Naltrexone: Cure for Alcoholism?

Naltrexone: Cure for Alcoholism?

By Joe Ricchio 02/28/17

I have never been delusional enough to think that there is any “miracle cure” or “easy way out,” but naltrexone really worked for me.

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A hand holding naltrexone pills
They worked.

Let me begin by admitting that, in my two decades of very heavy drinking, I have never been delusional enough to think that there is any “miracle cure” or “easy way out” when it comes to finally putting a very destructive habit to rest for good. I have literally spent the last 15 years working towards a point where drinking would be my career, and achieved this through my tenure both in the wine business and as a professional food writer. I am now able to openly say that one of my requirements for accepting a job was that I be allowed to be inebriated while performing my duties.

When I finally threw in the towel and accepted that I had no control over the booze, for what I thought was the last time in July of 2015, I managed to go an astounding nine months sober while maintaining a very happy relationship. I had literally not gone longer than 28 days in a row since I started drinking at age 13. However, in March, my job took me to Italy, alone, where I didn’t stand a chance against the temptation of relapse—and I enthusiastically dove in, head first. In the blink of an eye, I was back to my three to four bottle of wine per day regimen, coupled with Jameson—my relationship falls to pieces, and I began to accept that this is just the way my life is going to be. The usual scenario for the career alcoholic.

In November of 2016, I had a conversation with a friend, whom I would consider to be a seasoned drinker, about his recent trials and success with the drug Naltrexone, which is meant to eliminate the need to binge while allowing the alcoholic to safely drink in small amounts. He recommended a documentary on the subject called One Little Pill, which details a specific way of using the drug called “The Sinclair Method,” developed by the late Dr. David Sinclair. Coincidentally, my psychiatrist had also mentioned Naltrexone to me around the same time, so I figured it must be fate and got the prescription filled.

The premise of the film, which is produced and narrated by actress and Naltrexone advocate Claudia Christian, is that the traditional methods—most notably the abstinence component—of Alcoholics Anonymous are dated, and that science has since developed a better way. They argue that abstinence leads to increasingly intense cravings and, ultimately, heavier binging upon relapse. Sinclair claims to have developed a new method with a success rate of 78% that will disprove the adage that, “Once an alcoholic, always an alcoholic.”

Naltrexone falls into the category of drug known as an opioid antagonist, which is designed to negate the euphoric and sedative effects of alcohol (and other drugs) by blocking the proper receptors in your brain that usually trigger these sensations. With the Sinclair Method, the user takes the recommended dosage and waits approximately one hour for the drug to take effect before consuming an alcoholic beverage. This begins a process of what they refer to as “pharmacological extinction,” where you essentially train your mind not to associate pleasure with more drinks. Eventually, much like Pavlov’s dog, one’s brain will accept this as fact, warding off the need to binge and allowing the alcoholic to function as a “normal drinker.” They indicate an average of three or four months on the pill will achieve this result.

For me, the prospect of managing my addiction without having to endure the torture of AA meetings was certainly alluring, and I figured I had nothing to lose by giving it a try.

The Initial Reaction

My first day on Naltrexone begins with a raging hangover from the prior evening, and I resist the urge to drink Underberg bitters all morning to quell the pain, knowing that this would most certainly interfere with the medication. That same night, I purchase a six-pack of Victory Prima Pils, while assuring myself that I could easily employ my Drizzly app for booze delivery as a contingency plan if the drug failed me. I take 50mg, and wait over an hour to crack into my first beer.

What happens next is difficult to explain. I quickly shotgun the first beer and pour a second, but while I am drinking it, a strange phenomenon occurs as I literally begin to forget that I have an open beverage on my desk. Every 15 to 20 minutes, I glance at it and take a sip, while my interest in doing so rapidly declines each hour. Upon awakening the next morning, I dump the quarter of the second bottle that is left down the sink, which any devoted drinker knows is a very rare and somewhat surreal experience.

The very same six-pack ends up lasting for the next four days as I maintain my schedule with the Naltrexone, prompting me to believe I have stumbled upon the goddamn Holy Grail. Even when I end up drinking a whole bottle of wine on certain nights due to unforeseen circumstances, it happens over the course of four hours rather than 45 minutes. I also note that there seem to be no side effects, and I wonder why more people have not been prescribed this drug (many blame the profitability of the “Recovery Industry” in its current state).

The Problem

After about a month of utilizing my chemical “safety net,” I find that I can drink more and more while on the medication, especially if I begin with a tumbler full of Irish whiskey. My psychiatrist recommends doubling my dosage, which seems to even everything out nicely.

Properly utilizing the Sinclair Method literally involves following one simple rule: take a pill an hour before you plan on drinking. The problem is that, as someone who loves getting drunk, this begins to take on the connotation of, “You aren’t going to be able to have as good of a time tonight if you take this pill.” For a while, I continue to fire them down the hatch immediately to nip this thought process in the bud as soon as it begins—but eventually my lust for alcohol, the reason I began this process in the first place, takes over and I decide that I will have a few “snow days” from the pill.

While you are on Naltrexone, the drug effectively plugs up the receptors that normally cause the pleasurable effects of alcohol. However, your brain is quite crafty (just like me, when I’m looking for a way to justify excessive drinking), and in response to the pill it continues to create more and more receptors. This is not a problem if you continue the medication, but once you stop and introduce your usual regimen of booze back into your system, you’d better hold on for a bumpy ride.

I, of course, needed to find this out the hard way. My first evening off the meds I consume six bottles of wine, concluding with a two-hour blackout as the grand finale. One bottle in, I knew I was in trouble, as I already felt somewhat inebriated whereas before, it would have taken well over two bottles to reach this state. As would be expected, this turns into a four-day bender that is somehow more terrifying and surreal than those in the past. On day five, I decide to restart my Naltrexone regimen, which is surprisingly effective right off the bat. Throughout the next week, things seemed to return to normal. Then, a friend from out of town randomly shows up, and my “If I take the pill, I’ll have less fun” mentality kicks in right away. Queue another bender, and I’m back to square one.

Meanwhile, my friend who had initially recommended Naltrexone is still enjoying success with it. This leaves me with mixed thoughts about the effectiveness of the drug. Yes, if taken properly it does work—and works quite well—in quelling the inner voice that will stop at nothing to have another drink. The problem is that if you are a hardcore alcoholic, knowingly sacrificing the escape to oblivion by the simple act of taking the pill isn’t as simple as it may seem.

The Sinclair Method works, if done properly, and for many it could be the difference between life and death. Of course, most members of AA—and several in the medical community—have condemned its use because it involves continuing to drink. It comes down to the drinker’s personal commitment to staying sober—and there are certainly those out there, myself included, for whom attending an AA meeting is somehow the most potent trigger to binge drinking there is.

In the end, you’re going to have to put the work in, there is no easy miracle cure. What happens next is up to you.

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Joe Ricchio is a Portland, ME-based author who specializes in food, drink, and travel. He is the food editor for Down East Magazine, in addition to freelancing for such publications as Bon Appetit, Vice, Boston Magazine, and TheFix.com. You can find Joe on Linkedin.

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