Why Isn’t The Sinclair Method Used More Often?

I was really sorry to read that Dr. David Sinclair, who did so much research in the area of treating alcoholism, passed away at the beginning of April after a battle with cancer. The Sinclair Method is named after him and I hope that one day he will be as famous in the recovery world as Bill Wilson, the founder of AA.

In my opinion, the Sinclair Method is a system that could help so many people if more realized it existed and it was offered more often by treatment providers. In fact, I wish I had used it myself and been told about it by doctors back when I was struggling with alcoholism. It could have saved me a lot of pain and helped me control my drinking earlier, before I hit my rock bottom.

The Sinclair Method involves taking a simple pill, such as the prescription drug naltrexone (brand names: Revia, Vivitrol), an hour before you consume alcohol. Over time, the medication diminishes the desire to drink. The pill has no diminishing effect without alcohol (so if you don’t drink nothing will happen) and it is non-addictive.

How the Sinclair Method Began

Dr. Sinclair started his research in America during the 1960s. He established what he called the “alcohol deprivation effect” as a driving force in alcohol addiction. He later moved to Helsinki, Finland, to take his research forward using specially bred rats genetically predisposed to becoming alcoholic. The conclusion of Sinclair’s experiments? That alcoholism is a learned behavior. When a response or emotion has been “reinforced” with alcohol over a period of time it is learned. Some people (and some rats) have genetic traits that lead them to feel a lot of “reinforcement” from consuming alcohol, which eventually creates uncontrollable cravings.

Sinclair was influenced by the work of the Nobel Prize-winning Russian physiologist, Ivan Pavlov, famous for making dogs salivate when a bell was sounded. Once conditioned, dogs rewarded with food after a bell had been rung would salivate at the sound of the bell itself. Over time, Pavlov would ring the bell, but he stopped rewarding the dogs with food; the salivating tapered off. This is called “extinction” and Sinclair thought the learned behavior of an addiction to alcohol could be removed by extinction, too.

Following his early research, Sinclair hypothesized that alcohol produces reinforcement in the brain in a way that’s similar to opiates. His research indicated that alcohol produced reinforcement by releasing endorphins that bind with opioid receptors in the brain. So a solution to stopping the reinforcement cycle might be to block the receptors every time alcohol was used. Sinclair tested his theory on rats using naltrexone, an opiate blocker, and after that he conducted clinical trials in people. The results encouraging.

The solution discovered by Sinclair effectively means you have to drink yourself sober! This would surely be the perfect solution for many alcoholics and is probably a solution I could have excelled at. “Extinction” of the impulse to drink takes place over time and works for around 80% of people who use the method properly. It’s important to note that you take the pill an hour before drinking, not simply when you feel like it. Over time, the desire to consume alcohol will diminish and people end up abstaining most of the time or occasionally have a drink when they wish. You need to continue taking the medication before drinking, even when you feel things are under control.

There are a few people who don’t seem to respond to the medication, and others may have too much liver damage to use this treatment, but this is very rare. (They will do much more damage to their liver if they carry on drinking.) The Sinclair Method is not an instant solution and can take a few months to have the desired effect.

A Better “Cure”?

This may be the future of alcoholism treatment. It is common in the U.S. to call alcoholism a “disease” and this seems to be treating it as one. It will take time for people to accept such a radical concept, as it does go against the complete abstinence approach that most treatment centers advise people to use. Abstinence is great if you can manage it, but sadly, most people with a serious problem do not always do well. People I talk with who use the Sinclair Method often say how they struggled with the more traditional solutions; I can understand that. I wanted to stop many years before I finally managed abstinence and was nearly dead by the time I got my act together. I was lucky that I managed to stop with the support of others.

I think Bill Wilson would have approved of Sinclair’s work; after all, he himself experimented with niacin and even LSD in an effort to improve recovery from alcoholism. In chapter three of the AA Big Book it states, “Physicians who are familiar with alcoholism agree there is no such thing as making a normal drinker out of an alcoholic. Science may one day accomplish this, but it hasn’t done so yet.” That was written in the 1930s and Sinclair may well have finally achieved this. I think if this solution had been discovered in Wilson’s lifetime he would have probably endorsed it. Unfortunately, AA does not seem to endorse any of the newer solutions that have been developed since Bill passed away, which is sad, as it is the perfect organization to reach the largest number of people needing help.

In reality, I think it will take time for this solution to gain wider acceptance, especially in the US, where the treatment industry seems dominated by 12-step ideology. The Sinclair Method is becoming popular in other countries and is now available on the National Health Service in the UK, as well as being used extensively in Scandinavian countries such as Finland, with great success. It is gaining popularity in underdeveloped countries that don’t have a pre-existing 12-step recovery treatment industry, too. It is a much cheaper solution compared to inpatient rehab and this will be attractive to countries without the infrastructure to support hospitalization for many people.

There are some useful resources that explain the Sinclair Method in much more detail than I can do so here. The actress Claudia Christian has produced a great film explaining how the solution works, called “One Little Pill.” She has also started the C3 Foundation (the European site is here). The best book I have found so far on the subject is by Roy Eskapa, PhD, and is called The Cure for Alcoholism.

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    39 Responses to Why Isn’t The Sinclair Method Used More Often?

    1. Avatar
      Amanda June 3, 2015 at 1:47 pm #

      ithey gave me this in rehab and I continued on it when I got out for about 6 mos I was in rehab for opiate addiction not alcohol but it really helped me with cravings

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        massive June 6, 2015 at 10:01 am #

        You are suppose to use it for drinking. You also should take the pill , then 1 hour later drink. Its not a pill for abstinence. And I have not heard that is was for drug cravings. Watch One Little Pill by Claudia Christian.

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          Michael D June 8, 2015 at 7:29 am #

          Naltrexone is used a lot for opiate addiction https://store.samhsa.gov/shin/content/SMA12-4444/SMA12-4444.pdf It is not just used for the Sinclair Method.

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          TSMlady June 3, 2016 at 5:14 pm #

          I’ve been taking it for alcohol. I broke my ankle on it, and pain medication did not work. So it does work with opioids! A good thing. Just wanted to add that.

    2. Avatar
      Denise Krochta June 5, 2015 at 11:04 am #

      i am sorry to hear about Dr. Sinclair. Recently, on my radio show “Addicted to Addicts: Survival 101” I interviewed Claudia Christian on this topic. She had just recently come out with her documentary “One Little Pill” and since I wasn’t familiar with the Sinclair Method I was pretty sure my audience wasn’t either.
      It is a very interesting concept. I think it is important that more people know about choices and options.
      Thanks for writing about it.

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        Michael D June 8, 2015 at 7:16 am #

        Thanks for your comment. I think it is a really important solution, especially as many of the older support methods are not proving motivational for many people, who want something “up to date” and not spiritual. In the UK we have a big binge drinking culture and I think the probelms are getting worse rather than better, so this type of solution, when things get out of hand is really important. I really thought “one little pill” was a great film and I hope it reaches awider audience. I will have a listen to your radio show, it looks like you are covering a wide range of topics.

        • Avatar
          Denise Krochta June 15, 2015 at 11:14 am #

          Thanks for the reply. My show is global so if you find it informative and supportive, please share it with those you know who might benefit.

      • Avatar
        Kenny Glassman September 6, 2016 at 12:49 pm #

        What’s interesting is that it took Alcoholics Anonymous for Michael to change his 25-year relationship with drugs and alcohol.
        I’m a psychologist who’s specialized in addiction for over 25 years, and the Sinclair method is simply one of many strategies that alcoholics and addicts have founds can help them. There is no real evidence of long-term success (even the author’s 8 years may turn out to be simply whistling in the dark) with the Sinclair method.
        The author might want to direct some energy and incisive thought to investigate why twelve step methods and strategies worked for him when nothing else had.

    3. Avatar
      Hopkins June 9, 2015 at 11:10 am #

      Options options options! This is probably the best written and researched piece of yours that I’ve read, Michael. It was very informative and stuck to the topic. No, I’m not a professional critic but have certainly expressed my negative opinions in the past toward some of your writing. Even when not reciprocated I like to give credit when it’s due.
      I also appreciated the recognition of how badly 12 step is embedded into the U.S. industry and how much the industry could learn from other countries making pro-active changes and seeking options.
      In one of my treatment rehabs in the U.S. they gave out Naltrexone and encouraged everyone to take it regardless of their specific dependence problem. It was an abstinence based rehab so it appears that them having alcohol abusers take it daily was on the verge of incompetence by them. I was actually shamed for not wanting to take it, although my reasoning was merely not wanting to add another medication to the list. however, my instincts turned out to be good since I discovered that when I did take it my depression got worse. It was years later that I learned that Naltrexone can have that very side effect; blocking natural highs in some people or interfering with anti depressant medications. I think it’s a bit of a stretch to say that it is inactive when not drinking, since it appears that it wouldn’t be active toward the intended result but could have side effects.
      I actually hope David Sinclair doesn’t get the kind of reputation Bill Wilson did, since he was really just a scoundrel. He isn’t imo worthy to be mentioned along side accomplished doctors like Sinclair that have the well being of individuals at heart.

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        Norwegianblue October 8, 2016 at 9:45 pm #

        Very well put, Hopkins. Yes, I’m 5 months into The Sinclair Method and am still taking the medication on an almost daily basis (as I was a daily drinker). This means that it’s in my system for about 1/2 the time, and I do find that it affect my mood and that it might be slightly counteracting my anti-depressant medication….at least it did for a while; less now and during the past few weeks. However, the benefit is that my consumption of alcohol is about a third of what it was prior to treatment, and I don’t obsess about drinking or worry too much about it. Many people who are using the Sinclair Method don’t reach extinction (which I understand means abstinence for most “graduates”, but not for all) until about 10-12 months of taking Naltrexone while drinking. As for you refusing to take the pill, it sounds like that might have been a good choice at he time; to hand this medication out like candy and tell people to abstain seems a little irresponsible.

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      Bob June 23, 2015 at 10:17 am #

      This has been very helpful for me . It is very important to take the pill every time before drinking , or the effects will be reversed . For ex., I am down to 5 drinks , if I didn’t take a pill , I would immediately consume 8 drinks . One must also wait at least one hr ., I usually wait 11/4 hrs to make sure .

      It can take several months for the full effect . I used to consume a 5th of vodka , now 5 drinks is my max , but it took 5 months , around 80 sessions of drinking . Even after 5 times I was down to 18 ounces instead of 26 ounces .

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        Kenny Glassman September 6, 2016 at 12:51 pm #

        How’s the drinking going now Bob, one year later?

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      Jackie November 15, 2015 at 2:09 pm #

      The billion $ recovery industry will not give up its grasp of an endless clientel of humans addicted to alcohol. To even speak of a “cure” for alcohol addiction is akin to heresy in some places! When enough people experience the cure, The Sinclair Method will become the norm. In the meantime people will suffer and die of this disease because the myth that alcoholism is not curable is fanned by the flames of money and greed. 12 step programs are horse manure. Sinclair deserves the Nobel Prize for his work. It will save millions and millions one day soon.

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        Rex November 23, 2015 at 8:12 pm #

        I used the sinclair method 4 years ago.have never had a drink since,dont even crave at all.Just today I spoke to the AA yet again about my great success at beating a life long problem.They dont want to know and told me the 12 step is here to stay,the fact that it has very poor results has little to do with it
        I get the same response even from doctors.What a terrible shame that so many will never see an end to their dronking because of money and egos

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          Kenny Glassman September 6, 2016 at 12:53 pm #

          You haven’t beaten a lifelong problem, you just haven’t had a drink in 4 years.

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      SS December 21, 2015 at 1:06 pm #

      I have been doing TSM for 6 months now and it worked almost instantly for me. I went from an average of 15 drinks a night to 3 within one week and have maintained that ever since. My goal was not to quite. At this point the choice is mine whether I want to drink or not. A choice that was absolutely impossible prior to TSM.

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        Kenny Glassman September 6, 2016 at 12:54 pm #

        SS, I’d like to know how you’re doing now.

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      Susan Hood January 7, 2016 at 9:24 pm #

      I am somewhat confused. If someone drinks “for the effect” (the high), and this drug blocks the effect, what is their motivation to tske the pill? In other words, if I’m drinking to loosen up or forget my problems, and this med stops alcohol from doing that, I’d be tempted to NOT take the pill so I can get wasted….. did anyone who this method has worked for skipped taking the pill?

      Also, if I am going through withdrawal from alcohol, does taking the pill prevent me from getting a feeling of ‘normalcy’ (ie : hair of the dog/ drink to remove the hangover, but not to get drunk.

      I also do wonder about depression as a result of blocking pleasure in the brain…?

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        Struggler April 28, 2016 at 3:37 pm #

        I read on the “internets” (G.W. Bush), take that statement and what is found on the internet as you will, sites are saying that it is also shows signs of helping with the craving to continue drinking when taking Naltrexone 1 hour before they start they are more liable to drink less from what I read eventually, drastically reducing consumption and desire, I have am on bupropion ( for cigerattes) and clonazepam (anxiety) and Naltrexone (Addiction). From very early stages I am sign an improvement, May not work for everyone but that sound very promising to myself and I am sure many other. Not religious but i pray to god this helps…

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        Terrance Bridges July 3, 2016 at 7:41 pm #

        Very well said,, I just watchef the Claudia video today,, I practice the 12 steps witch teaches me to live life without alcohol & or drugs because alcohol worked,, temporaryly,, Im all for new approaches to this living desease called alcoholism,, y do some people have to hate on AA,, lets say u take the pill & eventually u cut down & stop drinking,, who or what teaches u to live life on lifes terms,, the very reason I abused alcohol & drugs to begin with,, hell y not use the pill & go to AA,, my rant for the night !!!

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          Terrance Bridges July 3, 2016 at 7:48 pm #

          I was referring to your comment Susan Hood,, again very well said,,,

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      Rodney April 3, 2016 at 4:14 pm #

      It cured me. Period.

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        Kenny Glassman September 6, 2016 at 12:55 pm #

        How long have you been “cured”?

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      Mark D April 6, 2016 at 8:12 am #

      Just this week I stared taking oral naltrexone @ 50 mg/day. My provider almost insisted that I go with the 1/month shot @ 380 mg. I looked into the cost and found it to be outrageous when compered to the pill, so I pressed to continue with the oral version only.

      I then asked why the clinic does not use the Sinclair method, and it was obvious the provider had not heard of it. She simply said, “We do not do that. We do not believe in it.” So, I pressed her as to why, and there was an uncomfortable silence. Finally she said, “I do not know what to tell you, we just do not do that.”

      I am happy I have found someone to prescribe this drug. I have been through treatment 8 times and have been to thousands of AA meeting over the past 30 years. Living in Minnesota, the Land of 10,000 Treatment Centers, I can tell you it is virtually impossible to find anyone who touts anything other than the Minnesota Model. I have had 2 physicians and one psychiatrist refuse to prescribe naltrexone in the past 5 years, and I really cannot understand why.

      I just hope I do not have to butt heads with my current provider if she continues to insist I use the injectable.

      Great article, and I wish there was a way to get this information more into the mainstream!

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        Henry Steinberger, PhD July 6, 2016 at 2:09 pm #

        Thank you for sharing your story. I’m passing your story and the article to my clients and maybe their Primary Care Physicians. It’s sad how uninformed and uninterested so many medical doctors are when it comes to alcohol related problems.

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      marc April 12, 2016 at 8:03 am #

      AA is humongous in this country. Through media and film AA has pumped itself up to be the only game in town for Alcohol problems. This is a serious problem in this country because AA and it’s twelve steps do not work well because everyone who suffers from Alcohol problems is a unique individual. We are not just a bunch of bozos on the bus. We all have specific problems that have led to abuse of alcohol or drugs. The mental health industry needs to change and the key is to forget about the whole “ABSTINENCE” is the only way. Harm reduction is the key. Sinclair method is excellent and should be researched more in this country but unfortunately it won’t. Because we love the AA and so do movies.

      • Avatar
        Kenny Glassman September 6, 2016 at 1:06 pm #

        Because the Sinclair doesn’t work for alcoholics, and – sorry – nothing but abstinence does.
        Long term – study the stats.
        Isn’t anyone curious as to why Michael only stopped drinking after he went to AA?

    11. Avatar
      Terrance Bridges July 3, 2016 at 8:00 pm #

      Get off your ass & spread the word,, I go to AA & work the steps,, teaches me how to live life on life’s terms,, I just watched the Claudia video about the Sinclare method,, & will be asking questions & suggesting the Sinclare method to those alcoholics I try to help & r not getting sober through AA,, I must keep an open mind,, but most of all I must help other alcoholics & addicts in order to stay sober myself. !!!!

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        JamesMay August 26, 2016 at 9:26 pm #

        This comment came as a HUGE relief to me at this very moment. I am very involved in AA and due to moving across the country and becoming sober in a new city, all of my friends I’ve made are in the program as well. I have been taking Naltrexone for a couple months now and have been considering the Sinclair Method myself. I have a history of relapse, and as much as I dedicate myself to AA, I still find myself wanting to drink and not being able to avoid it after a few months. My biggest fear is that I can’t have both AA and the steps, which I have found as a huge source of guidance on how to live a better life, but also deal with my addiction in a way that abstinence has yet to provide me with. I realize though, as unfortunate as it may be, I may have to keep my attempt at the Sinclair Method a secret, as even mentioning I take Naltrexon has brought me some grief from some of those in the program.

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          Kenny Glassman September 6, 2016 at 1:10 pm #

          Talk to there in AA about this James. Relapsing after a few months is common. After time the desire to drink does disappear – just talk to members that are long-term sober.
          Other methods can of course work or help for a while – the Sinclair method has no known evidence of long-term success, and that’s what you want.
          Talk to those that have long-term success in AA and do what they suggest, what they did.
          There’s no one using the Sinclair method that can do that because none have long-term success. Long term. none.

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          Norwegianblue October 8, 2016 at 9:54 pm #

          James, I used to be very active in AA as well, and I still have a lot of friends in the program. There are a lot of great people and some fearful close minded ones. Most of them are good people. I think the people giving you grief are just reacting out of fear for something they can’t understand. You know how the literature talks about science not having been able to make a problem drinker into a normal one, but it might one day accomplish this? Maybe it’s already happened. I don’t see any reason why you can’t do both TSM and AA, and if someone tells you that they have a problem with it, you can tell them from me to…call their sponsor! 😉

    12. Avatar
      george July 7, 2016 at 5:56 am #

      Does anyone know if Naltrexone can be used by people who are taking the HIV cocktail? Does it interfere with the effectiveness of the HIV cocktail. Thanks.

    13. Avatar
      Kirk August 17, 2016 at 6:26 pm #

      I found you can the drugs online without a script. (There are support sites that will give you links to reputable providers). Today is day one. I can’t wait until there is an app for tracking drinking to keep me honest.

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        Needs support August 31, 2016 at 12:25 pm #

        There is a site called moderation management that you can track your drinks on. I used it for awhile last year. Because I also have a problem with food I found my fitbit to be more helpful. MM did help me see that there are people with much bigger drinking problems than I have

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          Kenny Glassman September 6, 2016 at 1:12 pm #

          The founder of Moderation Management kept trying to moderate, had some success – as any alcoholic can do for a limited time with ANY method – then got drunk and killed several people in a car crash.

    14. Avatar
      Mike Waddingham August 28, 2016 at 10:49 pm #

      Dear all.

      Some great replies here.
      I’ve been subscribed nal but am scared to take it as i don’t like the idea of something that blocks endorphin release.

      Surely blocking endorphin release would cause low mood ? Also does it not effect lifes other pleaaeures in a negative way? I would love to here from those who have taken it. Mike

      • Avatar
        Norwegianblue October 8, 2016 at 10:15 pm #

        Mike, I do feel it affects mood, but it’s subtle and I wouldn’t say it causes low mood in a very pronounced manner. There might be a blocking of endorphin caused by live’s other pleasures, and to be honest I think it depends on what kind of drinker you are. If you don’t drink every day, there would be no need to take the pill every day. In fact, the TSM protocol is to only take the pills before you’re about to drink, you never take it otherwise. It’s what they call targeted extinction…you’re targeting the drinking behavior, not other behavior. I honestly don’t think you should worry too much about the low mood, unless you’re suffering from a sever mood disorder. Don’t forget that alcohol in unhealthy amounts also causes low moods! There are people who become argumentative and angry when they drink….or the next day. So whereas the Naltrexone might have a slight lowering effect on moods, the reduced intake of alcohol might counter some of this. After 5 months on the pill, I feel like I’m coming out of a fog, and I was definitely in a downswing of a depression cycle, but I was also extremely happy about not having to worry about my drinking getting out of hand. I’m still a daily drinker, but I drink about a third of what I used to, and when I’m done with drink #2 or 3 (sometimes #4), I stop drinking and don’t want anymore. That’s a new and very liberating feeling. I’m sticking with it, and the goal is to complete the TSM method and get to the point when I only drink on rare occasions. So I tried to share my personal experience with you, and it’s up to you if want to give it a try. I will say this…IF you decide to do it, stick to the TSM protocol (never drink without the pill in your system) and don’t give up. Those of us who are on TSM are really some sort of pioneers….there aren’t any support groups as far as I know, an no one pats us on the back and say “good job!” Our significant others might think we’ve just found an excuse to carry on like before. Mine did, but when she realized that I would not drink when we were out if I had forgotten to take the medication with me, she realized I was committed to getting well. I can tell you more once I have completed the treatment, hopefully I’ll “graduate” within 1 year as promised to me by people who’ve done it. I wish you the best of luck, Mike, and check out the C3 Foundation for more information. I’ve found their forums very helpful in answering specific questions.

    15. Avatar
      luis November 5, 2016 at 10:16 am #

      how can you get this treatment where do I go anyone knows about prices? im 26 I have tried everything i will quit for monthns then drink one drink and my whole week is just gone on booze and then i just stop again! sometimes I stop for more times than others! someone could send me an email and explain me a lil bit would be awesome

    16. Avatar
      Brandy November 5, 2016 at 12:34 pm #

      I have been on the sinclair method for more than seven months. I used to drink 14-20 bottles of beer or more friday and saturday every weekend, would start after work on friday and pretty much drink until sunday noon. By taking Naltrexone before drinking I immediately went to 5-7 bottles each time and some months after I was typically only drinking once a week these 5 bottles. The last months the frequency has gone down to every other weekend. My goal has not been to force things or necessarily stop drinking but my experience is that the craving and the binge drinking goes away and then the desire to drink gives in, leaving space for personal growth and maturity.

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