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Comment by lubujackson | Hacker News Reader

Honestly, doing something "an hour before" doing something compulsive might be a placebo that trains people to delay doing something destructive. Once that happens, it is much easier to stop doing it completely. I imagine if there was a diet that said "drink a cup of water before eating that cupcake" it might be equally as effective for compulsive eaters.

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Addiction is an "every minute" kind of thing. Sometimes you can put something off for an hour, or know that e.g. dinnertime is the time we open the wine, so you can wait. But then after an hour, it's still there, and another hour, and another, and then you break down and give in when it is late or you are alone. Which then negates/resets any value gotten from the initial delay. So I don't think this is a placebo at all.

Speculating about the drug's performance vs placebo is an argument from imagined evidence -- in this case contrafactual. As with most drugs, placebo is the benchmark naltrexone had to beat to demonstrate efficacy.

Indeed. Some clinical studies are listed here - http://www.c3foundationeurope.org/clinical-trial-evidence/

Also note when researching - many people prescribe naltrexone to be taken every day along with abstinence, and infact when taken this way it's shown to be no better than a placebo. When taken as per The Sinclair Method it has been shown to be over 85% effective.

> I imagine if there was a diet that said "drink a cup of water before eating that cupcake" it might be equally as effective for compulsive eaters.

Having participated in a number of eating disorder groups and also having studied it, I feel sure that is not the case.

Edit: (Assuming that the prior commenters method _is_ effective)

Indeed. And interestingly I believe naltrexone is sometimes used in the same way for eating disorders.

Many alcoholics are already quite adept at delayed gratification, whether it be waiting until they get home for the night before pounding 5-10 drinks, or even waiting for loved ones to go to sleep so they can "hide" their habit.

Addiction isn't a soft lack of will but an iron surplus of it despite perennial invectives; it's antifragile. Any cessation/treatment regimen/regime imposed on someone else merely reinforces their drive.

> Addiction isn't a soft lack of will but an iron surplus of it

Relevant: http://existentialcomics.com/comic/13

My my my there is a lot going on there! fun read.

And heck, "dry drunks" can go the rest of their lives pretending alcoholism isn't having a negative effect on their lives and the lives of those around them.

What the hell is a dry drunk?

It's an AA term. The narrative is that you are still an "addict" even if you are sober if you haven't dealt with the underlying emotional and psychological issues e.g. worked the steps.

A person who quit drinking, but still acts in destructive / dysfunctional ways.

This is the sense in which I used it.

Interestingly, many prescribe naltrexone along with abstinence, and say the drug should be taken every day. In clinical trials when taken this way it is shown to be no better than a placebo, but in trials when taken as per The Sinclair Method (ie, pill only taken an hour before drinking) it is shown to be far more effective. Here's some links to some studied - http://www.c3foundationeurope.org/clinical-trial-evidence/

People undergoing The Sinclair Method often find there are two parts to their addiction - the chemical part, and the habitual part. Sometimes once the chemical part is extinguished they also have the habitual part to stop.

The habit/chemistry dichotomy is also part of giving up cigarettes.

There are questionnaires you can take to reveal how much your addiction is chemical led e.g. do you smoke first thing in the morning (when the chemical levels are low) or do you smoke as part of some routine.

>In clinical trials when taken this way it is shown to be no better than a placebo //

What levels of effectiveness is that. Placebo's are reported as being pretty strong medicine: no better than placebo is pretty good if your placebo is effective in 40% of cases for example.

Naltrexone is an opioid receptor antagonist, so it has a very plausible mechanism of action. It disrupts alcohol's effects on the brain when you drink after taking naltrexone. This disruption can cause the alcoholic to quit (or significantly reduce consumption) naturally over time.

From a lot of proximity to this behavior in all of it's forms, there is no one solution and alternative habit forming that creates a mindful pause is one of them.

Unless this drug has a 100% success rate I take the placebo observation as a valid one. But it should not 100% discount the drug efficacy out of hand either.

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