Strictly Sinclair Week 2

[Krazy1]

Strictly Sinclair Week 2

Naltrexone Dosage

Hi Blondie,

Comgratulations on getting to 16 weeks with TSM! It can be a long haul, but in my experience, it's been well worth it. Some have found that increasing the dose to 75 or 100mg to be helpful, but no matter what - PATIENCE is the most important thing. I've had a really slow decline in drinking and craving levels, but that isn't what I've used to measure my success. No matter how much I drink now, I almost never really 'get drunk' - act and feel like a "normal" social drinker. I didn't have the choice to increase my dosage, because my psych will only prescribe the 'text book' 50mg, and he thinks I'm using it with abstinence. Same old crap with nobody knowing about or willing to learn about TSM - many of us have to lie to ensure we'll still get the Naltrexone. If you're seeing a decrease in craving level, that's a sign that the Nal is working for you to some degree. The actual reduction in drinking may take a while to show up.

All I know is that I got my life and my family back - 50 mg at a time! Even so, I've been at this for 8 months, so it didnt' happen overnight. That's OK with me - it's a small price to pay if I can undo the damage caused by 30+ years of drinking like a maniac! It's hard to hang in there when it takes so long, but don't give up. TSM works for the vast majority (80+%), so it's almost always worth the effort.

There is a lot of information and support if you check out thesinclairmethod.com • Index page - take a look, but still feel free to ask me any questions if I can help. Best of luck to you!

[Lenore]

Strictly Sinclair Week 2

Bumping my Nal dose to 75 mg helped me, blondemerlot. Good luck!

[SpringerRider]

Strictly Sinclair Week 2

Hi all. I used to haunt this place under Sinclair threads but have drifted away. I am bumping this thread because of some of the excellent posts in it. For the record, I have declared myself cured since mid-June.

Look for additional posts about the Sinclair Method to follow. I have too much time on my hands.

[cyclefan]

Strictly Sinclair Week 2

Hey SpringerRider good to see you, and great news about your cure. I'm very happy for you. xo Beth

[pinkmilk]

Strictly Sinclair Week 2

Hi Springer!
Nice to see you again. I remember we chatted a few months back when I was just starting out on TSM.
I'm now in Month 5 and sadly have yet not noticed any difference in either desire of quantity of my drinking....
But I said I would do it for six months, so I keep going a bit longer (finding it hard to admit I am one of the failures of TSM).
So good to hear it works for some people though. If I have to give in next month I need to find something else to try.... AA not an option!!!!
Glad you are still "cured"! Great! :h

[SpringerRider]

Strictly Sinclair Week 2

pinkmilk;755742 wrote: Hi Springer!
Nice to see you again. I remember we chatted a few months back when I was just starting out on TSM.
I'm now in Month 5 and sadly have yet not noticed any difference in either desire of quantity of my drinking....
But I said I would do it for six months, so I keep going a bit longer (finding it hard to admit I am one of the failures of TSM).
So good to hear it works for some people though. If I have to give in next month I need to find something else to try.... AA not an option!!!!
Glad you are still "cured"! Great! :h

I am sorry to here that you are not experiencing progress. You may have seen some of my discouraging posts over at TSM last year where I had serious doubts. I seemed to experience upticks around the 4th to 5th month. Remember, you are to repeat your drinking patters as before.

I had written something to Dr. Roy Eskapa about it and he forwarded it onto Dr. Sinclair. Sinclair answered it as a Phd but I will include this. Maybe it will help.

From David Sinclair - reply to this question. His response was quick and I appreciate it. I should state that almost everything I have learned about addiction science has been since I met Sinclair in 1990. The rest came from reading and working with people facing addiction issues. Here is an explanation for SpringerRider hot off the press from Helsinki, Finland:

What you describe is actually one of the basic processes in the nervous system. Learning is caused primarily by the synapses between nerve cells becoming stronger (reinforced), and thus making it more likely that you will make a response or think a thought or feel a craving again.

We know, however, that the opposite process - the weakening and eventually complete burning out of synapses - is at least as important. (Extintion) For example, most of the changes in the nervous system that occur in the first few months after birth are the removal of synapses. It is sort of like sculpting: removing all the other synapses (and thus breaking all the other neural pathways) until just the one correct one is left.


You may call this "deep in your psyche" but causing it is a real physical event.

The dissolving of the relationship to craving is the burning out of the synapses that previously had made you think about alcohol. It is not the relationship between craving and its satisfaction that is being removed, however. That relationship, or rather that between craving and reinforcement, is blocked as soon as you take the first naltrexone pill, and it is blocked so long as you have naltrexone in your brain, but it is completely unconscious. It just is a fact that if you happen to have endorphins released, they will not be able to cause any reinforcement (strengthening of synapses), but you cannot feel this. At most you will notice the lack of something when you do have endorphins released, after drinking alcohol, or by eating sweets, jogging, etc.

The really important factor is what happens after alcohol drinking causes endorphins to be released and then the expected activation of opioid receptors from binding their endorphins does not happen. At that part, the nervous system starts the mechanism of extinction. The synapses that had just been used, e.g., ones triggered by the sight of a drinking friend, or the smell and taste of your favorite drink, or by the mood when you drank, become weaker. These synapses are now less capable of making other neurons fire. Some of these neurons that are less likely to fire now are the once involved in thinking about drinking and in craving. Others that are less likely to fire are ones causing the drinking behavior itself.


There was a new report last week at the ESBRA meeting here in Helsinki. You may have heard of the MRI machines that can show when parts of the brain are active. The new report, from Germany, showed how alcohol-related cues (e.g., pictures of beer bottles) were able to stimulate strong firing in various parts of the brain in people who had become alcoholics because of reinforcement of synapses by endorphins. And these were the people who responded very well to naltrexone.


I found your description of how the craving grows with alcohol deprivation very interesting. This phenomenon, which I named "the alcohol-deprivation effect" is what got me started doing alcohol research over 40 years ago. It is a very powerful thing. It also is contrary to the ideas people had back then about what causes the motivation for alcohol. In particular, it was generally accepted that the motivations was logically caused by withdrawal from physiological dependence on alcohol: that people were drinking just to avoid withdrawal.

Consequently, the treatment they gave was detoxification and forced abstinence, long enough for the physiological dependence to be gone. Indeed, a misleading euphemism for alcoholism still used today is alcohol dependence. If they were right, detox would have been the cure for alcoholism. Of course, it was not. We found that the alcohol-deprivation effect does not disappear as physiological dependence is removed. Instead, the increased craving produced by the alcohol-deprivation effect grows stronger and stronger, week after week, and never went down in several months of deprivation.

Now to your question of whether you should intentionally deprive yourself of alcohol. The way you are doing it sounds good. It is a good idea to extinguish all of the various forms of drinking you had learned to do. You should drink alcohol (with naltrexone) in the same locations where you previously learned to drink, with the same people, and with the same moods.

One situation in which you previously had learned to drink was probably after a period of alcohol deprivation. Consequently, the synapses connecting the deprivation-induced feelings of craving to the act of drinking have become reinforced; and they now need to be weakened by extinction.


Naturally, there are certain cases in which you must try to limit your drinking: you must be particularly careful not to be drinking if you are going to drive, etc. The naltrexone may even make some aspects of intoxication worse.
There is another reason for have pauses in your drinking as soon as you can manage to do so: in order to strengthen healthy alternative behaviors.

It is a good idea make a list of things other than drinking that you enjoy doing and then noticing which ones are probably reinforced by endorphins. They include eating sweets, spicy, salty and other good tasting foods; jogging, sports, and other forms of strong exercise; cuddling with babies and pets; some forms of sexual activity. These behaviors will also be weakened if you do them while you are on naltrexone - but we do not generally want to have them reduced. Therefore, first, you should avoid as much as possible doing those other behaviors while you are on naltrexone and drinking. Second, when you are able, have a weekend without alcohol and without naltrexone. Saturday is a washout day in which the naltrexone is removed from the body. On Sunday afternoon you should reward yourself by doing one or more of these other opioidergic behaviors.

We have discovered a really nice thing about this. When you do the other opioidergic behavior, you will get enhanced reinforcement of it. Patients report that the first bit of chocolate, on that Sunday afternoon, is the best they have ever tasted.
The main reason for this is that while naltrexone was blocking your opioid receptors, your brain tried to compensating by making more of them. This is called "up-regulation". We have actually measured the increase; it was almost a doubling of the usual number of opioid receptors.

So long as there is a surplus of naltrexone in the brain, the increase in opioid receptors has no effect since they are all blocked. But when the naltrexone has been washed out, this huge crop of opioid receptors is standing, begging to be filled by endorphins from that chocolate, or from jogging, or from any of the other behaviors.

The increase only lasts a few days, but during this window of opportunity you have supersensitivity to endorphins and an enhanced ablility to develop other behaviors to fill the vacuum as alcohol drinking becomes less important in your life.
This also leads to the long-term solution for the drinking problem. In our three year follow study, we found that the patients drank progressively less often over the months and years. In other words, the deprivation periods became longer and longer. Some quit completely. Many others were down to drinking at most once a week - it was sauna night in Finland and they wanted to have a sauna beer, like everyone else around them. The rest of the time they were just carrying the pill with them, in case a drinking occasion arose. It costs nothing to carry it. And there is no risk of weakening any of the healthy opioidergic behaviors.

Just remember to always take the naltrexone before drinking, because this enhanced reinforcement has another part to it. If, during the time of supersensitivity you drink alcohol without taking naltrexone, there will be enhanced reinforcement of alcohol drinking. Done repeatedly, you would soon relearn all of the craving and drinking behaviors that had been extinguished.

David

[pinkmilk]

Strictly Sinclair Week 2

Thanks SoringerRider for posting this reply here!
It's good to remind myself why I am doing TSM and why I should stick to it.
I have been getting a lot of negative comments from my husband lately. He can't understand why extinction should take this long. I wish it was quicker too!
Anyway, it's so good to hear from people the Naltrexone has helped. Thanks again! And have a nice weekend!
Cerstin

[redcat]

Strictly Sinclair Week 2

Thank You for sharing with us Dr. Sinclair's response. I hope it will work well for all of us. I have another question: Does anyone know what happens if we take 75mg instead of 50mg? Is it affecting how the TSM works and How?

[gratitude]

Strictly Sinclair Week 2

sr-question

hey sr,
quick question. have you an opinion on why only certain people have cravings and others don't?
i get the extinction of neuronsas a way to a cure. not quite sure how the nal does this but i'll be doing alot of research. i read your posts on this thread and respect your opinion. just can't figure out why some people would develop this craving while others(normies) don't. if it is a psychological dependence that starts us down the path and then it becomes physiological why isn't everyone addicted? genetic factors? then wouldn't it really be a physiological disease. thanks in advance.:thanks:

[SpringerRider]

Strictly Sinclair Week 2

gratitude;758795 wrote: hey sr,
quick question. have you an opinion on why only certain people have cravings and others don't?
then wouldn't it really be a physiological disease. thanks in advance.:thanks:

That is an excellent question and worthy of a dissertation, if you are feeling up to it. In a sense, alcoholics are the winners of an evolutionary process. We are the quick learners. We all believe that learning is the hard part of life and in some areas, that is very true. Few people pick up on quantum mechanics from the "Dummies" series but, believe it or not, there are savants that simply look at the equations and see it as obvious. The mechanism for learning kicked in very early for us.

Why us?

I personally think that there may be a couple of factors. I believe the first is a genetic proclivity. Just as one person learns to ride a bike quicker than another, some of us are more conditioned to learn alcohol addition. But more importantly is the value we placed on drinking when we first started. So many proclaimed that drinking used to "work for them" when they first started. I know it did for me. The amount of value we placed on drinking is subjective and is the result of the sum of our values. For me, drinking was a wonderful experience that had magical properties. It made me feel grown-up because I was doing a grown up activity. I wasn't shy or insecure when drinking. I could talk to girls though they never wanted to talk to me. I loved being a clown and alcohol gave me the excuse. It was a magic elixir.

So, on a Friday night after school, I would find an adult "runner" to buy booze for us. The anticipation was Christmas eve. Waiting for the booze was like waiting for Santa. My expectations were so very high. And then the reward would arrive and I would drink and the endorphins would be released. Bingo! Addiction-not all at once but over repeated "high expectations" and "reward", my endorphin system dutifully made the linkage and learning set in. It did not have to be alcohol. It could have been food, sex, gambling, shopping, etc., etc. What is important is the value, consciously at first, that I placed upon the act. The lesser the value, the more exposure that is required.

Now I may have had a friend that "really had it together". Drinking did nothing for him because he already had it. He was popular and the babes loved him. He might want to pull a "drunk" for recreation but alcohol wasn't going to elevate his very person. He was already there. So while I am anticipating that first beer, he is simply going along for the fun. He is not waiting for endorphins.

Some people do not acquire the addiction to alcohol until later in life but something else always comes into place before the change. Maybe they have suffered a painful divorce or a loss of loved one and began drinking heavily to alleviate the emptiness. What has changed is the value of the reward that drinking returns. Then as above, the conditions for addition is enhanced.

In my humble unqualified opinion, if it were possible to step in and change the value of alcohol before a person began to drink through education and self-esteem therapy, you may very well present an alcoholic from happening. What if I had been swept aside at age 13 and was provided intense counseling, karate lessons, nice clothes, became popular, etc., etc. In other words, winning a psychological and spiritual lottery? Though the dynamics are beyond complex, let us just play it as a "what if?" If I did not have all the short-comings that I perceived alcohol could compensate for, would the addiction process have kicked in as soon? I do not think so. The high expectations and reward would not have been there to the same degree.

I believe there is a psychological and physiological component. If you don't perceive drinking as significant, you will not as easily set up the receptor/endorphin link.

The above is a non-scientific answer and strictly how I see it.

[SpringerRider]

Strictly Sinclair Week 2

redcat;758762 wrote: Thank You for sharing with us Dr. Sinclair's response. I hope it will work well for all of us. I have another question: Does anyone know what happens if we take 75mg instead of 50mg? Is it affecting how the TSM works and How?

I have not heard anyone recommend the upping the dosage. 50 mg is supposed to block all the opioid receptors for 24 to 36 hours. I have seen 75 mg recommended for other addictions but I would not stray from the usual 50 mg. Naltraxone has a low liver toxicity in the area of 300 mg. Why get closer to that?

The only reason I can think that upping the dose would be the speed that Naltrexone goes to work.

I would prefer an opioid antagonist that would kick in immediately and last for only six hours. That would more accurately target the event. Targeting is everything. Ideally, the drug would be mixed with the alcohol and therefore administered and removed with the very same process.

I do not see that happening anytime soon.

[Guest]

Strictly Sinclair Week 2

SpringerRider;759227 wrote: I have not heard anyone recommend the upping the dosage. 50 mg is supposed to block all the opioid receptors for 24 to 36 hours. I have seen 75 mg recommended for other addictions but I would not stray from the usual 50 mg. Naltraxone has a low liver toxicity in the area of 300 mg. Why get closer to that?

The only reason I can think that upping the dose would be the speed that Naltrexone goes to work.

I would prefer an opioid antagonist that would kick in immediately and last for only six hours. That would more accurately target the event. Targeting is everything. Ideally, the drug would be mixed with the alcohol and therefore administered and removed with the very same process.

I do not see that happening anytime soon.

SR: Dr. Eskapa stated in a thread in TSM if you are a 24-7 drinker you may benefit from 50 mgs taken two times a day.

You keep writing the wrong answer to people's question and it should be corrected.

Glad you are doing so well.

[gratitude]

Strictly Sinclair Week 2

SR

thanks for the reply. read about tsm all night. i'm a bit of a bookworm.
i think your response was spot on. alcoholism being psychological and physiological. like alot of maladies i suppose. i think our culture emphasises an either/or approach and it's probably a combination of factors.
i also have been doing a little research on bil w. and he seems to have been a little more open-minded than most of the aa's i know. i think he had a whatever works approach to help alleviate suffering. kinda off topic but i love that we are living in such an interesting time. science is a beautiful thing,eh?
back on topic, i too was rewarded by alcohol in the beginning. it was my solution. too social akwardness etc. and it worked like magic. i'm sure you have heard this in aa hundreds of times. it worked until it didn't. which i guess is the point at which the cravings kicked in and i couldn't function without it - or with it. maybe the saturation point of every last one of my opiod receptors,haaha. anyway, i never thought of classical conditioning having anything do do with alcoholism. learned behavior- really? makes sense though. my background is psych and it never occured to me. maybe because i was drunk all the time.
so now my new question: why does bac work on some people? are there different types of alcoholics? some respond perfectly to bac others to tsm. i know you have an analogy for me about how this works... maybe a sports analogy? anyway, thanks for the conversation. gratitude:thanks:

[SpringerRider]

Strictly Sinclair Week 2

oceanaocean;759423 wrote: SR: Dr. Eskapa stated in a thread in TSM if you are a 24-7 drinker you may benefit from 50 mgs taken two times a day.

You keep writing the wrong answer to people's question and it should be corrected.

Glad you are doing so well.

I keep writing the wrong answer to people's question?? I think this is the first time that I have ever made this assertion!!
I did not see that statement about the 24-7 type. I do know that the preferred patient is the episodic and binge drinker since the trigger can be far better targetted. But if you see an error in a statement I make, please be kind enough to correct me with a citation or link.

_sr

[Guest]

Strictly Sinclair Week 2

SpringerRider;759768 wrote: I keep writing the wrong answer to people's question?? I think this is the first time that I have ever made this assertion!!
I did not see that statement about the 24-7 type. I do know that the preferred patient is the episodic and binge drinker since the trigger can be far better targetted. But if you see an error in a statement I make, please be kind enough to correct me with a citation or link.

_sr

Sure, when I find the time I will link it as best I can.
I will get you the thread with the info about 50 mgs 2 X a day from Escapa.
No big deal, I think we all need to be careful of stating medical advise or knowledge, for what it's worth. I know we are all here to help each other with friendly support.
Once again, glad you are doing so well.