Naltrexone and Alcohol
Alcohol and Euphoria
When the average person drink alcohol he or she tends to have a nice time. This is due to the fact that we normally drink when we are set to have a good time: At parties, when going out or when celebrating something positive. It is also due to the psychotrope effects of alcohol, which tend to release a lot of endorphins: These are opiods that makes your brain see all things extra positive, less worrysome and troubeling. Things become softer, kinder and less painfull. The endorphins changes how your brain percieves the world. It is a bit like putting on rose colored glases that will make anything seem pink. The coloqial name for this effect is “beer googles”, known for making any woman look pretty and all words sound wise. This article will hopefully make it easier to understand the connection between alcohol, euphoria and addiction and explain the upsides and downsides to naltrexone alcohol treatment.
If you are affected by this more than most people you might be vulnerable to alcohol addiction. Jon Stewart (not the comedian) describes it this way: “I started when I was a teenager. It was nothing particularly out of the ordinary – I discovered booze, I started going to parties, I had a good time. Although I always seemed to be having a slightly better time than everyone else. I now know that this is to do with the way my brain responds to reward chemicals. Around 10% of drinkers, it’s thought, are overly sensitive to the pleasure stimuli in alcohol, and I happen to be one of them.”
What Stewart is pointing to is the fact that some people are in risk for alcoholism exactly because they are more sensitive to alcohol: Their bodies will react to alcohol with a much larger effect on endorphin levels after drinking. This probably just a genetic quirk, but it this kind of sensitivity can have a big impact on the probability that someone will become addicted to alcohol. The graph below is based on measurements of beta-endorphins in rat brains under influence of alcohol. This illustrates the difference between low risk and high risk people. In another study researchers found that for voluntary drinkers, endorphin levels increased significantly. You cant measure this in the brain of a live person because of ethical considerations. But as the brains of mammals are comparable in most ways you can get a good idea of what is going on by looking at say rodents brains. This is from a variety of rat-brains being subjected to alcohol while their endorphin levels are measured directly in the brain. In some individual endorphin levels were significantly decreased 30 and 45 min after ingestion. Both values had returned to normal after 24 hours.
The enhanced euphoria is a desired effect when drinking alcohol, a “feel good factor” that motivates the large consumption of alcohol in our culture. It is also a big part of why people can become dependent on alcohol for having a great time, even if their life is rather grey when sober. And it can drive addiction: If most of your pleasant experiences are had while drinking, there will be a constant gravitaional pull towards drinking. You start anticipating the time of day where you can relax with a drink. Perhaps even getting a bit impatient for that time to arive. This pull can be a factor in driving up consumption and ultimately addiction.
If you are in recovery from alcohol addiction and trying to stay sober the same gravitational pull will be there. It is really really easy to become impulsive and give in when opportunity present itself. Alcohol is associated with good times and staying sober can seem so very gray. And it will not take much of a endorphin boost to make your world or your life seem a happy one again. Any small drink will make your gray and mundane life so much better. If you are just a little bit impulsive, you might relapse.
If you keep having period with periods of sobriety mixed with periods where you go back to drinking there will be a stark contrast between the two: The glossy rose colored life while drinking and the grey sobriety. This contrast makes for a constant tension and frequent urges towards drinking.
If you have good self control you might stay sober. But if you for some reason dont get enough sleep it gets difficult. If you have some very stressful days, you might not have enough self control. And if you are challenged in some way that eat up your resources, it becomes very hard to stay sober.
Your genetic disposition is a cronic condittion
Being very sensitive to the euphoric effects of alcohol is not a disease. For a lot of people it is never even a problem. If you are are very sensitive to alcohol and have become addicted it is a problem. And you might find that you will never be able to treat alcohol in the same lax way that people who are not sensitive can. If sensitivity to alcohol and a strong endorphin response to alcohol is what drives your alcohol addiction, you might find that you will never be able to drink without getting into addictive behavior patterns. But there is a distinction here: This is not a sign that you have a cronic disease. It is a sign that you basic genetic makeup does not change no matter how long you stay sober or how much you rebuild your life after a getting sober. So even after years of staying sober you will still have that same disposition towards getting more euphoric after drinking. There is no known way to change your response to alcohol at this level.
Does this disposition make you an alcoholic while you dont drink? You can certainly find people who find people who thinks that this attitude will help you stay sober. But are kids with this dispositions also alcoholics even if they have never touched alcohol? Are you still an alcoholic if you find a way to stay clear of drinking and never have any problems byond making a midlife correction to your behavior? This kind of debate clearly gets into philosophical territory and perhaps there are more urgent issues to deal with.
Your allegiances are also very durable
Whenever something surprising happens you pay extra attention. Your memory will record more accurately as you have sensed that something unexpected is happening. Wheather is it good or bad, you need to pay attention and adjust accordingly. This reaction is based on the fact that anytime that your brain senses that things deviate from the normal, dopamine gets released and activate parts of the brain that would otherwise be ideling. This is higly usefull for adapting to changes in your environment. Good and bad surprises are recorded and behavior is adjusted to suit your needs for food, for safety or for procration.
You might think that learning and memory is a matter of being curious or at least interested. But there are systems in the brain that will make some kinds of learning effortles and result in long lasting adjustments. If you at some point got sick after eating a suspect salmon paté you will probably have no trouble rembering to avoid salmon paté for years after. If and when you get sick and throw up your brain will wind back a few hours, point a finger at the paté and ban it from the menü for all eternity. This works even when you know for a fact that it was the Vodka or Pernod that made you sick.
Someting similar happens when you have some unexpected succes: You will always remember where you cought that big salmon. You will never forget when and where your fiance proposed to you. If you have had some big succes, you will always try to recreate the circumstances hoping for a repeat succes. Even in ways that make no sense at all if you start to think about it. The formula one driver Alexander Wurz drove for many years with two different colored racing boots because it was associated with race win in his early career. This can seem superstitious or silly, but there is a strong neurochemical basis for this kind of reaction: Dopamine gets released strongly when you have some unexpected win or succes. And you automatically seek to adjust your behavior in accordance with the experience.
Now you might think that drug experiences are very strong and vivid, and that they for this reason will triger the same kind of response. But this understanding actually has it all backwards. The drug experience is based on artificially raised levels of dopamine, the very same dopamine that lets you record unexpected succes and adjust your behavior patterns accordingly. Addictive drugs will actually trigger enhanced learning before you have any idea what the eperience is and if it is good, bad or just weird.
In the same vein your subjective experience will be colored by the neurochemical effect of raised dopamine levels. In normal situations experiences can triger dopamine release and enhanced learning. In a drug driven state, dopamine will let your react to whatever situation that you find yourself in, as if it was deeply significant. And you will tend to adjust your behavior accordingly, which is the important part here.
You might take drugs or drink alcohol in certain kinds of situations. And these situations would get that special place in your heart because of the effect of dopamine. Different people will do different things while under the influence and this will color the way that the dopamine effect change their behavior. But all drugtaking situations have one specific thing in common: the drug taking! All addictive drugs will triger dopamine release and the dopamine will tinge the drug taking experience with that neurochemical fairy dust, that makes you remember and makes you try to repeat. And try to do so even when rational thinking does not support the efforts.
Naltrexone Alcohol Treatment
Naltrexone alcohol treatment is a pharmaceutical way to help alcoholics from relapsing. But how does naltrexone alcohol treatment work? Naltrexone alcohol treatment is a way to deal with the basic problem in alcohol addiction: That drinking tend to make you feel great as long as you are inebriated. One key to succesful treatment is to break the link between drinking and the mild euphoria that results from alcohol intoxication. Is is this connection that carry the attraction and the desire for alcohol.
Normally your appreciation of alcohol will be a mix where this mild euphoria will compete with the less wonderful effects of drinking. Both the euphoria and the hangovers, the disappointment of your family and freinds, the lacking performance and other negative parts of the alcohol related experiences will enter into a “big picture” evaluation of alcohol and make you desire alcohol to a higher or lower degree. There is however a natural tendency to be a bit shortsighted in general, so that emidiate effects will have more weight than delayed effects. That means that the euphoria will count for more than the hangover, just because the hangover are more distant in time than the euphoria. This already makes your choice of alcohol a less objective or “rational” choice. But wait, it gets worse. One of the main effects of alcohol is to narrow down timeframe for what seems relevant or important to you. That means that what is allready skewed towards a short time strategy becomes even more unballanced as alcohol change your brain function. Healt, education, reputation and financial prospecst slowly become less and less of a factor in how you decide things.
Naltrexone is an opiod receptor blocker: It will keep opiods from activating the opiod receptors in your brain. Opiods like the endorphins that alcohol intoxication produces. This means that you can drink alcohol without the pleasurable psychotrope effects and without the experience light euphoria. This is off course exactly what we dont want – in the short term. But the long term effect is extremely usefull: The huge contrast between being sober and being intoxicated will slowly dissapate. After a period where drinking is not such a great time, it tends to get easier to stay sober. It psychological terms this is called extinction: You no longer get the result that make drinking to attractive. As a result, you are then less and less attracted to drinking. The big contrast fades to something that is less important. The constant cravings subsides. You need less self control to master your situation – even when under stress or challenged in some way. In short, staying sober can become a lot easier.
The Sinclair Method
This method of naltrexone alcohol treatment is also called the Sinclair method, after the psychologist Dr. David Sinclair, who invented the method. He was inspired by the psychologist Pavlov who had demonstrated that he could make a dog salivate by ringing a bell: By ringing the bell when feeding the dog the sound of the bell became so closely associated with food that the bell sound alone would make the dog salivate. The same kind of association that connects Christmas decorations with presents when you are a kid. Or perhaps with fine wine if you are an adult.
Pavlov got very famous from these results and even won a Nobel price. But Pavlov’s research also showed something less famous: That if you kept ringing the bell without serving dog dinner, the effect would wear off. In learning psychology this is called “extinction” and is now a standard pathway to un-learning behaviors that you dont want.
What really happens is that your brain will connect an early sign of something important with the later occurance of that thing and gradually move its sensitivity and reactions from being sensitive to the actual sitation and instead become sensitive to the “imaginary” representation of the real thing. The result is that instead of reacting to the real sight of food you react to the call for dinner or a bell that is usually rung before food is served.
This kind of substitution is key to survival because it lets you react to something that is an early sign of what is to come. An early sign or indeed an early warning. It gives your organism time to reconfigure its internal state in numerous ways: Either salivate as with Pavlovs dogs or to elicit the cascade of stress hormones that lets you escape present danger. The substution of the real with an early representation thus gives you more time to “do” all this – or rather it gives your instinctive reactions time to unfold while you feel a growing urge to eat or run.
And exactly the passive “passenger like” properties of these reaction can get you in trouble if your past behavior have built habitual instinctual reactions to any and all situations remotely connected with a chance to drink alcohol. This is where naltrexone alcohol treatment fits in: If you have a problem with being too impulsive, if you lack self control in situations where cravings are trigered by what goes on in your environment – in those cases naltrexone alcohol treatment could make the difference for you. You make your commitment while you are at your best behavior and while you have enough sense to do just that. Later when temptation is running high and you might not have enough resources to resist naltrexone alcohol treatment will save the day for you. After taking you medicine, you are protected (essentially from yourself): As you have decided that drinking is not an option and effectivly barred the road to happy intoxication, you are no longer a victim of your own impulsivity.
No Cure for Cancer
In a field that is not burdened by overwhelming success, the introduciton of a promising medical option like naltrexone alcohol treatment is likely to elicit a bit of hyperbole. The sudden swing from an experience colored by lack of progress and pesimism to a aluring promise of quick and easy results can and will make people lose their balance for a while. The reactions to naltrexone alcohol treatment is no exception to this. This is a report that represents naltrexone alcohol treatment in way that on one side is fair and balanced, but which also is higly suggestive towards unrealistic expectations if you are a bit selective in what you notice:
If you keep a keen eye for potential shortcommings, this presentation will give an accurate picture. But if you are looking for an quick and easy solution to deepseated life problems, the video might lead you to some quite unrealistic expectations.
A Closer Look
You might also want to consider how naloxone is used for preventing death caused by heroin overdose: The overdose emergency drug Narcan (naloxone) can prevent death by overdose because the naloxone will block the opiod receptor site: If a person has taken opioids and is then given Narcan (naloxone), the opioids will be knocked out of the opiate receptors in the brain.
It can be vitally important to counter the effect of an overdoes. And it can be helpfull to counter the euphoric effects of alcohol. But the delicate balance between pain or fear on one side and happy anticipation on the other should be informed by experience, not by how much medications or drugs you take. Both drugs and medications that alter opiod or dopamine sensitivity will detach your experience from your actual environment. You actually become “unhinged” as your brain is then regulated by arbitrary levels of neurotranmitter and much less by what you hear and see. And as long as you introduce a powerfull noize and overwhelming distortions into the system, you will have a hard time relying on actual experience and realistic information about the world that you live in.
It actually worked too well
This is how one alcoholic patient describes his experience with naltrexone alcohol treatement:
“I spent 2 years in and out of AA. It was miserable. I was not an “AA person” at all. In fact, AA meetings made me want to drink. My doctor put my on Naltrexone. It worked immediately. It actually worked too well. I no longer craved or thought about alcohol but I also didn’t like the taste of food. I lost interest in sex. I lost interest in being physically active. I was spaced out constantly. It was not living at all. So I went off of Naltrexone and resumed drinking. When I was ready to try giving up alcohol again, I went back to Naltrexone BUT only took HALF a pill a day. This made a huge difference. I still feel as though I don’t enjoy many things like before. But I don’t have the option to drown myself in booze.”
The central problem with taking addictive drugs is that addictive drugs will introduce changes to your emotional feedback systems. While things are a bit bland when sober, the chemical enhancements to your dopamine systems will make almost any input result in sweet, soft, gentle euphoria. The systems that evaluate your environment and your behavior is normally in a finetuned balance that lets you sort out good or bad results and good or bad behavior.
If you are very optimitic the results a skewed a bit towards the positive side. If you are very pesimistic they get skewed a bits toward the negative side. But these variations are not very big and eventaully you will know for sure, accurately and realistically what is good for you. This serves a slow adjustment towards behaviors that will see you survive, stay healthy and down the line have some kids and lots of grand-kids.
Taking drugs that lets you feel euphoric about almost anything will throw that delicate balance way off. And this is not a exotic side effect of being an alcoholic. It is a main reason why people take drugs or drink alcohol in the first place. And it is in fact one of the central and important ways that alcohol will do damage to you and your life situation. Without this kind of fine tuned feedback system you will have rational thinking only to rely on for guidance toward anything that you want in life. And while we all like to think of ourselves as intelligent or smart, rational thinking plays a very minor part in the way that we usually make decision and change our behavior.
A few parties and the occasional bender will not make any huge difference. But if you regularly rely on alcohol or other drugs for an artificial high, you will slowly but surely undermine the instinct that guide you to avoid danger and to find long term succes in life. In theory you can still get there by rational self control and sheer willpower. But that would assume that you have more self control than most people. Which probably wont be the case if you rely on alcohol for stress relief.
The most likely scenario is that you got into the habit of drinking because your self control is a bit lower than average. Or because your environment is more demanding and tax your self control on a daily basis. Or both. If you then slowly errode your inner compass by the use of drug or medications, you might find that you are no longer in control!
One reason why sucessfull living can seem out of reach is that self control seem to be a key factor in gaining an education, a well paid job and having a less stressfull life environment. There are a few jobs that relies on doing what comes naturally, but most of us earn a living by either doing what is hard, or having done it in the past (education) to a degree that supports us now. So you would assume that people who get themselves into addiction as an alternative to sucessfull living would also be the ones who are in the low end of self control resources.
This is bad in itself as self control is key to health, social harmony and financial success. But it is especially unfortunate in connection with taking drugs as self controll is also key to reversing a pattern of addiction. Which means that those who needs a lot of self control to combat addiction to a large degree have been preselected from a pool of people that are low in self control for whatever reason. in fact there is strong evidence linking low self control with drug addiction. (Tangney, 2004) http://www.ncbi.nlm.nih.gov/pubmed/15016066) You are then no longer “taking drugs to make music to take drugs to”, but you are taking drugs to make you stop taking drugs. And if you take full dose every day, you are substituting small and incremenal changes to your emotional feedback loops with a wholsale shutting down and taking offline the entire system. Perhaps this would require some carefull consideration to go with the initial enthusiasm about the wonders of medications.
So what naltrexone alcohol treatment promisses is a way out of addiction that does not require as much raw self control as you would normally need. Specifically you dont need a constant high level of self control. If keeping a constant level of self control is you problem, what naltrexone alcohol treatment gives you, will sound wonderfull. Untill off course that you realize that this dos not really change a lot. And that not all the change is for the better.
But it does not make a life of drinking less attractive. You will still have memories of the sweet sweet time when you were comfortable numb. You still miss that dark euphoria. Just like being physically impotent would not remove your desire for sex, naltrexone alcohol treatment does not remove your basic desire for alcohol any more than being locked up in a rehab facility would. Your longing for a repeat will not be different from taking natrexone. And your resources for managing your desire and cravings will not be any better than what they used to be. In fact you could do just as well by paying your mother-in-law to make sure that you never had a good time when drinking. If she could be adequately obnoxious to curb your enthusiasm, that would probably have pretty much the same effect. Would you then stop longing for a endless night out with freinds, fun and lots of wine? Probably not.
Which also means that you would have to recommit to your decision about abstinence on a regular basis while taking naltrexone. In the endnaltrexone alcohol treatment is a tool that lets you do one specific thing: It lets you reduce the pleasurable effect of alcohol, if and when you take it before you drink.
The thing that is easily overlooked while you try to aleviate pain, crawings,
As described above, addiction is not just about crawings, but perhaps more essentially about loosing your way as the readings from your prime instrument of navigation are increasingly distorted. False learning, misaligned levels of pain, distorted levels of euphoria, a substitution between artificial dopamine release and reliable succes in the real world. All these are the effects that you want from alcohol or other drugs. Or at least it is what you get, and I suspect that everyone knows this at some level of their understanding. What is normally lacking from any public discussion of drugs and alcohol is the systematic ways in which this tend to make you blind to long term consequences of your actions. The “reward centers” of your brain are not really there to make you happy or miserable. They are there to give you a better chance of choosing a path that is the best possible compromise, that carefully considers short and long term consequences, that lets you survive without giving up your long term freedom, long term health or long term financial prospects.
This misalignment is at the core of the damage that you invite on yourself when taking addictive drugs or drinking alcohol to exsess.
In a better world we would focus addiction treatment on realigning this inner compass with the real world, not on giving in to some higher power to guide us.
The thing about balance is that it is easy to maintain while you have it. It is a lot harder to regain balance than to maintain it. If you try to balance a broomstick in you hand you will notice that is not too hard, you just need to constantly correct for imballances. But then if you let it slide for a short moment you will have a hard time regaining balance. Beyond a certain point you are just chanceless as you cant move your hand fast enough to get your hand under the center of gravity again. The thing about addiction is that at its core it is about loosing a balance that is hard to catch beyond a certain point.
As you accumulate more and more damage to your navigational system you will need more and more self control to overcome the lack of instinctual guidance. As you default behavior becomes more and more distorted by artificial reinforcement and the artificial euhoria you will need more self control resources to maintain the kinds of behaviors that non addicted people maintains with next to no self control. This is the real price of addiction. This is the way that behavior is more and more blind and more and more determined by illusions of succes that are fueled by artificial dopamine release.
Treatment effect and recomendations
So what are the recomendations in relation to naltrexone alcohol treatemnet? Some sources put a rather optimistic spin on this kind of treatment. Some are less enthusiastic. Considering the complex nature and the somewhat diverging information on treatment methods and results you should perhaps consider carefully if this is something to consider or if you are better served by other kinds of treatment.
Most credible sources are mixed in their praise for Naltrexone:
“Combining pharmacotherapy with psychosocial and behavioral interventions has helped improve the treatment of alcohol dependence. However, the clinical use of effective medications, such as naltrexone, is limited by poor adherence to a daily oral regimen.”
“Naltrexone should be used only in the context of a comprehensive alcoholism treatment program which includes counseling and other psychosocial therapies. The psychosocial therapy and therapists should support the use of pharmacotherapy and encourage medication compliance.”
A lot of people have pain from various sources. Pain from injuries, from inflammed joints, lower back pain and a host of other kind of pain. If you train or exercise it is easy to get small injuries and if you are a bit older, you might start noticing pain from inflamed joints, from muscle tension or from back injuries or wear. Normally this is not a huge problem as both your bodys own opiod production (endorphins) and prescribed painkillers can limit the problem. But while taking naltrexone either option is blocked. Litteraly blocked as the sites that the endorphins or opiod painkillers would normally activate are blocked by naltrexone. This is the whole idea of taking naltrexone, but it does come at a cost, in case you actually have pain of some sort.
If you are not taking naltrexone oraly, but in the form of injectable naltrexone, the problem is even worse: the long acting nature of the injections will complicate any emergency situation and “…regional analgesia, conscious sedation, use of non-opioid analgesics, or general anesthesia may be needed for pain management”
Naltrexone Side Effects
Side effects of naltrexone alcohol treatment include:
Joint or muscle aches
Fainting or lightheadedness
Any person who is allergic to the drug may experience symptoms similar to naltrexone overdose symptoms, including:
Tinnitus or ringing in the ears
Side effects also include a reduction of your immune function. Which is great if you happen to have an autoimune disease, but not so great if you are exposed to a flu virus or some other pathogen. Your immunesystem is there for a reason. So while your mother-in-law might be a pain, she might also be a bit safer than taking a drug like naltrexone.