Translated from the Finnish Reader’s Digest, February, 2000
(Kippis ja kohtuus! Valitut Palat, 18 - 26, Helmikuu, 2000)
Cheers For Moderation!
It’s true: an alcoholic now can have a drink or two without having to worry.
I’ll only have one for the road, that’s all—Esko Nupponen, from Lappeenranta (Finland), assured himself one Saturday evening. But like so many times before, even while opening the bottle he already knew that he would not quit drinking until he was drunk. "And in the mornings I’d get such horrible hangovers, I just had to keep on at the bottle," he reminisces about his life ten years ago. "I even started keeping a bottle under my pillow, just in case I woke up in the middle of the night and felt the need to get a drink," says Esko, now 56 years old.
Esko Nupponen started drinking when he was 17 years old, back in the relaxed and laid-back atmosphere of the 1960’s. He remembers having had quite moderate habits in the beginning when he would drink with his buddies on the weekends. Little by little his drinking increased, and finally he reached a stage where drinking one beer easily turned into a boozing session that lasted for days. His drinking started to affect his work, and soon after he got married at the age of 23, he noticed that his drinking was hurting his relationship with his wife, too. "I am not going to put up with your drinking." His wife finally gave him an ultimatum: "Either quit drinking or this marriage is through!"
This really scared Esko, who knew his wife was serious. "I promise I’ll try," he assured his wife. Esko did not want to loose his wife and ruin his own life. He dutifully tried his best, but his lust for liquor was stronger than ever. Esko soon started drinking again, but now in secret so his wife would not know. Periodically he would try to quit and to think of other things, for example, by franticly exercising.
"I ran like crazy, to keep my mind off drinking. I managed to be sober for a number of years in the 1980’s, but inevitably, I failed. Every time. Soon I would be back to my old habits, enjoying the comforting companionship of my bottle."
"I feared the future and what it had in store for me. It felt like life was passing me by with me just watching it, like a bystander. Finally just after my 45th birthday, I realized that I am really and truly an alcoholic with a capital A." In the early 1990’s Esko sought help from an A-Clinic (the public alcoholism treatment system in Fin-land) and tried an Antabuse capsule placed under his skin. The effects where short-term: he stopped taking his medication and started drinking again as soon as the effects of the drug had worn off.
Esko’s life by now was in shatters. Even the birth of his son in 1988 didn’t decrease Esko’s drinking.. Esko spent a brief time in a Finnish rehab center, but shortly after leaving, he started drinking again. Although at this time he wanted to stop more then ever, he could not control himself—alcohol had taken charge of his life.
Four years ago Esko Nupponen heard of a new method of treating alcoholics that successfully reformed alcoholics in to moderate alcohol consumers. This treatment, known as the Sinclair Method was based on the extinction of the addictive habit with the help of a medicine called Naltrexone. Esko felt that he had no other options. He sought treatment immediately.
THE SINCLAIR METHOD was developed by a American scientist, psychologist David Sinclair, Ph.D., who moved to Finland in 1972. While working in the biomedical department at Alko (the Finnish alcohol monopoly that funded alcohol-related research), he found that Naltrexone, an opiate antagonist, significantly decreased the alcohol drinking of laboratory rats.
"A person becomes an alcoholic when his or her nervous system learns to demand alcohol and in a way tunes itself to require alcohol," explains David Sinclair, currently a researcher at KTL, the Finnish National Public Health Institute. "We have gotten extremely reassuring results with Naltrexone treatment," psychiatrist Pekka Heinola, M.D., tells me. Heinola is doing clinical research on the use of Naltrexone in the treatment of alcoholics. "Naltrexone is a good option for anyone who have problems with their alcohol consumption and wants to decrease their drinking."
Sinclair’s finding is dramatic—it opens a whole new view on how to treat alcoholics. In 1986 Sinclair found that Naltrexone (used in treating drug addicts) decreased drinking when the medication was taken while drinking alcohol. All the other treatments that had been used so far required a patient to quit drinking completely all at once. The Sinclair Method decreases drinking while drinking.
It takes years or even decades to learn to become an alcoholic. Every time one drinks, endorphins (i.e., the brain’s own opiates that makes one feel the pleasure) are released, and sip-by-sip one becomes more and more dependent upon alcohol. This is why quitting is so difficult, if not impossible for the alcoholic.
So how can a person with a severe alcohol problem decrease his or her drinking without having to be-come a teetotaller? In Finland the thought of an alcoholic being transformed into a moderate drinker was quite unheard of. You either give it up forever or continue drinking. Like the old saying about an alcoholic goes: one drink is too many and twenty is not enough.
No one is an alcoholic at birth. Drinking is a learned behavior and thus can be unlearned, i.e., extinguished, with the right treatment.
The Sinclair Method sounds both tempting and yet unbelievable to a layman. "Naltrexone makes moderate alcohol consumption possible because every time one takes a drink after first taking Naltrexone, the desire to drink is decreased," Sinclair explains to me. Naltrexone has this effect because it fits into the place on nerve cells where the endorphins normally bind. When the receptor for endorphins is blocked, drinking alcohol does not reinforce the addiction; instead, every time one drinks after taking Naltrexone, the addiction gradually decreases. One gets drunk from drinking, but the desire to drink more is removed. "The medication is not used on a daily basis. You take Naltrexone only on those occasions when you are going to consume alcohol."
This kind of help is desperately needed. In Finland alone (with a population of 5,000,000), there are approximately 500,000 people who drink too much, to whom alcohol is a prominent health hazard. The economic, social, and criminal effects of alcohol multiply the problem. Alcohol is a major cause for depression, accidents, violence, broken families, and lost relationships. Approximately one in ten Finnish working age men consumes too much alcohol. Women have also increased their alcohol consumption alarmingly over the past 30 years.
If you add in the work days lost by alcoholics, the cost of alcoholism to society rises up to 30 billion Finnish marks ($4.7 billion). The cost of alcoholism is overwhelming. In addition to it, one must not forget the priceless value of the lives that are thrown down the drain by spending year after year intoxicated. The 30 billion marks society directly and indirectly pays on costs related to alcoholism could be spent in numerous other ways. Thus, this revolutionary new treatment method would benefit not only individual people, but also society as a whole.
Every year 50,000—80,000 people seek treatment for alcoholism in Finland. The market for an effective treatment for alcoholics is tremendous. The most typical treatment methods are detoxification treatment given at rehab centers, Antabuse pills, and the support of AA groups. Private clinics also treat alcoholics with laughing gas. Naltrexone is now used in treatment in A-Clinics.
Use of the Sinclair Method has been limited by its cost, which is relatively high compared to some other forms of treatment. In Finland patients are used to getting subsidized by the government for most treatments, and the Sinclair Method is no exception to this rule. However, the subsidies have a top limit to them, which the Sinclair Method exceeds.
"Most patients pay for the treatment out of their own pockets, but there is an increasing number of employers and insurance companies now picking up the bill in order to get their employees and customers treated with the new method," says Olli Kymäläinen, a psychiatrist who works for ContrAl Clinics, a chain offering the Sinclair Method in Finland, Estonia, The United States, Great Britain, Russia, Israel, and Venezuela.
The results from using the Sinclair Method have been very promising, to say the least. One of the patients cured by the Sinclair Method is Eeva, a 44 year old kindergarten teacher from Helsinki. For the last few years, she had been drinking heavily.
"I didn’t drink often, but when I did, I drank enormous amounts," Eeva says. "In other words, I just couldn’t limit my drinking at all. It was totally out of control. Once I started, I drank until I passed out." The amounts of alcohol Eeva drank were always substantial, exceeding twenty drinks in an evening. Afterwards she would not remember any-thing of what happened the night before. "It was very embarrassing for both me and my husband," she says.
A couple of years ago something happened that opened Eeva’s eyes to her problem. "We had invited friends to our house to celebrate New Years Eve. We had wine with dinner, followed by spirits and Cognac. I can’t recollect how much I drank, but it seems I had passed out in our yard, and the others had had to carry me inside." The next day Eeva felt horribly embarrassed. "Then and there I decided I can’t continue like this," she says. "I had read about the Sinclair Method, but I hadn’t gone in for treatment since I didn’t think my drinking problem was anything I couldn’t handle on my own."
First the doctor interviewed Eeva and got familiar with her way of drinking and the problems she had had. Eeva also went through a thorough physical health examination where her liver and blood values where taken. The treatment package consisted of a laboratory examination and eight sessions with a doctor or therapist.
"The basic treatment program always lasts at least three months, but in most cases the treatment takes four to five months," Jari Lahti, a psychologist responsible for co-ordinating training at ContrAl Clinics Finland. "The patient’s alcohol consumption is followed with a drinking diary the patient keeps. The therapy given in the treatment is meant to give the patient the means to start taking control of his or her own life once again."
Eeva is more than happy. "The treatment suited me very well," she says. "When I go out with friends, I always take my Naltrexone pill in advance. I have a drink, maybe two to be social, but I don’t have any need to exceed that. I can have the drinks and control myself completely." Eeva figures that the treatment has cost her about 8000 Finnish Marks. Every Naltrexone pill costs 30 marks ($4.70). "Its not cheap, but it is worth it," Eeva points out. "It would be a lot more expensive to drink like I used to!"
Not everyone succeeds
A large number of alcohol dependant people also suffer from depression. Decreasing one’s drinking even slightly usually eases the depression. Decreasing the amount of alcohol intake also has been found to lower the blood pressure and reduce heart problems, as well as helping with high cholesterol and excess weight. The blood values indicating liver damage improve with nearly all patients who decrease their drinking.
So far there are approximately 700 alcoholics who have gone through Naltrexone treatment at ContrAl Clinics (and 25,000 in all of Finland). Over half of the people coming to ContrAl have also tried other treatments in the past.
"Around 10% of the people who have received Naltrexone treatment have not been able to decrease their alcohol intake," says Kymäläinen, who designed the ContrAl treatment program. "Some of these people have came to the treatment at the request of their spouses and are not in the least motivated themselves." "It is crucial that the patient is motivated in order for the treatment to work," Kymäläinen explains. "The amount of Naltrexone taken and the timing of the medication taking are also important."
There are some cases where Naltrexone cannot be used in treating an alcohol problem. If one suffers from a severe liver disease, uses opiates, or has a extremely rare case of Naltrexone allergy, this form of treatment cannot be used. Naltrexone is not addictive, but a person who has been cured of alcoholism with Naltrexone must use the medication for the rest of his or her life always before consuming alcohol. The drug has no serious side effects; in fact, very few patients have any at all. Some have reported slight nausea.
"Because one must drink alcohol in order for the Naltrexone to work, this treatment is not recommended for those people who have managed to be sober for decades, for instance, with the help of AA," Olli Kymäläinen recommends.
(Names of people introduced in this article only by first names have been changed at their request to protect privacy.)