James, we must agree to disagree. I look at TSM as a big paradigm shift. The idea of telling alchohlics and alcohol dependent subjects to continue drinking runs counter to everything in addiction treatment and research. There are a few researchers out there who are pursuing the avenue of targeted naltrexone use. Have you run across this study by Kranzler et al in the J Clin Psychopharmacol. 2009 Aug;29(4):350-7.

Targeted naltrexone for problem drinkers.
Kranzler HR, Tennen H, Armeli S, Chan G, Covault J, Arias A, Oncken C.

This was done at the University of CT. I encourage you to read it in depth yourself. What I found interesting in this is at the 12 week end of study the targeted naltrexone group drank 19% less than the other treatment groups. This study was not published when Eskapa wrote "The Cure" but I find it interesting for a couple of reasons some scientific some trailblazing. Targeted naltrexone definitely showed a difference over the other treatment groups of daily NAL and targeted and daily placebo. I would characterize the effect as moderate. Now for the trailblazing analysis. Here is a quote from Bob3D in re: to your discussion with him about TSM effectiveness

Bob's experience at 12 weeks was almost exactly like the subjects in Kranzler's study. Slightly less than 20% decrease in drinking. Kranzler was on to something here but he just stopped a little too soon in this study. If he had carried this out for another 6-9 months and let extinction continue to work (if that what is really happening here) he may have been the one going to Stockholm. I doubt if he would give Sinclair any mention, however, because he doesn't even reference any of Sinclair's work in his references section. So this study now becomes part of the evidence in evidenced based medicine that targeted naltrexone is of moderate usefulness in reducing drinking. What happens to the study participants. Most likely they stop taking NAL and readdict themselves when they were so close to achieving what Bob3d and others have. You seem to have a wonderfully analytical mind and I enjoy your analysis of the research on NAL. If you use the evidence that is currently out there then at 12 weeks you should expect an approximate 20% reduction in your pre-TSM numbers. I hope you give it a little longer past then and see what happens. There are more things in heaven and earth, Horatio,
Than are dreamt of in your philosophy.

I am new to the Sinclair Method but I don't see ANY value in JamesCT's posts. These people are trying to make it work and he is trying to refute all of the findings. Again, where is the value in that?

Ok Refute this!! Im calling you out Orange! So refute that..prove a negetive..prove you are not agent orange?? if you are not,sorry..but as you said"you are not married to Tsm" well,some of us are..And while we are at it..30 drinks a week?? Dude if i could drink only 30 drinks a week,I would be cured already..I am not a lab rat..I get pissed when someone toys with me..So,here is my adress James or orange or whatever..839 HELENDALE ROAD..ROCHESTER NEW YORK 14609..stop by some time and we can finnish this conversation...God it makes me sick!! Im gonna start campaigning to have google shut u down also Orange..Good day...Goodman

Hi guys

somehow I missed this discussion before. Some quality posting here. I'd echo my support to James and Saint Vincent.

Goodman - I'm sure you've the best of intentions, but dude, take a deep breath before posting

As someone who has also gone back to the source papers listed in the book - I can confirm that many/most of them do not directly address TSM in any way. I think the best we can say is that the case is unproven in favour of TSM, but there is a body of positive evidence.
I've definitely experienced positive benefits, even if those stop short (at least till now) of my goal. Whether they are the result of a placebo effect or TSM itself, I'll be continuing the method for the foreseable future.

This is the first time I have read this Weekly Progress Report.

James: 1) This is a free forum and you don't need anyone's approval or anyone's permission to say what is on your mind. (Try that on soberrecovery.com).
2) I must ask though, how are you making conclusions so early in your treatment? You've been here a whole... almost 3 weeks. I had my doubts and significant criticism which are clearly documented in my weekly progress thread (I never deleted them and I will not delete them). Some of my worst days were in month 4. You're not even into week 4. Give it some time. There's much to gain and little to lose.
3) TSM... Placebo effect? give me a break! Many of us wind up here because we are trying everything attempting to discover something that works. I know I tried nearly everything, including the ultimate: Aversion Therapy, which has a high efficacy rate. I should have believed in that one. It makes you physically vomit after you drink. But I managed to find away around the Aversion Therapy and I went right back to my previous levels of drinking. Naltrexone and Baclofen were the last to try. 5 months into TSM, after I was making plans to try Baclofen after my 9 month TSM commitment, my drinking levels plummeted and at 6 months in I was at US NIAAA moderate drinking levels. Now a year later, I am abstinent because I don't feel like drinking. I never "tried" to stop on TSM. Look at my numbers or any of the folks on the "Cured" list that aren't here anymore. They are real numbers and TSM works. 78%? Not on this forum. Exact percentage? No idea. Greater than the 12-step AA voodoo 5%? Absolutely much better.

Goodman: Get a computer please. And please chill-out, if you can. These are just words.

saint vincent: Good posts! Especially the ones where you quote me.

Supplementary note to James: If and when you comment to this post, please PM me, because I don't spend much time here anymore, because TSM has given me my life back. Thanks, buddy!

Bob

EDIT: I added "if you can" to the chill-out comment, because I don't know what people's backgrounds or problems are. I thought of adding this comment as I was taking my hypomania meds. (Hypomania is the opposite of Depression). I remember when people used to tell me to calm down years ago. I couldn't, until I was properly diagnosed and eventually got the correct meds.

I really couldnt care less about what any study says, the only study I know anything about is my own. Results?, hell yea. In 6 months I havent fallen, I havent had any unexplained bruises,I havent blacked out, I havent been pissed out of my head, I havent woken up in any odd places in the house,I havent had a single row with Hubby about alcohol, I drink about a third of what I used to and even thats a struggle to get down at times. Placebo? I dont think so but if it i9s then all alcoholics should be on this particular pill for the placebo effect. Ive being tryng to cure my alcoholism for close on 15 years.

I really cant understand what all the nay sayers and negativity is about. Everyone here as far as I know are trying to cure their alcoholism with tsm and we are all here to get a bit of encouragement. Nobody is saying this is going to work full stop, what we are saying is tsm seems to work for a lot of people but if it doesnt there are other things to try. I personally would hate to have come across this thread my first or second week.

Each to their own, but I'd far rather read an honest thread where people voice their own doubts and explain their thoughts on the process.

To my eyes all James has done is (and this WHILE he is on TSM) is to cast a critical eye on the theory and the research. To my mind that is good for all of us as it makes us think and learn (and if you don't want to do those, then just don't read it). Scepticism is good and it is healthy, provided respect is accorded - which it certainly was here by James and Vincent.

I don't want to criticise individuals, but I'd have far more of an issue (although even this doesn't bother me much) with some of the other responses to this thread - which seem to me to be somewhat intolerant and 'shouty'. After all one of things that attracted most of us to this method is that it is a MEDICALLY based cure - not engaging in some circular arguments about higher powers and spiritual deficiencies. And furthermore this forum, unlike the likes of SoberRecovery or AA, allows debate and discussion.

Edit: One further point. The real benefit of the debate and critical analysis is not to those currently here. It is that it will help to either put together an unarguable case for future sufferers (assuming that TSM does work in the generality to the extent that Sinclair/Eskapa claim), or to put it in its proper perspective (if it has more limited benefit than claimed by the above two)

As you said 1 4 the road, each to their own, we are all entitled to our own opinion.

Interesting replies. As I have said, social support has benefits aside from any impact on AL intake.

I don't mean this in a snarky way, but people here looking for support only should just stop reading my posts. My naive view is that TSM is a medical therapy and it works or not on its own merits.

I have only been on TSM for 3+ weeks, but my posts have mostly dealt with the existing literature, which are not affected by anything I am doing. My analysis is not based on my experience or any anecdotes here, and are as legitimate as any outside observer.

I don't believe in the placebo effect, and I am supported by at least one meta-analysis from NEJM a few years ago. So I think that Bob, and other successful posters here, got real results from TSM. What is the cure rate? Compared to NAL given in the usual way? Compared to self-remission? We don't know. We need a well-designed clinical study. There are none to date.

The extinction model is true for rats bred for alcoholism, but there is no proof that this happens in human alcoholics. For example, a typical success in this forum is a rapid drop in AL, a plateau, and then another rapid drop. That does not conform to the animal model for exponential-decay extinction. Furthermore, in animals an extinction burst occurs very early and not months afterward. My conclusion is that TSM works outside of the extinction model.

St. V's reference seems to support TSM. I can only access the abstract, and I would appreciate if he can post the absolute numbers for AL intake among the treatment groups.

1-4: Thank you, thank you. But, I think you may be just an AA stooge like me

St> Vincent,

Thanks for the reference, but as I said I only have access to the abstract.

I am very puzzled about one finding. Targeted NAL use is superior to daily NAL. If TSM works by blocking pleasure as moderated by opioid receptors, then constant blockade should work just as well as intermittent blockade. Clinical results trumps theory, of course.

Does anyone look at Dr. Sinclair's work? I don't have access to the Citation Index, but it sounds like you may. In the past 5 or 10 years, what is Sinclair's score? (I won't ask about Eskapa, since I would guess he has no cites.)