Abstinence alternatives for the heavy drinker-
Abstinence is the crux of the vast majority of alcohol addiction treatment programs in the U.S. However abstinence is often impossible to achieve or frankly not desired by drinkers even thought they realize their drinking has become problematic. As a psychiatrist who treats alcohol addiction frequently, I know many people are extremely intimidated by the concept of complete abstinence and even if ultimately that is the goal of treatment, starting with complete abstinence can be counter-productive to one taking steps to get help.
Ideally when one is faced with problematic drinking, which can range from legal issues to problems in their relationship, they would give up alcohol and never drink again. However despite recognizing their drinking may be excessive or problematic, many people do not have the desire to stop all together and thus do not bother to get treatment at all.
Unfortunately many physicians and addiction counselors are unaware of alternatives to complete abstinence and meeting patients where they are in their desire to get help is paramount.
One extremely effective but under-utilized approach is dubbed the “Sinclai method” after a Dr. Sinclair who pioneered the approach. The treatment relies on the concept of Operant Conditioning (classic example is Pavlov’s dog) where one is driven by behavior’s that are rewarded which than condition those behaviors to be further desired. With alcohol for example, when one drinks alcohol, the brain releases potent pleasure chemicals called endorphins which cause one to feel pleasure. This pleasure reinforces one to want to drink and thus is conditioned to enjoy alcohol. This same principle is how other drugs, gambling and a multitude of other pleasurable activities can become habitual.
With the Sinclair method, a medication called Naltrexone (a block of opioid receptors including endorphin receptors in the brain) is given an hour before a person drinks. This prevents the pleasurable endorphins from acting within the brain which prevents the positive reinforcement to enjoy the alcohol. The program typically takes weeks to months to de-condition one from obtaining pleasure from alcohol and ultimately one loses the desire to drink. Some lose the desire to drink to the point of ending up quitting all together but some simply are able to control their drinking to a much more controlled level which ultimately eliminate any of the problematic behaviors they may have previously been associating with the drinking.
I utilize this potent tool often with great success and it offers a great alternative to someone who is experiencing problems associated with alcohol and wants to eliminate problematic drinking without giving it up all together.
While I promote abstinence ultimately for the benefits it can offer in terms of deeper psychological control barriers, I am first an advocate for my patient’s to succeed at getting help and that means working with them on a treatment strategy that meets their needs.
If interested there is a fantastic documentary called “One Little Pill” that documents the case of a woman and her experience with the Sinclair method. You can find the movie online by searching its title.
Michael Yasinski MD