FAQ For Doctors
Nalmefene/naltrexone isn't available/approved in Ireland.
This is incorrect.
Nalmefene, under the brand name Selincro, has been approved in Ireland for reducing alcohol consumption since 2014. As it is an expensive medication (>€100 for 30 tablets) many pharmacists do not keep it in stock but will be able to order it in within 24-48 hours.
Naltrexone has been approved in Ireland since the 1980s.
Nalmefene/naltrexone is only available for abstinent patients.
This is false.
Nalmefene has been approved since 2014 in Ireland for reducing alcohol consumption. This is fully consistent with on-label prescribing instructions and this approval is contained in The Irish Medical Formulary.
Naltrexone's on-label prescribing instructions in Ireland are different to those in other countries including the United Kingdom and the United States in that they do not cover usage for alcohol reduction. However, it can be prescribed off-label by anyone legally permitted to write prescriptions.
A wealth of information is available online relating to how naltrexone is used in the National Health System (NHS) in the United Kingdom , an example can be found here, and within the US Department of Health and Human Services in the United States, an example can be found here.
Nalmefene/naltrexone has to be prescribed by an alcohol disorder specialist.
This is incorrect. Nalmefene/naltrexone can be prescribed by anyone who is permitted to write prescriptions.
There is publicity about nalmefene/naltrexone being prescribed incorrectly/for incorrect issues.
There has indeed been such publicity but this relates to naltrexone being prescribed to treat certain forms of cancer. This publicity does not relate to its usage in treating alcohol use disorders and has no connection to The Sinclair Method.
Alcohol addiction can't be fixed by medication or by drinking.
This is an outdated belief which contradicts the evidence that TSM is hugely effective in resolving issues of addiction and alcohol use disorder. Chapter 17 of Dr. Roy Eskapa's book The Cure For Alcoholism has more information specifically for physicians on these tests. Additionally, Section 15: Toxicology of the Irish Medical Formulary has further information.
All data and information can be found courtesy of Sinclair Method UK.
Nalmefene/naltrexone damages/disables the reward system.
A clear guiding principle throughout TSM, both in its instructions and advocacy, is mindfulness practice. A subtle but crucial part of TSM is that the medication is only taken in conjunction with drinking. On days where the patient does not want to drink, it is fundamental that they do not take nalmefene/naltrexone but instead engage in activities which stimulate the reward system so that the brain learns, that whilst it no longer gets a rush from alcohol, it can and will get it from other, healthier activities which can include, but are not limited to, exercise, meditation, eating favourite foods, listening to favourite pieces of music etc. Nalmefene/naltrexone does not alter the reward system on days when it is not taken and learning to appreciate other aspects of life is a key part of TSM.
What about using campral/antabuse/librium/etc. instead?
Physicians are used to using different treatments for the same/similar ailments in different patients. Whilst neither Curing Alcoholism Ireland nor any other reputable TSM advocate will ever claim to know a patient better than the patient themselves or their doctor, it is a long established fact that in addiction/AUD recovery, patient commitment is one of, if not the, biggest indicators for success. If a patient who has thoroughly researched various addiction treatments, and possibly tried others, has decided that TSM represents their best chance for success then their commitment is already likely to be extremely strong. Librium is not a long-term alcoholism/AUD recovery medication. Rather, it is used to stablise a person's physical state during cessation of drinking where they have become physically addicted to alcohol. Campral is useful in reducing cravings but it does not eliminate them as nalmefene/naltrexone has been proven to. Antabuse is only suitable for patients who are absolutely certain that they will remain alcohol free because of the extremely unpleasant, and potentially dangerous, effects it causes when taken with drinking. Curing Alcoholism Ireland does not make any statement on the patient-specific usage of these or other medications as it considers this the exclusive remit of the patient and doctor.
What about AA/Smart Recovery/peer support groups?
Neither Curing Alcoholism Ireland nor any other ethical TSM information resource/advocacy service will enter into a crusade against AA/SMART Recovery. Any sensible commentator in the field of alcoholism/AUD recognises the countless individuals that AA/SMART Recovery/other peer support groups have helped. However, both AA and SMART Recovery have as their goal, complete abstinence. TSM neither advocates for nor against abstinence and indeed a significant proportion of "TSMers" do achieve and live a life free of alcohol. However, TSM is not limited to this and indeed many successful "TSMers" develop a healthy relationship with alcohol and learn to enjoy the occasional drink, whilst remaining vigilant in taking nalmefene/naltrexone one to two hours before consuming alcohol, as part of a healthy and alcohol problem free lifestyle.