Sinclair Method.

[John Rutledge]

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Edited October 29, 2009 by John Rutledge

[Mark]

JR and all Readers

Thanks for bringing this topic up. the Sinclair method is really interesting . I have no idea if it actually works - only a full scale scientific study can establish that - but I understand why it should work, and that makes it really very interesting from the perspective of learning theory, and as a posible alternative to other methods that have limited success themselves. Having lots of choice available is often a good thing, as some methods appeal more to some than to others (as we are all well aware).

The basic idea of the Sinclair method as I recall it (haven't listened to Dr. Dave's original podcast from Shrink Rap Radio in some time) is to use a drug to extinguish the desire for alcohol. Yes drug therapy is involved, but it isn't fair to say that the therapy is primarily about the drugs direct effect. It's more about the drugs side effects - which is to help a certain kind of learning happen. To put it another way - the Sinclair method is a drug-assisted behavioral therapy.

Here's how I summarized the method in a previous essay:

Sinclair's treatment method can be quickly summarized. Take an alcoholic patient and prescribe him or her some short-acting opioid antagonist medicine (probably in pill form) that he or she can take before drinking. Instruct the alcoholic person to take one of these pills shortly before they have a drink. Apart from the need to take their pill in advance of drinking, they are to keep drinking as they normally would. They are to do this every time they drink for the rest of their lives. If the alcoholic patients are able to comply, Sinclair suggests that their drinking rates will naturally decline over several months to normal or below normal social drinking rates. There will be no need for detoxification, because detoxification will occur naturally and gradually (and thus safely) over a period of months. There will be no need for psychotherapy such as relapse prevention, or alcoholics anonymous, because the craving for drink will actually gradually and naturally fall off with sustained use of the opioid antagonist medications as prescribed.

What happens is that the pills kill off the pleasurable or rewarding or reinforcing characteristics that having the drink normally produce. It is the presence of these rewarding characteristics that makes the alcohol so addictive in the first place (according to Sinclair). Without them happening, the idea is that the alcohohlic person will simply get less charge out of each drink, and over time, will lose the desire to have more drinks - because they are no longer associated with pleasure.

I guess this sort of thing feels counter-intuitive or paradoxical, but really, it isn't. It just challenges conventional wisdom in a manner that is at least superficially in accordance with well established learning theory.

This sort of learning (or un-learning, as it would appear to be) is known as extinction in learning therapy terms. You are taking apart an older association between a stimulus (the alcohol) and the response (the desire and need to continue drinking alcohol).

It would simply be great if this method actually worked. As I said above, however, I'd like to see the results of this method's application to a large population of alcohol dependent people before recommending it wholeheartedly.

Mark

Edited June 21, 2008 by Mark

[SuziQ]

Interesting theory. But we are not rats in a controlled environment. What is to prevent a human being from remembering what he/she felt was pleasure from alcohol and simply stopping the pill that is blocking that remembered pleasure?

[John Rutledge]

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Edited October 29, 2009 by John Rutledge

[SuziQ]

Hi John,

Did you see Wade's post under Statistics that there is a free recovery program in Thailand based on Buddism ? Thought of you when I read it.

Yes, it would be easier if our imagination did not lead us to make some very detrimental decisions in life. It also leads us to make wonderful discoveries.

Women, according to several studies, do not metabolize alcohol as well as men and it leads to greater damage. Also, women have more difficulty with shame. At a seminar on women alcoholics, we looked at behaviors when intoxicated--such as falling off a bar stool, not being there for children, sexual behavior, cursing, fighting, etc.--Many of these things were considered ok, and sometimes funny, for men--but not for women. Maybe facing her shame was harder to do than killing herself with alcohol. Alcohol addiction, as well as other addictons, is indeed "cunning, baffling and powerful" and drugs and alcohol are often seen by the user as a means of escape, as well as a pleasurable experience. I use day dreaming as my means of escape today.

It is nice to see a post from you. I always look forward to them.

SuziQ

[Mark]

Interesting theory. But we are not rats in a controlled environment. What is to prevent a human being from remembering what he/she felt was pleasure from alcohol and simply stopping the pill that is blocking that remembered pleasure?

Funny that you would leap to view the Sinclair therapy as something to be imposed upon you, as an experimenter might impose an experimental trial on a lab rat :confused:. That's not what this is about, I don't think. No therapy is going to be helpful to someone who doesn't want to change.

If Sinclair's method is a good one (and I'd love to see the data on that some day - he's been doing this stuff in Finland or something through their national health service), it would be something that alcoholics would need to sign up for because they want to quit. and the thing that would keep them going on the therapy would be because they wanted to quit. Of course people could stop taking the pills. Presumably, you'd have people participating in such a therapy in support groups where they could talk about this very issue (becuase it is bound to be a common issue among people using this therapy).

Mark

[SuziQ]

Mark,

Odd that you think I "leaped" to some conclusion. And exactly what conclusion did you believe I "leapt" to? My remarks were observations, made because I know how strong the pull to return to alcohol (and what may be perceived as pleasure) is. Observations are NOT conclusions. And, actually , that we are not lab rats, is a simple statement of fact. What I went on to ask was, if a human being had a memory of pleasant sensations and would want to return to alcohol and stop the pill, if given free choice, would it take the pill ? What about mental craving? It is precisely because it is NOT imposed that I made the observation. I think I read somewhere else that the Sinclair Method drug was originally tested on lab rats---hence my observation about lab rats.

If the Sinclair Method works, great. I have just seen many who want to quit one day and don't want to quit the next day. Of course I realize people would have to want to take it. Duh. If I read the your summation correctly, it said there would be no need for psychotherapy, AA, or support. That was the reason for the question. That summation did not presume additional support. The Sinclair Method, as summarized by that post, stops physical craving. So, that raises the question---are additions simply physical cravings?

SuziQ

[Mark]

SuziQ,

I don't think any program addressing addictions will work well without ongoing support (at least for the majority of people). Motivation is something that as you suggest tends to go back and forth. Given enough time the sinclair method ought to work, but only if you choose to stay on the medication. Probably it will be easier for some people to do that than others.

Sorry if you perceived my comment as an attack - I didn't mean it that way at all.

Mark

[SuziQ]

Thanks Mark,

Guess over these many years I have seen so many therapies come and go I just wonder about them. Aversion therapy, antabuse, finding God, finding Jesus, Synanon, scream therapy, nude therapy, and on and on. The therapies of the 60's, as practiced in LA, were something else. I do like Rational therapy. And,of course, psychoanalysis, which I told my analyst gave him a great history of my behaviors and gave me little new direction. That was in the 50's. I was never mentally ill. I just had a family that was sure someone or some therapy would change me into being what they thought I should be---whatever that means Later, I was just curious. And I did develop a drug problem for a period of time, less than four years. I was primarily a binge drinker.

Just really wonder why I would want a drug that allowed me to drink if it stopped the pleasure. What about the physical side effects of alcohol, such as impaired physical and mental abilities?

As you said, it might be fine for some. I have simply come to the conclusion that there is no "one size fits all" in the treatment of additions.

SuziQ

[John Rutledge]

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Edited October 28, 2009 by John Rutledge