Treating alcoholism with the ContrAl Method
The Sinclair Method uses selective extinction to reduce alcohol drinking without weakening other behaviours. The medication used in the treatment nalmefene (Selincro®) or naltrexone (Revia® or Vivitrol®) is begun in association with specific clinical protocols while the client may still be drinking, thus eliminating the need for prior detoxification in many cases. Instead, drinking usually decreases gradually as the treatment weakens the drive for alcohol. It thus differs from most other treatments that impose an external barrier to drinking without removing the internal cause. The Sinclair Method is designed also to improve the persistence of beneficial effects: in most complying cases it should provide a long-term solution.
The treatment at ContrAl Clinics is provided in an outpatient programme. Counselling follows cognitive-behavioural framework and focuses on decreasing alcohol consumption. The client’s physical and mental condition are assessed prior to treatment, and the few for whom medication is contraindicated (e.g., with severe liver cirrhosis) are refferred to some other form of treatment. Then the drinking habits and amounts are discussed in detail with the client, along with perceived reasons for drinking and the ways of affecting the addiction. The theory and the method of treatment are described in detail, as clearly and graphically as possible in order to assure the best atmosphere for the treatment and compliance. The stimuli, situations, and moods eliciting drinking are discussed in order to provide an understanding of the behaviour.
Clients keep a detailed diary of their drinking, medicine use, and reactions. Alternatives to drinking are explored and considered. The later stages of the programme focus on thinking about the future and the various possibilities provided by a new life style. Client dignity is assured; there is no need for self-effacement since the motivation for alcohol is reduced by extinction. Excessive drinking is simply a case of a behaviour having been learned too well – somewhat like fingernails that have grown too long. The Sinclair Method provides a means for trimming.
Each client establishes his/her own goals for the programme. The general goals are to decrease the dependency upon alcohol drinking and to develop the ability to control one’s own consumption.
The programme includes laboratory tests and prescriptions, together with a systematic series of sessions with medical doctors and psychologists trained in both the theory and use of pharmacological extinction.
The basic treatment period lasts usually 4-6 months. During and after the basic period, additional and follow-up sessions are provided according to individual needs. Sessions are mainly individual, but also couples and family sessions can be arranged.
Abstinence is not required prior to the beginning of treatment. In fact, alcohol can be consumed during the initial phase of the programme. Drinking tapers off gradually in the course of the treatment as the desire for alcohol is being diminished.
Selective extinction assures that only alcohol drinking is weakened; other behaviours may be enhanced; the number of days initially on medicine is reduced. Continued medication is provided as needed.