Is ‘drinking your way sober’ the cure for alcoholism?

This week’s People’s Pharmacy column mentions an alternative treatment for alcoholism that has had great success in other parts of the world but is not widely used in the U.S. yet.

Rich Mahan/AJC Special

Rich Mahan/AJC Special

Called the Sinclair Method, patients take a prescription drug, naltrexone, that help block the receptors for endorphins. This in turn reduces the patient’s craving for alcohol and the enjoyment he/she gets from drinking. In the book that discusses this form of treatment in detail, “The Cure for Alcoholism: Drink Your Way Sober Without Willpower, Abstinence or Discomfort,” the author explores studies and research on the Sinclair Method, which claims to have up to a 75% cure rate. (This is not an exact comparison because the methods are so different, but a 1992 study conducted by Alcoholics Anonymous indicated a 35% sober rate after 5 years in their program.)

There’s one element of the Sinclair Method that may surprise some people. The patient must continue drinking alcohol for the treatment to be successful. The drug naltrexone must be taken in conjunction with alcohol in order to be effective. While the drug may reduce the desire for alcohol so much that a patient eventually ends up giving up alcohol completely, abstaining from alcohol on a permanent basis is not a requirement of this treatment. One of the main goals is to get destructive, problem drinking under control so that a person can live a normal life.

With most Americans associating Alcoholics Anonymous with alcohol treatment, where abstaining from alcohol for life is a mandate, this is a very different way of looking at a problem that almost 18 million people in this country suffer from. Those critical of the Sinclair Method point out that it does not reduce the cravings for other drugs like marijuana and methamphetamine, so a poly-addict may just switch drugs to still get their fix. Critics also point out that there are often underlying reasons why people have problems with alcohol, whether it be childhood trauma, low self-esteem, etc. The Sinclair Method, which is designed to be a low-cost treatment, doesn’t have extensive psychological counseling or therapy built into the program. Social Work Today offers their pros and cons on the Sinclair Method.

What do you think about the Sinclair Method? Should alcoholics still be allowed to drink if they do so at what is deemed medically safe limits? Does the focus on abstinence-only treatment set alcoholics up for failure and repeated relapses?

If you are a former or recovering alcoholic, please let us know what methods of treatment worked or didn’t work for you.

66 comments Add your comment

Just for Today

February 25th, 2010
8:18 am

As an alcoholic, I’m fortunate to have a sponsor who gives very practical advice. There is always a way within the program, it’s the first 3 steps that get you sober.
He advised that if overwhelming obsession occurs, to find a brick and hurl it through the plate glass window of the police precinct.
You will accomplish the following:
You will develop a personal relationship with a power greater than yourself.
That newly dicovered power greater than yourself will keep you from drinking for at least 24hrs.
If necessary, repeat.

deborah

February 25th, 2010
8:48 am

Survivors of the Holocaust have reportedly said that many in the camps were so beaten down they simply gave up all hope. When they lost hope, it was over.

AA is simply not a living option for a lot of people. It would be like asking a committed Christian to consider converting wholesale to atheism–it’s a wasted mental exercise.

I’ve been to several different 12-step programs, and none were free of heavily Christian notions of sin, redemption, atonement and leaps of faith in a higher power. Even if these philosophic notions were not based on the programs, those involved always brought them in.

People who self-medicate — whether to cover trauma, tamp down generalized stress and anxiety, etc. — do not need redemption. They may not even need solidarity, if it is to be purchased through conversion. There is not always enough time or money in our remaining days to contextualize and understand alcoholism away.

I believe many success stories in treating alcoholism will involve other drugs, ones that are less dangerous to the liver. I also hope people will drop this notion of sinful addiction, or of some failure to be truly whole, simply because a cure might involve using other drugs.

Melis99

February 25th, 2010
9:34 am

I was an alcoholic and now I just drink occationally.(about 3 times a year). You really have to sit down and make a list of why you are drinking. List out the good and bad about it and pray. Make up your mind that it taste horrible and you have to give it up. It drives your cholestorl up, adds belly fat, makes your breath stink, makes a fool out of you, cost WAY too much money and sets a bad example for your kids. Try having someone video tape you while you’re really drunk, then watch it when you’re sober. Now that’s reality.

Janice

February 25th, 2010
10:29 am

Absolutely a terrible idea. Alcholics can never safely drink again. As a recovering alcoholic we learn that the bottles are just a symbol. Working the 12 steps of A.A. relieves us of the obsession to drink and we learn to have a relationship with the higher power of our understanding which enables us to live a life that is happy, joyous and free. People that need to stop drinking are always looking for a way to KEEP DRINKING! A.A. has a high success rate for those that continue to attend meetings no matter how long they have been sober. IT WORKS IF YOU WORK IT.

James

February 25th, 2010
11:25 am

See also – Moderation Management.

The Barr Tab

February 25th, 2010
12:27 pm

Hmmmmm…. Like eating to get skinny. I’ll have another barkeep!

Guy in atlanta

February 25th, 2010
1:35 pm

Love to see the steppers here. Folks, AA is a belief system, if it works for you great. However, it isn’t the only way. And, worse, I can find no credible study that even shows it works. Anecdotal evidence yes, however, nothing scientific. Did they measure the people who were sent to AA by courts? Did they count the ones who showed up once or twice and left? A true scientific study would include those folks. Not just the true believers.

If we found a drug that would help half of smokers quit at five years, there would be rejoicing in the streets. However, because of this odd belief that AA is the ONLY way, we have nothing but condemnation for a regime that reports a 75% success rate. What gives? Want people to quit or not? Either attack the underlying study and disprove the method or find a better way.

Luke Alphonse

February 26th, 2010
8:20 am

I don’t think the Sinclair method is a good one. The fact that alcoholics still be allowed to drink during this treatment is bizarre. Even though this medication reduces cravings what about long term effect. What the effect of alcohol in the brain , the digestive system, stimulation the nervous system causing more depression, stomach ulcers or cancer. This treatment set them for a failure later on in life without excercising their self control and their will power to overcome this habit. What arer the side effect of naltresone? is the alcoholics will continue taking it after the treatment over. What happen to the repeated relapses? People need to learn how to deal with their habits naturally with lifestyle changes which will have a better connotation to the long term health.

Guy in atlanta

February 26th, 2010
12:44 pm

I love words like “relapse.” I also love when no facts are discussed, and normative statements about what others should do are made. Having read some more information about this, I find it noteworthy that, once again, the “abstinence is the only way” and “you have to go to meetings” proponents are saying no. Again, if it gives a better outcome, why is everyone against it? These are good odds and the study was done by NIH. Here is a link: http://www.nih.gov/news/pr/may2006/niaaa-02.htm

I find the one year mark where counseling doesn’t work interesting. Highlights below:

COMBINE FINDINGS: HIGHLIGHTS

At 16 weeks

• All groups substantially reduced drinking during treatment. Overall percent days abstinent tripled, from 25 to 73 percent, and alcohol consumption per week decreased from 66 to 13 drinks, a decrease of 80 percent.

• Patients who received medical management plus either naltrexone or specialized counseling showed similarly improved outcomes (PDA= 80.6 percent and 79.2 percent, respectively), compared with patients who received medical management and placebo pills (PDA=75.1 percent).

• Patients who received naltrexone reported less craving for alcohol.

• The odds of a good composite clinical outcome relative to patients who received medical management and placebo were 1.82 for patients who received MM plus CBI (but no naltrexone), 1.92 for patients who received MM, CBI, and naltrexone, and 2.16 for patients who received MM and naltrexone (but no CBI). That is, adding either naltrexone or specialized alcohol counseling to medical management almost doubled the chance to do well.

• About 6 to 7 patients need to be treated with medical management and either specialized alcohol counseling or naltrexone for one additional patient to have a good clinical outcome. This “number needed to treat” is similar to that for other chronic conditions such as depression, Crohn disease, or type 2 diabetes.

At 16 weeks + 1 year:

• Naltrexone continued to show a small advantage of less relapse to heavy drinking, most markedly in patients who received medical management only but not in those who received specialized alcohol counseling.

• Although a return to at least one heavy drinking day was common during the 1-year follow-up period, overall abstinence was still significantly improved after 1 year (59 to 68 percent PDA) compared with study entry (25 percent PDA). Good composite clinical outcomes at 1 year were observed in 38 to 50 percent of patients, with the worst outcomes in patients who received medical management plus placebo and better outcomes in those who received medical management plus either naltrexone or specialized alcohol counseling.

scarlet

February 26th, 2010
1:56 pm

I was a fifth day vodka drinker. I could not stop and I’m small 5′3 120lbs. My anxiety was bad, I would wake up in the middle of the night in sheer panic and drink myself back to sleep. I sought out help through inpatient treatment. After inpatient treatment I went to AA because that is what they suggested. AA worked for me for a little bit, but the problem that still continues for me with AA is that it is a religious program predicated upon a christian god. We can all sit here and say its a spiritual program, but if you read the big book and the 12 by 12, why is higher power and God interchangeable? Why do they tell me to pray?
After being in the program, I stopped gaining what I needed from it. It seems that for some people AA becomes in and of itself an addiction. AA is supposed to teach you how to live sober, but I know many people for which the only thing they do is AA.
AA is also a sexist program. The big book didn’t even mention female alcoholics till the 70s. To me this is problematic. If you are a white male, you should do fine in AA, but I am not.
I do take it a day at a time and if I really feel like I need to go to a meeting I will, but to sit in those rooms with people who have over 20 years of sobriety, but haven’t figured out how to live sober yet is unsettling.
I am living today.

Guy in atlanta

February 26th, 2010
5:04 pm

It is stories like Scarlett’s that bother me. How can the “program” work if it never cures? The answer is to go listen to drunkalogs? Really? I thought we lived in an age of enlightenment and science. Yet, when a scientific approach to addiction treatment is proposed, folks whip out their ouja boards. It just doesn’t make sense.

Me Not You

February 26th, 2010
5:18 pm

My experience with AA is that it is not just religious, but a religion in and of itself. It is also the most dishonest organization I have ever been a part of. Manipulative sponsors, 13th stepping, ineffectiveness of the program (people failed right and left, and when they did, it was attributed to the fact that they didn’t properly work the program). Well over ninety percent of those I have seen walk through the doors leave in a short time. AAs believe that the program cannot fail, but can only be failed. The most unbalanced people I have ever known are AA people, and they represent a high percentage of the groups I have seen.

It is absolute brainwashing, and when I questioned this, the response was “sometimes a brain needs washing”. That is just one of the slogans I heard ad nauseum. There is a thought stopping slogan for every eventually, and over time people learn not to think. Reading the responses in this comment section, I see the AAs repeating these slogans without even thinking. I becomes second nature. Not thinking is looked highly upon in AA, and is encouraged. “Your best thinking got you here” is the line often used. There is nothing worse – nothing – than trying to have a rational conversation about the program with an AAer who drinks the kool-aid.

If you want membership in a whacked out cult, do AA. It took me some time to get deprogrammed from AA. I would try this or any other method of sobriety before I ever set foot in an AA meeting.

Ellen

February 28th, 2010
9:39 pm

OMG! I’ve read through all the posts and am astonished at the amount of misinformation and just wrong information is out there about AA and other sobriety programs! I’m Jewish, and the 12 Steps have worked for me for more than 20 years. I have no problem with the “Christian” orientation that people are talking about here. It’s not Christian, it encompasses all religions — even Zen and others like it. You decide who/what your higher power is going to be for yourself; no one asks you to believe in theirs. it’s your own deal. I have never been asked to believe anything I disagreed with, nor have I even been pressured into doing anything at all, actually. These are suggestions, not commands. Also, as far as AA being a cult, I’m personally very happy to be a member. It’s absurd to me to compare AA with the typical cult around these days.

Also, for the person who said that AA is sexist, you’re wrong about your facts. In the first edition of the Big Book of AA, published in April, 1939, there were at least three stories written by recovering women. AA was initially representative of its era, and has changed a lot since then.

I personally don’t believe that relying on a drug to keep me sober would work for me. As has been mentioned, compliance would have been a problem for me definitely. I also don’t want to have to take a drug for the rest of my life in order to stay sober. I can do that drug-free by using the 12 Steps in all areas of my life, not only for drinking. We talk about practicing these “principles” in all our affairs, and that’s why I still go to AA meetings and continue to change myself to meet conditions in my life.

Why so much anger and resentment, people? Perhaps you were too into your own heads to be open to any concept that required you to leave your ego at home? And someone else put it so well: you have to want to get sober in AA. AA’s not for people who need it; it’s for people who want it. Folks who come into AA and pick it apart rather than use it to create a happier life just don’t really want what we have. AA is NOT for everyone, that’s for sure. But it works for me. It’s sad that many of you are so judgmental about this; resentment is an ugly thing.

Mark Old Town Wilkes

March 1st, 2010
10:38 am

This drug could never get down to causes and conditions, that require’s some work I didnt read anything about addressing these issues. My impression is there could be alot of suicides with this medicine. When your best friend (King Alcohol)dosent work anymore is where AA starts. Merly stopping the recovery is incomplete. We call this a dry drunk in the program. If drinking was the problem we wouldnt need AA. Before comparing this pill to 12 step recovery, come to 90 meetings in 90 days get a sponsor and read the Big Book, you might agree there is alot more to this disease than drinking. And why would I take a pill and waste good booze? Put a little whoopie in the pill and now you got something. Oops that might be switching substances. Basically we come to AA because drinking has stopped working for us and we need to stop throwing up and start growing up. Actually this to me is a outside issue it deals with the drinking part we in AA dont have anything to say if a person would like to drink its none of our business, now if you want to stop one day at a time thats our business and we do offer permanent recovery. Read the Book before you snap a judgment on us. I dont believe the writer of this article has done an in depth reasearch on this wreckless comparison.

Guy in atlanta

March 2nd, 2010
12:31 pm

As others have pointed out, there are many slogans in AA. In your post, almost all the popular ones are used. From my point of view, it is trading one addiction for another. Even more to the point, your post is truthful on how AA views the problem – it is a moral failing. Not a disease. Which makes the “steps” illogical. In one, “powerless over a disease” in another, addressing “moral failings.” If it is a disease, it is not a moral failing. If it is a moral failing, then it is not a disease. Simple. A+B=C.
AA has never produced a credible study that shows efficacy of the “program.” There was no random sampling and following up for five years. I can very safely judge the “program” without reading the “Big Book” and 90 hours of listening to drunkalogs and how “grateful” everyone is. No hard evidence, means not credible. Anecdotal stories are not evidence.
Again, the best part of the Sinclair Method is that of the 75% who control themselves, for some reason, 25% of the ones who controlled their drinking COMPLETELY quit. For five years. Isn’t that what AA is about? A group of “people with the desire to quit drinking?” In terms of complete abstinence 19% of people who used this method in the study quit permanently. Can AA say that? Oh, ”it works if you work it.” But no evidence to back it up. And a way to discount the massive failure rate – “some cannot follow our simple method.” It isn’t a “snap judgement,” it is a rational scientific method applied to a problem. The results can be quantified.

Willx

March 9th, 2010
8:54 pm

I started drinking regularly at 16, heavily at 21. Up until about five(5)or six years ago, I can’t remember a single day I didn’t consume at least a quart of Whiskey. The last ten years of my drinking a consumed an average of half gallon/day. I worked at home and started drinking a 8 am and slowly drank all the way around the clock till 3 or 4 am. My weekly garbage cart dumping into the truck sounded like the morning after at a busy bar.

Nothing stopped me. Not the courts, not the mandatory AA, which made me want to drink as soon as I got back home. For me, AA was just a social club for old drunks. Sorry, just my experience. If it works for you, so be it. I was never a joiner of any clubs anyway.

I only quit, at 50 yrs old, when I made up my own mind to quit without anyone telling me I had too quit. I had already lost too many relationships with women. It was strictly a personal thing with myself. I had my last drink emptying my last bottle of VO at 4 am and went to sleep. When I woke up three hours later, I did not drink, or even be able to keep anything down including water for almost exactly 72 hours. Not even a piece of bread. I should have gone to the ER on the third day but didn’t. Its was the hardest thing I ever did and probably almost killed me. I don’t recommend it. I could barely stand up. I could barely lie down. After the 72 hours I could finally keep a sip of water on my stomach. I was dizzy for days, but I have yet to even have a single craving for a drink. Its still amazing I made it through the three days and probably is not believed by many. But, Its true. I have my life back, whats left of it. And apparently, no long term physical damage.

You just have to make your own mind up to quit. No one, can force you to quit but yourself.
If you depend on someone or something to stay sober, you will always be a ticking time bomb.

And no, I don’t have to consider myself an alcoholic to stay sober.

Best of luck to whatever helps you.