One thing’s for sure: it’ll be popular, because your typical alcoholic would rather not quit if he could think of an alternative.

iStock_000026308593Small“At some of these we balked. We thought we could find an easier softer way. But we could not.”

Alcoholics Anonymous, Chapter 5: “How It Works”.

Familiar words to most in recovery. But that experience hasn’t stopped science from a continuing search for an easier softer way, mostly in pill form. Here’s the latest candidate: nalmefene.

It’s an opioid antagonist (a relative of naltrexone) publicized as helping to reduce craving in persons who are dependent on alcohol. Other drugs, including naltrexone, have been used for the same purpose. But where those drugs are taken daily, nalmefene isn’t. Instead, the alcoholic takes it shortly before he commences drinking.

Why? Because it lowers the risk he’ll ‘overdrink’ (translation: get drunk). That’s what happened in a 1999 study of a hundred outpatients in an alcohol clinic.

Now it’s not entirely reliable — 33% of the folks who got the medication went ahead and ‘overdrank’ anyway — but, still, that’s a lot better than placebo. This is getting some controlled drinking advocates very excited.

I should note that where the emphasis to date has been on developing meds to help alcoholics quit drinking, this one is intended to help them continue to drink. Now that’s what I call a paradigm shift.

One thing’s for sure: it’ll be popular, because your typical alcoholic would rather not quit if he could think of an alternative.

Such drinkers are often described as deficient in ‘readiness’, as in “Bob really should quit, but I guess he’s just not ready yet.” Some would interpret that as evidence that Bob’s a candidate for nalmefene. Now I’ve got nothing against client choice, but if we offer Bob the option of going through treatment and the dramatic changes required for recovery, versus, say, popping this pill before he starts in drinking — which one do you think he goes for?

Of course the study was only a few months long, and the participants got cognitive-behavioral therapy throughout, and were monitored by breath tests and report from others. That suggests that real life results might not be quite as good in the absence of those controls.

I can imagine Bob making some subtle alterations in the treatment plan. “Last three times I drank I did OK,” Bob might think to himself, “but I miss that buzz I used to get right before I started in heavy. So what if I have a couple drinks first, THEN take the pill? Have my cake and eat it too?”

Alcoholics are very creative people, particularly in finding ways to screw up the best laid plans of research scientists.

Nonetheless I bet they sell a ton of this stuff. And AA members will likely say the same thing they’ve always said to newcomers: “Good luck to you. Come see us if it doesn’t work out.”


This is so very interesting – first I NEVER wanted to drink normally, I wanted to be able to get shitfaced without consequences. Second , it doesn’t sound like this pill would allow me to have a few drinks, get a little buzz going AND prevent me from then picking up my other drugs of no choice like crack for example. Guess I’ll just have to wait for the pill that allows me to smoke crack in moderation – lol. Think I’ll stick with AA & recovery – peaceful insides, happy, joyous & free. It trumps every other alternative.

Comment by Sharon Hesseltine — May 17, 2014 @ 10:34 am

Interesting in theory. There are frequently under lying psycological issues that come with alcoholism. Those issues need to be addressed regardless of quitting methodology.

Comment by durgrehaborg — September 12, 2013 @ 11:22 am

If you read in depth about the ” puritan” culture…. from the Mayflower down through a great many years, getting high…maybe not drugs, but certainly alcohol in the form of beer…was highly prevalent both on ships coming from England and in the colonies. Fresh clean water was not easy to come by, so ships were loaded with beer which was brewed in New England routinely. They may not have drunk themselves into oblivion too frequently…but the Puritans we’re less “puritanical” than people we were led to believe. Just sayin’

Comment by Joyce Goodale — September 7, 2013 @ 3:25 am

lol hi Doc. I see you found another place for your ad. My translation:

“This is Your Brain on Drugs. This is Your Brain after Intoxication Coaching. This is Your Brain Still On Drugs”

— brought to you by the Partnership for a Drug-Addled America

Comment by C. Scott McMillin — September 6, 2013 @ 10:13 pm

“but I miss that buzz I


Viewing intoxication as a biological inevitability gives us a better understanding of how drug use differs from drug abuse. Such use is not necessarily immoral or pathological but natural. Much like sex, drug use for humans is a natural drive. Everyone has a need to alter their consciousness and they will do so even at their own peril… from sky diving to smoking “crack” cocaine. The challenge for society is to address this biologically based need to “alter consciousness” in safe, non-abusive ways that will provide people with the “peak experiences” they universally crave. Furthermore, there is a non-abusive code for “getting high” that can be learned so that people who drink or take other drugs do not end-up embarrassed , sick, dependent or dead.

Why is intoxication coaching necessary? Getting ‘high’ in our culture has been taboo since puritan pilgrim times and so very rarely is it a topic in polite conversation. It’s not discussed. It’s no wonder people run around calling themselves Addicts striving for the high they’ve seldom ever attained. But it’s not their fault. It’s cultural. They have not been educated in anything else but prohibition and total abstinence.

Comment by Doc — September 6, 2013 @ 9:53 pm

Thanks for the shout-out re: WFS. I am about to start a new f2f meeting @ UConn.

Comment by Joyce Goodale — September 6, 2013 @ 5:28 pm

Oh, Lisa– I LOVE this. I’d like to have it in giant letters on a billboard opposite all those pharma research companies, stitched on a sampler on the office wall, printed on flyers, added to the posters from World Services: “We don’t need more a**holes on the planet drinking part time. We need more healers.”


What you said. Thank you. And thank you for being a healer. Your journey inspires me.

Comment by Cecile — September 6, 2013 @ 10:32 am

You’ve hit on the core of coaching work, at least in my opinion. Even if these “pills” worked 100% to allow normal drinking, the individual is still functioning with a less-than-functional set of beliefs. The drinking has become the solution, The drinking in and of itself, not the problem. The physical (chemical) dependency upon alcohol becomes the secondary issue. People need to deal with their issues. Some people can iron out life in a 12-step program, SMART, WFS, or no program at all for that matter. The bottom line is that if you want to succeed at anything in life you have to invest in the project. For addicts this is eliminating the substance AND intense work on self. Period. We don’t need more a**holes on the planet drinking part time. We need more healers. Any takers?

We are still looking for the answer to the wrong question. I’m grateful to be doing the work I’m doing. It’s incredibly confrontational, yet the greatest high I have every known. And It’s mine naturally.

I celebrate a spiritual journey. I don’t care what program I use. I live a principled life because living a principled life is AMAZING.

Comment by Lisa Neumann — September 6, 2013 @ 10:23 am

I am not against all meds in helping people with addiction. The agency I work suboxone for our opiod dependent clients. They offers struggle with the psychosocial treatment otherwise. The 12 step groups have been around for a long time. While they have been helpful for many I think its time to realize they may not be the only answer. I am wondering if anyone has done a study comparing 12 step to secular program like smart recovery

Comment by tim — September 3, 2013 @ 8:27 pm

What on earth is the point? If you want to drink, drink. If you want to stop, stop. Why take something that will let you drink but not feel the effects or drink but have as much as you would otherwise? I don’t see the logic or rationale behind the whole idea?

What am I missing?

Comment by Joyce Goofale — September 3, 2013 @ 7:12 pm

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