I am reading "The Cure for Alcoholism" and I am just wondering, in all honesty, how many of you guys actually attend regular therapy sessions to discuss your alcoholism with a professional.

I have been seeing a therapist ever since my divorce, just for the stress and grief. He is an addictions counselor from way back, and he has been hinting at my alcoholism ever since I started coming, and he is probably the reason I have decided to really examine it myself. But I told him about Naltrexone and TSM, in our last session. He seems to be a pretty big AA-style advocate of "once an alcoholic, always and alcoholic" abstinence. He had never heard of TSM or Naltrexone. He has made many references over the past year of people always expecting some magic pill, and that life doesn't work that way... So I was totally expecting him to be like, "This is a fluke. Nothing works, other than getting into the rooms." (i.e. AA).

He wasn't like that at all. I explained (or at least tried to) the opianoid antagonist bit, and how over time, the cravings go away, as you un-learn the positive reinforcement etc. He was on board. He and I both, however, think that a COMBINATION of therapy and TSM would be the only way to actually reduce drinking. And I agree. I mean, this is coming from someone who has yet to start the Naltroxone, so correct me if I am wrong. But I think that my social anxiety, my inability to sleep without alcohol, and all of the mechanisms and habits that I have formed around alcohol will keep me drinking no matter how many craving busting pills I take.

The fact is, I "need" alcohol to (a) talk to girls in a bar (b) feel normal at a party or social gathering (c) get to sleep at night without staring at the ceiling until 5:00 am (d) feel creative while making music.

Now, I know that I don't "need" alcohol for any of those things, but I have been doing it for the past 12 years or so. My entire adult life, from age 17 until now at 31, I have had alcohol right by my side for everything I've ever done from taking a flask into my grandmother's funeral, to taking shots right before I had sex for the first time, to celebrating my wedding, to grieving over my divorce.

And I don't think that I am alone in that at all. Anyone with alcohol as a problem in their life, I can't help but assume has the same if not worse of a situation as I did/do. So, I am wondering, how many of you actually go to a therapist and work on chipping away the calcified grip that your habits have wrapped around alcohol?

I''m sorry to seem so skeptical. I just can't get my insurance worked out fast enough to just go ahead and start the treatment, so I am kind of on the sidelines for the moment, yelling out questions.

Hi pisces,

A very interesting post for me, many of your feelings mirror my own. I have a long-standing social anxiety, am shy etc etc. I've always used alcohol as a crutch in such situations whenever possible. That's since the age of about 16, when alcohol was immediately available as my social life developed, until now, as a man of 34.

I also suffer from GAD independent of any anxiety that alcohol creates.

Now, here's the interesting part, perhaps: I had four months abstinence earlier this year - along with a daily support programme (not 12 step based although they did touch on step 1, which let's be honest any alcoholic needs, whatever you think about the other steps). We looked at things like dependency and co-dependency, assertiveness, self-esteem, all those kinds of things. Many of them helped me a lot. But the main thing is that after a while I started attending social functions, even bars, while not drinking, and my confidence grew and grew! The confidence from the alcohol is illusory, but once you tackle situations alcohol-free and succeed, greatly enjoy them even, then it's a true lesson learnt and very encouraging. Without the dependence on alcohol I became a more confident and socially relaxed person (although by nature I will never be super-confident or outgoing). I think I talked to ladies in a relaxed way socially for the first time in my adult life.

This ties in really with what you say about a 'magic pill' - Nal is not that, unless drinking has absolutely no knock-on effect in other parts of your life. It may reduce/eliminate your dependence on alcohol, but it won't affect any underlying issues that people like me blocked out by drinking. In fact, some very difficult things may have to be faced. Personally I have to learn more coping strategies with different situations, because for most of my adult life I haven't developed any but to have a drink. Nal may look too good to be true, and I think it is if we only consider it as curing our alcohol problems, without thinking about how that will affect the rest of our lives.

So, I absolutely agree that some support and advice will help you as you hopefully become de-addicted. I'm not sure though that anything extra is needed for the Nal to work as it should - to reduce cravings. I was under the impression it'll work, like it or not(!), as it's subconscious. Others know more about that than me here I'm sure so I stand to be corrected.

All the best to you!

8

I see a therapist regularly. I think I'm helping him more than he is helping me though. You can read my weekly progress thread to see what I mean. He has told me that I have no diagnosable psychiatric disorder, that I'm not even depressed and that alcoholism is my only problem. He also believes that TSM will resolve it.

In 2006 researchers published the results of the largest study ever done on alcoholism and it's various evidence based treatments. It was called Project Combine and is cited at the end of this post. They found that naltrexone alone was the most effective form of treatment and counseling did not increase the benefit.

Dr. Sinclair acknowledges the study and says that although he believes counseling can't hurt, “those rats never listened to a single thing I had to say and yet they quit drinking.”

Anton R. F., O’Malley, S. S., Ciraulo, D. C., Cisler, R. A., Couper, D., Donovan, D.M., Gastfriend, D.R., Hosking, J. D., Johnson, B.A., LoCastro, J. S., Longabaugh, R., Mason, B. J., Mattson, M. E., Miller, W. R., Pettinati, H. M., Randall, C. L., Swift, R., Weiss, R. D., Williams, L. D., Zweben, A. Z., for the COMBINE Study Research Group (2006) Combined pharmacotherapies and behavioral interventions for alcohol dependence: The COMBINE Study: A Randomized Controlled Trial Journal of the American Medical As­sociation 295: 2003–2017. Largest DBPC trial in addiction (n=1383 recently detoxified alcoholic) showed naltrexone with minimal medical interven­tion was best at increasing days of abstinence and reducing heavy drink­ing days. Intensive (20 hours) therapy without medication helped increase abstinence but did not reduce heavy drinking and did not make naltrexone better (the partially abstinence oriented therapy actually tended to reduce the benefit). Acamprosate had no significant benefits and taken at the same time as naltrexone did not help naltrexone.

Hi pisces,

People drink alcohol for many different reasons. For some, it's the "buzz". For others, it's to unwind after a stressful day. And so on. For me, I use alcohol as a form of self-medication against anxiety. And that's why I see my therapist on a weekly basis. Only by dealing with the root causes of my anxiety will I bring about a long-term solution to my alcohol dependence. Although I don't see a therapist specifically to talk about the alcohol issue, it is a topic that we cover at pretty much every session. That's essential as alcohol is so much a part of my life. If it weren't for therapy, I probably would never have appreciated the extent to which alcohol can affect our cognitive functioning.

For me, (psycho)therapy is my lifeline.

All the best.

V.

The Cure for Alcoholism would clearly make the argument that therapy IS NOT NEEDED in order for TSM to work. In fact, that's the exact conclusion of the COMBINE STUDY cited on page 203, the largest controlled clinical trial of alcohol dependence ever conducted. Naltrexone without therapy was found to be just as effective as naltrexone and therapy. The results of this study were duplicated in Finland and Australia. See page 203. (Oops, am only now reading the entire thread and see that LoOP already pointed this out.)

I'm not saying I agree with this necessarily, but this is definitely what Dr. Eskapa and Dr. Sinclair would say regarding this subject, namely, there is no need for therapy in addition to naltrexone.

Naltrexone should take away the craving to drink through social situations and various other triggers. But I entirely agree that all of us ran to booze in the first place in order to retreat from issues that will have to be addressed once we are no longer relying on alcohol.

I don't quite agree

Project COMBINE studied Naltrexone as taken while abstinent. Also, Sinclairs own published studies on the Finnish work had an element of therapy.

Where I would concur is that the pharmacological nature of TSM should mean that it is effective without therapy, I can't see (good) therapy doing anything but helping the process - especially if there are other co-occurring issues/conditions

I occasionally wonder whether there might be a slight but useful distinction between "therapy is not needed for this method to work" vs "this method can often even work without any therapy."

Er, on preview, what 1-4-the-road said

Maybe we should ask those who are on the cured list and have been that way now for sometime. We all know that the biggest source of depression comes from AL abuse and the havoc it causes for all of us and I'm not saying this is true for all of us. It seems some here started using AL for a relief of depression so I know it doesn't hold true across the board. There has been Al in my blood for so long I'm not sure what the world would look like without it I only know it has to look better than it does now.

corkit

There are two issues here: does therapy help people get over alcoholism and the issues that led to it? For most people, yes.

Second question: does TSM require therapy to work? According to the book, the answer is absolutely NO. There is no ambiguity in the book, the prescription to the cure is simple: naltrexone plus drinking = cure. No where in the formula is there a spot for therapist to be included. The whole point of the book is that you do not need rehab, or therapy or any expensive treatment for TSM to work: you just need to take the pill one hour before you drink. The "cure" occurs on a subconscious and physical level: the hard wiring in your brain is actually changed to its pre-addicted state. There is no need for a therapist for this biological cure.

The above is factual information, as presented in the book. If therapy were required, it would be stated as such in the book and it is not. Now whether the book is entirely accurate remains to be seen. Personally, I think everyone can benefit from therapy but I can assure you that Eskapa and Sinclair make it very clear in all of their presentations that therapy is not necessary for TSM to work.

I've been wondering where or even if to post my thoughts about the wisdom of supporting TSM with some kind of cognitive behavioral therapy counseling, and I guess this is the place to take the plunge. The doctor who recommended I take naltrexone to begin with (who has street creds) was slightly dismissive of TSM itself, I think in part because he truly believed that NAL needs some kind of behavioral reinforcement to work. I guess I’ve come to agree with him at least on the necessity for some kind of effort on my part besides taking a pill every time before I drink. And please don’t get me wrong – naltrexone has given me (and my family) my life back since I started taking it six weeks ago. I just am realizing I need to help it along.

OK, so here’s why: My recent careful re-reading of the studies that are cited in "The Cure of Alcoholism", including looking them up on Pubmed to read the originals, made me realize that 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 even 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." I believe the subsequent COMBINE study focuses on the efficacy (or lack thereof) of counseling regarding abstinence, not on the benefits of positively reinforcing with specific behavioral-modifying tools a patient's desire to drink less.

I love this forum, I think its members are amongst the smartest, warmest, and wittiest people I happen to not know, but I guess I fall into the category of thinking that there are no magic bullets, that NAL is an extraordinary tool, but it's not a ticket to a free ride. For it to work I believe it needs to be reinforced by even little behavioral modifications, like deciding you're going to alternate a glass of water with a glass of beer or wine or whatever your choice of beverage is. I don’t mean this to be heretical, but I wish Drs. Eskapa and Sinclair had spent as much time in the book on supporting appropriate behaviors on the days you are drinking as well as focusing on all the fun stuff you should do on your AF days.

I’m no scientist, but it seems to me that Darwinian extinction theory is based on a combination of behavior and physiology. I do believe in Sinclair’s extinction theory, but I would think it would take a heck of a lot longer to work if it wasn’t reinforced on the behavioral level as well. So I guess I’m saying that I’ve come to realize at least for myself that it doesn’t work to take TSM as an endorsement just to drink whenever or however or how much I want as long as I take naltrexone – I’ve got to make an effort to help the whole process along. For me at least that’s probably going to mean a mix of therapy and conscious changes in my routines surrounding my drinking – as well as taking NAL every time I’m going to drink. My teenage son tells me that despite its name there are a lot of disciplines involved in freeriding (in mountain biking et al) so I figure I can try that in my drinking life as well.
Sabrina