In the 1960s, an American scientist named John David Sinclair began to study the impact of alcohol on rats. Sinclair hypothesized that when rats were given alcohol for an extended amount of time and then cut off from alcohol for a few weeks, they would show less interest in drinking when alcohol was reintroduced. The opposite happened: Abstaining only made the rats want alcohol more. This, he suspected, was also true in humans, and it would explain why even long-term abstinence doesn't necessarily end cravings. Some recovering alcoholics battle their desire for alcohol forever.
This research eventually led Sinclair to Naltrexone, a drug that blocks endorphins from reaching the brain. If alcohol stopped producing a pleasurable effect, maybe the brain (and the person) would eventually lose interest, and the desire to drink would gradually cease, Sinclair thought, like Pavlov's ringing bell in reverse. The effect is called "extinction," and Sinclair found that it worked.
Sinclair died in 2015 at the age of 72, but Naltrexone has proven to be a solution for many people who struggle with alcohol. It's the treatment of choice in Finland, where Sinclair spent most of his career, and the success rate is an astounding 78 percent.
The Sinclair Method, as the protocol is known, is simple: You take Naltrexone one hour before you start drinking, each and every time you drink (and preferably not on an empty stomach). Instead of feeling that familiar euphoric buzz, drinking just makes you feel kind of sloppy and muddy-headed. (...)
Science backs this up. With Naltrexone, "alcohol becomes non-reinforcing," said Brian Noonan, a psychiatric nurse practitioner and the owner of Ballard Psychiatric Services. "With repeated trials of drinking without reward, the association of drinking with reward begins to extinguish." The patient starts drinking less and less often. Some eventually stop altogether.
Noonan practiced abstinence-based therapy for 12 years before he stumbled across the Sinclair Method in a book. He was interested immediately. Conventional therapy and giving his patients a list of nearby Alcoholics Anonymous meetings just wasn't working. The failure rate was high, and his patients often felt guilty when they'd relapse, perhaps in part because AA and other 12-step programs teach that taking even one drink is a broken promise to yourself. Who wouldn't feel guilty about that?
Noonan started introducing the idea to his patients. They were interested, too. For these patients, the idea of never drinking again—not today, not tomorrow, not ever—was unfathomable. It would be like never seeing a loved one again. Because Naltrexone doesn't require you to divorce yourself from drinking, it offered a way out of the cycle without doing something patients thought was impossible.
It's been three years since Noonan first learned about Naltrexone, and today his practice revolves around it. He's licensed to prescribe in 20 states, and he consults with patients all over the country via video chat, along with five other health-care providers working under him. (On the day I visited his office in Ballard, he'd just consulted with a man in Colorado who was out snowboarding.) Since making the switch, Noonan says he's personally prescribed Naltrexone to an estimated 1,000 patients, and about 80 percent of them, he says, have found success.
Unlike AA, where success is measured in the number of days sober, "The only marker for success I have is that the patient feels in control," Noonan said. "They can drink or not drink in a manner that is appropriate to them. Sometimes that's abstinence, or sometimes that's just drinking on the weekends, or sometimes it's just drinking on special occasions. I measure success by when people are happy about the way they are drinking or not drinking."
This idea, that some alcoholics can continue to drink, is anathema in conventional recovery circles, which argue that the only solution to alcohol dependence is complete and total sobriety. There is little evidence to support this claim, but still, the rhetoric of sobriety is widespread.
Alcoholics Anonymous, which was founded in 1935 by an alcoholic named Bill Wilson, doesn't keep records (that's part of the promise of anonymity), but according to Gabrielle Glaser, the author of the 2013 book Her Best-Kept Secret: Why Women Drink—And How They Can Regain Control, AA has an estimated success rate of just 5 to 8 percent. And yet, the organization, which says it has two million members worldwide, claims that if you just stick with the program, it will work.
Despite the lack of evidence that AA is effective for most people, there is one benefit: It's cheap, which means that many rehab centers—part of the $35 billion addiction treatment industry—take advantage of the 12-step model. These treatment centers are often under-regulated and frequently employ former addicts as counselors instead of paying high prices for doctors and experts. Rehab centers can charge up to $40,000 a month, but their counselors often have no training besides going through the program themselves. And drugs like Naltrexone don't really fit into this model. Not only does medication counter the idea that recovery is about willpower, it doesn't require much upkeep. You don't need daily meetings or weekly talk therapy; you just need a prescription. As far as rehab-related business models go, it won't get anyone rich. (...)
Still, Naltrexone isn't an instant fix. It can take 6 to 12 months to see a measurable effect. "People think it's going to take 15 days," Christian told me. "I tell them, 'It took decades to do this to your brain. It's going to take a little while to undo it.'" There can be side effects as well. Naltrexone can cause headaches and upset stomach, not unlike a hangover. There are ups and downs. Your drinking might decline for a while, then increase, then decline again, and then level out. And for around 20 percent of patients, it just doesn't work. No one knows why, Noonan said, although he thinks there's probably a genetic component.
This research eventually led Sinclair to Naltrexone, a drug that blocks endorphins from reaching the brain. If alcohol stopped producing a pleasurable effect, maybe the brain (and the person) would eventually lose interest, and the desire to drink would gradually cease, Sinclair thought, like Pavlov's ringing bell in reverse. The effect is called "extinction," and Sinclair found that it worked.Sinclair died in 2015 at the age of 72, but Naltrexone has proven to be a solution for many people who struggle with alcohol. It's the treatment of choice in Finland, where Sinclair spent most of his career, and the success rate is an astounding 78 percent.
The Sinclair Method, as the protocol is known, is simple: You take Naltrexone one hour before you start drinking, each and every time you drink (and preferably not on an empty stomach). Instead of feeling that familiar euphoric buzz, drinking just makes you feel kind of sloppy and muddy-headed. (...)
Science backs this up. With Naltrexone, "alcohol becomes non-reinforcing," said Brian Noonan, a psychiatric nurse practitioner and the owner of Ballard Psychiatric Services. "With repeated trials of drinking without reward, the association of drinking with reward begins to extinguish." The patient starts drinking less and less often. Some eventually stop altogether.
Noonan practiced abstinence-based therapy for 12 years before he stumbled across the Sinclair Method in a book. He was interested immediately. Conventional therapy and giving his patients a list of nearby Alcoholics Anonymous meetings just wasn't working. The failure rate was high, and his patients often felt guilty when they'd relapse, perhaps in part because AA and other 12-step programs teach that taking even one drink is a broken promise to yourself. Who wouldn't feel guilty about that?
Noonan started introducing the idea to his patients. They were interested, too. For these patients, the idea of never drinking again—not today, not tomorrow, not ever—was unfathomable. It would be like never seeing a loved one again. Because Naltrexone doesn't require you to divorce yourself from drinking, it offered a way out of the cycle without doing something patients thought was impossible.
It's been three years since Noonan first learned about Naltrexone, and today his practice revolves around it. He's licensed to prescribe in 20 states, and he consults with patients all over the country via video chat, along with five other health-care providers working under him. (On the day I visited his office in Ballard, he'd just consulted with a man in Colorado who was out snowboarding.) Since making the switch, Noonan says he's personally prescribed Naltrexone to an estimated 1,000 patients, and about 80 percent of them, he says, have found success.
Unlike AA, where success is measured in the number of days sober, "The only marker for success I have is that the patient feels in control," Noonan said. "They can drink or not drink in a manner that is appropriate to them. Sometimes that's abstinence, or sometimes that's just drinking on the weekends, or sometimes it's just drinking on special occasions. I measure success by when people are happy about the way they are drinking or not drinking."
This idea, that some alcoholics can continue to drink, is anathema in conventional recovery circles, which argue that the only solution to alcohol dependence is complete and total sobriety. There is little evidence to support this claim, but still, the rhetoric of sobriety is widespread.
Alcoholics Anonymous, which was founded in 1935 by an alcoholic named Bill Wilson, doesn't keep records (that's part of the promise of anonymity), but according to Gabrielle Glaser, the author of the 2013 book Her Best-Kept Secret: Why Women Drink—And How They Can Regain Control, AA has an estimated success rate of just 5 to 8 percent. And yet, the organization, which says it has two million members worldwide, claims that if you just stick with the program, it will work.
Despite the lack of evidence that AA is effective for most people, there is one benefit: It's cheap, which means that many rehab centers—part of the $35 billion addiction treatment industry—take advantage of the 12-step model. These treatment centers are often under-regulated and frequently employ former addicts as counselors instead of paying high prices for doctors and experts. Rehab centers can charge up to $40,000 a month, but their counselors often have no training besides going through the program themselves. And drugs like Naltrexone don't really fit into this model. Not only does medication counter the idea that recovery is about willpower, it doesn't require much upkeep. You don't need daily meetings or weekly talk therapy; you just need a prescription. As far as rehab-related business models go, it won't get anyone rich. (...)
Still, Naltrexone isn't an instant fix. It can take 6 to 12 months to see a measurable effect. "People think it's going to take 15 days," Christian told me. "I tell them, 'It took decades to do this to your brain. It's going to take a little while to undo it.'" There can be side effects as well. Naltrexone can cause headaches and upset stomach, not unlike a hangover. There are ups and downs. Your drinking might decline for a while, then increase, then decline again, and then level out. And for around 20 percent of patients, it just doesn't work. No one knows why, Noonan said, although he thinks there's probably a genetic component.
by Katie Herzog, The Stranger | Read more:
Image: Levi Hastings
