Hi Folks,

I have noticed in a good few posts members talking about the extinguishing of triggers. Although I thought I had a reasonable understanding of The Sinclair Method (TSM), I have to confess that I don't fully understand what people mean when they talk about triggers being extinguished. Perhaps an example would help to illustrate my confusion...

As most members know, I have serious anxiety problems. So, it follows that my anxiety is a trigger that causes me to drink alcohol. However, TSM does not target anxiety per se. In other words, TSM will not extinguish those thoughts that give rise to the feeling of anxiety. Now, that's an example of one of my triggers but I'd be interested in getting a better grasp of what other people mean by 'triggers'. I really can't get my head around this; I think I have a basic problem with the terminology. I'm even having difficulty phrasing my question in a manner that people will understand. I hope I'm making some sense and that this isn't total gibberish.

Would someone care to enlighten me?

V.

my explanation would be as follows Virgil (although I'm very open to being corrected here).

Over time you've developed (as we all do) a pyschological association between certain events and drinking alcohol. This association gets reinforced because of the (somewhat) positive effect of alcohol on the body. Essentially your brain is learning that in a certain situation you feel a certain way, and that if you then take a drink you feel better (if only temporarily). When you encounter that situation and try not to drink, your brain screams at you "Hey, drinking here is good - remember!" - that is a trigger. The difficulty for alcoholics is that as well as the trigger (pyschological), there is a real, physiological craving - your body actually goes into withdrawal without it once you're addicted, so you have to drink. And when are you going to drink? When you meet a trigger. And the cycle repeats.

Just quitting alcohol cold turkey brings on all the physiological effects - the DTs etc (depending how dedendent you are), but they pass after a few weeks. You could 'titrate' - i.e. slowly reduce your consumption over a long period of time - to eliminate the drastic physical effects, but it takes a lot of discipline. But either way you're still left with the psychological triggers which prompt you to drink.

TSM works by keeping the association between alcohol and the trigger, but removing the reinforcement mechanism that alcohol brings in that situation. Thus your brain starts to relearn the relationship between the trigger and alcohol. You aren't getting the same 'hit' that you got before, so your brain encourages you to try something else. It is a bit like if someone said to us - hey have some celery! We might try it, but pretty quickly we're going to figure it isn't doing much for our feelings at the time, so it becomes easy to subsitute it for something else.

TSM gives us the chance to break the link with alchohol and find some other (healthier) way of dealing with our triggers/stresses

Hello Virgil,

I'd be hardpushed to "enlighten" you here as it's something that puzzles me too, but it's good to kick it around and ask even more questions .
What puzzled me first is that if tsm says we drink because of biological craving
one might imediately say well that's a constant so what real relevance do any triggers have because we'd drink regardless of them as the craving on its own is force enough .
So could we see triggers as an additional thing that habitually tips us toward the soup , the thing we really needed to be unable to any longer resist the craving ?
Or even just the reasons we give to ourself for drinking to justify it and give it an interpretation : even the reasons we imagine we drink ? ( though the real reason is craving )
I come away only thinking for sure that there are hard things we have to contend with in life and if drinking does subside we're left facing these things without alcohol .
If tsm works and removes our real biological craving although those so called triggers or nasty things still remain . Formally we drank on them even if they are not really what made us drink but we still reacted to them .
And I think this is it "reactivity " something that spurred a certain behviour
As the addiction process advances we find we still have this reactivity and keep reacting to "triggers ". For you it would be the state of anxiety . For me anxiety too,
days empty of resposnability , my daughter's destruction etc .
So it seems that on a behaviourhal level we could go on for a good while reacting badly until we've unlearned ( extinguished ) said redundant reflex .
One day the message will get through that drinking is not a good response to a trigger ....and why not .... ? I think that's the endorphin re enforcement .
Additionally the triggers we recognize as drink friendly spurs no longer get the the
endorphin reenforcement that's the chemical speak for the same unlearning .

Hi Folks,

Many thanks for the feedback. Things are starting to get a bit clearer. I'm coming round to thinking that we can't actually extinguish the triggers themselves; instead, we can perhaps extinguish our response to a trigger. Sorry if I appear to be pedantic in pursuing this topic but, when members use certain expressions, I like to understand what is being said otherwise I feel as though I'm missing out.

Would anyone else care to throw in their two cents (or two penneth, if you're in the UK)?

Thanks.

V.

I've already lost my luster.

Bob at the corner

To me, a "trigger" is anything that makes me want to drink. Friday night, Saturday night, fights with GF, being in a party mood, etc.; these are all triggers for me. The reason they are triggers is because through years of drinking, I have almost always consumed alcohol during these occasions. And when I did drink, endorphins in my brain produced by alcohol, kicked in during these times, giving me pleasure. So when my body is presented with one of these triggers, say a Friday night, my brain tells me it's pleasure time and I reach for the booze. In my mind Friday night = drinking. So Friday night is a trigger for me.

However, under TSM, when something triggers me to drink, I still drink, but the endorphins giving me pleasure are blocked. So, if I keep drinking on Friday nights for long enough on nal, the positive reinforcement, the endorphins, are blocked over and over again. Eventually, Friday will come and I will no longer instinctively think that Friday night equals endorphin rush night. And once that happens, my Friday night trigger will have been extinguished -- Friday will come and I won't instinctively think it's time for me to have a drink. That is the theory called pharmacological extinction and is the foundation of TSM. Except that we have thousands of triggers that need to be extinguished, not just one, so it takes months and months before you are cured.

I think the extinction Dr. Sinclair is talking about is slightly different than the extinguishing of triggers that is talked about on the board -- it's the last piece in a chain reaction started by a trigger.

The Sinclair Method uses pharmacological extinction. The nervous system strengthens behaviors that stop hunger, thirst, pain, or release endorphins, and extinguishes behaviors that no longer produce reinforcement. When we take Nal + Drink, extinction breaks the reinforcement behind the behavior (drinking).

This is a model showing a potential connection between a thought and a behavior:
Thought --->Mood--->Physical Reaction-->Thought-->Behaviour

Example:
Thought {Trigger} ("the kids never listen to me!")-->Mood (Irritated/anxious)-->Physical Reaction (Increased Heartbeat, blood pounding)-->Thought (I need a drink)-->Behavior (Drink)

I think extinction actually happens somewhere further down the chain, here -->,...so the brain no longer associates the action of drinking with any type of release and therefore we change what our resultant thought is and thus the behavior. We have to cycle through our triggers (love that analogy WTE) multiple times to break the behavior reinforcement in our brains...but we aren't actually extinguishing triggers, it happens a little further down the line. Important to note because the further into the addiction we get the more triggers we have...to the point where life or breathing itself are triggers (in essence there are no specific events that are triggers anymore, only that last piece in the chain: "I need a drink" --> Drink).


...all this to say I agree with Virgil's second post

My two penneth/pennies/cents.

I'll have to re-read Eskapa's book regarding this point. However, when I think of a trigger, I think of Pavlov's dog and classical conditioning. You give a dog food, he salivates by instinct. You pair a bell with the food enough, and eventually the bell itself triggers the saliva in the dog. The dog has learned to associate the bell with food and therefore salivates when the bell rings even without food. This is called classical conditioning -- the bell in this example triggers salivation. If you remove the food and continue to ring the bell, eventually ringing the bell alone will no longer produce the salivation from the dog. This is the plainest, simplest example of extinction.

I believe this applies with drinking. Whatever we are doing at the time we drink is much like the bell paired with the dog's food. Soon whatever we were doing at the time we were drinking, alone, without the drink, will cause us to crave the booze. I have been conditioned to want to drink on Friday night just as the dog hears the bell and salivates. The things we have done over and over again when we drink become triggers, in and of themselves, and make us want to drink.

This is my understanding anyway of triggers and is my two pennies. I think Pavlov's dog and the ringing of the bell is the easiest way to conceptualize a trigger.

Hi Folks,

OK, the way I now see this is as follows:

Triggers are events or situations in which we find ourselves; we refer to them as 'triggers' because they trigger a response to an event or situation and they do this by stirring up memories that we associate with a particular event or situation. As Nick says, classical conditioning. Since triggers are something that happen to us, we have little, or no control over them. This being the case, it follows that we can't extinguish (i.e. remove) the triggers themselves. Instead, TSM extinguishes our desire to drink, which is our response to a trigger.

Thanks to everyone whose feedback has helped to clarify this.

V.

Hey everybody, I don't want to beat a dead horse, but what I said is entirely correct. I'll briefly re-phrase what I have already said, but after listening to Dr. Sinclair speak, I'm correct regarding this point.

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.