Hay Greg -- If you had been taking naltrexone all this time, think how far along you'd be already!! I repeat: You might as well take it.

First I concur with everyone here for the most part....Her's my 2 cents

I've tried cannabis once with alcohol and it helped considerably lessen the amount drunk. Anything at your current levels will help your body....

I WOULD NOT Recommend antabuse,...just take the baclofen,..some have suggested I do that as well as Naltrexone.....my hangovers have gotten worse since Nal,...I had 2 beers, 2 wine, and a martini and still have a headache mid afternoon...hate that....NEVER would've had that...I could've drunk twice as much and felt a little off the next day but no hangover....this is a really great negative reinforcement bonus.....(are you finding this Greg?) Please hang tight and post often....best Jim

Hi Greg,

OK, I now have a reply from Dr Sinclair. Firstly, the questions I put to him:

[1] Why weren't the clinical trial participants drinking at a level that is more representative of that which would be expected of someone suffering from alcoholism?

[2] Is it reasonable to assume that someone with a long history of drinking at high levels would take longer to be "cured" by TSM than someone with a short history of drinking at low to moderate levels? Is there any data available in support of this?

[3] Repeating the original question - does TSM work for heavy drinkers? Once again, is there any evidence in support of this?

One final point. Your reply will obviously be of considerable interest to forum members. Do I have permission to copy your reply to the forum?

This is the reply that I received, which Dr Sinclair gave me permission to reproduce in its entirety:

Pharmacological extinction works for anyone who wants to have greater control of their drinking, providing only that it was the opioidergic system that is primarily concerned with providing their reinforcement from alcohol.

Indeed, we have suggested that the method might be promoted as a means of prevention rather than reversal of excessive drinking. If a person (or one of our rats) were to take naltrexone before drinking, they would never develop alcoholism in the first place.

One of the problems in treating alcoholism is the stigma society (incorrect) associates with it. Many people refuse to enter treatment, even though they could benefit, because they do not want to wear that scarlet letter A for alcoholism on their foreheads. They might, however, find it easier to enter treatment that will prevent them from developing alcoholism.

As you know, naltrexone does not help all people. Apparently there is some other system that provides the reinforcement for alcohol drinking for some people. The data show that there are about 10-12% of the people who take naltrexone appropriately but do not, even after several months, obtain a reduction in craving and drinking. I suspect that a similar proportion of heavy drinkers would not benefit from naltrexone. The vast majority of heavy drinkers, however, will have a major reduction in their craving and drinking. Naturally, it will not be as large as the reduction produced in severe alcoholics simply because there is not nearly so far to go. But they will benefit.

David

So, there you have it.

V.

Are we not forgetting that Dr. A (sorry can't spell his name) - the French guy who wrote the book on baclofen, did not have success on naltrexone - that's the whole point - he stumbled on bac and took off from there.

I don't think Dr. Sinclair really addressed the specific question about heavy drinkers and long time abusers. He just repeated that naltrexone works. Anyway, I think we may be beating a dead horse. If it works for you great, if it does not appear to be working after 7, 8, 9 months maybe it's time to try bac??? or add bac to the mix???

I'm with you BGH. If after 8 or 9 months I see no improvement with the two of us I'm certainly going to try or add something else to the mix and hopefully I can wait that long. I have to give credit to those on this board who have been sticking with Nal for a long time and struggling.

corkit

Thanks to Virgil for eliciting a response from Dr. Sinclair. Dr. Amiesen was trying to use naltrexone as an anti-craving med so of course it didn't work. I didn't glean a clear response to the details from Dr. Sinclair's statement either. I think today's post from Providence on the thread she started is the best answer of all. I'm not where I'd like to be but I'm satisfied with my progress. I'll post when I have time. Meanwhile, one thing that really encourages me is the fact that Sinclair found improvement for up to three years for reduction in craving in compliant patients. Compare that to any other treatment (possibly now excepting baclofen); other treatments measure decline, rather than improvement, after the onset of treatment due to the inevitability of relapse.

The questions I wanted answered were not addressed in his response: why are the study results limited to 35 per week and does extinction take longer for people who have been drinking more and for a longer period of time? Because Dr. Sinclair is highly intelligent, I do not think he forgot to address these questions. Rather, I suspect there have been insufficient studies that he can rely on to give adequate answers and therefore he basically skirted the issues.

...but I guess as we've been saying elsewhere, there are different kinds of "cure" and some are happy with cutting back, some only with abstinence, some with control. And besides there must have been some in Dr. S's study that were at the deep end of the average? I can't do the math but if the average was 35 units could there not have been at least a few at 80/90 and some at 10? That's probably a laugh for you "graph" guys but that's as complex as I get and besides Dr. S says that it's not necessary for therapy or counselling but did those in the study quoted have a structured program to follow? Maybe we're just hanging out to dry (oh what an awful pun..) and won't get to the magic number 0 unless we pull out all the stops.

Me, I'm hoping for the three year thing.....

There is an AA saying that I believe could be applied here in a different context:

It works if you work it, so work it, you're worth it!

Point being, if the Nal cuts the drinking keep drinking with Nal.

Of course we say Drinking + Nal=CURE.

No method for anything is 100% for sure. But 100% of this method is worth anything for sure.

Don't give up before the miracle happens.

Thanks everyone for your input into this, and thanks Virgil for asking Dr. Sinclair. Unfortunately I too am still not sure how the Sinclair Method works for heavy drinkers versus those with lesser numbers. In my own case my heavy intake is causing severe liver damage, as shown by recent blood test results, and my thinking is foggy and slow even if I've sobered up. And when the booze is getting out of my system, withdrawals follow quickly unless I start drinking again. My blood pressure is high as the alcohol is leaving my system and I get ringing ears in conjunction with this. I did try TSM for about 3 months without noticeable positive results. I'm now looking at inpatient rehab if baclofen doesn't work for me, even though I know rehab isn't a cure for the vast majority of alcoholics, but I need some time out to physically and mentally get better. Maybe after that I could try TSM again at a lower level of drinking and therefore get results. I'm still trying the baclofen and intending to get up to a high dose to see if that can block my total craving for alcohol and my obsession with drinking until I'm drunk and almost comatose. When I first drank to excess about 20 years ago I'd say it was definitely to get the endorphin rush, but I hardly ever feel that now and only seem to feel the sedation, which would be due to alcohol's effects on GABA. I drink specifically to get this effect these days, so maybe people who experience this as the main effect are the "GABA type alcoholics". Baclofen works on the GABA system so may be more useful in alcoholics of this type, and it could possibly allow heavy drinkers to quickly lower their drinking or quit altogether without experiencing the Alcohol Deprivation Effect. Nothing else seems able to do this if a quick reduction from heavy drinking is required. I have no doubt that TSM would work for drinkers of nearly all types if they are able to keep drinking at their current levels for the many months that may be required for it to fully work. As you pointed out Lena, if I had stuck with it all this time I may well have been on the road to being cured by now, but by giving up on it, I have blown my chance at the moment due to my need to quickly quit drinking.

Just one more thing...I do think that most alcoholics need to make numerous changes in their lives, because their lives are likely to have been grossly altered by years of drinking. Many, such as myself, may have been drinking to try and cope with emotional and other life problems (or to blot out problems), and therefore those problems will still need to be dealt with even if medication addresses the alcohol addiction. I know I personally need to address a number of personal conflicts and issues that have troubled me all of my adult life, and despite disliking many aspects of AA, I may find that it is the only sober social scene and way of making friends that is now available to me (and also the only practical way of having something to do in place of getting drunk at night unless I can find night work).

Anyway I wish everyone who is using TSM all the best, and there have already been people here who have declared themselves cured, so it definitely works for many who follow it faithfully over a number of months.