How can a coach help someone change their drinking with the Sinclair Method?
In October 2021, I spoke with Samara Ibanez, who had been certified as a coach for the Sinclair Method (TSM) through the C3 Foundation the day before we recorded. She used the method herself after many years of binge drinking, and she now helps others cut back or stop.
This is an archive episode, recorded when the show covered addiction and recovery broadly. At 0:59, I gave listeners some background. The actor Claudia Christian found the method after years of struggling with alcohol, and she later started the C3 Foundation to support it.
What does extinction mean, and does the medication stay for life?
At 3:20, I asked whether a person could ever go back to drinking without naltrexone. Samara was firm. She will never drink without her medication again, and she describes herself as in remission rather than cured.
In her words, the brain’s drinking pathways start out as superhighways and slowly turn back into small country roads. The point where a person wakes up and no longer craves alcohol is called extinction. Some people go on to drink moderately with the medication, and others drift toward not drinking at all.
At 11:04, I offered my own picture of it. I sometimes call the drinking habit a malignant habit. Taking naltrexone before a drink is like laser tattoo removal, where each session fades the image a little more.
Why did her first attempt fail?
Samara was candid about it. Her first try was what she calls dabbling, without full commitment, and it ended in a return to uncontrolled drinking. At 16:18, she said she quit too soon, before her brain had fully recovered, and she believes many people make the same mistake.
The second time, she practiced what she calls purposeful TSM. From 14:05, she described logging every craving on a scale from one to 10 and asking herself whether a drink came from a craving, a trigger, or plain habit. She reached extinction in about five months.
At 15:46, I compared this to working out. The people who do best in the gym tend to keep a log, and I think tracking works the same way here.
What if someone feels better after only a few drinks on naltrexone?
At 13:20, I raised a common situation. A person tries the method two or three times, no longer wants to drink, and asks whether they can stop. Samara said some people are fast responders, but she needed several months.
At 17:41, I said I have instructed patients to treat each session like a clinical procedure, with the pill taken at a set time and the drink ready an hour later. I also suggested choosing a drink the person does not usually enjoy. Samara added that straight shots of liquor can overwhelm the medication, so she stuck mostly to wine and beer.
Why do alcohol-free days matter?
From 20:16, Samara explained her rhythm. She drank when she craved, always after a full meal and an hour after the medication. On days without cravings, she took no medication and took up spin classes instead.
At 21:37, I summed up the logic. On those days the opioid receptors are left open, and the brain learns to respond to healthy pleasures. Samara suggested exercise, art, or a walk in nature. In fact, she said the spin classes became a lasting part of her life.
At 25:03, I noted that this is one reason the monthly naltrexone injection, Vivitrol, may not suit most people following the method. Still, at 26:00 I mentioned that Dr. Adam Bisaga, an earlier guest, believes the brain’s reward system is strong enough for people to enjoy life on long-term blockade.
Is the approach different for daily drinkers and binge drinkers?
At 29:27, Samara said yes. For a daily drinker, she sees the work as breaking an ingrained habit, reaching a first alcohol-free day, and planning a new activity or community to fill that time.
Her own pattern was binge drinking. At 34:07, she described waiting after a binge until a craving returned, then planning what she calls an extinction session. She did not set a limit, yet she found she wanted far less. Once, she said, she poured a glass of wine back into the bottle after a few sips.
What about side effects?
At 37:12, I raised a worry many prescribing doctors share. A patient takes the first dose, feels nauseous or tired, and gives up. Interestingly, Samara was one of the people who had strong side effects, and she learned to manage them by trial and error.
Her main rule is to take the medication after a real meal, never on an empty stomach. At 40:24, she said that when she restarts after a break, she begins with half a tablet so her body can adjust again. Of course, at 44:36 I pointed out that most people who take naltrexone have no real trouble with it.
What if the method does not seem to work?
At 46:51, Samara said she has heard that a small group of people may not respond to naltrexone at all. At 48:20, I said I had not yet met a patient who had no response. Problems I had seen came from side effects or from starting the medication in the middle of a heavy drinking day.
In her experience, the main reason people do not succeed is that they stop too early. So, she asked people to be patient. Years of drinking sessions built the habit, and it takes many extinction sessions to undo it.
Why does a coach make a difference?
At 53:51, I said that many doctors are willing to prescribe naltrexone but do not know what to do beyond writing the prescription. The method sounds straightforward. However, there are many nuances, and people do better with someone who has walked through them.
Samara agreed at 55:02. She learned everything by trial and error, and she believes a guide would have shortened her path. Unfortunately, she spent years going in and out of abstinence before she found the method.
Who is Samara Ibanez?
Samara Ibanez is a Sinclair Method coach certified through the C3 Foundation. She drank for many years before using the method herself, and she now helps people with cravings, habits, alcohol-free days, and side effects.
What can listeners take away from this conversation?
The Sinclair Method can be explained in one sentence, but living it takes planning, patience, and honest record keeping. Samara’s story shows that a failed first attempt does not mean the method has failed. Often the person simply needs more time, steadier habits, and someone to help them through the details.
How do I approach this today?
My thinking has kept developing since this conversation was recorded. Today my practice is built on one idea that runs through all of it: when the body has adapted to a substance, the safest way off is usually gradual, with the smallest steps the person’s nervous system can tolerate. Physical dependence is not addiction.
For alcohol dependence I use the Sinclair Method. The person takes naltrexone about an hour before drinking, and over time the drinking itself becomes less rewarding, so the urge fades gradually instead of being fought every day. It does not require stopping on day one, and it does not rely on willpower or meetings.
Like a slow taper, it lets the brain change at its own pace. For many people that makes it a more humane path than a sudden stop, which can also be medically dangerous for someone whose body depends on alcohol.
Call 911 or go to an emergency department if there is a seizure, confusion or hallucinations, or thoughts of self-harm. For thoughts of suicide or any mental health crisis, you can also call or text the 988 Suicide and Crisis Lifeline.
This page is educational. It is not medical advice, and listening to the episode or reading this page does not create a doctor-patient relationship. Decisions about starting, continuing, or tapering any medication should be made with your own physician.
Full transcript
A note from Dr. Leeds: my guests speak from their own experience and expertise, and the terminology they use is their own. Whatever the topic, this show holds to one distinction: physical dependence on a prescribed medication is not addiction. This transcript is educational content, not medical advice, and nothing here creates a doctor-patient relationship.
Read the full transcript (60 minutes)
Dr. Mark Leeds [00:00] Samara Ibanez, welcome to the podcast.
Samara Ibanez [00:02] Thank you so much for having me. I’m really, really excited about this today.
Dr. Mark Leeds [00:08] So you’re a coach, a coach that helps people to quit drinking or cut back on their drinking, and actually you’re a certified C3 Foundation TSM coach, a coach for the Sinclair Method.
Samara Ibanez [00:24] Absolutely. As of yesterday, as of yesterday, I’ve been certified. I had a long call with Claudia herself. And, it was just wonderful. The talk that we were able to have, she is, she is very, very adamant about this method and she wants to coach people to become coaches actually to coach others. And that’s how she gets the word out. One of the ways that she gets the word out about this method. So, yeah, I’m really excited to be part of her team as of yesterday.
Dr. Mark Leeds [00:59] Oh, that’s great. And just to catch up the listeners who may not know much about the topic, Claudia Christian is a famous actor. She’s been in tons of movies. I’m sure people have seen her and some of the things she’s been in a lot of major movies. She was a star of a TV show for like four seasons in the nineties and being a sci-fi show, she has a huge following of people that go to sci-fi conventions and follow those kinds of things. Babylon five. And she discovered the Sinclair Method, I think after, you know, later in life, I think in her 40s, she developed an alcohol problem and went to rehab and nothing was working and came across this little known program where rather than trying not to drink at all, like, and going to AA and doing the 12 steps or taking medication and not drinking at all, the program is essentially naltrexone, a medication naltrexone plus alcohol leads to a person basically losing the habit to drink. And then she found it worked so well, like better than anything. And then eventually started a foundation in support of it, the C3 foundation.
Samara Ibanez [02:08] Yes, absolutely. Yeah. She’s been doing it for around 11, 12 years, she’s been just trying to spread the word about this method. And what I want to just go over is the way I described this method is that the Sinclair method, it’s a medically managed way to unlearn alcohol use disorder or alcohol addiction. And it’s actually been around for 30 years, but, and it’s scientifically proven to have a 78% success rate. Long-term, but it’s still virtually unknown. And there’s a lot of reasons for that. But, one of my missions as someone, as a survivor of alcohol addiction for 27 years, and then now being a coach and helping people get off of alcohol is, that But basically, you can become a moderate drinker. You know, like, have you heard that with this method? That you can actually become a moderate drinker, a safe and go back to safe drinking levels.
Dr. Mark Leeds [03:20] That idea about someone can return to safe drinking levels. That’s, I don’t know that, would you say that someone can ever like go back to drinking without taking naltrexone? Or is it that for life? Because the way I understand it is that for life, a person who does the Sinclair method and takes naltrexone to cut back on drinking or stop drinking should always take naltrexone anytime in the future when they drink again.
Samara Ibanez [03:44] Oh, yes, absolutely. I will never drink without my medication ever again in my life because it essentially I’m not, I’m not totally cured. I call it. I’m in remission. I’m in remission because if I do, if I were to start drinking again without the medication, I could basically relearn my brain could relearn all of the wiring that it did for the 27 years that I was drinking. And then I’ll go right back to where I was before. And that actually happened to me already in my journey. So I have experience with failure with TSM, which I’d like to talk about a little bit later. But essentially, when I first started trying TSM, I was dabbling, I call it dabbling. And I didn’t, I wasn’t totally committed. And I wasn’t totally sure about the method. And so I was just messing around. And I ended up failing at it the first time and going back to uncontrollable drinking and using. And so that was a big, huge wake up call so that the second time around when I actually really did purposeful, what I call purposeful TSM is that I was, I was able to do the program all the way till the, till the end. So there’s this thing called extinction that we talk about as TSMers. And basically it’s that you do the protocol, you take the medication and you drink, you take the medication an hour before you drink. And then you do that for months for several months, however long it takes for your brain to rewire and unlearn those, those neural pathways. Actually, what I describe as they become country roads. Again, they were super highways, you know, with endorphins going through them every time that you drank. And then now they’ve reverted back to small country roads. And basically that’s unlearning the behavior. And so you hit a point called extinction where you wake up one day and you just don’t crave alcohol anymore. You don’t think about it like you used to. You don’t upset you’re not obsessing about it you’re not I used to plan my life around every time wherever alcohol was going to be I had to plan my life around that and you just stop doing that you stop looking at all the liquor stores when you’re driving home like it’s just a very huge switch. It’s almost like a turn, like your, your brain turned off that switch for alcohol. And that’s called extinction. And so it’s a really important term because that’s what you want to hit. You want to hit extinction. And then what some people do is some people are able to drink the rest of their lives after that, but they end up drinking moderately at safe levels. And they use the medication, of course, the medications always used. And then about 25% of TSMers they’ve discovered, they end up gradually just becoming abstinent. And that it’s just such a natural process that it’s not so harsh, you know, like abstinence based, traditional abstinence based recovery is very harsh, because you just have to quit like cold turkey, and then you have to stay sober. And then you have to white knuckle it, because you’re, you’re cravings, you’re still having cravings for alcohol, but, you know, you can’t partake. And then that’s what leads to relapse. They’ve, they’ve just, they’ve discovered that the main reason for relapse is cravings.
Dr. Mark Leeds [08:00] Yeah. Yeah. They call it the alcohol deprivation syndrome. I think we’re it can, and it might not even hit right away. I guess the person can come out of rehab and feel like they’re doing really well, that they’ve, they’ve sobered up. They’ve gotten through the withdrawal syndrome. And then weeks or months later, it just suddenly hits them that they just suddenly start having extreme cravings and just constantly obsessing over alcohol all the time.
Samara Ibanez [08:24] Yep. Yep. That’s what happened to me. So I became a binge drinker because I was, I was in AA, I was trying to work the 12 steps. I did that for 15 years. I was trying to get rid of this problem, you know, in my life. And I would go abstinent for three months, four months, even longer than that, up to a year. And then something would happen and my craving would just overpower myself and I would just cave to the craving. And then I would, I would, I would always say, Oh, I’ll just have one glass of wine. But with heavy drinkers, it’s really hard after that first sip, it’s like all bets are off, you know?
Dr. Mark Leeds [09:10] No, when you, when you take naltrexone and then an hour later you have, say you have a glass of wine, for a person that didn’t take naltrexone and a person caught up in active addiction to alcohol, they would have a compulsion to keep drinking and you have one drink. And then before you even think about it’s not even really at that point in obsession before, you know, there’s another glass in your hand, you’re pouring another glass, then the bottle’s gone. Then you go into your second bottle. Do you find that when you take naltrexone or even when you first took naltrexone, did you feel that compulsion to have the second drink, was lessened or not there at all?
Samara Ibanez [09:46] Right. So that’s what, that’s what it does. So what the naltrexone does is it sits, the medication sits on your, opioid receptors. So when you have that first sip of alcohol, you normally, without the medication, you have a flood of endorphins that is produced from that activity that you’ve trained. Essentially, you’ve trained your brain over the course of many drinking sessions to flood your brain with endorphins from this one thing. And so now you’re not getting those endorphins. So the reinforcement is taken away. And the more you drink with the medication in your bloodstream and sitting on the receptors, the more you, it’s a gradual process, but your brain starts to realize that this activity is not that enjoyable. And, it’s quite, it’s quite amazing. I’m, I’ve actually become, this is my mission is to spread the word about this method because it saved me, it saved my life. And it gave me something to live for now, which is to spread this word about this message.
Dr. Mark Leeds [11:04] Yeah. Yeah. The way I think of extinction, you were talking about it, about, you know, that a person develops these super highways of addiction of that habit or thought of drinking. I sometimes call it a malignant habit. It’s almost like, almost like a cancer, but like not a physical cancer, but of the brain wiring or something. It’s like a this malignant habit but then you know as you go towards extinction little by little you take naltrexone you have alcohol and you know as you I sometimes think of it like an eraser like as if your brain is a piece of paper and you’ve drawn something on it and you’re every time you erase it you can see it a little bit less and or maybe maybe you can even compare it to like tattoo removal people have gone through laser tattoo removal yeah you can’t just go one time, you know, fades a little bit the first time, then next time and progressively keeps fading, and may take a really long time to get to the point where you don’t see it anymore. And it’s still there a little bit.
Samara Ibanez [12:03] Yeah, no, that’s, that’s a great analogy. I love using analogies, because it’s so hard to understand really what’s going on in the brain. And that’s, that’s great. It actually, once you hit extinction, so it can take anywhere between three months and a year or sometimes longer for people to get this, to get this healing in the brain. And for me, it took five months. I mean, literally on the fifth month, I woke up one day and it was just like magic. I just did not crave it anymore. Now I continued to drink compliantly. Compliantly means taking the medication one hour before you drink. And I continued to do that after hitting extinction and what I found I discovered something really interesting it made me it just kind of cemented everything so that I’m abstinent now by choice I just have no desire for alcohol it doesn’t do anything for me I don’t need it I don’t want it I don’t ever think about it so why drink it’s like a neither here nor there for me so yeah so I continued to drink compliantly and now I don’t even need to take the medication because I don’t drink
Dr. Mark Leeds [13:20] Oh that’s great I wanted to present you like some hypothetical cases of how things might go for a patient just in the beginning like just for example like say say a person goes and tries it you know they say I’m going to sit down and have my pill and have a drink. I don’t really believe this is going to work. And they do it like, wow, that really worked. I really didn’t enjoy that drink that much. And I didn’t have another drink. And then the doctor or the coach checks back with them a week later and like, how’s it going? Did you try again? And like, well, I really don’t feel like drinking. I did it once or two or three times and I don’t want to drink anymore. You know, can I just stop? I mean, do I have to keep going? As a C3 foundation coach, what would you recommend for that patient at that point?
Samara Ibanez [14:05] Well I mean some people are fast responders and I’ve heard of that kind of thing happening for me when I always refer back to my own experience because that’s I’m a case study so I help people learn through my journey and for me I needed to do it for several months because I noticed what I did early on was I logged my cravings and cravings are subjective And you have to be very aware, like self-aware so that you can even know if you’re having a craving or if you’re drinking out of habit or if you’re drinking from getting triggered by something. So I teach my student not my students my clients how to decipher whether it’s a habit it’s just an ingrained habit why they’re drinking every night or if it’s a trigger that caused it or if it’s a craving and for me it was cravings so I chose over the course of several months to just be very purposeful at the TSM journey and to just drink. I tried if life would have it, I would try to drink every time I craved. And I noticed over the course of weeks and then months that my cravings were becoming less and less. And I was logging my cravings on a scale of one to 10 every time I drank. So I would, I would write it down. And I was noticing that they were going down And then eventually that day came when no more cravings magic.
Dr. Mark Leeds [15:46] Yeah, that’s, yeah, that’s a great idea. And I think that’s a good thing that a person would get from working with a coach is just reinforcing that idea that keeping a log and writing down things, you know, tracking cravings, tracking when the person takes the medication, when they have a drink. I think that the more tracking, the better, you know, cause that’s the best way to see progress. It’s kind of like working out. They say the people who are most successful in the gym are the ones that keep a regular log of everything they do. And I think it would work the same way with TSM.
Samara Ibanez [16:18] Oh yeah, absolutely. Like I said, the first time around when I tried it on my own and I was just doing a lot of trial and error, it didn’t work for me. I ended up quitting too soon. And I think that’s a big thing that happens with a lot of people is that they quit too soon. They quit before their brain has fully recovered from the addictive part, you know, and then they end up still having some cravings there. And then they end up succumbing to the craving craving at some point and drinking without the medication. So that’s something I wish to spread awareness on is just doing it full out, doing it purposefully, you know, with all of those, with all of those things involved, which are logging and journaling and asking the right questions. Why am I drinking tonight? Why am I drinking? Is it a craving? Is it a trigger? Did my mother-in-law tell me something and it set me off to want to have a drink or is it just purely out of habit because every night at this time I watch this show sitting on the couch and I have this glass of wine yeah you know
Dr. Mark Leeds [17:41] So when you say that you quit too early like so you might have been like that patient who said you know I’m great I did it a couple times and I feel much better. So maybe in the case of that person, it might be good to encourage them to keep going, maybe even on a regular schedule of continuing the process of, I mean, like, just for example, I’ve instructed patients to do it as if it’s a clinical procedure, you know, not to think of it like you’re drinking recreationally, but you’re, you know, as if you’re going in for a, you know, an actual medical procedure, or like you’re taking medication, like you’re going to sit down at a certain time, take your pill, have your alcoholic beverage ready one hour later. And also I’ve been recommending recently, cause I’ve heard this works well. I’ve been recommending, drink something that you don’t like drinking, you know, like if a person drinks weird, if they like beer, drink wine, if you like wine, maybe drink a beer. You know, probably not something that’s too, too strong, you know, like a, not something that has a lot of alcohol.
Samara Ibanez [18:44] Yeah. So too many shots of pure, liquor can overwhelm the medication. So that’s something to keep to think about when you’re doing this program. It’s that, you can, you can have a drink, like a whiskey drink with, you know, something, but not like, not by itself is it’s not recommended as for me, I was drinking wine and beer mostly. So those are the safe ones because they don’t, they won’t overpower the medication. So that’s just something to think about when doing this.
Dr. Mark Leeds [19:24] Yeah. Yeah.
Samara Ibanez [19:28] And then I just really, you know, again, I just focused on the craving. So when I was doing purposeful TSM, I basically wanted to drink when I craved. If circumstances were good, I would drink whenever the day that I craved alcohol. And I noticed the cravings were there. And, you know, that was so big for me that I was able to stomp out those cravings in the end, you know.
Dr. Mark Leeds [20:00] So it wasn’t that you picked a certain day of the week or a certain number of days a week. You were just you were basically responding directly to cravings. Like if you didn’t have a craving, you might not drink that day. Yes if you have cravings every single day of a week you might do the Sinclair method every day of the week
Samara Ibanez [20:16] Absolutely yeah that’s what I did so there were some weeks that I craved a lot more so I just drank I tried to drink every time I craved and of course I did it there was a whole protocol because you can’t take the medication on an empty stomach which I learned the hard way And so you want to have a full stomach. So you have to, you know, eat a meal, take the medication and then drink an hour later. So you have to kind of plan it out a little bit. I mean, I definitely was planning out my drinking sessions, but I just wanted to do it when I when I was craving. And then I actually had days when I wasn’t craving. And so on those days, I considered them alcohol-free days and I did fun activities. So I basically started a new hobby, which was spin classes. And I incorporated that into my alcohol-free days. And that gave me a whole flood of endorphins that were naturally derived from a fun, healthy activity. And that helps the process. That’s one of the things that helps us get healed in the end is doing those activities on alcohol-free days.
Dr. Mark Leeds [21:37] Okay. And so that’s, you would consider that actually a part of the Sinclair method of having an alcohol-free day where you purposefully, you don’t take the naltrexone at all because that would block endorphins from, from attaching to opioid receptors, but then you would purposefully go out and do something that would stimulate endorphin release, like something positive, like, like mainly exercise, I think would be one of the most positive things for most people.
Samara Ibanez [22:01] Yep. Yes. That is definitely part of the method. You look forward to getting to those alcohol-free days so that you can start a new hobby, like something that you’ve thought about doing that, you know, or that something that you used to do, you could even do art like painting or sculpture. I mean, anything, something that you have a passion to do that you haven’t done. And for me, it was exercise. For others, it could be going on a hike, going on a walk in nature, you know, something that’s going to produce really good endorphins naturally.
Dr. Mark Leeds [22:40] Yeah. Or even if, you know, someone with children, maybe taking their child to Disney World or Disneyland or something like that, or, you know, something that the, you know, maybe that would be, would work, you know, just being able to see your child have a lot of enjoyment and having a, you know, a fun day together and that kind of thing.
Samara Ibanez [22:58] Yeah, absolutely. Yeah. Children and animals, great endorphin producing activity.
Dr. Mark Leeds [23:05] Yeah, take your child or your pet to the park and run around and have fun and throw a ball around or whatever. I mean, there’s just so many great things a person could do on those alcohol-free days when they don’t take naltrexone. And so you’re saying actually the producing endorphins, you know, purposefully, you’re kind of doing the opposite of on the alcohol days. You’re leaving those receptors open and then encouraging your brain to respond to positive experiences. And you’re kind of like replacing the bad habit with good habits.
Samara Ibanez [23:38] Exactly. Exactly. And that’s, that’s essentially what you end up doing. I’ve, I’ve stayed completely committed to those spin classes that I started back then. And the reason is because when you do have those alcohol free, free days and those naltrexone free days, your brain gets almost, you could say like a healthy addiction to that, to that healthy activity because you’re getting the endorphins from it. So you’re, you’re very much replacing the bad habit of alcohol and it stays with you end up, it becomes part of your life that those fun activities.
Dr. Mark Leeds [24:17] Yeah. And it sounds like, I mean, that’s something that’s like a neurochemistry thing. It’s not just, you know, a person doing, you know, good things and bad things, you know, it’s not just a behavioral thing or a psychology kind of a thing. It’s, you’re actually optimizing your brain chemistry by, you know, taking the medication with alcohol and then alcohol free days, specifically doing things to replace the bad with the good.
Samara Ibanez [24:43] I mean, 100%. So basically you are targeting with the medication, you’re targeting that one bad habit, the alcohol, and then you’re leaving yourself open to experience a lot, all the other fun things in life, you know?
Dr. Mark Leeds [25:03] And that makes sense as far as why Vivitrol might not be ideal for most people, you know, Vivitrol being the long acting month-long shot with naltrexone, where if a person gets a shot of Vivitrol, they have naltrexone in their system all the time for like a whole month. So you wouldn’t be able to do that process of having alcohol free and naltrexone free days.
Samara Ibanez [25:26] Exactly. So that’s where the Sinclair method, you know, comes in that the Sinclair method is targeted. You know, it’s targeted at those opiate opioid receptors when you’re drinking only. So that’s what makes the difference. I haven’t, I’m not sure about how that has worked, Vivitrol, in other case studies. But I could imagine that it would cause depression if you’re not getting any endorphins for a whole month.
Dr. Mark Leeds [26:00] I don’t think, well, another person I had interviewed on the podcast, Dr. Adam Bisaga, and we talked about long-term naltrexone, but mostly with respect to opioid addiction. And his opinion was that the brain’s reward system is very robust and that a person can enjoy life with long-term blockage of the opioid receptors. In fact, for people who take, even people who take Suboxone or Buprenorphine for opioid addiction, it basically does the same thing. It’s very similar to naltrexone. The difference is it blocks just like naltrexone, but at the same time, it activates the receptor slightly or partially. So, but you’re still blocking the receptor long-term. So people can enjoy life, although it’s interesting, the idea of kind of going completely the opposite direction of having days where you really do positive reinforcement, but without the medication. And that’s something that someone who’s on long-term daily naltrexone wouldn’t have the opportunity to do because they wouldn’t have that opportunity to not take it if they were on a long-term medication that’s always in their system.
Samara Ibanez [27:09] Yeah. Yep. Yeah, I agree. That’s interesting that you point that out, that they can still have really positive times even doing the Vivitrol.
Dr. Mark Leeds [27:22] Yeah. I’ve had patients on Suboxone long-term where the issue was… Oh, that’s okay. Yeah, we have dogs all the time on the show. And so actually, in fact, our head of our network, I think she always ends every podcast episode with her dog barking. So
Samara Ibanez [27:45] I can’t control it.
Dr. Mark Leeds [27:48] Yeah. Yeah. The interesting thing about that, I’ve had patients on Suboxone long term, which, like I said, does the same kind of a thing. And sometimes I do notice that they don’t get the same like a runner’s high type thing from exercise. But otherwise, they’re pretty much able to enjoy life for the most part. But I think that’s a good thing for people to keep in mind that part of the Sinclair method, and maybe to optimize it, is to plan for alcohol-free and medication-free days and not just take the medication every single day. Although there may be people who are taking it every day is the right thing for them.
Samara Ibanez [28:19] In the beginning, I took it every day. I mean, because I was craving a lot, you know. So in the first couple months, I took it almost every day. I mean, maybe I had like one or two alcohol-free days a week at that point. And then I noticed because I was journaling and I was logging everything, I noticed that I started having more and more alcohol-free days and it became more and more and more. Towards the end, I was only drinking one day a week.
Dr. Mark Leeds [28:50] Okay. And how long did that take before you really started noticing that you weren’t drinking every day? Did it cut back to like maybe just two or three days a week or less?
Samara Ibanez [28:59] Two months, about two months, I was drinking consistently most days a week. And then it, you know, the second half of my recovery that I call it, or my TSM journey, it was significantly reduced to only a couple days a week of drinking.
Dr. Mark Leeds [29:23] Okay. And you never went through alcohol withdrawal by doing it that way?
Samara Ibanez [29:27] No, but I was, I was a binge drinker. So binge drinkers tend to not get the shakes because we can go for a whole week or two weeks or even a month without drinking. And then all of a sudden we binge and then we binge for like two days straight. And then, and then we stopped drinking again. And we, so it’s a little bit different. So what I do with my clients is I find out a little bit of history on them and I find out if they’re a daily habitual drinker and if they’re a binge drinker because the protocol is a little bit different for both. The way that they even go about doing TSM is a little bit slightly different when you’re a habitual daily drinker and if you’re a binge drinker.
Dr. Mark Leeds [30:17] Oh, how would you do it differently? Like for, like for someone that’s a daily drinker.
Samara Ibanez [30:21] So for someone that’s a daily drinker, it’s all about habits, changing your habits. And you really got to go about it. Thinking about your, about how to change their habits, because their habits are so ingrained, and they’re really getting all of their endorphins from the alcohol, because they’re drinking daily. So they’re drinking every single night, let’s say after work. So they’re getting all of their endorphins from the alcohol and they don’t have any other activity that they do in life that is giving them the natural endorphins because they’re relying on their drinking, right? So you have to break that habit and it’s such a strong ingrained habit. So there’s a lot of coaching that gets him that is involved with it in habit breaking and forming new habits and getting to that alcohol free day their goal is to get to an alcohol free day and then once they get to that alcohol free day it may take a couple months then planning an activity in advance that will, that they can do to replace. And then once they start getting those alcohol-free days, incorporating that activity and start a new hobby. I, with daily habitual drinkers, I encourage them to start a new hobby. Remember an old hobby that they used to do, you know get involved in some some community you know you know having a community around you so you’re not at home home drinking by yourself you’re you know at home drinking yeah that’s really important so yeah it’s a little bit different
Dr. Mark Leeds [32:11] And that’s something that the 12-step programs are good at as far as building community and building networks of new friends that are have the same goals. Although with TSM, you wouldn’t really a person wouldn’t really fit in that Alcoholics Anonymous talking about how they’re working towards extinction drinking on a regular basis.
Samara Ibanez [32:32] I know it wouldn’t work. I’ve been I’ve thought so much on how to reach those people because I was in AA for 15 years in and out of those meetings, getting the chips and then having to forego all the chips that I had gotten because I drank again and I relapsed. And I mean, it was just like a revolving door of going back and forth in AA. And I don’t know how to reach those people because it’s very dogmatic what it’s become. It is really the gold standard for recovery in this country currently. And, but what I’ve seen in the research that I’ve seen, it’s doesn’t have a very high success rate of long-term success. It’s about five to 10%.
Dr. Mark Leeds [33:27] Yeah. It’s not very successful now as far as like when someone starts, okay. So you had the daily drinker and the daily drinker starting out, you might recommend And you’re already drinking every day. Now you’re going to take Naltrexone an hour before with food, wait an hour, have a drink, try to maintain just the one drink, I guess, in some cases, a second drink. So that’s the daily drinker. Now, the binge drinker. Now, say that you spoke to someone who wants to get started and they say, I just came off of a binge and I feel really sick from it. I don’t think I’m going to drink again for another couple of weeks at least. How would you approach that case?
Samara Ibanez [34:07] Yeah so that was me that was totally my scenario and the way I approached it was I just did a real natural thing I just if I came off a binge I didn’t drink until I craved I just I went by my cravings and as soon as I started craving again I would plan an extinction session which is what I call it and where I take the medication with food an hour before I drink and I would just plan that extinction session for the next time I wanted to binge. And then I didn’t limit my alcohol use during my extinction sessions. So with the medication, I did not limit, I drank as much as I wanted until my heart was content. But what I noticed with the medication was that you don’t drink as much as you used to. You don’t, you just don’t down those drinks because it’s almost like your brain has an off switch and it, you take, you have like two or maybe three drinks and then your brain is like, okay, I’m satisfied. I don’t need any more. And then it, the more extinction sessions that you do, the more your brain turns off that switch to want to drink more that night. So you end up stopping drinking. Like I remember pouring a glass of wine back into the bottle because I just had a couple sips and I didn’t, my brain was fully satisfied. I was fully satisfied. I did not need any more than a couple of the wine. So yeah, it gets to that level. It gets to that point where you don’t even need to drink it.
Dr. Mark Leeds [36:03] Oh, that’s, that’s great. And so what, so now as far as have you, did you ever have to take like a second one? Cause I know some people do that where they’ll take another naltrexone within the same 24 hour period.
Samara Ibanez [36:16] Yes. I did experience that on one occasion, I was out at a, at a boat party out in Fort Lauderdale, you know, like it was a, it was a holiday. I think it was like Memorial day. And I was with all these friends and everyone was, it was a drinking party. And, I was in the middle of my TSM journey. So I was still doing TSM very strongly. I ended up re-dosing after six hours because we had started drinking early in the day and then it was towards the evening and, you know, I wanted to be protected. It’s all about staying protected, be quiet. It’s all about staying protected. And when you’re drinking on the medication, you’re, you’re protected, you’re protecting yourself. So I did redose, yes.
Dr. Mark Leeds [37:12] Now, one other thing that happens, and I think this is what a doctor who prescribes naltrexone for the Sinclair method is afraid of happening, is that a patient takes the medication and they’re all excited about getting started. They go home and they take it and they get really sick from it. They feel like either really nauseous or they get a headache or maybe makes them tired. They get side effects to the extent that they don’t want to do it anymore.
Samara Ibanez [37:41] Yeah, I’ve encountered that a lot. And interestingly enough, I was one of those people that gets pretty bad side effects. But in the beginning, I didn’t know how to mitigate those side effects. And I was just doing everything by trial and error. And I discovered that there is a very important protocol to do to mitigate those side effects and reduce them and even remove them completely. And so the main three things are, eat it or take the medication on a, on a full stomach, not just a snack. You need to have a full stomach from a meal. And then, I implemented this where whenever I take the medication, I take it with non drowsy Dramamine or any over the counter nausea medication. It does, it can create a little bit of nausea in the beginning, initially while your body is adjusting to the medication between the first in the first within the first two weeks, like seven to 14 days. Sorry about that.
Dr. Mark Leeds [38:44] Oh, it’s no problem. So the so the reason for that, because I saw that you’ve written that and you had written a document that helped people through side effects and I saw a non drowsy Dramamine. So the purpose is that of that is to deal with nausea from the medication.
Samara Ibanez [38:59] Yes, the purpose of that. And let’s just say I don’t, I’m abstinent now by choice, but let’s just say, you know, I’m, let’s just say that some time comes around and I feel like having a glass of wine with my friends, I will eat a big meal. I will take the medication after the big meal. I will take the medication with non-drowsy Dramamine just because I haven’t had the medication for several months now, because I’ve been abstinent. And I don’t want to, I don’t want to experience those side effects. If, you know, if that were to happen, I don’t want to experience those side effects. So I will do everything to protect myself and make it a, an easier experience. And it really does mitigate the side effects when you do these things. If you take it on an empty stomach, it’s not good.
Dr. Mark Leeds [39:58] Yeah. Yeah. That’s something that does come up. It’s come up with some patients that I’ve talked to where that exact situation where they say that if they take naltrexone on a regular basis, the side effects get better. But then if they take a break from it for a while, then go back to it, then they get side effects again. And in one case, this one patient said, I don’t want to have to take this all the time, but I don’t want to have to get used to the side effects all over again each time.
Samara Ibanez [40:24] Well, that’s what happened to me. That’s exactly what happened to me because, because I’m a binge drinker. I would go for a week without drinking sometimes naturally. And then I would have to get used to the side effects all over again. So I created that article to help people with that because I experienced it myself. And I figured out every single time I start the medication again, I cut it in half. I do the 25 milligrams because it’s just, for me, I have a lot of side effects. So I want to mitigate as best possible. And so I cut it in half. I take it with the non-drowsy Dramamine. I take it on a full stomach every single time. And, but, you know, now the reason why I say I practice purposeful TSM. One of the reasons behind that is that I got to a point in my life where I don’t really need to take the medication because I don’t drink, you know, and that’s like, I wish that would be the goal for many people. But if people want to continue to drink moderately and at safe levels, that’s perfectly fine. They just will have to take the medication with it. And so that would mean mitigating side effects and doing, taking the medication a certain way so that they don’t have a lot of side effects.
Dr. Mark Leeds [41:56] Yeah. And you mentioned taking half that, you know, And the usual dose, just for people listening who don’t know about this, about TSM, the usual dose of naltrexone is 50 milligrams. I don’t think they even come in any other dosage normally, the 50 milligram tablet. And so one way to get used to it to avoid the side effects would be to take half of a tablet, break it in half and take a 25 milligram. But would you recommend, or in your experience, did you take that with alcohol, the 25 milligram? Cause I’ve, I’ve heard that it’s just not effective enough, or would you take it that way? Like a few days before you have a drink.
Samara Ibanez [42:36] So very interesting. And that’s a great question. I did it both ways. In the beginning, I did it where I took 25 milligrams, several nights, during the week without alcohol, just to kind of get my body adjusted to the medication until I took the full dose with alcohol. But actually the second time around when I did TSM and it actually worked for me, I wanted to speed up the process. It’s very interesting. I wanted to speed up the process. So I wanted to have as many extinction sessions, extinction drinking sessions as I could quickly so that I could hurry up and get healed. Right. So I actually was taking the 25 milligrams with alcohol. And I did for myself, I can’t speak for other people, but for myself, I did notice it still worked. It still worked great. Like I, it was reducing my alcohol intake. It was healing the brain. It was doing everything it needed to do. And I gradually went up to the full dose. And then once my body was after about two weeks, my body was fully adjusted to the medication on the full dose. And I just kept going, I just kept going for a few months, you know, taking the full dose one hour before I drank. Yep.
Dr. Mark Leeds [44:04] Okay. So yeah, so there’s definitely different ways to do it, depending on the person.
Samara Ibanez [44:08] Yeah, I think it depends a lot on the person how they metabolize the medication. Some people metabolize it much quicker. Some, you know, Some people have, some people don’t even have any side effects. I’ve, I’ve seen people that don’t get any side effects from the medication and they don’t have to even take it with a full meal, but it is suggested even in the scientific research in the papers that I’ve read to always take it with food. So,
Dr. Mark Leeds [44:36] Yeah, yeah, that makes sense. And yeah, we should say that, you know, we’re focusing on side effects now, but most people don’t have side effects. It’s probably like 10% of the people that take it and 10% is significant. I mean, so that’s like one out of 10 people, but then that’s nine out of 10 that pretty much don’t have any real issue with side effects.
Samara Ibanez [44:56] Yes, yes, exactly. So the side effects, I just happened to be one of those people that was sensitive to it. But I know a lot of other people from the groups that I’m in that don’t get side effects at all from the medication. So, yeah.
Dr. Mark Leeds [45:13] So now they say it has a 78% success rate. And I think we all agree that they need to do more research and define that better. And it’s not just for the Sinclair method. There’s other medication-assisted treatment programs where there may be a number, a percentage number of success. And those numbers are based on, you know, maybe one research study. You know, like, for example, Suboxone, they say has a 50% success rate, methadone 75%, you know, for opioid addiction. There’s a doctor I interviewed that’s doing studies for meth and cocaine addiction, or mainly meth addiction in his studies. And I think he said they’re defining like something like around an 80% success rate with a particular medication protocol. But, you know, there’s a lot of factors that go into success or failure. In fact, with the Sinclair method, you know, I’m not sure in that study how they define success because Because in other studies where they might define success or failure with alcohol or drugs, they look at urine tests and they look to see, is the person drug-free and how long do they stay drug-free? But if you tell someone you can drink with a medication, I mean, success is really going to be an individual thing. It’s kind of a difficult thing to study, although it could be studied. You just have to look at it differently. But is there anything that a person might try this? And that you could say like, Oh, this isn’t going to work for you’re in that 22%. Or would you say that pretty much anybody, no matter how they start out that they should just stick with it because there’s ways to work around issues that they might have early on.
Samara Ibanez [46:51] Yeah. A great question. There is there’s supposedly there’s a 10% amount of people that have a different shaped, opioid receptor and the medication does not attach to it. So that is something to look out for. If a person takes the medication and doesn’t, it doesn’t re it, the medication just does not reduce their drinking. They just simply react the same exact way as they were without the medication drinking. Then that would be that 10% of people. Then there are other options and there are other, drugs that can like anti-craving drugs that I think can be tried out in that case. But the 78% long-term success rate that comes from people that have done the TS like TSMers who have done it to completion to hit they’ve hit extinction and then they have long-term success so they just never became they never became out of control drinkers again they just stayed true to the program I guess and then became moderate safe drinkers in their life so I think that’s what that’s talking about I know that. Have you heard about that 10%?
Dr. Mark Leeds [48:20] No. Yeah, I wasn’t aware of that. And I don’t think I’ve, so far, I haven’t come across anyone that didn’t respond at all. I mean, so far there’s been issues of, you know, whether it’s side effects or, you know, they try, another issue is a person starts the medication on a day that they were drinking heavily. And that seems to not be a good idea, you know, to where they’re already drinking all day and then they take the naltrexone
Samara Ibanez [48:42] Oh yeah yeah
Dr. Mark Leeds [48:43] But yeah it always seems like you know once we try different things you know we get to a point where it’s working but I haven’t come across yet a person who took it and had no response whatsoever to it
Samara Ibanez [48:56] Yeah I haven’t either I haven’t either and most people that I talk to have at least some success from it. And the main thing that I’ve come across is that, you know, some people don’t, maybe they don’t completely believe it’s going to work. And so they quit before they’ve gotten their, their, you know, breakthrough in their brain or yeah, like they just didn’t give it enough time for it to work. Cause you gotta be, you gotta be patient with this process. It’s, I mean, we’ve done a lot of drinking sessions to get our brains to the point of addiction, right? So it takes a lot of extinction sessions to get our brain healed from that addictive, you know, that addictive brain that we had.
Dr. Mark Leeds [49:48] Yeah. What would be some examples of like other anti-craving drugs that someone might like ask their doctor about if they, you know, if they happen to be in that minority of, you know, that one 10% or whatever, where naltrexone might not be ideal for them.
Samara Ibanez [50:01] Oh my gosh. I can’t think of the name right now. You might know.
Dr. Mark Leeds [50:06] Well, there’s, I know there’s Campral or acamprosate.
Samara Ibanez [50:09] Yeah, that’s it. That’s the one.
Dr. Mark Leeds [50:11] And that might even be as likely even safe to take the two of them together, you know, naltrexone and Campral together. I’ve seen people ask about that and I’ve looked it up. I don’t really see any necessarily any kind of contraindication for taking them together.
Samara Ibanez [50:26] Yeah, I’ve heard, I’ve heard they can be taken together. I don’t know much about that medication at all. I bet there have been cases where that I had heard about that took it instead. And then nalmefene is available in the, in Europe and it’s the European version of our naltrexone and that one, it gets digested in a different location. I think it’s not liver. Do you know much about that one?
Dr. Mark Leeds [51:01] No, I mean, as far as I thought it was just like a different drug that did the same thing. And I haven’t prescribed it, although it is different. So it’s possible. I actually, someone did reach out to me and didn’t become a patient, but asked about it. And she said that, nalmefene works better for her than naltrexone and had asked if I would prescribe it. And I told her, I, you know, it’s not available in the U S and she told me that U S doctors can send prescriptions to certain European pharmacies and they’ll honor those prescriptions. I don’t know much about that. I haven’t done that, but that’s,
Samara Ibanez [51:34] That’s amazing. Nalmefene is not processed in the liver. So if people have maybe high liver enzymes or, you know, they’re struggling with that, they, you can get, put them safely on nalmefene and it does the same thing. So yeah, very interesting stuff.
Dr. Mark Leeds [51:52] Yeah. And then there’s a whole category of things up and coming things that are not quite available yet, but the whole category of the psychedelic drugs, and there’s apparently even ones that don’t have psychedelic effects that are derived. Like there’s a Ibogaine, which is a dangerous kind of a scary drug that they’re using in some countries. And then there’s a new one called 18MC, which they’re studying, which is derived from ibogaine. But apparently it doesn’t cause like the psychedelic effects, but it helps with treating things like addiction and maybe chronic pain and other kinds of related issues.
Samara Ibanez [52:25] That’s just so wonderful to hear that our science is progressed so much that we can treat these addictions with medications and with these kind of psychedelics that this is this is shows a lot of promise in this field and I’m really excited for what’s to come with all of this oh yeah definitely we’ve gone a long way from believing once upon a time believing that when you have a craving for alcohol, just wait five minutes and it’ll go away. That’s what my people used to tell me back when I was in AA. I can’t think of the name, but my sponsor used to tell me, just wait five minutes. It’ll go away. And I never understood why my craving wasn’t going away. My craving was getting worse. It was progressing. It was, it was getting stronger every day that I abstained. And that’s just the main focus for me for this method is that you don’t have to live with white knuckling those cravings for the rest of your life. I’ve been given this gift of total freedom, you know, from cravings, from triggers. And I want to be able to pass on this gift that I’ve been given.
Dr. Mark Leeds [53:51] Yeah. Yeah. It’s great that you’ve, you know, I think that’s something we need because that’s a something missing as far as what you’re doing, the TSM coach, especially that you’ve become certified and you’re working with the C3 foundation, which is the main organization dealing with educating doctors and the public about the Sinclair method. But, you know, a lot of doctors, I think, may come on board early on where they’re willing to at least prescribe the medication, but they just don’t know enough about what to do beyond that. And so you’re definitely, you know, providing a service that is really needed, you know, that the patients can at least maybe hopefully get access to the medication. And then, you know, as we talked about, the program is very straightforward, but then once you get past that straightforward thing of naltrexone plus alcohol equals extinction, there’s so many nuances and so many individual experiences that, you know, people really need to work with someone who has experience and knows, you know, what we can try next to some one thing doesn’t work. And, you know, all these other things like, like logging and, you know, like you were saying, you know, developing a hobby. I mean, there’s just so much more to it beyond the simple statement of how it works.
Samara Ibanez [55:02] Absolutely. Yeah. And everything I learned through trial and error, but if I would have had somebody guiding me when I was doing it, then I could have achieved it in much less time, I think, because it really ultimately only took five months for me to get healed from a 27 year long battle with alcohol. It took me five months. And I’m not saying that’s the case for everyone, you know, everyone’s different. But even if it only takes a year, imagine getting rid of a 30 year long battle with alcoholism in one year.
Dr. Mark Leeds [55:38] Yeah. I’m sure you wish you could go back in time 27 years and back to your earlier self and say, here’s some naltrexone. Here’s what to do.
Samara Ibanez [55:47] I would have gone back to the days when I was relapsing, going to AA. I would have, I would have done it back then and been, been totally done with it. I would have had a whole 15 years of my life given back to me.
Dr. Mark Leeds [56:00] Yeah. Yeah. And people listening to this that are wondering if they should try it or not, you know, just imagine talking to your future self 20 years from now, wishing that you had tried this earlier and not suffered nearly as much. I mean, it’s really something that people need to hear about that it’s out there and that it does work.
Samara Ibanez [56:18] Absolutely. And I just want to close with one thing. I just wanted to say that something that I learned recently, the founder of AA, Bill Wilson, I’m not sure if you know about this, but according to the nurse’s notes on his deathbed, he begged, well, he asked for whiskey and they said, no, then he begged for whiskey. They said, no. And then he demanded that they bring him some whiskey and both his wife and the nurses, you know, they denied him. And it’s just, to me, that story is, it’s so sad that someone had to white knuckle their cravings their whole life and not get the freedom that I have the freedom of just not having any craving, not craving alcohol, not needing it, not thinking about it, just being completely free. Like what a difference this makes, you know, really healing the brain. From this addiction.
Dr. Mark Leeds [57:24] And people should be aware that Bill Wilson, founder of AA, was not against medication-assisted treatment for addiction. Yeah, there’s a story that Dr. Bisaga told in his book about how Bill Wilson met with the founder of the Methadone Maintenance Program in New York and asked him if there’s something similar that would work for alcoholism that would help to relieve people’s cravings so they could work on their recovery program. And apparently he was also interested in psychedelics as well. So, he was, you know, the founder of AA was definitely in favor of medication assisted treatment of addiction.
Samara Ibanez [58:00] Yes, absolutely. I’ve, I’ve done a lot of studying on him and he actually was very much for, he didn’t believe that there was just one answer for alcohol recovery. But unfortunately, you know, he in his lifetime, it really wasn’t available yet.
Dr. Mark Leeds [58:24] So. Yeah. So Samara Ibanez, thank you for joining me in the podcast today.
Samara Ibanez [58:30] Thank you so much, Dr. Mark. I’m so happy you had me. And let me know if you have any questions. I would love to answer them. And thank you so much.
Dr. Mark Leeds [58:40] So as far as where people can reach you, Is the best place to go look you up on the C3 Foundation or do you have a direct website where people can look for you?
Samara Ibanez [58:48] Right now, I will be on the C3 Foundation webpage as of this week. So you can find me there. And then the best place to find me is my Instagram. And I respond to anybody DMing me. And that is at the underscore Samara show. I can send it to you if you’d like.
Dr. Mark Leeds [59:12] Okay. At the underscore Samara show.
Samara Ibanez [59:15] Yeah. At the Samara show, but it’s an underscore between the and the Samara show.
Dr. Mark Leeds [59:23] Okay. Yeah. I’ll definitely put that on the show notes and okay. Perfect. So yeah. Thank you again. Thank you for joining me.
Samara Ibanez [59:30] Thank you. I really appreciate it. You have a wonderful day.
Dr. Mark Leeds [59:34] Oh, you too. Thank you. Okay. Bye. Okay. Bye.
