Harm Reduction: How Pragmatic Policy Can Improve Public Health, November 28, 2016
Full Speech Text:
This is naltrexone. It’s an inexpensive, generic medication. When used properly, it helps the vast majority of those people who use it; recover from alcohol use disorder. Naltrexone is not habit forming. It’s not a narcotic, or a replacement therapy drug. Nobody abuses it—because they can’t. It’s simply not possible.
Research shows that traditional treatment for alcohol abuse fails 85-90 percent of the time. Government data indicates a 90% relapse rate over four years. About half of those relapses happen within six months.
The treatment method I’m here to talk about flips those statistics. It SUCCEEDS for about 80 percent of those who use it, and most people see dramatic improvement in about four months.
Sounds too good to be true, doesn’t it? That’s the way medical breakthroughs have always been. Remember when cancer and HIV were death sentences? Medical science has given millions of people the opportunity to live full lives. I stand here before you as proof that the notion of “once an alcoholic, always an alcoholic” is wrong...thanks to The Sinclair Method.
The Sinclair Method was discovered by American scientist Doctor John David Sinclair. His revolutionary research to reduce harmful drinking levels was funded by an act of Parliament in Finland.
The Sinclair Method is backed by science. The concept is simple, but contrary to the current paradigm of treatment by abstinence. Naltrexone is taken an hour before the first drink of the day and over the course of a few months cravings dissipate and drinking declines. It might sound like magic, but it’s not. More than 120 published clinical trials from around the world show that naltrexone works this way.
The technical term for the Sinclair Method is targeted pharmacological extinction. Naltrexone works by blocking the chemical reinforcement of alcohol in the brain. In order to interrupt that reinforcement and extinguish alcohol cravings, both naltrexone and alcohol have to be present. That’s why naltrexone is scientifically superior to every other available treatment when it comes to reducing heavy drinking and the percentage of heavy drinking days.
However, in spite of recommendations from the Veterans Administration, the National Institute of Alcohol Abuse and Alcoholism, SAMHSA, and more, many doctors still refuse to prescribe this life-saving medication. And those who do are prescribing it in the least effective way—once daily with abstinence, because when naltrexone was approved more than 20 years ago, researchers were practically forbidden to consider anything short of abstinence as a successful outcome we now know that moderation is a safe more realistic goal.
Abstinence... The entire concept of never drinking again for life continues to be one of the most difficult barriers for a person with AUD to overcome. “Just say no” often means saying “no” to treatment. And with a 90% projected relapse rate, many people rightly believe that abstinence-based treatments don’t work. That’s why most people with AUD, struggle for at least a decade before we seek professional help. Then our heads are filled with the unrealistic notion that we can achieve recovery in 30 days or less.
That’s another problem—too many people believe that a long-term battle with alcohol addiction can be simply stopped with willpower and talk therapy in 30 days or less. There is nothing scientific about a 28-day rehab stay.
The American Medical Association first labeled alcoholism as a disease of the brain in 1956, but those with AUD are not treated as though they have a disease. What if other diseases were treated like addiction? Would your doctor refuse to address your high cholesterol or blood pressure until after you had a heart attack? Would your doctor tell you to see a nutritionist, but withhold insulin until after you’ve proven you are ready to stop eating sugar entirely? Would he or she tell you it’s your fault that your cancer has returned? This is the reality for someone with an addiction to alcohol. Society, and many treatment professionals, believe a person has to hit rock bottom and lose it all before they can commit to recovery.
Rock bottom is unethical. It is the polar opposite of harm reduction. It’s immoral...and making patients reach rock bottom before medical treatment is given should be considered malpractice.
The 35 billion dollar a year treatment system is failing our citizens with AUD. It is largely based on information written by a couple of men in the 1930s who struggled to maintain their own sobriety. Science has made countless discoveries since then. Researchers have identified functional pathways in the brain and found medications like naltrexone are effective treatments.
After almost 20 years of use in Finland, clinics are still reporting a 75% long-term success rate.
Why aren’t we taking advantage of the Sinclair Method here in the United States?
Harmful alcohol use costs Americans $249 billion dollars a year. Research estimates nearly a third of American adults will meet the diagnostic criteria for an alcohol use disorder at some point in their lives. Alcohol misuse contributes significantly to disease, loss of life, auto crashes, domestic violence, broken families, homelessness, and more.
We can do so much better than this. Imagine the difference if 75 percent of those who drink harmfully were able to achieve real and lasting recovery. I can almost guarantee that each and every one of you can think of at least one person that could use a little help controlling how much alcohol they drink. It’s shameful that for 22 years we’ve had the tools to make a real and lasting change in our fight against alcohol addiction, and it’s been overlooked...while lives were destroyed. So honestly, what’s stopping us now?
In the 7 years I’ve been counseling people who choose to try TSM, I have provided peer support for doctors, law enforcement and government employees, pilots, and a myriad of others who have a pressing need for privacy when dealing with drinking issues. Employees are encouraged to seek help, but when they actually do so, their careers may be at risk.
The Sinclair Method can be done privately. There’s no need to miss work, to find time in a busy schedule for meetings, or to confess sins and shortcomings to strangers.
SAMHSA, recommends the use of naltrexone for alcohol use disorder. They maintain a registry for what are considered evidence-based treatments. This registry is supposed to be a clearinghouse of treatments that work and, considering the name, have evidence to back them up. However, it isn’t that simple.
Addiction treatments using medication must include behavioral or psychosocial components in order to even be considered for review as an evidence-based treatment. If they don’t, no amount of clinical, practical, or scientific research is enough to elevate a medicinal treatment to the status of evidence-based—even if it has been replicated, peer-reviewed, and published. This, in spite of SAMHSA’s own report that indicates about 60% of people with an AUD do NOT have a co-occurring mental illness.
How does the “gold standard” of science, double-blind, peer-reviewed, published research NOT count as evidence of effectiveness when the science indicates significant measures of success? And why are 100% of people seeking treatment for AUD coerced into receiving the expensive psychosocial and behavioral treatments that only 40% need?
The system is stuck in the 1930s. Sobriety and variations of the 12-step program are the status quo. AA isn’t the problem. In fact, a person can easily participate in AA and be in recovery using the Sinclair Method. The problem is that the addiction treatment industry is charging people thousands of dollars for what AA offers for free….only with yoga and equine therapy thrown in. For most people, expensive detox and inpatient treatments don’t work on a long-term basis. Often it actually has the opposite effect—because of the alcohol deprivation effect.
Discovered in the 1960s and backed up by science, the alcohol deprivation effect is a side effect of sudden, forced sobriety. Basically, when a person is addicted to alcohol and suddenly quits each subsequent relapse gets worse and worse.
The 35 billion dollar treatment industry’s detox and cold turkey approach triggers the alcohol deprivation effect and creates a revolving door of desperate people who feel they have no choice but to return to the same industry that failed them the first time. It’s an institutionalized positive reinforcement cycle and the only winner is the bottom line of the addiction treatment industry. How can we reduce the socioeconomic harms of alcohol use if the primary treatment being offered is making people worse?
Medicare data from 2013 shows that per patient treated, oral naltrexone cost 10% of the name brand injections. As elected officials, I’m sure you can see the value in being associated with supporting a program that is both highly effective and saves taxpayers 90% .
88,000 people die each year from alcohol-related causes in the U.S. It’s estimated that 47,000 people died from drug overdoses in 2014. With the growing opioid epidemic, the Sinclair Method is a viable way to save money on fighting harmful alcohol use so that funds can be redirected to reducing the harms from drug addiction. By lowering the cost of treating AUD while increasing effectiveness, that frees up more funding for fighting drug abuse.
Since naltrexone is generic, it must be protected as a low-cost medication. We don't need another Epi-pen inflation and we can see that the cost of naloxone is showing signs of spinning out of control...so it can happen. Naltrexone is a perfect candidate for a shift to over-the-counter status. It’s already an OTC in some countries, but if a drug company were to pay the high fees charged by the FDA, the price for the medication would surely rise...once again making it difficult for many to obtain.
In conclusion, I ask that you take some time to learn more about the Sinclair Method and naltrexone. Continue to create and support legislation that protects the low price of generic medications to ensure those who could benefit from naltrexone will always be able to afford it. Encourage more doctors prescribing through Medicare Part-D to treat patients with oral naltrexone instead of the more costly injection to achieve a savings of 90 percent. Talk to your own doctor, to the people you love and care about, and begin to see alcohol use disorder as it really is...treatable, curable, preventable.
Deaths from alcohol misuse are at a 35-year high in America, and that doesn’t include drunk driving statistics. One of the most ubiquitous sayings in addiction treatment is the Serenity Prayer. It states, “God, grant me the serenity to accept the things I cannot change, courage to change the things I can, and wisdom to know the difference.”
NOW is the time to change the things we can no longer accept. We have the tools. All we need is the courage to break tradition and encourage our Nation’s doctors to treat alcohol addiction like the long-term, preventable condition that it is using an inexpensive, FDA-approved medication that is well tolerated and non-habit forming. Those with alcohol use disorder want help. We need to make it as easy as possible to attain.
The Sinclair Method saves lives, and you have the power to make it accessible to everyone who needs it.