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After years and years of struggling with alcoholism and AA, I got sober with naltrexone using the "Sinclair Method". I followed the treatment plan for a few weeks and at the end quitting drinking was easy and obvious. That was just over ten years ago and I haven't had a drink or gone to any meetings since.

I'm only one person and I'm fully aware that the plural of anecdote isn't data. However, the experience was so drama, and more importantly self-loathing, free and so effective, that I can't help but feel bitter towards the proponents of AA who insist on it being a monopoly... especially those in positions of power in the criminal justice or public health systems because from my perspective it's a malicious and vindictive stance.

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From your short message, it seems our experience with alcohol is similar. I've been struggling with my level of alcohol consumption, about 7-8 months ago I read an article on the Atlantic[1] that detailed the effectiveness of naltrexone.

I've included it as others might find it helpful.

[1] - https://www.theatlantic.com/magazine/archive/2015/04/the-irr...

These are useful references for Naltrexone.

Roy Eskapa, the Cure for Alcoholism [book] https://www.benbellabooks.com/shop/the-cure-for-alcoholism-s...

One Little Pill [documentary film] https://www.onelittlepillmovie.com/

These wikipedia pages are also helpful:

https://en.wikipedia.org/wiki/Naltrexone

https://en.wikipedia.org/wiki/Nalmefene

Naltrexone/nalmefene works with 85% of the population, while 15% do not respond because of genetic disposition.

Of the 85% who do respond, 75% are successful in what they are attempting.

Proponents advise you to take it for the rest of your life. Naltrexone is not costly. This is your decision.

I quit taking it when I quit drinking. I literally never finished the second box of tablets.

What you are referring to are those who for whatever reason wish to continue drinking in moderation.

Using the Sinclair method you only take naltrexone when you drink (well just prior to drinking). Not at all times. It's not expensive and it works so so well. In Finland it is the first line treatment option for alcoholism and it's wildly successful.

>However, the experience was so drama, and more importantly self-loathing, free and so effective,

I remember reading a while ago that this is the main problem with 12 step programs. Not that they don't work (they often do), but the manner in which failure is viewed. With typical medical and therapy treatments, if one treatment (psychological or chemical) is not working, the attitude of the doctor is to consider other treatments. The claim was that with the 12 step program, if it doesn't work for a person, the person is the problem. The notion that the 12 step program isn't for everyone is usually absent.

> The notion that the 12 step program isn't for everyone is usually absent

I lament the notion that the 12-step program is the be-all end-all for curing all addictions for everybody everywhere. It is not. It should stop being sold as such. Yes, it is helpful for many; it is also not helpful for many others.

Naltrexone is an amazing medication!

Two things to note about it though.

One, it’s not a quick fix. It works by inhibiting the pleasure response of alcohol. Therefore, it takes a very long time (a few months) for the brain to become re-conditioned and not associate alcohol with pleasure. During this time, one will continue to drink, but the desire to drink should gradually wane.

Two, it has a very short half-life. Therefore, it’s very easy for the brain to trick itself into not taking it. I have seen many people ‘accidently’ forget to take it before drinking. And, since the goal is to re-train thr brain, this really defeats the purpose.

Anyway, I recommend it to all of my friends. Unfortunately, it’s not well-known, so I only discovered it after doing my own research. And, then, I had to seek out doctors that even knew about it.

> ... I can't help but feel bitter towards the proponents of AA who insist on it being a monopoly... especially those in positions of power in the criminal justice or public health systems ....

Not an alcoholic, but I had extended discussions with a number of AA members some years ago. And I found that many of them also felt pretty negatively about the involvement of the justice system with AA. What happens (they said) is that people are forced to attend AA meetings as part of sentencing, but these people generally are not interested in recovery. The result is a lot of wasted time and the diversion of resources away from people who could be helped.

Agreed. AA has a tradition of "attraction rather than promotion" but AA cannot control what those outside of AA do.

Does this only work for alcoholism, or does naltrexone work for any compulsive behaviour?

Naltrexone is an opioid antagonist, meaning that it blocks your opioid receptors and basically prevents opioids from having an effect. Naltrexone and naloxone (another opioid antagonist) are used in treating opiate addictions.

Not an expert, but my understanding is that these receptors (and naturally occurring opioids) play a role in the reward pathways in the brain, so it's possible that naltrexone and other opioid antagonists could be effective for other types of addiction or compulsive behaviors.

Apprently its an opioid receptor antagonist and its mechanism of action for treating alcoholism isn't well understood. Since it modulates the reward system of the brain it could potentially be useful for any addictive behavior, however there's probably a reason it doesn't seem to be prescribed outside of alcoholism or opioid addiction.

I believe I read that Dr. Sinclair was thinking Naltrexone could also be used to help with any sort of addiction such as smoking or overeating. I don't think there is any clinical research to support this though in the same way there is research supporting its effectiveness with alcoholism.

Link? Curious!

I believe it was in Eskepa's "The Cure for Alcoholism"

Commonly used to treat opiate dependence, often a combo of buprenorphine + naltrexone

What margin of error did you have with the sinclair method, like if you were off an hour or two with taking the naltrexone would that matter? Also - did you have any withdrawal symptoms?

Anyone know if there is something similar to quit smoking? Tried to quit cold turkey 20 times at least, usually can’t get past the first day.

Wellbutrin (bupropion hcl) is FDA approved as a smoking-cessation aid.

I took it for a year or so (though not for smoking cessation), if you have any questions I'd be happy to answer them! Email in profile.

Juul has helped a few friends quit smoking, but some still use the juul. Nicotine salts in their juice make it feel stronger than cigarettes, so its easier to switch than standard nicotine-base juices.

I've known several people in my life who went from being 2-pack a day smokers to, well, vapors on a low nicotine dose. Juul is sort of an overpriced unit and really they're trying to run a subscription model on their dumb pods - but in general vaping can help in smoking cessation (though not necessarily nicotine addiction!)

Ibogaine is extremely efficacious, but it's quite intense.

I had the same problem and then quit with the first round of chemo treatment for Hodgkin's Disease, and certainly not because I had an epiphany.

It must have been one, or a combination of the many drugs against nausea, vertigo etc. I strongly suspect that the mild euphoria caused by the Corticosteroids played an important role.

Nicotine chemical dependence is gone in 48-72 hours. Take a 3 day vacation without access and you'll be done.

You can probably justify first class tickets to and from Singapore with the money you'll save to ensure you won't have access.

Vaping did it for me. For some reason that I ignore, you can then, as a second step, quit vaping very easily (at least for me, it was much easier than quitting cigarettes). There have been some studies about this, it’s been speculated that it’s because of the different way you absorb nicotine when vaping, as opposed to smoking. (Sorry I’m unable to find a link now but I will try later when I get home). I am now 2 years off the stinkies, and about 9 months off vaping.

10 years ago I quit smoking. I don't recommend doing it this way, but I started chewing tobacco. I didn't like it, didn't care for the taste, but for some reason, it let me break the mental habits of having a cigarette every so often, and the hand movements, etc.

About a year later, I was planning on having Lasik eye surgery. They recommended no nicotine/caffeine for 24 hours prior and 7 days after. I gave caffeine up for the next year, and never picked up nicotine again.

There is probably a few reasons why you smoke. Just remember, you probably like all of them. Start to figure out how to remove and replace them. And keep trying to quit. At some point it will work.

I probably tried to quit 200 times cold turkey, 2 or 3 times with medication, and maybe a dozen times with patches.

I’ve had success with nicotine patches. For me it worked best to very slowly ween myself down to lower doses over a period of several weeks. Been cigarette free for almost 5 years now (after smoking for 17 years).

First congrats on finding something that works for you and making it stick!

From that perspective, I can see why you would not like folks that insist on AA being a monopoly, but I'm curious about that position. I've seen a lot of people that hate AA and a lot of people that think it saved their lives, but I've never seen anyone say that AA must be the only way to sobriety. What's the angle?

I can't speak from first hand experience or actual knowledge, but I've seen several articles over the years about AA being the only US court approved treatment, leaving some people with the choice of accepting only AA or jail. Atheists in particular have commented on this, but also people that take issues with certain other AA stances (such as "you will forever be an alcoholic").

I have no idea if this was federal, state, or local courts.

> "you will forever be an alcoholic"

That doesn't seem like an unjustified statement to me. I'm not an alcoholic, but I am a food addict and the experience of losing half my body weight and keeping it off for years has only reinforced, to me, the idea that I will always be a food addict.

Many agree with you. I've not encountered an addiction myself, (yet, at least, knock on wood), so I have no stance one way or another, but I've read accounts where many people have experiences similar to yours, and yet there are others that (claim to, at least) encounter it like an illness. They were sick, got treated, and now are not sick. Perhaps the Sinclair method that others discuss does that, breaking the longing for the alcohol, perhaps not.

From where I sit, if you're in a place where you are no longer suffering and others are no longer suffering, you get to define how you relate to the problem you had. Having your only option be a group that insists you must be a victim when you don't agree feels wrong. Now, do we have real people in that situation - not a perma-alcoholic but somehow being forced to join AA or go to jail?. I don't know.

>you will forever be an alcoholic

I believe that this is the current medical understand of alcoholism as well.

You may have encountered these people casually in passing but not read anything from AA proponents. Basically every AA proponent I’ve ever read from tows the party line that it is the only viable treatment. Many of them disparage and suppress alternatives like the Sinclair method.

This is completely contrary to anything officially published by Alcoholics Anonymous. Possibly "proponents" have their own opinions but AA itself specifically states in its that it does not have a monopoly on recovery from alcoholism.

http://www.aagrapevine.org/node/34635

That's one example. It is also in the main text.

AA's "Big Book" says "Rarely have we seen a person fail who has thoroughly followed our path. Those who do not recover are people who cannot or will not completely give themselves to this simple program, usually men and women who are constitutionally incapable of being honest with themselves."[1] In other words, "it works if you work it". They may not say that AA is the only way to sobriety, but why would you need anything else?

[1] https://www.aa.org/assets/en_US/en_bigbook_chapt5.pdf

Wow! Beautiful results. Count me in :)

Can you detail this more?

You really naltrexone when you drink, and only when you drink. They also advise drinking somewhat frequently at the start so your brain can quickly break the connection between alcohol and having a really good time. Once it is broken you do need to continue using naltrexone every time you want a drink or over time you will go back to being addicted. But it is generic and not expensive to get.

Where did you get it generic and cheaply from? My primary won't prescribe it.

See the book:

https://www.benbellabooks.com/shop/the-cure-for-alcoholism-s...

There is a chapter in this book "for the physician."

If you have brought this to your physician, and you are still refused, get a new physician. Request all your records, and depart.

GoodRX will let you price compare. Most sources are under $2 per pill.

You can either get a new doctor or buy from India.

I’m confused. When I googled Naltrexone, it warns: “Alcohol: Avoid. Very serious interactions can occur”. So are you supposed to take it hours before drinking or something else?

It is Definitely safe to take with alcohol. Not sure where your seeing that it's not.

> It is Definitely safe to take with alcohol. Not sure where your seeing that it's not.

“It is for some people less unsafe, in a very specific treatment model, with alcohol than continuing untreated alcohol dependence is” would be more accurate.

> When I googled Naltrexone, it warns: “Alcohol: Avoid. Very serious interactions can occur”.

The whole point of using Naltrexone to treat alcohol abuse is to use the adverse reactions to foster aversion to counteract the desire to drink.

Wouldn't you consider beating an addiction to actually being able to take one or two drinks and leaving it at there?

In other words, if you're constantly counting the days without a drink and struggle with yourself to not drink, are you really "cured" from the addiction?

Truly curing it would mean that. But you've still beaten the addiction if you can stay away, and beating the addiction is by far the important part for your health.

Every person i've ever met that's quit an addiction has never thought of themselves as cured. They may not partake in they're substance of choice any more but they've all still called themselves addicts and think about their substances still.

As far as the counting the days thing I think I agree with you on that. A couple years ago a friend of mine was struggling to quit their drug addiction. For almost a year they would count the days or weeks between the times they 'fucked up' as my friend called it. In the end after some pretty bad things happening and a few times almost losing their life. My friend got serious about it and they've been over a year now clean. The thing is this time my friend hasn't been counting the days or thinking about how long it's been. They've just been getting on trying to rebuild their life and avoiding the people and things that used to be part their addiction and I think it's made a big difference.

The term “lifestyle change” has been abused and overused, but what you’ve described is a true perfect example of the difference between something like a diet, and true lifestyle change. An alcoholic who sits in his old local drinking soda water and counting the days he’s been clean hasn’t changed the factors that led him to drink, his habits, and everything other than just not drinking. Your friend decided, not just that he should stop drinking, but that he wants to, and wants to change his life accordingly.

The problem with addition is that there’s often an “upper level” cognitive process that wants to stop, doesn’t enjoy the fallout of addition, but that exists with the “lower level” processes of enjoying the drugs and disliking withdrawal, boredom, finding new friends and ways of living. You can only really change and stay changed when you unite both of those urges and work hard to change beyond just quitting x. AA does that in a way that seems to work for some, as religion has always been capable of restricting people’s lives. Of course people who don’t believe in that framework don’t actually need it, but they do need something comprehensively geared to changing their overall lifestyle.

I think the idea of a group setting for support is smart, the idea that the group has to be fanatically religion is not.

It's not a struggle to not drink (other than potential social impacts).

The problem is that once you start you have a set of well-worn reward pathways in your brain that want more of it.

A true cure would need to look at neuroplastic, genetic, and environmental factors that lead to an addiction response. But what's the point when you can just not drink, which is unhealthy anyway.

>Wouldn't you consider beating an addiction to actually being able to take one or two drinks and leaving it at there?

Sure.

>In other words, if you're constantly counting the days without a drink and struggle with yourself to not drink, are you really "cured" from the addiction?

This is an entirely different statement from your first point and a mischaracterization of recovery.

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