The Not Drinking Alcohol Today Podcast

The Critical Role Anti-Craving Medications Can Play in Alcohol Recovery: All Your Questions Answered By Dr Chris Davis, Clean Slate Clinic

• Isabella Ferguson and Meg Webb • Season 2 • Episode 101

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Today we talk to Dr. Chris Davis, co-founder and Chief Medical Officer of the Clean Slate Clinic about the critical role anti-craving medications, such as Naltrexone and Campral, can play in alcohol recovery. Dr Davis answers all of your questions about these medications, including how they work to reduce cravings, how long you need to be on them, how often you need to take them, how safe they are to use, how to talk about the to your GP, and which craving medications work better than others depending on your unique circumstances. Dr Davis emphasises the importance of building a robust support system alongside anti-craving medication use, highlighting the essential pillars of social connections, counselling, exercise, nutrition, and sleep to aid longevity in your alcohol reduction. Hear about the role of general practitioners in prescribing these life-changing medications and the necessity of a holistic approach to recovery. Learn how these medications can help kick-start recovery and how they can be used when you need them from time to time. This episode is packed with practical advice and essential information for anyone striving to lead an alcohol-free life or to drink substantially less. Don’t miss out on this compelling conversation with Dr. Chris Davis.

Learn More About the Clean Slate Clinic

Web: https://www.cleanslateclinic.com/
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MEG

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BELLA

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Isabella Ferguson: https://isabellaferguson.com.au
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Speaker 1:

A huge welcome back to Dr Chris Davis, who is co-founder and chief medical officer of the Clean Slate Clinic. Welcome back, Chris.

Speaker 2:

Thanks, bella, lovely to see you again.

Speaker 1:

You too, and huge congratulations on Clean Slate's podcast. I hear that episode one is particularly amazing.

Speaker 2:

Absolutely the start of the show.

Speaker 1:

Yes, and I think I actually heard on one of your most recent podcasts that you had embarked on a bit of an alcohol-free challenge that was limited in time. How did that go, and how's that still going for you? Anything gained and learnt?

Speaker 2:

Absolutely. I mean, I really started helping people change their relationship with alcohol about 12 years ago because I needed to change my relationship with alcohol and I've certainly had some bumps along the way over those 12 years, and very quickly. I mean, what the evidence tells us is if you have 100 days of abstinence, then your chances of changing your relationship with alcohol are much greater than if you say, start drinking again after your dry July and I'd been proselytizing this to all of my clients you know they'd say my goal is to return to social drinking. I'm like great, let's help you do that. The best way would be to have that 100-day break, and I'd embarked on a few attempts at hitting that milestone and never quite made it. Got to six weeks, two months, and I'd frequently have months off, weekends off if I was on call.

Speaker 2:

And so this time I was determined to hit the, the three months without drinking, and managed, which was was great. I mean, um, you feel great and yeah, I mean it, it did. And then, as you, if you listen to the podcast, you know, I spectacularly fell off the wagon with some friends at lunch, thinking I'd be fine. And yeah, it really opened my eyes to how poisonous alcohol is and I was incredulous at the fact that you know certainly when I was a lot younger that you know those Sunday morning hangovers were just normal and the fact that you'd spend all morning in bed and not do anything on a Sunday was okay. You know normal to make yourself that sick that you don't want to leave the house oh my God, you're right.

Speaker 2:

Yeah, yeah. So even though I've been sort of an expert in this area for all of these years, I think you have to learn these lessons yourself. No one can tell you.

Speaker 1:

Now, of course, today we are talking about a topic that crops up, a lot of which I have very limited knowledge about, which is the role that medications can play specifically in relation to reducing cravings. So I've got a few questions. I'd love to ask about that Just before we launch in. Just to remind people, what does Clean Slate Clinic do?

Speaker 2:

Clean Slate Clinic is a social enterprise that is aiming to break down all those barriers to accessing drug and alcohol treatment. The biggest barrier, or one of the biggest barriers certainly is stigma. Is that guilt and shame that we feel, um, that we haven't been able to manage this problem in our lives on our on our own, and society certainly suggests that you should. Um, you need to drink, but not not too much, and if you drink too much, then then you're evil, and and if you don't drink at all, and you're a wowser, and and there are so many societal rules around it that just completely stigmatize any conversation, even with your gp.

Speaker 2:

Sometimes, you, you feel that's a shame, and so to be able to um access treatment from people who are trained and specialize in the area and indeed, throughout the company we have lived experience to be able to access stigma-free treatment from the comfort of your own home is is partly what, partly what we're about. So we're a telehealth service that offers a full assessment, detox and withdrawal and at least 12 months of recovery follow-up with the same nurse and clinical team throughout that journey. So you only have to tell your story once and and we're getting incredible outcomes that I'm just so proud of this. This project really is a complete dream come true for me that we can bring this service into people's homes and meet people where they're at on their journey.

Speaker 1:

Yeah Well, thank you Really grateful for the service that you do. Breaking down barriers, reducing stigma Wow, two of the biggest hurdles out there facing everyday Australians. So incredible, chris. Now let's jump on the topic of cravings. I might just start with the question of how would you define a craving?

Speaker 2:

A craving is an often intense, sometimes uncomfortable urge to drink, and I've certainly experienced cravings when I've been on my breaks from drinking. I remember being in a restaurant and watching people drink around me and I couldn't drink because that was the decision I'd made. Strangely, and I was driving, but everyone around me was drinking and I had this horrible feeling of isn't fair, actually I do want to drink and I can't now because of this, because of the situation I'm in, and that I was distracted and anxious.

Speaker 2:

I couldn't really concentrate or think about anything else and, yeah, that stayed with me for for up until dessert, I think you got the sugar yeah, and then, and then actually, then it passed, um, and, and they, on average, a craving and this is obviously an average lasts about 20-25 minutes, which is quite a long time to feel uncomfortable, and especially when you know, if you have a drink or use a substance, that that that feeling will go away. Yeah, so dealing with those cravings is a massive part of recovery and and they're normal. You know, cravings are normal when we've had a habit for a long time. There are, um, innumerable associations, um, and and if you find yourself at a time when you normally drink with a person you normally drink with, or sitting with an emotion that you use alcohol to to solve, then that can trigger you. It can trigger a craving.

Speaker 2:

Uh, sometimes you don't need an association. A trigger can come from nowhere and um, so, being aware of what your associations are, you've got a little bit of control over managing those and what your triggers are. So you might have a dear friend who you always drink with on a Friday, who you love and you don't want to let them down, and so having that conversation about look, I really like spending time with you, but I'm having a break from drinking right now. Why don't we go for a coffee on a Tuesday instead. It's you taking control and that's really, really powerful.

Speaker 1:

Yeah. So there would be the feeling-based triggers, I imagine, like stress, loneliness, boredom. Could even be locational-based or people-based, and I've heard even people you know say look, when the summer, the seasons turn, it gets warmer and there's that celebratory vibe in the air. So we've all probably have our own very different triggers, but when they hit, so it's that intense, almost repetitive, uncomfortable feeling that we have to learn to sit with, between that urge and then the gratification of it. If you're a person that is really struggling, so you might've been able to do your 30 days, but the cravings tend to always hit and you're just not able to resist them. Hit and you're just not able to resist them. When might you fall within a category of being somebody that should start to make inquiries about medication to see if you can just get some help with cravings to get you over, get you a decent stretch of alcohol-free to help you change those habits?

Speaker 2:

You know, I think if cravings are getting in the way of you meeting your goals, then ask your GP early on. The anti-craving medications are really safe. Ah, so you know, they're not just for the people that I see in my inpatient detox unit in the hospital, they're not just for people who are in a in my inpatient detox unit in the hospital, they're not just for people who are in a three month rehab program or therefore anybody who is struggling with cravings. So if your, if your goal is to do dry July and you're falling over over two weeks, or you just you just want to go weekend without drinking but you just can't get over that hurdle, then then medications can help. And and now look, medications are safe and successful at helping people meet their goals. But when we're talking about recovery, I like to think about that.

Speaker 2:

I talk about the pillars of recovery, of which there are many, and the more as we have holding us up, the better the chance we've got. So we know social connection is huge and having that conversation with your drinking buddy on that Friday is really important. And some one-to-one counseling or therapy can't be underestimated. And the smart recovery groups are fantastic. You're making sure you're getting regular exercise, building your self-confidence with your physical fitness, eating the right foods, getting enough sleep. You know, these pillars are pillars for not just recovery, but for for life. Many of those as strong as we can because say we rely on exercise and we hurt our ankle or we rely on one particular friend, but then they emigrate. So the more pillars we've got, the better, and medication can be a really important pillar.

Speaker 2:

So I think if you're struggling with cravings and you're not meeting your goals because of it, then why not add another pillar to your support network, especially when you know that they are licensed for this purpose, that they are PBS listed so that they're cheap, that any GP can prescribe them. So if your GP says I can't prescribe those, ask him to do, or her to do, a bit of reading. I can't prescribe those. Ask him to do or her to do, a bit of reading. Send them to the website or tell them to call us, because they all can and should, because they help people with this issue.

Speaker 1:

And that actually leads me to a question I really want to ask how receptive and knowledgeable is your average GP out there on the topic of issuing these medications? I mean you'll be surprised.

Speaker 2:

So myself and some colleagues educated two and a half thousand GPs in drug and alcohol treatments. Every GP in Australia will have a large caseload of drinkers and these medications are not new. They've been around for a long, long time. So if your GP isn't aware of them, then you could argue that they should be and most GPs will be, absolutely. And if it's not in their wheelhouse in the same way that some GPs specialize in children or diabetes There'll be someone in the practice or in the area that they might be able to point you towards. And look, we can prescribe them through Clean State Clinic, absolutely. So even if you don't need a medicated detox, we have a recovery arm of the program. So you can just say you're not a heavy daily drinker that needs a diazepam detox, you just need a bit of extra support. Then you can just link into the recovery part of our program, see one of our GPs and receive a prescription that way. So this isn't a specialist area.

Speaker 1:

Yeah, would it be a standalone treatment or is there then a bit of an inquiry to look at those other pillars of your life and counselling that might be involved? Or is Sky the Limit? It's flexible, determining on how you present.

Speaker 2:

It's flexible, determining on how you present. So medications are good, but, as I say, you can't rely on a medication on its own for a problem which has so many factors influencing it. So this isn't an infection that will be cured by an antibiotic. There are social, societal, cultural, behavioral, emotional, definitely physical and definitely mental factors at play here. So we can't just rely on a pill to take away or help us with all of those factors.

Speaker 2:

So and this is where gps are fantastic, because you might go and say, look, I think I'm drinking too much and and, and you know, and alcohol use disorder is, is a disease by classification in the icd 10, but the icd, but I I sort of see it more of a symptom, symptom of there's something else in our life that might not be going well. It might be an untreated mental health issue or an abusive relationship or something else that we're trying to trying to escape from. And so a GP can help you unpick what else might help in your, in your choice not to drink or to drink less. Yeah, don't be afraid to ask about the medications. If your GP is not familiar with them, then he or she should be able to point you towards someone who is. There's information on our website which you can trust and rely on. You can come to us. There are obviously specialist services in public and private hospitals as well, which is our bread and butter.

Speaker 1:

Yeah, thank you, and I think when you mentioned that it's not an antibiotic that suddenly fixes this whole alcohol thing, the fact is you're still going to be, I guess, eventually when you stop and I want to ask you a bit about that, like how long you should be on it. But you're going to venture back into the world, you're still going to have your triggers, you still might have your loneliness, your boredom, your friends still going to be there in those social settings. So I imagine that it's the work that you're doing over the timeframe that you're on it to help strengthen the ability to withstand the urge, so you're getting in better, healthier habits to deal with all of those things over time. Because, yeah, it's not going to help you with social anxiety necessarily without help on those other skills.

Speaker 2:

That's right. But it can help you beat a craving which gives you another day under your belt, yes, and then you're getting closer. So gives you another day under your belt and then you're getting closer, so it's another day without drinking and that means your sleep is getting that bit better and you're gaining more confidence. The cravings, you know. I guess the bad news is that they can make you feel uncomfortable. They're really unpleasant, but they diminish and certainly you know that's why I was so disappointed.

Speaker 2:

I fell off the wagon after three months, because at that point I could easily take it or leave it. I wasn't thinking about it. It wasn't, you know, unless I was in one of those situations that I found myself in and they all knew it was the end of my three months, which was, you know, anyway, this is not about me, but honestly it's a lot, lot easier and that 100 day mark is a real golden milestone. And, and once you get you know, the further you get into recovery, the easier it gets. And because that that 100 day, three month, 100 day milestone is so important, that's how long I would set your sights on taking the medication for and and and that's what the guidelines would suggest.

Speaker 2:

Now that doesn't mean you have to stop the medication at three months. As I say, these are really safe, effective medications. So if you're at three months and still having some doing some brain miles, or you're worried or your motivation isn't there or you're still having those triggers, carry, carry on that medication. I've had people on these medications for two years. It's probably the longest I've had someone on it and I'll be trying to persuade them that they probably don't need this medication anymore. But they were happy on it. It was helping them, giving them a bit of confidence.

Speaker 1:

And how do they work neurochemically to stop physical craving? It's fascinating to me.

Speaker 2:

So to understand how the they work, like neurochemically, to stop physical craving, it's fascinating to me. So to understand how the medications work, we need to have a little bit of understanding of how alcohol works. Yes, and on the brain, and different drugs affect the brain in different ways. When we're thinking about medications, in some ways it's easier to treat people who are dependent upon heroin or painkillers, because heroin and opioid painkillers just work on that one opioid pathway. We use medications that act on that pathway and they're very effective. The stimulants, for example, they work on the dopamine, the serotonergic pathways in the brain.

Speaker 2:

One of my heroes, professor David Nutt, in his book he describes alcohol as the most promiscuous drug out there, and that's because alcohol is complicated in that it affects so many different pathways in the brain. Really, but probably the well, there's the two important pathways that these medications work on is the reward pathway and an anxiety pathway, and so one of the and they're the sort of two hooks that alcohol, two main hooks that alcohol has some people drink for the reward it gives them. It's like the friday, I've done a hard day's work and this is my reward. Uh, they use it to socialize, to give them confidence and for that euphoria and that that pathway is the opioid pathway. Actually, we do get some other reward chemicals, but the main reward pathway that alcohol uses is that opioid pathway Amazing. And then we have people who drink to reduce stress and to escape, escape their um and to lower their anxiety but yeah so, when we're anxious, the body puts us into that fight or flight mode.

Speaker 2:

So, say, we're in an abusive relationship that we can't escape. Our body is in fight or flight. And to get us ready to run from a dangerous situation, we have high levels of stress hormones that are adrenaline, cortisol, glutamate. So we're, you know, our heart is racing, the body moves blood to our muscles, away from our guts, or, you know, we get that feeling in our guts that's uncomfortable. And then, when we drink alcohol, it releases what we call an inhibitory neurotransmitter called GABA. And so when we, when we release GABA, it inhibits all of those stress hormones, it relaxes us, oh you know, and we feel so much better.

Speaker 2:

However, the perpetrator is still in the next room and our brain is like well, hold on, we need to still be ready to run. And there's this poison that is lowering my defenses. So in the background, you're producing more of these stress hormones to keep you awake and keep you ready in that fight or flight mode. Uh, when the alcohol wears off, at three or four in the morning, you've got a big load of stress hormones that, uh, wake you up, give you that fit, fitful sleep, and that's important in the withdrawal phase as well. So that's why we need other medications to keep us safe, because when we stop drinking, if we're heavy daily drinkers, yeah, that rush of stress hormones that's unabated um can cause the seizures and the delirium tremens. And you know, for most of us, the shakes, the anxiety, the nausea, that the real bad hangover yeah yeah, um, so there's two main drugs that we use.

Speaker 2:

Naltrexone is probably the the most common first line medication. Uh, it's and and that's the one that works on the reward pathway. So naltrexone uh blocks that, that single reward pathway. So people are worried. When I talk about naltrexone it's like so does that mean I won't get pleasure from?

Speaker 1:

yes, I'll never, never feel happiness and relief, all those juicy feel good vibes.

Speaker 2:

Yes, and and it just hasn't been borne out in our experience or in the evidence. So, people who? So you take naltrexone and it blocks that pathway, but it's very specific for the effects of opioid medications and alcohol, um, I've, so I've had a couple of patients and, bear in mind, I've prescribed this medication over a thousand times probably.

Speaker 2:

Well, yeah, definitely over a thousand times in my career, and I've had two people say that they didn't get quite the same buzz out of exercise so exercise does use that reward pathway a little bit, not completely, um, but interestingly uh, both of them decided to stay on the medication because it because so effective, and I think it was sort of a sign of how effective it was they really weren't craving for alcohol either, so they were willing to sort of trade a bit of lower buzz for the exercise, for the effect of naltrexone.

Speaker 1:

Yeah, and I wonder, chris also, if you've been a heavy drinker for quite a period of time, your neurotransmitters may have been so affected anyway, so youters may have been so affected anyway, so you may not have been producing a natural, healthy baseline of those feel-good transmitters anyway. So if you're taking the naltrexone but you're stopping alcohol, you're getting fitter, you're healthier, you're starting to operate like a well-oiled machine, maybe you're going to start to feel better anyway, You're actually right, I'm not a neuroscientist. Yes, of course, of course. Neither am I.

Speaker 2:

No, but you've reminded me I did miss out. An important part of that neuroscience story is that when you drink and you get these big hits of reward over, your body down regulates those reward receptors so and that's how you build tolerance in the same way, with that anxiety pathway to keep, if your your body wants you to be in fight or flight because of the perceived threat that's out there, um it then down regulates your GABA receptors so that the alcohol doesn't have as much of an effect so again, when, when you remove alcohol, if you know, if we're thinking about the reward pathway, there's this period of boredom.

Speaker 2:

You know, and it's one of the most rewarding things that I see when I'm helping my patients is that they come and see me and that in the first week after detox and things are starting to get better.

Speaker 2:

You know their relationships have already started to get better because people are proud of what they're doing, their sleep's better, but you know they're not getting those hits of, they're not getting that reward and and and over time, over the weeks and months, as as they go further into their recovery and those receptors are up regulating again, that, their time with the family that walks on the beach, you know, people come in with a massive smile on their face, show me photos of, you know, the pebble they found on the beach in the dark and all these things that just weren't interesting them before. Yeah, and it's the same with that anxiety pathway. You know, once those GABA receptors are upregulated and you've got your own natural GABA and you've got those falsely risen levels of stress hormones that are responding to the, the alcohol, it's an amazing, amazing journey to go on with people yeah, yeah.

Speaker 2:

Yeah, so sorry. Back to the medication. So just talking about naltrexone then. So that blocks that reward pathway. Now what that also does is it reduces cravings, and that's the main effect. So that pathway is firing.

Speaker 2:

It's like I'm not getting enough dopamine from playing Angry Birds on my phone. Where's my drink? My drink gives me the reward I want. So taking naltrexone just quietens that down. It just turns that off.

Speaker 2:

So people who take naltrexone say they think about alcohol a lot less often. The average craving time is really reduced. So when that thought about drinking comes in um, or you know my jealousy of that sauvignonanc on the other table it's like, oh, I fancy one of those. Oh well, I'm not drinking at the minute. And you carry on and you're getting pleasure from other things as well. And the nice secondary effect of naltrexone is that if you do have a drink while you're on naltrexone, you don't get that reward. Reward you don't get that buzz or that that warmth feeling. So you're much less likely to go on and have a second or third drink. So even if you do slip, you're less likely to then go to a lapse or a full relapse and hopefully we've given you those support networks that if you do have a slip, then you can chat about it in your smart recovery meeting or talk to your counselor or your clean state nurse or whoever it might be. Yeah, you stay on track.

Speaker 2:

Um, it's important to know naltrexone that it does block that opioid pathway, so opioid painkillers don't work in the same way. Um, yes, most people don't get any side effects from naltrexone in my experience, but one in 15 people get a mild nausea. So we we start with half a tablet to start with. If you do get side effects, they generally settled within that week and then you can go to a full pill and I recommend taking it in the morning. So we all wake up saying we're not going to drink today and our resolve is strong. Then we have a terrible day and then it's five o'clock and your partner's drinking and it's it's hard and the craving hits you. But if you've already taken your naltrexone in the morning, then it's like oh, okay, well, I've taken my pill. I know the craving is not going to last so long and even if I do have a drink, it's not going to give me the feeling I want.

Speaker 1:

I'm going to go for a walk instead yeah, yeah, um with with all of this, I imagine abstinence is the goal, isn't it?

Speaker 2:

oh, I mean, you know, I not necessarily your. Your goals are your own um you know, in an ideal world, if alcohol was invented today, it would be banned and no one would drink. And the countries that don't drink, uh, they're a lot healthier than the ones that do in general. So if we're thinking about our health, it's abstinence would probably be a goal for all of us. Um, but, uh, yes, so certainly I would aim. No matter what your goal is, I would aim for that three months of abstinence yeah, break down those triggers break down, break down those uh associations and help you regain control of the habit Absolutely.

Speaker 2:

But even if you then want to control your drinking after that break, you can carry on with these medications, particularly naltrexone, because again it will break that sort of association between alcohol and a reward. You've probably heard of the Sinclair method.

Speaker 1:

Can you remind me a little bit about that? I have heard a podcast, but I got quite confused.

Speaker 2:

There was a very persuasive TED Talk about the Sinclair method, called the Magic Pill or something like that.

Speaker 1:

Yeah.

Speaker 2:

Where the Sinclair method really worked for this lady that's right, it was an American lady yeah, and and around.

Speaker 2:

Well, you know, even now I get people who've seen that TED talk who want a bit of it because it sounds great, that sounds like the magic pill. I keep drinking, I don't do anything, I just keep drinking, don't get any of my other pillars of recovery in place. I take this pill, it will make me, it will take the pleasure out of alcohol. I'll slowly reduce and then I'll stop and I'll never want to drink again. And that's really attractive, right? And if it worked, oh my God, you know, my life would be so much easier in a way, and I wish it would work.

Speaker 2:

The evidence for the Sincan method is very messy and and and I've heard of some success stories, anecdotally, the main one being that lady in the ted talk to be um, so I don't recommend it. Um, first line, if someone is really adamant that they want to try it, that's okay. And and generally, what it looks like is that you take naltrexone about half an hour before you have your first drink and it's supposed to take the pleasure out of the drink and then you slowly reduce. But I think, unless you've done all of the other work around it, um, again, the magic pill, unfortunately. As much as I wish it did, doesn't exist. Um, so, look, it is an option I have. I have tried it with very limited success with a number of patients. Um, so I don't want to dash anyone's hopes, but yeah, I I wouldn't. I wouldn't recommend it, but certainly first line, unless you've tried lots of other things and and then probably in conversation with with someone like me or someone who who specializes in in addiction yeah, thank you for bringing that up.

Speaker 1:

Uh, chris, I forgot that that was out there as another theory of using medication in a way to drink less. For me, it kind of takes away from focusing on the sectors of your life which had otherwise supported or enabled a lifestyle that led to you drinking too much, so that you can make some tweaks to sort of, yeah, create a lifestyle that supports you more, reaching your drinking goals or alcohol-free goals, if that's what it is for you. So, yeah, it's hard for me to see the longevity in that. I'm sure there's a whole lot of research around it. But, chris, another question that I had just related to naltrexone, I think, is the idea that sometimes you can take it just for specific moments. Is that something that's supported or not? Or have I picked that up somewhere that's not backed by research? You know, just on a weekend, just when you're going out on a holiday, I don't know.

Speaker 2:

Yeah, I mean, initially it was licensed for the goal of maintaining abstinence, yeah, and you take it daily with counseling.

Speaker 2:

That was sort of the you know the prescribing parameter, um, but certainly, and I would recommend that you take it daily, particularly if you're a daily drinker for those three months, um.

Speaker 2:

However, if your pattern of drinking is is binge drinking, certainly my, my pattern is is that and was that um, or you've gone through the three months you don't really want to take a pill every day, but you know you've got a wedding coming up this weekend or johnny's coming around on saturday and and you you don't want to drink um, or you don't want your drinking to go too far. Then, yes, I do recommend that you have that in your toolbox so, alongside your support person who knows you don't want to drink that day, your your exit strategy, um, your alcohol-free beers or whatever else you're going to use to help you in that moment. Then you can take a naltrexone. So you do get decent levels of naltrexone in your system After about half an hour. You get full sort of bioavailability after a couple of days, but it will have an effect and so, yeah, you can use it as a tool in your box, like that Okay, yeah, look, thank you.

Speaker 1:

This whole discussion has been really valuable, I think, for many people on so many different levels. Particularly, I'm picturing the person that has a great deal of anxiety and shame around drinking, that feels like they're on their own, that it's a battle that they're just kind of up against and can't seem to succeed at. It's just another element of support there just to help them through the difficult phases, which is fantastic. Is there anybody that it so?

Speaker 2:

um, again, the, the stressed out drinker. Um, the naltrexone, might you know it might not be targeting the right pathway in the brain, gotcha, and and, and there is a range. And, like the, the, the guy who wasn't, you know, enjoying exercise, he also wasn't thinking about alcohol. It was like a miracle drug for him. He had no cravings at all. It switched them off, which is why he was happy to take that side effect. Um, all the way to some people who say, yeah, you know what, I think it is helping. Um, I think it's helping, I don't, you know, I'm not sure. It's hard to say, isn't it?

Speaker 2:

Because you can't do a randomized control trial yeah yeah, um, so so if it, if it's not, if you're still getting breakthrough cravings or I think we've, we've got you're a different type of drinker, then we can choose campra or a camprosate, right, so that works on that gaba pathway so that helps. So, as I was saying, when you're're, uh, you're drinking um regularly for for a long time to get that GABA to reduce your stress hormones, and in the background your brain is like, reduce is down, downgrading or reducing the number of GABA receptors in your brain, and then you're building up the tolerance of the alcohol is not having enough effect and then when you stop drinking you know you don't have enough GABA receptors, uh, to deal with the stress hormones and that causes the craving. You know it's like I'm too stressed. I know alcohol is going to help me. Right now my GABA receptors aren't working very well, help. So camprel helps up, regulate those GABA receptors again, helps rebalance that anxiety pathway. So we know your stress hormones are going to reduce because we've removed alcohol. That's the most important thing. And now Camprel helps reduce that anxiety that comes with the craving by working on that pathway. So that's a really attractive um idea for for a lot of people. And um, and certainly campbell is another really good tool in our toolbox.

Speaker 2:

Um, it again is very safe, so it doesn't interact with your other medications, unlike that naltrexone hat can have that interaction if you need those strong painkillers. Yes, no interactions. Um, both has no interactions. Both naltrexone and Campylyl are safe on the liver, so even if you drank yourself to a point where your liver is struggling, we can still use these medications. And Campylyl has very few side effects, even less than the few side effects naltrexone has. So occasionally someone will get a bit of diarrhea for the first couple of days they take naltrexone has. So occasionally someone will get a bit of diarrhea for the first couple of days they take naltrexone.

Speaker 2:

Other than that, it's very well tolerated, so Camprol is an excellent option. Also, it is a three times a day medication, which can be seen as a downside, and what the studies show is that people will forget their lunchtime dose or their nighttime dose, and then that renders it less effective. So that's one you have to be good at taking it. However, I think taking a pill three times a day just to help reinforce your decision not to drink that day can be quite powerful too. Taking this pill to help me reach my goals and just setting an alarm on your mobile can sort of get through that, um, and it does take sort of one to two weeks to have its full effect. So it's not a pill you can take just on the weekends, because it just won't work.

Speaker 2:

Now check soon you can, but not, not with camprel. And so what happens is, what happens is you're doing pretty well, you're on that pink cloud. You're taking this pill three times a day, you're forgetting to take it. You've not managed to take it regularly for a week or two, it's not giving you the full effect and people stop taking it. So give it a try and give it a good try. So take it regularly for a month, you know, and then judge it. Yeah, the other nice thing about these two medications is, if you're not getting, if you're not getting there with one, you can take them both together.

Speaker 2:

And because they work on different pathways in the brain. They have an additive effect. So we know that if and generally and I'm talking very generally let's say we start someone on naltrexone, I'll review them regularly, make sure they get in the counseling and I've got all those pillars yeah, it's got the pillars working in the background yeah and um, and then in two weeks time they're like yeah, it's okay, you know, I think I'm I think I'm doing all right, but I'm still getting those cravings, I'm still anxious.

Speaker 2:

And social situation then I might add in the camper at that point as a as a boost, and that works really well together as well yeah, thank you so much for your time.

Speaker 1:

This has been absolutely fascinating and it kind of marries in well with a limited background knowledge that I have about our neurotransmitters that I learned with study with Jolene Park, oh yeah who talks a lot about particularly GABA as being, you know, the brakes on our system, and I think studies have shown that those who drink a lot tend to be very deficient in it before. Absolutely yes. So she talks a lot about natural ways of boosting your GABA reserves, but I imagine that none are going to be able to hit the marks that you need to do to really sustain longevity if you're getting those intense cravings that you can otherwise get from Canberra.

Speaker 2:

I mean, I love Jolene's Grey Area Drinker.

Speaker 1:

Oh, I love it.

Speaker 2:

And, yeah, what she talks about really are those pillars and they're so important and that's why I emphasised right at the beginning that that's the important bit. But if we can use these medications that we know work and are safe, then absolutely we should be, because anything that helps is worthwhile.

Speaker 1:

That's right, Because anything that helps is worthwhile. That's right. And in the background you can do all that nourishing the nervous system and building your reserves naturally over time. Thank you, Dr Chris, for jumping on the podcast talking to us about the medication support that you can get if you're otherwise struggling to reach your goal, to get to your 100 days or otherwise. It's just reassuring to know that there's another layer of help out there. Thank you so much.

Speaker 2:

It's my pleasure. I'll give Meg my best.

Speaker 1:

Oh, I will, I will, I will indeed See you, chris.

Speaker 2:

Cheers Bella.

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