Comment by tippecanoe | Hacker News Reader

Comment by tippecanoe | Hacker News Reader

For those who have a problem with alcohol from being a bit of a drunk to an addict, there's a pill for that: Naltrexone, taken one hour before drinking, blocks positive reinforcement for drinking alcohol. This treatment is called the "Sinclair method."

Studies show Naltrexone and the Sinclair method prevents excessive consumption and over time can extinguish addiction. Over the course of a year alcoholics can basically totally lose interest in alcohol.

It's not a fringe treatment. It has been the standard of care in Finland for decades.

Here is a global listing of physicians familiar with the treatment: https://cthreefoundation.org/find-a-physician

These board certified physicians prescribe it in many states in the US via telemedicine consultations: https://www.mdproactive.com/what-we-treat/alcohol-use-disord...

(I'm suggesting this online practice because I understand it may be hard to find a physician familiar with this treatment in some areas in the United States.)

I went from being a bit of a drunk even by American standards to having no interest in alcohol after a couple pills.

The first time I took it, I knew it could have saved by grandfather's life.

It's really heartbreaking that so few people know about this treatment.

Anyone who likes alcohol would be amazed how useless it is without the opioid response (that Naltrexone blocks).

You can find papers about this on Google scholar: https://scholar.google.com/scholar?hl=en&as_sdt=0%2C14&q=sin...

https://en.wikipedia.org/wiki/Naltrexone https://www.youtube.com/watch?v=53JObexh0w0 https://www.amazon.com/Cure-Alcoholism-Medically-Eliminate-A... https://www.youtube.com/channel/UCdeh0LP6kuSQ9GsorQpVnUw

What an incredibly dangerous suggestion that people seek out a prescription for this kind of drug online at mdproactive or anywhere else.

You also did not mention that a number of studies have shown this drug to be only modestly effective at treating alcohol abuse, and that there are better treatments. It can also cause liver damage. It's not a magic pill.

Maybe those physicians, who are licensed to practice medicine in the United States, know better than you do.

You are contending, without evidence, that these physicians are dangerous. That is a serious claim.

If you are concerned that these physicians are endangering the public, you should take it up with their respective state medical boards straightaway.

> Maybe those physicians, who are licensed to practice medicine in the United States, know better than you do.

There is nowhere near a consensus among professional physicians that this drug is as good as you claim it to be. Meanwhile I can find plenty of physicians like Dr. Oz who are snake oil salesmen, so I reject your fallacious appeal to authority.

EDIT: I see that you have now edited your comment to say "(An appeal to authority is the purpose of medical licensing.)". You should not edit your comments in an attempt to make people who responded to you look bad, or look like they missed something that was actually not there.

Now you keep adding even more! If you want to respond, then respond. I quoted the entire text of your original comment at the top of mine.

The Sinclair method faces a lot of institutional incentive-related difficulties (generic drug, permanent treatment). It also has some aspects that are counterintuitive at first glance (e.g. it requires drinking alcohol, which creates skepticism when proposed by an alcoholic) but which are scientifically grounded. To anyone facing the problem of alcoholism: please do take the time to research it, read the studies, and form your own opinion. It’s really worth the time, and it’s not something you’re likely to hear about through traditional sources (yet) for the aforementioned reasons.

Considering my experience with Varenicline and how it effectively worked in abandoning nicotine, I tend to agree that a deconditioning drug taken while consuming is a very effective therapeutic path.

Yes there are many unethical physicians, but majority of physicians still are hard-workers and know way better than you.

> Yes there are many unethical physicians, but majority of physicians still are hard-workers and know way better than you.

The majority of physicians do not prescribe this drug, and even the ones who do prescribe it do not recommend that patients try to obtain it online and self-medicate.

You twisted my meaning into an attack on physicians, which it certainly was not. It was a rejection of a fallacious appeal to authority.

The fact that some physicians recommend something is simply not convincing. It's not hard to find a small number of physicians who would recommend homeopathy either, nor is it hard to find a small number of scientists who reject climate science. A consensus among physicians (or scientists) is what makes an appeal to authority reasonable.

Show your sources. The studies that indicate it’s not effective are in comparison to a placebo when alcohol is NOT consumed with the drug. The Sinclair method is very specific about taking the drug with alcohol (and measuring its reduced usage over time).

To my knowledge liver damage has only been documented at doses far beyond what the Sinclair method directs.

Edit: source as requested below: https://academic.oup.com/alcalc/article/36/1/2/137995

Show your sources too, please

Added to the original comment, thanks.

source? it's common sense that drugs can interact with others. always see a doctor before taking anything. again, it's not specific for this case, it's plain common sense. even aspirin is dangerous if you're diabetic, for example.

It's interesting that you use the words "dangerous" and "this kind of drug" for a drug that is the antithesis of the opioid epidemic.

If you're worried about liver damage please look into Acetaminophen.

Naltrexone is generally safe for most, but in severe cases of cirrhosis it's not recommended. There are alternatives, but someone with that level of alcoholism usually needs to be clinically monitored.

I feel like you're missing something if you object to a treatment for alcoholism on the grounds that the treatment might cause liver damage. Alcoholism definitely will cause liver damage.

Yes definitely go to your doctor or see a psychiatrist before ordering medication online. There are alternatives like Baclofen or Gabapentin, moreover there could be other underlying issues that need to be treated. Self medication is not a solution.

This isn't self-medication - it's talking to a licensed professional and asking for a prescription for the actual condition you have. (Of course it's abusable but it's not the same thing as buying controlled substances on the dark web or even lying about symptoms to get a prescription.)

It can also cause liver damage

As opposed to the liver-sparing lifetime of alcoholism?

Principle of least harm comes into play, here.

Came to the comments to look for this post. I completed TSM myself not so long ago. It has been nothing short of life changing. Seemed too good to be true, but really doesn't seem like there's a catch.

There's a subreddit here too which is becoming more and more active. https://reddit.com/r/alcoholism_medication

I agree that Naltrexone can help curb alcohol use in the case of heavy/problem drinkers, but alcoholism/addiction is entirely different than "developing a taste".

For anyone who is struggling with addiction, or thinks they may have a problem - please treat this like any other disease and consult a medical professional.

I'd also suggest, if possible, speaking with another addict in recovery to learn about what they have found successful. There are 12 step support groups (AA and NA being the two most well known) worldwide.

There are many available treatments and it's really difficult to know what will be best for any one person (and what works for an individual at any given point in time may change).

(Also, if you have been actively using alcohol or benzodiazepines, please consider talking to medical professional before abruptly stopping - there are serious risks during withdrawal and it can be deadly).

If anyone need help finding more information, don't hesitate to message me.

Absolutely appalling to see this comment being downvoted. Thank you for taking the time to write it.

> appalling to see this comment being downvoted

I didn’t downvote. But AA has a mixed track record with respect to effectiveness [1]. It’s also been likened to a cult [2]. This might explain some downvoted.

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2746426/

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

> https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2746426/

That article shows that people who regularly go to AA meetings are more likely to be sober (e.g. 67% people who went to one or more meeting a week were sober 16 years later).

Because of the universal nature of AA, it is hard to randomize for it (if you just randomly tell an alcoholic to go to AA, they have already been told that by others, so that's not a very good randomization; the control is contaminated); that said, there are studies where people randomly selected to go to AA are more likely to be sober. A 2014 meta study shows that greater AA attendance results in greater sobriety, which can not be attributed to self-selection (in other words, we have finally scientifically demonstrated that the people doing well are being helped by AA):

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4285560/

Now, that Gabrielle Glaser article you link to which claims AA is a cult uses some very dubious figures for AA's success. They come from Lance Dodes; since Dodes could not find any studies that AA has a 5% success rate, he instead multiplied multiple numbers from unrelated studies to synthesize the 5% figure. His numbers have been questioned by a number of treatment experts, including Thomas Beresford, John Kelly, Gene Beresin, and Jeffrey D. Roth (who called Dodes's figures a "pseudostatistical polemic").

AA works fundamentally by substituting an addiction to Alcohol to one for AA - This to me has always seemed like a workable (if in the short term) way to solve the problem.

Here is a peer-reviewed paper which describes how meetings are beneficial, not addictive:

https://www.tandfonline.com/doi/abs/10.1080/108107397127806

(Note that this is a paywall link. Here is a quote to give readers here a gist of that article: "acceptance of the tenets of AA may be associated with positive behavioral change"; the paper describes how working the AA program results in people having a more positive world view)

12-step meetings are not a short-term fix; I have already linked to a paper which shows that two out of three people who regularly go to AA meetings in their first year of alcohol treatment are still sober 16 years later. Here's the original paper with those figures:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2220012/

While I have personally found AA to e very useful, it may not be the right solution for everyone (personally, it took me a long time until it helped).

I'd also like to add, each group is different and yes, some can be cult-like. I'd suggest trying more than one.

I'm really not trying to promote AA, just mentioning that it's one of many options (in addition to medically assistant therapy, individual and group counseling etc).

Anybody who claims to know what will work for any one person is full of it. But to anyone struggling, please keep trying different methods until you find the treatment that works for you.

The main reason that AA/NA helped me was that it brought me around sober/clean people that I could hang out with and make friends with. The step work is BS in my opinion. But the sober friends kept me alive.

That may be true. A 2018 paper shows that other non-12-step fellowships are as effective as AA (as long as the goal is abstinence from alcohol, not moderation). Since the paper is still under paywall until later this year, here's a good lay summary:

https://www.vox.com/science-and-health/2018/3/5/17071690/alc...

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