large percentage of people who want to replicate the past. Rather than build on the work of the people who preceded us and look forward, they believe that they have to follow the exact way that they think these people did it back almost a hundred years ago now. I find it frustrating. But I think what will happen is as society changes, people… The older that damn book gets, the more ridiculous it gets. Our group now, we started a Secular AA group in Kansas City, we don’t use the Big Book. It would be silly. I mean, I can see it as an historical document to understand where we came from, but the language of that book doesn’t speak to the 30-year-old of today. [chuckle] You know what I’m saying?

44:53 Gary: Yeah. Yeah.

44:53 John: So, yeah. But I speak as an AA member and someone who loves it, but I also recognize a lot of the flaws, and I’m a little frustrated also with this love for the past, this weird desire to cling to one specific narrow-minded way. And that’s not to say that The Sinclair Method is for everybody. It’s not for me. But it might have been for my brother-in-law, who’s no longer with us. My sister-in-law, maybe she could benefit from it. I don’t know what her status is now. I worry, too, there’s a lot of people who are waiting for liver transplants who can’t stop drinking. I wonder if The Sinclair Method would help them.

45:38 Gary: Good point. It might… At that stage, where someone has actually got a cirrhotic liver, it may be prohibitive to prescribe naltrexone, given that it does have hepatic toxicity potential. I can’t believe that I just pronounced those words correct.

[laughter]

45:58 Gary: I’m amazed at myself. But it can put a little bit of strain on the liver. But…

46:03 John: Yeah, that makes sense.

46:04 Gary: For normal people, it’s only at six times its normal optimum dose. So putting that into perspective, it has about as much risk as paracetamol. Paracetamol is quite safe taken as one tablet or even two tablets, but for even the slightly-built man, six paracetamol tablets can actually be quite dangerous. So…

46:32 John: Yeah, that makes sense.

46:34 Gary: I think the liver toxicity issue when it comes to naltrexone is perhaps a little bit overstated. But it does need… But yes, you’re quite right, it’s something that any physician needs to bear in mind.

46:51 John: Yeah, it’s heartbreaking. I read a study not that long ago about liver transplant patients, and it’s just really, really, really sad. These people are dying and their life depends on a new liver and… Anyway. So…

47:08 Gary: Oh! Something I should…

47:09 John: Go ahead.

47:09 Gary: Quickly mention. Sorry to interrupt you. We’re just talking about the potential for liver toxicity. There is nalmefene, which is in fact naltrexone’s sister drug..

47:21 John: Oh, yeah

47:22 Gary: That’s actually available on the NHS now, in Britain and in other places. That, in fact, isn’t processed through the liver.

47:34 John: Oh!

47:34 Gary: So that doesn’t have the same potential for liver toxicity that naltrexone does. But the caveat is that it does come with other side effects, issues with it. So there is that to bear in mind potentially, if the liver is… It is a bit of a worry, a bit of an issue.

47:58 John: I was wondering that too, if the National Health Service in the UK is now beginning to prescribe this, and if doctors in the UK are now recommending The Sinclair Method.

Gary today.

48:10 Gary: Good question. Honestly, John, it’s a geographic lottery in the UK, with lots and lots of places not prescribing it. Even though they should be prescribing it, they’re not, which is a shame. But it is interesting because I do have a friend of mine, a gentleman called Paul Turner, who is… He’s actually quite a high-ranking… He’s a nurse who works with his partner in this private clinic. And it’s interesting, what he said about the fact that even though nalmefene is available, they do actually prefer to prescribe naltrexone because it, in fact, has less side effects, which is interesting.

49:01 John: Yeah, I don’t know if it’s used in the United States. I know that people use naltrexone, but not the way that Dr. Sinclair suggested that it be used. I’ve actually had people in my home group who’ve talked about the benefits of using naltrexone, and who have actually drank on it, and I think that their relapse was less significant because of that. In fact, at one of our meetings, the guy, [chuckle] this is funny, he thanked AA and naltrexone for his sobriety.

[laughter]

49:33 John: So that might be the future, I don’t know. [chuckle] But only at our group would you hear that…

49:39 Gary: Well, I’ll tell you what. Science is just as good as any other higher power, I think. I mean, I think if you’re going to choose a higher power, then why not use science? Why not use pharmacological extinction? Hey, it’s better than a rock or a doorknob…

50:00 John: Right. Yeah, I love science, and I’m very interested in the science of addiction, too. And have really only become interested in it, believe it or not, fairly recently, over the last year or so. I’m learning more about it, and it’s a fascinating topic but it makes sense. A good book I would recommend to you that if you haven’t heard about it, it was written by a fellow Englishman, it’s Alcohol Explained. And he talks about how people become addicted to alcohol much the way that it’s described by The Sinclair Method. But it’s something that you might want to check out. And he also has a blog and a Facebook page that’s interesting.

50:41 Gary: I’m just looking for a pen. [chuckle]

50:43 John: Yeah. His name’s William Porter. Alcohol Explained. Now, he advocates abstinence, but he actually… When he wrote his book, he says, “You don’t have to stop drinking when you’re reading this book. Read this book,” and he actually encourages people to track their drinking and ask themselves how they feel when they’re drinking and so forth. Because the whole idea is that, pretty much just as Sinclair described, it’s almost a learned behavior, that you get these rewards from drinking. And then when the alcohol leaves you, you become a little bit irritable because you’re not… Anyway. I’ll let you read it. So, thank you. Very interesting conversation. I’d like to get, if you can email me later, the links to your blog so I can post that with the podcast.

51:36 Gary: Sure, yeah.

51:37 John: And we’ll also post some links to… I think this is a new website, thesinclairmethod.com.

51:44 Gary: Yeah, that’s actually a website that my friend Mike Dempsey set up.

51:48 John: Oh!

51:49 Gary: I believe that’s the guy who did the article you mentioned at the beginning of this podcast. I believe he was actually the author.

52:00 John: Yeah, I would recommend that. It’s a really cool website. And actually, I was reading from that website to  prepare for this interview…

[chuckle]

52:08 John: So it was very really helpful. Some good information out there. And then what’s the other foundation called? Is it called CH3? Or C…

52:16 Gary: It’s C Three Foundation.

52:18 John: The C Three Foundation?

52:18 Gary: Yeah, this…

52:19 John: I’ve actually gone on there, they have a forum on there. And I actually went on there because I was concerned at one time about my sister-in-law. And I guess she’s doing okay now, but… Anyway. It’s nice to have that outreach where at that particular place, you can go on that forum and you can learn about maybe people who know doctors who do prescribe naltrexone using The Sinclair Method and stuff like that. That helps people network, and it’s handy.

52:47 Gary: Yeah! Sure., I can send you some links for your readers. Yeah, I’d be quite happy to do that.

52:53 John: Well, thank you very much, I really enjoyed this conversation. It’s been enlightening. It might be a controversial subject for some of my listeners, but that’s okay. I think that it’s important that we educate ourselves about the newest treatments in drug and alcohol addiction. Because there’s a lot going on out there, and this is just one option of many out there that will help people. It won’t help everybody, but it certainly helps a lot people. Thank you very much, Gary.

53:20 Gary: Thank you, John It’s been a pleasure. 

[music]

53:26 John: And that concludes another episode of AA Beyond Belief the podcast. Thank you for listening, everybody, I certainly appreciate it. I hope you enjoyed that episode as much as I enjoyed having the conversation with Gary. What a great guy he is. Next week, we’ll be speaking with our friend Bob K, who has written a new book. It’s actually an historical fiction about Bill W. So that should be interesting. A lot of good stuff coming up. If you enjoy this podcast and would like to support us, please consider making a monthly donation at Patreon. You can visit our Patreon page at patreon.com/aabeyondbelief. Only if you can do it. A dollar or two a month will help out a great deal for paying for the expenses of the podcast. So we’ll be back again real soon. You all take care and be well.


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  1. Justine April 25, 2018 at 7:54 pm - Reply

    This is crazy. I just watched Claudia’s TED talk on Monday , emailed my Dr ,and today he said he’ll prescribe it to me ! Then this morning this podcast showed up in my email .Wow ! I’m seeing my Dr on Friday ,he is aware I want to try TSM .

    • Gary Bell April 26, 2018 at 6:29 am Reply

      This is great news, Justine!!!! I hope it really works out for you.

      P.S. Claudia’s TEDx talk is great, isn’t it? She’s doing marvellous work. She really gave me the “push” that I needed to give The Sinclair Method (TSM) a go over 5 years ago and I can tell you that I’ve never looked back. I recently did a really fun video podcast with her for my YouTube channel to mark my 5th TSM “birthday”, by the way: https://www.youtube.com/watch?v=NBa4Szg1kjI

    • John S April 25, 2018 at 9:08 pm Reply

      Good luck, Justine and thank you for listening.

  2. Phil G April 25, 2018 at 7:36 pm - Reply

    Ironically, I listened to the podcast on the way to Houston to help get a friend on Suboxone maintenance, which is a medically assisted option for opiate dependency. Basically, it eases both withdrawal symptoms and cravings. One of the ingredients is naltrexone. It is still undermined if his insurance is going to cover any of it. And he was unable to find a doctor or facility in small town suburbia that would prescribe it, hence a 1.5 hour drive, probably daily for a while. They both still adhere to residential treatment where you are isolated from the world, then released to face life with only support groups for help. Suboxone maintenance has some similarities to the Sinclair method with some of the same problems.

    • John S April 25, 2018 at 9:10 pm Reply

      Thanks for listening, Phil. I wish your friend well. He’s fortunate to have you in his corner

  3. life-j April 25, 2018 at 5:44 pm - Reply

    Hmm, so here we have this great podcast, and it seems by the fact that its the end of the day and no-one else has commented, that this is just not at the top of anyone’s list, helping alcoholics quit, if it isn’t done the AA way. Even among agnostics! WTF? Is AA a religion to us, too, just one without a god, or do we really mean that we feel responsible?

    Anyway, John and Gary, thanks. It is apparently a long way to get out of faith healing, even for us. I hope the debate picks up. I guess too many people hold antabuse as the standard for medicinal recovery, though that is a horrible medication, all it does is for an alcoholic to fear for their health if they drink, and we aren’t that fearful to begin with. Antabuse does not address the actual problem any more than if you give a person mineral oil to drink against a bad cough. But naltrexone does.

    It’s another uphill battle to get doctors to prescribe naltrexone in the off-label manner, instead of the FDA way, which apparently does not really work.

    Evangelical recovery does have a stranglehold on us, it would appear. One more thing to fight…..

     

    • Gary Bell April 26, 2018 at 6:12 am Reply

      Hello life-j,

      Thank you for your kind words. It was a blast doing this interview with John. You bring up some interesting points… you’ve given me pause for thought, actually.

      Part of the problem, I think, is that even for a lot of people who aren’t that pro-AA something like The Sinclair Method is difficult to process because its mechanism of gradual pharmacological extinction as opposed to abstinence is quite hard to swallow. This is something that I sympathise with because I remember that when I first read about The Sinclair Method my gut reaction was something like “Whaaaaat?!??? Hold on – you actually have to take the pill AND drink in order to gradually erode the craving? That’s just nuts”. So I was quite sceptical myself before doing further homework and realising that, contrary to my disbelief, it was actually grounded in solid science with scores of medical studies to back it up.

      Regarding your comment: “It’s another uphill battle to get doctors to prescribe naltrexone in the off-label manner, instead of the FDA way, which apparently does not really work”… gosh, yes… you’re quite right; that’s something that’s still a real hindrance. What some people have privately told me is that their doctor has got round this dilemma by telling them that whilst he or she is still obliged to prescribe it according to that protocol they’ll more or less tacitly “wink” and say something to the effect of: “…But if you decide to take it according to The Sinclair Method, then I cannot stop you”.

    • John S April 25, 2018 at 6:21 pm Reply

      Thanks, life-j. I don’t see it that way. Podcasts don’t generally garner a lot of comments. It takes awhile for people to invest the time to listen or read the transcript and usually they are listening on the run, so podcasts are a little different in that respect. It was interesting to get the first-hand report from someone who actually used the Sinclair Method and is so knowledgeable. There is a lot of good information here and also in the article that you wrote on the subject. Your article about the Sinclair Method remains the most read article on our site.

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