Inexcess: In search of recovery

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Monday, January 12th, 2009 Naltrexone

Naltrexone has been described as a pill that can cure alcoholism. It also is a cheap and effective method of treatment. Notwithstanding, there is no costly rehab process. The question remains, why are so few doctors supporting this product?

Penny Wark of the Times (12 01 09) gives an insight to both the drug and it’s merits.

Her first interview is with a lady to be known as Mrs M, who drunk herself approximately five years ago into a comatose state. Moreover, Mrs M consumed more than a bottle or two on a daily basis, more specifically she declares that what she drunk was not just wine, but explains, “It was the only way I knew to resolve a problem.”

However, having spoke to Mrs M over the last week, she advises that she has not had a drink in the last four days. She will enjoy a couple of glasses of wine with her meals over the weekend. Mrs M remarks, Oh yes, I still enjoy good wine. I savour wine. But there’s no craving.”

What is interesting, is the concept of Mrs M’s condition sounding a little bit just too good to be true. The old adage once an alcoholic, always an alcoholic springs to mind. It has been argued that the only way for an alcoholic to lead any sort of normal life is to abstain, furthermore, abstention should mean what it says as there is a tendency for alcoholics to resume their worst excesses after just one drink.

Naltrexone appears to have the answers for Mrs M who takes the drug before she takes a drink. According to Wark on Mrs M states, “Naltrexone interrupts the pathways in the brain that enable alcohol to release pleasure-giving endorphins. As Matt, another naltrexone user and recovering heavy drinker, puts it: “With naltrexone, it’s weird. You drink and you feel the effect of the alcohol but it doesn’t have the magic.”

The idea is that every time you actively engage in behaviour that releases endorphins, you actively strengthen that behaviour. Likewise if you engage in behaviour and don’t get the endorphin release, you weaken the urge to use it. Thus, unburdened by a craving for alcohol, a former heavy drinker can use alcohol with control.

This method of treatment is known as the Sinclair Method, after it’s founder David Sinclair, a scientist and who claims a 78% success rate over three to four months. The measure of success is controlled drinking within normal safety limits, or abstinence.

Sinclair works at the National Public Health Institute in Finland, and it is reported that his method has become part of a mainstream treatment for alcoholism. Hitherto, inexcesss of 100 000 clients have used the treatment since 1995. Ironically, in the UK naltrexone is licensed for the treatment of heroin addiction but not alcoholism (though it is available on private prescription) and Mrs M, who lives in Scotland, is fortunate to have an enlightened doctor who has sought permission to use it to treat alcohol problems for about 50 carefully selected patients over the past ten years.

A Book published in the US two months ago advocating the Sinclair method was not given the attention of the media and only went on to sell a few thousand copies. Indeed, Roy Eskapa, a psychologist who has worked with Sinclair since the 1990s, hails him as a genius who deserves a Nobel prize for finding a cure for the world’s biggest killing disease. Bearing in mind that according to the World Health Organisation (WHO) alcohol kills 1.8 million per year. The British Medical Association (BMA) estimates that one in 25 adults are alcohol dependent..

It can be argued, according to Eskapa that the Sinclair method could in reality change the way in which society perceives addiction. Thus enabling a treatable condition rather than incurable.

Moving on and attempting to assess why the Sinclair method has largely been ignored, we need to get back to basics. The discovery was made in 1964 whilst Sinclair was still an undergraduate. His research involved alcohol and rats.

More specifically, given rats that had been denied alcohol for two weeks, he decided to test a theory and gave them a choice of an alcohol solution or water. Even though it was daytime, a rat woke up and “started drinking the alcohol solution almost out of my hands”, says Sinclair. The other rats joined in. After more studies, Sinclair began to see that the more the rats were deprived of alcohol, the more they craved it.

According to Sinclair who states “Nobody had seen motivation for alcohol in a rat before,” he says. “This changed the understanding of what causes alcoholic drinking. At that time almost everybody in the field accepted that there wasn’t enough pleasure from drinking alcohol to make an alcoholic drink. The pleasure didn’t match the unpleasantness, so they theorised that the craving was caused by withdrawal symptoms, by physiological dependence, and all alcoholics were drinking to avoid withdrawal. So the main treatment was to get rid of the physiological dependence - you sent them to rehab with the idea that they would come out and have no reason to drink. If dependence was the cause, it should have been a cure, but it isn’t.

“So we starting rethinking what causes alcoholism. It is learnt. A person isn’t born an alcoholic but every time they drink there is a release of endorphins. For genetic reasons some people have very powerful receptors for endorphins, get a lot of reinforcement from the alcohol and have a high risk of developing alcoholism. The neural structure that is causing this behaviour, and the craving, gets stronger each time they drink, and with some people it becomes so strong that they can’t control it. The only solution is somehow to weaken the behaviour that is so powerful.”

In 1972 Sinclair moved to Finland, and after many more studies he concluded that the most effective drug for treating alcoholism was naltrexone. It is not addictive, it has been proved to be safe in 50mg doses, it does not require detoxification because it reduces craving slowly, and it is cheap - about £170 for three months’ supply.

Indeed, the is specific: naltrexone plus alcohol equals cure. For it to work, you have to continue to drink. thus based on the need to drink is the main reason why the Sinclair Method has been rejected by so many alcohol addiction professionals.

From a very cynical perspective it can also be argued that the drug itself does not generate enough incomes as it is relatively cheap. The question is as suggested by Wark, could the Sinclair Method kill off the alcohol rehab industry? I ask Sinclair. “It could,” he replies, “though some people will still need detox if their liver is too shot to take naltrexone.”

Getting back to Mrs M, Dr Jonathan Chick, consultant psychiatrist at the NHS Lothian Alcohol Problems Service, continues to see his patient every six weeks. He prefers to use naltrexone in conjunction with counselling, in spite of clinical trials that suggest that this is unnecessary.

Chick agrees that naltrexone may not serve the commercial interests of the pharmaceutical industry. “The other reason the Sinclair Method hasn’t been taken up is a very correct reservation about sanctioning continued drinking by people with severe alcohol problems. For many, complete abstinence is by far the best method and needs to be applied quickly.

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