Information for Friends and Family
- Written by Paul Turner
One of the most difficult things for a person with an alcohol problem to deal with, is the guilt and shame they feel which is made worse by pressure from the people who love them and who worry for them and the attitude of society to people who are unable to control their drinking. Traditionally, the treatment of alcohol problems has been behaviour-based, dealing with the way that people cope with their drink problem. The problem with this approach is that it doesn't consider the physiological reasons for the addiction to alcohol. Alcohol dependence is a MEDICAL condition and it is NOT a lifestyle choice.
Millions of people drink safely, they even get drunk from time to time, but they can drink when they want and they can stop when they want. A percentage of people get into difficulty and it is about the way they are built, NOT because they chose that path in life.
Imagine two students, Peter and Paul. They do what many students do and spend a great deal of their student days socialising and drinking way in excess of what is advised. They drink equally irresponsibly and spend many nights seriously drunk. Then they graduate and get jobs, get married, have families. Both know that this is the time to start acting more responsibly.
Peter changes and becomes an occasional drinker, he loves a pint but, if he doesn't have one, he doesn't really think about it. He can enjoy the taste and the atmosphere of a social occasion but he doesn't think about it in between such occasions. He has alcohol in the house which was bought for Christmas but which has remained untouched for months since New Year's Eve.
Paul finds that if he goes without alcohol, he keeps thinking about it. He can't just sit and have a pint in the pub garden on a sunny day and walk away. If he has one, he goes on to have a session. If he has a hard time at work, he has a drink. He always keeps alcohol in the house, frequently drinks it and replaces it when it runs out. During a particularly stressful time, he begins to rely on having a drink to deal with the pressure of life. When he drinks, he gets great relief. As time goes by, his two or three pints is not enough to satisfy him and he needs more because his daily drinking has led to a tolerance of alcohol and it takes more to satisfy his need.
Clearly, Peter is fine, Paul is heading for trouble. The difference between the two of them is the way their body reacts to alcohol. Peter gets the common reaction of enjoying the taste, soaking up a fun atmosphere and the less inhibited conversation with other people. Paul gets all that but he gets an additional 'reward' on top.
Certain pleasurable activities release endorphins. Exercise, extreme sports, rollercoaster rides, sex, gambling, cuddling babies and seeing cute animals all do this, and so does drinking alcohol.
Alcohol, for Paul, however, gives him way above the normal pleasure. He gets a 'hit' that Peter doesn't get, as the endorphins attach to his opioid receptors. When Peter and Paul meet up, Peter thinks 'what the hell is Paul doing? Why does he have to get so drunk, why can't he be like me and just enjoy a couple of pints?' That is because Peter doesn't know about this additional reward that Paul gets from alcohol. To Peter, it is simple, Paul is CHOOSING to get drunk all the time. Paul doesn't understand how people can drink small amounts and appear satisfied with that.
The difference between them is physiological. Their opioid receptors react differently to alcohol. It is very likely that Paul has inherited this vulnerability. But when Paul realises that he needs to get some help, he is made to stand up in front of strangers and talk about his guilt and shame, how he has let himself and his family down, how it is nobody else's fault but his own, nobody put the bottle to his lips. Paul tries to change what he is doing, but the cravings get stronger and stronger, the longer he goes without a drink. Every day is a nightmare, just trying to get through to the end of it without having a drink. It is like telling a person to hold their breath and not to let go, eventually, they will have to breathe. Paul feels like this about having a drink.
One very effective method of treatment is The Sinclair Method. Naltrexone blocks the opioid receptors. It prevents endorphins from attaching to them. If Paul takes Naltrexone before having a drink, that drink will not have the same effect that it had for him before. He will therefore find that, without that additional reward, he will drink far less. If he begins to take a tablet every time before he drinks, he will eventually 'unlearn' his addiction because he will be getting only the same response to drinking as Peter. This process is called 'pharmacological extinction.'
There is a newer drug called nalmefene which was licenced for use for people who continue to drink alcohol in 2014. This has been recommended by NICE who publish guidelines for clinical treatment in the UK on behalf of the government. The problem with nalmefene is that the side effects can be so difficult to deal with that people are scared to take it. While naltrexone has far less severe side effects, it is licenced, in the UK, for people who abstain from alcohol. The problem with this is that it does very little for a person abstaining. To prescribe naltrexone for use with The Sinclair Method, the prescriber has to do this 'off-licence' which is perfectly legal and acceptable but needs to be justifiable. Unfortunately many doctors in the UK do not feel that they have the experience in the field of alcohol use disorder to use it in this way.
Having used both nalmefene and naltrexone, we believe that naltrexone is far more effective and therefore no longer use nalmefene for The Sinclair Method.
There are people who drink to deliberately get drunk because, when they are drunk, they feel less pain from the issues going on in their life. Nalmefene can be no help in this situation. However, if, like for most people with alcohol dependence, the cravings are the reason for the excessive drinking, Nalmefene can make a massive difference by, over time, eliminating those cravings. The thing that people need to know is that their addiction cannot be totally cured. They would ALWAYS need to take a tablet before they drank. However, the decreased desire for alcohol means that many simply carry a pill with them just in case they decide to have a drink.
The Sinclair Method will not resolve issues which led to people drinking excessively like divorce, lost jobs, financial problems. However, the people who use alcohol to deal with those problems are normally biologically similar to Paul with that increased risk already built-in.
I am diabetic, I have to inject myself with insulin. I am not ill, I have a condition which I control and it causes me no problems except for minor hassle. I have never had to stand up and admit my shame and guilt for being diabetic. I don't have to say 'I'm Paul and I'm a diabetic and I have been a terrible person and it is all my fault' because diabetes is recognised as a medical condition that is not my fault. Alcohol dependence, however, is still seen as a behaviour and a choice. It's time that changed and the research done by Sinclair (The Sinclair Method) has proven that there is a physiological reason for it.