I've read the book by Eskapa, reviewed a bunch of the articles by Sinclair and others cited in the book and found elsewhere and listened to radio interviews by Eskapa and Sinclair.

I have also started TSM and find that NAL before drinking limits the "buzz" from alcohol consumption and makes it much easier to limit intake of alcohol once consumption has started -- of that there can be no mistake.

However, the claim made in Eskapa's book (and elsewhere by Sinclair) is more than the above. The claim is that there is of a 'cure' for alcoholism via pharmacological extinction, a process that, to quote from Eskapa's book, "cut[s] the addictive mechanism out of the nervous system." (p. 87) In other words, drinking on NAL not only limits the buzz and the amount the alcoholic drinks, it actually 'cures' the drinker of his or her addiction.

This is a radical claim and the process is not merely psychological but the results are seen, it is claimed, at a microscopic physical level in the nerve cells in the brain. "Pharmacological extinction" is a process that changes the alcoholic's actual brain by weakening certain connections or synapses in the nerve cells. To quote Eskapa:

"Synapses become weaker and can even be burned out completely, becoming 'silent synapes.' Eventually, the upper nerve cell again will have to fire one hundred or more times to make the lower nerve cell fire and produce drinking. Thus the cause of alcoholism is removed, and controlled drinking becomes possible again" [emphasis added]. (p. 264) See Appendix B. in Eskapa's book for a detailed explanation of the alledged physical changes due to pharacological extinction.

So, my question is this: what evidence is there that pharmacological extinction can cause this type of physical cure? Reduction in drinking is possible via NAL without this radical claim of extinction -- i.e., because it is known that NAL blocks the edorphins from binding to the opiod receptors, thus making drinking less rewarding.

I created this thread because I am looking into this question and doing some research on it and would appreciate any feedback even from Dr. Eskapa. I may even email him or Dr. Sinclair. However, if anyone has any comments or can point me towards any evidence of a physical cure, I'd appreciate it.

Merlot

Further to the above post, I want to create a thread where I can post what I learn about this method via academic articles, etc., and not just based on my individual experience. If others find it interesting or useful or want to add something or comment, that's great. In fact, I'd appreciate it.

To restate what I was getting at in my first post above, I believe there are at least two possibilities re. NAL and drinking:

1) NAL may simply block the high or buzz many drinkers get from alcohol which in itself may have positive results. By taking NAL and drinking the heavy drinker is able to cut back on his (her) drinking, detox slowly and gain more control over his drinking habit. This in itself is a good result. As long as the problem drinker takes NAL while drinking, he'll probably get a lot less pleasure from it and drink a lot less.; OR

2) NAL and drinking may do something much more fundamental over time -- i.e., what Eskapa claimed in his book: gradually reset the problem drinker's alcoholic wiring in the brain to the point that they are no longer an alcoholic or problem drinker. After the reset, the problem drinker is essential at the stage before he developed his alcohol problems -- i.e., probably genetically predisposed to alcoholism, but not an alcoholic or alcohol dependent.

From reading Eskapa's book and cited articles, I did not really find any evidence of 2). To put it another way, couldn't 1) above be sufficient to explain the results of any positive clinical studies/trials? So long as the problem drinker takes NAL before drinking, they will drink less?

I want to find out what evidence there is, if any, of the more radical claim in 2) -- i.e., the so-called extinction cure.

Merlot

"Pharmacological extinction" appears to have been coined by David Sinclair - so you won't find much evidence for it outside of his work on mice. His work on mice is very convincing (with the usual caveat that people are not mice, and in particular not mice bred to be alcoholics).

Fundamentally, there is no need for any evidence because the underlying concept is very basic, universally accepted and can be traced back to the early works on Pavlovian conditioning. It is well established that consistent blocking of the association between cue and stimulus will slowly lead to the unlearning of conditional response. As long as we remain materialist and believe that changes in behavior are reflected in changes in the brain - which means cells and communication between cells become different.

So from the basic theory, TSM "ought" to work - assuming, of course, that opioid receptors are the only things involved. Since there is no doubt that opioid receptors are not the only things involved in addictive behavior, the question on whether TSM and it's underlying idea visualized as "pharmacological extinction" work becomes purely empirical one. (Also, naltrexone is antagonist of all types of opioid receptors while each of them has its own function; so the interplay becomes very complex; then again, similar types of complexity apply to virtually any drug). And no, there is not a whole lot of evidence for it. At least not the kind of evidence that is commonly accepted by medical establishment as evidence. Which isn't saying a lot because most of the evidence accepted by medical establishment is wrong anyway.

Thanks for your response Nutella and your points are well taken. I hope to add more to this thread when I have some time.

Merlot