Dr Mark Leeds: Grey Area Drinking

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Transcript, Gray Area Drinking Dr. Mark Leeds Day 1 Panel 1:


Jenny: Welcome back everybody. How is the sound? Dr. Leeds, go ahead and say “Hello” so people can make sure that they can hear you.

Dr. Leeds: Hello. How are you?

Jenny: How’s our sound everybody. All right, looks like our sound is good. So once again, I am Jenny Williamson, Executive Director of the C Three Foundation. On behalf of myself and our founder and CEO, Claudia Christian, we are glad you're watching our second annual virtual TSM conference, Stronger Than Your Drink. Please feel free to use the chat function if you are watching live on Twitch to ask questions all throughout the panel. I will be collecting them and asking our presenter your questions during the Q&A following the presentation. Also if you are on Twitter, please feel free to live tweet our conference with the hashtags, #strongerthanyourdrink and #optionssavelives. It’s a great way to amplify the impact of our conference. This conference is available to view and to participate in for free thanks to our two co-headline sponsors Ria Health and Workit Health. If you'd like to support the work of the C Three Foundation, there is a donation link in our profile, and we have a timer that will also drop a donation link into the chat during the broadcast.

Next up we have Dr. Mark Leeds presenting about gray area drinking. Dr. Mark Leeds is an osteopathic physician whose practice is focused on harm reduction and medication-assisted treatment for alcohol use disorder and opioid use disorder. In recent years he's seen a significant increase in patients seeking help to reduce or eliminate their alcohol intake. Dr. Leeds provides The Sinclair Method as a form of medication-assisted treatment and harm reduction to help patients reduce alcohol use. TSM, in providing pharmacological extinction of psychological alcohol dependence, has been highly successful for his patients. Dr. Leeds has noted that gray area drinkers, people who consume excess alcohol on occasion, and have not yet faced serious consequences of alcohol use, respond particularly well to naltrexone therapy. There may be an immense benefit to society in promoting the use of TSM in gray area drinkers to prevent their progression to a diagnosis of alcohol use disorder. In addition to practicing medicine, Dr. Leeds is the host of the Rehab podcast on the Mental Health News Radio Network. Dr. Leeds also currently serves on the board of the Digital Tech Initiative supporting the treatment, research, and awareness of digital media addictions. So I'm going to go ahead and hide my video from the broadcast now, and Dr. Leeds, whenever you are ready, you can go ahead and begin.

"Gray area drinking is a level of drinking that is below that of a severe case of alcohol use disorder, and it is above the level of an occasional, casual drinker who rarely drinks and never gets intoxicated."

Dr. Leeds: Thank you. What is gray area drinking? Gray area drinking is a level of drinking that is below that of a severe case of alcohol use disorder, and it is above the level of an occasional, casual drinker who rarely drinks and never gets intoxicated. A person who has an occasional sip of wine or champagne, not finishing the whole glass, is not a gray area drinker. Having a sip or two of champagne on New Year's Eve is not gray drinking. At the other extreme, a person who drinks to get drunk every single day is probably beyond being a gray area drinker. Having blackouts where you forget where you were the night before, or waking up with people you don't know, is beyond gray area drinking. Driving drunk and getting charged with drunk driving is a sign of someone who is beyond gray area drinking. Gray area drinkers typically don't drink in the morning to get rid of the hangover. They're more likely to try other remedies and suffer through the hangover, wishing they'd not had so much to drink the night before.
Are gray area drinkers – just alcoholics in denial?
Of course, as the name implies, there is a gray area where it is hard to define where a person is on the spectrum of alcohol use disorder, alcohol use or misuse. Addiction is characterized by denial. People do not want to acknowledge that they have a problem until the problem gets bad enough that they have no choice but to get help. There are certainly people who fit the definition of alcohol use disorder, who do not see themselves as alcoholics. They may admit to drinking too much on occasion, but not having a problem with the drinking, to the extent that they need outside help. They believe that they have the problem under control. A gray area drinker does have control over their drinking much of the time. They do not drink every day. They control whether or not they're going to drink. But when the drinking starts, they have a tendency to get out of control, until the night is over. Gray area drinkers are at risk for progressing to becoming alcoholics. While not all will develop alcohol use disorder, many eventually will, as they continue to drink excessively on occasion. The progression may begin as they start going out to drink one extra night during the week. Maybe the party starts on Thursday night, instead of Friday. One day, with a particularly bad hangover, they may decide to finally try having a morning drink, to see if it really does get rid of the hangover and the headaches and the sickness. A traumatic life event may lead to more drinking and more life problems associated with drinking alcohol. A death in the family, a breakup or a loss of a job, can lead to anxiety and depression. For someone who already has a tendency to drink excessively on occasion, they realize that they can self-medicate with alcohol. Eventually the level of control that the gray area drinker has over when the decided to go out drinking starts to fade away. Yet if the person identified themselves as a gray area drinker for many years, they will still believe for some time that they can fit into that category, even after they have progressed into the realm of alcohol use disorder.
Is gray area drinking a problem?
Gray area drinking is common in college age young adults and even with many young working adults. On college campuses where alcohol is allowed, students will drink to unwind from a weekend of hard schoolwork. They go to campus parties and let go, drinking as much as they want on the weekend nights. Young healthy people in their early 20s have a sense of invincibility. They see their peers drinking to get drunk, and they see no problem with doing the same. Drinking may seem fun in the beginning, and it leads to exciting and unpredictable outcomes. Couples may meet on campus after a night of drinking at a party. New friendships may begin during a drunken night.

But is gray area drinking a problem for these young adults? As we know there is no amount of alcohol that is healthy. Alcohol is a substance that is toxic and it strains the body, and it leads to irreversible damage. The American Cancer Society recently announced that there is no safe amount of alcohol. Even young and healthy college students would be better off not drinking at all. Alcohol use affects performance. If a college student is concerned about not keeping up in class and not having the grades they want, they should first look at their alcohol intake and drug intake as well, if that's a factor. While most gray area drinkers in college will not become alcoholics, their drinking may have long lasting consequences. Drinking too much on the weekends has an effect on studying and performance in class during the week. A student may dream of going to a graduate program, such as law school or medical school, where they may look forward to a good job with a specific company after graduation. Either way, they may have to change their plans along the way, because they're unable to achieve their goal, or they downgrade their expectations. Poor grades and changes in life plans are often justified and explained away as being either because the person was not capable of achieving their goal, or was not really what they were meant to do. But what if gray area drinking is what killed their dream? These days, people are often looking for a magic pill that can make them perform better academically, or work to be more successful. It turns out that one of the greatest superpowers a person can have to make them succeed in achieving their dreams and making their dreams come true, is to remain alcohol and drug free.

Gray area drinking could go on for a lifetime. If the problem never progresses, then it never gets to the point where help is definitely needed. No one is going to be confronted with a family intervention because they've had a few too many drinks at dinner occasionally. A person may arrive at the age of 50, 60 or 70 years old, and realize that their life dreams have slipped away because they never reach their true potential. Even as mature adults, they may still not attribute their life failures to the occasional excessive drinking. On the other hand, the alcoholic may get help along the way and go into recovery. Being alcohol and drug free, they discover they're able to do anything they want in life. The recovering alcoholic has the advantage over the gray area drinker in this way. In fact, people in recovery from alcohol use disorder often start to notice that family and friends around them are gray area drinkers who regularly have too much to drink.
Do gray area drinkers need medication to help them stop drinking?
Should gray area drinkers take medication to help them cut back on drinking? Most gray area drinkers would probably say no to medication or medical treatment. Why should they get medical treatment when they don't have a problem? Yet gray area drinking is a problem, and all gray area drinkers would benefit from cutting back on their drinking. It is possible to stop gray area drinking without medication. There are many coaches that will work with clients to talk them through slowing down and stopping their excessive drinking. These coaches work with clients by pointing out all the ways in life they can enjoy and accomplish, all things they can enjoy and accomplish without alcohol. They show them how alcohol use is really not fun at all. Suggesting medication for a problem that can be solved without medication may seem excessive. Yeah, we take medication all the time for things like headaches, allergies, upset stomach and more. Anti-inflammatories, anti-histamines and antacids – are these drugs safer than a drug, such as naltrexone? Why would we think taking a few Advil gel caps is fine, but taking a naltrexone tablet before going out to the party is bad. The problem is a general lack of understanding of what naltrexone is and how safe it is for most people. Of course it is not right for everyone, but neither is Advil, Claritin or Tums.

"I believe that a gray area drinker is a perfect candidate for The Sinclair Method. The medication is safe for most people and works well to help people reduce their alcohol intake."

Is The Sinclair Method appropriate for the gray area drinker? I believe that a gray area drinker is a perfect candidate for The Sinclair Method. The medication is safe for most people and works well to help people reduce their alcohol intake. In a perfect world, no one would drink and no one would feel the need to drink. We would all realize that enjoyment of life is better found in other ways than going out for a night of drinking. On a cruise ship for example, people sit at the dinner table and have one drink after another. Then they go to the various ship bars and have more drinks. Cruise lines sell drink plans that allow vacationers to have as much alcohol as they can consume. But wouldn't it be more pleasant to walk on deck and enjoy the sea air and peacefulness of the open ocean? On a ship at sea you can enjoy beautiful sunrises and sunsets, and there are many other fun activities to do on board that do not involve any alcohol. Unfortunately, people still drink too much on vacation, and when they go out to nightclubs and parties. What if they had a prescription for naltrexone, and were able to take a pill before going out? What if people on a cruise ship could take a pill to help them naturally keep the drinking under control? When it comes to alcohol, less is always better. Naltrexone is safe. Instead of thinking in terms of a person being either alcoholic or non-alcoholic, we should think more in terms of harm reduction. While not everyone would choose to take the pill, if we made it more available there would certainly be people who would make the choice to try the treatment, and see how they feel with less drinking. College students would be more productive. Vacationers would enjoy their vacations more. Workers would get more work done and feel better going into work on Monday morning. No one has ever woken up in the morning, wishing that they had gotten drunk the night before.

"My clinical experience in providing TSM to gray area drinkers, is that it does work incredibly well. The results are dramatic and almost hard to believe."

How well does TSM work for gray area drinkers? My clinical experience in providing TSM to gray area drinkers, is that it does work incredibly well. The results are dramatic and almost hard to believe. There are people who call my office inquiring about TSM, who are clearly gray area drinkers. They only drink on occasion, but when they do, they tend to go on one-night drinking binges. In my experience, a typical gray area drinker patient has their consultation and gets their prescription, and then I often don't hear for them back right away for a while. When I finally do get in touch with them, they report back that the results were better than expected. In a short time, the gray area drinker loses interest in alcohol. I have on multiple occasions had patients who asked if they needed to continue with the treatment after just a few sessions. They would rather not drink anymore at that point. They quickly lose interest; they lose the desire to drink all alcoholic beverages. A large formal study on the efficacy of TSM on gray area drinkers should be done, and I believe that the results would reflect my experience that gray area drinkers respond very well, and quickly to TSM.

The most common question I get from gray drinking patients on The Sinclair Method is that, do they need to keep going on with it. That is a good question. Is further pharmacological extinction beneficial when the patient does not want to have another drink? I don't believe that a few sessions of TSM will completely end a person's alcohol use for life, even if they are a gray area drinker. However, the treatment is certainly beneficial and should be continued, or even restarted if needed, going forward.
Should gray area drinkers have to go to a doctor for a prescription for naltrexone?
If naltrexone is so safe, why do people need to go to a doctor to get a prescription? Why are some medications over the counter and others are not? The kinds of medications that are OTC vary from one country to another. In many countries, people have the freedom to purchase more types of medication, and then they decide if they want to see a doctor to guide their treatment. In the US, the FDA is conservative in making decisions to allow a medication to become over the counter. In some cases, special interest groups lobby the FDA to keep the medication for becoming over the counter. For example, there was an asthma rescue inhaler that the FDA was going to approve to be the over the counter. The reasoning for approving it was because it would be far safer than the existing over the counter inhaler, which has a serious cardiac risk associated with it, allowing people to make the choice to buy the safer inhaler would have been a form of harm reduction. Of course it's always great when people get to go see their doctor for guidance but in the real world, people self-treat with what they can find on the shelves of your local pharmacy or grocery store. If the only asthma inhaler is the over the counter one which is more dangerous, people will choose it simply to avoid having to sit in a doctor's waiting room for to ask for a prescription and then wait in line at the pharmacy. A safer inhaler was never approved by the FDA, because a group of pulmonologists lobbied to prevent the approval. Why would they want to prevent the public from having a safer over the counter choice? Their argument was that if people with asthma can get the good inhaler without seeing a doctor, they might choose not to see an asthma specialist and get a proper full treatment for their asthma. There is some justification to their decision, in that lung function should be measured and asthma is often best treated with a combination of medications. However, they did not take into account the concept of harm reduction. It would be great if everyone with asthma would see a pulmonologist, but unfortunately, many people are not going to see a doctor if they know that there's an over the counter medication that they can purchase and use as needed. If there was no rescue inhaler available over the counter, then those patients would have no choice but to go see a doctor for a prescription. But since there is a dangerous inhaler currently on the shelves, and there exists much safer inhalers available only with a prescription, the proper decision that should have been made by the FDA is clear. In the end, people will choose to buy a more dangerous drug over the counter because it is the only one available out of prescription. By choosing harm reduction over the greedy lobbying of a group of specialists, the FDA would have without a doubt, saved lives.


Should naltrexone be approved for over the counter use?

Should people be able to purchase naltrexone tablets without a prescription, without speaking to a doctor or pharmacist? The most important consideration is safety. Over the counter medications are typically relatively safe to the extent that members of the general public can be trusted to read the instructions and take them in a safe manner. Naltrexone does have side effects and contraindications. Not everyone should take naltrexone, yet it is very safe for most people. It is on par with the safety profile for other drugs available without a prescription, such as ibuprofen, acetaminophen and aspirin. Why wouldn't the FDA approved naltrexone to be an over the counter drug? Clearly gray area drinkers everywhere would benefit from the drug being more easily available. Many doctors are already refusing to prescribe the drug without good reason. Their patients often have a better understanding of naltrexone than they do. Imagine if naltrexone were available at the checkout counter in the grocery store, or at the cash register at the local gas station. What if universities could hand out packets with one or two naltrexone tablets? Schools already give away free condoms to students, why not naltrexone tablets? Imagine if you could buy naltrexone in the bar from a vending machine. They already sell a variety of medications in the bathroom, such as aspirin, ibuprofen or naproxen, why not naltrexone?

How can TSM gray area drinkers improve people's lives, how can TSM for gray area drinkers improve their lives? TSM can clearly make the lives of gray area drinkers better. By not drinking they're able to enjoy and appreciate the things in life that are truly rewarding. Imagine spending an evening with your children, watching a movie, or playing a board game, or getting to bed early to enjoy a peaceful walk in the early morning. Life is much better without alcohol, or at least with a lot less alcohol.

How can society be improved by using TSM for gray area drinkers? It's nearly impossible to measure the lost productivity from gray area drinking. The problem is so prevalent and pervasive in society, that its effects extend to all areas of modern life. When your phone doesn't work because of the new update you downloaded and it has bugs, is it because the software engineers had a few too many drinks at the bar drinking wine on the weekends? When your child's teacher puts on a video for the class to watch Monday morning, instead of providing an inspiring lecture, is it because the teacher had a hangover from the night before? It's hard to imagine how much better things might work if it was less drinking. It's likely that gray area drinking is a much larger problem than alcohol use disorder and drug addiction. People in recovery often point out that the drug that brought them down the fastest was what got them into recovery, so they did not have to linger in active addiction for too many years. Gray area drinkers are essentially lingering in a low level of functional active addiction that can last many years, or even a lifetime. There are likely many more gray area drinkers than there are alcoholics and drug addicts. It's time for us to start thinking about how we can address this potentially much larger problem.

Should doctors offer naltrexone to all their patients? Naltrexone is not an over the counter medication, and probably not, will not be approved anytime soon. I don't know who would lobby against its approval but probably someone will have something to say about it. Maybe the makers of Vivitrol. In the meantime, it is the responsibility of doctors to decide who should get a prescription for naltrexone. Of course, there are limitations to who should get a prescription for naltrexone. Some people who are prescribed opioids cannot take naltrexone. Pregnant women and people with liver problems should not get a prescription. Otherwise, who should doctors offer naltrexone to? Should doctors carefully screen patients for gray area drinking? Doctors are currently expected to screen patients for alcoholism. There are various questionnaires and screening questions that can help a doctor to determine if a patient has alcohol use disorder. Realistically it is not a problem, it is not a problem that doctors especially want to discover. If a doctor asked if you wear your seat belt and you say no, the solution is simple. They tell you to wear your seat belt. Alcoholism is more complex. Your doctor can't simply tell you to quit drinking and expect that you, that that will work. They should probably refer you to an addiction specialist and they may also recommend peer support meetings like 12 step meetings. But what if you're a gray area drinker visiting your doctor for your yearly physical?

"Instructions for following The Sinclair Method are fairly easy. They can be described in a few sentences."

If you're a gray area drinker visiting your doctor for your routine yearly physical, you'll most likely pass right under the radar of the alcohol screening questions, if they're asked at all. There's an old joke that an alcoholic is defined as someone who drinks more than their doctor. Your doctor may also be a gray area drinker. If your doctor does not see your drinking behavior as a problem, why would they offer you treatment? There is a similar medication to naltrexone that is freely prescribed to patients for the purpose of harm reduction. In fact, there are situations where doctors are legally required to provide a prescription for this particular drug. Narcan nasal spray is a rescue drug that can reverse an opioid overdose. Doctors are expected to prescribe it to people who take opioids, whether prescribed or obtained from the streets. They are also expected to prescribe Narcan, to people who live with opioid users. Narcan is a brand name for the drug naloxone. Naloxone is an opiate receptor blocker just like naltrexone. If a doctor is doing their job, they are freely prescribing and recommending Narcan nasal spray. It's possible to justify prescribing or recommending Narcan to nearly everyone. We all have the potential to come in contact with someone who uses opioids and is at risk for overdosing on opioids. The more Narcan out on the world, the more Narcan out in the world, the better. It is a safe drug and has the potential to save lives. Doctors might want to consider looking at naltrexone in a similar way. Naltrexone and naloxone are both very effective harm reduction medications. Naloxone can save a person's life from an accidental opioid overdose. Naltrexone can save a person from a lifetime of excessive drinking. Rather than looking for excuses to not prescribe naltrexone, doctors should instead look for more reasons to prescribe the medications to more patients. Instructions for following The Sinclair Method are fairly easy. They can be described in a few sentences. Doctors give out diet sheets that are more complicated than The Sinclair Method. A prescription for naltrexone, and a short instruction sheet will be helpful to any adult patient who is a drinker. The patient may choose not to fill the prescription or they may fill it and choose not to take it at first. Still treating gray area drinking as a condition that deserves medical treatment will signal to the patient, that their drinking is a problem for their overall health, even if they're not an alcoholic. At some point, that person before going out to a party or to dinner, may look at the naltrexone bottle and start to think about the benefits of cutting back on their alcohol intake. By discussing the issue, writing the prescription and providing an informational sheet about the benefits of TSM, the doctor will be planting the seed in the mind of their patient. That patient may then talk to family and friends about gray area drinking, and how there is medical treatment that is easily obtained from their family doctor. In busy clinics where patients come in for various complaints or general physicals, and the hurried doctor goes in and out of the exam room every few minutes, there's often a pattern to how these brief medical visits go. The patient states their chief complaint, and the doctor asked questions, and then performs a physical exam. Then the doctor makes recommendations. They may recommend a healthy diet and exercise program, safe sex practices, wearing a seat belt while driving. If the patient has a health condition such as a common cold, the doctor will recommend supportive therapies to feel better, while the cold runs its course. Sometimes the patient has a condition that warrants a prescription for medication and sometimes not. However, there's often an expectation from the patient that a medical visit should end with a prescription. The patient may ask for an antibiotic for their cold, even though it will not help. They may ask if there is something they can take to give them more energy or to help them sleep better. Usually the doctor must disappoint their patient in explaining that there is no prescription needed, only education. The doctor educates the patient on sleep hygiene, eating less, exercising more and so on. What if the doctor offered a prescription for naltrexone and told their patient that this medication could change their life? They'll get to sleep easier on the weekend nights, they’ll wake up refreshed, lose weight because they're not drinking so much, have more energy, enjoy life more and be more productive and creative projects in school and at work. Life can improve dramatically when even occasional excessive alcohol is taken out of the picture. Doctors can provide their patients a prescription that has the potential to change their lives for the better, giving them a better and brighter future. The Sinclair Method is an excellent solution to the problem of gray area drinking. Hopefully more doctors will learn about this harm reduction protocol, and start to have this conversation with more of their patients. Thank you.

Jenny: Okay, thank you so much for your presentation Dr. Leeds. As our audience continues to, send in your questions guys, but I'm going to start with a question that I am asking all of our presenters, and in your TSM patients, gray area and not, what would you say the overall success rate has been?

Dr. Leeds: Very high, definitely in the beginning like they're near 100%. I'm always a little bit of, you know, concerned about that, to see that one patient that tells me it didn't work at all, and I haven't seen that yet. Occasionally a patient complains of an upset stomach or, you know, a mild side effect which they usually get over, but usually it's even the patients that are expecting it to work are surprised at how well it does work, and they're like wow, this really does work as advertised. I really didn't have any, you know, obsession or compulsion or need to keep going. The one drink was enough. And then the issue is just to make it clear that they have to keep going. Sometimes the question is, what do I do after this you know, I really enjoyed having a drink and getting a buzz from the drink and being able to unwind. And now what, and you know they might benefit from therapy, you know, learning what other activities, maybe going through one of those coaching programs to help them find new things that can help them to enjoy life more without needing to take something.

Jenny: Wonderful, and so one of the audience questions are, are there psychotropic medications that should not be used with naltrexone?

Dr. Leeds: Oh, good question. Yeah, and I'm sure there are. I usually do a check for, you know, when a patient, you know when a patient is taking other medications I always put it into a drug interaction checker, and check it, and so far I'm trying to think, I don't think I've come across anything that was a definite contraindication. But yeah, I may not be the best person to answer that question. I would kind of check it, patient by patient basis and so far, other than those basic, you know, the obvious contraindication of anything that's an opiate or opioid-like. That is an interesting thing, that when I asked people do you take opioids and they say no, I then will ask them do you take anything that's opioid-like in its action. You know, there's, there is an antidepressant, tianeptine or something like that. I don't think it’s prescribed in the US, I think it's from other countries around the world, that it is opioid-like in its behavior and maybe a person would go into precipitated withdrawal if they took naltrexone with that. I asked people about Kratom, which is a herbal opioid-like substance that people drink in a tea. I actually did have a patient that went into precipitate withdrawal. He swore he’d taken no opioids for at least several months, but didn't tell me that he’d been drinking Kratom tea on regular basis, and it's another call Why is he so sick? and we went more into the history and found out the reason. He was fine after a short nap. But yeah definitely it's important to look up drug interactions when prescribing anything.

Jenny: Yeah, we usually tell people that they should avoid Kratom for that reason. So Katie asks: What about binge drinkers who drink a couple times a month, but it's very bad when they do, how do you use TSM with them? Are they considered like a high end of a gray area drinkers still, or what?

Dr. Leeds: Yeah, yeah, that's a great, I think that would be a typical gray area drinker. I mean, there's the person that drinks on the weekends, there’s the person that drinks once or twice a month. And, you know, maybe even the person that just drinks a couple times a year, but they get carried away when they do drink. I just recently saw a patient where he only drinks when his partner drinks. But when the partner does drink, he drinks, he gets out of control and just keeps drinking on the same night, and the two of them ended up coming in for treatment together, and I even recommend why not do it together and each of you take your tablet together and, you know, do the program together even though one drinks more than the other. But yeah, a person that occasionally binge drinks once or twice a month, that would be a perfect example of someone that could just take their naltrexone that one or two times when they're gonna go out for a drink. There's no amount of alcohol that safe. Binge drinking is never good. It's kind of like a sunburn, you know, you get a couple of bad sunburns in a lifetime and you’re at more risk for skin cancer. You know, a couple of times, drinking, binge drinking does damage the brain and put a strain on the liver, it's not, there's no level of alcohol that's safe or good for anyone.

Jenny: And in your gray drinkers, how much support do you recommend that they get, in addition to the medication? Do you tell them to join peer support or have coaching?

Dr. Leeds: Yeah, I usually recommend one of the non-12 Step programs only because I've seen so much push back from people that really don't want to go to AA, or they've been, they weren't happy with it, and probably for a person who is a gray area drinker, they're not going to really relate to Alcoholics Anonymous. But yeah definitely will recommend SMART Recovery, you know, for people that want to religious program, they might like stuff like Celebrate Recovery. I know Life Ring is one of the, I don't have a lot of experience with patients on Life Ring, but I've heard good things about it. And there's a group that someone shared a link with me. It's specifically for TSM, for The Sinclair Method, and I haven't heard a lot of feedback yet, but I hear it's a really good group, and you know they've been on Zoom periodically, and so it would be good to know more about groups like that, you know, maybe groups popping up there purely support for The Sinclair Method with people going through the same experience. Coaching. I have a few coaches that do specifically gray area drinking coaching. They're not especially, they don't involve medication in their program, but they're not against it either.

Jenny: Okay, sounds good. Yeah, it sounds like you were probably linked to Embody Daily, that does the daily stuff. That’s with Katie Lain. She's also one of our TSM coaches with the yoursinclairmethod.com coaching. So, yeah, it sounds like that's who you were introduced to. And then you mentioned you haven't had any patients who really weren't responders. So, have you had any that needed a higher dose of naltrexone?

Dr. Leeds: No I haven't come across that. I know that they say that some people need 75 or 100 milligrams. I've had a couple of patients that when they first had side effects that we cut back to 25 milligrams for a while until they tolerated better, and then once they were ready, we go back up to the 50. But yeah, as far as, I mean when they talk about the 22% that don't respond, I don't know if that means that there's going to be like 1/5 of people are just not going to respond at all, but I haven't seen any of them yet. I mean I'm sure they're long term going forward, you know, it depends on how you, how you're measuring that. Are you measuring do they say, you know on the program for a year, five years but everybody so far has seemed to respond, initially to the program.

Jenny: And have you seen any of your patients who need maybe a second dose, if they're drinking all day long, or the round the clock drinkers? Who were drinking daily, all the time at the beginning of the process.

Dr. Leeds: Oh that's a good point. That might be beyond my clinical experience, as far as what I tell people, and that's, you know, I'd like to learn more about that, if that's something of the person you can take a couple of doses during the day in the beginning, because I've basically been instructing people, you know, you get the one pill, wait an hour, get the one drink, and that's it and if they, you know, start out having a few too many drinks – in fact, I think that's why some, you know, at least one patient I can think of got sick initially and I said, you probably were drinking all day before he started, and, you know, the idea is that you're going to do the method, take the pill, and the one drink, but yeah that would be great to learn more about that if there's other ways of implementing the program initially.

Jenny: Wonderful and so I don't know if you're aware, but as you were talking about naltrexone over the counter and for use pretty much as a preventative to keep the gray area drinking from escalating to severe alcohol use disorder. It's very aligned with what we are trying to do as well, because we want to be one of those interest groups that petitions the FDA to update the label for naltrexone. We want to have them update the label first to reflect the prescribing for an hour prior to drink instead of daily with abstinence to align with the science, and then our ultimate goal is to have it available over the counter. And so what you have said, was really resonating a lot with me listening to you, because these are things that have been on our long term plan, this whole time, especially with the CDC estimating that 9 out of 10 people who drink problematically do not meet the criteria for a severe alcohol use disorder. So, what, everything that you were saying about over the counter, is just so aligned with our vision. And part of why we're even doing this conference is to get that information out there, so I really appreciate you talking about that angle of naltrexone and The Sinclair Method use. Another audience question is, is naltrexone safe for people who have heart conditions.

Dr. Leeds: Good question. I'm not sure that that's something that, you're maybe better, somebody else can address that. Yeah, I haven't really come across that anybody with any serious heart conditions that's come in for naltrexone treatment but yeah that's a good question.

Jenny: All right. Audience go ahead and get any last minute questions in. We do have about five minutes if you have any additional questions. So, Dr. Leeds would you say that addressing gray area drinking with The Sinclair Method is equally preventative as it is harm reduction? Preventative in the sense of escalating from at risk and gray drinking to mild, moderate, and severe alcohol use disorder.

Dr. Leeds: Oh yeah, definitely. I mean, the idea is to slow things down, and hopefully prevent that progression. Yeah, I mean, there's medications out there that they promise at best to slow down the progression of disease, not even to stop or reverse it, but only to slow the progress. If we can even do that to, instead of a person, progressing to becoming a full alcoholic at a certain point to slowing down that progression, you know, giving us a chance to intervene before that happens, that yeah definitely is a preventative, as well as harm reduction is definitely important.

Jenny: And here's one last question from me. And the theme of this year's conference is Stronger Than Your Drink. How does the Sinclair method, make your patients, stronger than their drink?

"They are stronger than the drink or stronger than that process that leads to the next drink and the next drink.

Dr. Leeds: Well the drink doesn’t control them. It’s hard to imagine for a person that binge drinks to have control over their drinking. You know, they have the one drink, and then they have the next drink, and so on, and it’s a chain reaction that doesn’t stop until the night is over, and they pass out, or however that goes. But, by having that naltrexone in their system and blocking that opioid endorphin reinforcement system, then they just don’t feel that compulsion to keep going, so they are stronger than the drink or stronger than that process that leads to the next drink and the next drink. Yeah, I mean, a person, there’s people that at one point really enjoy the taste of wine, to be able to take a sip of wine and enjoy the taste, and the smell of the glass and just that environment of being in a restaurant with family and take that sip, and everyone’s taking a sip of their wine and putting it down. It would be great to be stronger than that glass and not feel that trepidation, that fear and terror that that one sip is going to lead to a night of embarrassment and sickness and regret the next morning. So yeah, definitely it makes a person stronger than their drink.

Jenny: Well thank you so much for kicking off our conference with us as our first speaker of the day. Today is the third annual Global Sinclair Method Awareness Day. So, we’re glad to have you here with us, sharing your expertise. And tell everybody how they can get a hold of you if they’re interested in connecting with you, either as a peer for other medical professionals who may be watching or potential patients.

Dr. Leeds: The best way to reach me is to just start by looking at my website and there’s my phone number, e-mail, contacts form, it’s all there. It’s drleeds.com. Or my podcast website which is therehab.com and you can find all sorts of great episodes there, including an interview with Claudia Christian and some other interviews related to the Sinclair Method and treating alcoholism.

Jenny: Well thank you so much again to Dr. Leeds for participating and we would like to thank our co-presenting sponsors, Workit Health and Ria Health. We’re going to go ahead and take a short break while we prepare for our next panel. So this is your time to get up, stretch, stay hydrated and get ready for our next presenter, Dr. Jennifer Purdy. So, thank you everybody. Bye.