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You should work with your doctor on this.
Benzodiazepines (like dazepam/valium) are often used in traditional detox to substitute for the depleted GABA levels that produce withdrawal (anxiety, shaking, the DTs) in the brain caused by heavy drinking can complicate de-addiction with the Sinclair Method.
The idea behind pharmacological extinction is that since you are currently drinking excessively you should always take naltrexone before you do. You have an 80 % chance (some say more) of gradually cutting back the biology - the circuitry - driving the addiction in your brain. If you stop drinking do not take naltrexone - this integral to the Sinclair Method (due to something called receptor up-regulation and because you will experience no benefit from naltrexone used with abstinence).
A word of caution: there is no way to extinguish craving for benzodiazepines - apart from gradually reducing the dose - so be very careful - and work with a good physician.
This is what we said in the book about detoxification:
Patients treated with the Sinclair Method are, in fact, slowly detoxified over the course of treatment. They start the treatment with a physiological dependence on alcohol, but after several months of gradually reducing their drinking, they are consuming so little that they no longer show withdrawal symptoms. Thus, giving naltrexone to drinking alcoholics can be viewed as a new, improved form of gradual detoxification.
Alcohol withdrawal is a severe condition, sometimes causing hallucinations, tremors, anxiety, depression, and seizures. It can even be fatal. The usual way to deal with severe withdrawal symptoms is to prescribe benzodiazepines like Librium® or Valium®. Although these drugs help with the withdrawal symptoms, there is the very real risk that the patient will become seriously addicted to these drugs. Inpatient detoxification is also very expensive. A study published in 1997 found the cost then ranged from $6,336
with no medication to $9,630 when both lorazepam and phenobarbital were used.37
It has always been known that the safest way to withdraw from alcohol would be to reduce the amount of alcohol taken each day slowly. Then the body would have time to adapt gradually. There would be no severe withdrawal reactions, and it would not be necessary to expose the alcoholics to other addictive medicines. The trouble was that alcoholics would not be able to taper off their drinking on their own. After all, the core of the problem is that they cannot control their alcohol intake.
Extinction with naltrexone, however, automatically produces this safer form of detoxification. Thus, the actual amount of alcohol drunk each day while taking naltrexone is reduced automatically, gradually, and rather effortlessly. Naltrexone, unlike benzodiazepines and barbiturates, is not at all addictive. No one ever gets high or develops a craving for naltrexone.*
The Sinclair Method—taking naltrexone before drinking—safely and effectively detoxifies the patient. It gradually removes the physiological dependence on alcohol with less risk than the traditional inpatient or outpatient detoxification programs.
The Sinclair Method is a safe and effective detoxification procedure with one additional benefit: the patient is also cured of alcoholism. The craving for alcohol and the obsessive drinking—the basis for the alcoholism—are also removed.
Seventy-two clinical trials consistently show that naltrexone and nalmefene, when used according to the Sinclair Method, are effective in treating addictions. addictions.**• This is generally understood to be the most powerful way of treating alcoholism. Again, the trials consistently show naltrexone must be used along with drinking and the Finnish clinical trial shows the best way of using it in conjunction with drinking.
Finally, the results of Project COMBINE, the largest clinical trial in the history of alcoholism research, consisting of 1,383 diag
* The litmus test for an “addictive substance” is whether rats or humans will “work” to get it. Will they work to receive reinforcement from alcohol, cocaine, nicotine, or heroin? Yes. But they will not work for naltrexone or nalmefene.
** See Appendix A.
nosed alcoholics and conducted by an assembly of the top American researchers in the field, were published in the Journal of the American Medical Association (May 3, 2006).38 This trial confirmed that naltrexone was effective but did not find significant benefits for another medicine called acamprosate. Most important, Project COMBINE found that naltrexone is effective for compulsive drinking with only basic medical management—no intensive psychotherapy is required. Naltrexone had originally been tested only within comprehensive programs of alcoholism treatment, including intensive counseling and therapy; consequently, the FDA approved it for use as an adjunct within such programs.
Project COMBINE clearly shows that this restriction is not correct. Naltrexone works without counseling. This has also been found in a smaller Australian study39 with naltrexone and in a Finnish trial40 with nalmefene. Therefore, the original restriction of prescribing the medication only within the context of highly specialized treatment or rehab has been removed. Now, your family doctor can safely prescribe naltrexone.
The Finnish clinics using the Sinclair Method have found that it is effective in 78 percent of the patients. Clinics using it in Florida report 85 percent efficacy. The first results from CORD*, a nongovernmental organization (N GO) using the Sinclair Method in India, indicate a 75 percent success rate.
About half of the cases in which naltrexone was not effective involve a failure to take the medication or a patient dropping out of treatment. This is a very low rate of noncompliance for alcoholism treatment. There is, however, a small minority of patients—perhaps 10 percent—who, according to their “drinking diaries,” are using naltrexone properly but do not benefit from it. One of the hot research areas today is trying to find “markers” to identify these individuals who do not respond to naltrexone. There is evidence that they tend to be people who do not have close relatives who are alcoholics, who do not like very strong sweet solutions, and—according to Project COMBINE—who have a particular form of opioid receptor.
* Chinmaya Organization for Rural Development, Sidbari, Himachal Pradesh, India.
The positive clinical trials, the results of Project COMBINE, and
the reputation of the Journal of the American Medical Association
mean that the use of naltrexone—and eventually, its sister medication, nalmefene—should increase greatly in the months and years to come. In other words, once the word that Naltrexone + Drinking = Cure gets out, alcoholism’s days are numbered.
The American Medical Association usually restricts access to published studies on its Web site, but at the time of publication, it considered the results of Project COMBINE to be so important that it made the study freely available for download.
The Project COMBINE study began in 2001. When its results were published in May 2006, it was immediately recognized— even picked up by the media—as a landmark in alcohol research. Raymond Anton of the Medical University of South Carolina and Stephanie O’Malley of Yale University led the trial in collaboration with twenty other leading alcohol researchers.
Although Project COMBINE did not specifically set out to test the Sinclair Method formally, it concluded that naltrexone is invaluable in the treatment of alcoholism and recommended that the medication should now be prescribed for alcoholism in general medical practice, even without the requirement for intensive counseling or A.A. meetings. Although less than 2 percent of alcoholics in the United States have ever had the opportunity of being prescribed naltrexone, the indications are that it could become the new gold standard for treatment to reach the millions of alcoholics in America, Europe, and beyond who would otherwise be left untreated and unprotected from the ravages of this progressive illness.
Even in the United kingdom, where naltrexone can—scandalously—only be prescribed for alcohol abuse on a private basis (that is, not subsidized by the government’s National Health Service), the treatment now offers a brighter future for alcoholics, heavy drinkers, and those who simply need more control over their drinking.
David Sinclair reported on the lasting benefits of naltrexone three years after the start of treatment, in which patients continued to take naltrexone an hour before drinking.41 The patients did not take the medication on days when they were not drink
ing. The patients’ craving, drinking levels, and liver damage markers were all way down. Indeed, these patients were drinking and craving alcohol less after three years than they had been after the first five months of treatment. Traditional abstinence-based alcoholism treatments had always found that the results were best at the beginning of treatment, and then gradually, week after week, the patients would relapse and the drinking would increase to the level it had been before treatment. Pharmacological extinction produces exactly the opposite pattern, as shown by this three-year follow-up study. The drinking and craving is highest in the first weeks of treatment, but becomes progressively lower as the weeks on treatment progress because each intervening episode of drinking while on naltrexone was one more extinction trial. In other words, the more often people drink while on naltrexone, the less they will want to drink.
The clinical trials demonstrating the efficacy of naltrexone continue coming out. For example, Morley et al. published an Australian double-blind, placebo-controlled study of 169 alcoholics in 2006.42 Like the earlier studies, it showed naltrexone was effective in preventing alcoholics who were drinking while on the medication from relapsing to heavy drinking, but taking naltrexone during the initial period of abstinence did not delay the first sampling of alcohol.
The United States now has 1,630 drug courts; they are beginning to use naltrexone for alcoholic defendants who, rather than serving custodial sentences, can be monitored to ensure they take the medication. California Superior Court Judge Stevens was one of the first to institute mandated naltrexone treatment. He was so impressed with the results that he said, “We have had too much success not to use it.” Describing himself as conservative, Judge Stevens is emphatic that imprisonment and standard therapies leave addiction intact. In his view, they basically do not work because they cannot prevent alcohol and opiates from “lighting up the brain”—which is why he believes most offenders relapse and find themselves back before the courts. An interview with Judge Stevens can be viewed on the Internet.*
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