I did some research on the long term success of the Sinclair Method which uses naltrexone or nalmafene to extinguish alcohol addiction. The TSM people boast of a 78% success rate but the study I found shows that this figure represents the number of people who reduce their drinking to about 10 units a week. Here is the study: Evidence about the use of naltrexone and for different ways of using it in the treatment of alcoholism | Alcohol and Alcoholism
The study shows some interesting facets of this treatment. For instance, the treatment must be taken with alcohol. If it is not, then it is no more effective than placebo. While on the treatment, the effects of Nal make alcohol intoxication worse, so if anyone takes this treatment, they should be warned that they could end up feeling more drunk and getting into worse problems related to intoxication than if they only drank.
Then there is the question of long term benefits. Only 26 percent of people on this treatment achieved sobriety. That's nothing to sneeze at but my concern, I have to say, is that this drug is for people who are able to regulate their behaviour and take a pill with them everywhere they go and take it at a specific time before they have a drink. In my mind, this sort of drinker is not an "alcoholic". For me, that ends this debate about the drug. Alcoholism as a disease is something which is out of control, something over which one cannot exercise one's own will power. TSM depends on the exercise of will power so by definition, it excludes people who are ill from alcohol abuse from it's statistics...because those people can't engage in the treatment.
Moving on, the study shows that rats who were given Nal relapsed to heaving drinking because they "relearned" the behaviour that led to heavy drinking. I may be wrong but this suggests to me that they are no "relearning" but that their brains have experienced regrowth of the pleasure receptors which the Nal extinguished.
My feeling about this treatment is that it is going to become very popular among people who aren't actually clinically suffering from AUD but who want to cut back on their drinking and in some cases abstain. The problem with it is that it has risks, cannot be combined, so it seems with abstinence and involves continued drinking while under treatment and that the treatment itself can contribute to worsened drunkenness and the problems that flow from that. In addition, unless it is paid for by insurance or government health care, it is much more expensive than baclofen.
I have a couple of big problems, myself, with this treatment. I have bought Nal for my wife and it made her so bad that she accused me of trying to poison her and called the police. The other problem is that for those alcoholics who drink a liter of spirits a day or more, it is not a viable treatment at all because they just are too far gone.
I've always said this about this forum. This is not a forum which is representative of the full spectrum of alcoholics because those suffering most from the illness dont' have computers... or jobs, or the ability to engage in forums like this... Which is perhaps why I come across as so heavily in favour of baclofen, because it works in the worst cases and also because the theory which Ameisen sets out actually shows what alcoholic craving is. For me, Nal use shows that there is a neurological mechanism called extinction in cases where an opiate antagonist is used while consuming alcohol. That is a very different issue from what the cause of addictive behaviour in alcoholism is. Yes, if you deaden the brain's Gaba A pleasure receptors while drinking, you get less pleasure from it until you don't get a kick from it. But...what about people who have a disorder of the Gabab receptors and can't stop drinking. These people, the truly ill alcoholics who are too ill to follow TSM and are ACTUALLY ILL are weeded out of the statistics for this treatment BECAUSE they are ill from alcoholism. Those who are included in the statistics for TSM success are there because it is very easy to use the term "alcoholism" loosely to apply to people who aren't actually ill from AUD.
The study shows some interesting facets of this treatment. For instance, the treatment must be taken with alcohol. If it is not, then it is no more effective than placebo. While on the treatment, the effects of Nal make alcohol intoxication worse, so if anyone takes this treatment, they should be warned that they could end up feeling more drunk and getting into worse problems related to intoxication than if they only drank.
Then there is the question of long term benefits. Only 26 percent of people on this treatment achieved sobriety. That's nothing to sneeze at but my concern, I have to say, is that this drug is for people who are able to regulate their behaviour and take a pill with them everywhere they go and take it at a specific time before they have a drink. In my mind, this sort of drinker is not an "alcoholic". For me, that ends this debate about the drug. Alcoholism as a disease is something which is out of control, something over which one cannot exercise one's own will power. TSM depends on the exercise of will power so by definition, it excludes people who are ill from alcohol abuse from it's statistics...because those people can't engage in the treatment.
Moving on, the study shows that rats who were given Nal relapsed to heaving drinking because they "relearned" the behaviour that led to heavy drinking. I may be wrong but this suggests to me that they are no "relearning" but that their brains have experienced regrowth of the pleasure receptors which the Nal extinguished.
My feeling about this treatment is that it is going to become very popular among people who aren't actually clinically suffering from AUD but who want to cut back on their drinking and in some cases abstain. The problem with it is that it has risks, cannot be combined, so it seems with abstinence and involves continued drinking while under treatment and that the treatment itself can contribute to worsened drunkenness and the problems that flow from that. In addition, unless it is paid for by insurance or government health care, it is much more expensive than baclofen.
I have a couple of big problems, myself, with this treatment. I have bought Nal for my wife and it made her so bad that she accused me of trying to poison her and called the police. The other problem is that for those alcoholics who drink a liter of spirits a day or more, it is not a viable treatment at all because they just are too far gone.
I've always said this about this forum. This is not a forum which is representative of the full spectrum of alcoholics because those suffering most from the illness dont' have computers... or jobs, or the ability to engage in forums like this... Which is perhaps why I come across as so heavily in favour of baclofen, because it works in the worst cases and also because the theory which Ameisen sets out actually shows what alcoholic craving is. For me, Nal use shows that there is a neurological mechanism called extinction in cases where an opiate antagonist is used while consuming alcohol. That is a very different issue from what the cause of addictive behaviour in alcoholism is. Yes, if you deaden the brain's Gaba A pleasure receptors while drinking, you get less pleasure from it until you don't get a kick from it. But...what about people who have a disorder of the Gabab receptors and can't stop drinking. These people, the truly ill alcoholics who are too ill to follow TSM and are ACTUALLY ILL are weeded out of the statistics for this treatment BECAUSE they are ill from alcoholism. Those who are included in the statistics for TSM success are there because it is very easy to use the term "alcoholism" loosely to apply to people who aren't actually ill from AUD.
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