This New Year’s, millions of people will decide that this is it. This is the year they will finally quit drinking for good.
A few of them will actually do it. But for others, quitting drinking isn’t just difficult, it’s nearly impossible.
Katie Lain was one of these people. Lain, now 35, realized she had a drinking problem in 2011, while sitting on a beach in California drinking a warm vodka and Diet 7UP. She liked to drink cocktails while tanning and would often end up passing out and leaving the beach with a nasty sunburn.
On that particular day, she says, “It dawned on me that I couldn’t even remember the last day that I hadn’t had a drink. It had been more than a year, but I honestly couldn’t remember it.”
The realization scared her enough that she decided to take a weeklong break, but it wasn’t easy. She took sleeping pills to get through the night and wondered how people tolerated life sober. Once the week was over, she returned to drinking just like before. It was the first of countless breaks and sobriety attempts, but no matter what she tried—from AA meetings to 30-day challenges, workshops, cleanses, and spiritual retreats—she could not seem to quit.
It got to the point where she was hiding her drinking from her husband, nipping into the kitchen to take sips of whiskey or vodka she’d hidden in a cabinet behind vitamins and supplements. She also kept a stash in her car.
Like most people, Katie assumed that the only path out of Alcohol Use Disorder (the preferred term for “alcoholism” these days) was abstinence. Once an addict, she thought, always an addict. But despite the ubiquity of the abstinence-only model and programs like AA, millions of people try it each year and fail. Some studies show that AA has a long-term success rate of between just 5 to 10 percent. Of course, AA has helped countless people quit drinking and has saved an unknown number of lives, but for the vast majority of people, including Katie Lain, it just does not work.
Katie struggled to quit for years, but even when she could manage to take weeks or months off, she was consumed by her desire to drink. The longer she went without, the more that she wanted it, and she knew in the back of her mind that she would eventually relapse. She prayed for a rock bottom so that something would finally force her to quit. It’s a type of disordered thinking that is common among alcoholics—I’ll just wait until I need a liver transplant, then I’ll really quit. But despite the hangovers, the lost hours, and even a near-DUI, that rock bottom never came. She just struggled, secretly and miserably, on her own.
And then Katie stumbled across a little known treatment that upends all conventional wisdom about alcoholism. It’s a treatment that would change her life—and, if it were more well known, could change lives for the millions of people who struggle to control their drinking.
In 1972, an American scientist named John David Sinclair moved to Helsinki to work at Alko Laboratories, one of the top research facilities for alcohol abuse in the world (and now a part of Finland’s National Public Health & Welfare Institute). Sinclair knew all about the success rates for rehabs and abstinence-based programs, and he went to Alko with a bold idea: It was possible to find not just a more effective treatment for Alcohol Use Disorder, but a cure.
At Alko, Sinclair began to test his theory on rats, but the fundamental premise comes not from rats but from dogs: Pavlov’s dogs, in particular. Ivan Pavlov, famously, conditioned dogs to salivate at the sound of a bell that signaled feeding. After a while, the bell alone would make them drool. But less often discussed is what happened to Pavlov’s dogs next: If he repeatedly rang the bell without rewarding them with food, eventually, the drooling would stop. It’s a sort of reverse conditioning, or what scientists call pharmacological extinction.
Sinclair wondered if this same effect could be achieved with alcoholics because he’d realized something important during his studies: If he gave rats alcohol over long periods of time and then took away their access to it, when given access again, they binged. Abstinence seemed to make their cravings grow not weaker but stronger.
Sinclair called this the Alcohol Deprivation Effect, and it explains why it is so difficult to stay sober after a period of abstinence—and why the prospect of abstinence is so daunting for some drinkers. This feeling is probably familiar to any addict. You manage to stay clean for days or weeks or even months or years, and then, well after the alcohol is out of your bloodstream and any physical dependence has waned, the cravings are back, stronger than ever. This is exactly what Katie experienced each time she tried to get sober, and the stronger the craving, the harder it was to resist. Satisfying it becomes a compulsion, one that, under the abstinence model, the only choice is to fight. Addicts call this internal battle white-knuckling it.
Realizing that abstinence actually increases the desire to drink, Sinclair had an idea. What if there was a way to stop rats (and then people) from getting the expected reward from alcohol itself. Would they then lose the desire for it?
To test this, he gave rats that had been bred over generations to like alcohol an opioid-blocker called naltrexone before they drank. That way, when they consumed alcohol, they wouldn’t get the high, the euphoria that keeps people (and rats) coming back to the bottle.
After just five sessions, all but one of the rats abstained if given the choice to consume alcohol or not. They’d reached extinction. The behavior, once learned, had been unlearned. The drooling had stopped.
But could this translate to people?
In short, yes. Of the first 147 human subjects tested at Alko Laboratories in the late 1990s, 115 significantly reduced their drinking over just three months if they strictly followed the protocol, or what’s now known as The Sinclair Method. Since then, these findings have been replicated in clinical trials.
The Sinclair Method is simple: Take an opioid blocker (typically naltrexone or, in some places, nalmefene ) at least one hour before drinking and then proceed to drink as normal. Gradually, the blocker retrains the brain not to expect the reward associated with alcohol and so the desire to drink is either greatly diminished or entirely stops. And the success rates are shockingly high, especially compared with abstinence-based programs like AA: Nearly 80 percent of people who follow the protocol see major reductions in drinking. They are able to do something many clinicians and doctors think is impossible after addiction: control their drinking. They are able to drink like non-alcoholics.
For some, that’s the goal—control. They want to be able to have a glass of wine with dinner instead of the whole bottle. Others get entirely sober, including Katie Lain, who hit extinction after nine months and has now been sober for four years. She’s such a believer in TSM that she changed careers and founded Thrive Recovery, a coaching and support service for people doing TSM. People, that is, just like me.
Drinking came naturally to me. I’m almost 40 now, but I started drinking in high school with lukewarm bottles of Zima, the beverage of choice for girls and gays in the late ‘90s. By the time I was out of college, I’d moved onto beer and liquor and was a full blown barfly, parked at the bar before dark. At some point, I was no longer drinking because it made me feel good but because not drinking made me feel awful. Like Katie Lain, I could not imagine how people would stay sober or why they would want to in the first place.