Receptor Upregulation - Why I've been away, the The Sinclair Method's Achilles Heel

A quick update as it has been a long time since I’ve posted anything here.

In many ways that’s a measure of the success of The Sinclair Method, and possibly its achilles heel.

Thinking back to my drinking days I had plenty of time on my hands - let’s call it internet time.  I got the bus to work, I idled away lunch hours in front of screens, I sat up drinking in to the small hours of the morning after everyone else had gone to bed.

When I started on TSM, and my drinking tapered away other things started to change.  I switched to cycling to work, I’d go to the gym at lunch times, for the first time in my life I started to understand the value of a bedtime and early nights, and the free time I had left was more likely to be spent away from a keyboard or a screen.

This was partly a product of pharmacological reinforcement, or receptor upregulation - one of the biggest, but less well known side-effects of both nalmefene and naltrexone.

While the nal suppresses the the uptake of endorphins while we are drinking, on non-drinking days immediately afterwards our brains are temporarily more sensitive to reinforcement from endorphin release.  After taking naltrexone, there is a period of a few days when our opioid receptor produce more reinforcement whenever endorphins are released.

This ‘supersensitivity’ to endorphins means this window gives us more reward than ever for ‘good’ activities that release endorphins

This means that as we stop drinking, we can harness this side effect to replace our drinking with, in my case, a gym and cycling habit.

As Dr Roy Eskapa explains in The Cure for Alcoholism:

As You will find your interest and enjoyment will increase progressively for the healthy activities, helping to fill the vacuum as drinking decreases. Naltrexone offers a window of opportunity for pharmacologically enhanced learning of healthy behaviors. If you last took naltrexone on a Friday afternoon, Saturday is a washout day, when the medication is being removed from your body. Starting Sunday afternoon, roughly two days since your last dose of naltrexone, you are in a state where patients report that doing those alternative behaviors is especially reinforcing. A highly flavored meal tastes great. Even the first bite of chocolate is fantastic. Sex is more rewarding. Exercise feels marvelous. The supersensitivity gradually disappears over the next few days, so it is wise to make an effort to engage in the healthy activities during this window while you get more reinforcement.

It was also just what happened when I reclaimed my life from alcohol.  I started doing more things that were physical, and outdoors - things that didn’t lend themselves so well to sitting in a room alone, and things that were, consequently, less conducive to maintaining a blog.

And this, my friends, is a double-edged sword for The Sinclair Method.  AA is a life-long programme, replacing the pub with meeting rooms, and your drinking buddies with sober buddies.  It substitutes one ingrained pattern of thinking and habitual behaviour with another, and it replaces dying members with new ones, who keep those rooms and those meetings, and who go out to the world to spread its message.  Their sobriety sets them apart, and recovery becomes as much a feature of their life as their drinking was.

The Sinclair Method is a life-long programme - the nal is with you for the rest of your life - but you can keep going to the pubs and you can keep the friends you want to keep.  You don’t need to replace your drinking with new habits that keep you sober, and you don’t sign up to a lifetime of meetings.  You just become normal.

Neither your drinking nor your sobriety attracts attention, and neither is a feature of your identity.  But that does mean TSM is cursed with a kind of social invisibility.  It’s successes blend in, and by not being hooked in to an ever-expanding TSM community, it’s difficult to see how it will ever gain the recognition it deserves compared to methods like AA whose biggest flaw is, ironically, its great strength in terms of building a reputation based on numbers and return customers.

Gary bell captures this well in his post and I think my conclusion is the same as his - it is down to us to keep on speaking, to keep on being honest, and to spread the word.

And this is why I thought it was time to pop back up again.  But here’s a spoiler…  This has explained where I’ve been, and focussed on the success, but I’d be lying if I said it has all been plain sailing.  Next time some thoughts on compliance, complacency, and some bumps in the road.