Chapter 3: The First Dose
After many failed attempts to quit drinking, it's time to start the one treatment that might actually work.
This is the third installment in an ongoing series and it’ll make a lot more sense if you read them in order. Catch up on earlier posts here.
I didn’t need to go to my doctor to get Naltrexone because I already had three years before during a prior attempt at The Sinclair Method. At the time, I’d been laid off from my design job and was sort of freelancing but mostly day-drinking while my husband, then-boyfriend, was at work. I’d come across an article in The Atlantic about The Sinclair Method while googling how to get clean, then I printed it out and made an appointment with my doctor. She was unfamiliar with Naltrexone for this use, but agreed to write me a script.
The next day, I picked up my new bottle of Nal from the drug store along with a tallboy of Pabst. When I got home, I cut it in half (TSM recommends starting with 25 mg and working up to the full 50 mg dose), shoveled some bread into my mouth so I didn’t have an empty stomach, drank a full glass of water, and set my watch. One hour. One hour until I could drink.
If the goal was to make drinking less appealing, it worked; before the hour was up there was a persistent ache at the back of my head and I felt car sick—not unlike a hangover. I had heard there could be side effects for some people and mine kicked in before my timer had gone off. By the time I opened my beer, it seemed as alluring as a pint of motor oil. I didn’t just feel sick; I felt deflated, dejected, as though there was no hope left in my life. I forced down half the can and went to lie with my head under a pillow. When my husband got home, I told him I had a migraine and put the prescription bottle in the back of a drawer in the bathroom. It sat there, ignored but not forgotten, until now.
The reason I finally decided to try again was because, since I first picked up that prescription, my drinking has only accelerated, especially since the onset of Covid, when I could have used the down time to get into sourdough or exercise, but instead, mostly drank. And while I’ve tried to get sober many times since that first failed try at TSM—going cold turkey for weeks, even months—it’s never stuck, so I figure I’ll give TSM one more go before I confess to my husband and start selling plasma to pay for rehab.
In preparation for today, I’ve spent the last few days reading the foundational text for The Sinclair Method cover to cover (or, since it’s a free PDF, pixel to pixel). Called The Cure for Alcoholism: The Medically Proven Way to Eliminate Alcohol Addiction, the book was written by Roy Espaka, a clinical psychologist who worked closely with John David Sinclair until his death.
The book explains how The Sinclair Method works in detail, but it may also have answered a question that’s plagued me for years: Why me? Why I am, a semi-decent human being who has definitely walked an old lady across the street at least once and has never even come close to kicking a puppy, dealing with this bullshit? The addiction therapist I saw in my 20s had an answer to this question (Why you? Why not?). But I’ve been in search of something more concrete, and Eskapa provides an answer.
When John Sinclair and his colleagues were doing their early studies on rats, they were able to breed a population that was predisposed to drinking alcohol. It was basic Mendelian genetics: They took individuals with a taste for booze and then made them fuck. What resulted, generations later, were rats with a predilection for alcohol abuse. Let’s call them… Irish Catholic.
This, to Sinclair and his colleagues, made something clear: There’s a genetic component to alcoholism, a finding that has now been established many times over. It certainly appears to be true in my case: I come from a long line of Irish Catholics, er, alcoholics. And not the fun kind but the dead kind.
A shortlist of family members who have succumbed to alcohol abuse: both grandfathers, three uncles, at least five second cousins, and an aunt who lost her kids, then her house, then finally her life when she had a heart attack at 55 while her husband was out buying vodka. Half my first cousins have been to rehab and the ones who haven’t just can’t afford it. You can imagine the liquor bill at our family reunions.
Despite this unfortunate family tree, I also know that genetics aren’t fate. As Roy Eskapa wrote, “Even people who have the ‘right’ genetic constitution for alcoholism will not become addicted if they never drink in the first place.”
An example of this could be my brother, who is older than me by just 13 months and who has never had more than two beers in one sitting. When he complains that beer makes him “full” and “tired” and he doesn’t “see the point,” I think, “Well because you don’t drink enough, moron.”
While it’s certainly possible that my brother didn’t get whatever genes code for alcoholism, he also didn’t start drinking, like I did, as a teen. While I spent weekends partying with my friends, developing the taste for cheap booze that would take over my life years later, he was in his room playing Doom. He may be the only person in history whom video games actually helped. Even weirder: As an adult, he doesn’t get his endorphins from alcohol; he gets them from running. Frankly, I’m almost sure he was swapped out at birth with my real brother, who is probably somewhere waiting for a new liver.
According to Roy Eskapa, it’s these two factors—genetics and exposure—that lead to alcoholism, and I have plenty of both. I spent most of college wasted, assuming I would quit after graduation, but by the time I was 21, I was a full-blown barfly, perched on a stool next to middle-aged alcoholics before sunset. I did this for years, gradually teaching my brain not just to like it but to need it.
John Sinclair put it this way: “Addiction does not happen overnight. It takes time and practice to learn it.” Well, I’ve always been a good student, and just as I learned my addiction, my hope is that, through Naltrexone, I’ll be able to unlearn it. Starting now.
I find the three-year old bottle stuffed among old antibiotics and allergy meds in my bathroom. There it is, 100 50-mg doses of Naltrexone with my name on it. At noon, right around the time I usually start to drink, cut the pill into fourths. I figure if half made me depressed and sick the first time, maybe a fourth would have fewer side effects. Please, God, have fewer side effects.
For the hour until I can drink, I sweep and mop my house and will time to go by faster. I feel slightly anxious but that could be the medicine or the nerves.
When I can finally start drinking, my Pabst tastes like garbage, but that’s always the case. It’s Pabst.
Physically, I feel not great but okay. A little headachy. A little sick. There does seem to be something different though it’s hard to describe exactly what. It’s like I’m still getting drunk but I’m not getting buzzed. By three drinks, I feel like I’ve had six—like it’s the very end of the night and the fun has worn off and now I’m just drunk. My body is tired and my brain feels like I’m swimming through mush.
Still, I drink two more while scrolling through Instagram and then Twittter and TikTok and then back again. Then I jump in the shower and prepare to put on my sober face for my husband. When he asks how my day was I say, Oh, the usual. Nothing much to report.
That night, I wake up at 3 AM, slightly sweaty and full of the usual shame and regret, like I always do on my drinking nights. It seems 12.5 mgs of Naltrexone cannot fix that. Still, I repeat the protocol the next day and then the next, and my intake is, indeed, lower than usual. I suspect that’s less the Naltrexone than the fact that my husband has been getting early off work, but I keep reminding myself: You didn’t learn this overnight. You won’t unlearn it overnight either.