Parabola
01-17-2009, 04:25 AM
[QUOTE]Naltrexone is cheap, effective and requires no costly rehab. So why do so few doctors endorse it?
Pill Cocktail
Penny Wark
Mrs M, as she asks me to call her, isn't sure exactly when she last drank herself into a comatose state, but she knows it was about five years ago. At that time she got through a bottle or two each day - and not just wine, she explains. “It was the only way I knew to resolve a problem.”
When I spoke to her last week she had not had a drink for four days, though she expected to have a couple of glasses of wine with a meal on Friday night and the same on Saturday. “Oh yes, I still enjoy good wine. I savour wine. But there's no craving.”
For anyone who has encountered alcoholism, whether personally or through friends and family, Mrs M's win-win trouncing of her condition may sound too good to be true. We all know that the only way alcoholics can lead normal lives - as Mrs M does now - is to abstain, and that abstention must be absolute because alcoholics have a distressing habit of resuming their worst excesses after just one drink. Once an alcoholic, always an alcoholic and all that. So how has she done it?
The answer lies in the use of a drug called naltrexone, which Mrs M takes before she drinks. Naltrexone interrupts the pathways in the brain that enable alcohol to release pleasure-giving endorphins. As Matt, another naltrexone user and recovering heavy drinker, puts it: “With naltrexone, it's weird. You drink and you feel the effect of the alcohol but it doesn't have the magic.”
Related Links
* Am I an alcoholic?
* Home detoxing my alcoholic friend
If, each time you engage in a behaviour that releases endorphins, you strengthen that behaviour, it follows that if you engage in the behaviour and don't get the endorphin release, you weaken the urge to use it. Thus, unburdened by a craving for alcohol, a former heavy drinker can use alcohol with control.
That is the theory and this treatment for alcoholism is called the Sinclair Method, after David Sinclair, the scientist who discovered it and who claims a 78 per cent success rate over three to four months. The measure of success is controlled drinking within normal safety limits, or abstinence.
In Finland, where Sinclair works at the National Public Health Institute, his method has become part of the mainstream treatment for alcoholism, used by 100,000 people since 1995, he estimates. In the US it is used by 2 per cent of doctors who treat alcoholism. In the UK, however, naltrexone is licensed for the treatment of heroin addiction but not alcoholism (though it is available on private prescription) and Mrs M, who lives in Scotland, is fortunate to have an enlightened doctor who has sought permission to use it to treat alcohol problems for about 50 carefully selected patients over the past ten years.
Two months ago a book championing the Sinclair Method was published in the US. Called The Cure for Alcoholism, it has sold a few thousand copies but received no media coverage. In it the author, Roy Eskapa, a psychologist who has worked with Sinclair since the 1990s, hails him as a genius who deserves a Nobel prize for finding a cure for the world's biggest killing disease. According to the World Health Organisation, alcohol addiction kills 1.8 million people a year, and in the UK the British Medical Association estimates that one adult in 25 is alcohol-dependent. Sinclair's work could change the way in which society perceives addiction, making it a treatable condition rather than incurable, Eskapa maintains.
His claims are big - preposterous, some would say. But perhaps the most remarkable aspect of this story, which began some 40 years ago, is that while Sinclair can name 76 clinical trials that prove the efficacy and safety of his method, most alcohol addiction professionals don't know about it, or reject it. “I cannot help remarking that anyone who claims to have found a ‘cure for alcoholism' cannot be taken seriously,” says one of the UK Government's eminent advisers on alcoholism.
To understand why the Sinclair Method is often ignored, we need first to look at how Sinclair made his discovery. In 1964, as an undergraduate at the University of Cincinnati, he was involved in research on alcohol and rats. Given rats that had been denied alcohol for two weeks, he decided to test a theory and gave them a choice of an alcohol solution or water. Even though it was daytime, a rat woke up and “started drinking the alcohol solution almost out of my hands”, says Sinclair. The other rats joined in. After more studies, Sinclair began to see that the more the rats were deprived of alcohol, the more they craved it.
“Nobody had seen motivation for alcohol in a rat before,” he says. “This changed the understanding of what causes alcoholic drinking. At that time almost everybody in the field accepted that there wasn't enough pleasure from drinking alcohol to make an alcoholic drink. The pleasure didn't match the unpleasantness, so they theorised that the craving was caused by withdrawal symptoms, by physiological dependence, and all alcoholics were drinking to avoid withdrawal. So the main treatment was to get rid of the physiological dependence - you sent them to rehab with the idea that they would come out and have no reason to drink. If dependence was the cause, it should have been a cure, but it isn't.
“So we starting rethinking what causes alcoholism. It is learnt. A person isn't born an alcoholic but every time they drink there is a release of endorphins. For genetic reasons some people have very powerful receptors for endorphins, get a lot of reinforcement from the alcohol and have a high risk of developing alcoholism. The neural structure that is causing this behaviour, and the craving, gets stronger each time they drink, and with some people it becomes so strong that they can't control it. The only solution is somehow to weaken the behaviour that is so powerful.”
Sinclair moved to Finland in 1972 and, after many more studies, he decided that the best drug to extinguish alcoholic craving was naltrexone. It is not addictive, it has been proved to be safe in 50mg doses, it does not require detoxification because it reduces craving slowly, and it is cheap - about
Pill Cocktail
Penny Wark
Mrs M, as she asks me to call her, isn't sure exactly when she last drank herself into a comatose state, but she knows it was about five years ago. At that time she got through a bottle or two each day - and not just wine, she explains. “It was the only way I knew to resolve a problem.”
When I spoke to her last week she had not had a drink for four days, though she expected to have a couple of glasses of wine with a meal on Friday night and the same on Saturday. “Oh yes, I still enjoy good wine. I savour wine. But there's no craving.”
For anyone who has encountered alcoholism, whether personally or through friends and family, Mrs M's win-win trouncing of her condition may sound too good to be true. We all know that the only way alcoholics can lead normal lives - as Mrs M does now - is to abstain, and that abstention must be absolute because alcoholics have a distressing habit of resuming their worst excesses after just one drink. Once an alcoholic, always an alcoholic and all that. So how has she done it?
The answer lies in the use of a drug called naltrexone, which Mrs M takes before she drinks. Naltrexone interrupts the pathways in the brain that enable alcohol to release pleasure-giving endorphins. As Matt, another naltrexone user and recovering heavy drinker, puts it: “With naltrexone, it's weird. You drink and you feel the effect of the alcohol but it doesn't have the magic.”
Related Links
* Am I an alcoholic?
* Home detoxing my alcoholic friend
If, each time you engage in a behaviour that releases endorphins, you strengthen that behaviour, it follows that if you engage in the behaviour and don't get the endorphin release, you weaken the urge to use it. Thus, unburdened by a craving for alcohol, a former heavy drinker can use alcohol with control.
That is the theory and this treatment for alcoholism is called the Sinclair Method, after David Sinclair, the scientist who discovered it and who claims a 78 per cent success rate over three to four months. The measure of success is controlled drinking within normal safety limits, or abstinence.
In Finland, where Sinclair works at the National Public Health Institute, his method has become part of the mainstream treatment for alcoholism, used by 100,000 people since 1995, he estimates. In the US it is used by 2 per cent of doctors who treat alcoholism. In the UK, however, naltrexone is licensed for the treatment of heroin addiction but not alcoholism (though it is available on private prescription) and Mrs M, who lives in Scotland, is fortunate to have an enlightened doctor who has sought permission to use it to treat alcohol problems for about 50 carefully selected patients over the past ten years.
Two months ago a book championing the Sinclair Method was published in the US. Called The Cure for Alcoholism, it has sold a few thousand copies but received no media coverage. In it the author, Roy Eskapa, a psychologist who has worked with Sinclair since the 1990s, hails him as a genius who deserves a Nobel prize for finding a cure for the world's biggest killing disease. According to the World Health Organisation, alcohol addiction kills 1.8 million people a year, and in the UK the British Medical Association estimates that one adult in 25 is alcohol-dependent. Sinclair's work could change the way in which society perceives addiction, making it a treatable condition rather than incurable, Eskapa maintains.
His claims are big - preposterous, some would say. But perhaps the most remarkable aspect of this story, which began some 40 years ago, is that while Sinclair can name 76 clinical trials that prove the efficacy and safety of his method, most alcohol addiction professionals don't know about it, or reject it. “I cannot help remarking that anyone who claims to have found a ‘cure for alcoholism' cannot be taken seriously,” says one of the UK Government's eminent advisers on alcoholism.
To understand why the Sinclair Method is often ignored, we need first to look at how Sinclair made his discovery. In 1964, as an undergraduate at the University of Cincinnati, he was involved in research on alcohol and rats. Given rats that had been denied alcohol for two weeks, he decided to test a theory and gave them a choice of an alcohol solution or water. Even though it was daytime, a rat woke up and “started drinking the alcohol solution almost out of my hands”, says Sinclair. The other rats joined in. After more studies, Sinclair began to see that the more the rats were deprived of alcohol, the more they craved it.
“Nobody had seen motivation for alcohol in a rat before,” he says. “This changed the understanding of what causes alcoholic drinking. At that time almost everybody in the field accepted that there wasn't enough pleasure from drinking alcohol to make an alcoholic drink. The pleasure didn't match the unpleasantness, so they theorised that the craving was caused by withdrawal symptoms, by physiological dependence, and all alcoholics were drinking to avoid withdrawal. So the main treatment was to get rid of the physiological dependence - you sent them to rehab with the idea that they would come out and have no reason to drink. If dependence was the cause, it should have been a cure, but it isn't.
“So we starting rethinking what causes alcoholism. It is learnt. A person isn't born an alcoholic but every time they drink there is a release of endorphins. For genetic reasons some people have very powerful receptors for endorphins, get a lot of reinforcement from the alcohol and have a high risk of developing alcoholism. The neural structure that is causing this behaviour, and the craving, gets stronger each time they drink, and with some people it becomes so strong that they can't control it. The only solution is somehow to weaken the behaviour that is so powerful.”
Sinclair moved to Finland in 1972 and, after many more studies, he decided that the best drug to extinguish alcoholic craving was naltrexone. It is not addictive, it has been proved to be safe in 50mg doses, it does not require detoxification because it reduces craving slowly, and it is cheap - about