The Sinclair Method is not for everybody, it would seem...

General health and lifestyle
1

I've been following this forum for about a year and had two attemps at reducing my drinking with Nalfamene (Selincro) in the same time. I must conclude this wasn't my solution, but I see how it could be one for others. (Re: side effects, yes they can be bad for 5 days max but at the same time they help lessen your desire to drink. My advice is to take the pill with a lot of water.)

For context I'm a full-time married working mother of 2 young children, early 40s, who started drinking socially at age 16 and it had only progressed. I typically drink about 2 glasses of wine a night and a lot more on weekends and vacations. I'm more than happy to drink alone in public or at home although the partier in me goes a bit crazy when out at bars with friends or at parties (6-8 drinks including vodka leaving me with a bad hangover and embarrassing memories). This continues today.

My first Nalfamene attempt lasted 2.5 months. At first I thought I had found my solution, I was drinking a lot less due to the inital lack of a buzz and being aware of my intake. But after about a month I started taking it irregularly and then when I did the side effects became a problem again, shutting down my night completely. So I stopped for a few months. My habits from before hadn't changed.

On the last Nalfamene attempt, started 5 months ago, ended 2 weeks ago, I took my pill regularly 2 hours before desire to drink. I had read a lot more about how consistency and long term commiment was essential. However, since I always want to drink something (even just a glass or two of wine) I took it 6-7 days a week when leaving work. As usual with these drugs, the first couple of weeks seemed to work - I had less interest in each glass and purposefully kept the bottle far from me. But then those effects wore off and drinking under the pill became drinking as usual. This time I held out the suggested 4 months, while taking the pill 2 hours everytime I was at risk to drink, but again, there was ultimately no final/net, reduction of alcohol for me.

During the year I saw a psychiatrist monthly who prescribed me the meds. I told him, at the beginning and during treatment, that I want to be able to continue drinking as I do (socially and personally, loving the taste of some alcohol) and just not have any negative health effects or have the habit get worse. He said that sounds lovely but it's not possible. He also voluteered, after my last treatment period basically failed, that he only sees a 50% success rate among his patients with Nalfameme / Natrexone. 

At this point I'm going to continue drinking as I do (approx 30-35 units a week) and maybe I'll try taking a month off alcohol this fall, to help my liver. I really don't want to stop drinking wine, beer and yummy cocktails, I just don't want my drinking to get worse. I recently took another liver panel blood test and my levels are fine. I plan to do this annually.

Point being, I guess it isn't an adrenelin issue for me and so this method didn't work. After the past year of effort, I am disapointed, but I can also see how it can work for people who perhaps don't have this habit and this taste for alcohol so embedded in their daily lives (ie drinking wine daily and drinking for 25 years).

Anyone else have a similar experience?

2

Hi merrydeath,

I have had a similar experience, having used Selincro for a few months and then stopping and switching to Naltrexone because the Selincro really affected my sleep.  In a nutshell, the Selincro worked at reducing my alcohol consumption but it really disrupted my sleep and mood, so I switched to Naltrexone (half a tablet, which was enough.  The Selincro tablets could not be halved, so I thought that maybe the full dose was the problem).

Anyway, after one year of taking the medication, I was still drinking almost every night, but was down to 1 - 1 1/2 glasses of wine per evening.  However, I found that my desire for other things that I used to enjoy, also decreased (certain foods, activities, even sex) and that I was becoming a very negative, boring person with almost no more interests or pleasures.  Subesequently, I stopped the treatment about 6  months ago and my alcohol consumption remained low for the about four of those months.  Unfortunately I am now on about 4 drinks per evening, and am not at all happy about that, but am not ready to go back to not enjoying anything at all.

I would like to give up alcohol completely and feel that I could if I were on my own, but unfortunately my husband of 28 years, and almost all of our friends are drinkers (many are heavy drinkers), and when I did stop drinking completely for several months in the past, I felt very alone and many of my circle resented the fact that I was abstaining in their company, or felt that I was judging them for continuing to drink in mine.  This may sound like I am weak or that I use their peer pressure to continue to drink, but what is the option?  Divorce with three kids and a big house?  Being totally alone in a foreign country?  I am an expat and I'm sure there are many others in the same situation so I would like to hear from you, please.

3

'However, I found that my desire for other things that I used to enjoy, also decreased (certain foods, activities, even sex)'

This is called anhedonia. I can't post links, but you may want to Google it.

As for peer pressure, that is very difficult. Which country are you in and where are you from?

4

I am in France and originally from Canada.  I have had good medical treatment over here (I saw an addictologist for two years) so am not lacking in clinical help.  It really is an environment/habit issue with me. I do think the Naltrexone contributed to my 'anhedonia' by blocking the way my brain normally responded to alcohol (and other opioids).  I also stopped the drug because I really felt I was not doing my brain any favours by using it regularly. I know I have o sort myself out regarding the drinking and the situation I'm in, and I'm working on that.  Thanks to all who read and respond to my messages.

5

Hi, I have been using Naltrexone for a few months now. Here in Britain it is prescribed as a daily dose. I however used it using The Sinclair Method as I had read about the 'anhedonia' effect. I take it if I know I am going to drink and at times when I may drink. So I take it at least 1 hour before any drinking. I am happy to say it has worked for me. 

I am sorry that it hadn't worked for you.....it does sound as if you take it daily. Could you perhaps try TSM approach.....maybe drinking every 2 days or something as a form of 'weaning off'. This may reduce your intake of alcohol significantly as you don't want to actually give it up. 

I do do hope this post doesn't sound tripe....only a suggestion, in case it helps. Xx

6

Yes, you are correct.  The Sinclair Method is not for everyone, of course.  There is no one particular treatment out there that works for 100% of the people.  However, your psychiatrist tells you of his treatment shows only a 50/50 success rate, and that is well down in terms of the percentages reached by those who fully understand the method - they are in the rate of around 75-80%, which is roughly what the clinical testing showed, too.  The success rate that I have counselling people through this method is actually nearer the 85% mark.  I am not a psychiatrist, but I am a counsellor.  Sometimes a psychiatrist will understand the science behind the method and that is truly awesome, but may lack a little of the practical way to apply TSM.  There is also another treatment provider who chats on this site too, Paul Turner, and my understanding is that he is also around that same percentage as I am.

So, just in the interest of making sure you know you gave this a good shot with all the areas covered, there are basically 4 parts of TSM.  If you have ticked all of these boxes, then you know that TSM is not for you.  If there is an element that has not been featured, then you should maybe discuss that particular element with your psychiatrist again.  It is shown that in clinical trials, only around 10-12% of people did not respond to TSM.  Another 75-78% reduced their drinking, and the remainder stopped the treatment for whatever reason, whether it be an intolerance to the medication etc.

1. Adherence.  That means every single time you drink.  Not just taking the pill, but also ensuring you wait the relevant time.  If you have been 100% adherent then great, if not then that WILL have an influence on the overall result.

2. Craving vs Habit.  It's very important to recognise that you work in partnership with the medication.  So, that means recognising that the medication will prevent the chemical reaction in your brain that compulsively drives you to drink.... and then working towards slowly chipping away at your old habitual drinking.  For example, instead of taking the tablet before leaving work because you ALWAYS drink after work, a good way to start making the change is to delay the first drink by not taking the tablet until you get home.  Or, when you have started drinking, making small changes to learn to recognise to interrupt your drinking, for example, putting the drink slightly further than arms length so instead of just reaching for it absentmindedly, you start to bring in your conscious brain and actually decide if you really want it enough to have to get up.  This is working WITH the medication to achieve the desired results.

3.  Selective Extinction.  This is SO very important.  Working as per above will (eventually) get you to the stage of not drinking for a day, so no medication required.  To spur things on a little, you need to use this day without having your receptors blocked to give them a good BLAST of endorphins from an activity such as exercise, or eating a spicy meal.  This will feel great and as you string good days together, then your brain will start to learn that alcohol is no longer the experience it was, but, by gosh, that other activity felt goooood.  The 'pendulum' in your brain will begin to swing from wanting alcohol (not chemically rewarding) to wanting that other good, more normal activity (which is giving it a chemical reward).

4.  Patience.  Not usually our strong point, I know!!!  But this is vital.  In clinical trials, the results were around the 3-6 month mark.  For me personally, when I did this method, it took around 3 months of uninteruppted treatment for me to be able to conisently get things moving substantially, and then another 5 months of the same until I was totally craving and habit free.  So, in total 8 months.  I have just counselled another man through it and that took 9 months in total.  It seems that real-life pressures mean that for the majority of people, reaching the end goal takes longer.  Dr Sinclair himself said that if someone has been doing TSM compliantly for about 8 months, and they have experienced NO change whatsoever, then they may be one of the 10-12% that this treatment is medically ineffective for. 

From my experience, when you mentioned that you had an initial response, this tells me that this method IS going to work for you, as long as the four points above are all fully engaged in.  I have no supported well over 600 people through this, so I have a lot of 'real-life' experience with it.  My drinking history was in the 20+ year mark, and that gentleman I mention above was well over 15 years in traditional treatment.

As I mentioned, IF you have engaged fully in all of the above 4 areas, then TSM may not work for you, but before you really decide that for sure, make sure to know that you have ticked off all the above, otherwise the missing component may be influencing things.  This is not a magic pill and will not miraculously stop you putting the drink to your lips - it takes work on you part, too.

And finally, good luck with whatever you decide on works best for you!

7

Very very helpful as always Joanna and has given me a new lease of life and hope and the will to persevere thanks

8

Thanks Joanna, for your comprehensive response. During the last year on treatment I read messages like these often and implemented them into my daily actions. Can I say that for 4.5 months every point was met 100%? For most of the points, yes. But sadly, I think I got in front of myself with the whole "I took a pill, so I can drink tonight" and then drinking, instead of trying not to. It became a justification almost. The fact is I don't want to completely deny myself something I enjoy.

Point 3 of yours, "selective extinction" didn't really work for me. On days I took the pill I loved holding my children and going to the gym just as much as days I didn't take it, for example. Unfortunately I didn't ever experience this difference which seems to be a fairly important part of TSM.

While both my attempts were surely not 100% perfect nor lasted for six months or nine months, I don't think I want to give it a third go because any medicine takes a toll on your liver (in addition to the alcohol) and it's precisely that, and trauma to my brain, that I'm worried about long term. I generally take zero medication. 

Thanks

9

Hi Jacqueline

Thanks for your very interesting comments and story. I too am in France now (am from West coast USA) - is this part of our problem? My husband actually isn't a big drinker but he enjoys drinks on special occasions, vacations and when with old friends (the perfect drinker who enjoys a glass but barely ever thinks about drinking!!). It would be super weird for me to not drink during the holidays with his family, for example.

Not that I would want to do this - I love that the French associate champagne with Christmas! And back in California everyone seemed to love wine and craft beer pretty much all the time - there seems to be no getting away from alcohol in my life, but I also definitely seek it out.

My husband would probably be happy if I stopped drinking totally - though I be less fun and probably bitchier. It sounds like you have a harder situation...

10

Absolutely your choice, MD, and I totally respect that.  I just wanted you to be sure knew as much information as possible, so that you are making an informed choice, for you.

11

As the others have already said, thanks so much for your succinct restatement of TSM's basic tenants. I am in month five and am compliant with all five of your conditions for best chance of success with the exception of number one. I ALWAYS take my 50mg of naltrexone but don't always do so an hour before having a drink. I rationalize that the drug will get to the necessary blood quantum level fast enough and do its work regardless. Can you try and explain why I am incorrect?

Additionally, I have read "The Cure for Alcoholism" twice now and I can find no real description of what one is supposed to "feel" when drinking after taking Naltrxone. I'd like to understand the chemistry behind the blocking of the receptors and the alcoholic "high"......

Aloha,

Brian

12

Hi Brian,

Can you tell me how long you are generally waiting between taking the tablet and having the first drink please?  I will be able to answer this better then.

Thanks

Joanna

13

Oddly the Sinclair method doesn't work for me. I gave it a try versus taking Naltrexone daily. I found taking it daily made me neutral towards the idea of drinking. But if I did take a drink, it did nothing. I continued until the bottle was done. 

I plan to continue taking it daily, so that I can get rid of the obsession to have that first drink. 

Through trial and error I found how it works best for me. So if TSM doesn't work, try the daily method. I don't miss it if I don't crave it in the first place. 

14

Anywhere from two before to an hour after the first drink.

15

Thanks for that. Still not getting any rationale answer to why TSM should work better than the daily dosing. I understand it’s about “re-training” but I guess I need more specific information.....

16

Ah, I see.  Well immediately I see the issue here.

First of all, there is only one golden rule of this treatment but it's so important that it is simply just non-negotiable.  That rule is that you wait for the craving to hit, then take the tablet.  If naltrexone, wait 1 hour before drinking to give the tablet time to be absorbed and effective in blocking the receptors in your brain from receiving the endorphins that drinking alcohol causes.  If nalmefene, wait two hours for it to be effective.

In order for this to be an effective treatment, you must not drink before that time is up because then you are allowing the endorphins to received by the receptors in the brain.

Taking a pill an hour after your've started drinking is pointless - basically, trying to catch the horse after it's bolted.  How can your allow your brain to learn that it is never going to get the reaction from alcohol that it craves for if you intermittently let it get that endorphin rush?

17

Have you read the book that explains this?  Or watched the documentary that also explains it?

If not, then message me your email address and I will email you back a PDF copy of the book and the link to watch the documentary.

18

Sorry, I have just re-read the entire thread and see that you have read the book.

It completely explains the science behind the method in the book, but if you confused about the daily vs TSM way of taking naltrexone, I'll try explain below:

TSM allows a person to specifically target the blocking of those endorphins only, by only taking the tablet an hour before those endorphins are going to be released by the brain when alcohol is consumed.  This then leaves a person free to allow their brain to feel and enjoy the endorphins that are released during other activities.  The naltrexone is only taken prior to the specific behaviour that the person wants to extinguish (in our case drinking)

A person taking naltrexone daily blocks ALL endorphins from every activity.  There are no activities that can cause a chemical cascade in the brain thanks to the blockage from the naltrexone.

By specifically targeting only the drinking, the brain learns that drinking no longer produces a good chemical reaction anymore, but other activities to.  The easiest way to explain this is that an imaginary pendulum in your brain begins to swing from the activity that is no longer rewarding, towards the activity that is still rewarding.  Over some months, that pathway in the brain that had so strongly associated alcohol with the rewarding chemical reactions in the brain is weakened and eventually breaks down completely.  The brain no longer needs or wants alcohol because it knows that it doesn't provide that chemical rush anymore.

That is the science explained as easy as I can explain it.  On the C3 Foundation Europe website there is a two page explanation of the scientific way that naltrexone works to cause extinction of alcohol cravings written by Dr Sinclair himself, so if you google that then you can read the scientific explanation in detail.

19

Thanks for that explanation about how it works.

I also asked earlier in the thread “Additionally, I have read "The Cure for Alcoholism" twice now and I can find no real description of what one is supposed to "feel" when drinking after taking Naltrxone. I'd like to understand the chemistry behind the blocking of the receptors and the alcoholic "high"......”

So would it be correct to say that the effects of the alcohol are still present, “high”, loss of coordination, etc., but that through the blocking of the receptors it simply becomes less interesting to drink...? In other words, if I still can feel “high”, even though my brain isn’t getting the endorphin rush, why would one stop.....?

20

There is no right or wrong way to feel when drinking on naltrexone.  Some say it feels different somehow, but can't put their finger on why.  Others say they notice that the drink tastes the same but after a couple of drinks they notice that the compulsion to continue drinking is gone and that they are satisfied with the couple they had.  And others say they feel no different drinking on the naltrexone at all.....

The blocking of the receptors happens in the part of the brain that has no feeling, hence why some don't notice anything other than the missing of that compulsion to continue.

When the endorphins are produced by the alcohol and attach to the receptors in the brain, it creates a chemical cascade that produces a whole other load of chemicals and reinforcees in the brain that alcohol produces this chemical reward.  By blocking the receptors in the brain, that cascade can not happen but the rest of the drinking experience remains - someone will still end up drunk if they drink too much, and a few glasses will still cause the relaxation effect. 

Some view naltrexone as the 'off' switch that allows them to stop when they are satisfied.  This is just like a normal drinker without an alcohol problem would do.  For the most part, they can have a few drinks, realise when they have had enough and then stop for the night.  For those like us, we want to be normal but that chemical cascade going on makes us compulsive continue and we lose control.  Naltrexone (taken correctly) prevents that cascade and so we are able to learn how to make better decisions when we drink.

Doing this over some months means that we stop obessing about alcohol and are no longer being driven to drink even when we shouldn't.  When extinction is reached, we can drink like a normal drinker if we so wish, but in many cases we often chose not to drink because we are back in the driving seat again and drinking on every available occassion just isn't that important anymore.  Other enjoyable activities such as being present with the family, enjoying sports, hobbies....  all this stuff becomes more important than drinking and the drinker can make the choice, rather than there being no choice because alcohol is the all-consuming drive that it previous was.  Many people who reach extinction just stop drinking because it is no longer important to them and they want to fully focus on other things.  The remainder tend to have a drink or two on social occasions.  It's an entirely personal decision depending on how you feel when you get reach that stage.

Hope that all makes sense.