Alcohol Addiction Sinclair Method Step 4

Start your journey with nalmefene or naltrexone and drinking

You can start treatment for your addiction to alcohol as soon as your prescription medication is in your hand. Thanks to the proven science behind this type of treatment, you can allow yourself some optimism. Continue to drink but with one important addition: take nalmefene or naltrexone 60 minutes before starting. Since you are able to receive a patient assessment within 48 hours, you can get started on your road to recovery this very week.

You may wonder whether you should tell other people about your treatment. The answer will depend on how comfortable you feel on a personal level. For example, you may feel confident in telling very close friends or relatives about the Sinclair Method. You can tell them to no longer worry if they notice you having a drink because you are on medication — nalmefene or naltrexone — that can stop your addiction when combined with drinking in around 12 to 16 weeks. On the other hand, you might not feel comfortable sharing your treatment with people you are not as close to, such as acquaintances, your employer or work colleagues. Don’t forget to consider cultural differences when you decide which people you will disclose your treatment to. Some cultures view a person’s health as an entirely private matter, while other cultures see it as a family or community concern.

People have very different drinking styles and habits. You might drink heavily every day, beginning with a drink at breakfast or at lunch. Or, you may not begin to drink until night time. Other people only binge drink during certain times, such as the weekends or when a craving for a drink simply becomes overwhelming. Keep in mind that drinking problems manifest themselves in various ways. There is a whole menu of potential drinking triggers out there.

There are surprising similarities to skydive training

At this point, you are probably aware that your addiction and cravings don’t just disappear when you are trying to stop drinking. If you simply can’t stop drinking using faith-based or other psychological treatments, give the Sinclair Method a try.

When you start the Sinclair Method, it can feel a lot like attending prep classes before you skydive. Your skydive teacher might use educational videos that demonstrate plane jumping form and technique, share ways to overcome height fears and provide demos on using the backup parachute if the main one fails. Because the information is so important, the teacher might repeat the same things over and over until you feel yourself struggling to pay attention. Despite this, you know why the teacher constantly repeats the same concepts. If you’re going to jump from thousands of feet up in the air, you absolutely must know the proper way to do so. Doing it right will keep you alive and safe, just like with the Sinclair Method.

Now, when you have the urge, you can have a drink once you have had your medication. Every drink you consume on nalmefene or naltrexone is another part of your cure curve as you work to free yourself from addiction. Keep in mind that this is an incremental cure. For every drink you take on your medication, the tiny but intricately wired addiction system which is part of your brain becomes weakened and is eventually broken.

Measuring your drinks

While a drinking diary is not required under the safe and effective Sinclair Method, it is recommended. When you record each drink, you’ll be able to actually see your progress in black and white. This can really help motivate you throughout your nalmefene or naltrexone plus drinking treatment.

Prior to starting your medication regime and diary, get familiar with the measurements of drinking. These numbers indicate how many alcohol units are in one beer, a shot of hard liquor and so on. While your mouth may register the difference between the varying types of alcohol out there, your brain experiences all alcohol in the same way.

The following diary for your drinking shows how much alcohol is in each drink, relatively speaking. While pubs, restaurants and bars measure alcohol using standardised servings, studies have found that people drinking in their home or outside of a formal setting usually pour larger amounts. People simply don’t realize how often they are drinking or how much they consume when they do. Use the format shown below for your diary, and take note of the accompanying drinking levels which are considered safe.

The drinking dairy

The drinking diary below is the format recommended for use with the Sinclair Method. Use a diary that’s small so it’s easily portable.

Measurements for drinking

A single drink unit consists of 0.50 ounces of alcohol which is completely pure in the United States, where this treatment was created. Refer to the list below for common drink measurements. Each measurement line represents one drink unless otherwise noted.

• 4 to 5 per cent alcohol beer, 10 oz.
• 4 to 6 per cent alcohol wine cooler, 8 to 12 oz.
• 9 to 12 per cent alcohol table wine, 4 to 5 oz.
• 20 per cent alcohol fortified wine, 2.5 oz.
• 40 per cent alcohol distilled spirits (80 proof), 1.25 oz.
• 50 per cent alcohol distilled spirits (100 proof), 1 oz.

Drink measurements outside of the US

• 4.7 per cent alcohol beer, 330 ml. or 1 bottle
• 4.7 per cent alcohol beer, 1 mug (1 and 1/2 drinks)
• 6 per cent alcohol beer, 1 bottle (1 and 1/3 drinks)
• 10 per cent alcohol beer, 1 mug (2 drinks)
• 10 per cent alcohol wine, 12 cl. or 1 glass
• 10 per cent alcohol wine, 75 cl. or 1 bottle (6 and 1/2 drinks)
• 20 per cent alcohol fortified wine, 8 cl. or 1 glass
• 20 per cent alcohol fortified wine, 75 cl. or 1 bottle (9 and 1/2 drinks)
• 40 per cent alcohol spirits, 4 cl. or one shot
• 40 per cent alcohol spirits, 50 cl. or 1 small bottle (12 drinks)
• 40 per cent alcohol spirits, 70 cl. or 1 bottle (17 and 1/2 drinks)

Keep in mind that champagne is included in wine, and vermouth, port and sherry are types of fortified wine. Cognac, liquors, rum, whiskey, gin and vodka all fall under spirits.

Moderate drinking upper limits

• Men: Five units in any one drinking session or a total of 24 units in a week’s span.
• Women: Four units in any one drinking session or a total of 18 units in a week’s span.

There is help available if you’re not sure about drink unit counts. Go to www.knowyourlimits.info to view guidelines on glass sizes and more information. A patient assessment is also available within 48 hours if you’re ready to take the next step in overcoming your addiction.

Measurements for cravings

Cravings are part of addiction and excessive drinking, so you should review the level of cravings you experience each week so you can see how you are progressing. Use the simple Visual Analog Scale of Alcohol Craving — known as VAS — so you can see what happens to your cravings over the duration of your treatment. Show your current VAS results to your trained counsellor, if you are meeting with one, as you move forward in your treatment.

Using VAS

Think about a situation in which you would normally drink and imagine yourself there. How much do you want a drink? When you take a look at the line down below, determine which point describes your craving level the most accurately. Draw a line vertically at the point you’ve chosen.

Start your diary for drinking

Once you have the nalmefene or naltrexone prescription, you might wonder what to do next. Luckily, it’s simple: start your diary and take your medication as you drink. Instead of drinking, you’re now ‘nal-drinking’ to null your drinking, as one patient put it.

Start by taking 50 per cent of a standard dose, so 25 milligrams, the next two times you have a drinking session. Your pharmacist can divide your 50-milligram tablet evenly for you or you can do it at home. Once you have taken 25 milligrams of the medication two times, you can increase to the officially recommended 50-milligram dose.

Your diary for drinking is a crucial part of your treatment. This simple book will serve as a map for your cure. It does not matter if you imbibe every day or on weekends only. You can still plot your drinking and watch how the pattern declines over time. In the beginning, you will probably not see a big difference. However, as you progress, you’ll notice a consistent reduction in your drinking. Most people experience a noticeable reduction in cravings and see their weekly drink units drop over the first 42 days of treatment.

Don’t get discouraged if you notice you’re drinking too much or are far over the safe limit at first. This is, after all, your reason for trying the Sinclair Method to begin with, and it is common. You must learn how much you actually drink. Otherwise, you will not be able to plot your drinking accurately or truly follow your progress each week. Many clinics offering this method have discovered, on average, that it reduces drinking to under nine drink units a week after 12 to 16 weeks.

There are two things to keep in mind with your medications. First, never drive or try to use any type of machine after drinking. Naltrexone might increase some intoxication aspects. Dr Sinclair found that rats given alcohol showed more motor impairment with this medication, and later research confirmed his initial findings. Second, don’t drink more than you used to on nalmefene or naltrexone. Neither medication will prevent alcohol poisoning.

What to expect

People experience things differently, so there’s no one universal experience with this treatment. Some people will respond faster than others. Side effects from nalmefene and naltrexone are rare, including mild symptoms such as temporary nausea and itchiness. Many patients have found the side effects of these medications to be minor and short term. Most people will not experience any serious side effects on these medications, and this treatment is regarded as very safe.

It’s worth noting that, even early on, you might notice you can suddenly stop consuming alcohol just after two drinks or so. However, a decrease in the urge to drink is just a sign that the treatment is working. Your nalmefene or naltrexone acts as a blocker of some effects of the alcohol. It also blunts the effect of trained stimuli which prompt your brain to release feel-good chemicals known as endorphins from your initial drink. This is very beneficial, but the full benefit of pharmacological extinction develops more slowly over time and won’t stop your addiction in just a week. You did not reach today’s current drinking and craving levels in a blink of an eye. Expect to need 12 to 16 weeks of treatment, at the minimum, to break the addiction cycle. Reducing the brain’s addictive wiring — known as neurological scaffolding — and restoring it to its state from before you were addicted takes time.

You will go through treatment following a pace that is appropriate for you, but you still must remember what you need for success: nalmefene or naltrexone plus drinking. You should be optimistic about your success, just like the 75 patients below (Fig. 8) who experienced fewer cravings over 12 to 16 weeks.

It’s possible your drinking will drop to around 15 drinks per week over 12 to 16 weeks. Eventually, you’ll get to just nine drinks over a week, which is illustrated below (Fig. 9).

You will have the chance to decide your treatment goals. While only around three per cent of Dr Sinclair’s first patients picked full abstinence as a goal with this method, close to 25 per cent of them no longer drank once they were treated for 12 weeks. It might be impossible to imagine living your life without drinking before your treatment starts. Once your treatment period has ended, however, your cravings will have significantly decreased, possibly to the point at which abstinence is a real possibility. You’ll no longer be a prisoner of alcohol. You will notice you don’t think or obsess about alcohol anymore. Keep in mind that the overall goal with this treatment is to stop your addiction so you have control over your drinking and not the other way around.

Some people might want to drink just at three or four points in the year, such as around the holidays. You can do this, but you have to use your medication every single time. A big advantage of the Sinclair Method is that it gives you the opportunity to reduce your drinking or stop without feeling deprived or risking relapse, unlike other treatments. You are not required to attend a regular support group, but you can if you wish. Many people find that support groups help during this time, and you’ll be able to connect with other people who are going through a similar experience.

Should you opt to keep drinking, your treatment will reduce how much you want alcohol and your drinking levels. De-addiction happens right at the synapse and endorphin receptors in your brain. This means you won’t immediately realise why the nagging voice that normally suggests it’s time to drink has vanished. Your freedom from drinking appears to happen by magic, but it’s just the results of the effective yet safe Sinclair Method.

Many people also notice other changes. Once they no longer have blackout drinking sessions, suffer from hangovers, exhibit aggression and have to deal with the consequences of embarrassing incidents involving loss of control and personal judgment, life seems far different.

How to maximise your selective extinction results

A technique known as selective extinction is one way to boost your alcohol resistance and encourage desirable and positive behaviours to replace drinking. After one or two months of treatment, you’ll notice your alcohol cravings have deceased with your drinking plus nalmefene or naltrexone sessions. Now, you don’t feel like drinking every single day of the week. With selective extinction, you don’t take medication or drink on certain days. Instead, it’s time to do things you find rewarding which don’t involve any drinking.

Before you begin to take your medication, write down all of the positive, healthy behaviours you feel are rewarding or enjoyed before alcohol took control of your life. In a clinic setting, a physician would identify these endorphin-reinforcing behaviours for you, but this is something you can do without help, too. Sex or good exercise, including aerobics, tennis, jogging, sailing, yoga or hiking, all fit the bill. Paternal or maternal actions, such as interacting with a baby or cuddling with pets, are very likely to produce endorphins. Thrill behaviours, like getting on that giant rollercoaster, and things as simple as eating flavourful foods, acting and singing all signal your body to release endorphins.

Generally, activities alcohol stimulates are opioidergic or reinforced by your endorphins. Behaviours which involve staying still and paying attention for longer periods of time, such as in hunting, are likely not opioidergic. Keep in mind that there are other opioidergic behaviours which are not good for you, such as taking other drugs and gambling, to steer clear of. Some people mistake the replacement of one unhealthy addiction with another as success, but in reality, you’re just changing masters.

Do not take part in your healthy activities after taking your medication. These activities are meant only for the days when you are not taking your medicine and drinking.

On the days when you are not taking medication and drinking, your brain’s opioid system responds to endorphin release reinforcement more because of receptor upregulation, a phenomenon that causes receptor hypersensitivity. Your medication causes this phenomenon; however, you won’t feel it with the medication blocking your brain receptors. If you are off the medication for a short time, you have about three days during which the nalmefene or naltrexone is out of your system. This causes a large amount of free opioid receptors in the brain to appear, so whenever you release endorphins, more reinforcement is produced as a result. Use these hypersensitive opioid receptors for your benefit. Your activities related to endorphins will reward you more during this time. In a way, you can start replacing your negative endorphin-releasing activities, like your drinking, with positive activities like working out. Your enjoyment of and interest in healthy activities will progressively increase, beginning to erase the void left behind as your drinking deceases.

With nalmefene or naltrexone, you have an opportunity to learn positive, healthy behaviours with the enhancement your medication provides. If you took your medication on Friday, for instance, the medication leaves your body during Saturday. By Sunday, around two days after your last medication dose, you are at a point where patients often find alternative behaviours are particularly reinforcing. A flavourful meal tastes amazing. Simple desserts suddenly taste wonderful. Sex is even better. Working out is terrific. This hypersensitivity will gradually ease over a 72-hour period, so it’s recommended that you focus on doing more healthy activities over this period since you will experience more reinforcement.

You can begin to drink again whenever you want, but you must take your medication 60 minutes prior to having your first taste of alcohol. Usually, patients start this treatment with just a weekend of medication plus drinking — engaging in healthy things only on Sunday — and go back on nalmefene or naltrexone plus drinking while avoiding other types of behaviours which could trigger the release of endorphins.

The time you spend with no alcohol or medication will become longer over time. Eventually, your medication plus drinking only occurs once a week or so, and your time free of alcohol and medication occurs at least six days per week. To get started on your journey in under 48 hours, reach out to a provider for your patient assessment as soon as you can.

Follow up and through

Visit a doctor monthly, regardless of whether your medication prescription automatically renews. If you can’t go to your doctor’s surgery that often or just don’t want to, it’s possible for you to work on your recovery alone. Use the Sinclair Method as publicly or privately as you choose. However, you have to do one thing now and even after you finish the program: take your nalmefene or naltrexone prior to having your first drink.

You will need to be motivated to use your medication as directed. This is something you will always have to do whenever you decide to drink. After you start this program, there’s no reason to start and stop repeatedly. Keep yourself on the road to success and a new life – one that does not let your addiction control everything.

This will take time

To enjoy the freedom the Sinclair Method can provide you with, research shows you will need to stay with the treatment for at least 84 to 112 days. Be honest with yourself: your brain’s additive system became stronger over a period of years and not overnight. You can’t deactivate those years of addictive wiring after just four to eight weeks of treatment. If you don’t make it through 84 to 112 days of treatment, at the minimum, you’re much like a sundae without the topping. Your treatment is not complete, and you’re still struggling with alcohol addiction.

In reality, your treatment will never stop. After your treatment period ends, you will still carry your medication with you even if you rarely use it anymore. There will, however, never be a time when you skip your medicine before you drink. If you do this after successfully stopping your drinking, you will begin to relearn your alcohol addiction and undo all of your hard work. You can completely abstain from alcohol with the help of this treatment, but you don’t become addiction-proof.

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