TSM: Hacking alcohol recovery

It seems everybody loves a good life hack. Human beings have a tendency to pack way too much into an average day, so anything we can do streamline our lives and reclaim time can feel like a miracle. In this respect, recovery from alcohol use disorder is not much different. We’ve compiled some tips that can help ensure you are focusing on the right TSM alcohol recovery hacks while avoiding shortcuts that can sabotage your success.

The Sinclair Method is already the alcohol recovery hack you have been searching for.

Decades of research and (finally) countless resources lay out the instructions for how to leverage opiate antagonists to cut a problem that many people believe lasts until death, to an average span of somewhere between nine to 18 months. Think about that. A year and a half is a long time, but if you have several decades left to live, it’s a small percentage of the time you have left. As with most things, success with TSM requires a commitment to follow the instructions…every time.

Medication adherence is critical

I’m willing to bet that for those of you who are currently on the Sinclair Method, naltrexone (or nalmefene if you are in certain parts of the world) is not the first medication you have ever taken in your adult life.

Maybe you have needed antibiotics for an infection. Maybe you’ve taken over the counter analgesics for pain or inflammation. You might be taking something for an unrelated ongoing mental or physical health issue. Women, maybe you have taken birth control.

With this in mind, can you think of another medication you either have or are currently taking that you actively test the effectiveness by using it against the instructions that are provided “for best results”?

Hopefully not, yet it seems that almost every day, we at the C Three Foundation witness people who do that very thing. We see the questions and statements pop up in support forums. “What if I decide that sometimes I don’t want to wait the hour before drinking?” “Can I drink without my medication sometimes?” “I barely drink anymore so I stopped taking my medication even on those occasions when I do drink. So far I feel fine.” And then there’s the ever so prevalent, “I dabbled with the Sinclair Method for a few months and it didn’t work for me.” You’re trying to hack the hack in a way that will break it and undermine your efforts toward recovery.

For many, all this experimentation with the Sinclair Method and its medications happens because people are desperately seeking the fastest way to end the suffering, anxiety, fear and shame of alcohol use disorder. Decades of being told you will never really recover have taken its toll. But every time you try to shave away part of the process, what you are actually doing is leaving out pieces of your recovery puzzle and severely limiting your chance of full and complete success.

The required wait time

Imagine you are painting a room. The room is painted the most hideous color you can imagine and you know from the beginning that you’re going to need at least one coat of primer plus the new paint. If you know that the primer takes an hour to completely dry, would you start applying the paint after 45 minutes when there are still spots on the wall that are tacky to the touch? What would the end result look like? Probably sloppy and not what you’re hoping for. Would you blame the paint or the primer for the disappointing results? After all, you knew before you started that you’d have to wait for each coat to dry.

When you don’t wait long enough for your body to properly absorb and begin metabolizing your medication, your brain’s receptors are not completely prepared to block the reward that drinking alcohol produces. If you are not fully blocking the reward, then you will take much longer to see results.

Like fresh paint on the wall, if you wait a little longer than the required minimum time, you are still ensuring your medication has been properly absorbed into your system.

Flirting with disaster

There are some people who equate nal with being a “condom for drinking.” It’s not necessary to use when practicing abstinence, but it’s a great harm reduction tool when you’re not. Like a condom, your medication is only going to work when you use it the right way. Taking it sometimes, but not every time you drink is like having sex and expecting condoms to protect you both when you are and when you are not wearing one. It doesn’t work that way.

The Sinclair Method is simple in its protocol; always take your medication before you drink alcohol, for as long as you continue to drink it. That means if you are still occasionally consuming alcohol 20 years from now, you will still be putting yourself at risk if you drink without your medication. Ladies, if you are/were taking birth control pills, would it make sense to claim that just because you took them as prescribed for years and didn’t get pregnant, that having unprotected sex while not on the pill will still keep you from risking pregnancy? Of course not!

 

Improving upon greatness

Now that we’ve established that TSM is the hack and that trying to “hack a hack” can backfire, let’s look at what you can do to streamline your recovery process. The following tips from CEO Claudia Christian are focused on helping to reduce the percentage for whom TSM appears not to work, specifically by addressing lack of compliance, giving up too soon, etc.

• • Keep a drink log. This sounds obvious but you’d be surprised how many people do not make the effort to log their drinks. You need to see how much you are drinking in order to be accountable and to start training yourself to drink mindfully.A drink log is also useful so that you can track your progress. Data is objective and a reduction graph is a wonderful tool to take to follow up visits with your provider, or to share with a skeptical loved one. It will help remind you after those rough days that you are still making progress. Download the free drink log spreadsheet or TSM Drink Log app

• • Drink mindfully. Many people ask what that actually means. It means paying attention while you are drinking. Drink slowly to enjoy your drink NOT to get buzzed as soon as possible or to have that familiar “hit” of alcohol reach your brain in record time. You also have to ask yourself: do I want or do I need a second or third drink? If I do, then why do I want or need it? Am I just enjoying a few pints with my friends or am I trying to recreate the same feeling I used to get from drinking pre-TSM? Am I drinking out of boredom? Habit? Until you recognize and face these issues you will not be retraining your brain to “drink normally.”

• • UPDATED – Ask your doctor or pharmacist about breaking your naltrexone tablets in half before taking. There are several reasons why you might think breaking your pills will be more effective. However, there are also great reasons not to do this without first consulting your doctor and/or pharmacist.
    First, the likelihood that you are getting equal doses out of each piece is very small. How can you be adhere to the medication protocol if you do not even know with certainty what dose you are actually taking?Second, some coatings are meant to protect the medication until it gets to the right place in your digestive tract. If the medication is exposed too early, the active ingredient can be destroyed by enzymes before it’s absorbed. So not only are you NOT absorbing your medication faster…you may be absorbing much less of it at the same pace.

    Third, splitting your pills may actually INCREASE your side effects. If your reason for taking a smaller dose is to avoid side effects, but you continue splitting it, you are inadvertently sabotaging your efforts.

    If you have a need for a smaller dose, have your doctor send your prescription to a compounding pharmacy. They specialize in taking medications and formulating them for better absorption, for faster absorption, or for smaller doses when the standard size pill is too much.

    For more information, see Tablet Splitting When Two Halves Don’t Equal a Whole.

• • Stagger your drinking times, for example: if you normally take the medication on your way home from work at 5 p.m. and have a drink at 6 p.m. then switch things up and retrain your brain to not be in “habit mode” by taking the pill when you get home at 6 p.m. and doing a hobby or craft or meal preparation or answer emails, write a letter etc. for 75 minutes then have a drink at 7:15…anything to break the habits you have developed over the years and to tell your “lizard brain” that it’s not the boss of you anymore.

• • Start new hobbies or pick old ones up again. You’d be surprised to hear that playing an instrument, wood carving, dancing, working out, attending a book club and other activities have been instrumental in people’s success with TSM, but it’s true. The most successful “TSMers” have found ways to engage their minds and bodies other than drinking and have found happiness, fulfillment and distraction in these many hobbies, crafts and exercise plans. They have also reported that they “forget” to drink; now THAT’S what we’re aiming for!

• • Join the forum or Facebook pages. It’s important to know that you are not alone when doing TSM. Our Options Save Lives forum is a terrific way to engage with people and find online support plus there are currently two Facebook pages run by and attended by people on TSM. Please note that these are peer support groups and should NOT be used for medical advice. Click here for a list of peer support options.

• • If you are a round the clock drinker or a lunch and dinner drinker then you might wish to talk to your doctor about taking a second dose 4-8 hours after the first dose. Many doctors suggest taking a second dose 6 hours after the first dose. For example, if you take 50 mg of naltrexone at noon and drink at 1pm and you are still drinking in the evening and into the night, you should take a second pill at 6pm to protect yourself. Take the second dose then wait an hour then drink.Please discuss this with your doctor so they can provide you with enough medication if you need to take a second dose.There are doctors who believe that you can wait 4-12 hours between doses so you really need to discuss the specificity of the dosing with a medical professional. People have different weights, fat to muscle ratio, and they metabolize naltrexone in a different amount of time, so please discuss this with your doctor to find a plan to ensure that you are fully protected when you drink for long periods of time. Hopefully within a few weeks this point will be null and you will not have the need for more than one dose of naltrexone per drinking session.

• Give back and wear your journey with pride. I’ve spoken about my desire to reduce shame and stigma but to be honest, it starts with YOU. You must understand that AUD is a learned behavior, a compulsive brain disorder, it is not a “curse” or a “moral failing” or an indication that you are “weak” or a “bad person.”

Learn to forgive yourself and find a way to be comfortable in acknowledging that you have an issue with alcohol, but you are being pro active in utilizing a medical treatment to regain control or quit drinking all together. Be proud of yourself, be accountable and most of all be forgiving. Surround yourself with people who encourage you and take a break from those who doubt you or your chosen path. Part of healing is understanding when someone is helping you or hindering your progress, this is your life; choose the people who help you. Once you reach a point where you feel your drinking is under control or you have reached extinction, consider giving back and helping others who are struggling. Whether it’s becoming a TSM “buddy” (much like a “sponsor”) or encouraging beginners online with your journey or simply spreading the word about TSM; giving back will solidify your experience on TSM and it will make you feel even better, trust me.  A great way to give back is to donate so that we can continue to provide free information to individuals, we rely on donations.

Additional resources

Personal TSM Coaching

C Three Foundation YouTube Playlist