Q: Are people treated with TSM, who have their alcohol addiction extinguished, at risk to immediately develop some other addiction? Answer by John David Sinclair, Ph.D.
A: No, we saw no sign of that in the alcoholics we treated with naltrexone at ContrAl Clinics nor in the 3 year follow up on those patients.
It also does not make make sense according to our understanding of addiction. The consensus is that addictions are learned. Some people with the right genetics and the opportunity to drink get so much reinforcement so often that the behavior eventually after many years becomes so powerful they cannot control it. After we extinguish the alcohol drinking, it is possible that they could start learning some other addiction but that we take at least as many years as it took to develop alcoholism previously. Probably longer, because if they make the other behavior, e.g. shoplifting, on one of the days when they are drinking and taking naltrexone, the stealing will not be reinforced and indeed will itself be extinguished.
There is a myth that alcoholism is caused by the development of some underlying mental problem, e.g., depression. If that were true, one could cure alcoholism with anti-depressive drugs. That has been tried many times and it does not work. Also, if that were true, we would not be able to extinguish alcohol drinking with naloxone or nalmefene. Actually, our results showed a rather interesting relationship between alcoholism and depression. It is true that most alcoholics suffer from depression. We also found this in the ContrAl patients. Prior to treatment we had them fill in the Beck index for depression, and most of them had elevated levels. After about 4 months of treatment, we had them fill in the index again; they showed a highly significant decrease in the depression index. Indeed, it was one of the most powerful effects we found. The results indicate that the depression found in so many alcoholics is not the cause of their drinking but rather, in some way, the result of their drinking. Get rid of the drinking and you get rid of the depression in nearly all of the subjects. (I should mention that there are rare cases who have depression as a primary disease, and also become alcoholics. I met one at the clinic in Boston. The naltrexone had extinguished his alcohol drinking. Incidentally, it had also gotten rid of his cocaine use. But he still was depressed. This is, however, a rare exception and the vast majority of alcoholics get rid of their depression when their drinking is extinguished.)