http://www.podcastdirectory.com/podshows/1571068

Addiction to alcohol is a learned behavior. We drink, endorphins are released giving us pleasure, and we then associate whatever we are doing or thinking when we drink with pleasure. After years of conditioning, we have learned that a specific trigger -- whatever we were thinking or doing historically when drinking -- should result in giving us pleasure. For example, you see your favorite bar and you are triggered into wanting to drink. This is exactly what happened to Pavlov's dog with the bell, which, by total coincidence, is the same example Dr. Sinclair uses in the above podcast when explaining extinction theory. The bell paired with food makes the dog think of food when the bell is rung, thus eventually producing saliva when the bell rings without food. The bell has become a trigger for the dog in this example. Take away the food and continue to ring the bell, and eventually the bell alone no longer produces saliva. The bell, the trigger in this example, has been extinguished because the dog no longer associates food with the bell and therefore no longer salivates when the bell rings. For us, we will be cured when we no longer associate alcohol with any of our specific triggers. A trigger will come our way -- our favorite bar for example -- and we will see it, and will no longer crave alcohol because our brain will no longer associate the bar with pleasure.

This process of un-learning behaviors is called extinction. By definition, when we drink on naltrexone, the pleasure is blocked, and we un-learn the connection between whatever we are doing or thinking at the time of drinking (the former trigger) and pleasure. This is extinction -- unlearning the positive association between triggers and drinking on naltrexone when there is no endorphin release, which is blocked by naltrexone.

This issue is discussed in the interview, above. We are extinguishing triggers when we drink on naltrexone. That's the definition of TSM.

[Lena's clarification]

Thanks Nick -- and I would add that this "learning" is a clinical term related to classic conditioning -- NOT the conscious sort of acquiring knowledge in the lay person's sense of the term. This is very important because many of us just instinctively are trying to tweak the extinction, or un-learning, process as though we have some control over it. "As you drink on naltrexone, you will not be aware of the neural super-highways being weakened and cut back into their original condition." Eskapa, p. 106. This is repeated throughout the book: While we may feel some superficial differences drinking on nal, especially at first, these are meaningless in terms of the real work of the cure -- extinction, which takes at least three to four months(p. 117-118).