This is my further analysis of TSM, so beginners and the desperate please don't read.

I had said that that I should not address scientific matters any more, but I cannot resist countering some of the assertions made. I am sorry if any of this sounds patronizing.

There is little scientific support for TSM. The 70 studies quoted contain many laboratory studies of rats bred for alcoholism. Yes, they showed alcohol deprivation effect, they show classic extinction curves. But they are rats. Not even normal rats, but rats bred to show these results. They point the way to human studies, but cannot be transferable to human results. In fact, "alcohol deprivation effect" has never been demonstrated in humans. It is never even been claimed in human studies.

Many of the positive studies used NAL as adjuncts to attempts to abstinence. Any attempted analysis of TSM is post-facto use of subsets, and thus of little scientific relevance. For example, I read a letter from Dr. Sinclair about this from > 10 years ago in the New England Journal of Medicine and he was easily refuted. I haven't found any publications from him in a professional journal since.

The oft-quoted 78% success rate from a Finland clinic in the 1990's was not peer-reviewed and has never been duplicated. In fact, the clinic doesn't even currently show their current success rates. It charges 1400Euros for a course of treatment and doesn't accept the Finns' national health insurance. Of interest is that Finland has one of the highest alcoholism rates in the world.

Many of the studies quoted to support TSM in fact showed no such thing. I have already posted that the COMBINE study does not support TSM at all. Some of the most prominent researchers into alcoholism and NAL - e.g. O'Malley and Anton, quoted in support of TSM - have in fact ignored TSM and Sinclair in their high-profile publications, such as NEJM and NIH consenses.

One can put on a tin-foil hat and assumes that the entire scientific and medical establishment ignores TSM because they want to make money for the talking heads. I can assure you that it is not how scientific/medical academics work. If any assistant prof. thinks they can get a heads-up, he will go for it.

There is proof that NAL works. TSM prob. works, but probably not better than any other NAL use. Again, there is *no* proof - none - that TSM works at all in a clinical setting. Nobody is willing to study it, because the science behind it is iffy.

By all means, give TSM a try, as I am doing. But please don't pretend that this is scientific with a 78% cure rate.

One last comment, and then I will shut up for the week. Really.

The double-blind placebo trial is the gold standard for a clinical intervention for very good reasons. Let me use alcohol dependence as an example:

A large number of alcoholics assigned to self-remission (on their own tried to cut down AL intake) actually succeed short-term.

Some TSM'ers get "cured". Some of them never post again. I assume that some TSM failures also never post again. Thus it is impossible to guess at the real cure rate.

If anyone gets cured on TSM, I congratulate them, I feel happy for them - really, and I wish that I will do the same. But...it does not prove to me that TSM works. Many of us will cut down our drinking anyways whether we take NAL, follow TSM, or whatever. Without a rigorous study, we just don't know if TSM works better than anything else.

I want to ask, what about the 100+ studies they claim to have now?
I have heard these claims. I don't know if they are true or not, but I'd like to see what you make of them, I don't remember if these were written somewhere or if Eskapa told me in an email.

I started this under the impression that double blind placebo tests had proven TSM successful. Now I feel like a fool. but I swear I wouldn't be drinking so much less if not for TSM. I mean I did AA. talk about placebo effect!

seriously though, after reading this post, which I believe because the way the book was written always made me queasy, if TSM cured me, it sure as hell won't be a placebo effect now.

James, why don't you go to facebook, friend Eskapa, and ask him a bunch of tough questions in personal messages? really put the screws to him. I am curious now, and I don't have the scientific prowess to do it right. c'mon, get us some answers about the misleading information. and I would like to read this article in the medical journal where sinclair was refuted

The whole notion of whether The Sinclair Method is bogus or not reminds me of the tale of Dr. Semmelweis. When we look back at the particulars of what Dr. Semmelweis was suggesting in 1847 it looks obvious to our 21st century minds now. Dr. Semmelweis correctly postulated that washing hands with chlorinated lime could reduce the incidence of childbed fever by 10 fold. His contemporaries declared that Semmelweis's findings lacked scientific reasoning and Semmelweis eventually died in an insane asylum in 1865.

One of the problems with being a trailblazer is there is no trail to follow so evidence based outcomes do no good when you are trying to discover something new. Evidence based medicine is only useful when it is being applied to current knowledge;it doesn't easily allow for new discovery. Anyone interested in reading the story of Dr. Semmelweis here is a link http://en.wikipedia.org/wiki/Contemporary_reaction_to_Ignaz_Semmelweis

I work in a world that is equal parts art and science and although I tend to be very science minded I sometimes have to wonder about the things that we can't currently explain with science alone because we just don't know the answers yet. Brain chemistry is as infinitely complex to us now in 2010 as aerodynamics and flight were to the Wright Brothers in 1903. I will say that as I've been watching my drink count decline over the last 10 weeks I have the enjoyed the intellectually stimulating discussions around TSM. We may look back 20 years from now on Sinclair and either see him as a fraud or a Semmelweis. Good night all.

Hi Joe,

I'm too sleepy now to do justice to your insightful questions. I will try to elaborate later.

But, if you are cutting down on your AL intake with whatever you are doing, something is working and you should keep up with it.

I don't think anyone buys into the 78% success rate or 3-4 month time period, so why does anyone accept the whole program? I have actually read some of Eskapa's references, and they do not support or refute TSM. As I have said several times, there is no DBPS head-to-head support for TSM. Of course, this doesn't refute TSM, and as another poster stated, we may be pioneering a whole new paradigm, just like germ theory. If Dr. Sinclair wins a Nobel Prize, I hope that he mentions us in his speech in Stockholm.

I am not advocating EBM, just reading the available literature. Again, in the absence of a real clinical study of TBM, I have no idea whether it works or not. The evidence is that NAL works moderately, and I may as well take it on a TSM basis. If it doesn't work for me, I go on to something else.

Some of us will get better, some of will get worse, some of us will see no real change whatever we take. That is why clinical studies are important. I hope I get better, but I accept that there is no magic bullet. In the meantime, whatever my AL intake, I will try to be a better person. That's all I can do.

I buy into the "three to four months" time period because that's pretty much how I experienced it. I have no opinion on the overall success rate. I understand, accept, and expect that other people's experiences will vary.

Saint Vincent,

I respect your intentions, but any cursory scientific study (wash hands/do not wash hands) would have solved Semmelweiss' claim. There is no paradigmatic shift in accepting TSM. The study is simple: give alcoholics NAL or placebo and they can just drink per their usual pattern but taking a pill. Pay them $25 to come in every month for refills. At the end of 6 or 9 months, ask them within the past week if they drank 5 units in one day or if they drank 25 units in that week. Run the chi-square. That's it.

Even simpler, give the study participants monthly Vivitrol vs. placebo. Vivitrol has been shown to be (moderately) effective in an abstinence model. Well, just tell the new group to drink as per usual, and see the results in 6-9 months.

How well TSM works can be easily determined with present study protocols.

Hey James, I concur with Joe12's last post - When I read the book, it all sounded too good to be true....and I wondered how effective it really would be....but now I have some very strong results I am a complete convert. Try not to over think it; go with it....and see what happens. Everyone has a different journey...but even if things don't happen as quickly as in the book, those who consider themselves NOT CURED YET...are still seeing amazing results. Personally I know I could NEVER have achieved the results I have got, any other way.

All the best with your TSM journey.

Kiwi

Hey James,just thought I'd pipe in..I really don't understand most of this scientific stuff but I do understand its importance..Please keep posting your findings..From that perspective though, I must ask..Don't you think the rat studies do more than point the way to human research?? The way I took them before, and still do,is that they kind of take the human element out of the whole thing..And they prove that alcohol addiction has nothing to do with any of the nonsense that conventional programs teach the average alcoholic..I guess what I am saying, is the rat studies kind of sealed the deal for me, as they proved what I kind of knew all along..That my drinking has nothing to do with morality,weakness,spirituality,etc..I'm not trying to convince you,just tryng to keep myself from getting disillusioned with this whole thing..Anyways thanks for the posts..That is very kind of you to invest that much time to provide us with that info.....Goodman

James,,I work nights in a pretty layed back environment..That leaves me a lot of time to read..Now,Ive spent the better part of 12 hours on this board..Mostly reading your posts..I am also a very emotional person,as you may have gathered,so please don't take this the wrong way..Can you please break this down so a caveman can undrstand it?? This is what I find so annoying about doctors and such..Their inability to speek english..If you want me to believe that you know what you are talking about,then at least show enough intelligence to speak my language..This is not a slam or a rant..I REALLY am interested in what you have to say..I am only asking that you dumb it down a bit for us simple minded folk?? Now Bob3d has stated that he has a letter in to Agent Orange..If you have ever read any of his stuff,you would see how he speaks the tounge of the natives..And I think he does the same thing you do,only guys like me understand him..Dude,I could use a guy like that around here..Or a guy like you if I could understand what you were saying?? Please James,the insult here,is on me..Im the dummy...please dumb it down??Notice,I stopped cursing for you....Thats just what guys do...This is a support group? I think? Goodman