The People's Perspective on Medicine

753 Overcoming Alcohol Dependence

Alcoholism is notoriously hard to treat and the relapse rate is extremely high. But an old drug may be surprisingly effective in helping people overcome alcohol dependence.

Naloxone and its cousin naltrexone have been available for decades. They are usually thought of as drugs to counteract a heroin overdose or reverse an excessive amount of opioid narcotic. But naltrexone has also been approved for treating alcoholism. What is the best way to use it, and can it help against other addictions? We get two perspectives on its effectiveness.

Guests: Roy Eskapa, PhD, is an Associate Fellow of the British Psychological Society. He is the author of The Cure for Alcoholism; Drink Your Way Sober Without Willpower, Abstinence or Discomfort.

Henry R. Kranzler, M.D., is Professor of Psychiatry, Genetics and Developmental Biology, Associate Scientific Director of the Alcohol Research Center, and Assistant Dean for Clinical Research at the University of Connecticut School of Medicine in Farmington, Connecticut.

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    About the Author
    Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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    For those seeking a prescription for Naltrexone, try locating a D.O. (osteopathic physician) as more of them are gearing toward holistic, complementary medicine with more healing modalities than sending you to the pharmacy for a “cure”. I know of two DO’s that use it with patients with a variety of medical issues.

    My husband had prostate cancer and kidney failure, so sees a nephrologist, urologist, and internist on regular basis. But it was the CranioSaccral osteopath that prescribed the naltrexone for its benefits of cancer control. The MDs he sees don’t give it much credence, but at least have not requested he discontinue it. I just don’t think it is pushed by the Big Pharma because it is such an old, inexpensive drug, so no one is making money off it. And drug companies are huge sponsors of the MCE meetings to make them more affordable for the practitioner. At least, that is how it is in my Veterinary profession. But we still decide which drugs are best for our patients based on effectiveness balancing level of side effects. I hope the MDs do too, but if there is no funded ongoing research about naltrexone, some may just think it is old school and thus of no value.

    what kind of DR do you see that will prescribe naltrexone. Also has any one been on this for a year and stopped drinking if so, please tell us how you are doing- we care about you. I am hoping this will help my 48 yr old son.

    So sorry for your loss, and for the tardiness of a treatment that may have allowed you to share more time with your husband. Thank you for sharing your story.

    I heard this program and was encouraged to think there might be a way to be able to enjoy a glass or two of wine and not feel compelled to finish the bottle. I am a child of an alcoholic who died from its effects. I work in the beer and wine industry, so like it’s been said, we work closest to our biggest weakness.
    I was thrilled to hear about this method. I mentioned it to my doctor at my next office visit, unfortunately it was at an OB-GYN who said they couldn’t help me with something like this, but said my internist, who I see for a thyroid disorder, would probably be able to help me. I scheduled an appt. to see him, told him what I wanted and he said he couldn’t help me. He referred me to another doctor, when I called and told the receptionist what I was looking for, they called back and said they couldn’t help me.
    Later I saw a different primary care doctor for another problem, mentioned my desire to try Naltrexone, who recommended I go to a substance abuse center, and they would give me a shot of Naltrexone that lasts 30 days, which is NOT covered under insurance and costs $100’s of dollars. I did not want to go that route.
    Meanwhile, I continue to drink about a bottle of wine a day. I can function, go to work everyday, work hard, and come home wanting that next glass EVERY DAY.
    I have been to AA, and I know it’s not for me.
    I just want to be able to drink socially and not feel compelled.
    How do you find doctors who are willing to prescribe Naltrexone? I’ve been trying over a year.

    Thanks for the very positive response to the use of this medicine. I just finished the book and am very excited about it. I have a family member who struggles with alcohol, has done all the steps but no permanent success.
    Is it difficult to get the medicine? Are doctors helpful in allowing people to have it without much fuss or does it have to be a big hassle to get it?
    Thanks M.J.

    Carl – Where are you at now – 8 months later?

    I heard this program and was encouraged to hear about something that I thought could change my life for the better. I have not read the book but did some research online and wanted to find a doctor who would be willing to prescribe this for me.
    Having grown up with an alcoholic parent, I’ve seen firsthand the terrible effects that alcoholism can have on health and relationships. I have also always heard that alcoholism is a physical condition that can be inherited.
    I discovered around 50 years old and having a habit of daily drinking for several years that I most likely was an alcoholic. It’s easier for me to not drink at all than to try to limit myself to a couple or few drinks. Once I start I’m not able to stop. I know I am going to have big problems because of this habit if I don’t find a way to stop the craving.
    I tried AA, but found it didn’t give me what I needed. I tried total abstinence for almost a year. But I want to be able to enjoy moderate drinking – one or two drinks with dinner occasionally.
    I don’t have a primary care physician. I see a gynecologist and internist (for low thyroid) yearly. I mentioned to my gyno I might want to try naltrexone, she said she couldn’t help me but probably my internist could. I made an appointment to see him, told him what I wanted and he said he couldn’t help me with this, but recommended another doctor who could. I called her office and explained what I wanted, was told by the receptionist that she would discuss this with the doctor and they’d get back to me. Eventually they said the doctor wasn’t willing to help me with this.
    How do you go about finding a doctor who is willing to do this? Any ideas for a doctor in the Greensboro, NC area?

    I first came across naltrexone in the Newsweek article “Deconstructing Alcoholism” http://www.newsweek.com/2010/09/01/deconstructing-alcoholism.html
    I’ve been a heavy drinker for 25 + years, but have spent months not drinking, and not by any intention – I just didn’t have the desire or situation to drink. I don’t believe I’m an alcoholic, but hey – I could be wrong. My girlfriend is another story – she did her first rehab almost a year ago, and almost made it a year without a drink. She has continued counseling, but did not like AA – I don’t know if she had a problem with the message, but she flat out didn’t want to attend. In her words, it wasn’t for her, and I’m sure she’s not alone.
    Given the revolving door of rehab and the limited success rates of AA or any program, it’s not surprising that many would be interested in researching the Sinclair method further.
    I’d encourage anyone to buy the book (despite the title), hear Dr. Eskapa’s well stated argument for the Sinclair Method, do your own research and come to an educated decision on whether it’s right for you. What we both found most compelling was the extinction of craving that is well documented, and the focus on curing the addiction, not living with it every day; a focus on quality of life, dignity and respect for the afflicted. I applaud those who have and can do it through willpower and the support of groups like AA, but to lift the desire, the craving seems to me the best way to tackle such a strong addiction.
    And we both decided to put our money where our mouth was.
    Tonight after work we met with our nurse practitioner (who has a lot of professional experience in addiction) and talked about the Sinclair Method. She was familiar with naltrexone, having recently prescribed it to a woman who was not drinking at the time. By the end of our appointment she had ordered the book, set us both up with liver workups, and after reading the free chapter “For Medical Professionals” said she is excited for us to try it, going to call a doctor friend who works in an alcohol treatment facility to get together and discuss what she felt may be a real chance at introducing a new and promising therapy in our area. I’ll post our progress here to see how things go.

    Just wanted to pass on to those interested that the 7th installment of the Charlie Rose series on the brain recently took on the subject of addiction. Scientists who have been working on this had very interesting thing to say, echoing some of what Roy Eskapa had to say and going into more detail.
    If you go to http://www.charlierose.com, look on the right side of the page where it says “Last Night,” “Web Exclusive,” and “Recent Shows,” select “Recent Shows” and scroll down to just BELOW the April 22 show where you will find “Brain Series Episode 7” which you can still watch in its entirety online.

    Altho’ in large metro areas there are AA groups for “non-traditional” folks such as GLBTs, secularists and new-agers, there is a dearth of such specialized groups in most of the country. Even tho’ AA has supposedly changed its language, referring to a “higher power” instead of God or Jesus, for instance, if one lives in a more small-town area of the country where Christianity is widespread it is difficult for a secular person to fit in, let alone get comfort and direction from the method.
    I attended two Al-Anon meetings in my area in the hope of finding some help in dealing with my husband’s alcoholism, and tho’ I tried mightily to be tolerant, the constant “Jesus” talk was too off putting for me to continue. This was always my husband’s objection to seeking help from AA, and after my experience I realized there was no point in urging him to even try it. I am not condemning Christians, just pointing out that there are many people who don’t find a religious viewpoint at all helpful in such matters.
    What a world we live in–with alcoholism such a big problem (and if today’s college students are any measure, destined to be much greater in the future) the best most of the medical community can do is to direct the alcoholic to a mutual aid organization which, tho’ we all know someone or many who have been helped by the method, has such a miserable cure rate.
    I thank the People’s Pharmacy for this program to which we have both listened several times. My husband is interested in trying naltrexone but thus far his attempts to get a doctor at the V.A. Hospital to prescribe it have been unsuccessful, and since the recession caused him to lose his business and his health insurance, the V.A. is his only hope.

    Here is what Dr Kranzler says about the cost-saving from naltrexone:
    http://www.upi.com/Health_News/2010/04/06/Naltrexone-may-save-money-in-the-long-term/UPI-65531270592719/
    Summary:
    Dr. Henry Kranzler of the University of Connecticut Health Center and colleagues found oral naltrexone raised initial costs but over the long term helped reduce healthcare costs for patients with alcohol-use diagnoses.
    The study tracked healthcare costs for 1,138 patients with an alcohol-related diagnosis prescribed naltrexone matched to a control group of 3,411 alcohol patients not receiving the drug and another control group consisting 3,410 patients with no alcohol-related diagnosis.
    The findings are published in the journal Alcoholism: Clinical & Experimental Research.

    If it sounds too good to be true: it probably is! There is no “magic” cure for alcoholism, and continuation of drinking yet taking a drug is surely flirting with trouble for those who truly are alcoholic. Having said that, using any tool to get started on the right path–which most alcoholism professionals believe to be abstinence–is worth while for a percentage of the alcoholic population.
    Antabuse is yet another drug with some success (alcohol + Antabuse causes a most unpleasant reaction, making drinking undesirable). No one way works for all–and thankfully, there are a number of avenues which work for some. AA, religion,etc. etc. AA has been the most successful during the 20 years I spent in the field, so always worth trying.
    Interestingly, many physicians simply do not understand alcoholism, do not recognize it, and have no idea how to help. A sensible alcoholism professional is likely to be the best source of information. Beware those who think only one way works. Talk to several, research treatments yourself. Above all, determination to do something about drinking and admitting there is indeed a problem, is a huge move in the right direction.

    I am a third generation alcoholic perhaps even 4th or 5th. This is the first time I have ever read, heard, found anything remotely close to an avenue of help. I am the child of an alcoholic who married a drug user/alcoholic and have a child that is a meth user. If Carl M. has found a way to reduce his drinking then I would like to know what steps he took.
    I am also a healthcare professional and am worried about being diagnosed in order to receive naltrexone. Is there a way to get help without being diagnosed an alcoholic? It is a family curse. This family addiction has always been attached to much shame. The shame drives the desire to drink.
    OK Carl M. What say you?

    I am a 62 year old male emergency room nurse with a history of drinking 6 to 8 alcoholic drinks a day for the past 30 years or so. My drinking is confined to the hours between 5 and 10 PM. My motivation for drinking is I like the “Buzz”. I honestly don’t believe my alcohol use is a coping mechanism, as both my personal and professional life is very satisfying and successful.
    I do however have an addictive personality. (I was a 2 to 3 pack a day smoker until 20 years ago when I stopped “cold turkey”). I have no desire to stop drinking, but I realize that if I continue my present rate of consumption I will sooner or later suffer health problems. I just want to reduce my consumption to a reasonable level.
    I heard the interview with Dr. Eskapa on NPR in early January, bought and read his book, and started on Naltrexone on January 5th. I could become the poster child for this drug. In the 3 weeks I have been taking it, I’ve had 1 to 3 drinks a day (usually 2), and have suffered absolutely no side effects. Indeed, the subtitle to the book (Without Willpower, Abstinence or Discomfort) has proved 100% true.
    I realize I am still very early in the game, but I am absolutely convinced that this is a “life changer” for me. I have spoken to a number of my friends and coworkers about Naltrexone and am amazed at the interest they have shown, either for themselves or their loved ones.
    If the drug continues to be as successfully as it appears to be over the next 3 to 4 months, I intend to very actively and publicly promote its use. I would very much like to learn of other peoples experience with Naltrexone, including their motivation, the drugs effectiveness, side effects and any crossover effects on other behaviors.
    Please feel free to contact me by responding to this comment.
    Carl M.

    I have battled compulsive, binge-eating interspersed with almost anorectic, extremely health-conscious and controlled eating habits for nearly thirty years. While my intellectual understanding and my emotional health regarding my disorder have improved astronomically over the years of my battle, I still find myself falling prey to the compulsion to binge-eat. The description given during your program of the physiology of the neurons involved in opiate/endorphine uptake helped me to understand why the binge behavior still captures me so compellingly and suddenly and often much to my surprise.
    It sounds like, during my “abstinent” periods, my addicted neurons remain unchanged, and the first bite of a trigger food eaten at a moment of weakness restarts the whole full-blown compulsive cycle again, along the neuronal pathways that have been laid down over many years in my brain. Is this true? Can eating addictions be compared thus to alcoholism? And could naltrexone be useful in treating food addictions?
    PEOPLE’S PHARMACY RESPONSE: IT IS POSSIBLE THAT EATING ADDICTIONS MAY USE SIMILAR PATHWAYS. THERE ARE A FEW STUDIES OF NALTREXONE FOR BINGE-EATING. THEY LOOK PROMISING, BUT WE CAN’T FIRMLY CONCLUDE HOW WELL IT WORKS.

    Terry and Joe I have to commend you on the terrific service you provide. I’m an integrative medicine provider in Missouri and have learned much from yourselves and your guests. I’ve been listening for a about 6 months and many shows have been great but none better than the recent ones on bone health and the treatment of alcoholism. I really appreciate your provision of two perspectives for each topic which allows for a better, and broader understanding of these important conditions and their treatment. Too often an impressive health claim is put forth and validated in the media but no opinions that may run counter or are limiting are put forward to put topic, for the listener, in perspective. Thanks, and keep up the terrific work!

    I would like to second the comments made by Chris B. and add that the statement made by Dr. Eskapa, “why go to 90 meetings in 90 days” when you can merely take a pill will very likely result in the death, institutionalization, and/or incarceration of some number of alcoholics. Very irresponsible since for many alcoholics AA does work and alcoholics should not be discouraged from trying the AA program.
    I would urge both doctors to attend a number of open AA meetings, if they have not already done so, to better understand how AA works and it’s value as a spiritually based transformative program. That’s not to say that AA is for everyone. But it should be understood that physical sobriety, while essential, serves primarily to open the door to recovery from a disease that’s physical, mental, and spiritual in nature.
    I would also urge the doctors to read AA’s Big Book under the direction of a an alcoholic who has recovered from a hopeless condition by following the directions in the book. And please Terry and Joe, the next time you do a show on alcoholism (not just alcohol dependence), please have an actual alcoholic on the show.

    While this drug may indeed be effective, it doesn’t in any way address a major underlying symptom of alcoholism, the inability to cope with reality. People dealing with life’s issues develop coping mechanisms, healthy or unhealthy, whether its sharing their woes with friends, joining a church, exercising, or yelling at their spouse. But the alcoholic drinks. Always.
    The alcohol IS the coping mechanism for the alcoholic. So what happens when the coping mechanism is suddenly ripped out from under the alcoholic?
    At the risk of “outing” that well known 12-step program, the whole “secret” behind AA is just this: it is a way of life, it’s a book of directions on how to live soberly and happily, combined with a group of people who demonstrate – precisely – how they manage to live days, months, years without alcohol.

    I have also been involved with AA for several years, but at the moment I have only 2 months of sobriety and it is not due to involvement with AA. AA is great and works for many people, but reality tells us that is it not the only way for people to get sober, and that only 10-20% of people involved in 12 step programs are likely to find lasting sobriety.
    It pains me to hear people talk in absolute terms like George R. Many of them attend church/AA and they know absolutely that theirs is the only true way and there is absolutely no room in their belief system for the possibility of another right way. Glad you found your way but please allow for the possibility of other right ways.
    For those of us alcoholics who have not been long to sobriety, a chance at sobriety, almost regardless of the method, should not be discouraged. I have an alcoholic friend who has been in and out of AA and has no real sobriety under his belt. Despite this he also has discounted the Sinclair Method as something that could not possibly work because he knows from his AA involvement that abstinence is the only way. The problem is that ABSTINENCE IS NOT WORKING FOR HIM!
    Please tell me how 6-12 months of his life where he tries the Sinclair Method is a waste of time when nothing else is reducing the impact of drinking on his life?

    One comment made by Dr. Eskapa seemed to undermine his argument. He reported that subjects with alcoholism directed to take Naltrexone daily but directed to abstain from alcohol relapsed. Even given the “abstinence” effect, when these subjects did drink again, they should have experienced the same extinction of the urge to drink as those allowed to drink “normally.” That they did not suggests a problem with the theory.
    Moreover, I worry about the potential harm from the resumption of the usual drinking in these cases in terms of accidents and health consequences as I suspect that levels of drinking would be rather high at least in the beginning of treatment. I think that the experience with opiate addicts and Naltrexone is telling on this point and was not addressed by either guest. The urges for the high leads opiate addicts to discontinue the Naltrexone. The use of Naltrexone in opiate addiction, where it should have the same benefit as Dr. Eskapa describes for alcoholism has been generally poor. Whether this potential problem could be overcome by prescribing the injectable depot form which last a month remains to be seen.

    As a research psychologist with some experience in substance abuse treat I am very excited about the new approach to treating this difficult problem. I found Dr. Kranzler’s critique of the Sinclair Method to be confusing, since the approach espoused by Drs. Eskapa and Sinclair seems to be supported by Dr. Kranzler’s own research (see Pubmed citation below)!
    J Clin Psychopharmacol. 2009 Aug;29(4):350-7.
    Targeted naltrexone for problem drinkers.
    Kranzler HR, Tennen H, Armeli S, Chan G, Covault J, Arias A, Oncken C.
    This study aimed to replicate and extend prior research showing that the targeted use of naltrexone is a useful strategy to reduce heavy drinking. We compared the effects of naltrexone with those of placebo in a sample of 163 individuals (58.3% male) whose goal was to reduce their drinking to safe limits. Patients received study medication (ie, naltrexone 50 mg or placebo) and were instructed to use it daily or targeted to situations identified by them as being high risk for heavy drinking. An interactive voice response system was used to obtain daily reports of drinking and medication use during the 12-week trial. Analyses were conducted using hierarchical linear modeling, with sex as a potential moderator variable. On the primary outcome measure, mean drinks per day, at week 12, men in the targeted naltrexone group drank significantly less than patients in the other groups did. On a secondary outcome measure, drinks per drinking day, during week 12, the targeted naltrexone group drank significantly less than the other groups did, with no moderating effect of sex. These results support the use of a targeted approach to reduce drinking among heavy drinkers, particularly men, but argue for the use of additional strategies or more efficacious medications than naltrexone to increase the effects of such an intervention.

    After listening to your radio talk show with Roy Eskapa, PhD, I felt very hopeful that there may be a way out for some alcoholics.
    I am in my mature age now (the over 50 club:) and I am finding that a lot of people over the age of 50 are drinking more than ever. They have suppressed so much anger about the what ifs’ in their life that now it’s become to painful to think about it. I find that as people are getting older, they have too much time to think about what they did not have in their lives when they were younger and now find themselves in the same state. Alone and unhappy with themselves. To me, that makes the drinking even more profound.
    If taking a pill will help suppress the desire to drink until you cannot stand up, then especially over the age of 50 let them take it. I believe it is never too late to try and have a alcohol free day, night, week, month, year in our remaining lives. And actually find out why you do not like yourself?? Get in touch with your inner spirit and be honest about who you are and either accept it or work on making thing better.
    MOST ALCOHOLICS THINK ABOUT THEMSELVES TOO MUCH AND OF COURSE THAT WOULD MAKE YOU DRINK A LOT……

    I did not like the title of Dr. Eskapa’s book and he sounded a bit too slick for me. BUT I realize that from my own experiences losing and keeping weight off, that be it kicking over eating or over drinking it is difficult for some people to stop. And even if successful relapse of both occur every day.
    The method seems to help a significant number of people control their drinking and not get addicted. That part confuses me since taking the med will not stop someone from getting drunk and driving. But if it can stop even 10% of the alcoholics, then it should be viewed as a USEFUL TOOL to stop addiction and deaths.
    I have never and hope to never walk a mile in an alcoholic’s shoes so I cannot imagine what they go through. It has to be many many times tougher than my staying away from the crunchy peanut butter jar in the cabinet.

    I can be emailed at royeskapa (AT) yahoo (DOT) com if listeners have questions and I will respond to specific questions if possible.
    Best wishes,
    Roy Eskapa, PhD

    it’s lethal, if you ask me.

    thank you, chris.

    I think it is EXTREMELY irresponsible to suggest that taking a pill (while DRINKING!??!!) can “cure” alcoholism. There is no such thing as better living through chemistry. That’s how I found my seat in AA meetings–
    Wendy

    since dr. eskapa was kind enough to respond to another mother, i am sending in my own question to him. first, i did not hear the program but the link was immediately forwarded to me by a friend. i have order the c.d. and your book. my son is a binge drinker who when he is not drinking is a charming, intelligent, competent person. he has been to rehab once and goes to AA–which does not work for him–only when everyone who cares about him is desperate to do something to help him. are doctors in this country familiar with this approach and are they willing to prescribe the medication you recommend? how does one go about getting this to happen? thanks for your time. i look forward to hearing the program and reading your book.

    The disease of alcoholism as described by bill Wilson, is a 3 fold disease mental, physical and spiritual. I hope this drug does aid in the recovery of my other brother and sister alcoholics.
    That being said, alcohol is only a symptom. Alcoholics are tortured by a pain of loneliness, anger, resentment and above all self centered fear. The solution that works for millions is one alcoholic helping another. The 12 steps to recovery are the process to a spirutual awakening. I hope this message reaches one alcoholic out of the millions who may read this. You are not alone. We love you, and we will be waiting to usher you into the fourth dimension of the spirit only if you want to.
    Go to AA and you will find everything you always wanted, on the path and only on the path of the 12 steps. getting involved. People in AA saved my life, and today I am only sober by the grace of god and the fellowship of AA. If an AA is reading this I love you. Thank you for my life.
    Chris B New York, One day at a time.

    My husband and I both are compulsive drinkers. My mother died as a result of over-consumption, and I firmly believe my husband inherited his addiction from his mother’s father. We are compelled to drink. We work in the industry (they say you work closest to your biggest weakness). We found this show very promising. To think I could drink and not be compelled to finish the bottle, what a great idea! I intend to research this further. Thank you, Teresa and Joe, for bringing this front and center!

    My husband committed suicide (age 49) after battling alcoholism since his first teen-age drink. He became a serious addict, drinking a liter of brandy a day. By his own volition, as well as court mandates, he participated in seven treatment programs, Hazeldon included and attended AA meetings, but because of severe dyslexia, he struggled with reading aloud and journaling (he was a brilliant machinist) – these programs did not work for him. Perhaps Naloxene would have relieved his drinking compulsion. AA isn’t for everyone.

    Your son has a good chance of responding as well as Ella Glaser – aged 22 –
    Listen to her story on a radio interview at http://www.thecureforalcoholism.com
    Download Ella Glaser mp3
    Best wishes,
    Roy Eskapa, PhD

    I know it is necessary to be patient when interviewing academics but somehow I wish that alcoholics in recorvery would have heard if this drug safely could be used to let them drink responsibly again (most in recovery want that!) Further, it could be helpful if listeners knew clearly how to learn more about such treatment from professionals. Finally, I know the man is trying to sell books but the title is too reminiscent of fraudulent tabloid hype!

    The pain of may years of alcohol addiction to our daughter has been devastating to our family. We have buried her many times in out heart. Suicide attempts has also been part of this experience.
    We with many other families really know what pain alcohol has brought to ur families.
    Our daughter is going to drink when she is relased from jail for the same reason she went in there. This is a fact both my wife and I as well as our daughter know.
    Abstaining can work for those that are closer to reaching thier goal of getting away from this terrible drug. For other such as our daughter this could be a trail to overcoming this aufull pain.
    Attempting this might be the solution to this addiction. We have grown tired of using the same processes and getting the same results.

    I am listening to your program with Dr. Eskapa, and it is most interesting.
    I am very interested in tobacco-use cessation, and am in process of developing a program — primarily based on behavior modification and a system that was shown to work in a large number of cases — for tobacco users to quit. I was wondering if naltrexone and the Sinclar Method could be used for treating nicotine addiction. Dr. Eskapa just said in the program it does not work with nicotine addiction, but another drug might.
    In general I oppose use of nicotine patches and gums in that they are not just a crutch, but actually the addictive substance itself and this does not solve the underlying issues of the addiction. Were an approach similar to the Sinclair Method be deemed to work in the case of nicotine addiction, and the subject need continue taking nicotine (as the alcoholic needs to keep drinking for the naltrexone to work) for the treatment to be effective, would it not be counterproductive for them to continue using tobacco given its harmful effects on the user and others? In that case, would taking nicotine independent of the tobacco, like a patch or gum, be effective in the treatment without the negative effects of smoking or other tobacco use?
    One other question also arises in that tobacco use, much like alcohol abuse, is as much a habit as an addiction, and I still see where behavioral modification would be an important element to avoid recidivism in the habit of smoking, or drinking.
    I welcome your comments and also having these questions to be passed on to Dr. Eskapa. Even more, I would be most grateful to be put in direct contact with Dr. Eskapa to further explore this question of the potential of something along the lines of the Sinclair Method in treating nicotine addiction.
    Thank you, and you have a great program I listen to each week and it has been most useful to me.
    Kindest regards.

    An interesting show! The two experts gave interesting information about alcohol addiction and its treatment with naltrexone. The first expert recommended the “Sinclair” treatment where heavy problematic drinkers are told to take naltrexone and then drink. He said that clinical trials proved this treatment to be highly effective. Allegedly, the naltrexone worked by blocking the pleasurable effects of alcohol on the endorphin system.
    Neither he nor the second expert mentioned that many, if not most, problematic drinkers use alcohol as relief in an effort to escape depression, loneliness, anger, anxiety, and all sorts of personal misery. The negative reinforcement (relief) can be much more important than the positive reinforcement (high).
    The theoretical endorphin mechanism aside, the first expert claimed that the “Sinclair” treatment was highly effective in controlled clinical trials. The second expert said naltrexone treatment was modestly effective when used with recovering drinkers whose goal was abstention and weren’t drinking much. More to the first speaker’s point, he said that the Sinclair treatment was NOT well supported by controlled clinical trials.
    After listening to this absorbing show, I confess that I don’t know what to believe about the effectiveness of the Sinclair treatment.

    Hope- anything is worth a try for my son.

    As a 30 year plus recovering alcoholic, I was sorry to hear this encouragement for folks, who might be trying to stop drinking, to seek another chemical (drug) ‘solution’ which sounds so easy compared to the way that really does work (Alcoholic Anomymous) for anyone with the disease of alcoholism who really wants to be able to live sober. The craving, due to genetic enzymatic deficienies in the liver, does not begin until there is alcohol in the body, and then the body demands more alcohol to ease the pain induced by the aldehyde produced by the first drink. Good luck to the guy peddling his book and the drug industry taking advantage of all the poor souls who are looking for the ‘easier softer way’, and who will be deluded with the promise of this one.

    Sounds promising. But one component of recovery was not discussed. People with an addiction undergo a personality change. If they abstain from alcohol and other drugs they continue to have interpersonal problems, called a dry drunk. Has Dr. Eskapa studied his subjects psycho-social well being 6 or 12 mos out from treatment?

    Found the program informative and balanced. Have forwarded it to friends who might benefit from its content.

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