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Comment by aenis | Hacker News Reader

For those struggling with alcohol - I can recommend the Sinclair Method. The idea is to take an opioid antagonist, naltrexone, before drinking -- this helps reset the association between drinking and pleasure, since drinking on naltrexone is devoid of any pleasure, while the downsides of alcohol are still felt by the body. Do it a few times, and the desire to drink wanes. Also, when under the influence of naltrexone, it's hard to drink a lot, since it really is not enjoyable. It allowed me to basically stop drinking alcohol, but I can still go out with friends and have a drink if I want to, as long as I take naltexone before, there is zero risk of this ending up in a binge. Good stuff.

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Highly recommend The Sinclair Method. I chose to try it because I wanted to be able to continue to drink socially as the OP mentioned. I actually overshot this and find myself completely abstinent for over a year now. It actually made me "too sober" which can be slightly frustrating but it a REALLY good problem to have considering where I was a few years ago.

Some more resources:

https://www.reddit.com/r/Alcoholism_Medication/ - a great community and how I first discovered The Sinclair Method

https://www.onelittlepillmovie.com/ - documentary on The Sinclair Method

https://youtu.be/6EghiY_s2ts - TED talk on The Sinclair Method

https://www.dropbox.com/s/60fs7gmvbyzs1kk/Cure%20for%20Alcoh... (warning: large PDF) - book about The Sinclair Method, definitely the best way to learn more, it is surprisingly simple and the first few chapters cover everything but you may find yourself reading on because there's some interesting case studies and tips on how to succeed

Does the Sinclair method have a track record for people who don't drink primarily for pleasure? I find that I already don't typically get a lot of actual pleasure out of drinking; it's mostly a way to help me relax because my baseline anxiety level tends to be pretty high. I don't have the classic "alcoholic" pattern of behavior, but I've done the math and the number definitely needs to go down.

(Please spare me the "ackchyually alcohol makes anxiety worse" spiel. Whatever my problem is, it was there long before I started drinking and has not improved during periods of abstinence.)

Likely. Your body won't get the euphoric rush from alcohol, so I thinik it will prevent it from functioning as anxiety medication. Its works on low hardware level, so to speak, and should nullify any positive effects from alcohol on the psyche.

from a friend: They have a shot version too. The pill will work if you don't cheat. But taking the shot takes out all the guessing. I would do this your first few months.

I would modify this recommendation to say that the shot version (Vivitrol in the US) is not necessarily compatible with The Sinclair Method which requires you to take Naltrexone only when you are drinking. So unless you drink every day, it might not be the best fit. I myself was a binge drinker, on any given day I drank either 0 drinks or 10+, so the Naltrexone pills were the best fit for me.

According to the sinclair method, the shot is only good if you do drink every day.

Otherwise, the pill is better. Take it if you plan to drink, and dont take it otherwise.

As another poster has said, its easy to "overshoot". For me, after three pills I stopped craving for alcohol and only drink on social ocassions.

Is there something similar to this for smoking, barring Chantix (I believe it was recalled last year for having carcinogenic compounds itself)?

FWIW, it seems like you need a prescription to buy naltrexone in the US.

I used telemedicine to get my first prescription. I had a few appointments and probably talked to the total for about 30 minutes in total. The Sinclair Method is pretty straightforward once you understand it and there is only one hard rule (always take Naltrexone at least 1 hour before consuming alcohol). But the doctor will want to do a liver enzyme test and ask some basic questions to make sure that it is safe for you to take Naltrexone. If your liver is damaged, you may have to take Nalmefrene instead. Or if you are using opiates, it can be unsafe to take Naltrexone (not sure of the details here).

At some point I was able to get my PCP to refill my Naltrexone subscription. Naltrexone is pretty widely known for treatment for alcoholism but the prevailing wisdom in the medical community is that it must be taken every day to prevent cravings and alcohol should not be consumed when on Naltrexone. I've heard that this way of using Naltrexone isn't any better than placebo. The TSM book[1] does a good job of explaining why this is the case: the mechanism of action is that the Naltrexone blocks the endorphin rewards from consuming alcohol, so it doesn't work if you don't drink and there is no point in taking Naltrexone without drinking.

tldr: you may be able to find a TSM specific doctor via telemedicine. Additionally, most PCP will probably prescribe Naltrexone, although you need to be mindful that they may recommend to take it every day and this is not TSM

[1] https://www.dropbox.com/s/60fs7gmvbyzs1kk/Cure%20for%20Alcoh...

I wonder if this works for gaming addiction.

There has been research into using it to fight gambling and binge eating addictions (with some moderate success in both cases). I'd guess it will work better for addictions which are associated with the state of euphoria, and less so or not at all with compulsive behavior where one feels miserable the whole time.

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