Bruce Rose Talking about Alcohol Use Disorder 2019

Linda Elsegood: This week we're not going to be talking about low dose naltrexone We're going to be talking about full-dose naltrexone in 50-milligram tablets, which is used for alcohol use disorder using the Sinclair Method. And today my guest is Bruce Rose from Alcohol Recovery Scotland. Thank for joining us today, Bruce. 

Bruce Rose: No problem. I’m pleased to be here.

Linda Elsegood: Can you tell our listeners about the Sinclair method, first of all?

Bruce Rose: Yeah, the Sinclair method, um, as you were saying, it just includes, uh, using 50 milligrams of naltrexone. And simple way to describe it is an alcohol reduction program leading to either, um, safe drinking or down to abstinence, particularly, uh, where clients will use 50 milligrams of naltrexone alongside alcohol is probably the simplest way.

Linda Elsegood: And can you tell us how you came about to set up this alcohol recovery in Scotland? 

Bruce Rose: Yeah. My background for numbers of years was, uh, in management of alcohol and drug rehab centres. Um, I'm actually based up in the Highlands of Scotland and I moved up to the Highlands of Scotland to manage an alcohol and drug rehab centre.

Bruce Rose: Um, here in the UK at the moment, especially in Scotland, um, funding is so, so difficult to get hold of, um, to run a rehab centre. At the moment, you're probably looking at, you're not getting any change from about half a million times a year to look to run a rehab. Um, and the cost of it was just, uh, it was just impossible.

Um, so the rehab that I was working at initially was privately funded. Um, and they basically ran out of funds. They couldn't keep the rehab going on a long period. Um, so I, I just started looking around and researching on the internet. I started looking around and I thought, there must be a cheaper way. It was difficult to get a cheek, a model with a successful model, which was the battle.

Um, so I looked around and looked around and I searched the internet and search the internet and essentially came across a video that was talking about the Sinclair Method within how people could work without couple, um, issues from the comfort of their own home simply by using medication and being on a support program that came with it.

Um, I have to be honest, when I first heard about it and the first short, my whole background was abstinence-based. It was stopped and clean, um, grab hold of the Munis chair and hopefully if they would come to me in recovery and three to four years clean, um, can I just ask you that button? Sorry. How successful.

Linda Elsegood: Was the program you were using at that time? I mean, were people able to come off alcohol and if so, did they stay off? Did they relapse? What would you say the success rate was in the rehab centres? It was difficult to judge it on a long-term basis because obviously once clients left, you couldn't really see them much.

Bruce Rose: Um, when they were with us, actually in the centre, the success rate would be probably quite high. I would estimate about the sort of 60% mark, 60 to 70% mark. Um, but that's, whilst they were in a very controlled environment, they would be tested on a regular basis. Um, the challenge came when they left. Naltrexone works, uh, without going into too many of some medical details, but the whole foundation, it was such as the process of addiction and takes away the craving that people have.

So the challenge that you had, we haven't been. In most of the rehab centres were one's people left. Then the craving and the addictive side of the alcohol was still there. Um, and all it took was a life situation, some sort of issue that happened in life, and then people would then relapse and then they went back into the whole cycle again.

Um, so I think longer-term, yeah, I've seen different figures vary. They referenced, so three to five years, you're probably looking at about seven to ten per cent success rate.

So yeah, no, great. And then when I show the same Sinclair method, they were saying that it was a seven to 8% success rate. Which to be honest with you, that's why they looked at it enough. You know, it's just not possible. Um, so did some research. I spoke to lots of different people. Um, they were claiming that there were 120 clinical trials done.

Um, I spoke to Claudia Christian in America. Um, I saw the Little Torch Association. Uh, there's a book called The Cure for Alcoholism. Um, it's a lot of medical information in there. Um, the more I looked at it, I spoke to some people, um, different places who use them in the program already, and it all seemed to stack up.

Um, and I thought, this is crazy. This, this looks like it will work. Um. So, yeah. So that's not been led me to leave the rehab centre. I never want to knock at the rehab centres cause they do, they do a lot of good work for the people that it works for. But it's just, no one size doesn't fit all in the recovery world.

Linda Elsegood: I have interviewed some people who have used this method and they've managed to come off of alcohol. So could you tell us? How your experience has been with helping people with the Sinclair Method. 

Bruce Rose: Yeah. It's been a learning process from, from the start. So, um, at the moment in Scotland, I believe I'm the only person that's doing it in Scotland. Um, so I have a doctor that I had worked with in Edinburgh who does all the prescribing. Um, and all the medical, um, work for me. Um, but a lot of it was initially it wasn't trial and error as in the medication and the lessons that were all medical. Um, the trial and error came in the support programs. Uh, we ask people to keep drink diaries, um, we phoned them on a weekly basis, uh, once they've got into the program.

Um, there are lots of different suggestions that we made for people to change habits, to change processes. Um, so we've been learning a lot as we've been going along with the whole process. Um, so initially, um, I would guess we would probably have about a 50% success rate with the things that I've been learning from it recently.

Um, the success rate has now gone up. Um, and I would say it's probably around about. I'd have to go back and check my figures, but we're talking about 65 to 70% success at the moment. So the idea is that you take the 50-milligram tablet before you start drinking alcohol, which then yup. Um. Doesn't affect you.

Linda Elsegood: You don't get any high or a buzz from the alcohol. You just stay exactly the same as you did before you started drinking, which then decreases that desire because it doesn't give you what you're looking for from the alcohol. How? How long before you start drinking? Do you have to take the 50-milligram tablet?

Bruce Rose: They take one hour before they drink. Um, so we always recommend people to take, take a pill one hour before you drink. Um, and then people will then consume alcohol. Um, after the the hours go on. I'm not just giving them an hour two to get into the system and to allow to get to work properly. Um, and then from there, people, they initially stopped off.

We're seeing in the first, I was checking this morning, um, in the first three to four weeks, we're seeing about 40 to 50% drop in individual's alcohol intake in the first three to four months. Um, and that seems to be a very regular pattern with people that we have on the program. Um, and then from then that tends to level out for a few weeks, and then it drops a little bit.

We ask people to send us a graph every week, so we. Well, it's a good switch then correlates into a graph. Now we have a fairly clear picture from a week to week basis on where people are at. So what we find is people will drop a little bit, they might increase a little bit the next week, and then they'll drop bit more.

Linda Elsegood: But the average as the months go on, it definitely just drops and drops and drops and drops. Compliant with taking the medication? 

Bruce Rose: Yes, yes. If you don't take it, it doesn't work. I interviewed one gentleman who said that you know, he would open a bottle or can or, I can't remember. And once you'd open the first one, he would have the second, the third and so on.

He couldn't stop drinking and he was taking the 50-milligram tablet and the number of beers he had started to reduce until he got to the stage where he opened it. And he actually put it down and went and did other things. You know, he didn't have to drink it all in one go. And that came as quite as a surprise to him that he could walk away from it.

He didn't, you know, have to drink it. And then the desire to drink. Every day started to go because there was no reason for it and he started doing other things. So it is altering your lifestyle, as you were saying, alongside taking it to fill the gap of what you would normally be doing. Absolutely.

Bruce Rose: Yeah. We, we have a big discussion that we have with people and we always talk about the difference between addiction and cravings versus habit. Um, but what the naltrexone does is it starts to work without going into too many details when at the time it breaks down the neurological pathways and it's an opiate blocker.

So it stops the release of endorphins, which is what people are addicted to. That’s the treasure and the reward is the brain gets from that. So the medication deals with the craving and the victim addiction side of it, and then you have the habits. So I have a lot of people that have been on the medication for two or three months.

The alcohol levels sometimes haven't dropped as much as they want too. So prior to that stage, and then starting to talk to people and counsel people and say, okay, at this stage, the medication stopped them to do the work that it needs to do. What we meant to look at now is the habits. So instead of coming and home understanding just to, okay, enough with a book and glass of wine, um, take the dog for a walk for a couple of hours or.

Just change the lifestyle or the habit, the routine that you do. And I've had a number of occasions where people have just, they've come home, they've changed the plan. When they come home, they've gone out for a walk that on something else, and then by the time they get home, they've realized or they're starting to understand them, that the medication has done the job.

So they're not craving alcohol at night, which is what they're used to it just to do it out of habit. So they woke up the next day and say, “Oh, I can stop now.” Why? No, no. We've got to get, we've got to do this slowly. Insurance of the whole process works properly. Um, but it is, it's definitely two sides to, it was craving the addiction versus the habit, and we slowly separate the two of them as time goes on.

But the medication tends to the craving. The main difference. I'm Simon sheer compact. She knew that the abstinence side of things. The medication stops long-term craving is the longterm Cleveland, the relapses in a normal, the normal recovery program.  I mean, you can stop the craving once somebody who stopped the drinking with them, or you can choose the relapses by the crucial and a number of papers who've told me. Oh, I have to have a glass of wine in the evening, stroke, beer, stroke, whiskey, whatever it may be after a busy day because it helps relax me. So their thought pattern has to change. You know that you don't need alcohol to relax. 

But of course, it's very easy when you are not addicted to it to see that. But it's not always easy to see it if you do have a problem, because I'm sure until you get to the stage where you want to ask for help, you've had the problem for quite a while. And if people were to suggest you had a problem with alcohol, people would say, no, I don't.

I, you know, I don't have a problem. So, you know, the people that come to you. How long would you say that had a problem with alcohol? It can vary from just a few months up to 10 years, 10-15 years. Um, what I am finding at the moment is that most wine is the biggest shoe that I've got at the moment. Um, I would say that 75 to 80% of my clients have a moment of wine when they start.

Um, it's becoming a huge epidemic in this country and it's, we're not having, Wayne used the word, um, words, alcohol use disorder rather than alcoholism. Um, because when people mentioned the word alcoholism, they think of someone who is what I would classify as a chronic drinker. Someone who's drinking a bottle of vodka a day or that kind of level.

Um, most people that I speak to, they, they're not strategic Scottish word. Cool.

Um, that they're not staggering around the place. It might come. Um, they coming home, having a bottle in lunch and a glass of wine, the full meal and having a glass of wine with a meal and then finishing off with what the lecture on at night, but they're doing it on a day to day basis. But the main crux, every single one of them was telling me is.

But I'm not in control. I just could quite easily turn into two or three bottles. Um, and the whole life and the whole thinking and the whole structure to what we're doing on a day to day basis. Um, they're going up to work. I've got to get to the supermarket before it was kind of clocked here in stockings.

Um, I've got to get to the supermarket in time of put a whole day on. The whole routine was, are structured around when can I get my drunk? When come, when can a bargain one. Um, and I've been from just a few months, but the main thing as well that we're saying is that we all know bumps and. For the control of how much they drink doesn't work anymore. I suppose the main thing that I'm hearing as well. 

Linda Elsegood: Hmm. Um, and what about binge drinking? I mean, we used to hear a lot about binge drinking a few years ago where youngsters would not drink during the week, but then just drink as though it's going out of fashion at the weekends.

Bruce Rose: Yup. Yeah. I mean, just, you know, I've worked with youngsters who think that by doing that, because they don't drink during the week, they're not going to become addicted. Yeah. Yup.

There are two different ways of getting to that level where some people will start out just by doing their own drinking during the week and then they'll binge at the weekend. And then what then happens is they binge on a Friday, Saturday, and then the, which then turns into Thursday, Friday, Saturday, and then it's Thursday, Friday, Saturday, Sunday, and then it breaks pathway.

What happens quite often we'd see it with guys in the rehab centres. They would come in, they'd go for periods of absence, like whatever, a month or two months or three months, they'd hold steady. We reached a stage of addiction with, with the alcohol. So then what they'd do is they would stop drinking. They would have a month off.

Drink or two months or three months. Um, but then what, uh, what's actually been called the alcohol deprivation principle kicks in. So the lumber, they off the drink, the more the cruising boats and boats and boats, and I'm essential, they'd give them to it. They have one drink. Um, the, such a big reward. Then, the declaration transport has built what people then wash them, couldn't get a high on metal than when they did before.

It only just attends to build and build and build. So they were drinking probably when people are young, when they just, they go out on a Friday night. And, um, that's how it comes to start. Um, but once people are established drinkers, uh, if you're an established junk and you're drinking a lot, you hear a lot about dry January and things like that, but there'll be different schools of thought in it. But from the people I've worked with, um, it's not a good concept because the craving builds and builds, builds, all the way to January, and then at the end of the month, if I had not drunk all January, twice as much weekend the first weekend, and then they go off drunk crunching much, so they stopped for another one.

But then what you're doing is you're creating a binge drinker, which is actually worse, your system. Mm. It's trying to get people to reduce the and then just try and spread it out a little bit rather than just a big bind of alcohol and system. I mean, nothing. Again,

And I'm sure a lot of our listeners have children or grandchildren. And the worry is that when they are not school children anymore, you know, or even some school children, unfortunately, experiment with alcohol. What can we do this, like he was saying, buying alcohol from supermarkets? It's so easy to get alcohol.

I mean, on cigarettes there are warnings. There is nothing on alcohol and it's relatively easy to get hold of. Many children find where the parents keep their alcohol. What can we do to try and keep our children safe from becoming addicted to alcohol? I asked about 40 of them. One of the hardest questions that are a little bit like cigarettes or I don't know, 20 years ago, 25 years, um, was a lot of education that's needed with children need to be taught.

And made aware of the dangers of alcohol, but when you've then got the other side of it where it's so socially acceptable, what the parents are contained in the friends and families and everybody's drinking. So the kids are all looking at the pants and the door and the adults. Can we go? Um, so I said, I personally think it needs a huge intervention as we did with the cigarettes where they very slowly stopped to reduce the TV spot. Um. 

We, everywhere in the workplace, we're starting to notice there's a lot more, um, drink awareness campaigns that have gone into workplaces to speak to people. Um, it's just the stop. It doesn't stop the problem, but it's, it's, it's growing and it's actually making the start and making people aware of how much they're drinking and what sports being does and what's not doing.

Cause, um, I don't want to take the social away from it. There was a. What social sites, but it was actually very dangerous on Twitter. I must admit, when we go out, my husband will have a bottle of, um, alcohol-free beer. He says it tastes as good and it doesn't give him a headache. Um, he has, uh, a beer probably once a month or something, but he does like this zero alcohol beer.

But that's the other thing, isn't it? Is peer pressure. If you are out with friends and they're all drinking beer, you probably feel uncomfortable drinking a Coke or something. Yeah. But if you can have an alcohol free beer, that might be the way to go. Do you think, and um, do they have alcohol free wine? I think they have types of, um, wine without alcohol.

I mean, do you think bringing those kinds of products to the market will help with the problem? Yeah, absolutely. Because it's, uh, it's just another one of these RESILIA there's, I think in Sculpin that they've introduced, uh. They increase the price of some of the cheaper alcohols that you can buy in the supermarket and in the shops.

So a lot of people are saying, well, it's not solving the problem, but most people are expecting that one issue to solve the whole frame. But I think it's just, it's a much bigger picture, so that needs to be a lot more alcohol-free. On the market and bars and pubs and places where people can go and have enough to hold drug and alcohol-free term, um, as well as looking career stuff as well as, uh, education for children as well as, um, I was, I was looking at some cities this morning and it was just, it was showing that um.

I caught onto the dates, but in years ago, most of the drinking was done in pubs, and most of the drinking was done with others. Nowadays, the majority of Trenton was actually done at home, and it's one, so the whole culture has changed. Um, so we need to target the numbers of the number of women that I'm speaking to at the moment. You were saying that it's so socially acceptable amongst their friends and, um, just to go around to the house and, and open up a better wine. And, um, whereas if you go around and have four or five cans of beer, and if the MailChimp's slightly frowned upon.

Hmm. So it's just, again, it's just another cultural thing. What needs to be changed. And of course, they had, um, when my children were younger, these are. I will call pop drinks. Yeah. I mean, where you would think it was a soft drink. Dick was got fought coronial something, but going out with friends and having a good time and laughing and joking, you don't need the alcohol to be able to do that.

You can still have a good time without it. So I think if. I mean, would you say youngsters are more aware now than they were? I mean, what age group would you say of the biggest drinkers? I would say I would, um, in the field when I was in it and hadn't been central about the scoping for awhile. Um, and things are very, very distant.

Gotcha. From 35 years upwards. So 35 years up with was all alcohol. Um, actually when you spoke to that 55 years and plus that uncomfortable, um, I'm under 35 now. I'm slightly different up here in the Highlands. That can come on to that in a second, but I would say the most of the rest of Scotland, um, under 35 is.

So the drug area, it's hitting the drug sector, the real epidemic amongst the young ones at the moment. Um, the up here in the Highlands, there's such a drinking culture up here that you find the under 35-year-olds drink, um, took drugs, but cocaine, um, was a horse tranquillizer called ketamine that's on the market at the moment.

Um, that's very common amongst children. Um, so it's, it's difficult, they still there. Then the the drug side of things is, it's become huge amongst them. And that's the next area we want to watch out for. Scary, isn't it? But you were saying about charts and graphs and things. Um, Dr Jill Cottel. Um, did a very good presentation on, um, LDN.

Oh, Oh, Naltrexone for alcohol use disorder, and you can watch that video. She did it for, um, our 2017 conference. If you go to our YouTube channel and put Dr Jill Cottel, alcohol use disorder, you'll find it. It's also on our YouTube channel. And Dr. Cottel also got us to add extra things to the LDN app to be able to monitor patients.  That we're taking for alcohol use disorder. So it's free. The app is free. Um, if you go to LDNapp.org you'd be able to download that and you can put in there your alcohol intake, and then you can print out graphs and charts. So once you've got the app, which can be used on an iPhone and Android, PC or Mac and whichever device you log into, they sync automatically.

So you only have to go in it and put how many units or what. However you measure your alcohol in there, and it does wonderful things. It shows you over a period of time. So if anybody's interested in that, it's free and you can download that from LDN. I guess I'm just on that as well. It's, it's amazing the motivation and encouragement it gives people just to see, um,  how much they drink on a weekly basis.

So just to see that on paper, on a cross, on some form format is great. And then to see it reduced as well is a very, very good.

Like you say, it boosts your confidence that you're actually doing something and it's that feel-good factor, isn't it, that you know on making a change. But I'm afraid we've run out of time. But I would say it's been amazing talking to you, and I'm sure, I'm sure people will have learned a lot, even though, as I say, it wasn't low dose naltrexone, but it is something where I'm sure everybody has been touched by somebody who may have alcohol issues.

Linda Elsegood: So really, thank you very much for being my guest today. Bruce. No. Thank you. I really, really appreciate that. Thank you. This show is sponsored by Alcohol Recovery Scotland, helping individuals break free from alcohol addiction using the Sinclair Method TSM in Scotland. Contact them through their website at www.alcoholrecoveryScotland.co.uk.

Any questions or comments you may have, please email me at Linda@ldnrt.org I look forward to hearing from you. Thank you for joining us today. We really appreciated your company. Until next time, stay safe and keep well.