The Sinclair Method is not for everybody, it would seem...

Hi merrydeath,

I have had a similar experience, having used Selincro for a few months and then stopping and switching to Naltrexone because the Selincro really affected my sleep.  In a nutshell, the Selincro worked at reducing my alcohol consumption but it really disrupted my sleep and mood, so I switched to Naltrexone (half a tablet, which was enough.  The Selincro tablets could not be halved, so I thought that maybe the full dose was the problem).

Anyway, after one year of taking the medication, I was still drinking almost every night, but was down to 1 - 1 1/2 glasses of wine per evening.  However, I found that my desire for other things that I used to enjoy, also decreased (certain foods, activities, even sex) and that I was becoming a very negative, boring person with almost no more interests or pleasures.  Subesequently, I stopped the treatment about 6  months ago and my alcohol consumption remained low for the about four of those months.  Unfortunately I am now on about 4 drinks per evening, and am not at all happy about that, but am not ready to go back to not enjoying anything at all.

I would like to give up alcohol completely and feel that I could if I were on my own, but unfortunately my husband of 28 years, and almost all of our friends are drinkers (many are heavy drinkers), and when I did stop drinking completely for several months in the past, I felt very alone and many of my circle resented the fact that I was abstaining in their company, or felt that I was judging them for continuing to drink in mine.  This may sound like I am weak or that I use their peer pressure to continue to drink, but what is the option?  Divorce with three kids and a big house?  Being totally alone in a foreign country?  I am an expat and I'm sure there are many others in the same situation so I would like to hear from you, please.

Yes, you are correct.  The Sinclair Method is not for everyone, of course.  There is no one particular treatment out there that works for 100% of the people.  However, your psychiatrist tells you of his treatment shows only a 50/50 success rate, and that is well down in terms of the percentages reached by those who fully understand the method - they are in the rate of around 75-80%, which is roughly what the clinical testing showed, too.  The success rate that I have counselling people through this method is actually nearer the 85% mark.  I am not a psychiatrist, but I am a counsellor.  Sometimes a psychiatrist will understand the science behind the method and that is truly awesome, but may lack a little of the practical way to apply TSM.  There is also another treatment provider who chats on this site too, Paul Turner, and my understanding is that he is also around that same percentage as I am.

So, just in the interest of making sure you know you gave this a good shot with all the areas covered, there are basically 4 parts of TSM.  If you have ticked all of these boxes, then you know that TSM is not for you.  If there is an element that has not been featured, then you should maybe discuss that particular element with your psychiatrist again.  It is shown that in clinical trials, only around 10-12% of people did not respond to TSM.  Another 75-78% reduced their drinking, and the remainder stopped the treatment for whatever reason, whether it be an intolerance to the medication etc.

1. Adherence.  That means every single time you drink.  Not just taking the pill, but also ensuring you wait the relevant time.  If you have been 100% adherent then great, if not then that WILL have an influence on the overall result.

2. Craving vs Habit.  It's very important to recognise that you work in partnership with the medication.  So, that means recognising that the medication will prevent the chemical reaction in your brain that compulsively drives you to drink.... and then working towards slowly chipping away at your old habitual drinking.  For example, instead of taking the tablet before leaving work because you ALWAYS drink after work, a good way to start making the change is to delay the first drink by not taking the tablet until you get home.  Or, when you have started drinking, making small changes to learn to recognise to interrupt your drinking, for example, putting the drink slightly further than arms length so instead of just reaching for it absentmindedly, you start to bring in your conscious brain and actually decide if you really want it enough to have to get up.  This is working WITH the medication to achieve the desired results.

3.  Selective Extinction.  This is SO very important.  Working as per above will (eventually) get you to the stage of not drinking for a day, so no medication required.  To spur things on a little, you need to use this day without having your receptors blocked to give them a good BLAST of endorphins from an activity such as exercise, or eating a spicy meal.  This will feel great and as you string good days together, then your brain will start to learn that alcohol is no longer the experience it was, but, by gosh, that other activity felt goooood.  The 'pendulum' in your brain will begin to swing from wanting alcohol (not chemically rewarding) to wanting that other good, more normal activity (which is giving it a chemical reward).

4.  Patience.  Not usually our strong point, I know!!!  But this is vital.  In clinical trials, the results were around the 3-6 month mark.  For me personally, when I did this method, it took around 3 months of uninteruppted treatment for me to be able to conisently get things moving substantially, and then another 5 months of the same until I was totally craving and habit free.  So, in total 8 months.  I have just counselled another man through it and that took 9 months in total.  It seems that real-life pressures mean that for the majority of people, reaching the end goal takes longer.  Dr Sinclair himself said that if someone has been doing TSM compliantly for about 8 months, and they have experienced NO change whatsoever, then they may be one of the 10-12% that this treatment is medically ineffective for. 

From my experience, when you mentioned that you had an initial response, this tells me that this method IS going to work for you, as long as the four points above are all fully engaged in.  I have no supported well over 600 people through this, so I have a lot of 'real-life' experience with it.  My drinking history was in the 20+ year mark, and that gentleman I mention above was well over 15 years in traditional treatment.

As I mentioned, IF you have engaged fully in all of the above 4 areas, then TSM may not work for you, but before you really decide that for sure, make sure to know that you have ticked off all the above, otherwise the missing component may be influencing things.  This is not a magic pill and will not miraculously stop you putting the drink to your lips - it takes work on you part, too.

And finally, good luck with whatever you decide on works best for you!