My opinion: What is Alcohol Use Disorder?
I've been involved with The Sinclair Method, and writing about it for 10 years, after using it to reach pharmacological extinction 10 years ago. I want to have a discussion about this.
In that time I have written numerous posts and articles about it on Facebook, and here recently. I have formulated my thoughts on it and what I have come to is this. Alcohol Use Disorder is primarily behavioral, it has a physiological component that causes dependence. As such TSM is primarily a behavioral modification system or protocol, which uses an opiate blocker to treat the physiological craving, and Alcohol Deprivation Effect.
This is in contrast to what the long held belief about AUD being a progressive, fatal, and incurable brain disease, as promoted by 80 years of abstinence only recovery programs. We also know it's not a matter of character defects, weakness of will, or powerlessness over alcohol, and once an alcoholic always an alcoholic is an old myth. Because time after time I have seen people over the last 10 years come to TSM, and use it to successfully return to a state of control.
What abstinence recovery has failed to understand is that the reason for relapse is not character, or will power, it is not a failure to avoid people places and things, which always makes me laugh because those are nouns, but most of the times in my life I get in trouble because of the verbs. AA, and other abstinence programs think is once you detoxify someone with AUD they are then free from alcohol, and the only thing that have to do in attend meetings, do steps, work with a sponsor, be of service, and carry the message. I other words AA works primarily by distracting the person with AUD long enough that they don't think about drinking long enough to get drunk. As I said they failed to understand the main reason for relapse isn't failure to do all those things, it is because of something they don't know about and that is Alcohol Deprivation Effect. Now I'm going to describe ADE as best as I know it, it is a process by which our opioid receptors are upregulated during a period of abstinence to become more sensitive to our endorphins. This leads to increased craving, and eventual relapse over time. This understanding is something I doubt the abstinence recovery world wants to admit, and come to grips with, because it throws their whole model of detoxification and abstinence with a program of steps and meetings into question.
So if we understand the basic mechanism by which TSM works, taking naltrexone or nalmefene 60-90 minutes before drinking, and repeating that over time leads to the reward signal being blocked, and the reinforcement to do the behavior being blocked over time the behavior returns to it's original state of not being addicted, TSM makes perfect sense.
What continues to be a difficult is getting the word out for TSM in a treatment setting, and that is obviously because all of the other methods that are abstinence only, is it's incompatible. We could also say a reason TSM is not more widely known is because not only is there no money in a treatment we can do in the privacy of our own homes, but that eventually we wouldn't need revolving door rehabs, because people will no longer be addicted. I throws the whole 12-step model out the window, and would make AA obsolete over night, unless they changed their whole program, which is something they would never do, because they haven't changed anything in the first 168 pages of the Big Book in 80 years.
So that's what I wanted to talk about, what does everyone think, does what I say make sense, can I maybe explain it better, what would you add?