Less than 2% of Alcoholic Americans Offered Breakthrough Treatment from Finland – The Sinclair Method – New Book Published
Extract from The Cure for Alcoholism (Benbella Books, October, 2008)
Author: Dr Roy Eskapa
Foreword: Dr David Sinclair
“The Cure for Alcoholism provides something that ‘s never been offered before… the potential of A REAL CURE. This book does not deal with prayer, will power or abstinence. This is the first book and program I’ve seen that genuinely offers to modify an addiction that is neurologically rooted and thought by so many to be incurable. I believe that The Cure for Alcoholism will change the face of this serious addiction and rock the rehab industry. ”
Professor Arnold A. Lazarus, Ph.D.
Arnold A. Lazarus, Ph.D. is a Distinguished Professor Emeritus of Psychology at Rutgers University (having also been a faculty member at Stanford University, Temple University Medical School, and Yale University where he was the Director of Training in Clinical Psychology for two years). He has written 17 books and over 350 professional articles and has been the recipient of numerous honors and awards. He is a Diplomate of the American Board of Professional Psychology and was also awarded Board Certification.
CASE HISTORIES FROM BOOK:
JuliaÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢s Story: Sinclair ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œDeluxeÃƒÂ¢Ã¢â€šÂ¬Ã‚Â Treatment
ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œThe most astonishing thing about miracles is that they happen.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â
ÃƒÂ¢Ã¢â€šÂ¬Ã¢â‚¬ÂG. K. Chesterton (1874ÃƒÂ¢Ã¢â€šÂ¬Ã¢â‚¬Å“1936)
ALTHOUGH INTENSIVE PSYCHOTHERAPY is not a requirement for successful treatment, JuliaÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢s story has been included because it provides an insight into both the theory and practice of the Sinclair Method and, at the same time, illustrates how the treatment can be enhanced through close, one-to-one contact with competent, caring professionals.
Julia, a thirty-eight-year-old woman, and her devoted husband, James, have been married for eighteen years. They live in a beautiful lakeside house in the Pacific Northwest together with their two adolescent daughters. A little more than two years ago, Julia lost her ability to control her drinking. Although she could sustain periods of abstinence, she frequently found herself craving alcohol, especially by the end of the week. The family became
accustomed to Julia getting drunk at parties and on Friday and Saturday nights. But when episodes of severe intoxication spilled into the week as well, her features thickened and her delicate, luminous complexion turned rough and pallid. She began taking ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œhair of the dogÃƒÂ¢Ã¢â€šÂ¬Ã‚Â drinks on Monday mornings after everyone had left the house.
A gifted potter, Julia once ran a successful small pottery business from a studio at her home. But her studio was now a mess, and she no longer used it. James, a highly respected lawyer and a passionate conservationist whom everyone thought of as a gentle soul, could not stop himself from quarrelling with her over her drinking. He had always adored her, but their once near-idyllic life had come to resemble a war zone. Horrified to find himself contemplating divorce, he implored her to seek professional help, but she angrily refused.
ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œI just have to drink,ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â she told him. ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œI donÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢t know why. You can all leave me if you want to; I just canÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢t stop it.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â
A few days later, James read a newspaper article about the Sinclair Method. He nervously contacted the clinic in Florida that was offering this new treatment. He explained that his wife was terrified because she had heard that addicts were hospitalized, forced to stop drinking and attend group meetings, and go through the torture of detoxification. She had also heard that many people who had gone to rehabilitation were often not only unsuccessful, roller-coasting between abstinence and relapse, but were often left feeling even more desperate after treatment. The trained receptionist explained that the Sinclair Method was different, a completely new approach that did not demand total abstinence, and she sent James an information packet describing the treatment.*
The skillfully worded packet went a long way toward persuading Julia to see a doctor at the clinic. ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œNo one is born an alcoholic,ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â one brochure in the packet explained. ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œDrinking is gradually learned. Each time you drink, alcohol causes the release of endorphins or morphine-like substances in the brain.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â Endorphins are the bodyÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢s ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œmolecules of emotionÃƒÂ¢Ã¢â€šÂ¬Ã‚Â and can suppress pain. The
endorphins strengthen or reinforce the drinking and everything that goes along with itÃƒÂ¢Ã¢â€šÂ¬Ã¢â‚¬Âthinking about alcohol, going to the bar, wanting a drink, ordering it, waiting for it, and finally, drinking it. This happens to everyone but some people, because of their genetic make-up, receive more powerful jolts of reinforcement from the endorphins. Over time, alcohol begins to dominate their lives, and they end up out of controlÃƒÂ¢Ã¢â€šÂ¬Ã¢â‚¬Âtotally addicted to alcohol. But, the brochure explained, the vicious cycle can be broken or weakened through the ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œnatural process of extinction using the medicine naltrexone to block the endorphins and the reinforcement they produce in the brain.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â
The entire family read the information packet. They learned that the treatment did not require hospitalization. This was especially encouraging to Julia, who hated anything to do with hospitals. She read that her goals would be ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œreduction, control or abstinenceÃƒÂ¢Ã¢â€šÂ¬Ã‚Â and that she need not abstain before beginning treatment. The treatment would reduce her desire to drink while she continued to drink! The clinicÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢s brochure explained that the drinking would decrease, not because of external demands or threats, but because the patient would simply lose interest in it. Using an approach that is entirely compatible with that of Alcoholics Anonymous, the Sinclair Method ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œworks well for both people who are severely addicted, and for those who merely drink more than they would like.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â
This seemed too good to be true to Julia, but she was encouraged by the fact that she would not be given strong medications, such as barbiturates or benzodiazepines, which can be addictive. Julia also learned that the World Health Organization and the FDA had already reported that naltrexone was safe and did not produce lasting or serious side effects when it was used together with alcohol. The treatment, which normally takes between three and four months, was not to be undertaken without a doctorÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢s prescription. Individual therapy was not always required, but could be helpful as part of a comprehensive treatment program. Julia and her family agreed that she should make an appointment at the clinic.
Her first appointment was not what she expected. The staff at the clinic treated Julia with dignity and did not label her as a
ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œweak-willed alcoholic.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â Julia was told that she would be seen by a team consisting of a physician, Dr. Anderson, and a counseling psychologist, Dr. Simon. Having two primary caregivers, she was informed, was not necessary but could be helpful.
At JuliaÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢s first screening session, Dr. Anderson explained how she had become addicted to alcohol. He decided to accept her for treatment, saying, ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œThe Sinclair Method is not for those who are currently abstinent.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â
ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œYou mean to say that if I were in A.A. already for a few months and not drinking at all, I would not be able to have this treatment?ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â Julia asked, astonished.
ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œThatÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢s right,ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â Dr. Anderson smiled, ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œThe treatment is only for those who are currently drinking. It only works if you take the medication an hour before you have your first drink. We do not prescribe this treatment for those who are abstinent.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â
ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œWell, itÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢s a good thing I am drinking, isnÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢t it?ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â
ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œUntil I saw Dr. SinclairÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢s research data, I never would have thought this possible,ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â Dr. Anderson replied. ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œWeÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢ve treated a few hundred cases, and the results are excellent!ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â
In addition to the standard psychotherapeutic approach of ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œinspiring hope,ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â Dr. Anderson made certain that Julia was not pregnant, did not have a medical condition that would make her unsuitable for treatment, and was not taking other opiates, such as heroin. As a final precautionary measure, Julia was scheduled for lab work to test for any undiagnosed medical problems.
From the start, Julia was impressed by the nonjudgmental approach of her doctor. She felt a faint flutter of hope. ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œThese people really care,ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â she thought. ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œThey really are trying to help me.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â She was also impressed by the visual aids Dr. Anderson showed her, detailing the connections and pathways in her brain that had become strengthened over years of drinking. Julia said later that she felt better knowing that there was ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œsomething physically wrong in my brain and nerves and not me as a person. The way my drinking had become worse over the years suddenly made sense to me. After all, I didnÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢t start out with this craving. I certainly never drank in the mornings, or binged. Before I became addicted, I used to drink quite moderately.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â
Julia took James to her next appointment with Dr. Anderson. He checked the Drinking Diary he had given her at their first meeting and conducted a medical examination. Julia had not been drinking every day since her initial screening visit, but her diary did show bingeing: well over sixty drinks per week, with most of it concentrated over the weekend. ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œI just canÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢t stop after the first drink. Why, doctor? Why?ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â She then saw some biological drawings depicting how addiction had been ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œburnedÃƒÂ¢Ã¢â€šÂ¬Ã‚Â into her brain over years of drinking through the mechanism of reinforced learning.
(Please see the images and explanation in Appendix B.)
The biological or ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œPurple RainÃƒÂ¢Ã¢â€šÂ¬Ã‚Â drawingsÃƒÂ¢Ã¢â€šÂ¬Ã¢â‚¬Âas Dr David Sinclair calls themÃƒÂ¢Ã¢â€šÂ¬Ã¢â‚¬Âshowed how alcohol causes endorphins to reinforce drinking, so that the nerve pathways become stronger. The next set of drawings showed how taking naltrexone before drinking would ultimately extinguish her addiction. For Julia, these drawings placed things in perspective, and she was relieved and thankful that the cause of her problem was not personal weakness but ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œbrain biology.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â Her genetic predisposition for alcoholism and many drinking sessions over the years had combined to make her an alcoholic.
The learning was connected to stimuli. She learned to drink in response to various external or internal stimuli. These stimuli thus gained the ability to make her crave and drink alcohol. One set of stimuli always present with every drink except the first one of the day are the sensations produced by the alcohol already consumed, including the taste, smell, and feel, and the stimulatory effect produced by low doses of alcohol. Julia learned that was why the first drink made it almost impossible to stop. Her drinking was learned, and much of it had been learned as a response to the stimuli produced by the previous drink.
ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œI was just better than others at learning drinking,ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â Julia exclaimed.
Dr. Anderson said that the situation could be corrected in a matter of monthsÃƒÂ¢Ã¢â€šÂ¬Ã¢â‚¬Âwithout willpower or even trying to stop drinking. ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œAll I had to do to beat this thing was to take one of those white tablets before having a drink,ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â she thought to herself later on.
To James, it seemed a dangerous contradiction to encourage an alcoholic to carry on drinkingÃƒÂ¢Ã¢â€šÂ¬Ã¢â‚¬Âeven after taking naltrexone. Emotionally, he still reacted by hating the fact that his wife had become an alcoholic, that alcohol was destroying their lives. Surely Julia should stop drinking immediately? But James finally grasped the theory. He was even more optimistic when he was shown the reduced craving and drinking results compiled from other successful patients.
Dr. Anderson gave Julia her prescription for naltrexone, and he informed her that this was not a ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œget soberÃƒÂ¢Ã¢â€šÂ¬Ã‚Â medicationÃƒÂ¢Ã¢â€šÂ¬Ã¢â‚¬Âshe should not operate machinery or drive while drinking. Looking at the tablets in her hand, Julia still wondered if they could actually help her. As directed, Julia started out by taking her first dose (25 mg) an hour before taking her first drink. Two days later, an hour before her next drinking session, she took the full (50 mg) dose.
ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œI didnÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢t really notice anything much,ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â she told her psychologist, Dr. Simon, at the next meeting. ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œPerhaps there was a bit less of a buzz, but I canÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢t be sure.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â
Dr. Simon was supportive. ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œThere are no right or wrong reactions,ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â he said.
She handed in her Drinking Diary and the Visual Analog Scale (VAS) form, which tracked her craving on a scale from 0 (no craving) to 10 (highest craving). Drinking was slightly down at forty-six drinks for that week and her craving was in the high rangeÃƒÂ¢Ã¢â€šÂ¬Ã¢â‚¬Â naltrexone was not a ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œmagic pillÃƒÂ¢Ã¢â€šÂ¬Ã‚Â and did not work overnight. Julia was still seriously addicted to alcohol.
ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œThe Golden Rule,ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â her psychologist repeated, ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œis that you always take the medication an hour before drinking. The fact that you reduced your drinking by a few drinks this week is because, by blocking the effects of endorphins, the naltrexone reduced the stimulatory or first-drink effects of alcohol. Extinction has started, but you still have a way to go. You have just begun treatment. keep going.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â
Julia was thrilled that she had had less to drink because it gave her more than just a flutter of hope. The session involved an explanation of stimuli or triggers that elicit craving and drinking. When asked about her drinking history and the situations that set
off her drinking, Julia explained, ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œI found that I started as a way to enjoy myself or relax on weekends. I loved it when the kids were small, tucked up in bed, and James and I could be alone. It was so romantic to be in front of the fire with a bottle of red wine. Red wine, thatÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢s my favorite. Drinking seemed to improve our lovemaking and took the inhibitions out of me. And thatÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢s when I started drinking socially, which is interesting because I didnÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢t drink as a teenager. Now I donÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢t even need an excuse; I drink out of habit.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â
Julia told Dr. Simon that when she first began drinking, parties were major triggers for getting drunk. James dreaded them. He thought Julia was being selfish when she drank too much. He didnÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢t know that her brain biology would not allow her to keep her promise not to drink. It was during this session that Julia learned about the specific triggers that caused her to drink. Over several years, she had come to associate drinking with many situations. The therapy would require that Julia drink while on the medication in all the situations in which she normally drankÃƒÂ¢Ã¢â€šÂ¬Ã¢â‚¬Âprivately at home, in social situations, through all seasons, in the morning, afternoon, and eveningÃƒÂ¢Ã¢â€šÂ¬Ã¢â‚¬Âwhenever she was accustomed to drinking. She had to use naltrexone to extinguish her addiction with every drinking situation.
ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œJust wait till I tell the family about all this,ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â she told Dr. Simon. ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œMy drinking had become a secretive, private matter. It was like a love affair, taking precedence over the things I most treasured. I am beginning to understand why my drinking was more imp ortant to me than my wonderful family. It was because my brain took over and ran the show.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â
ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œOnce we have your drinking under control or you have reached your goal in a few months, we will still want you to keep your medication with you at all timesÃƒÂ¢Ã¢â€šÂ¬Ã¢â‚¬Âjust in case your craving returns and you have the urge to drink. But, for the moment, letÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢s proceed with you taking your medication and drinking. Go home, take your medication, and drink as usual. Remember to keep up with your Drinking Diary. We can discuss options of where and when to drink at your next session. Though before we meet, you will have a short meeting with Dr. Anderson.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â
The next meeting with Dr. Anderson lasted only ten minutes.
Julia was asked if the medication had any side effects, but there were none to report. She handed in her Drinking Diary and her subjective craving level was assessed. The number of drinks per week and her craving levels were still high. She was also given standard research questionnaires. The Beck Depression Inventory evaluated depression. The Obsessive Compulsive Drinking Scale assessed her thought patterns related to drinking.
Her next counseling session two weeks later with Dr. Simon was designed to help her prepare for the future. JuliaÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢s drinking habits were explored. ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œEveryone has their unique triggers,ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â Dr. Simon said. ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œI see from your diary that your drinking is down a bit, from forty-six to thirty-eight drinks this week. Normal progress.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â
Julia still found that she wanted to drink on her own as well as on social occasions. ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œI am so grateful that my family understands that I have to drink to be cured,ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â she said to Dr. Simon. ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œIt was a hard one for my daughters to understand. Now they are even pleased when they see me with a glass in my hand! They know how the medication and treatment works.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â
ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œBe alert for the festive season, for emotional triggers, for any situation in which you normally would drink,ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â Dr. Simon reminded her. ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œAnd above all, remember our golden ruleÃƒÂ¢Ã¢â€šÂ¬Ã¢â‚¬Ânever drink without first taking naltrexone!ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â
The session ended with Dr. Simon saying that a support group for patients had started and that Julia was welcome to join it. Julia did not feel this was for her.
By the end of the eighth week, JuliaÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢s drinking had dropped to twenty-three drinks per week. This was good progress, but still a bit above the safety limit for women. She told Dr. Anderson what had been happening in her life: ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œJames and I are getting on better already. We actually made love for the first time in ages! I no longer stumble into things. For one thing, my knees are better because IÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢m not bumping into the glass coffee table. My hangovers have lessened. I am actually enjoying my non-drinking days. Last weekend we all went for a picnic. I had my naltrexone and a bottle of nice California red wine with me. But I didnÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢t open it. The girls were amazed, and James said I was being strong. The amazing, wonderful thing is that I was not being strong. My urge to drink
simply was not there. I wonder if it really is possible to stop altogether. I can see how it might be.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â
Dr. Anderson noted that Julia still had three instances over the past two weeks where she had consumed more than five drinks in a single drinking session. He explained that she was doing well, but still had much of the neural circuitry that caused craving and drinking in line with her binge-style drinking. ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œFocus on enjoyable activities on your non-drinking, non-medication days,ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â Dr. Anderson advised. ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œYour social drinking has diminished already, but I see that you are still drinking on your ownÃƒÂ¢Ã¢â€šÂ¬Ã¢â‚¬Âdrinking less, but you still took more than five drinks one after the other on your own.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â
Julia felt positive. She had begun to sense that control over alcohol was within her reach. Her mood improved. She was optimistic and, for the first time in years, had a sense of purpose.
When she arrived home, the first thing she did was to go into her disused pottery studio at the end of her garden. She stood by the lake under a bright blue sky. The air was crisp and blazing fall colors reflected on the water. Julia felt happy and with that feeling came a sudden urge for a drink. Because, although she was happy, she was also sad. Sad that more than six years had gone by without doing much pottery. Sad because of what her drinking had done to her marriage and to her family. She looked at the disused trays, the dusty objects she had so lovingly crafted, painted, and fired. Then she reacted the way she did automatically under stress. She rushed to the kitchen and poured a stiff vodka. She knocked it back neat without having taken her medication.
In a state of panic, she called Dr. Anderson.
ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œAm I relapsing?ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â she asked urgently.
ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œWhen did you have the drink?ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â
ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œAbout fifteen minutes ago.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â
ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œTake your medication as soon as you hang up. It will still have the chance to do some good. DonÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢t worry, Julia. The worst thing is for you to punish yourself. You will get there in the end.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â
Julia followed his advice and took the medication. She returned to her studio carrying the bottle of vodka and her portable CD player. ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œWhat the hell,ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â she thought. ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œI may as well. IÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢ve taken my mediÃƒÂ¯Ã‚Â·Ã¢â‚¬Å“
cation.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â She spent the next three hours listening to music while she cleaned the studio and threw out broken pieces of pottery.
Julia was startled when her eldest daughter, Sonia walked in.
ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œWhat are you doing here, Mom?ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â Sonia asked anxiously.
ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œOh, nothing much. I thought I would clean the studio. I guess IÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢d better lock up, and get some dinner ready.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â It was then that she noticed the bottle of vodka. She had not touched itÃƒÂ¢Ã¢â€šÂ¬Ã¢â‚¬Ânot once since the first drink. The thought of drinking had not entered her mind. Surprised and delighted, she told Sonia about it.
ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œYou are coming back to us, Mom, you are coming back!ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â Sonia said, ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œLetÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢s tell Dad.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â
JuliaÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢s next appointment was with Dr. Simon, who had asked if James would be able to attend part of that session. The idea was to go over the treatment with James because he was so intimately involved with Julia.
ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œI canÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢t believe it, Doctor, I am getting my wife back,ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â James said. ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œShe drinks, but not as much. She doesnÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢t get crazy. Her moods are better, right, Julia?ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â
Julia smiled and said, ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œIÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢m sure itÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢s working. But I still somehow think I need time. I donÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢t crave as much. IÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢m not fixated on getting my next drink.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â
After four months, the Drinking Diary showed that Julia was drinking within safe limitsÃƒÂ¢Ã¢â€šÂ¬Ã¢â‚¬Âless than eighteen drinks per week and no more than four on any single occasion. Dr. Simon was cautiously optimistic. ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œYouÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢ve come a long, long way, Julia,ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â he said. ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œWe expected this. The great thing is that you wanted to stay on track. It would be best for you to continue with our therapy sessions. We can explore whether you wish to continue drinking with naltrexone or to abstain altogether.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â
Six months later, Julia realized that her life was no longer being controlled by her drinking. ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œWhy then should I continue to drink?ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â she asked herself. She came to the conclusion that drinking was not for her. She was able to attend parties without drinking. She was happy to tell people that, after her Sinclair Method treatment, she thought it best for her to avoid alcohol. ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œBy all means, you go ahead,ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â she told others at a party. ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œMost people can handle alcohol. I canÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢t.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â
Julia keeps her naltrexone pills with her at all times, just in case the urge creeps up on her. Even now, after five years of complete
RichardÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢s Story: The Sinclair ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œLiteÃƒÂ¢Ã¢â€šÂ¬Ã‚Â MethodÃƒÂ¢Ã¢â€šÂ¬Ã¢â‚¬ÂSame Great Success, Less Intensive
ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œMiracles donÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢t just happen, people make them happen.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â
RICHARDÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢S CASE demonstrates that the Cure is successful with minimal intervention from doctors and therapists.
While I was on sabbatical in South Africa, I traveled to a lovely oasis town set among oak-lined streets in a valley surrounded by mountains. The people in South Africa are particularly friendly and hospitable, and it wasnÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢t long after we checked into our guesthouse that we were invited to a party given by a local family we had met at one of the townÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢s bars.
It was a perfect summer evening. At the party, we got around to discussing Nelson MandelaÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢s brilliant achievements, other beautiful places to visit, and of course the wonderful South African wines. The conversation veered to the high levels of intoxication I had obÃƒÂ¯Ã‚Â·Ã¢â‚¬Å“
served throughout South Africa. Alcoholism is also a problem in South Africa. At the party, I met Margaret, an attractive, friendly woman with a bold, direct gaze. As soon as she heard that I was a psychologist with an interest in addictions, she told me that her husband, Richard, was a severe alcoholic. ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œI didnÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢t know he was when I married him. I probably would never have married him if I had known,ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â she sighed. ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œI thought he simply liked his drink.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â
ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œHave you been married long?ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â I asked.
ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œFive years and three months,ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â she replied. ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œThis is my second marriage, but his first. I already had two kids when we married. My late husband was a great father. He died quite suddenly of cancer. I decided to leave the city and move to a small country town. The school here is good, and I wanted my kids brought up in a clean and healthy environment. Then I met Richard and we fell in love. HeÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢s been fantastic to my kids.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â She clutched her necklace. ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œI didnÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢t know he was an alcoholic,ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â she said again.
ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œWhat do you mean by alcoholic?ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â I asked.
ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œHe wakes up at 3 a.m. to start drinking again,ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â she replied. ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œItÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢s physically amazing. I wouldnÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢t have believed it unless IÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢d seen it for myself. He simply canÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢t stop. A real addiction.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â
I noticed her twelve-year-old daughter Alice nodding in agreement. ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œYes, he drinks all the time,ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â Alice said. ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œItÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢s terrible.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â
ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œHeÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢s a great guy,ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â Margaret said. ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œWe all love him. HeÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢s not like the other alcoholics I know. His personality barely changes when he drinks. He doesnÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢t become violent or nasty like so many others IÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢ve met.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â
A short while later, when Alice had gone, Margaret spoke more openly. ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œRichard simply drinks all day long. IÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢m worried about his health. Our sex life is zero. ThereÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢s nothing we can do about it. I wish there was. HeÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢s had seizures, and IÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢ve had to rush him to hospital. A few years ago, he managed to stay clean for six months. HeÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢s been to the local A.A. and for meetings in other places. But he always goes back to drinking. Our doctor is a great guy but says he canÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢t help.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â
At this point, I mentioned SinclairÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢s work: ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œThousands of alcoholics have already been successfully treated for this addiction,ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â I told her.
ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œI beg you, I implore you, please tell us if there is anything like this out here. Personally, I find it hard to believe that anything can help, but IÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢m ready to try anything. You see, I think Richard is dying.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â Her voice dropped to a whisper. ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œIÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢m sure that if he goes on like this, heÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢ll die.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â
I quickly explained how the Sinclair Method works, how the patient must be medically evaluated before treatment with naltrexone. I made it clear to her that the method works only by combining the medication with drinking alcohol, and that there were dozens of published clinical studies in support of the treatment. I told her that Richard would need to keep a record of his craving, as well as a Drinking Diary. I ended by assuring her that there was every reason to be hopeful.
ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œPlease, will you meet my husband?ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â she asked.
Richard was forty-five years old, yet looked much older. He had a ruddy complexion, was somewhat underweight, but otherwise looked healthy. He appeared to have a great deal of energy and was very friendly. He certainly believed he was well able to handle his drink.
ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œA bottle of wine is nothing for me,ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â he said. ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œLots of guys lose their judgment after only a few drinks. I remember virtually everything that happensÃƒÂ¢Ã¢â€šÂ¬Ã¢â‚¬Âexcept if IÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢ve had a blackout. I am an alcoholic. No question about it. I donÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢t deny it. If I try to stop, I get the shakes. Margaret says you have something that might help. IÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢m curious. As IÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢ve said a million times, IÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢ll try anything. I get up at 2 or 3 a.m. and start with my first drink. I hardly eat or sleep. My job is great because I run a pub so I can drink as much as I like, and I donÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢t have to worry about being fired.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â
Richard and I arranged to meet the next day at his pub so we could discuss his situation in private. I met with Richard, and Margaret joined us after about an hour.
Richard had been able to stay sober for periods of about three months before relapsing. ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œIÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢ve been to A.A. IÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢ve done my ninetyday-every-day meetings. ItÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢s a great idea and works for some guys. But I always end up relapsing. ItÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢s those one or two drinks. The devil gets into me and IÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢m on a roll again. Of course I donÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢t like it.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â A worried look settled on his face. ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œI love hiking in the mounÃƒÂ¯Ã‚Â·Ã¢â‚¬Å“
tains around here. I used to ride horses, take tourists on three-day trails. ItÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢s been years since I last went out. IÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢m dying to see more wildlife. There are leopards and other amazing cats around here.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â He stared moodily at his drink. ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œBut IÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢m in the grip of this stuff. Then of course thereÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢s Margaret. I love her kids as my own. I know IÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢m harming them, too.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â
I began with the standard explanation of how the Sinclair Method is being used to great effect in the United States, Europe, and Australia. It is well known that inspiring realistic hope is a powerful therapeutic tool. So I went through a basic explanation about the scientific basis of how the treatment works. ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œYou have an 80 percent chance of being successful, but you have to be conscientious about keeping accurate records, as well as always taking your naltrexone before you drink,ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â I said. ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œBesides all that, the fact that you really want help will go a long way toward being successful.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â
I went on to explain that naltrexone was available in many countries, and that it was now available in South Africa as an import under the name ReViaTM. Richard was eager to give it a proper try, and I suggested I speak with his doctor about the treatment.
RichardÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢s physician, Dr. Gordon, was very friendly and open. He grasped the fundamentals of the Sinclair Method within minutes. He even made fun of my repeating myself about how the medication should only be taken if the patient drinks, that it should not be taken during periods when the patient is not drinking.
ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œIt seems odd to me, but if you say the studies show it works this way, letÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢s go with it,ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â he said. He asked me to e-mail some medical publications on extinction to him and agreed to examine Richard, order blood tests, and provide a prescription.
I offered to support Richard by telephone and to see him again after about a month. In the past, he had been given diazepam (Valium) to calm his withdrawal symptoms, and his doctor was aware of this. Both Richard and his doctor knew that this treatment would require at least three to four monthsÃƒÂ¢Ã¢â€šÂ¬Ã¢â‚¬Âperhaps even longer.
Margaret was especially supportive and involved, but was afraid of hoping too much. ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œIf you can help us, I donÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢t know how IÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢ll ever be able to thank you,ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â she said repeatedly. ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œWeÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢ll do exactly as you say. I only hope and pray it works.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â
I informed her that it was up to Richard to be proactive, but that her involvement would be crucial. She was the most supportive of partners. Her love for Richard was obvious.
Prior to seeing Dr. Gordon to begin treatment, Richard kept a Drinking Diary. His drinking level was clearly way over the top; he took the equivalent of more than fifteen drinks per dayÃƒÂ¢Ã¢â€šÂ¬Ã¢â‚¬ÂthatÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢s more than one hundred drinks per weekÃƒÂ¢Ã¢â€šÂ¬Ã¢â‚¬Âthe equivalent of three bottles of 12.5 percent wine every day. Yet despite this, his liver tests showed relatively mild elevations. Dr. Gordon found that his blood pressure was high enough to prescribe an antihypertensive medication.
Richard started out on half the dose of naltrexoneÃƒÂ¢Ã¢â€šÂ¬Ã¢â‚¬Â25 mg for the first two days. He then moved onto the recommended dose of 50 mg per day and experienced slight nausea over the next few days. After a week, Richard said, ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œIÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢m doing exactly as you say. I am taking the medication an hour before I have my first drink at around 3 a.m. IÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢m drinking about the same amount, perhaps a few drinks less per day. I feel less nauseated, though. May I call you next week?ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â
By the end of the second week, Richard reported, ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œIÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢m drinking less. In fact, on Wednesday and Thursday I didnÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢t drink anything.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â He laughed suddenly. ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œNo, I didnÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢t take my medication as you said not to take it unless I was drinking.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â
ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œThatÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢s exactly how extinction works. It doesnÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢t happen overnight,ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â I replied.
However, RichardÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢s journey was not entirely smooth. I received a frantic call from Margaret late one night about a month into treatment, ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œRichardÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢s hands are trembling, and heÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢s shaking all over. What if he has another seizure?ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â
ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œCall Dr. Gordon and explain that the symptoms may be related to his detoxification,ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â I said. ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œYou see, he is gradually detoxifying. Even though heÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢s down to almost half his usual number of drinks, because of the sheer amount he has been drinking, he may be experiencing some withdrawal symptoms. If he were to stop abruptlyÃƒÂ¢Ã¢â€šÂ¬Ã¢â‚¬Âgo cold turkeyÃƒÂ¢Ã¢â€šÂ¬Ã¢â‚¬Âwe would probably have to hospitalize him. But the Sinclair Method allows for a gradual reduction in drinking.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â
Dr. Gordon concluded that the symptoms were related to withdrawal, and said that he could offer medication for that but would prefer not to. Richard was slowly going through withdrawal. Because his drinking levels had been so high, it was both normal and expected that he would experience some withdrawal symptoms as he began reducing the amount he consumed. But because the Sinclair Method allowed for gradual withdrawal by continuing to drink while taking naltrexone, RichardÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢s symptoms were far less severe than if he had suddenly gone cold turkey. This is a major advantage of the Sinclair Method. By the end of the seventh week, Richard was drinking less than thirty drinks per week and had had several alcohol-free days.
ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œDonÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢t for one minute let yourself think that you are cured,ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â I said to him over the phone. Richard understood the idea behind selective extinctionÃƒÂ¢Ã¢â€šÂ¬Ã¢â‚¬Âthat he should avoid hiking in the mountains while on naltrexone. Because endorphins are also released during vigorous exercise, he should not hike or ride on the same days that he takes his naltrexone. He should save his days off drinking and the medication for hiking and other positive activities.
By the end of the twelfth week, Richard was drinking well within accepted safety limitsÃƒÂ¢Ã¢â€šÂ¬Ã¢â‚¬Âless than twenty-four drinks per week, and no more than four drinks in a single drinking session.
ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œI just donÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢t feel like it,ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â he said. ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œIÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢m sleeping much better. My appetite has returned; just ask Margaret. IÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢m eating like a horse. I feel like I have begun a new life. The main thing is that my craving is far lower than it has ever been.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â
After five months Richard felt that alcohol was not the major feature of his life.
ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œI can easily serve customers in my pub without having the least desire to drink,ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â he said, ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œI thought I might be less funny and entertaining, but that has not been a problem. The kids are pleased, and so is my fantastic Margaret.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â
At seven months, Richard was hardly drinking at all. Yet he felt he was the kind of person who might occasionally want to have a drink in the future. ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œYes, I know what you are going to sayÃƒÂ¢Ã¢â€šÂ¬Ã¢â‚¬Ânever, ever, take another drink without first taking my medication.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â
When I next saw him about a year later, Richard showed me a gold cylindrical pendant made by a local jeweler. He wore it around his neck. He opened the cylinder to expose two naltrexone tablets. He laughed. ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œI know what you are going to say next.ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â
ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œWhatÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢s that?ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â I said.
ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œNever leave home without it,ÃƒÂ¢Ã¢â€šÂ¬Ã‚Â he replied.
One of the main points about RichardÃƒÂ¢Ã¢â€šÂ¬Ã¢â€žÂ¢s case is that his treatment was successful with a limited number of one-to-one sessions. Richard also did not receive any conventional psychotherapy. At that time, the results of Project COMBINE, published in the Journal of the American Medical Association in May 2006, had not yet been published. It confirmed that patients could be treated with naltrexone in primary care settings without intensive psychotherapy. Nevertheless, it should be pointed out that this ÃƒÂ¢Ã¢â€šÂ¬Ã…â€œliteÃƒÂ¢Ã¢â€šÂ¬Ã‚Â version is not always suitable for patients who have psychological problems in addition to alcoholism. Such patients may require additional psychotherapeutic support. Yet if Richard had not tried this way, he would most certainly have been left untreated in his idyllic country town. He would still be struggling with his drinking. He would still be reflexively waking up at 3 a.m. for a drink, his family would still be unhappy, and his health would still be deteriorating. Instead, he is healthy and enjoying the countryside on long hikes.
About the Author
Roy D. Eskapa, Ph.D., obtained a B.A. (Psychology Major) from Reed College in
Oregon and went on to complete a Ph.D. in clinical psychology at the
California School of Professional Psychology, in Los Angeles (1983). He had
a variety of postdoctoral training experiences including forensic psychology,
multimodal therapy, and instruction in the science of addiction. He has
published several articles and book chapters as well as a four hundred-page
tome on Bizarre Sex. He developed a successful product for treating
childhood enuresis and approximately 15,000 patients were helped by it. He
also obtained a New Jersey license to practice psychotherapy and treated a
broad spectrum of patients. He is an Associate Fellow of the British
Psychological Society, and is a Chartered psychologist in Great Britain. At
present he is writing a book on Dr. David Sinclair ‘s pioneering approach to the
treatment of addictions – especially alcohol.