In this short video excerpt from our Tackling the Tough TSM Questions live stream on Twitch, C Three Foundation CEO Claudia Christian and Executive Director Jenny Williamson discuss the definition of extinction and how people will know when they have “reached” it.
Jenny: All right. Question number five is another doozy of a question.
Claudia: Oh boy.
Jenny: What does extinction even mean, and how will I know if I’ve reached it?
Claudia: That’s a great question, and I believe in my heart and soul that you will absolutely know when you reach extinction, but it’s something different for just about every person. When you think about the compulsive aspect of an alcohol use disorder or cravings – When you think about these things, like for instance, if you’re trying to work, and all that keeps popping into your head is: What time is it? Is it time to drink? Can I take my pill? Can I drink tonight? Should I drink tonight? How much alcohol do I have in the house? Should I go to the market? All of this committee, this conversation going in your head, that’s usually a big part of addiction to any substance. Same with cigarette smokers: When can I go outside to have a smoke? When can I go outside to have a smoke? So you think about that, and then you think about that physical discomfort when you haven’t had a drink in a while, that sort of, “Oh God, look I’m just, my skin is crawling, my muscles feel tight I’m, oh god, I just want to feel that sweet relief of my drug of choice.”
So those are cravings; and that is a mental craving and a physical craving. So you know what those, if you’ve experienced that feeling, those feelings, then you will absolutely know when an entire day has gone by, or a couple of days have gone by, a week has gone by, and you haven’t experienced any of those feelings. In fact, you have not thought about alcohol. As a matter of fact, you had to remind yourself that you had not had a drink in two weeks. As a matter of fact, you’re standing in the supermarket and you’ve walked down the booze aisle even though you’ve avoided that for the past four years, you’ve now walked down it and not even noticed that you’re in the alcohol aisle.
You go to a party and people are drinking and you don’t care how much is left in the bottle, because you’re fine with your one glass or you don’t feel like drinking tonight. You go to social situations all the time regardless of whether or not there’s alcohol served there, because it doesn’t bother you anymore that people are drinking – that to me is extinction.
When alcohol just simply doesn’t play a role in your head or in your soul; It doesn’t dictate where you’re gonna go or what you’re gonna do; it just doesn’t really it’s not important any more, and it used to be the most important thing in your life if you were anything like me. Every single thing in my life was dictated about whether there’s going to be alcohol there, whether there’s not going gonna be alcohol there. So extinction, in my opinion, is when that sweet relief of not thinking about it comes and also the cravings disappear. You realize it’s four o’clock in the afternoon – that you not only haven’t thought about alcohol all day but yeah you could take your pill but you don’t feel like it. It’s a dissipation of the power that alcohol holds over you. A dissipation of that lizard in your brain being in the driver’s seat. He’s now asleep. That’s how I describe extinction.
Jenny: Well I agree with everything you said except one thing.
Claudia: Oh, oh.
Jenny: And that’s that people absolutely will know when they’ve gotten there because that’s the whole reason that question has gotten onto this list. So I’m going to read something that I have pinned to our general peer support group page, and in fact give me a second, I’m going to drop a link into the chat as well. On all replays I’ll make sure that this link is included, and it’s an explainer of the concept of extinction, because a lot of people really struggle with trying to figure out when they’re at extinction.
So extinction is a process discovered by Pavlov. TSM is pharmacological extinction, which means using a medication to assist in that process of extinction. You know the process has worked for you when you are able to make the choice whether or not to drink. Extinction is not abstinence. It is not overcoming habits. It is not even reaching reduction goals. It’s not never craving alcohol again, and it’s not never desiring a drink again. So many people have likely completed the process of extinction – I mean in Dr. Sinclair’s rats it was three to four months, but we know that humans are a lot more complex than that. But people keep telling themselves that they haven’t reached extinction because they’re still struggling with their habits and with their triggers, or it’s because they experience an episode of what’s ironically called spontaneous recovery, which is when the behavior being extinguished suddenly and inexplicably returns, but it’s usually for a very short amount of time and passes.
So the line of thought that because you haven’t overcome all of your habits yet, you haven’t reached extinction, it’s counterproductive and it can be a subtle form of self-sabotage. It makes you think that you are failing at TSM when you’re not. It keeps you focused on what you think the pill should do, while diverting your efforts from addressing habits and triggers.
No matter how long you use the Sinclair Method, after it breaks the alcohol equals reward conditioned response, the only thing left for it to do is to keep you from relearning it, which is why adherence is important after the extinction process. But it will never address your habits or your triggers. It just gets you to a point where you have the power to focus on them. So a lot of people, especially in the peer support groups, I feel like they, you know, they’re like, “well I feel like, I’m not craving any more, I’m not obsessing about alcohol but I drank too much last week so I’m not at extinction yet. I’m not ready to say that I’m there,” and so I think people are very hesitant about it when they should be celebrating.
“Have you reduced your drinking? Are you happier? Is your life better? Is your health better? Is work better? Your relationships better? That’s terrific! Why are you so obsessed with this word extinction?”
Claudia: I think if you have any feeling of freedom, I mean that’s, you know this is all so personal, but I mean for me it was when things didn’t trigger me anymore, but that’s not to say that I didn’t use alcohol incorrectly on TSM. I absolutely used it when I was triggered by certain individuals or events, and that’s not healthy, but you know, we know a lot more now about changing habits and about dealing with triggers in more positive healthy ways. So if you have a sense of freedom from the clutch of alcohol, but you’re still making, you know, choices based on habits, that’s the time to really explore things beyond the biological aspect of addiction. That’s when you really get into therapy or peer support or find a loved one that you can discuss these things with so that you don’t continue down the same path, which is using a substance in an unhealthy manner, and that would be to, you know, subdue emotions or trauma or deal with things like that, and that is, once again, we’re back to being self-aware and to monitoring our behavioral responses to things.
Jenny: So what would you say to someone who really just doesn’t know, you know, “I’m doing a lot better but I don’t know if I’m at extinction yet.”
Claudia: Well first of all I would ask them, why does it matter so much? Because the bottom line is: Have you reduced your drinking? Are you happier? Is your life better? Is your health better? Is work better? Your relationships better? That’s terrific! Why are you so obsessed with this word extinction? Extinction, to me, can be interchanged with freedom. Are you free from the claws of addiction? If you can say just, you know, alcohol no longer has a hold on me like it used to, that is a huge win! So this whole obsession with, “oh I haven’t reached extinction,” or, “she reached extinction in four months, you know, I’m nine months in” and all this stuff.”
I mean. I think it’s such a personal thing – has your relationship to alcohol changed? And have you made an effort to change your relationship with that substance? Have you included new things in your life to deal with triggers and with stress? Have you started making habitual changes? Great, but did the pill relieve you of the constant thoughts and cravings for alcohol? If you can say yes to that, I would say that you’re in a form of extinction. If you no longer crave alcohol or think about alcohol, for god’s sake, that’s a form of extinction. You’ve extinguished cravings, so bravo on that now let’s work on breaking habits. I think people should just lay off the obsession with this terminology I mean it’s, because it means different things to different people as well.
Jenny: And I think that’s what makes this such a loaded question because TSM, or I’m sorry, extinction itself is a process built on multiple repetitive actions. In this you know, we often call TSM Pavlov’s dog in reverse, but Pavlov would ring the bell and not give the food, and then the dog would stop salivating over time. That didn’t mean the dog no longer wanted to eat! But, you know, I think people get caught up in the terminology because there’s been a pattern of declaring extinction as a singular event, which is basically just saying I’ve completed a process.
Claudia: Yeah. I can tell you, if anyone’s experienced something that has come and gone, whether it’s an earache, or for me OCD counting things as a child. I remember the day when that compulsion to count things went away. To me that’s extinction. It just went away. I was done. Extinction is extinguishing a behavior, so when your earache goes away you feel that sweet relief – oh my god my ear, my ear feels great! I don’t have that constant pain in my ear. There will come a day when you can say, “oh my god. I have not thought of alcohol all day.”
Jenny: Yeah Helen mentioned – she was, “I knew I was working toward extinction when I managed to drink one drink and I stopped. I have never done that in years, and it was a true feeling of freedom.”
Claudia: There you go, there’s the word, freedom. You’re back in control. That is it. All these little things and these are big things, that’s a form of extinction. I’ve extinguished a certain behavior associated with my addiction. I no longer hide my alcohol. I no longer lie about my consumption. These are huge changes in the right direction, and people aren’t taking, they’re taking these for granted. That is a huge thing to stop hiding alcohol, to stop lying about it, to stop drinking before you go to bed. I know some people that had a drink by their bed on their bed table for years. That would be their last drink, their safety drink in case they got up in the middle of the night, and then they say, “oh, I no longer do that. I stop at 10 and put the bottle away.” Oh my god, that’s extinguishing a really bad behavior, that’s fabulous.
Jenny: In your opinion, is hyper fixation on extinction as an end goal as opposed to a process – is that keeping people from having the ability to celebrate those smaller victories?
Claudia: It’s absolutely keeping, it’s hindering people from celebrating their positive actions, and the positive results of TSM. Absolutely! Because they’re so fixated on this end-all, and that’s a competitive thing that I see online a lot, and I think, that’s why I tell people, please don’t compare yourself to anybody else. This is your journey. It’s your progress. You know when you’ve had a good day. You know when you’ve fallen into habit and you’re watching a movie and you mindlessly drink, and maybe you’ll do better the next time. People, as long as you’re aware and you’re mindful and you’re complying, you are doing a fabulous job, so stop comparing yourself to other people. It’s going to happen when it happens.
“addiction is so wrought with shame and guilt that we don’t want to pat ourselves on the back because we don’t think we deserve it. That’s why self-care and loving yourself and being good to yourself, and recognizing any small change in the right direction is imperative to a healthy recovery.”
Jenny: So Batmando says, “I turned down free beer and booze, top shelf stuff, because I didn’t feel like drinking that night. That was my extinction event.”
Claudia: Absolutely, that’s an exciting event. That is completely. Pat yourself on the back. Yeah you’re there, you’re there, baby.
Jenny: And bellankeyboy says, “I knew I reached extinction when I started dating someone who’s drinking I noticed was uncomfortable to me.”
Claudia: Bravo. That’s huge David that’s huge. Yeah. There you go. It wouldn’t have mattered before. In fact, it might have made you feel comfortable about your own drinking, and now yeah, and now you’re not comfortable with it. That’s, that’s amazing. That’s fantastic.
Jenny: And I like Letitia’s comment as well. “Any step, no matter how big or small, is moving closer toward your goal.”
Claudia: Absolutely. We need to continue to remind people of this, because, you know, addiction is so wrought with shame and guilt that we don’t want to pat ourselves on the back because we don’t think we deserve it. That’s why self-care and loving yourself and being good to yourself, and recognizing any small change in the right direction is imperative to a healthy recovery.
Jenny: Yeah, I forget who said it, but I did see it once in one of the peer support groups – if you’re asking the question whether or not you’ve reached extinction, you probably have.
Claudia: Yeah. It’s so true. It’s so true. Yeah, that’s a good question.
Jenny: Any other questions or comments about extinction. Or even spontaneous recovery which is a part of extinction, because what that’s usually called in most of our peer support groups, that’s also called an extinction burst, or when the lizard brain fights back.
Claudia: Oh gosh yeah. That’s a very common occurrence. It’s almost like the lizard gives one last gasp before he goes to sleep, and you’re in remission, but it can happen. I’m, you know, I’ve had people that are doing great, doing great, doing great, and then suddenly, “oh my god did I have a bender last night!” and then they’re not only back on track, but suddenly they have no interest in drinking. So that that is a common occurrence
Jenny: And it is part of the extinction process itself, in the sense that Pavlov documented that. I mean that predates TSM, the concept that that’s going to happen. It’s just that we have a very specific and narrow set of examples where it happens within the realm of TSM, and I think that first of all, when people aren’t expecting it, they think that it’s unique to them, and that “oh my god this is my TSM failure moment,” when actually it’s common. It’s normal, and as long as you learn to be compassionate with yourself, and realize that it’s normal, and stay the course, the bounce back afterward seems to always be even stronger than what it was before.
So, oh (comment from live audience) “we need chips that say I might have reached extinction, but I know I’m doing better because of TSM.”
Claudia: I like that, and they’re never taken away from you. They’re never taken away. You always have your chips. You never lose them, and you never lose your time.
Jenny: Who knows, we might be able to make that happen. I’ll have to look into that. So, if there are no other questions we’re going to pause and go ahead and move along to question number six.