The Cure for Alcoholism - Drink Your Way Sober Without Willpower, Abstinence, or Discomfort - New Book by Dr Roy Eskapa with a Foreword by Dr David Sinclair, National Public Health Institute, Helsinki, Finland. Available from Bookstores and on Amazon now.

Drink Your Way Sober: The Medical Treatment From Finland Backed By Seventy Clinical Trials That Will Save Millions …

The Cure for Alcoholism: Drink Your Way Sober Without Willpower, Abstinence or Discomfort by Roy Eskapa, PhD with a Foreword by David Sinclair, PhD - (Finnish National Public Health Institute, Helsinki, Finland)

Published by BenBella Books, Dallas, Texas, September, 2008

The Cure for Alcoholism delivers exactly what millions of alcoholics have been hoping for – a painless, dignified, and medically proven cure for their addiction.  Backed by over seventy clinical trials the Sinclair Method deploys an opiate blocking medication, naltrexone, in a very specific way - in combination with ongoing drinking – to permanently extinguish the addictive 'software' in the brain.  Like removing an unwanted computer program, the de-addiction process literally rolls back the addictive mechanism in the brain to its original pre-addicted state - before the first drink was consumed. That's why it is a cure.

What's more, the treatment avoids dangerous withdrawal allowing patients to detox gradually and safely while they are still drinking. This removes the need for expensive and unpleasant inpatient withdrawal regimes. Craving and actual drinking levels automatically decrease until control over alcohol is restored. The bottom line is that patients drink themselves sober according to a simple yet powerful formula known as pharmacological extinction: Naltrexone + Drinking Alcohol = Cure. So long as patients abide by the formula and never drink without taking Naltrexone (a safe, non-addictive,  approved medication) and avoid taking naltrexone when not drinking, the Sinclair Method will do for society's costliest disease what Jonas Salk's vaccine did for polio, or what anti-biotics do for infection.

The Cure for Alcoholism is not great news for the $6.2 billon dollar drug and alcohol rehab industry, but it is wonderful  news for anyone who wants to gain control over their drinking.  

Advance Praise :  

"The Cure for Alcoholism provides something that's never been offered before... the potential of A REAL CURE.  This book does not deal with prayer, will power or abstinence. This is the first book and program I've seen that genuinely offers to modify an addiction that is neurologically rooted and thought by so many to be incurable.  I believe that The Cure for Alcoholism  will change the face of this serious addiction and rock the rehab industry. "  Professor Arnold A. Lazarus, Ph.D.  

Arnold A. Lazarus, Ph.D. is a Distinguished Professor Emeritus of Psychology at Rutgers University (having also been a faculty member at Stanford University, Temple University Medical School, and Yale University where he was the Director of Training in Clinical Psychology for two years).  He has written 17 books and over 350 professional articles and has been the recipient of numerous honors and awards.  He is a Diplomate of the American Board of Professional Psychology and was also awarded Board Certification.

The Cure for Alcoholism is the first authoritative book on pharmacological extinction or the Sinclair Method as it has come to be known - see Wikipedia The book represents a major break-through in addiction science and it is being hailed as a life-saver for millions of alcoholics.

Each year 105,000 Americans die from alcoholism, 18 million have their health damaged by it, and the cost to the nation approaches $200 billion.

The cure for this terrible affliction is revealed in this definitive and ground-breaking new book by Dr Roy Eskapa - The Cure for Alcoholism: Drink Your Way Sober Without Willpower, Abstinence or Discomfort - which rejects the pervasive belief that alcoholism is incurable without total abstinence.

Instead The Cure for Alcoholism publishes a detailed account of 70 major clinical trials which prove beyond doubt how the Sinclair Method removes the underlying biological cause of craving and compulsive drinking in the brain. The treatment has an outstanding 80 % success rate and offers a safer, kinder and far more cost-effective solution than previous techniques.

The Sinclair Method involves always taking a safe, non-addictive, FDA approved opiate blocking medication called naltrexone before actually drinking any alcohol.

It is widely accepted that alcoholism is the result of the combination of a natural genetic predisposition for alcoholism combined with learning the addiction over many years. The addiction occurs as a result of endorphins – the brains own opiate or morphine-like substances – being released each time alcohol is consumed. Each drinking session releases endorphins which in turn reinforce the behavior. The result is super-strengthened opioid pathways in the brain. These addictive pathways become permanent and they cause an increase in craving the longer alcoholics attempt to abstain from alcohol. The longer they abstain or are deprived of alcohol the more alcoholics crave alcohol.

This phenomenon was identified as the Alcohol Deprivation Effect by Dr David Sinclair in the late 1960s. It is now widely accepted by leading alcohol researchers as the major reason why 85 per cent of alcoholics in standard abstinence-based treatments soon relapse back to heavy drinking - because the addictive craving  pathways remain intact as the patient tries to abstain. Eventually after a period of deprivation from alcohol the craving peaks and the alcoholic inevitably relapses back to heavy drinking. Fortunately, Dr. David Sinclair and his team working for the Finnish government discovered a way of actually removing the addictive pathways in the brain. This profound discovery, known as pharmacological extinction, took thirty years to reach patients in need.

By using naltrexone to block the effects of endorphins released when alcohol is consumed, the addictive pathways in the brain are gradually removed. Eventually, after several weeks of treatment the pathways are trimmed back so that both craving and actual drinking levels are naturally reduced and control over alcohol is restored.

The problem drinker or alcoholic is then able to either choose to continue drinking within safe limits, or to abstain altogether. Dr. Eskapa presents the formula for de-addiction as: Naltrexone + Drinking = Cure - a revolutionary concept supported by the clinical trials. This stands in stark contrast with the way naltrexone many patients have been previously been instructed in the use of naltrexone - together with abstinence. As the clinical trials described in the book prove, naltrexone is utterly ineffective if taken with instructions to abstain from alcohol. If you give naltrexone to patients with instructions to abstain, the medication has no effect on craving and addiction and the patients will inevitably relapse.  In other words:Naltrexone + No Drinking Allowed = Failure.

The book describes a five-step method for the reader and offers a chapter for doctors showing exactly how to prescribe naltrexone properly – together with alcohol, not with instructions to abstain. The Five Steps presented in the book equip the reader with a blueprint to break free from compulsive drinking. Dr Eskapa says, “Curing your addiction and regaining control over alcohol is not complicated. It does not require abstinence. But it does require meticulous preparation before, during, and after treatment. The Five Steps do not demand complex psychosocial therapy or an examination of the past to find out why control over alcohol was lost. Unlike standard rehab treatments, there is no insistence on intensive psychotherapy, the trauma of inpatient detoxification programs, withdrawal, or white-knuckling it through arduous abstinence for the rest of one’s life.”

The Five Steps guide the reader through the de-addiction process as follows:      
Step One - Understand and think about addiction in an entirely new way.

 Step Two - Check the severity of the problem and find out if help is required. 
Step Three - Working with a physician to obtain a prescription for naltrexone.

 Step Four - Learn about alcoholic beverage measures and keep a record of drinking and craving as the journey through de-addiction begins. Now the patient is taking naltrexone before drinking alcohol. As he or she become de-addicted craving and drinking levels gradually and automatically decline.  Step Five - The cure takes about three months. Now the goal is to stay cured once the program is completed. REMEMBER THE GOLDEN RULE: "Never drink alcohol without first taking Naltrexone. If you don’t you could become re-addicted within several weeks."

Once patients have successfully completed the treatment they are no longer "alcoholics in recovery" because they have recovered. In other words, patients no longer have to face a persistent, life-long battle against craving and relapse back to heavy drinking since the opioid pathways driving the addiction in the brain and nervous system have virtually been cut back to their pre-addicted or pre-learned state. The opioid system in the brain resembles the condition it was in prior to having the first drink that lead to learned alcoholism.

In summary, The Cure for Alcoholism offers readers: An insightful introduction by Dr. David Sinclair (National Public Health Institute, Helsinki, Finland)

The story behind how the cure was discovered - from theory to laboratory to a practical cure – and future applications against other drug and eating addictions Hard evidence behind the program: more than 70 proven clinical trials are summarized in the appendix

Testimonials from former alcoholics who have been cured Interviews with doctors and patients from clinics around the world who have adopted this method

A precise description of the five steps toward cureA chapter for doctors on how to prescribe naltrexone for alcoholism and the clinical data in support of pharmacological extinction The Cure for Alcoholism offers problem drinkers, health professionals treating alcoholics, and those families helplessly afflicted by the addiction of a loved one a revolutionary and medically proven formula for a cure.
Book Details: Title: The Cure for Alcoholism: Drink Your Way Sober without Willpower, Abstinence or Discomfort

Author: Roy Eskapa, PhD
Foreword by David Sinclair, PhD
Publisher: BenBella Books, Distributed by Independent Publishers Group; BenBellaBooks.com; and Amazon.com Publication: September 15, 2008, $14.95, Trade, ISBN-13: 9781933771557 Alcoholism 274 pages, 6 x 9 www.TheCureForAlcoholism.com

Two Case Histories from The Cure for Alcoholism

Julia’s Story:

Sinclair “Deluxe”

Treatment

 “The most astonishing thing about miracles is that they happen.”
—G. K. chestertoN (1874–1936)

ALTHOUGH INTENSIVE PSYCHOTHERAPY is not a requirement for successful treatment, Julia’s story has been included because it provides an insight into both the theory and practice of the Sinclair Method and, at the same time, illustrates how the treatment can be enhanced through close, one-to-one contact with competent, caring professionals.

Julia, a thirty-eight-year-old woman, and her devoted husband, James, have been married for eighteen years. They live in a beau­tiful lakeside house in the Pacific Northwest together with their two adolescent daughters. A little more than two years ago, Julia lost her ability to control her drinking. Although she could sus­tain periods of abstinence, she frequently found herself craving alcohol, especially by the end of the week. The family became accustomed to Julia getting drunk at parties and on Friday and Saturday nights. But when episodes of severe intoxication spilled into the week as well, her features thickened and her delicate, luminous complexion turned rough and pallid. She began taking “hair of the dog” drinks on Monday mornings after everyone had left the house.

A gifted potter, Julia once ran a successful small pottery busi­ness from a studio at her home. But her studio was now a mess, and she no longer used it. James, a highly respected lawyer and a passionate conservationist whom everyone thought of as a gentle soul, could not stop himself from quarrelling with her over her drinking. He had always adored her, but their once near-idyllic life had come to resemble a war zone. Horrified to find himself contemplating divorce, he implored her to seek professional help, but she angrily refused.

“I just have to drink,” she told him. “I don’t know why. You can all leave me if you want to; I just can’t stop it.”

A few days later, James read a newspaper article about the Sin­clair Method. He nervously contacted the clinic in Florida that was offering this new treatment. He explained that his wife was terri­fied because she had heard that addicts were hospitalized, forced to stop drinking and attend group meetings, and go through the torture of detoxification. She had also heard that many people who had gone to rehabilitation were often not only unsuccessful, roller-coasting between abstinence and relapse, but were often left feeling even more desperate after treatment. The trained recep­tionist explained that the Sinclair Method was different, a com­pletely new approach that did not demand total abstinence, and she sent James an information packet describing the treatment.*

The skillfully worded packet went a long way toward persuad­ing Julia to see a doctor at the clinic. “No one is born an alcohol­ic,” one brochure in the packet explained. “Drinking is gradually learned. Each time you drink, alcohol causes the release of en­dorphins or morphine-like substances in the brain.” Endorphins are the body’s “molecules of emotion” and can suppress pain. The

endorphins strengthen or reinforce the drinking and everything that goes along with it—thinking about alcohol, going to the bar, wanting a drink, ordering it, waiting for it, and finally, drinking it. This happens to everyone but some people, because of their ge­netic make-up, receive more powerful jolts of reinforcement from the endorphins. Over time, alcohol begins to dominate their lives, and they end up out of control—totally addicted to alcohol. But, the brochure explained, the vicious cycle can be broken or weak­ened through the “natural process of extinction using the medi­cine naltrexone to block the endorphins and the reinforcement they produce in the brain.”

The entire family read the information packet. They learned that the treatment did not require hospitalization. This was especially encouraging to Julia, who hated anything to do with hospitals. She read that her goals would be “reduction, control or abstinence” and that she need not abstain before beginning treatment. The treatment would reduce her desire to drink while she continued to drink! The clinic’s brochure explained that the drinking would decrease, not because of external demands or threats, but because the patient would simply lose interest in it. Using an approach that is entirely compatible with that of Alcoholics Anonymous, the Sinclair Method “works well for both people who are severely addicted, and for those who merely drink more than they would like.”

This seemed too good to be true to Julia, but she was encour­aged by the fact that she would not be given strong medications, such as barbiturates or benzodiazepines, which can be addictive. Julia also learned that the World Health Organization and the FDA had already reported that naltrexone was safe and did not produce lasting or serious side effects when it was used together with alco­hol. The treatment, which normally takes between three and four months, was not to be undertaken without a doctor’s prescription. Individual therapy was not always required, but could be helpful as part of a comprehensive treatment program. Julia and her fam­ily agreed that she should make an appointment at the clinic.

Her first appointment was not what she expected. The staff at the clinic treated Julia with dignity and did not label her as a

“weak-willed alcoholic.” Julia was told that she would be seen by a team consisting of a physician, Dr. Anderson, and a counseling psychologist, Dr. Simon. Having two primary caregivers, she was informed, was not necessary but could be helpful.

At Julia’s first screening session, Dr. Anderson explained how she had become addicted to alcohol. He decided to accept her for treatment, saying, “The Sinclair Method is not for those who are currently abstinent.”

“You mean to say that if I were in A.A. already for a few months and not drinking at all, I would not be able to have this treat­ment?” Julia asked, astonished.

“That’s right,” Dr. Anderson smiled, “The treatment is only for those who are currently drinking. It only works if you take the med­ication an hour before you have your first drink. We do not prescribe this treatment for those who are abstinent.”

“Well, it’s a good thing I am drinking, isn’t it?”

“Until I saw Dr. Sinclair’s research data, I never would have thought this possible,” Dr. Anderson replied. “We’ve treated a few hundred cases, and the results are excellent!”

In addition to the standard psychotherapeutic approach of “inspiring hope,” Dr. Anderson made certain that Julia was not pregnant, did not have a medical condition that would make her unsuitable for treatment, and was not taking other opiates, such as heroin. As a final precautionary measure, Julia was scheduled for lab work to test for any undiagnosed medical problems.

From the start, Julia was impressed by the nonjudgmental ap­proach of her doctor. She felt a faint flutter of hope. “These people really care,” she thought. “They really are trying to help me.” She was also impressed by the visual aids Dr. Anderson showed her, detailing the connections and pathways in her brain that had be­come strengthened over years of drinking. Julia said later that she felt better knowing that there was “something physically wrong in my brain and nerves and not me as a person. The way my drink­ing had become worse over the years suddenly made sense to me. After all, I didn’t start out with this craving. I certainly never drank in the mornings, or binged. Before I became addicted, I used to drink quite moderately.”

Julia took James to her next appointment with Dr. Anderson. He checked the Drinking Diary he had given her at their first meeting and conducted a medical examination. Julia had not been drinking every day since her initial screening visit, but her diary did show bingeing: well over sixty drinks per week, with most of it concentrated over the weekend. “I just can’t stop after the first drink. Why, doctor? Why?” She then saw some biological draw­ings depicting how addiction had been “burned” into her brain over years of drinking through the mechanism of reinforced learn­ing.

(Please see the images and explanation in Appendix B.)

The biological or “Purple Rain” drawings—as Dr David Sinclair calls them—showed how alcohol causes endorphins to reinforce drinking, so that the nerve pathways become stronger. The next set of drawings showed how taking naltrexone before drinking would ultimately extinguish her addiction. For Julia, these draw­ings placed things in perspective, and she was relieved and thank­ful that the cause of her problem was not personal weakness but “brain biology.” Her genetic predisposition for alcoholism and many drinking sessions over the years had combined to make her an alcoholic.

The learning was connected to stimuli. She learned to drink in response to various external or internal stimuli. These stimuli thus gained the ability to make her crave and drink alcohol. One set of stimuli always present with every drink except the first one of the day are the sensations produced by the alcohol already con­sumed, including the taste, smell, and feel, and the stimulatory ef­fect produced by low doses of alcohol. Julia learned that was why the first drink made it almost impossible to stop. Her drinking was learned, and much of it had been learned as a response to the stimuli produced by the previous drink.

“I was just better than others at learning drinking,” Julia ex­claimed.

Dr. Anderson said that the situation could be corrected in a mat­ter of months—without willpower or even trying to stop drinking. “All I had to do to beat this thing was to take one of those white tablets before having a drink,” she thought to herself later on.

To James, it seemed a dangerous contradiction to encourage an alcoholic to carry on drinking—even after taking naltrexone. Emotionally, he still reacted by hating the fact that his wife had be­come an alcoholic, that alcohol was destroying their lives. Surely Julia should stop drinking immediately? But James finally grasped the theory. He was even more optimistic when he was shown the reduced craving and drinking results compiled from other suc­cessful patients.

Dr. Anderson gave Julia her prescription for naltrexone, and he informed her that this was not a “get sober” medication—she should not operate machinery or drive while drinking. Looking at the tablets in her hand, Julia still wondered if they could actually help her. As directed, Julia started out by taking her first dose (25 mg) an hour before taking her first drink. Two days later, an hour before her next drinking session, she took the full (50 mg) dose.

“I didn’t really notice anything much,” she told her psycholo­gist, Dr. Simon, at the next meeting. “Perhaps there was a bit less of a buzz, but I can’t be sure.”

Dr. Simon was supportive. “There are no right or wrong reac­tions,” he said.

She handed in her Drinking Diary and the Visual Analog Scale (VAS) form, which tracked her craving on a scale from 0 (no crav­ing) to 10 (highest craving). Drinking was slightly down at forty-six drinks for that week and her craving was in the high range— naltrexone was not a “magic pill” and did not work overnight. Julia was still seriously addicted to alcohol.

“The Golden Rule,” her psychologist repeated, “is that you al­ways take the medication an hour before drinking. The fact that you reduced your drinking by a few drinks this week is because, by blocking the effects of endorphins, the naltrexone reduced the stimulatory or first-drink effects of alcohol. Extinction has started, but you still have a way to go. You have just begun treatment. keep going.”

Julia was thrilled that she had had less to drink because it gave her more than just a flutter of hope. The session involved an ex­planation of stimuli or triggers that elicit craving and drinking. When asked about her drinking history and the situations that set

off her drinking, Julia explained, “I found that I started as a way to enjoy myself or relax on weekends. I loved it when the kids were small, tucked up in bed, and James and I could be alone. It was so romantic to be in front of the fire with a bottle of red wine. Red wine, that’s my favorite. Drinking seemed to improve our lovemak­ing and took the inhibitions out of me. And that’s when I started drinking socially, which is interesting because I didn’t drink as a teenager. Now I don’t even need an excuse; I drink out of habit.”

Julia told Dr. Simon that when she first began drinking, par­ties were major triggers for getting drunk. James dreaded them. He thought Julia was being selfish when she drank too much. He didn’t know that her brain biology would not allow her to keep her promise not to drink. It was during this session that Julia learned about the specific triggers that caused her to drink. Over several years, she had come to associate drinking with many situations. The therapy would require that Julia drink while on the medica­tion in all the situations in which she normally drank—privately at home, in social situations, through all seasons, in the morning, afternoon, and evening—whenever she was accustomed to drink­ing. She had to use naltrexone to extinguish her addiction with every drinking situation.

“Just wait till I tell the family about all this,” she told Dr. Simon. “My drinking had become a secretive, private matter. It was like a love affair, taking precedence over the things I most treasured. I am beginning to understand why my drinking was more imp or­tant to me than my wonderful family. It was because my brain took over and ran the show.”

“Once we have your drinking under control or you have reached your goal in a few months, we will still want you to keep your medication with you at all times—just in case your craving returns and you have the urge to drink. But, for the moment, let’s proceed with you taking your medication and drinking. Go home, take your medication, and drink as usual. Remember to keep up with your Drinking Diary. We can discuss options of where and when to drink at your next session. Though before we meet, you will have a short meeting with Dr. Anderson.”

The next meeting with Dr. Anderson lasted only ten minutes.

Julia was asked if the medication had any side effects, but there were none to report. She handed in her Drinking Diary and her subjective craving level was assessed. The number of drinks per week and her craving levels were still high. She was also given standard research questionnaires. The Beck Depression Inventory evaluated depression. The Obsessive Compulsive Drinking Scale assessed her thought patterns related to drinking.

Her next counseling session two weeks later with Dr. Simon was designed to help her prepare for the future. Julia’s drinking habits were explored. “Everyone has their unique triggers,” Dr. Si­mon said. “I see from your diary that your drinking is down a bit, from forty-six to thirty-eight drinks this week. Normal progress.”

Julia still found that she wanted to drink on her own as well as on social occasions. “I am so grateful that my family understands that I have to drink to be cured,” she said to Dr. Simon. “It was a hard one for my daughters to understand. Now they are even pleased when they see me with a glass in my hand! They know how the medication and treatment works.”

“Be alert for the festive season, for emotional triggers, for any situation in which you normally would drink,” Dr. Simon remind­ed her. “And above all, remember our golden rule—never drink without first taking naltrexone!”

The session ended with Dr. Simon saying that a support group for patients had started and that Julia was welcome to join it. Julia did not feel this was for her.

By the end of the eighth week, Julia’s drinking had dropped to twenty-three drinks per week. This was good progress, but still a bit above the safety limit for women. She told Dr. Anderson what had been happening in her life: “James and I are getting on bet­ter already. We actually made love for the first time in ages! I no longer stumble into things. For one thing, my knees are better because I’m not bumping into the glass coffee table. My hangovers have lessened. I am actually enjoying my non-drinking days. Last weekend we all went for a picnic. I had my naltrexone and a bottle of nice California red wine with me. But I didn’t open it. The girls were amazed, and James said I was being strong. The amazing, wonderful thing is that I was not being strong. My urge to drink

simply was not there. I wonder if it really is possible to stop alto­gether. I can see how it might be.”

Dr. Anderson noted that Julia still had three instances over the past two weeks where she had consumed more than five drinks in a single drinking session. He explained that she was doing well, but still had much of the neural circuitry that caused craving and drinking in line with her binge-style drinking. “Focus on enjoy­able activities on your non-drinking, non-medication days,” Dr. Anderson advised. “Your social drinking has diminished already, but I see that you are still drinking on your own—drinking less, but you still took more than five drinks one after the other on your own.”

Julia felt positive. She had begun to sense that control over alco­hol was within her reach. Her mood improved. She was optimistic and, for the first time in years, had a sense of purpose.

When she arrived home, the first thing she did was to go into her disused pottery studio at the end of her garden. She stood by the lake under a bright blue sky. The air was crisp and blazing fall colors reflected on the water. Julia felt happy and with that feeling came a sudden urge for a drink. Because, although she was happy, she was also sad. Sad that more than six years had gone by without doing much pottery. Sad because of what her drinking had done to her marriage and to her family. She looked at the disused trays, the dusty objects she had so lovingly crafted, painted, and fired. Then she reacted the way she did automatically under stress. She rushed to the kitchen and poured a stiff vodka. She knocked it back neat without having taken her medication.

In a state of panic, she called Dr. Anderson.

“Am I relapsing?” she asked urgently.

“When did you have the drink?”

“About fifteen minutes ago.”

“Take your medication as soon as you hang up. It will still have the chance to do some good. Don’t worry, Julia. The worst thing is for you to punish yourself. You will get there in the end.”

Julia followed his advice and took the medication. She returned to her studio carrying the bottle of vodka and her portable CD play­er. “What the hell,” she thought. “I may as well. I’ve taken my medi‑

cation.” She spent the next three hours listening to music while she cleaned the studio and threw out broken pieces of pottery.

Julia was startled when her eldest daughter, Sonia walked in.

“What are you doing here, Mom?” Sonia asked anxiously.

“Oh, nothing much. I thought I would clean the studio. I guess I’d better lock up, and get some dinner ready.” It was then that she noticed the bottle of vodka. She had not touched it—not once since the first drink. The thought of drinking had not entered her mind. Surprised and delighted, she told Sonia about it.

“You are coming back to us, Mom, you are coming back!” Sonia said, “Let’s tell Dad.”

Julia’s next appointment was with Dr. Simon, who had asked if James would be able to attend part of that session. The idea was to go over the treatment with James because he was so intimately involved with Julia.

“I can’t believe it, Doctor, I am getting my wife back,” James said. “She drinks, but not as much. She doesn’t get crazy. Her moods are better, right, Julia?”

Julia smiled and said, “I’m sure it’s working. But I still somehow think I need time. I don’t crave as much. I’m not fixated on getting my next drink.”

After four months, the Drinking Diary showed that Julia was drinking within safe limits—less than eighteen drinks per week and no more than four on any single occasion. Dr. Simon was cautiously optimistic. “You’ve come a long, long way, Julia,” he said. “We expected this. The great thing is that you wanted to stay on track. It would be best for you to continue with our therapy sessions. We can explore whether you wish to continue drinking with naltrexone or to abstain altogether.”

Six months later, Julia realized that her life was no longer be­ing controlled by her drinking. “Why then should I continue to drink?” she asked herself. She came to the conclusion that drink­ing was not for her. She was able to attend parties without drink­ing. She was happy to tell people that, after her Sinclair Method treatment, she thought it best for her to avoid alcohol. “By all means, you go ahead,” she told others at a party. “Most people can handle alcohol. I can’t.”

Julia keeps her naltrexone pills with her at all times, just in case the urge creeps up on her. Even now, after five years of complete abstinence, she is never without her naltrexone.

 

 

 Richard’s Story: The Sinclair “Lite” Method—Same Great

Success, Less Intensive

 

“Miracles don’t just happen, people make them happen.”

—Katsura

RICHARD’S CASE demonstrates that the Cure is successful with minimal intervention from doctors and therapists.

While I was on sabbatical in South Africa, I traveled to a lovely oasis town set among oak-lined streets in a valley surrounded by mountains. The people in South Africa are particularly friendly and hospitable, and it wasn’t long after we checked into our guest­house that we were invited to a party given by a local family we had met at one of the town’s bars.

It was a perfect summer evening. At the party, we got around to discussing Nelson Mandela’s brilliant achievements, other beautiful places to visit, and of course the wonderful South African wines. The conversation veered to the high levels of intoxication I had ob‑

served throughout South Africa. Alcoholism is also a problem in South Africa. At the party, I met Margaret, an attractive, friendly woman with a bold, direct gaze. As soon as she heard that I was a psychologist with an interest in addictions, she told me that her husband, Richard, was a severe alcoholic. “I didn’t know he was when I married him. I probably would never have married him if I had known,” she sighed. “I thought he simply liked his drink.”

“Have you been married long?” I asked.

“Five years and three months,” she replied. “This is my second marriage, but his first. I already had two kids when we married. My late husband was a great father. He died quite suddenly of can­cer. I decided to leave the city and move to a small country town. The school here is good, and I wanted my kids brought up in a clean and healthy environment. Then I met Richard and we fell in love. He’s been fantastic to my kids.” She clutched her necklace. “I didn’t know he was an alcoholic,” she said again.

“What do you mean by alcoholic?” I asked.

“He wakes up at 3 a.m. to start drinking again,” she replied. “It’s physically amazing. I wouldn’t have believed it unless I’d seen it for myself. He simply can’t stop. A real addiction.”

I noticed her twelve-year-old daughter Alice nodding in agree­ment. “Yes, he drinks all the time,” Alice said. “It’s terrible.”

“He’s a great guy,” Margaret said. “We all love him. He’s not like the other alcoholics I know. His personality barely changes when he drinks. He doesn’t become violent or nasty like so many others I’ve met.”

A short while later, when Alice had gone, Margaret spoke more openly. “Richard simply drinks all day long. I’m worried about his health. Our sex life is zero. There’s nothing we can do about it. I wish there was. He’s had seizures, and I’ve had to rush him to hos­pital. A few years ago, he managed to stay clean for six months. He’s been to the local A.A. and for meetings in other places. But he always goes back to drinking. Our doctor is a great guy but says he can’t help.”

At this point, I mentioned Sinclair’s work: “Thousands of alco­holics have already been successfully treated for this addiction,” I told her.

“I beg you, I implore you, please tell us if there is anything like this out here. Personally, I find it hard to believe that anything can help, but I’m ready to try anything. You see, I think Richard is dy­ing.” Her voice dropped to a whisper. “I’m sure that if he goes on like this, he’ll die.”

I quickly explained how the Sinclair Method works, how the patient must be medically evaluated before treatment with nal­trexone. I made it clear to her that the method works only by com­bining the medication with drinking alcohol, and that there were dozens of published clinical studies in support of the treatment. I told her that Richard would need to keep a record of his craving, as well as a Drinking Diary. I ended by assuring her that there was every reason to be hopeful.

“Please, will you meet my husband?” she asked.

Richard was forty-five years old, yet looked much older. He had a ruddy complexion, was somewhat underweight, but otherwise looked healthy. He appeared to have a great deal of energy and was very friendly. He certainly believed he was well able to handle his drink.

“A bottle of wine is nothing for me,” he said. “Lots of guys lose their judgment after only a few drinks. I remember virtually everything that happens—except if I’ve had a blackout. I am an alcoholic. No question about it. I don’t deny it. If I try to stop, I get the shakes. Margaret says you have something that might help. I’m curious. As I’ve said a million times, I’ll try anything. I get up at 2 or 3 a.m. and start with my first drink. I hardly eat or sleep. My job is great because I run a pub so I can drink as much as I like, and I don’t have to worry about being fired.”

Richard and I arranged to meet the next day at his pub so we could discuss his situation in private. I met with Richard, and Margaret joined us after about an hour.

Richard had been able to stay sober for periods of about three months before relapsing. “I’ve been to A.A. I’ve done my ninety­day-every-day meetings. It’s a great idea and works for some guys. But I always end up relapsing. It’s those one or two drinks. The devil gets into me and I’m on a roll again. Of course I don’t like it.” A worried look settled on his face. “I love hiking in the moun‑

tains around here. I used to ride horses, take tourists on three-day trails. It’s been years since I last went out. I’m dying to see more wildlife. There are leopards and other amazing cats around here.” He stared moodily at his drink. “But I’m in the grip of this stuff. Then of course there’s Margaret. I love her kids as my own. I know I’m harming them, too.”

I began with the standard explanation of how the Sinclair Meth­od is being used to great effect in the United States, Europe, and Australia. It is well known that inspiring realistic hope is a power­ful therapeutic tool. So I went through a basic explanation about the scientific basis of how the treatment works. “You have an 80 percent chance of being successful, but you have to be conscien­tious about keeping accurate records, as well as always taking your naltrexone before you drink,” I said. “Besides all that, the fact that you really want help will go a long way toward being successful.”

I went on to explain that naltrexone was available in many coun­tries, and that it was now available in South Africa as an import under the name ReViaTM. Richard was eager to give it a proper try, and I suggested I speak with his doctor about the treatment.

Richard’s physician, Dr. Gordon, was very friendly and open. He grasped the fundamentals of the Sinclair Method within minutes. He even made fun of my repeating myself about how the medica­tion should only be taken if the patient drinks, that it should not be taken during periods when the patient is not drinking.

“It seems odd to me, but if you say the studies show it works this way, let’s go with it,” he said. He asked me to e-mail some medical publications on extinction to him and agreed to examine Richard, order blood tests, and provide a prescription.

I offered to support Richard by telephone and to see him again after about a month. In the past, he had been given diazepam (Va­lium) to calm his withdrawal symptoms, and his doctor was aware of this. Both Richard and his doctor knew that this treatment would require at least three to four months—perhaps even longer.

Margaret was especially supportive and involved, but was afraid of hoping too much. “If you can help us, I don’t know how I’ll ever be able to thank you,” she said repeatedly. “We’ll do exactly as you say. I only hope and pray it works.”

I informed her that it was up to Richard to be proactive, but that her involvement would be crucial. She was the most supportive of partners. Her love for Richard was obvious.

Prior to seeing Dr. Gordon to begin treatment, Richard kept a Drinking Diary. His drinking level was clearly way over the top; he took the equivalent of more than fifteen drinks per day—that’s more than one hundred drinks per week—the equivalent of three bottles of 12.5 percent wine every day. Yet despite this, his liver tests showed relatively mild elevations. Dr. Gordon found that his blood pressure was high enough to prescribe an antihypertensive medication.

Richard started out on half the dose of naltrexone—25 mg for the first two days. He then moved onto the recommended dose of 50 mg per day and experienced slight nausea over the next few days. After a week, Richard said, “I’m doing exactly as you say. I am taking the medication an hour before I have my first drink at around 3 a.m. I’m drinking about the same amount, perhaps a few drinks less per day. I feel less nauseated, though. May I call you next week?”

By the end of the second week, Richard reported, “I’m drinking less. In fact, on Wednesday and Thursday I didn’t drink anything.” He laughed suddenly. “No, I didn’t take my medication as you said not to take it unless I was drinking.”

“That’s exactly how extinction works. It doesn’t happen over­night,” I replied.

However, Richard’s journey was not entirely smooth. I received a frantic call from Margaret late one night about a month into treatment, “Richard’s hands are trembling, and he’s shaking all over. What if he has another seizure?”

“Call Dr. Gordon and explain that the symptoms may be related to his detoxification,” I said. “You see, he is gradually detoxify­ing. Even though he’s down to almost half his usual number of drinks, because of the sheer amount he has been drinking, he may be experiencing some withdrawal symptoms. If he were to stop abruptly—go cold turkey—we would probably have to hospital­ize him. But the Sinclair Method allows for a gradual reduction in drinking.”

Dr. Gordon concluded that the symptoms were related to with­drawal, and said that he could offer medication for that but would prefer not to. Richard was slowly going through withdrawal. Be­cause his drinking levels had been so high, it was both normal and expected that he would experience some withdrawal symptoms as he began reducing the amount he consumed. But because the Sinclair Method allowed for gradual withdrawal by continuing to drink while taking naltrexone, Richard’s symptoms were far less severe than if he had suddenly gone cold turkey. This is a major advantage of the Sinclair Method. By the end of the seventh week, Richard was drinking less than thirty drinks per week and had had several alcohol-free days.

“Don’t for one minute let yourself think that you are cured,” I said to him over the phone. Richard understood the idea behind selective extinction—that he should avoid hiking in the mountains while on naltrexone. Because endorphins are also released during vigorous exercise, he should not hike or ride on the same days that he takes his naltrexone. He should save his days off drinking and the medication for hiking and other positive activities.

By the end of the twelfth week, Richard was drinking well with­in accepted safety limits—less than twenty-four drinks per week, and no more than four drinks in a single drinking session.

“I just don’t feel like it,” he said. “I’m sleeping much better. My appetite has returned; just ask Margaret. I’m eating like a horse. I feel like I have begun a new life. The main thing is that my craving is far lower than it has ever been.”

After five months Richard felt that alcohol was not the major feature of his life.

“I can easily serve customers in my pub without having the least desire to drink,” he said, “I thought I might be less funny and entertaining, but that has not been a problem. The kids are pleased, and so is my fantastic Margaret.”

At seven months, Richard was hardly drinking at all. Yet he felt he was the kind of person who might occasionally want to have a drink in the future. “Yes, I know what you are going to say—never, ever, take another drink without first taking my medication.”

When I next saw him about a year later, Richard showed me

a gold cylindrical pendant made by a local jeweler. He wore it around his neck. He opened the cylinder to expose two naltrexone tablets. He laughed. “I know what you are going to say next.”

“What’s that?” I said.

“Never leave home without it,” he replied.

One of the main points about Richard’s case is that his treat­ment was successful with a limited number of one-to-one ses­sions. Richard also did not receive any conventional psychother­apy. At that time, the results of Project COMBINE, published in the Journal of the American Medical Association in May 2006, had not yet been published. It confirmed that patients could be treated with naltrexone in primary care settings without intensive psy­chotherapy. Nevertheless, it should be pointed out that this “lite” version is not always suitable for patients who have psychological problems in addition to alcoholism. Such patients may require ad­ditional psychotherapeutic support. Yet if Richard had not tried this way, he would most certainly have been left untreated in his idyllic country town. He would still be struggling with his drink­ing. He would still be reflexively waking up at 3 a.m. for a drink, his family would still be unhappy, and his health would still be deteriorating. Instead, he is healthy and enjoying the countryside on long hikes.