Dr Eskapa,

I was wondering if any correlation had been established between the time it takes for the Sinclair Method to 'kick in' and the following factors:

[1] A person's weekly alcohol intake
[2] The duration (years) over which a person has been consuming alcohol

I ask this question because, from a layman's point-of-view, it seems to me that a person (e.g. myself) that has been consuming excessive amounts of alcohol over a period of several years will take longer to see the benefits of the Sinclair Method than someone who has been consuming less alcohol over a shorter period of time. You can see from my figures below that I am new to the Sinclair Method, having completed just four weeks on it. At the moment, there is no sign of my alcohol intake reducing but it's early days and I can live with that. I did not experience any honeymoon period.

Any feedback would be greatly appreciated.

Thank you.

V.

I asked Dr Sinclair about this. Here is his reply:

As to the pattern of drinking over time, this is somewhat variable. The extinction curve is the average shown in the book, and the most likely pattern. But some individuals may have their drinking go up at one time or another. If you compare the individual results with naltrexone with practically any other behavioral measure, the surprising thing is how little variability there is with naltrexone. But it is true that people differ. And there are those rare individuals who do not benefit from naltrexone. It was only a 78% success rate, not 100%.
Concerning the side effects, again it is true that there are individual variations, but on the average naltrexone is extremely well tolerated with very few side effects. The only proper way to measure side effects is in comparison with a placebo group - where neither the naltrexone nor the placebo patients know which medicine they are getting. The results with this type of analysis from our Finnish clinical trial (Heinälä et al., 2001) were surprisingly good.
In our two groups that got either naltrexone or placebo along with instructions to abstain, we did find significantly more side effects from naltrexone than from placebo, mostly nausea and intestinal problems, and most during the first week of treatment. Among the patients treated with the Sinclair Method, there was no significant difference between the naltrexone and placebo groups. There was no peak in the first week, and there was no time during the entire trial when the naltrexone groups showed significantly more side effects than the placebo group, or significantly more of any particular side effect.
It probably is impossible to show graphs at the forum. Pity the one here is beautiful. Plotting the mean number of side effects shown by each of the 4 groups during the week before treatment and for each week of the treatment, you see this one big peak of increased side effects, during the first week on naltrexone for the support of abstinence group. (Meaning take naltrexone and do not drink.) The naltrexone group with drinking show no peak at any time.
We speculated that the peak in the naltrexone/abstinence group was probably a mild opioid withdrawal: they had been getting endorphins from their alcohol everyday, but during the first week of treatment, the naltrexone was blocking the endorphins from binding to their receptors and causing a mild withdrawal. The specific symptoms were also similar to what might be expected from a mild opiate withdrawal.
So did the naltrexone+drinking group not show similar withdrawal symptoms? We figured this way. The usual treatment for opiate withdrawal is barbiturates or benzodiazepines. Alcohol is a dirty medicine affecting many systems, including the GABA system where barbiturates and benzodiazepines work. So the group drinking alcohol while on naltrexone are getting drug effects similar to barbiturates or benziodiazepines, which help to suppress problems from the opioid withdrawal. (Of course, a person drinking alcohol is always getting these drug effects.)

On the other hand, that was not a huge trial: only 121 patients. We have seen patients in the clinics who were showing side effects and needed attention. Since there were no placebo controls at the clinics, we cannot say for sure that naltrexone was causing the side effects. It is better, however, to be safe, so if there are side effects, see a physician.

David

Dr Eskapa,

I greatly appreciate your reply. Dr Sinclair's comments about the side-effects are very interesting but the main reason for asking my original question was to gain a better understanding of how long it takes for the benefits of the Sinclair Method to become apparent - particularly in relation to an individual's history of drinking.

Perhaps the data I am requesting simply is not available. I see from Figure 3 in The Cure for Alcoholism that a 50% reduction in alcohol intake occurred, on average, after 100 days in treatment. The same graph shows a 30% reduction in alcohol intake after 50 days. So, I need to be patient.

Thanks once again.

V.

Virgil -

I am 37 years old and have been drinking pretty heavily since I was 24 - so 13 years. TSM started showing the first hints of progress at 12-14 weeks, but those were just "feelings". It was fully 4 months before I was comfortable declaring it a success - that meaning my drinking was down to safe (if still personally too high) levels.

RV

RV,

Many thanks for the feedback. It is apparent from some members' weekly progress that their alcohol intake took several weeks/months before a reduction was evident. However, Figure 3 in The Cure for Alcoholism shows an immediate and steady reduction in alcohol intake right from the outset. I'm not sure how to reconcile these two observations. Furthermore, my original question to Dr Eskapa was prompted by my enquiring mind wishing to explore the relationship (if any) between an individual's drinking history and the time that it takes to see the benefits of following the Sinclair Method.

All the best,

V.

RV. That question is exactly the one I would like answered. How a individual"s drinking history affects progress of the Sinclair method. If it gets answered here I can remove it from my questions for Dr Eskapa.

Me too - appreciated the input on side effects, but still would like to hear any feedback from Dr. Escapa on Virgil's 2 original questions on weekly alcohol intake w/ our history of it and if that might affect when TSM "kicks in".

I am almost at the 3 month mark and feel no changes. Never had the honeymoon, etc. I had renewed hope rereading the book & the recurrent claim that it takes "3-4 months MINIMUM"...still here I am coming up on it, and I am a wee bit nervous I am in the 20ish%. Any input from Dr. E on this would again, be appreciated.

Hi All

Im interested in this also as I am on week 15 and no real change - although I think less badly of myself. I also re-read the book to keep up my motivation. I just downloaded the Heinala paper (I have academic access to it) and think the following is important. It was a 32 week trial where they considered the first 12 weeks to be an induction period and the final 20 weeks were seen as the test period - with targeted medication taken only when craving was high. This is very encouraging to me. I believe I really need to start assessing my cravings properly. To date I have wanted to achieve success as quickly as possible and therefore have been drinking on more days than previously out of a sense of 'duty' to my treatment. perhaps now at week 15 it is time I began to 'wait' until my cravings are strongest, then take the naltrexone and drink an hour later. In other words - maybe I should put up a little bit of a challenge to myself and ask myself on a daily basis "Do I really want a drink or am I drinking out of duty?"

Cheers

Camelia

Hi again,

I just picked this response from Dr Escappa up from another thread

" Craving and drinking levels take weeks - 12 to 16 on average - to notice the benefits with the Sinclair Method. Some people take 24 weeks - 6 months".

It was on the thread about the black patch in eye.

Cheers again

Camelia

Thanks, Camelia. Both of these posts are encouraging. So far my drinking patterns are very erratic. So far this week I have a couple of days where I'm down to about half of my pre-Sinclair levels, then two days where I drank 9 units - or nearly as much as before.

My BF is doing GREAT. He had one heavy drinking day, but even then didn't drink as much as before. Yesterday he took his Naltrexone and didn't really even want to drink, though we were in a social setting. Ended up with only two beers.

I think your decision to more closely monitor cravings is a great one. Gonna try it myself today, rather than looking at the clock and thinking, "Well, it's about time for my naltrexone. . ." I'd love to get another AF day or two!