Well said, Sabrina. I think I agree with you but it will depend somewhat on what happens with me and the method in the future. And I should emphasize that my previous statement -- that TSM works without therapy -- is not necessarily my personal view point. Right now I'm not in therapy and am following the book, which describes an "effortless" cure that does not require rehabilitation or therapy. The fact that Eskapa says the method should be "effortless" and the fact he repeats over and over again that there is only one very simple rule (take the naltrexone one hour before drinking) make me highly confident that according to the book anyway, therapy is not necessary for TSM to work. Frankly, I think you guys are parsing words and are looking very carefully for the answer that you believe to be correct, namely, that TSM only works with therapy, in arriving at a different conclusion. But that is clearly not what Dr. Eskapa says in his book. As I said, his simple, "effortless" formula is naltrexone + drinking = cure. And therapy requires effort -- a great deal of it -- so I do not believe it is a required element to succeed using TSM as Eskapa views it. That being said, the book is far off the mark on several key issues and it's quite possible that this may be another one. I may very well take the cognitive behavioral approach if I continue to pound ten drinks in a night for that much longer.

Hi AJ_,

Many thanks for your post. From my point-of-view, you have hit the nail on the head.

All the best.

V.

"To suggest that no-one on TSM should get counselling would be to draw conclusions from COMBINE that can't be supported by the study."

First, I never suggested no one should get counseling. In fact, I said, everyone I know, including non-alcoholics, would benefit from counseling.

Second, I am not familiar with the Combine Study, apart from its general conclusion. The Combine Study was NOT a TSM study and is not the basis of my argument. Moreover, the Combine Study was not a Dr. Eskapa or Dr. Sinclair study. We are following TSM as outlined by Dr. Eskapa in his book, as well as Dr. Sinclair.

The original question was this: DOES ONE NEED THERAPY TO SUCCEED WITH TSM? The answer to this question does not come from the COMBINE study, which was a non-TSM study. The answer comes from Dr. Eskapa in The Cure for Alcoholism and Dr. Sinclair and his various clips. And they repeat over and over again, TSM requires one simple rule, take the pill one hour before you drink: NO EFFORT IS REQUIRED, i.e,, no rehab, no therapy. THERAPY REQUIRES EFFORT. AJ, re-read the book. If you conclude that therapy is necessary after re-reading the book in order for TSM to work, then you are wildly off the mark. Page 3 pretty much captures it: "THE BOOK'S TITLE, THE CURE FOR ALCOHOLISM: DRINK YOUR WAY SOBER WITHOUT WILLPOWER, ABSTINENCE, OR DISCOMFORT, MEANS WHAT IT SAYS. ADDICTION TO ALCOHOL CAN NOW BE CURED -- NOT THROUGH ABSTINENCE, BUT BY ALWAYS TAKING A MEDICATION CALLED NALTREXONE AN HOUR BEFORE DRINKING ALCOHOL." This mantra is repeated probably 100 times in the book and never once is there, "And oh yeah, get a good therapist too or it will not work." If therapy were a critical aspect of the method, there would be an entire chapter included on the importance of therapy in the book. It simply is not a necessary part of the method as outlined by Dr. Eskapa and Dr. Sinclair.

Again, this is not my personal view point as I believe therapy is a good thing -- for everyone. But if anyone here is arguing that Dr. Eskapa and Dr. Sinclair conclude that therapy is necessary in order for TSM to work, then you are wildly misrepresenting what they have to say on the subject.

I don't think anyone is arguing, not sure. I think, for me, I have been thru a lot of the counselling part of alcohol treatment already. I believe I have taken everything from 12 steps I am gonna get. I look at it as I did the counselling before starting TSM. I do believe counselling could help anyone. I think a psych that would be willing to help w/ TSM would be great.
I believe when I read the patent docs in the book, Sinclair did write it up as an adjunct to other types of therapy. I believe this was more of a CYOA thing from reading the book and his statements.
Another reason a lot of us don't get any therapy along w/ this is we don't have anyone supporting us, ie our Dr.s. So, it makes it hard to even pursue help in this way.

Nick -- Could some of this partly be a difference of semantics (like it depends on what your definition of "is" is)? For me at least, the notion of therapy can cover a wide gamut from Freudian feet on couch to the cognitive behavioral therapy that I think is helping me to complement NAL in reducing my drinking (very concrete practical steps like pacing drinks, setting stop times etc).

I also wonder if what Drs Eskapa and Sinclair say to promote the book and what they actually did might be slightly different (if you use my definition of therapy as covering a range of "counseling"). That's certainly forgivable since I think they are entirely well-meaning in trying to get out the most important message -- get people to try naltrexone. But to tackily quote myself from a previous post, when I reread descriptions of the studies in the book most of the patients did receive some kind of ongoing counseling throughout their trial periods -- even if just touching base once a week with a professional in the field of addiction behaviors. Dr Eskapa says in his chapter for medical professionals that "counseling aimed at improving compliance (to always take naltrexone before drinking) is probably beneficial, as is help at adapting to a new life in which alcohol drinking is not the primary focus." (The second phrase being the crucial one I believe.) And in a 2001 article reviewing earlier NAL studies for the journal "Alcohol and Alcoholism", Dr. Sinclair says, "All of the successful clinical trials have been conducted with naltrexone in conjunction with comprehensive programmes of psychological therapy for treating alcoholism."

The only reason I'm harping on this is that I think some of us who have difficulties with the NAL alone might benefit from some additional kind of "therapy," which I actually don't think fundamentally contradicts TSM and which might keep people from getting discouraged and giving up the NAL entirely, which I think would be a tragedy.
Sabrina

"The only reason I'm harping on this is that I think some of us who have difficulties with the NAL alone might benefit from some additional kind of "therapy," which I actually don't think fundamentally contradicts TSM and which might keep people from getting discouraged and giving up the NAL entirely, which I think would be a tragedy."

It's interesting because we both have a much larger agenda here in addressing this rather critical issue. Yours is to ensure that people who might be struggling on naltrexone alone do not quit TSM before trying it in conjunction with therapy. My concern is the opposite: most people DO NOT HAVE THE MEANS, TIME OR INCLINATION FOR THERAPY and my concern is for them: if therapy is a necessary prerequisite for success with TSM according to Eskapa and Sinclair (and I repeat, IT IS NOT), then this much larger group is **** out of luck. Which would be a real tragedy, especially when it is based upon an incorrect reading of the book and entirely flies in the face of "an effortless cure" of just taking naltrexone one hour before drinking, as stated over and over again in the book.

Sabrina, Eskapa wrote a 300-page book about TSM in which he says over and over again, "there is only one rule: naltrexeone plus drinking = cure." There is no mention anywhere of a therapist requirement and in fact, the COMBINE study is cited in the book in support of Eskapa's conclusion that therapy is NOT a required component of TSM. Which is why after the COMBINE STUDY, General Practitioners are permitted to prescribe naltrexone without the requirement of a therapist, which, had been the rule prior to the COMBINE STUDY. General Practitioners are MDs who DO NOT GIVE THERAPY. They hand you a prescription and tell you to go to the drug store, as my doctor did with me. If that is your idea of therapy, then yes, therapy is required. However, IMO, THIS IS NOT THERAPY. And you are taking a partial clause of a single sentence in support of your conclusion that therapy is a necessary component of TSM, when IN FACT, IT IS NOT.

I do not understand why you insist on creating something that is not there. Therapy is great -- have at it -- no one says it will not help you. But to turn that fact on its head and to falsely report that TSM will only work in conjunction with therapy is not only incorrect, but more importantly, is potentially a huge disservice for the vast majority who will try TSM without the benefit of a therapist. If you had told me in advance that TSM only works with therapy I probably wouldn't have tried it and I'm sure I would not be alone in that regard. I really think it's a disservice to anyone reading our posts to suggest that Dr. Eskapa and Sinclair conclude that TSM only works as an adjunct to therapy, when, in fact, they conclude the opposite: no therapy is necessary, just take the pill one hour before drinking.

I just reviewed the book. The following facts are relevant.

1. In the Foreword, Dr. Sinclair explains the method, naltrexone plus drinking = cure. There is no mention of therapy in this section as a requirement. Moreover, Dr. Sinclair concludes that TSM "has the greatest potential benefit, in developing countries" where traditional treatments have not been established. Page XX. Developing countries, to my knowledge, do not have trained psychotherapists readily available for cognitive behavioral treatment. If therapy were a required component of TSM, there is no way that Dr. Sinclair would conclude that its greatest possible use is for developing, third world countries.

2. The "essential features" of TSM are listed on page 43 and include naltrexone plus drinking = cure and taking naltrexone for life. There is no mention of a therapy requirement because therapy is not an essential element to the treatment.

3. Page 51. "Project COMBINE clearly shows that this restriction [naltrexone used only as an adjunct to counseling and therapy] IS NOT CORRECT. NALTREXONE WORKS WITHOUT COUNSELING." Emphasis mine.

4. Julia's story, page 131. "Although intensive psychotherapy is not a requirement for successful treatment, Julia's story has been included because it provides an insight into both the theory and practice of the Sinclair Method and, at the same time, illustrates how the treatment can be enhanced through close, one-to-one contact with competent, caring professionals."

Point 4 sums it up best: therapy is not required for TSM to work, but it can ENHANCE TSM, if there is a competent professional involved.

I am not sure how anyone could read the above and conclude that Dr. Eskapa and Dr. Sinclair have concluded that therapy is necessary for TSM to work. It plainly is not an essential element of TSM, per the words of Dr. Eskapa and Sinclair.

Wishing success to all those on NAL and therapy and to all those just on NAL and no therapy. I personally am not getting therapy and just following the golden rule Nal + drinking = cure and when I read the book I didn't walk away with the thought that I should seek a therapist.


corkit

I am unaware of any of the Cured that had therapy concurrent with TSM. I know I didn't. I do know I wasted 2 years of therapy pre-TSM that had little or no affect on my drinking behavior.

Bob

Eek Nick – I think this is a case where what I meant to say versus how it came out in writing are miles apart. I did not mean to say that I thought TSM would only work in conjunction with therapy, but that for some people it might be a useful thing to consider if they weren’t making headway. And I guess I also meant therapy in a very broad sense. When I was talking about my cognitive behavioral therapy, I wasn’t talking about seeing a therapist, I was talking about the actual actions I’m trying to take to help cut back my drinking (my fault for using the wrong word). For instance, I now periodically go to the NIH site http://rethinkingdrinking.niaaa.nih.gov ... /Tools.asp and try and use some of its suggestions. I also agree that TSM is wonderful precisely because it doesn’t require intensive professional counseling.

But I guess I’m also trying to say that at least for me, even though I believe in TSM, in the efficacy of naltrexone, and in the extinction theory, this process has been really difficult for me, and I’m desperate to make it work. Right now for me it is an effort even though I know it’s not supposed to be, and there may be a few others on this forum undergoing some of the same struggles. I didn’t think it would be anti-TSM to try and come up with other suggestions for things we can do to reinforce the NAL for people for whom it’s not working as quickly or smoothly? In some cases, if the person is inclined and able to afford it, that might include seeing a professional, but for others it might be as simple as brainstorming about what tricks or methods are helping cut back on their consumption. I religiously read Springerrider and Bob’s posts to see what if anything they did or do that helped them along to be such successes – even if it was something tiny like waiting until 6 pm to start drinking. I even think poring my heart out in this forum is a kind of therapy.

Anyway, I am so sorry if you or anyone else took this as disparaging to TSM –- unfortunately it seems to be a rockier road for some (including me) and not for others, and I’m not sure what to do about that. I don’t want to give it up, but I need to augment it somehow for me. I haven’t looked at My Way Out, but I guess that may be where I should go?

With my heartfelt apologies,
Sabrina

Classic example of how hard it is to communicate via the internet.

No apologies necessary Sabrina, and I'm sorry if my response made you feel obligated to offer one. The problem is that my last post was addressed to several of the prior entries, many of which wrongly concluded that therapy is a necessary part of TSM. That was the very specific point I was responding to and my concern was not with disparaging TSM but with making sure that readers come through here and do not walk away with any erroneous conclusions about the necessity of therapy and TSM.

I applaud any and all efforts to reduce consumption. Therapy, for me, is a stickier issue. I've seen my share of therapists. From my experience, most of them suck. There are literally a dozen people I've chatted with in this forum who have far greater insight into the human condition than your average therapist. Which is why it is so critical to me, personally, that therapy not be a key ingredient to the method. Because if it were, the method is doomed for failure if it relies upon competent therapists, as there is a critical shortage that make this list, IMO.

FYI, my father was a clinical psychiatrist; my mother a clinical social worker. They helped thousands of people in their lives. I majored in psych and was almost a therapist myself. Therapy in the hands of a gifted therapist is a great thing; in the hands of your average person; not so much. So, I second what Corkit said: I wish everyone the best in dealing with this issue, therapist or no therapist. But I know for a fact Eskapa and Sinclair conclude that TSM works without need of a therapist.