At Kentuckiana Integrative Medicine we offer a variety of different approaches to detoxification from opiates, alcohol, cocaine, meth etc. Each patient’s preferences and individual situation is considered. We can prescribe suboxone and wean you off in 30-60 days or 6-18 months depending on your situation and preference.
Thanks to Dr. David Sinclair’s research, you may not find a better solution to beat Addictions including Alcoholism, Drug Addiction [Heroin, Opiates, Meth, Cocaine] even Gambling Addictions.
The Sinclair Method has a 78% success rate.
NOTE: The Sinclair method to cure addictions involves taking naltrexone which is a very safe medication that is generally free of side effects. However, it should NOT be taken if you take narcotic medications, have liver disease with elevated liver enzymes or are pregnant. Narcotic-Heroin addicts may start naltrexone after being off opiates for 72hours. Starting while taking opiates can precipitate withdraw and even death.
Alcoholics, meth and cocaine addicts can start immediately. In fact, alcoholics must take the medication 1 hour before drinking and must drink alcohol if they are to succeed. Very few methods of treating addictions are as effective as naltrexone.
RAPID DETOX PROGRAM: For those wanting rapid safe detoxification from narcotics like oxycodone, heroin, suboxone etc., we offer monitored ketamine IV anesthesia sedation with IV naltrexone which displaces ALL the opiates from the body. This process is also called Anesthesia Assisted Rapid Opiate Detoxification (AAROD). Essentially, in 2-4 hours a person can go through withdraw WITHOUT experiencing the nasty side effects of WITHDRAW because they SLEEP through the withdraw side effects waking up with little or no symptoms. You will NOT be intubated [tube in trachea]. You are gently sedated and monitored so you sleep through withdraw like when having a colonoscopy. Once opiates are out of the system, successful recovery-sobriety becomes not just a frustrating impossible goal but a reachable reality. Then naltrexone orally daily or Vivitrol [naltrexone monthly injections-if you prefer and covered by your insurance provider] will help control your cravings while you develop coping strategies.
We can also help patients by replenishing the patient’s body with nutrients, B Vitamins from a Myers-Gabys IV cocktail and we help detoxify the body using high dose IV Vitamin C and IV Glutathione therapies.
Next you can select counseling, naltrexone orally daily or Vivitrol [naltrexone monthly injections-if you prefer and covered by your insurance provider], an Intensive Outpatient Home Based Program or an Intensive College Dorm-like Based Program. Treatment programs approach and lengths are tailored individually based on individual needs and preferences.
Insurance coverage may be available for the counseling portion of program. The IV treatments ARE NOT covered by insurance.
Cost are variable depending on complexity of the medical situation and length of treatment.
The first step toward successful treatment involves profound shifts in thinking about excessive drinking and alcoholism. The Sinclair Method is based on a completely new understanding of how alcohol addiction develops and how it can be permanently cured by removing the addiction from your brain and nervous system.
Understanding how the treatment works will ensure that you solve your drinking problem smoothly and efficiently. It will also show those of you who are only beginning to develop a problem how to prevent or inoculate yourself against one in the first place. Many people will think it’s crazy that if you have a drinking problem, alcohol can actually be necessary for recovery. The research, however, proves drinking is necessary – but only if you take naltrexone or nalmefene whenever you drink. Most of us think of addiction as a deep-seated problem, virtually impossible to conquer. But now, clinical trials based on the Sinclair Method have proven otherwise. While heavy drinking and full-blown addiction to alcohol must be treated as a very serious condition, the latest research proves that it is not nearly as difficult to prevent or cure as it used to be. Now, millions of lives can be freed of compulsive and addictive drinking without resorting to torturous and antiquated treatments.
NO ABSTINENCE ALLOWED
Unlike other alcohol treatments, the Sinclair Method does not demand that you stop drinking. Perhaps you have avoided going into treatment, not only because of the stigma associated with being labelled alcoholic, but because you will have to stop drinking completely. It is perfectly understandable that many people cannot picture their life without alcohol, dread a future of deprivation, craving and total abstinence. The Sinclair Method is good news for those who wish to carry on drinking moderately – it allows you either to stop completely or to carry on drinking safely. Many of you may have already tried to control your drinking using some higher power, willpower, with religion, on your own with professional counselling, or through a traditional support group like A.A. Some of you may have been through expensive private treatment programs, only to find yourselves relapsing back to heavy drinking. Studies prove that many alcoholics manage to abstain for a few weeks – even months – at a time. This is especially true if you have just started traditional rehab and are feeling optimistic about going straight. But as time passes without having a drink, feelings of deprivation close in and the craving for alcohol intensifies. You might be able to resist the impulse to drink the first time, the second, and the third. But all too soon, you find it impossible to resist the craving, and you relapse back to drinking. You may have promised yourself you would drink moderately, but after a drink or two, you end up bingeing, depressed, and hung over.
As chapter 2 showed, when rats already addicted to alcohol are deprived of alcohol for a few days, weeks, or even months, they immediately start binge-drinking much higher amounts than their original daily intake when they are again permitted free access to alcohol. Monkeys also this is Alcohol Deprivation Effect. The same pattern applies to human alcoholics. The Sinclair Method is about as far away from traditional rehab as you can get; to beat your addiction, you must continue drinking. There is, however, a major proviso: you must only drink while on the endorphin-blocking opioid antagonist medication, naltrexone or nalmefene. As shown in chapter 3 on the hard evidence for the cure, if you abstain from drinking alcohol while taking naltrexone or nalmefene, you will not meet with success because you will not trigger the physiological mechanism causing de-addiction. As you proceed through the treatment, you will notice a gradual reduction in craving and drinking levels within the first few weeks. While this will encourage you to continue, the clinical trials prove that you have to continue drinking while taking naltrexone, or nalmefene, for at least three to four months until you meet with real success.
STRAIGHT THINKING – UNDOING THE MYTHS
Like many problem drinkers and alcoholics, you may have come to believe the following about your addiction:
- You are hopelessly incurable.
- Once an alcoholic-addict, always an alcoholic-addict.
- You have a weak ‘addictive personality’.
- Trying to control or reduce your drinkingor drug use is a delusional pipe dream.
- In general, while about 10% of alcoholics are able to stop on their own, the only way to beat your drinking problem is through a total abstinence regime for the rest of your life. This means you must continually battle the demons that cause craving through the use of some form of willpower to achieve abstinence – your only realistic goal.
- Advanced alcoholism is usually a terminal illness.
- You are born an alcoholic.
- The only way to conquer alcoholism-addiction is to tough it out, through the Twelve Steps, Tough Love, or similar total abstinence program.
- Alcoholics & addicts must go through a rigorous, difficult detoxification and drying-out process.
- You have to come out of denial by hitting rock bottom before you will seek help.
Until the discovery of the Sinclair Method, these statements made sense. Prior to the Sinclair Method, alcohol and drug addictions seemed incurable. Once acquired, the addiction tormented you for the rest of your life. No doubt about it, you had to struggle for lifelong abstinence. Research proved that nearly all attempts at controlled drinking for alcoholics were disastrous. Old-fashioned willpower, an external higher power, or various rehabilitation programs based on total abstinence were the only way to do. Sadly, whatever the treatment and despite the best intentions, the majority of alcoholics invariably ended up relapsing.
Before the discover of the Sinclair Method, difficult and often dangerous inpatient detoxification (drying-out) procedures were compulsory – they simply had to be endured. But now with the Sinclair Method, there is a safer, cheaper, and easier way to remove the physiological dependence. With the Sinclair Method, you need no longer fear the dreaded customary warnings – ‘incurable’ and ‘85% relapse rates’ – so endemic to traditional rehab environments.
The Sinclair Method puts an end to these dangerous myths. You can now expect to beat your addiction:
- Clinical trials show you have reason to anticipate a full reversal of your addiction, in other words, a cure. If you are a heavy drinker or addicted to alcohol, it does not mean you are condemned to remain so for the rest of your life. Your addiction can be conquered through Sinclair’s discovery of pharmacological extinction – the formula of Naltrexone (or Nalmefene) + Drinking = Cure.
- Heavy drinking and alcoholism has nothing to do with ‘personal weakness’ or immorality. Rather, you may have inherited an ‘addictive brain biochemistry’.
- Research proves that controlled drinking is a realistic goal with the Sinclair Method. The formula of Naltrexone (or Nalmefene) + Drinking = Cure means that your craving and drinking levels will either end completely or be reduced to safe levels. Even the most severe cases no longer mean a slow death sentence.
- You are not born alcoholic. Excessive drinking is caused by a combination of an inherited genetic predisposition and learning the addiction – installing it into your brain – over many drinking sessions.
- Abolishing the craving and the heavy or addictive drinking no longer demands ‘hitting rock bottom’, ‘Tough Love’, or ‘Toughing It Out’ one day at a time through the Twelve Steps of A.A. or other total abstinence programs. No doubt such programs have helped some alcoholics, but the Sinclair Method offers you a more effective and far less drastic alternative.
- Alcoholics who have managed total sobriety for years without relapsing are in the minority and deserve praise. But they all remain at risk for relapsing to dangerous drinking – 85 to 90% will relapse within the first year following treatment. A single drink for an alcoholic can lead to a major relapse, even after years of abstinence.
- People who attend A.A. regularly report that they encounter fellow alcoholics who have relapsed even after decades of total abstinence. As we saw in chapter 2, the Alcohol Deprivation Effect in the brain means that the addiction remains in the ‘always on’ position. Until Sinclair’s extinction treatment, nothing could be done to remove the factor causing alcoholism, to delete the fundamental neural circuitry drinking your addiction. No amount of willpower or conventional rehab can remove the over-strengthened addictive wiring in your brain. Without access to the Sinclair Method, the addictive wiring remains intact throughout the brain for life. Thus, even if you have not had a drink for thirty years, you are still addicted and always at risk of relapsing. ‘One drink and it’s over’ is your First Commandment for life. The Sinclair Method changes this by removing the addictive neural pathways from your brain. After completing de-addiction treatment, your craving will be gone, and you will be cured.
- Detoxification through the Sinclair Method is a gradual, relatively painless process. You will continue to drink while on your medication and your craving and actual drinking levels will subside automatically. Indeed, the ideal way to detox is to do so slowly, bit by bit, so the body gradually adapts to life without alcohol. Pharmacological extinction provides an easier, more dignified way of accomplishing this.
HOW YOU LOST CONTROL AND HOW THE CURE HELPS YOU FIND IT
The scientific research from animal and human studies proves that loss of control over drinking, craving, and addiction happen for two major reasons:
- You probably inherited a powerful genetic predisposition that enabled you to be particularly good at learning to drink alcohol. In other words, you have inherited a particularly powerful endorphin (opioid) system in your brain. Drinking alcohol causes the morphine-like substances known as endorphins to be released in your brain. Dr Candace Pert, the acclaimed Johns Hopkins and National Institutes of Health neuroscientist who, in 1973, discovered opioid receptors in the brain, describes endorphins as ‘Molecules of Emotion’.
- You had considerable experience drinking alcohol. The genetic predisposition or alcoholism combines with drinking experience to produce addiction to alcohol. After you drink, the endorphins progressively strengthen the pathways wired throughout your brain that had recently been active, the pathways that are neural circuitry producing craving and drinking. Each time you drink, the resulting endorphins make this circuitry stronger, especially if you have the genetic predisposition for alcoholism and receive large amounts of reinforcement from the endorphins. These neural pathways become etched into your brain, just as paths become permanently established as people tramp through the mountains. The more drinking you do – the more you trample down the path – the wider and stronger the pathways become. Eventually, the super-strengthened system becomes so established that craving and excessive drinking are no longer under your conscious control. Now you are addicted to alcohol.
THE CURE ALSO PREVENTS ALCOHOLISM
The Sinclair Method can prevent or inoculate against alcohol addiction before it has taken root.
Genetically predisposed rats soon go on to become addicted if allowed free access to alcohol. If, however, the rats are given naltrexone before gaining free access to alcohol, they never develop the wiring that drives alcoholism.
So what should you do I you think you are at risk of becoming addicted? Let’s say that you feel you simply drink too much at parties, on airplanes, on your own, at restaurants, or while driving. Or maybe you say things you later regret or wish you had not had so much to drink, and that this has happened once too often. Moreover, you know that some of your relatives have become alcoholics and you suspect you may have inherited the same heightened risk of becoming addicted. If you want to make sure your drinking does not increase, or indeed if you would like to reduce your drinking to safer levels or stop altogether, say goodbye to hangovers, improve your self-esteem, health, and overall life – the answer is to always take naltrexone or nalmefene before you drink. If you do this, you will soon stop the development of excessive drinking in it’s tracks.
YOU DON’T HAVE TO BE AN ‘ALCOHOLIC’ TO BENEFIT FROM THE CURE.
One of the main advantages of the Sinclair Method is that you do not need to have a serious drinking problem or be an alcoholic to take advantage of extinction treatment. If you tend to drink too much on certain occasions and simply want to reduce your intake, begin taking naltrexone or nalmefene before drinking.
The research proves that you will find yourself more in control, and you will begin to drink less. You can still drink, moderately and safely – if you chose to do so. The Sinclair Method is easier than dieting because you do not have to avoid the temptation to drink. Naltrexone (or Nalmefene) + Drinking works automatically – it is your formula for successful de-addiction.
HANDLING THE CONTROVERSY
It is also important that you be aware that you may encounter a certain amount of controversy surrounding the Sinclair Method. The treatment might not make common sense to everyone – especially if they are unfamiliar with the science behind it. After all, how can instructing compulsive drinkers to continue drinking possibly be helpful, even if they have been given naltrexone or nalmefene? You will probably find people especially sceptical if they know you already have a problem and see you drinking, even if you tell them about the medication and the way it works. You must, above all, have faith in the research data.
You might also encounter professional health workers and lay counselors who proclaim aggressively that ‘you can’t cure a drug addiction with another drug. Rehab, cold turkey, A.A.’s Twelve Steps and total abstinence are the only way.’ You may get negative feedback from some health professionals when you tell them about the treatment because knowledge of pharmacological extinction has not yet been widely disseminated around the world.
If you are told that you should not be a ‘guinea pig’ for such a treatment, you can safely reply that the guinea pig stage of research has long since passed; tens of thousands have already been successfully de-addicted through Sinclair’s Naltrexone or Nalmefene + Drinking formula. The scientific data overwhelmingly support the position that pharmacological extinction is the most effective de-addiction treatment ever put into practice.
Other treatment methods have helped some people to cope with craving. They have employed the most powerful tools known to psychology for an individual to overcome drives and desires. However, once the addiction is fully installed in the brain, none of the earlier methods has been able to remove the hard-wired neural circuitry that produces the drive and desire for alcohol. Apart from the Sinclair Method, all current treatments leave your brain in a state of permanent addiction. Prior to extinction treatment, your addiction meant a lifelong battle for abstinence, which was the basis for the truism ‘once an alcohol, always an alcoholic’. That’s why, for an abstinent alcoholic, even a small amount o alcohol is exceedingly dangerous.
Unlike pharmacological extinction, traditional treatments have never been able to cut the addictive mechanism out of the nervous system. Indeed, the NIAAA, WHO, and other governmental bodies confirm that standard treatments for alcohol prevent relapse for only 10 to 15% of alcoholics. Because alcoholism has not been curable, the majority of alcoholics relapse – 85 to 90% relapse within the first year of treatment. They relapse at the point when the Alcohol Deprivation Effect and environmental stimuli have increased craving to particularly high levels, causing dangerous bingeing. This is when alcoholics are most at risk of harming themselves and others.
Be prepared to face initial puzzlement when explaining how the Sinclair Method actually works. Interestingly, many people who are in the midst of the battle with alcohol seem to grasp the logic behind extinction treatment more readily than those without first-hand experience of what it is like to cave in to craving, bingeing, and addiction.
WHO SHOULD NOT BEGIN THE CURE
Pregnant women should not be drinking alcohol, nor should they use naltrexone or nalmefene or numerous other medications.
If you have an addiction to an opiate such as heroin, morphine, or any synthetic opiate such as oxycodone, you should inform your prescribing physician because you could precipitate and opiate withdrawal reaction if you take naltrexone. This is critical because precipitating opiate withdrawal could be fatal. Do not take naltrexone or nalmefene if you are physiologically dependent on opiates.
If you are currently abstinent, unless you are relapsing, there is no valid reason for you to start the treatment. You are to be commended – stay with your current treatment if it is working for you. The Sinclair Method is intended for those who are currently drinking excessively, whether frequently or infrequently, or wish to prevent an escalation of the drinking. Naltrexone of nalmefene do not cause withdrawal reactions from alcohol.
COMPULSIVE DRINKING IS NOT YOUR FAULT
It is now widely accepted that about 10% of the normal population inherit the genetic potential for alcoholism. Even though you may have the genetic predisposition for alcoholism, you will only develop the addiction if you begin drinking. At this stage, you are able to chose whether or not to drink. Most people are not genetically predisposed to alcoholism. When they start social drinking, they generally do not get enough reinforcement from endorphins to go on to compulsive addictive drinking.
However, if you are genetically predisposed to alcoholism and you begin drinking, the compulsion creeps up, gradually becoming programmed into your brain. As this programming becomes more firmly entrenched over several years, you drink increasing amounts. You may notice that two or three drinks are not enough so you drink more. Even though you might not set out to become intoxicated, you find this happening way too often.
Your craving for alcohol, the conscious and unconscious thoughts, feelings, and sensations telling you that you really need a drink, starts building to higher and higher levels. Whether you notice it depends on your style of drinking. If you drink in a Mediterranean style, that is, drinking every day, along with meals, you may never feel the craving until you try to stop drinking. For many people, the motivation for alcohol is all a matter of scheduling. It is a product of the Alcohol Deprivation Effect and Mediterranean-style alcoholics may never feel the overpowering craving until they have been deprived of alcohol for a few days or more.
At this stage in the learning of the addiction, you may realize that alcohol is interfering with your life and try to limit the amount you drink. After one too many hangovers, perhaps after doing and saying regrettable things, you swear that you will never touch a drop of alcohol again…. until, or course, the next time.
By this time, you have lost control over alcohol, and drinking has become a powerful unconscious biological reflex. It is as though in addition to the normal drive for food and water, a new drive has been installed into your body, in this case for alcohol. Once this has occurred, the drive for alcohol becomes permanently entrenched as a physiological addiction, and you being to ‘need’ alcohol as though it were water.
You no longer drink out of choice. Just as your brain is wired to instruct you to drink water when you are thirsty, you drink because your brain has become wired to crave and drink alcohol – the choice is no longer yours. Instead, your addiction brain makes the choice for you. You are ensnared and enslaved because drinking has now become an unconscious, automatic, uncontrollable ‘learned reflex’.
You probably did not realize you carried the genetic potential for compulsive drinking when you took the first drink of your life. But years later, by the time you had lost control, taking a drink for you was different than it was when you first began your journey. You find yourself unable to stop at your second or third drink, which have now become just like throwing gasoline on a fire. Your drinking flares up uncontrollably, with a single drink being enough to ignite a serious bout of drinking. In chapter 13, we’ll see how recovered alcoholic David, a telecom programmer, explained how he considered his own alcoholism in terms of computer programming. The programming is like the addictive wiring – the neural circuitry in your brain causing craving and drinking – and the software programming is the repeated learning to drink with endorphin reinforcement from alcohol over many sessions.
As you proceed through the Sinclair Method, remember not to be hard on yourself – as so many alcoholics tend to be – for your addiction. You are not a weak, immoral person. No amount of self-recrimination can de-addict you. Like millions of others, you are no more responsible for compulsive drinking than you are for any other inherited illness. But, just as a diabetic is responsible for regularly taking insulin – or the use of a condom is absolutely necessary to practice safer sex – you are responsible or your own cure. Always take your medication before drinking alcohol.
By now, you should appreciate that the Sinclair Method works by blocking reinforcement (which is not the same as pleasure) from the endorphins released by alcohol in your brain. You were programmed to crave alcohol through repeated reinforcement from endorphins over many drinking sessions. More precisely, the neural pathways that cause you to think about alcohol, to want it, and to drink it, became progressively more powerful each time they were used and then bathed in endorphins.
Certain neurons in the brain release substances similar to morphine and other opiates. These substances are called endorphins and enkephalins. They fit into the same receptors as morphine and heroin. The release of such substances also occurs in the most primitive organisms. Even some bacteria release and opiate-like substance, apparently as a signal to other bacteria that something has disturbed the integrity of the community. In higher organisms, the natural opiates play a role in intestinal contraction. They also can block the transmission of pain, such as from injury or child-birth. This is why morphine is effective as a painkiller.
In the brain, the endorphins are generally released into the open space between neurons, rather than being confined to a small space within a synapse. Thus, one neuron releasing endorphins is able to affect hundreds or thousands of neurons in its vicinity. Endorphins, therefore, do not act like synaptic transmitters such as glutamate, serotonin, or acetylcholine and might instead be called local hormones. Both external opiates and natural endorphins provide reinforcement. That is, they strengthen the connections within the pathway of neurons that have just recently been used; therefore, whatever behavior occurred just before the opiates or endorphins appear becomes more likely to occur again in the future. (Some researchers have speculated that endorphins produce reinforcement by releasing dopamine, but it now seems more likely that the endorphins have a direct reinforcing ability themselves.) In other words, each time you use a pathway that produces a behavior that, in turn, releases endorphins, the endorphins make the pathway stronger by reinforcing it. As a result, it will take less stimulation to get that pathway activated again in the future, and it will be harder for some other pathway to inhibit it and prevent the behavior from occurring.
The opioid system has evolved the function of reinforcing behaviors particularly on the basis of sensory input. For example, putting a drop of sugar or saccharin on the tongue causes sensory neurons to fire and eventually produces a release of endorphins in the brain. This provides a very useful survival function from an evolutionary perspective. Instead of having to wait until after a food has been digested to reinforce the behavior that produced the food, we have developed an instant chemical dipstick – our tongue. We stick it into a good. It analyses the amount of sugar present. if there is a lot, endorphins are released, and we quickly and efficiently learn to eat ripe fruit with the nutrients we need rather than unripe, unhealthy fruit. The endorphin reinforcement requires only the sensory input, rather than the actual ingestion of the nutritious substances. Consequently, although it is a useful shortcut for learning, it can be fooled, for example, with saccharin that produces the sweet sensation – and the endorphin release – but no nutrition.
WHAT HAPPENS WHEN YOU DRINK ON NALTREXONE
Ingesting sugar, saccharin, and alcohol causes endorphin release in the brain. Naltrexone or nalmefene has the ability to completely block the effects of the endorphins diffusing around the brain – which would otherwise be activating billions of opioid receptors resulting in reinforcement or strengthening of the pathways or circuitry producing craving and the drinking.
However, each time you drink while on naltrexone or nalmefene, the reinforcement from endorphins will be blocked in your brain. Taking naltrexone or nalmefene will not only prevent the opioid pathways in your brain from being reinforced and strengthened, but each time you have a drink while on naltrexone or nalmefene, you will be weakening the endorphin-reinforced pathways – the super-highways that became hard-wired into your brain and now control your drinking and your life. The Sinclair Method progressively reverses your addiction, ultimately removing it from your brain by trimming back the super-highways so that they are restored to their original condition as the narrow pathways you started our with before you began drinking.
The solution to your problem is not through abstinence – it is through Naltexone or Nalmefene + Continued Drinking.
STEP TWO. SELF ASSESSMENT. DO I NEED HELP?
It’s A Disease: That’s Why There’s A Cure.
In its policy statement on Alcoholism as a Disease, the American Medical Association (AMA) states that it ‘urges change in federal laws and regulations to require that the Veterans Administration determine benefits eligibility to require on the basis that alcoholism is a disease’. The issue of whether of not ‘alcoholism is a disease’ is most relevant in terms of funding. If patients have ‘a disease’, then it is is easier to obtain paid access to treatment through private and public health insurance programs. The American Medical Association considers alcoholism to be an ‘illness characterized by significant impairment that is directly associated with persistent and excessive use of alcohol. Impairment may involve physiological, psychological or social dysfunction’. The amount you drink is not the crucial issue – it is a question of what happens when you do and that is why it is said, ‘If you have problems when you drink, you have a drinking problem’. One of the problems is simply the impairment produced by intoxication. Other problems are caused by the fact that alcohol tends to accentuate whatever we are feeling at the time we drink it. If we are feeling happy and talkative, we may feel more intensely elated and talkative. But it can also accentuate feelings of depression and despair. And if we are angry or aggressive, alcohol can exaggerate those feelings while interfering with the good judgment need to keep out of a fight. On the other hand, much of what distinguishes alcoholics is what happens when they do not drink. How severe does craving become? Some of the Mediterranean-style alcoholics do not know they are alcoholics until they try stopping and find it impossible. This is probably the most important sign of alcoholism: the inability to remain abstinent.
Alcoholism is a ‘progressive disease’ that has been described in stages. Do any of these stages apply to you? Are you in the early or middle stages? Do you have a loved one or friend to whom any of these apply? Begin thinking about your drinking in terms of these stages:
- You are beginning to experience problems with your drinking. You become preoccupied with drinking, start sneaking drinks, and feel some guilt about your drinking behaviour.
- You sometimes become intoxicated, and may have had blackouts – not remembering what you said or did while drunk.
- You look forward to drinking sessions, associate with other heavy drinkers, and are less interested in activities that do not involve drinking.
- Friends and family are concerned about your drinking, and drinking interferes with your work – for instance, you being calling in sick because of a hangover.
- You experience withdrawal symptoms such as tremors, depression, and anxiety when you stop drinking.
- You may or may not openly acknowledge it, but drinking has become a problem for you.
- You are unable to manage your drinking. Even though you wish that you could drink less, you find yourself drinking compulsively.
- You begin to use alcohol as an antidepressant but find that drinking results in hangovers, which make you even more depressed.
- You begin to have health problems, and your doctor may recommend you drink less or stop altogether.
- You may miss workdays and lose your job, get convicted of drunk driving, or get into alcohol-related conflicts with loved ones and friends. You start having alcohol-related medical problems such as liver inflammation, heart disease, or diabetes.
- Withdrawal symptoms – tremors, depression, and anxiety – as the alcohol wears off are now a regular part of your life.
- Your life is now totally unmanageable.
- You may have hepatitis, cirrhosis, pancreatitis, high blood pressure, and internal bleeding.
- Deep depression, sleep disorders, and memory problems are prominent. If you have been drinking many years, your memory may become impaired by Wernicke-Korsakoff Syndrome, a condition that results in permanent brain damage. In The man Who mistook His Wife for a Hat, Oliver Sacks describes how one of his patients thought he was living decades earlier because years of drinking had erased entire portions of his memory.
- You may experience hallucinations, convulsions, and have brain seizures know as delirium tremens (DTs) when you stop drinking. This can be fatal and you need medical attention urgently.
Is the Cure Right for Me?
Do you identify with any of the stages described here? Do you agree with the statement: ‘If you have problems when you drink, you have a drinking problem’? Does alcohol control you? Would you like to regain control over your drinking? Do you want to stop altogether? Has drinking interfered in your family, social, or work life? Has your health suffered? Have you had any bruises, falls, or accidents while drunk? Have you experienced ‘blackouts’ as a result of heavy drinking? Have you encountered legal problems as a result of your drinking?
If you answer affirmatively to any of these questions, then you should definitely consider the Sinclair Method because it is grounded in mainstream science and offers the most hopeful, effective, and clinically proven plan to break the cycle of compulsive drinking – without the demands of going cold turkey or abstinence. It is especially work considering if you have tried and failed with other therapies.
In its original form, the Method involved close supervision over either sessions with a physician and psychologist. However, the research now proves that it is possible to proceed on your own with minimal therapy, as long as you are medically fit to receive a prescription for naltrexone or nalmefene.
Your Mental Health
You can benefit from the Sinclair Method even if you have a psychological or psychiatric condition in addition to alcoholism. For instance, if you suffer from clinical depression distinct from your drinking problem, the treatment can help you with compulsive drinking. However, if you have been diagnosed with a psychiatric condition, you should always consult with a trusted physician before beginning the Sinclair Method.
One of Sinclair’s findings from an analysis of the Finnish alcoholics was that the treatment produces a very large decrease in depression. The patients took a test for depression (the Beck Depression Inventory) before treatment and again after about three months of being treated with naltrexone. Naltrexone, or nalmefene, themselves do not have any antidepressant effects, but the depression was dissipated because the drinking had decreased. This helps to answer an old puzzle in the alcoholism field: does depression cause people to drink excessively or does excessive drinking cause people to feel depressed? The fact that it was possible to reduce depression to normal levels in the vast majority of patients with naltrexone shows that usually it is the drinking causing the depression. There were, however, exceptions: patients with a primary problem of depression remained depressed even after their drinking was well under control.
The Cure Does Not Judge You
The Sinclair Method advocates a non-judgmental position with respect to addiction. From a philosophical and practical point of view, it is imperative that you try to avoid the stigma, taboo, and shame so often associated with the label addict, alcoholic, or drunk. You should not consider yourself morally degenerate, weak, or inferior because you have a drink problem.
From a Sinclairian perspective, you would most certainly not be labeled in a negative way. In any event, labelling does not help with treatment. Nevertheless, it is useful to ask yourself important questions about your drinking patters. The questionnaires and tools in the next parts of this chapter can help with that.
In the past, a great deal of effort has been expended trying to draw a demarcation line between alcoholics and people who are not alcoholics. In fact, alcoholism exists on a continuum – some are more badly affected than others – and there is no split between the two. It is like trying to define between red and yellow: it is impossible to say at which shade of orange that red stops and yellow begins.
The effort would be worthwhile if the treatment given to alcoholics were different from what should be done with heavy drinkers, or if the treatment were so dangerous, painful, or expensive that it should only be given to alcoholics. None of these condition are true, however, for the Sinclair Method. It will cure the alcoholic, but it also is useful for the heavy drinker as a preventative against developing alcoholism. It is safe, painless, and cost-effective.
On the positive side, diagnosing someone as being an alcoholic can be useful in helping the person get into treatment. The self-diagnostic tools here may be useful for getting yourself into treatment. If you have found that you do fit the following criteria, then by all mean get help. The Sinclair Method, however, is also for people who simply want more control over their drinking or want to prevent future problems with alcohol. You do not need to have the scarlet letter ‘A for Alcoholism’ branded on your forehead.
Questionnaires and Tools to Help with Self-Assessment.
Please consider the following questions for yourself right now:
- Do you have a blood relative who has had a drinking problem? Yes/No
- Has anyone ever told you that you drink too much? Yes/No
- Do other people have different opinions about your drinking style than you do? Yes/No
- Do you sometimes think that drinking causes problems in your life? Yes/No
If you answered yes to question 1, you should consider the possibility that you may be at risk of alcoholism if you ever start drinking. If you answer yes to questions 2 through 4, consider the relevance of your answer. Others might be wrong, but sometimes they can tell if you are harming yourself, even before you recognize it yourself.
The CAGE questionnaire, which was developed in 1970 by Dr. John Ewing, founding director of the Bowles Centre for Alcohol Studies for family practitioners and alcohol treatment profressionals, consists of four powerful questions:
- Ever felt you ought to Cut down on your drinking? Yes/No
- Have people Annoyed you by criticizing your drinking? Yes/No
- Ever felt bad of Guilty about your drinking? Yes/No
- Ever had an Eye-opener to steady your nerves first thing in the morning? Yes/No
Interpretation of CAGE Questions
These questions are significant if your affirmative answers apply within the past twelve months. Answering yes to two questions is considered a strong indication of an addictive drinking problem; answering yes to three questions is said to confirm an addictive drinking problem. These questionnaires are not intended as a formal diagnosis; they are included to help you begin thinking about your drinking style.
STEP THREE: YOUR PRESCRIPTION FOR NALTREXONE OR NALMEFENE
Obtaining Your Prescription – Drinking on Naltrexone or Nalmefene is ‘Good Medicine’
Chapter 1 described how naltrexone was approved for the treatment of drinking problems by the FDA in 1994 in the United States and subsequently by medical authorities in many other countries. Back then, the World Health Organization endorse naltrexone, and the NIAAA confirmed it was the first truly effective medication to help in the battle with addictive drinking. But it took another twelve years for the American Medical Association (AMA) to acknowledge that naltrexone should be widely used for alcoholism in general medical settings with its May 2006 publication of the results of Project COMBINE, the largest multi-center clinical trial in the history of addiction research.
Unfortunately, the fact that naltrexone is not a sufficient ingredient in itself generally remains underreported. In other words, it will not work on its own together with abstinence. Most doctors and patients assume that medications are taken or specific illnesses or conditions. Thus, aspirin helps reduce pain, antibiotics cure bacterial infections, and insulin controls diabetes. Doctors write out prescriptions for medications. Patients follow doctors’ orders and take the medications, which are presumed to have inherent healing properties. Whilst most medications – antibiotics, anti-hypertensives, or antidepressants – may work like magic, the patient need do little apart from taking the medication.
This is not the case with naltrexone nor nalmefene for alcohol addiction. The medication is only part of the treatment. Active drinking is required in combination with the medication to produce results. As we have seen, the scientific evidence from more than seventy published clinical trials confirms that the medication only works with concurrent drinking – according to the formula or Naltrexone or Nalmefene + Drinking = Cure.
Although pharmaceutical companies list every conceivable drug side effect for legal reasons, they characterise naltrexone as a well- tolerated, safe, non-abusable medication. Naltrexone (50mg) was first branded as Revia ™ in the United States and in several other countries. In the United Kingdom, it is branded as Nalorex ®. it is also sold under the brand name Depade ® in the United States. Other brand names for naltrexone include Naltima and Nodict (India), Narpan (Malaysia), Antaxone and Celupan (Spain), and Narcoral (Italy). The long-acting monthly injectable form of naltrexone is branded as Vivitrol ® in the United States. The equivalent dosage of nalmefene (18mg) is branded as Selincro ® across Europe.
Naltrexone is available in time-release formulations that ensure it is released slowly and continuously into the bloodstream, and is always in the body. When this happens, the opioid receptors are blocked continually for a month or more. This procedure offers some advantages over taking pill orally, and nice results have been obtained with the monthly sustained Vivitrol ® injection. However, the long-term effects of the slow-release preparations have not been fully examine. Continual administration also prevents the use of naltrexone selectively to weaken only alcohol drinking and not other behaviours (discussed in chapter 9), as well as preventing pharmacologically enhanced learning of healthy alternative behaviours.
During Step Three, you begin thinking of drinking alcohol while on naltrexone or nalmefene, as being ‘good for me’ or at least ‘necessary for me to get better’. At first, it may feel strange, but you will soon get used to it. Remember, the combination of the two – Naltrexone or Nalmefene + Drinking – is your medicine, your ultimate cure and freedom from your addiction. But doing either alone – drinking without taking naltrexone or nalmefene or taking naltrexone or nalmefene without drinking – will do nothing to help reduce craving and break your addiction.
Here are some reminders. Naltrexone or Nalmefene + Drinking alcohol over three to four months produces:
- Decreased craving for alcohol without having to stop cold turkey.
- Reduced interest in and obsessive thoughts about drinking.
- Drinking reduced to within normal safety limits – no more than twenty-four drinks per week for men and no more than five drinks on a single occasion, or no more than sixteen drinks per week for women or four drinks on one occasion. (Upper limits are set by different agencies; these limits are derived from the World Health Organization.)
- The ability to choose to abstain totally – but only after an average of three to four months on the Sinclair Method.
- Automatic and gradual withdrawal and detoxification from alcohol.
- Setting your own goals – total abstinence or drinking within safe limits.
What Does It Feel Like to Drink While Taking Naltrexone or Nalmefene? If you took naltrexone or nalmefene without drinking, your would feel about as much as you would if you took a multivitamin – virtually nothing. Fewer than 10% of patients reported temporary nausea in clinical trials in which it was given to abstinent patients. It produced even fewer side effects in patients who were still drinking. The medication is not psychoactive, and it will not make you feel high or low. Naltrexone or nalmefene does not bring relief from alcohol craving like a painkiller relieves a headache. Some patients report they do not get a ‘buzz’ from the first drink when they begin drinking while taking naltrexone or nalmefene. However, even when you do take it together with alcohol, you do not subjectively feel it working in your system.
One of the nice features of naltrexone, nalmefene and other opioid antagonists is that the endorphin system they block is relatively unimportant most of the time. Endorphins are involved in many forms of reinforcement, but usually as just a backup or shortcut system. Their role as painkillers may be important in the wild, where animals often have to function despite severe injury in order to survive, but in our modern world, we are seldom faced with such challenges. Other neurochemicals that modulate behavior, such as dopamine, serotonin, and epinephrine, are critically involved in the regulation of vast numbers of activities, and one must be very careful with drugs that alter these systems. With the endorphin system, however, most people can’t even tell if it has been blocked by an antagonist such as naltrexone. Indeed, that has been tested in some of the double-blind clinical trials in order to demonstrate that the patients really could not tell if they had been given an opioid antagonist or a placebo.
Remember, naltrexone or nalmefene by themselves will not reduce the craving or de-addict you in fifteen minutes, fifteen days, or fifteen years. You should be aware of false claims on the Internet that naltrexone can abolish your craving within fifteen minutes. As we saw in chapter 3 on the scientific evidence behind the Sinclair Method, naltrexone or nalmefene is only effective if combined with drinking over the course of at least three to four months. Extinction takes time and requires active drinking together with naltrexone or nalmefene before full de-addiction can happen.
Alcohol Abuse and Addiction Are Not Rational
Some people have questioned whether patients would actually take naltrexone or nalmefene. If they block the ‘pleasure’ from drinking, a rational patient would simply stop taking the medication in order to get pleasure again from drinking.
First, let’s start with an established fact. Compliance has been extraordinarily good with the Sinclair Method. More than 85% of the alcoholics being treated with naltrexone do indeed take their medication, even though they have been told that it blocks initial euphoria from alcohol.
That is not rational, you might complain. No, it is not, and the reason is that alcohol abuse is not a rational behaviour chosen logically for its ability to produce euphoria. Studies of human social drinkers show that euphoria is only occasionally increased by alcohol. If you are in a melancholy mood, red wine will make you bluer. If you in a party mood, you will fly through the air on bubbles of champagne. If you are feeling frustrated, you may become aggressive – hence, the violence associated with drinking and crime. If you are in a hospital gown in a stainless steel laboratory at nine o’clock in the morning with nothing to eat or drink, alcohol will not produce euphoria – as was demonstrated in one PET brain scan study in Finland on the effects of alcohol. The study demonstrated nicely some of the immediate effects of alcohol on the brain, and it showed that an opioid antagonist blocked these effects. The researchers had hoped to measure if it was blocking euphoria as well, but failed because the alcohol did not produce any significant increases in euphoria under stark laboratory conditions.
Among alcoholics, there is very little – if any – pleasure obtained from drinking, and certainly not enough pleasure to compensate for all the pain they get from their continued abuse of alcohol. Alcoholics drink because they have become wired to drink. There is no rational reason for choosing to drink because they do not ‘choose’ to drink, any more than you choose to lift your leg when the doctor taps your knee. You are wired to produce the knee-jerk reflex, and the alcoholic has become wired to produce the drinking reflex.
So, yes, naltrexone or nalmefene may partially block the pleasure – if any – from drinking. But pleasure is not why alcoholics continue drinking. Consequently, the blocking of pleasure from alcohol stopped few patients from taking their naltrexone or nalmefene. If they had been told to abstain from drinking, compliance would have been much more difficult. Alcoholism, by definition, is difficulty in abstaining from alcohol. And clinical trials that have instructed patients to abstain have met with more problems with compliance. However, being told to take a pill before drinking is an easy command to obey.
The pleasure from alcohol may be unimportant for the alcoholic, but the overall pleasures in life are important. Many behaviors are reinforced by endorphins, and we would not want to lose these other joys in life. As a solution for this problem, the Sinclair Method uses a process called selective extinction that removes the behaviors related to alcohol craving and abuse but supports and strengthens the other behaviors reinforced by endorphins. (This will be discussed in chapter 9 in the section titled Selective Extinction: How to maximize Your Results.)
Your subjective sensations, feelings, and emotions hardly change when you drink while taking naltrexone or nalmefene. However, the pathways controlling your drinking are incrementally weakened each time you do it. This occurs at the microscopic level of trillions of connections between neurons in the brain. Just as you cannot feel the metabolic processes in your liver or kidneys, you do not feel the de-addiction process as your nervous system is restored to normal.
As you drink on naltrexone or nalmefene, you will not be aware of the neural super-highways being weakened and cut back into their original condition. The process amounts to the gradual but steady weakening of the addictive circuitry wired throughout your brain and nervous system. As you proceed to drink while taking naltrexone or nalmefene, your brain is no longer being enforced by endorphins, This produces pharmacological extinction – Sinclair’s amazing discovery – which automatically weakens the wiring causing your addiction. De-addiction happens slowly but surely with the research showing that the more often you drink on naltrexone or nalmefene, the more you weaken your addiction. One could not ask for an easier, more elegant, or dignified solution to addictive drinking – you literally ‘Drink Your Way Sober’.
Working with Your Doctor Toward Your Cure
Regaining control over your drinking means taking the initiative as soon as possible. You need to enlist the support of a physician to prescribe naltrexone or nalmefene. Your main objective in Step Three is to obtain your prescription so you can follow the simple yet powerful formula of Naltrexone or Nalmefene + Drinking over three to four months = Cure in Step Four.
Your physician does not have to instruct you to carry on drinking while on the medication. He or she simply instructs you that, if you are going to drink, always take your medication before you do. An additional instruction would be ‘Do not take your medication on days when you are not drinking’ because naltrexone or nalmefene have no de-addictive action on their own.
The question of whether it is unethical for physicians to tell you formally to drink, especially if you are addicted to alcohol, is easily resolved. If you already have an addictive drinking problem, you will drink anyway, no matter what anyone, including yourself, tells you to do. In this way, your doctor can safely say, ‘I do not advise you to drink but, if and when you do drink, make sure you take naltrexone, or nalmefene, beforehand.’
The aim of the Sinclair Method is to reduce craving and drinking to safe levels. Because withholding an effective treatment is not in the patient’s best interests, in light of the research supporting extinction treatment, it may also be argued that it is unethical to instruct patients to take the medication in the wrong way – together with abstinence. Success is accomplished by drinking while taking the medication in order to reset the wiring in your brain, driving the craving and addiction back toward zero. Remember, as we saw in chapter 3, the research on the opioid antagonist medications (naltrexone, nalmefene, naloxone) proves that the addictive wiring, acquired over many years of drinking, is restored functionally to the state it was in before the addiction took root.
If you have a trusting relationship with your doctor, you might wish to refer him or her to chapter 17 (‘For Medical Professionals’) and to the research articles listed in this book – especially if your physician is unfamiliar with the way naltrexone or nalmefene works with the Sinclair Method. You might also want to inform your physician that pharmacological extinction is part of mainstream medicine and that it has been scientifically substantiated over the past thirty years. Now it has the backing of more than seventy published clinical trails (listed in the annotated bibliography). You may also wish to inform your doctor that naltrexone was approved by the FDA in 1994, and endorsed for use in alcoholism by the WHO (1994) and by more than twenty leading alcohol researchers in the United States, who published their findings of Project COMBINE in the Journal of the American Medical Associations in 2006 (Anton, O’Malley et al., 2006).
Because naltrexone and nalmefene are opioid antagonists, it cannot be abused. You cannot get high from it as you can with tranquilizers or many other prescription drugs. Naltrexone and nalmefene pose no addictive risks. Therefore, physicians can feel safe about prescribing it in general medical settings.
DOSAGE: The normal dose is 50mg of naltrexone to be taken an hour before drinking alcohol. Some doctors recommend that you begin treatment with half the normal dose (25mg) by breaking the tablet in half. This is recommended to help you get used to taking the medication on the first two or three drinking sessions.
The normal dose of nalmefene is 18mgs. The tablet cannot be broken in half.
Your doctor will require a liver blood tests before prescribing naltrexone to check for cases of existing liver damage. The reason for this is that one study using massive doses of naltrexone (3oo mg daily) found they were stressful to the liver. There is no evidence that any lower doses of naltrexone stress the liver. Moreover, one of the common measures showing the effectiveness of naltrexone is that the same measures of liver damage improve as a result of the treatment. Nevertheless, it was felt that naltrexone should not be given to people who already had severe damage to their livers, so a liver function test is needed, and a small percentage of patients will not be able to start naltrexone. Although 100-150 mg doses are occasionally prescribed in special cases, you must stay within the recommended dosage and not take more than the usual 50 mg dose of naltrexone without consulting your physician – taking a higher dose will not speed up your three to four month de-addiction process. A dose of 50mg should block 100% of the opioid receptors for most people; doses of 100 or 150 mg still only block 100% of the receptors, and thus do not accelerate the treatment.
One of the advantages of nalmefene, the sister compound to naltrexone, is that it is not metabolised in the liver, so doctors will not require liver function tests before prescribing it.
If you are a weekend drinker, only take your medication on weekends. Do not take it during the week, unless of course you find yourself drinking during the week. If you drink every day, take your medication every day. If you drink six days a week, take it six times during the week, one hour before you have a drink. If you find you have the urge to drink and have accidentally had a drink without taking your medication, take your tablet immediately. Always keep the medication with you. Some people keep their medication on their person for years, even after choosing to abstain completely – just in case.
Naltrexone or Nalmefene + Drinking = Cure
Don’t be alarmed if you come across misconceptions about taking the medication. Many people assume that naltrexone and nalmefene should be used with abstinence. Such misconceptions are often understandable. While they may be unscientific, they seem to make good common sense – ‘Take this pill for that problem’ is the way in which we have become accustomed to thinking about medication in general. Most of us are taught to think of tablet-taking as a passive process. We take tablets for headaches and the headaches go away – there is nothing more we have to do. They work magically to kill pain, put us to sleep, cure infections, and restore normal heart rhythms – all by themselves.
The administration of naltrexone or nalmefene is a profoundly different procedure. It requires continued drinking on the medication. Your de-addiction is an active process. You actively take naltrexone or nalmefene and then you actively drink alcohol. Remember, your de-addiction is not instantaneous. It takes time to de-addict yourself. But if you follow the formula of Naltrexone or Nalmefene + Drinking = Cure, your chances of beating the bottle – or regaining control over alcohol – are in the region of 80%.
The main objective of Step Three is to secure your prescription for naltrexone or nalmefene. In practice, most physicians in the United States will be pleased to write you a prescription for naltrexone – especially because the AMA published the results of Project COMBINE in May 2006 endorsing the use of naltrexone for alcoholism in general medical settings.
However, if for some reason your doctor feels that the Sinclair Method is beyond his or her expertise, do not be disheartened. Your doctor may refer you to another physician or you can be proactive and find one who is more open-minded, someone who will take the time to consider the solid science behind the Sinclair Method. Please refer to chapter 17 (‘For Medical Professionals’) and to www.TheCureForAlcholism.com for updates.
STEP FOUR: CHARTING REDUCED CRAVING AND DRINKING
Beginning Your De-Addiction with Naltrexone (or Nalmefene) + Drinking
Now that you have your prescription for the medication, you can actively and enthusiastically begin your de-addiction treatment. The science behind the treatment proves that you have every reason to be optimistic. You continue drinking as you normally do except that now, you are sure to take naltrexone or nalmefene an hour before every drinking session.
You must decide for yourself if you feel comfortable about telling others that you are in treatment. This is a matter of personal choice and judgment. For instance, you might feel secure telling people close to you – loved ones or close friends – that you are following the Sinclair Method. They should not be concerned if they see you drinking because now you are taking naltrexone or nalmefene, and Naltrexone or Nalmefene +Drinking will break your addiction in about three to four months. At the same time, you might feel better keeping your treatment to yourself with people with whom you aren’t as close – employers, colleagues, or acquaintances. Cultural differences should also be considered. In some cultures, one’s health is a completely personal matter. In others, it is the concern of the family or the whole community.
Drinking habits and styles vary enormously from person to person. Some of you may be drinking heavily of a daily basis, starting your day with an alcoholic drink early in the morning or with one at noon. Others might begin at 6 p.m. and drink steadily throughout the rest of the evening. Some of you may be bingeing only on weekends or only after a period of days or weeks when the craving has built to a breaking point. Drinking problems come in many shapes and forms and there are probably as many triggers for drinking as there are varieties of alcoholic beverages.
It’s Like Learning to Use a Parachute
By now, you should know that the end of your craving and addiction won’t come from trying to abstain. If you are unable to control or stop your drinking through normal psychological or faith-based treatments, you actually have to start using the Sinclair Method.
Starting treatment can feel like attending preparatory classes for skydiving. Your instructor may use instructional videos to show you how to jump out of the plane, how to overcome your initial fear of heights, how to use your safety parachute if your main on malfunctions. The instructor may be repetitive and even very boring. Of course, you understand the reasoning behind your instructor’s repetition – doing things properly can make your trip from an altitude of 15,000 feet back to earth smooth and enjoyable. Above all, doing things properly can save your life. The Sinclair Method is similar.
Now, as the urges arise, you permit yourself to drink – but only if you have already taken your medication. Each drink on naltrexone or nalmefene is part of your curative curve as you start the first of many Naltrexone or Nalmefeme + Drinking sessions to break free of your addiction. Remember, the cure occurs incrementally – drink by drink – as the microscopic yet densely wired system driving the addiction in your brain is dismantled, weakened, and ultimately broken through extinction.
Starting with the first application of the Sinclair Method, the usual practice has been to have patients record their drinking in a diary. However, the benefits from Naltrexone or Nalmefene + Drinking are not dependent on keeping the diary. (The rats never kept drinking diaries and it worked for them.) On the other hand, diligently keeping the records probably is beneficial to your progress and being able to look back and see the progress you have made often helps maintain motivation. Therefore, keeping a Drinking Diary is strongly recommended.
Before you begin taking your medication and start your Drinking Diary, you should familiarize yourself with drinking measures, which indicate the number of alcohol units in a beer, a short of vodka, or a glass of wine. Many people think that there is a difference between drinking beer, wine, and spirits, but it’s all the same as far as your brain is concerned – alcohol is alcohol. The following Drinking Diary lists the alcohol content of each drink. Although restaurants, bars, and pubs measure alcohol by standardized servings, it has been found that when people drink on their own, they tend to pour larger quantities. Research shows that people frequently they drink. Please keep Drinking Diary using the following format and be aware of the safe drinking levels outlined below. Many people often underestimate how much and how often they drink.
Sinclair recommends the follow format for your Drinking Diary. Use a small diary you can easily carry with you.
In the United States, one drink unit is defined as having one-half ounce of pure alcohol, such as the following:
- 10-12 oz of beer (4-5% alcohol) = 1 drink
- 8-12 oz of wine cooler (4-6% alcohol) = 1 drink
- 4-5 oz of table wine (9-12% alcohol) = 1 drink
- 5 oz of fortified wine (20% alcohol) = 1 drink
- 25 oz of 80 proof distilled spirits (40% alcohol) = 1 drink
- 1 oz of 100 proof distilled spirits (50% alcohol) = 1 drink
- 1 bottle (330 ml) beer (4.7% alcohol content) = 1 drink
- 1 mug of beer (4.7% alcohol) = 1.5 drinks
- 1 bottle strong beer (6% alcohol) = 1.3 drinks
- 1 mug strong beer (10% alcohol) = 2 drinks
- 1 glass (12 cl) wine (10% alcohol) = 1 drink
- 1 bottle (75 cl) wine (10% alcohol) = 6.5 drinks
- 1 glass (8 cl) fortified wine (20% alcohol) = 1 drink
- 1 bottle (75 cl) fortified wine (20% alcohol) = 9.5 drinks
- 1 shot (4 cl) spirits (40% alcohol) = 1 drink
- 1 small bottle (50 cl) spirits (40% alcohol) = 12 drinks
- 1 bottle (70 cl) spirits (40% alcohol) = 17.5 drinks
Wines include champagne. Fortified wines include sherry, port and vermouth. Spirits include vodka, gin, whiskey, rum, cognac, and liquors.
Upper Limits of Moderate Drinking
- Men: Twenty-four units per week or five units during any single drinking session.
- Women: Eighteen units per week or four units during any single drinking session.
For assistance in counting drink units, visit this Web site: www.knowyourlimits.info
Measuring Your Cravings
Craving goes hand in hand with excessive drinking and addiction. You should assess your craving levels on a weekly basis. The Visual Analog Scale of Alcohol Craving (VAS) is a simple instrument to help you chart your craving levels as they decline over the course of treatment. You will actually be able to plot the reduction in craving over the next few weeks and months. If you are working with a trained counsellor, you may wish to share your weekly VAS results with him or her as you progress through treatment.
Visual Analog Scale of Alcohol Craving (VAS)
Imagine that you are in a situation where you would typically be drinking. How badly would you want to drink? Determine the point on the line below that best describes your level of craving for alcohol and draw a clear vertical line at that point.
Begin Your Drinking Diary
Now that you have your supply of naltrexone or nalmefene, what do you do? You should immediately begin your Drinking Diary and continue drinking on your medication. One patient aptly described this process when she said, ‘I no longer simply go drinking. I go Naltrexone-drinking so that I can Null my drinking’.
Begin by taking half the normal dose, 25 mg, for the first two drinking sessions. You can break your 50 mg tablet in half or ask your pharmacist to do this for you. After the first two doses, you move to the full dose of 50 mg, which is the official recommended dose.
The Drinking Diary is an integral part of your treatment plan. It serves as your roadmap, guiding you toward the cure. If you drink only on weekends, that is fine – you will be able to plot your weekend drinking. If you drink every day, you will be able to plot your daily drinking pattern as it declines. At first, you might not notice much of a difference, but as time passes, you will experience a steady decline in your consumption. Most people notice an observable reduction in craving and the actual number of drink units per week within the first six weeks.
When you begin treatment, you should not be perturbed if you find yourself drinking well over the safety limit of even far more than you like. After all, this is why you are on the Sinclair Method. Some people drink many times over the safety limit – twenty four units per week for men and no more than five units on one occasion and eighteen drinks per week for women and no more than four units on one occasion – every week. Knowing how much you drink is essential. (Please note that many restaurants serve ‘a drink’ equivalent to two or more units.) This way you can accurately plot how much you are drinking and this monitor your progress on a weekly basis. Clinics have found that the Sinclair Method brings drinking down to an average of fewer than nine units per week after three or four months. A couple of cautions are in order. First, you must be particularly careful not to drink and drive or use machinery. Naltrexone can actually increase some aspects of intoxication. Sinclair found an increase in motor impairment from alcohol in rats. Later research found increased problems from alcohol related to the divided attention needed in driving. Second, do not drink more in a session than you are used to. Naltrexone or nalmefene will not block alcohol poisoning.
What Should You Expect to Happen?
The answer is that no two people are alike. Some people respond to treatment more quickly than others. Generally, naltrexone and nalmefene side effects are rare and include symptoms like mile itchiness or transient nausea. Compared with the side effects of addictive drinking, most patients report they are both minor and temporary – well worth the effort. The majority of patients taking naltrexone or nalmefene report few or no side effects. Be alert that, even very early in your treatment, you may occasionally experience a surprising ability to stop after only a couple of drinking. However, this decrease in drinking and craving is merely an artefact of the treatment. The naltrexone or nalmefene is blocking some of the effects from the first drink and from stimuli that have become conditioned to release endorphins; this helps block the ‘first-drink effect’. It is a beneficial but weak effect. The powerful effects from pharmacological extinction develop much more slowly and cannot cure you in a week or two. It took you a long time to reach your current craving and drinking levels, and it will take at least three to four months to reverse the addiction. Some people take longer before the neurological scaffolding – the addictive wiring in the brain – is brought down, reduced, and restored to it’s normal, healthy, pre-addicted state.
Of course, each of you will be progressing through treatment at your own pace. But everyone has to follow the formula: Naltrexone or Nalmefene + Drinking = Cure to be successful. You should expect success – like the seventy-five patients in Figure 8 who showed reduced craving over three to four months.
You can also expect your actual drinking to go down to about fifteen drinks per week within three to four months and eventually down to nine drinks per week, as shown in Figure 9.
You set your own treatment goals. Only 3% of the patients originally treated by Sinclair’s group chose total abstinence as their original goal, but about a quarter of them were abstinent after three months of treatment. Before treatment, it may be difficult to imagine a life without alcohol, but by the end of treatment, your craving will have decreased so noticeably and dramatically that total abstinence becomes a matter o personal choice. You will no longer fear alcohol. You will not be in its vice; you will not be it’s servant or puppet. You will find that you no longer obsess or think about it and it will become more or less irrelevant in your life. However, the ultimate goal is to break the addiction so that you control your drinking instead of it controlling you.
Some people may wish to drink two or three times a year – for instance, at Christmas or on New Year’s Eve. This is fine as long as you always take your medication before you do so. The point is that the Sinclair Method allows you to cut back or stop altogether without the nagging feelings of deprivation and threat of relapse associated with traditional abstinence-based treatments. You will not have to attend regular support groups – unless you choose to do so. If you choose to continue drinking, the treatment will result in a massive decrease in your desire for alcohol and also the actual amounts you drink when you do. You will find yourself simply losing interest in the party. Because de-addiction occurs at the microscopic level of opioid (endorphin) receptors and synapses in the brain, you will not know why the voice in your head suggesting ‘I could do with a drink’ or ‘I need a drink’ simply seems to have disappeared. Your rescue from the bottle happens as if by magic. It is not magic, of course, but the fruits of the Sinclair Method are astonishing indeed.
Most likely, others will also notice positive changes – you no longer get drunk, depressed, hung over, out of hand, or aggressive, and you don’t lose your judgment and control. Drinking + Naltrexone or Nalmefene produces a state of permanent physiological de-addiction.
Selective Extinction: How to Maximize Your Results
Selective Extinction is a technique you can use to enhance your resistance to alcohol while encouraging competing positive, desirable behaviors. After a month or two of treatment, you will find that your craving for alcohol has progressively decreased with each Naltrexone or Nalmefene + Drinking session, so there are days when you will simply not want to drink. Selective extinction means that on these days you do not take naltrexone or drink but instead do things that you normally find rewarding.
If possible, before you start naltrexone or nalmefene, you should make a list of healthy, positive behaviours that you find rewarding – or found rewarding before alcohol began negatively interfering in your life. Typically, in clinics, the physician will point out which of these behaviors are probably reinforced by endorphins, but you can do it yourself. For instance, you may include sex or some vigorous exercise such as hiking, sailing, jogging, tennis, yoga, or aerobics on your list of pleasurable activities. Maternal and paternal activities, such as the warm ‘Ooh! The baby!’ feeling you get from cuddling children or pets, almost certainly produce endorphins. So do thrilling behaviours (for example, amusement part rides), novel experiences, eating highly flavoured foods, especially sweets and spicy meals. Sensual pleasures usually involve endorphins. Performing, singing, presenting, and acting all involve endorphins.
In general, activities that are stimulated by a little alcohol, such as an appetizer before eating, are opioidergic, that is, they are reinforced by endorphins. On the other hand, behaviors that involve long periods of high attention and holding still, like target practice, are probably not opioidergic. Of course, there are unhealthy opioidergic behaviours like high-risk behaviours, gambling, or taking opiates and other drugs, which obviously should not be on your list.
Make sure you do not participate in the healthy opioidergic activities while you are on naltrexone or nalmefene – save them for your ‘No Drinking – No Naltrexone or Nalmefene’ days.
On naltrexone- and drinking-free days, the opioid system in your brain will be more sensitive to reinforcement from endorphin release because of a phenomenom known as receptor upregulation, which causes receptor super sensitivity. The naltrexone or nalmefene causes the upregulation, but so long as it is in the brain and blocking the receptors, there is no effect. When you stop taking naltrexone or nalmefene for a while, however, there is a period of a few days when the naltrexone or nalmefene is gone and the extraordinary large number of opioid receptors are now free, producing more reinforcement whenever endorphins are released. You can take advantage of opioid receptor super sensitivity because endorphin-related activities are more rewarding than normal. In this way, you begin replacing ‘bad’ endorphin activities such as drinking with ‘good’ ones such as vigorous exercise. You will find your interest and enjoyment will increase progressively for the healthy activities, helping to fill the vacuum as drinking decreases. Naltrexone or nalmefene offer a window of opportunity for pharmacological enhanced learning of healthy behaviours. If you last took the medication of a Friday afternoon, Saturday is a washout day, when the medication is being removed from your body. Starting Sunday afternoon, roughly two days since your last dose of naltrexone or nalmefene, you are in a state where patients report that doing those alternative behaviors is especially reinforcing. A highly flavored meal tastes great. Even the first bit of chocolate is fantastic. Sex is more rewarding. Exercise feels marvelous. The super sensitivity gradually disappears over the next few days, so it is wise to make an effort in the healthy activities during this window while you get more reinforcement.
At any time, you can return to drinking; just make sure you take naltrexone or nalmefene an hour before you take the first sip of alcohol. Typically, patients start by having only a weekend with naltrexone or nalmefene and drinking – and with practicing a healthy behaviors on Sunday afternoon and evening – then return to Naltrexone or Nalmefene + Drinking, and avoiding the other opioidergic behaviors. Subsequent periods without alcohol and naltrexone or nalmefene become progressively longer. Eventually, drinking while on naltrexone or nalmefene was occurring only once a week or less often, and the periods without alcohol and naltrexone or nalmefene were six days or longer.
Follow Up, Follow Through, and Therapy
You should see your physician from time to time – at least once a month – even if you have a renewable prescription that does not require regular visits. However, in situations where it is not feasible to see your doctor more frequently or you simply do not wish to, you can still be successful on your own. You can follow the Sinclair Method as privately or as publicly as you choose. But you must follow the Golden Rule now and after you complete the program: always take the naltrexone or nalmefene before you drink.
The Sinclair Method requires personal motivation to take your medication consistently before drinking. You do this for the rest of your life – but only when you drink. Once you have started the program, there is absolutely no point in stopping and starting.
Stay with It; It Takes Time to Work
Research shows that the minimum time for obtaining most of the benefits from the Sinclair Method is three to four months’ worth of treatment. Don’t fool yourself – the addictive wiring in your brain became super-strengthened over years, not overnight. The addictive circuitry will not be sufficiently de-activated after a month or two of the Sinclair Method. If you do not complete the minimum three to four month treatment period, you will be like a half-baked cake – a cheesecake without the cheese – and because your treatment will be incomplete, you will still be addicted to alcohol.
Actually, the treatment never stops, although after the three to four months, most of the time it consists of only carrying the medication around with you. There never comes a time, however, when you drink without taking the medication. If you did, even after you are cured, you would start relearning the addiction to alcohol. Being cured does not mean you cannot develop the disease again.
STEP FIVE: THE GOLDEN STEP – STAYING CURED
How Do I Know I’m Cured?
You will know when you are cured when your craving for alcohol is noticeably reduced. Because de-addiction is automatic and integral to the Naltrexone or Nalmefene + Drinking formula, you will become increasingly aware that you are less preoccupied with getting the next drink and that you are drinking less as you progress through treatment. Your interest in alcohol will wane. You no longer need it. You can take it or leave it.
In summary, these are the main indicators of success:
- You are drinking within the safety limits or not drinking at all.
- Your craving levels are way down or non-existent.
- Your mood has improved and you feel better physically and emotionally.
- Hangovers are history.
- Others notice that you are drinking less.
- Alcohol no longer dominates your thoughts or rules your life, and you have stopped obsessing about the next drink.
- You have simply lost interest in drinking – you can take it or leave it.
- Your confidence and self-esteem have improved.
- Your relationships no longer suffer as a result of your drinking.
- Your psychological and physical health has improved. Your depression has lifted. Your liver function is improved.
You are cured because your brain has been restored to the condition it was in before you began to drink. This means that the reflexive addictive wiring is no longer connected in your body. Based on the empirically tested discovery of pharmacological extinction, the treatment has proved to be the most powerful alcohol de-addiction tool in the arsenal of weapons against alcoholism. Indeed, prior treatments were like using bows and arrows against addiction. The Sinclair Method presages a new era in treatment, not only for alcohol, but for many other substances (for example, heroin, cocaine, amphetamine) and non-substance addictions (for example, gambling).
You did not need lengthy, expensive, and unpleasant detox and costly hospitalizations. You did not have to experience delirium tremens (the shakes) or seizures. There was no need to break promises that you would never drink again. De-addiction did not have to be difficult or painful. You did not need to embrace a new ideology, religion, or rigid treatment regime. You did not have to suffer needlessly. You no longer end up disappointing yourself and others. Now you are drinking – if you have chosen to continue drinking – within safe limits. Or because, for the first time in years, you are easily able to choose not to drink at all.
Once you have successfully completed the full course of pharmacological extinction, your brain is restored to the state it was in before you had your first drink, before you learned the craving and the addiction. The little voice in your head asking for a drink is either dulled or simply gone.
The Golden Rule of the Cure: If you are a patient following the Sinclair Method you have only one absolute rule: take naltrexone or nalmefene before drinking. You must take your medication for the rest of your life – but only when you drink alcohol. Following this Golden Rule is easy to do. Always take your medication before drinking.
If you begin to drink without the medication, you will undo the gains you have made. If you drink without your medication, even though you have completed the full course of treatment and are ‘cured’, one can predict with a high degree of confidence that you will eventually return to where you began. On average, it will take you roughly three to six months to reach your original craving and drinking levels and become re-addicted – re-wired – if you drink without naltrexone or nalmefene.
Of course, a single drinking session without naltrexone will not re-addict you are completing the Sinclair Method. However, before you ever contemplate drinking without naltrexone or nalmefene, ask yourself if it is worth taking the first step back on the road to addiction again. Remember, extinguished behaviours can be relearned if they are made while reinforcement is not blocked, and the relearning is faster than the original learning. Naltrexone or nalmefene is your insurance policy against relearning the addiction, and therefore against relapse. Always take your medication before drinking – if you drink.
‘Recovering’ versus ‘Recovered’
If you follow this Five-Step Plan meticulously for at least three to four months, the wiring controlling the craving and drinking in your brain will be weakened to the point where your nervous system will be restored to virtually the same state it was in before you began to drink, before you learned how to crave alcohol, and before you lost control. This is what is meant by being cured of your addiction, and why the Sinclair Method is such a profound breakthrough in psychological medicine. Over months of treatment, the primary cause of the alcoholism – the super-strengthened system – is destroyed. The connections between neurons in your brain that had been reinforced so often and so well by endorphins when you drank have now been weakened and silenced. No other treatment has ever been able to claim that it can remove an addiction from your nervous system so that you are cured by the treatment. Being de-addicted means that your opioid-reinforced brain has been returned to essentially the state it was in before you had your first drink (and the thousands that followed it), which led to Learned Alcohol Addiction.
In other words, once you have completed extinction treatment, you will be cured. Therefore, you will not, as you would with every other traditional rehab, be in a state of on-going perpetual recovery. You will not be a recovering alcoholic who is always at risk of relapsing and slipping back into benders or bouts of heavy drinking.
In biology, the term metamorphosis means ‘a profound change in form from one stage to the next in the life history of an organism, as from the caterpillar to the pupa and from the pupa to the adult butterfly’. The Sinclair Method allows you to become that adult butterfly.
Once you have successfully been through the Sinclair Method, you will be de-addicted. Now you are a former alcoholic – a recovered alcoholic – and will remain so for as long as you follow the golden rule.
Congratulations! You have beaten your addiction to alcohol.