This is an interesting read...
Author: SpringerRider [ 09 Jun 2009, 21:07 ]

Post subject: Moving beyond the flat spots


Dr. Eskapa,
I started the Sinclair Method with your book as a recipe on Jan 16. I have proclaimed myself cured of the addiciton of alcohol. I place no effort at not drinking but drink very rarely. I was invited to a friends birthday party and did drink 8 beers over a 3.5 hour period. In pre-Sinclair days, this would have been my "warming up" amount. That was last Saturaday night and I had probably not drank for two weeks prior nor have I drank since.

Several participants have written and told me that they felt that had reached a plateau that was gratisfying but not to a level they felt they should be for the time they have been in the program. Some had asked if I "tried" to limit my drinknig at any time or did I just "let it flow" and simply take my Naltrexone before drinking. I guess my answer was Yes and No for at times I simply surrendered to the mildest of urges but other times, the demands of life forced me to defer any drinking until conditions permit.

I have my own theory about the curative effect of the addiction process. Any female can relate to my misogynistic analogy. Every woman knows that the act of denying gratification to a man only heightens his desire. As a male, we called those ladies "teases". Teasing is actually a way to enhance sexual desire.

Now imagine that a lady has been teasing a male but never delivering the goods. After a degree of frustration the gentleman will give up and no longer respond to the teasing. Without the gratification, the teasing will eventually becomes dissociated with the reward of sexual gratification.

But what happens if there is no teasing or enticement? What if the sexual gratification is made available without any delaying or denial? What if the prize is surrendered without demand? The desire weakens but only because it is being easily satisfied. This is often referred to as “marriage”. But my goal is not to preserve desire but to neutralize its relationship to drinking alcohol.

So if I deny myself the drink after the point where I feel a desire and prolong the denial for some period of time, my desire will only become more pronounced (more endorphins released). Now before I succumb, I take my Naltrexone, wait the prescribed hour and drink. I am now consuming alcohol but the opioid receptors are blocked. Somewhere deep inside my psychy, the relationship between the craving and its satisfaction is dissolving. I believe the greater the desire is frustrated, the more learning that takes place.

I assume the above process has accounted for some of my “leaps” in progress.

The question after this lengthy post is how much effort should a participant expend to defer drinking?

I see several who are reporting the same consumption rates week after week and those rates are way above the accepted. I.e. 80 to 100 units.

I have recommended that participants consciously defer drinking, not to the point for gut-wretching craving, but to stretch the envelop a little more each week. If I normally start drinking at 4 PM, start pushing it back to 5 PM. Then maybe start skipping a day.

I believe this has contributed to my curative process significantly. What say you doc?

_________________
50 mg /5 Months
Average AF days 3/wk
Average Drinking < 3 drinks/day

experiencing alcohol free weeks


Drinking to my Health

Author: DrRoyEskapa [ 17 Jun 2009, 08:22 ]
Post subject: Re: Moving beyond the flat spots
From David Sinclair - reply to this question. His response was quick and I appreciate it. I should state that almost everything I have learned about addiction science has been since I met Sinclair in 1990. The rest came from reading and working with people facing addiction issues. Here is an explanation for SpringerRider hot off the press from Helsinki, Finland:

What you describe is actually one of the basic processes in the nervous system. Learning is caused primarily by the synapses between nerve cells becoming stronger (reinforced), and thus making it more likely that you will make a response or think a thought or feel a craving again.

We know, however, that the opposite process - the weakening and eventually complete burning out of synapses - is at least as important. (Extintion) For example, most of the changes in the nervous system that occur in the first few months after birth are the removal of synapses. It is sort of like sculpting: removing all the other synapses (and thus breaking all the other neural pathways) until just the one correct one is left.


You may call this "deep in your psyche" but causing it is a real physical event.

The dissolving of the relationship to craving is the burning out of the synapses that previously had made you think about alcohol. It is not the relationship between craving and its satisfaction that is being removed, however. That relationship, or rather that between craving and reinforcement, is blocked as soon as you take the first naltrexone pill, and it is blocked so long as you have naltrexone in your brain, but it is completely unconscious. It just is a fact that if you happen to have endorphins released, they will not be able to cause any reinforcement (strengthening of synapses), but you cannot feel this. At most you will notice the lack of something when you do have endorphins released, after drinking alcohol, or by eating sweets, jogging, etc.

The really important factor is what happens after alcohol drinking causes endorphins to be released and then the expected activation of opioid receptors from binding their endorphins does not happen. At that part, the nervous system starts the mechanism of extinction. The synapses that had just been used, e.g., ones triggered by the sight of a drinking friend, or the smell and taste of your favorite drink, or by the mood when you drank, become weaker. These synapses are now less capable of making other neurons fire. Some of these neurons that are less likely to fire now are the once involved in thinking about drinking and in craving. Others that are less likely to fire are ones causing the drinking behavior itself.


There was a new report last week at the ESBRA meeting here in Helsinki. You may have heard of the MRI machines that can show when parts of the brain are active. The new report, from Germany, showed how alcohol-related cues (e.g., pictures of beer bottles) were able to stimulate strong firing in various parts of the brain in people who had become alcoholics because of reinforcement of synapses by endorphins. And these were the people who responded very well to naltrexone.


I found your description of how the craving grows with alcohol deprivation very interesting. This phenomenon, which I named "the alcohol-deprivation effect" is what got me started doing alcohol research over 40 years ago. It is a very powerful thing. It also is contrary to the ideas people had back then about what causes the motivation for alcohol. In particular, it was generally accepted that the motivations was logically caused by withdrawal from physiological dependence on alcohol: that people were drinking just to avoid withdrawal.

Consequently, the treatment they gave was detoxification and forced abstinence, long enough for the physiological dependence to be gone. Indeed, a misleading euphemism for alcoholism still used today is alcohol dependence. If they were right, detox would have been the cure for alcoholism. Of course, it was not. We found that the alcohol-deprivation effect does not disappear as physiological dependence is removed. Instead, the increased craving produced by the alcohol-deprivation effect grows stronger and stronger, week after week, and never went down in several months of deprivation.

Now to your question of whether you should intentionally deprive yourself of alcohol. The way you are doing it sounds good. It is a good idea to extinguish all of the various forms of drinking you had learned to do. You should drink alcohol (with naltrexone) in the same locations where you previously learned to drink, with the same people, and with the same moods.

One situation in which you previously had learned to drink was probably after a period of alcohol deprivation. Consequently, the synapses connecting the deprivation-induced feelings of craving to the act of drinking have become reinforced; and they now need to be weakened by extinction.


Naturally, there are certain cases in which you must try to limit your drinking: you must be particularly careful not to be drinking if you are going to drive, etc. The naltrexone may even make some aspects of intoxication worse.
There is another reason for have pauses in your drinking as soon as you can manage to do so: in order to strengthen healthy alternative behaviors.

It is a good idea make a list of things other than drinking that you enjoy doing and then noticing which ones are probably reinforced by endorphins. They include eating sweets, spicy, salty and other good tasting foods; jogging, sports, and other forms of strong exercise; cuddling with babies and pets; some forms of sexual activity. These behaviors will also be weakened if you do them while you are on naltrexone - but we do not generally want to have them reduced. Therefore, first, you should avoid as much as possible doing those other behaviors while you are on naltrexone and drinking. Second, when you are able, have a weekend without alcohol and without naltrexone. Saturday is a washout day in which the naltrexone is removed from the body. On Sunday afternoon you should reward yourself by doing one or more of these other opioidergic behaviors.

We have discovered a really nice thing about this. When you do the other opioidergic behavior, you will get enhanced reinforcement of it. Patients report that the first bit of chocolate, on that Sunday afternoon, is the best they have ever tasted.
The main reason for this is that while naltrexone was blocking your opioid receptors, your brain tried to compensating by making more of them. This is called "up-regulation". We have actually measured the increase; it was almost a doubling of the usual number of opioid receptors.

So long as there is a surplus of naltrexone in the brain, the increase in opioid receptors has no effect since they are all blocked. But when the naltrexone has been washed out, this huge crop of opioid receptors is standing, begging to be filled by endorphins from that chocolate, or from jogging, or from any of the other behaviors.

The increase only lasts a few days, but during this window of opportunity you have supersensitivity to endorphins and an enhanced ablility to develop other behaviors to fill the vacuum as alcohol drinking becomes less important in your life.
This also leads to the long-term solution for the drinking problem. In our three year follow study, we found that the patients drank progressively less often over the months and years. In other words, the deprivation periods became longer and longer. Some quit completely. Many others were down to drinking at most once a week - it was sauna night in Finland and they wanted to have a sauna beer, like everyone else around them. The rest of the time they were just carrying the pill with them, in case a drinking occasion arose. It costs nothing to carry it. And there is no risk of weakening any of the healthy opioidergic behaviors.

Just remember to always take the naltrexone before drinking, because this enhanced reinforcement has another part to it. If, during the time of supersensitivity you drink alcohol without taking naltrexone, there will be enhanced reinforcement of alcohol drinking. Done repeatedly, you would soon relearn all of the craving and drinking behaviors that had been extinguished.

David

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Jaba, thanks for sharing this.