Alcohol Cravings and Cutting Back: How Naltrexone Can Help

Join Coach Kevin Bellack and Coach Frank Spinelli, MD, one of Reframe's trauma-informed health coaches, for a guest-free deep dive into the medical side of changing your relationship with alcohol. In this episode, they unpack Reframe Med and the growing role of medical interventions in cutting back or quitting drinking.

The conversation centers on naltrexone: what it is, how it works to blunt alcohol's effects by blocking the brain's reward system, and why it's most effective when paired with behavioral change. Kevin and Frank talk through who might benefit, what the research says about combining medication with coaching and community support, common side effects, contraindications, and the important reminder that no medication is a "magic pill." They also explore the different ways people use naltrexone depending on their goals, whether that's going alcohol-free or cutting back.

From there, they look ahead to GLP-1 medications, an emerging area of research for alcohol use disorder, and discuss how these drugs may quiet cravings the same way they quiet "food noise." Along the way, Kevin shares his own honest experience getting started, and the two dig into why tools like medication and AI so often get dismissed as "cheating" rather than embraced as legitimate resources.

Whether or not medication is right for you, this episode offers a clear, judgment-free look at what's available so you can make informed decisions or better support someone you care about.

Please note: nothing in this podcast is medical or mental health advice. Always consult your healthcare provider about what's right for you.

The Reframeable podcast is brought to you by the Reframe app. Reframe is the #1 app to help you cut back or quit drinking alcohol. It uses neuroscience to reframe your relationship with alcohol and unlock the healthiest, happiest you. If you're enjoying this podcast, please like, subscribe, and share with those that you feel may benefit from it. If you have a topic you'd like us to cover on the podcast, send an email to podcast@reframeapp.com or, if you're on the Reframe app, give it a shake and let us know what you want to hear.

Transcript

Kevin (00:01.772)

Okay. Cool. Yeah, that helps me too. So not gonna complain. all right. We are live.

Frank Spinelli (00:02.759)

Really appreciate it. Yeah.

Frank Spinelli (00:07.039)

Yeah.

Kevin (00:17.582)

Okay. All right.

Kevin (00:23.542)

Welcome everyone to another episode of the Reframable Podcast, the podcast that brings you people's stories and ideas about how we can work to reframe our relationship not just with alcohol, but with stress, anxiety, relationships, enjoyment, and so much more. Because changing our relationship with alcohol is about so much more than changing the contents of our glass. This podcast is brought to you by the Reframe app. Reframe is the number one iOS and Android app to help you cut back or quit drinking alcohol.

It uses neuroscience to reframe your relationship with alcohol and unlock the healthiest, happiest you. My name is Kevin Bellach. I'm a certified professional recovery coach and the head of coaching at the Reframe Act.

Frank Spinelli (01:01.619)

And I'm Frank Spinelli. I'm one of the trauma-informed coaches and health coach at Reframe as well. So we were just talking about your recommendation for to see the Odyssey. So you thought, yes. was that your nugget? Well, we can go back to it. Well, I don't, yeah, I don't know. I don't know if it qualifies as a nugget, but it's definitely a recommendation, right?

Kevin (01:14.87)

Yes. you took my nugget away from me that I was gonna share at the end. no. That's not r that's not that's not really a nugget. But yeah, we just saw it yesterday and

Kevin (01:29.686)

Yes. Yes. Definitely a recommendation. definitely see it in IMAX if you can. 'cause yeah, we were we were look my wife last week said Odyssey's coming out this week, make it happen. Cause she's been wanting to see this forever. yeah. So I looked, I'm like Friday and Saturday, there are no showings that aren't first row for IMAX. Like I'm looking straight up at the yeah. and so I I

Frank Spinelli (01:43.098)

Wow.

Frank Spinelli (01:55.091)

Yeah, which yeah that

Kevin (01:59.531)

I ski I got tickets for three o'clock on Eastern time on Sunday. And then a day later I was like, shit. World cup the World Cup final is that is is on at that time. And I didn't watch this for a month to miss the final. So I got refunded and we went at eleven AM yesterday. So yeah.

Frank Spinelli (02:20.788)

all right. Well you made it. Well speaking of, were you happy with the results of the World Cup?

Kevin (02:27.082)

yeah. Not to piss anybody off here, but the last two games Argentina's just playing dirty, in my opinion. So like the yeah, it was ridiculous.

Frank Spinelli (02:30.239)

Well I mean

Frank Spinelli (02:35.773)

really? Well, yeah. I I work with a lot of Europeans. So I had people on my team who are from the UK, Paris, and Argentina. So it was really heated last week. And today was not a happy day for the two Artina Argentinians. So condolences go out. But I think everybody was pretty happy for Spain. I think a lot of people felt they deserved it, and yeah, good for them. So

Kevin (02:50.922)

wow. Yeah. Yeah.

Kevin (02:56.706)

Yeah. Yep.

Kevin (03:01.408)

yeah.

yeah. I mean, yeah. Last four teams in it were the top four teams going into it, so kind of worked out well that way.

Frank Spinelli (03:13.343)

So you had a packed weekend, the Odyssey, which is what, under two hours or over?

Kevin (03:18.08)

No, it's like I think two hours and forty five minutes, maybe.

Frank Spinelli (03:21.243)

wow, so yeah. Well it's it's the Odyssey, obviously. Our long meandering journeys, yeah. And speaking of long meandering journeys, I

Kevin (03:24.224)

It's the Odyssey, yeah. It it it's it's yeah, it wrote the book on long stories, yeah. Long journeys. Yeah. Well one of the well, real quick, one of the funniest things I saw today. Well, it was it cracked me up. It's like Hollywood has spent over seven hundred I think it was seven hundred million dollars bringing Matt Damon home. And it it was cause he's he was saving private Ryan.

Frank Spinelli (03:49.247)

The Martian. you save in private, Ryan.

Kevin (03:53.773)

The Martian, yeah, he was Private Ryan, saving Private Ryan, Martian, this and Interstellar. so yeah.

Frank Spinelli (04:02.316)

my god. What is he in El in interstellar? well.

Kevin (04:05.516)

Yeah. He's one he's the person who I don't wanna give anything away, but he's one of the people who it's been out for a while. It's one of the people that go out first and then they go to find him. Find all the find all the different people.

Frank Spinelli (04:15.601)

Out. Okay. they go to find him. Yeah, another another film by the same director. So yeah, they're they're all pretty good. I like him. what's it Nolan?

Kevin (04:27.31)

Yeah.

Yeah. Christopher Nolan, yeah.

Frank Spinelli (04:31.357)

Right? Christopher Nolan, yeah, they really good. And you know, it's an IMAC, so like the technology is there. Well, we don't as you might be aware by just seeing us, we don't have a guest today, but that's okay because we have something interesting we want to talk about.

Kevin (04:42.381)

Yeah.

Frank Spinelli (04:48.281)

for those of you who are already on the app, on the Reframe app, Reframe has instituted something called Reframe Med. And currently, Reframe Med is offering Daltrexone, which is a medical intervention for alcohol use disorder. And we thought we'd talk a little bit about that and other offerings that will be coming down the pike real soon. So I thought it would be important for you, Kevin, to understand a couple of statistics. You know me, I love a I love a good statistic, and whenever

Kevin (05:15.501)

Yes.

Frank Spinelli (05:18.025)

it's pertinent I like to pipe in with them so alcohol use disorder affects approximately nearly 30 million Americans and this is a relatively recent study it was done in 2023 and of

Those people, 30 million people, only seven percent receive treatment annually. And unfortunately, and we can't say this is the causality, but alcohol use disorder is responsible for over 95,000 deaths every year in the United States, making it one of the most preventable causes of mortality. So bearing this in mind, fortunately, the FDA took steps to look at what could be

An intervention, a medical intervention combined with behavioral therapy, and they came up with naltrexone, which is interestingly a drug that's been out for a very long time. It's considered one of those drugs that's been around for a long time. It has a relatively safe therapeutic index. And it was actually indicated for something else, but they found that the people that were taking naltrexone had reduced craving. So, first, before you ask me, what is naltrexone? Naltrexone is an opioid.

Receptor antagonist. That means it blocks the mu opioid receptor. What does that mean? It sounds really like algebra. Well, your brain, when you drink, gets triggered. We've talked a lot about this. You've probably heard this before. It is a brain reward system that gets triggered and where you release dopamine. So you have a drink of alcohol, your body just explodes with dopamine. So just to give you some context, you you release.

Release dopamine by other things that are pleasurable. So, for example, Kevin went to go see the Odyssey. He really liked it. Really cool. It's on IMAX. His body's like, thank you, Kevin, and relieving all this dopamine, and he's feeling great. However, the levels of dopamine he's releasing are nothing compared to the super physiological doses that are released when you drink alcohol. So

Frank Spinelli (07:30.506)

For those of you who like Star Wars as much as I do, imagine alcohol is the Millennium Falcon and it wants to land in the Death Star, right? Remember that big Darth Veda planet? Well, you have to go into the docking bay, right? There's tons of them. Well.

Naltrexone is blocking the docking bays. It doesn't block alcohol, it blocks the docking bay. So what happens? There is no release of dopamine, and you get this blunted response. What does that mean for you? If you are taking naltrexone and you drink alcohol, you will not feel euphoric.

In fact, you'll feel pretty blunted. Many people have said it felt like drinking a glass of water, which is no fun.

but to be very clear, you are still consuming alcohol. You will have blood alcohol levels. And so it is very important for you to understand that if you do decide to go on naltrexone, that you will if you consume alcohol, you're still consuming alcohol, it's still in your body, but you're not feeling the brain reward system getting triggered. Does that make sense?

Kevin (08:45.25)

That does that does make sense. you had me at Star Wars and I c I could have I have I don't have the Death Star, but I do have the Millennium Falcon Lego. I could have used as a prop here and shown. but the when you say blunted, what how is that? So you're not gonna feel the buzz. You're not gonna feel that euphoric effect and things like that. can you feel

Frank Spinelli (08:50.963)

Ha ha ha.

Kevin (09:15.182)

Drunk on it.

Frank Spinelli (09:16.947)

So that that's a really good question. The thing is this when you feel this blunted effect, you're not feeling the euphoria, you're not feeling the issa that sort of like, you know, easygoing, a little

Kevin (09:25.645)

Mm-hmm.

Frank Spinelli (09:32.276)

Bit, you know, happy. You're not feeling that. You're actually just feeling blunted. And for many people, they don't realize that they are still getting intoxicated. They're just not experiencing that euphoria. That's why we caution people a lot don't try to then over drink, because what'll happen is you won't get drunk, but you will be severely intoxicated and you don't want to get behind the wheel of a car, certainly because you don't want.

Kevin (09:33.187)

Yeah.

Kevin (09:52.333)

Yeah.

Frank Spinelli (10:02.249)

get into an accident or hurt anybody, but you don't want to get pulled over because you will fail a breathalyzer. So the point of the matter is I think this really comes down to the why. Why are you on now Trexone?

And so for many people, and I'd be curious to hear what you have to say, because I'm sure you've worked with clients who have taken naltrexone, is why do you want to go on naltrexone? And so for the cup, you know, for the many clients that I have had that went on naltrexone, they just felt they needed something more, that they just were not able on their own to do a sustained

Kevin (10:25.187)

Mm-hmm.

Frank Spinelli (10:44.291)

Abstinence from alcohol. Like they'd get a day here, they'd get a day there, but then they just start drinking again. And their goal, their goal was abstinence. They wanted to stop drinking. They just couldn't get there. And so after employing all the behavioral steps and tools and journaling and really looking at modification and the zebra striping and trying to use mocktails and avoidance of triggering events or social activities that may

make them want to drink, we said, okay, maybe we should try a course of naltrexone. And of course you go through everything and when you go through Reframe Med, you are going to consult with somebody who's a prescriber, not one of the coaches, someone who's licensed to prescribe Naltrexone, and they'll do an evaluation and it's all done through the app, which is very convenient. And and by the way, I I want to point out why it's more than just a convenience. For many people

People to go on now Trexone would mean having to log a diagnosis of alcohol use disorder. Now, when you go to your healthcare provider, they may be like, you know, this is great. If you want to do this, I totally support you, and I'm gonna write this prescription. However, it does go down in your chart, it does skip billed to your insurance, and they will know this. And some people just don't feel comfortable with that, or they rather they that not be registered with their medical.

Medical record. So doing it another way kind of alleviates that. So I want to just point that out: that it's not just that the app offers it, it offers it because there are certain privacy issues that they can overcome. So once we agree that perhaps now trexone is something that might be worthwhile for them to explore, we do the evaluation. Part of that evaluation is really to discuss what their goals are. And the reason why I bring this up for you, and I'm sure you've counseled people is

What is this not? It's not a magic wand. It's not a magic pill. It's not a silver bullet. I don't know. Insert metaphor here. It's not magic. You have to want to do it.

Kevin (12:46.626)

Magic pill. Yeah.

Kevin (12:52.045)

Yeah, yeah.

Frank Spinelli (12:58.275)

And you it's very similar to when I was prescribing chantics to smoking sensation. You have to want to stop smoking. If you're gonna join Jenny Craig or Weight Watchers, it's because you want to lose weight. It doesn't happen to you. You have to employ what they're teaching you. And certainly what now Trexone has to offer or Chantics or any of those other interventions, but you have to incorporate it and

Kevin (13:03.608)

Okay. Yeah.

Frank Spinelli (13:23.677)

The study that was done with Naltrexone is called Combine, and they found that there were higher rates of success when people with alcohol use disorder took naltrexone combined with behavioral therapy. So what is that?

For example, going on the reframe app, doing the daily tasks, participating in the forum, possibly getting a coach, or attending community meetings. You have to consistently do something to change the way you think in order to change your behavior, because why? Notrexone isn't a magic pill. It's not gonna do that for you. And so that is the first step. And then once somebody I'm working with says, yeah, I I think this is worth

Kevin (13:57.08)

Mm-hmm.

Kevin (14:02.572)

Yeah. Yeah.

Frank Spinelli (14:11.643)

exploring. we do some baseline labs. You know, sometimes we look at their liver because if you have severe liver disease, not just you know elevated liver enzymes, but severe liver disease, you probably should not be on naltrexone. The only real con

Kevin (14:24.376)

Mm-hmm.

Kevin (14:28.386)

Se severe, what what would what would you classify as severe? Just like severe, I think cirrhosis is the obviously the top end. But what about like fatty liver?

Frank Spinelli (14:35.257)

Well, definitely, definitely up there. But like I think, yeah, it it would be like your liver enzymes are three or five times the the normal. It's not just elevated, it would be severely elevated. So certainly if you were all you know, above the upper limit of normal, that would be something of a caution to do.

Kevin (14:47.735)

Okay.

Kevin (14:53.651)

And and did did we start off with this? Like no nothing in this podcast is medical or mental health advice. we'll just throw that in there too. I don't know. I don't know why I yeah.

Frank Spinelli (14:59.441)

no.

No, this is just opening your mind to what are the therapeutic interventions besides behavioral therapy. And it's just it's good to know, even if you don't think naltrexone is right for you. It's even just important for you to know because hey, you might be able to help a friend who may need it. and so like I said, the combined study really showed that with combined with behavioral therapy and naltrexone, which was studied at 50 milligrams once a day. So it's very simple. It's one pill once a day.

Kevin (15:12.096)

Exactly.

Frank Spinelli (15:32.05)

You could take it really anytime, day or night, depending on when you normally take pills, and you don't have to take it with or without food. It's basically just that simple. So, you know, they we really find that what it works is that it works almost immediately. You will get a sense that if you drank, like if I took, if we took Notrexone this morning and we wanted to go for a drink this afternoon.

it would already have taken effect. There is no like leeway where you have to take it for like a few days before it has an effect. So does that make sense?

Kevin (16:08.726)

Yes, that does. Sorry, I was mute I was muted there. What's that?

Frank Spinelli (16:08.797)

Have you ever had any clients on have you ever had any clients on Naltrexon yourself or

Kevin (16:14.924)

Yes, I have. I I do now and I have in the past on on various things, whether it's Nautrax Zone or yeah, there's others out there that aren't as well documented, you know, longstanding and with as as good of results. But yeah, and usually it is that they they do notice that feeling of okay, I'm not feeling this and it and it's not as

beneficial for me, let's say. pleasurable. Yeah. It's not doing what I'm used to it w you know, what what I'm used to. And therefore, and that's the whole thing. It's breaking that neural pathway that, I drink this, I feel this. Now it's like I drink this and I don't feel this. It's like, well, why am I drinking this then? You know, that kind of

Frank Spinelli (16:46.185)

Pleasurable, yeah. Let's and that's

Frank Spinelli (17:06.011)

Exactly. And that's called negative reinforcement. You're doing something and getting no benefit from it. So your brain is like, don't do this. It's not fun. And and I think that's really what's important. I also think, you know, another thing that's really important that we touched on it just minutes ago is that

Besides it not being a magic pill, which I'm gonna say probably f 50 more times before we're done here today, is you know, it's not magic. You have to want to do this, you have to make a decision on where you want to go.

Kevin (17:29.472)

Yeah, I s I d do all the time, yeah.

Frank Spinelli (17:39.006)

With this. Now, I'm I've mentioned that people drink on this. They do. it and it has been shown to curtail people's drinking. Certainly, if you want to go alcohol-free, this is a great way to go because it really will motivate you because you won't get any benefit from it. But whatever you do, whatever you decide, it's important to have a plan. so part of it is that understanding, yeah, this is not a magic pill. Secondarily, I'm gonna start taking it today, it's Monday, and I am going to see how my drinking.

But to understand that I won't feel the euphoria, I will feel blunted, and perhaps use that as a signal to say, you know what, then why are we drinking? We don't want you to think you're going to over-drink it or get over this hump. And I bring this up because what this reminds me of, I don't know, Kevin, I had patients that used to get the gastric bypass.

Kevin (18:34.471)

huh.

Frank Spinelli (18:35.037)

And so you you really limit the capacity of someone's stomach. Well

Let's face it, human nature, we're tenacious. If you want to eat, you could eat your way out of the gastric bypass. And I don't want ever to recommend that to anybody, but you can do that. The same thing for naltrexone. You could be on naltrexone and drink and just say, gosh darn it, I'm gonna have I'm gonna drink until I start feeling drunk. And that would be really, really a serious mistake to make. So the idea.

Kevin (18:50.947)

Yeah.

Frank Spinelli (19:11.385)

Is how do you avoid that? By knowing fully well that when I go on naltrexone, what it's not a magic pill, and two, I'm doing it to curtail or cut back or stop drinking completely. And that in no way should I even consider over-drinking to compensate because you will not, you'll only make yourself sick. And I can't think of anything worse than drinking.

And not feeling any pleasure and then waking up the next day with a hangover. Because you got all the negative, you got all the worst side effects and none of the benefits. So, but that's what happens. It happens quite often because people just think they're gonna drink.

Kevin (19:43.214)

Yeah, exactly. Yes. Let's get the worst of both. Yeah, yeah.

Kevin (19:54.895)

Yeah. And I'm curious, yeah, and I'm assuming that you've had clients and and or just experienced patients, yeah, who have been on this. And so what if I'm somebody who I don't want to quit completely? I'm curious because obviously if I want to go alcohol free, if I want to quit, this makes sense for you know to keep taking that and then okay, I'm slowly kind of you know.

Frank Spinelli (20:03.465)

Patience, yeah.

Kevin (20:25.058)

disassociating that with the pleasure signals and and moving on, right? But if I'm somebody who wants to moderate, be a mindful moderator, do is that okay to incorporate this? And how do you how do you incorporate that? I'm assuming it's not every an everyday type of thing, perhaps, but how does that show up?

Frank Spinelli (20:45.097)

Well, you know, that's interesting that you brought that up. So the way it was studied and the way it is been FDA approved is it's a once a day modality. You take it every day, day or night, and it and it works better that way because there is a consistent therapeutic level in your body.

Kevin (20:54.071)

Okay.

Frank Spinelli (21:03.675)

Now what makes this so good is that you know it really does get to peak levels within hours. So it's it if you miss a dose, you can just go right back on it. And certainly if you want to stop at any time, you don't have to wean yourself off. You just you just stop. So it's it's convenient in its dosing, but it's also convenient in its therapeutic index.

Kevin (21:11.854)

Mm-hmm.

Frank Spinelli (21:24.521)

For people who want to mindfully moderate, there is two pathways. One is the traditional pathway where you just take it every day and you occasionally drink and you realize you're not gonna have the pleasure. Now

If that bothers you and you want to feel the pleasure, well then you'd have to come off of it and it gets complicated. Now, there is another method which is not FDA approved, and it's certainly not one that Reframe would recommend, but it's worth exploring. It's called the Sinclair method. So Dr. Sinclair, who you know developed this method, was basically saying you could take now Trexone at will.

So Monday through Friday, I'm good. Like, I don't even think about drinking. I work, I'm very busy. but come Friday night, yeah, I want that 5 p.m. cocktail, and Saturday it's my friends, and we're, you know, we're drinking. So, what you do is you take now Trexone just on those days a few hours before. And what it will do will be to curtail your drinking because.

Because you'll still get the negative benefits. You won't you, I mean the negative outcomes, you won't feel anything, and you're likely, like we talked before, just not drink because you're like, why am I drinking? It doesn't really do anything for me, so you stop. So those are the two methods. One is every day to cut back or really go alcohol-free. The other way is to use it ad hoc if you want, on certain days, according to the Sinclair method, but to really say,

Kevin (22:46.797)

Mm-hmm.

Frank Spinelli (23:10.605)

Well, today is a drinking day, then you probably should really think about why you're taking now trexone because it would involve a lot of real thought. I mean, you'd have to say, all right, I'm gonna take it every day, and then when I want to drink, and you know, maybe not take it that day, but still there might be some levels in your body, so it gets really complicated. So it's basically an intervention to stop or cut back severely.

Kevin (23:30.572)

Yeah. 'Cause I was thinking

Kevin (23:35.939)

Okay. And cut back severely. And then yeah, and in doing so you're going through and implementing it, 'cause we said can't it's not a magic pill, so we have to do other stuff. And so you're doing other things to help along the way, so that when you do cut down and whether and this is leading to, I guess another question is how long do I have to take it? Or and that's not have to, but you know, what's what's the

Who what's the literature say on recommendations there?

Frank Spinelli (24:10.249)

Well, that's that's a good question, you know. for some people, there there's a so there's a variety of reasons people take naltrexone. There is a lovely reframer, who I won't say who she is, but she gives this great story where years ago she went on naltrexone, didn't really work, she still drank, didn't even she didn't she felt the side effects, which we'll get into in a second.

And eventually she stopped and she had what she called a major slip. Years later, she is alcohol-free, on her own, totally engaged. She just really had a turning point in her life. But she did have a small slip.

And she was very hard on herself about it. And she shares this all the time in meetings. And she wanted to go back on naltrexone. And I said, But why? You you're doing great. You're like, whatever. She was like 300 days alcohol free. I was like, You you're in the home stretch, you're done. She goes, No, I I feel like I think about it. So remember, we talked about naltrexone really cuts back on cravings, and it does. So she went back to her healthcare provider and they had a really long talk.

And they put her on nontrexone. I believe she started at a lower dose, 25 milligrams. She's a small person, and she did really well. And she's shared again on many meetings and talks about her journey and

More and more I really it clicked with me what she was doing. It was giving her the confidence to say, I don't even think about it anymore. I know I got this in the in my back pocket if I need it. I can walk through life feeling really confident. I can enter any room without feeling like I'm I'm getting shaky, and I'm I'm all for it. So that is one example of somebody typically if you're gonna

Frank Spinelli (26:14.325)

Start and let's say your goal is to quit drinking. You would start and anywhere between three but more likely six months or more. Now, there are people who just stay on it. Like I said, it's relatively safe ish as a drug. There are a few side effects. Most common one is nausea, which is mild to moderate, and it pretty much goes away after a few days. So to mitigate that.

Kevin (26:41.71)

Mm-hmm.

Frank Spinelli (26:44.401)

If you're feeling nausea or any of the gastrointestinal side effects, you might want to take it with food. That sometimes mitigates it. Remember, there's no restriction. And if it makes you feel a little tired, then just take it all before you go to bed. That way you sleep through it. But regardless, it's for you to just evaluate every day when you take the pill. What are my side effects? Is this tolerable? If it's not, then you should talk to your healthcare provider. But certainly after a week or

Two the side effects should go away. And certainly, if you're if you're doing well on it and you're not drinking, and you just want to stay on it as a way to continue boosting that confidence and get you to a point where you're not even thinking about it, then yeah, people stay on it for over a year. It's really up to you and your healthcare provider to really talk about a plan. The second thing that brings up is.

A lot of people feel and I'm I'm sure you've heard this, like I'm taking a drug to stop taking a drug, right? It is that seems counterintuitive. Yeah.

Kevin (27:50.583)

Yeah. Yep. Well, no, I I typically hear it this way, and I I think I just shared this with somebody too. Like, I'm taking a drug to address alcohol, to which I'm I I remind everybody that alcohol is a drug. You know, it's so because that's good marketing, like right? Alcohol and drugs, drugs and alcohol. It's like, no, it's all it's all just drugs. Let's let's call call it what it is. so sorry, go ahead.

Frank Spinelli (28:13.439)

It's all drugs.

Frank Spinelli (28:19.047)

No, no, that would that's a good clarification. So what I would say to that is, well, that's one way of looking at it. The the way we're looking at it is you're unhappy with your relationship with alcohol.

You have tried ways to cut back or get rid of alcohol from your life and it's not been successful. You want to try now trexone or consider trying naltrexone for a period of time. It's not for life. And certainly we know like if you look at alcohol use disorder versus naltrexone, there's a clear differentiation about what's causing your body the most harm.

Kevin (28:59.084)

Mm-hmm.

Frank Spinelli (28:59.579)

And I think for many people it's just a matter of how long do I need to be on it? Well, try three to six months, see how you feel. If you need more, go further than that. Certainly with your guide with the guidance of your healthcare provider. But more importantly, once you stop.

Let's say, let's say after a year, you stop. You've you've achieved alcohol-free for a very significant portion of time, you're ready to come off of it, you don't even think about alcohol, and you stop it today. All that work does not just go away. The cravings don't come rushing back to you. It's not as if the now trexone, once it's no longer in your bloodstream, that all the behavior from day zero comes back. That's not how it works.

That's why the behavioral therapy is so important in combination, because the naltrexone is just teaching your brain, we don't get anything out of this. We're not going to trigger the reward system. And your psychological part of your brain is saying, you're doing great. We're learning new ways to cope with being out and about with people who are drinking, with all the past little activators that we might have had. So when you do decide to stop taking naltrexone,

The success is going to continue, most likely, if you are still motivated to stop drinking, because you will have achieved so much in that time with the behavioral modification and the naltrexone and just living your life alcohol-free.

Kevin (30:33.742)

Yeah, because, you know, for instance, I drink because I'm stressed, right? And now if I'm not drinking or not drinking as much because I'm using non-trexone, I that doesn't address the stress. So I still have to put tools in place. I still have to work on that and find ways to handle that better, to mitigate that, to remove that, and to, you know, put other things in place that I'm happier to do and I'm more willing to do and that become more automatic.

Frank Spinelli (30:45.586)

Right, exactly.

Kevin (31:03.458)

to do to deal with in this example, stress. It could be anything there. Connecting with other people, like you said, or you know, all of that. And therefore, yeah, you're laying that groundwork so that now it's like alcohol isn't the first thing that you think about when you're stressed just because you stop naltrexone, it's like, well, no, I've been doing all these other things and that becomes the new, I'll say normal, or that's the goal, right? That that becomes the new normal. Yeah.

Frank Spinelli (31:03.816)

Right.

Frank Spinelli (31:22.311)

Right.

Frank Spinelli (31:29.417)

Yeah. Yeah, and I I think a lot of people put they're very quick to describe things, modalities like now trexone as a crutch. And I I don't necessarily see that at all. I think like if you had a if you had an infection, you'd take an antibiotic.

So why is it that we can't just think of these as therapeutic interventions to help us get past a period that we possibly just can't do on our own? And I think once you accept that, you can then say, okay, may maybe I can really consider if this is what's right for me.

Kevin (32:14.146)

Yeah. Well, and then I don't I don't know if this is a fair comparison, but I'm like the would those same people get a sprained ankle or something and not use a crutch? An actual crutch, right? I mean, it's there for a reason. It's to support us when we need extra support. And then what do we do? Then we do I you know, I had knee surgery. I couldn't put weight on my my leg for two months. And so I was crutching around, but I was also going to physical therapy.

Frank Spinelli (32:24.103)

Yeah. Mm-hmm. And it and it's

Yeah. I I totally agree.

Kevin (32:43.867)

And doing things to help strengthen this. And you know, you can make that same kind of comparison here. And yeah, crutches are useful.

Frank Spinelli (32:44.049)

Right. You were doing

Frank Spinelli (32:53.353)

Crutches are useful. People need crutches sometimes. It doesn't mean you're a failure. It certainly doesn't mean you're less than. It just means that we're gonna try something new for you. And I think when you open your mind to the possibility of it and say to yourself, okay, let me try this. And and again, we're not pushing this because it's not right for everybody. Certainly there are people who just don't believe in taking medicines and for whatever reasons, or they're more naturopathic in their approaches, and that's all great. We celebrate all of that.

Kevin (32:56.95)

Yeah. Yeah.

Kevin (33:14.157)

Yeah.

Frank Spinelli (33:25.195)

If you want to go to AHA in combination, there are many different resources for you to utilize, but certainly it's important for everyone to understand what is available to them if they'd like to. The other thing that I want to point out, we talked about side effects. One of the other things that I think is important to talk about is contraindication. So I said that there is a good therapeutic index. There's very few drug-to-drug interactions or DDIs, so you can certainly take other drugs.

There are people that were asking on recent meetings about taking it with GLP1s, which we'll get into in a second. And the answer is yes. The one drug class you cannot take with naltrexone is an opioid. Why? Because it's an opioid receptor antagonist. So, example.

If you are going, if you're on naltrexone and you're doing great and you're going to have surgery, like a knee replacement, you have to tell your surgeon, hey, I'm on naltrexone. If you give me an opioid, it's not gonna work. I'm gonna feel pain. So we don't want you to feel pain. The bottom line is: one, you have to talk to your surgeon or whatever in this case and say, Listen, I'm on naltrexone. And here are the options. So one might be

Kevin (34:23.342)

Yeah. Yeah.

Frank Spinelli (34:47.133)

They give you something that's not an opioid painkiller, or there are options there. Or two, you may go off naltrexone for a period while you're in recovery. so the the important thing there is you do not want to take an opioid when you're on an opioid receptor antagonist because it will not work. So, so yeah.

Kevin (35:07.074)

Yes, that's a good good idea, 'cause yeah.

Frank Spinelli (35:10.175)

Cause you'll be in an emergency room going, wait a minute, I need more pain meds. Yeah, I bet. Yeah, I bet. Did you have a knee replacement? okay.

Kevin (35:17.026)

Yeah. I know my knee was not fun, so

no. I it my doctor said I had a pothole where my cartilage should have been. So i is the easy way to call is to to describe it. But yeah, I I had like an arthroscopic surgery in January of that year, which I I like to say harvested some of my cartilage and then they regrew it in a lab. And then in May of that year they opened

Frank Spinelli (35:41.597)

okay, good.

Kevin (35:51.723)

opened it up fully, not octoscopic, and then put it in there with a patch over it. And yeah, so it had if if I had a knee surge if I had a knee replacement I would have been walking on it the next day for therapy. but no, yeah, it was

Frank Spinelli (36:05.865)

Wow, you got like a harvested knee you it sounds it sounds very bionic. They grew they grew it in a petri dish on your ledge in the sunlight. Wow, that's interesting. So you had a pothole. Hmm. Was it an injury or?

Kevin (36:10.168)

Yeah.

It does, even though it's it's my it's my cartilage, I guess they regrew, so they say. I yeah. Yeah.

Kevin (36:25.846)

Yeah. No, 'cause yeah, we talked about that. I think he said he's like unless you came in and you just had a severe car accident or something, he's like like something like that that would have done this. He's like, it's usually it's more of a genetic thing that he sees. So I mean I played football, you know, into college and that, but I never had but I never had issues with my knees. So yeah.

Frank Spinelli (36:42.791)

Frank Spinelli (36:46.141)

Yeah, I was gonna say, did you play football?

Frank Spinelli (36:52.713)

What about termites? No joking. The cartilage. They eat they eat wood and cartilage. No, I'm joking. So yes. So that so any any more do you have any questions on now Trek Zone or are you fully, fully versed?

Kevin (36:54.51)

They were they were eating away the they were eating away the cartilage, yeah.

Yeah.

Kevin (37:10.274)

Well, I think when you said too, I think it was like twenty eight to thirty million people in the US alone, like that was a twenty twenty three number, with alcohol use disorder. I I feel like you know, there there's obviously you can go online and research what that is exactly and it it can be it's a spectrum, right? So I'd like to bring that up just because some people might be like, Well, I'm not bad enough to take that or

You know, keep because, you know, I'm putting bad in quotes there, right? Because it it's there there historically is black and white thinking and stigma around a lot of these things, which it's either I have a problem or I don't, and maybe if I'm taking out Trexone, this admits I have a problem or whatever. But it's it I don't think it has to. I mean, we talk about it in reframe all the time. It's like my my thought is is.

You don't have to get to a certain level except the level that doesn't work for you. And that could be like, I had a I had a drink last night and I woke up with a migraine and or it doesn't even have to be that. I I just didn't like it and anymore and I'm gonna stop. Like it doesn't have to reach any certain level, that is. But I mean, I know there are, you know, different levels to meet the sp specific criteria for alcohol use disorder, but I just like to share that I mean it's a spectrum.

So yeah.

Frank Spinelli (38:36.093)

And I I think any of those like definitions that we have about number of drinks are all relative because.

It you know, it's it really comes down to whoever's going to prescribe it needs to come up with some objective metrics to say Kevin came in, he's unhappy with his relationship with alcohol. He drinks X number of drinks, so therefore he qualifies for now traxome based on this definition. But like you said, it is a spectrum. And I think it really comes down to what we say all the time: if you're unhappy with your relationship with alcohol, then you probably

Kevin (39:00.419)

Yeah.

Frank Spinelli (39:13.889)

Have some form of alcohol use disorder just by definition of being unhappy and wanting a change. That's really what it comes down to.

Kevin (39:21.324)

Yeah. Yeah. But like you said too, the my example of the person who has one drink here and there, the doctor's probably maybe I'm not gonna say probably, but maybe not gonna prescribe it to that person. It's not doesn't make sense in that case. So but you but that's where you go.

Frank Spinelli (39:28.475)

Yeah, probably not.

Frank Spinelli (39:33.68)

Yeah. Well, it it would be but it would warrant a conversation and certainly talking about what's going on in their life. There are other things that that make people predisposed to drinking and not being happy about it. And I think that would be, you know, really maybe they just need a a good coach like Kevin. So any other now trexone related questions? I'm trying to think if I have.

Kevin (39:52.054)

Or Frank.

Kevin (39:56.472)

Nice.

Kevin (40:00.412)

I do not think so.

Frank Spinelli (40:03.391)

Trying think if there's any. I had a picture for you, but I can't show it to you now. But yeah, we went over the side effects, we went over the contraindication, basically to

Kevin (40:11.874)

Are there people who take it and have just said, I've been taking this and I still get a buzz and I still feel the same? Like it does it just not work for some people, do you know have you s

Frank Spinelli (40:20.465)

Of yeah, of course. There's always there's always gonna be examples of people where it just doesn't work as successfully as it does for others. There are some people that certainly said they didn't notice any discernible changes or they didn't feel anything. And then that that's the key to for you to say, okay, well, how serious are you about this? again, e I think

What I want to really dispel is this idea that once you take the pill, you're like, doo-doo-doo, I don't need alcohol anymore. No, it's not that dramatic. I wish it was, but it isn't. It's very subtle. you'll just notice that it's not really pleasurable. That's the thing. It's blunted. I think that word has been used, and I think it is the best description. It just blunts the way you feel on alcohol, which is not pleasant.

Kevin (40:46.188)

Yeah. Yeah.

Kevin (41:07.042)

And I was wondering to let's see if you can you answer this question. Cause you know, I I like to think about like the, you know, dopamine. I I think typically with drinking, it gets whenever I start to crave alcohol, like, okay, I'm on my way home, I get home, like I think of dopamine being released there in the craving phase of it, because dopamine is also a motivation chemical from what I've

you know, seeing as long as well as pleasure pleasurable. and so it's it's motivating me to go get the drink. And then I get the drink and I might get a little bit of additional dopamine there. But since I gave myself what I wanted, I'm good. Whereas if I don't give myself what I want, I think, you know, the in my and and this is coming from a former accountant. So Frank's the expert here. but the

But like, you know, that my that dopamine rise, if I if it rises, like it's going to fall to counterbalance that. And so I'm going to feel a little bit lower if I don't give myself that drink. And I wonder, is it because my mind is expecting my brain is expecting this thing and I'm giving it to it, but I'm not really giving it to it.

Frank Spinelli (42:21.501)

Yeah, well yes, yes and no. So the idea that like at five o'clock you're driving and you know the liquor store is coming up, what you're experiencing with the craving is actually the brain reward system being triggered to pay back debt.

Your brain is like, remember, we gave you all the dopamine. Now we want it back. How do we get it back? You gotta go buy some alcohol. And so if you do, you're you know, you listening, you know, let's say it's not a bank, it's a loan shark, right? So you you bought you borrowed some money from a loan shark. The loan shark's like, five o'clock, we need you to go get whatever that alcohol is because we need to be paid back. One, you can say, no, I'm not gonna do it.

Kevin (42:45.644)

Yeah. Yeah.

Kevin (42:56.13)

Yeah, I I like that. Yeah.

Frank Spinelli (43:09.553)

I I'm just not gonna get on that merry-go-round. It's always gonna be a high interest rate and I'm never gonna be able to pay them back because that's the truth. You're never gonna be able to pay them back. Or you go and you buy.

Whatever that bottle is, and you drink it, it's still not going to pay them back because they're not getting all the dopamine that they would have gotten. So the idea is that the craving is just trying to launch you into getting it. And so again, it's the behavior loop that you're getting from using nowotrexone, which is the blunted response, the negative feedback, and you're not getting those cravings anymore because it's just not going to give you the.

The response you desire, which is the euphoria, which you don't get.

Kevin (43:53.847)

Yeah. I like that. I'm gonna have to think of that that whole metaphor more.

Frank Spinelli (43:57.738)

We have we had to think of it a we had to think we went from accountant to loan shark to bank. Okay, we did it. So yeah, we won't we won't, but you know, my cousin Rocco will be there with a bat.

Kevin (44:03.928)

Yeah.

We we won't go to what happens if you don't pay the loan shark, so we won't go there, but you can use your imagination.

Frank Spinelli (44:15.207)

I don't know how he fits into this, but yeah. So there are other medical interventions for alcohol use disorder. obviously naltrexone is the gold standard by far. interestingly, it was for opioid dependence, I said back in the 80s, and then I believe it was studied in the 90s, and that's where the FDA approval with the combined study came from. There are other interventions, and we could just mention them, but they're

Kevin (44:17.466)

Yeah.

Frank Spinelli (44:42.483)

There are varying degrees reasons why people don't use them. One is called antibuse or disulfurum, which

If you drink on it, you will have a violently ill reaction. And I've seen it in ERs, and you do not want to see it. And the other one is a camprosate, which is which has been which has been used as well. And the only thing is you don't drink on it, and that more or less works on the GABA and the glutamate, which you know is also good. It's just, I believe, and I'm sorry, I'm gonna I'm gonna choke here. I wanna say it's too.

Pills three times a day. It's a lot. It's certainly not one pill a day. So that's what makes it a little bit tough. And of course, relatively speaking, these are very inexpensive drugs. Now, to segue, there is a new class of drugs, and you probably heard about it. I'm gonna just go out on a limb and say you've probably heard about it.

Kevin (45:25.507)

Yeah.

Kevin (45:42.424)

Just yeah, just go out on a limb. Not not a very far limb.

Frank Spinelli (45:46.848)

It's called GLP1s or a glucagon receptor. They're probably it everybody has heard of them at this point because they're everywhere. So glucagon-like peptide one is a is both a gut hormone that's your guts and a brain neuropeptide. And it was originally studied for appetite.

And for control of insulin. So the one that everybody probably knows is called semiglutide, which is also sold as ozempic. Ozempic is indicated for diabetes for the insulin regulation. And then there's wagovi, which sounds like a Japanese steak to me when I think about it. And that is for weight loss. And it is a synthetic GLP1 receptor agonist, not an antagonist like naltrexone, and its effect on alcohol.

was discovered incidentally. And by the way, that's way a lot of things are discovered. I mean, that's how we found that finesteride grew hair. And and I mean we could go on and on on where we found out that the secondary effects of medications work for other ways that are actually beneficial. So patients taking it found that their metabolic conditions began to spontaneously report

Reductions in alcohol cravings. So it looks like GLP1s are in the process of doing a large-scale study for alcohol use disorder. Now just as an aside,

GLP1s, man, they're like, they're taking the world by storm. And and probably for really good reason. I I I talk about this example, but I have a cousin, and we recently ran into each other at a funeral, and he had diabetes, hypertension, he was overweight, he has rosacea. I mean, just a lot of things. And when I saw him, I was like, What? You look great. Well, like, what's going on? And he goes, Yeah, I'm Anozempic.

Frank Spinelli (47:51.448)

And I dropped fifteen pounds, my rosacea cleared up, and my diabetes has never been better. And I was like, wow.

So, I mean, when you when you think about it, I mean, I I I mean, I'm not joking, you guys. It it looked almost like the guy got plastic surgery. He looked great. I was like, when'd you get Botox? He just looked really healthy and not like he lost all this weight. I mean, I've noticed we've seen people on TV who have gone too far. He just looked like he dropped a few pounds, which he did. and so of course, it was definitely indicated as an anti-inflammatory, it was helping.

Kevin (48:10.53)

Yeah.

Kevin (48:21.421)

Yeah.

Frank Spinelli (48:29.697)

People with their insulin and their sugars, certainly, certainly to lose weight. It's very well documented. But now, now, lo and behold, we have this new possible indication that's coming for alcohol use disorder. And again.

Just to give you a bit about why it works. So GLP1 is synthesized in the brainstem, right? And it projects directly to the ventral tegmental area. Sorry. You know, it I don't know why, but I think everybody knows that when I'm recording, there has to be visitors. So, and my poor dog can't okay, yeah. Sorry. All right, wait, hold on, let me see.

Kevin (49:07.522)

Yeah, yeah. If you want to start over, feel free. No, that's not a big deal.

Frank Spinelli (49:16.403)

gosh. Anyway. Yeah, mark it there. Okay. So my god. My poor dog. Anyway, so

Kevin (49:17.676)

I marked it too, so

Frank Spinelli (49:27.705)

GLP1 is synthesized in the brainstem neurons and it projects directly to the VTA, the ventral tegmental area and the nucleus acubins. If you know anything about alcohol, this is where we're talking about the circuits that reinforce alcohol's effects. And this has a neurological action. So it's not surprising that it actually diminished the cravings. And so alcohol's reward, as we said, depends on dopamine, that real burst that you get from that loan shark. And G1.

GLP1s decrease the dopamine release. So again, if you're on a GP GLP one, you're not getting that release. So even if you did listen to the loan shark, and even if you did go to the liquor store to pay them back, you will not get the dopamine and you will not make the cut for the week and your percent interest is going to go up. And this has been shown in neuroimaging. I mean, all of this has been shown, even

with other studies. And the other part of it is is that semiglutide has increased the GABA. And so what alcohol does is throws that off into disequilibrium. And so then you have it going back into where it would be. And then beyond that,

GLP ones really affect stress and cognitive function. So they're driving lower rates of relapse, which is really significant. And I think if they can show that in a clinical trial that there was lower rates of relapse because people were on GLP1s for another reason or for because they were on for alcohol. I mean, I think you're gonna see a huge change in the way we approach alcohol use disorder for individuals who really need a medical intervention.

Kevin (51:10.21)

Yeah. Yeah. And when i So is that

You said that's coming, that cl those cl th those are the clinical trials coming, but now it is very much reported that yeah.

Frank Spinelli (51:19.059)

Mm-hmm.

Right. I mean, certainly yeah. I mean you could certainly get it as an off label use. I mean the semiglutide is approved for diabetes and obesity. And remember, as I said, as Ozempic and Wagovy, it is not indicated as of yet. It's imminent, but the phase three trials are in progress. it'll definitely get read out soon.

Kevin (51:33.581)

Yeah.

Kevin (51:40.856)

Yeah.

Frank Spinelli (51:47.7)

But I believe the trial was is done. So I think it's just a matter of getting the FDA approval. But regardless, I think the real take home here is that this will be another offering, correct? From Reframe Med.

Kevin (52:01.546)

Reframe med, yeah. Yes. Coming soon, yes. I know. yeah.

Frank Spinelli (52:03.891)

Wow, so can you believe that? That'll be interesting to see what the what the reception is for that.

Kevin (52:14.222)

And I have had clients who have been on a GLP one for I don't want to say what I was gonna say for weight loss specifically versus diabetes, but I don't wanna I can't confirm or deny that really. But it's and and have had good results as far as the cravings reducing or being eliminated, but a lot a big reduction in in that. and as I mentioned, you know, to you.

earlier that when we started we were like, we'll talk about this. I was like, well, just so you know, I started I started using Wigovi three weeks ago too, not through Reframe Med since that's not out yet, but

Frank Spinelli (52:53.663)

Wow. So so so spill the tea, Kevin. How's it going?

Kevin (52:59.144)

it is it's been it's been very interesting. And I'm actually glad I did it for many reasons, but you know, just so the fact I can I know what happens. because and mine was for weight loss and yeah, like Ozempic and those things. My doctor, you know, I looked at things on places online who prescribe and and then I went through my doctor to see, okay, can I get this through insurance? And and most of the w

Frank Spinelli (53:10.707)

Ha ha.

Kevin (53:28.866)

things that he could prescribe me through insurance were only if I was, you know, had diabetes specifically. Like Ozempic was one of those. He told me. and so, you know, I went through doesn't matter how I got I went through my doctor to get the I I went with Wagovi. And I'm I'm only again I think I'll take the fourth dose tomorrow. I'm three weeks in. but it is definitely been interesting. And

I could see it being it's something that I've definitely had to I've said definitely a lot here, I feel like. I've definitely had to get get mindful about really quick as far as I'm like, okay, how how much, you know, just how much do I need to eat? What do I need to eat? And changing that because, you know, it it does change immediately food what I call food noise.

Frank Spinelli (54:05.328)

Yeah.

Kevin (54:27.116)

that like that is because I I I'm more of a I would fall into the category of a binge eater and usually and it kind of plays in with I'm also I also have ADHD in case you haven't watched the podcast before. and I'm I do take Adderall for that. And and so that's one thing that I watch and was worried about from the start is while while Adderall doesn't typically as a stimulant

suppress my appetite anymore now that I've been on it for a few years. But I know initially it definitely did. But I also have an issue with you know making sure I'm consistent with eating or, you know, I'm busy and I go from one thing to the next and I forget about that. And then I get to the end of the day and I'm ravenous and I that's where like the binging comes in. So this has made me again, like you said, it's not a magic pill because now

Frank Spinelli (55:02.321)

It's Ed, right.

Kevin (55:24.364)

You know, yeah, sure, I've lost weight already, but I've also changed how the things I'm eating, how I'm eating, how often I'm eating, how I'm getting reminders for that, what I'm tracking. And I'm just being more mindful. So it's it's definitely shut shut the c you know, shut off the food noise. Almost almost immediately. It was surprising.

Frank Spinelli (55:50.836)

You know, I it's so interesting you said that because I just brought up a document because I was looking at the GLP one one pager that I created and there is a study, I won't read it to you, it but it was with diabetes, obesity, and metabolism. And here is the verbatim quote.

Kevin (56:00.899)

Mm-hmm.

Frank Spinelli (56:11.071)

Patients describe the same quiet around alcohol that GLP1 uses reported around food. And it's so funny you said the word noise because that seems to be the way people describe it. There is this quietness where that inner voice about have a drink or that inner voice of you're hungry is speaking to you, you will suddenly don't hear it anymore. so you that's really what you're describing.

Kevin (56:20.27)

Wow. Yeah.

Kevin (56:39.372)

Yeah, yeah. and

Frank Spinelli (56:42.109)

And when you do eat, can I ask, when you do eat, do you find that you're just full earlier?

Kevin (56:48.448)

full earlier I I've already started a I'm pretty quickly started adjusting like what my portions are. Yeah. And I I you know I'll spread out, you know, I'll order things that and I could tell you about you know things I've done or you know, I I use Claude AI to I ask a lot of questions in AI about like, well what should I do here? How should I, you know, what's my minimums my chiropractor the other day I told him about it.

Frank Spinelli (56:55.689)

To the amount.

Frank Spinelli (57:04.731)

Ha ha ha.

Kevin (57:15.66)

Because he was asking other questions and it kind of related and he's like, Well, he you know, I I knew he I I didn't think he would be based on like his books he has and like the way he goes about it, he wouldn't be maybe on board with doing this, but just his personal views, I guess, i is how I look at it. but he's like, make sure you're 'cause I was like, Yeah, I'm making sure I'm getting, you know, enough protein and all that. And he's like, Well, yeah, he's like, one

One gram of protein for you know every pound of you know body the body weight that you want to have or whatever. And I'm I'm like I'm like I'm like, holy shit. I'm like, that's I'm like, I wanna be 205. you know, and but I'm like that's a lot of protein. And so I went into I went into Claude and asked yeah, let's pull the research. And obviously I have to check it still too. I don't rely on that solely, but

Frank Spinelli (57:51.455)

Yeah, I could see that.

Frank Spinelli (58:05.114)

Ha ha ha.

Frank Spinelli (58:10.407)

huh.

Kevin (58:13.644)

It's like actually what he's thinking of is more you want one gram per lean body weight. Yeah, not total body weight. And and so yeah, your muscle mass. And so I'm like, okay, that makes a lot more sense. And he's like it's he clawed it's like point seven to one gram, not yeah, so i people everybody has a opinion about a lot of things and that there's there is research out there that you could look at for

Frank Spinelli (58:20.051)

Body lean yeah, lean lean muscle mass, yeah. No.

Frank Spinelli (58:34.621)

What did definitive one go?

Kevin (58:43.362)

this, but you know, I like data. You know, I have like I like have an aura ring for four years now. And I actually I actually got I know I got I got my continue because they offer the continuous glucose monitor. So I got that. And that's actually been helpful because I'm I've been I don't like to track you know as far as habits are concerned. Like if I'm trying to change how I eat, there's a lot of different habits that are involved there. And then if I add on

Frank Spinelli (58:48.607)

I know. You're like a walking experiment.

Kevin (59:12.598)

like tracking calories and things like that. That's just a lot more work and I tend to be perfectionistic about it, which then I'm weighing stuff and I do that. When I go down that rabbit hole, I know it's like two day I have two days before I stop doing what I'm doing as far as the food's concerned. Because the second I miss one of those, you know, meals or whatever, I'm like, well, I'm not perfect. So I might as well just eat whatever I want and stop tracking. I have that tendency.

Frank Spinelli (59:14.803)

Yeah. Yeah.

Frank Spinelli (59:28.735)

I say.

Frank Spinelli (59:36.815)

you you you empty your your fuck it bucket.

Kevin (59:42.382)

yeah. And and so I like I like apps that do like I can take a picture of it, AI analyzes it, tells me what a media. I'm like, sure, that's close enough.

Frank Spinelli (59:52.574)

You know, I I really well, thank you for sharing that. I love like listening to the the way you're approaching this. It seems like you're being very mindful about it and certainly utilizing all the resources that are provided to you. And I'm sure, sure, sure, you're going to be paying attention to your appearance, but also how you feel physically and you know, working out and and you're gonna see changes in your body, obviously. But it's what I find really, really funny,

Not that it's funny, I find it, you know, interesting, is that you're also incorporating AI. And when I think of the two things that have become villainized, it's AI and GLP ones. People have such an aversion to technology and such an aversion to the GLP ones as though, as though.

Kevin (01:00:30.33)

Yeah.

Frank Spinelli (01:00:45.159)

The technology is too good or too fast that we can't accept it. Like, you're you're cheating. That's the word people use. You're cheating by being on a GLP one. You're cheating by taking outrexon. You're cheating using AI. And I kept thinking to myself, don't you use spell check?

Kevin (01:00:55.267)

Yes.

Frank Spinelli (01:01:06.419)

Didn't we didn't don't we all use spellcheck? It's now it's just part of the way we integrate how we type. I mean, why wouldn't you use something as a modality? I don't think it's going to replace us. Maybe one day it will replace us, but certainly it's it's user-dependent. So if you're going to commandeer your

Kevin (01:01:20.119)

Yeah.

Frank Spinelli (01:01:28.871)

restriction on alcohol from your life, you're certainly at that point where you're going to be managing the way you use GLP ones and certainly how you use AI in association with that, you know. I don't know.

Kevin (01:01:41.401)

Yeah. Yeah. Yeah. And that's exactly. And and yeah, talking about like the yeah, it's being villainized and I'm an early adopter, so this isn't early for like GLP one, but I'm just saying like I I have no problem trying new things if I can. But you know, I've heard that. I I think my wife recently said that. Well I'm gonna

keep trying, you know, before I even think about doing that, I'm gonna keep trying to get it. And for me, I was like, okay, I've been trying for I I was feeling, you know, I was in a good space myself like two years ago or so. A lot of things happen. I've had back issues that I could I've I've used as an excuse. I recognize that in the past. But also it's like I take two steps forward, a couple steps back a lot of times when

Frank Spinelli (01:02:22.431)

Right.

Kevin (01:02:35.99)

I get going on things and I'm I'm working on that's why I'm going to the chiropractor and doing other things. I'm I'm adding in again, it's that I can't just do that. I have to focus on fixing this. And I want to build something that, you know, I'm not gonna be on this forever. So I wanna make sure that once I get to a point where I'm comfortable getting off of it, I have these things in place. And, you know, if if using AI to help me, like

Frank Spinelli (01:03:00.957)

Yeah.

Kevin (01:03:04.97)

Like I'll I'll go in and ask it like we wanna order from, you know, or we wanna go to a certain restaurant or we wanna order food in. I'll I'll just be like, where do you where you guys want to eat? And I'll go and I'll I'll I'll throw in a I have a project in there. I'm like, all right, we're eating here tonight. What should I get? And I just say, 'cause it knows like all what I'm doing as far as like what I'm taking that, so you know and how much I can eat. and so it recommends things.

Frank Spinelli (01:03:08.862)

Ha ha.

Frank Spinelli (01:03:15.656)

Ha ha ha.

Frank Spinelli (01:03:19.847)

Hmm.

Frank Spinelli (01:03:23.443)

The noise.

Kevin (01:03:32.671)

And I I've almost tried to just like be like, All right, I'm gonna take that, you know, instead of taking away the decision fatigue of this and

Frank Spinelli (01:03:42.087)

physici the decision fatigue and also the amount of time you'd probably spend researching it.

Kevin (01:03:48.013)

Yeah, yeah, yeah. And it just pops up and it looks at the website and it comes back and be like, get you know, I'll I'll sometimes lead it too, because we'll be ordering from like this taco place here, and there's a there's a protein bowl that I like, which I thought was good, but I was like, I like I don't want it to tell me something different. So I'm like, I usually get this at this place. I'm like, is that good versus tell me what to get here? anyway. Yeah.

Frank Spinelli (01:03:52.222)

Yeah.

Frank Spinelli (01:03:58.784)

wow.

Frank Spinelli (01:04:08.607)

Yeah, yeah, yeah. yeah, well you leave it open-ended. Well I I I commend you for being honest and telling us. I also think, listen, I I think you're dispelling a lot of really negative myths about

crutches and cheating and taking the easy way out. I don't see it that way at all. In fact, I know a lot of people coming from families that eat and have eating disorders and and I and I don't mean to use that term

lightly. There are people who really struggle with eating. And then there are people who just eat. They love to eat. And certainly in my family, especially, you know, if you're not big, you're not healthy. And so there's a lot of negative there's net a lot of negative connotations to being thin or underweight or whatever. And we're not suggesting any of that. And we're also suggesting that you work with a healthcare team. But

I don't, you know, I'm one of those people where like stay curious, keep your mind open, learn, learn before you judge. AI seems to be scary for so many people. I think it's here to stay. It's not even like it's coming, it's here. Get used to it. And and as far as like the GLP ones, I mean, we're gonna be finding that there are a lot of.

Kevin (01:05:21.752)

Yeah. Yeah. Yeah. Yeah.

Frank Spinelli (01:05:33.304)

uses for them and it's certainly going to be expanding. And by the way, I think I've talked too about this on other shows, is my my day job is I work in research. We're being

motivated to use AI to design clinical trials that would have taken months or years to develop and AI is doing it very quickly. So think of it that way. Think about the it's it's not so much taking your role, it's about taking away the time that it takes to do it by humans.

Kevin (01:06:08.534)

Yes. Yeah.

Frank Spinelli (01:06:11.241)

Maybe we've been watching one too many sci-fi movie. You know, we don't I I keep going back to Alien where Bishop was that deranged guy who like, you know, was trying to Yeah, exactly. Terminator, Matrix, all of them. You don't want it.

Kevin (01:06:13.986)

Yeah, hey.

Kevin (01:06:18.922)

yeah. I always think of the Matrix or Termin or Terminator. Yeah. and that was and that was one of the other things like I I you know, yes, I'm I need I have I want to, you know, lose weight and that's a big part of it. for my health and, you know, helping my that's only gonna help my back, which then I can work on my back more and then work out more and

Frank Spinelli (01:06:45.351)

Yeah, exactly.

Kevin (01:06:47.21)

but there were other reasons too, which I'm not gonna get totally into, but I know there are there were there was this, I think it was called the Essence Trial. I that's what that's what I found in researching it, published in New England Journal of Medicine, April 2025. and it was it's it's the number the percentage I saw here, I found. So I you can again never also

Frank Spinelli (01:06:50.141)

No, no.

Kevin (01:07:12.728)

Forty-five percent of all the statistics I use are made up on the spot. But this one at least I have in front of me with research. but sixty-two point nine percent of semaglutide patients achieve mash resolution without worsening fibrosis. Yeah, with your f and fatty liver and that, which I was diagnosed with. And I saw that like and I and I was diagnosed with that in twenty eighteen and twenty nineteen and and I haven't, you know, I'm seven years alcohol free, but I I went back twice after that and

Frank Spinelli (01:07:16.443)

Ha ha ha.

Frank Spinelli (01:07:23.84)

okay. Would would mash, right, right.

Frank Spinelli (01:07:34.958)

okay.

Kevin (01:07:41.231)

for ultrasounds, which aren't the best way to measure that. And it was, you know, it still said fatty liver, but my liver enzymes are down and I'm not too worried about it. However, that's always in the back of my mind still. And I saw something last year about this, which kind of stuck in the back of my head. And that was the other reason that I kind of decided to, you know, if it's gonna help that too, like good. That that'll be a little bit more extra a little extra peace of mind, I think, for myself, but

Frank Spinelli (01:07:41.352)

Okay.

Frank Spinelli (01:07:51.239)

Mm.

Frank Spinelli (01:08:04.723)

Right, right.

Kevin (01:08:11.808)

Again, bonuses and you know, there's a lot of different things coming out about what it helps with.

Frank Spinelli (01:08:16.647)

Which is probably the best closing statement we can make, which is

None of these modalities are a one-size fits-all. Everybody needs to take what they can and go back to their healthcare provider with questions and see if they can tailor make something that would work for you because obviously everybody's different. And you know, who knew about you know the liver issues and the weight and the back? I mean, it's just very complicated and nuanced. And so the approach has to be just as nuanced. So good luck. I can't wait to follow this journey.

Kevin (01:08:46.147)

Yeah.

Kevin (01:08:49.644)

Yeah. Yeah. Yeah. Thanks. and and just here's my nugget, even though we don't have to do nuggets. was and then I'm not gonna get the exact quote right, but I remember listening to a Rich Roll podcast where Johan Hari was on because he came out with a book. He took Ozempic for like a year. This was a few years back, so I wonder how much has changed in the book. But the book is called, I believe, Magic Pill.

Frank Spinelli (01:08:52.341)

Yeah.

Frank Spinelli (01:08:58.687)

Yeah.

Kevin (01:09:17.91)

And he was talking about it. And you know, they were ri Rachel and him were on opposing kind of pretty much opposing sides of it. But he said something to the effect of, you know, this is a manufactured solution for us I don't know if he said somewhat, but I'll just add somewhat manufactured problem, right? With the f with our food industry and the you know, the way the way food is

Frank Spinelli (01:09:41.277)

Marketing industry, food industry, alcohol industry, culture, romanticizing movies.

Kevin (01:09:43.113)

Yes. For manufactured solution for a manufactured issue or you know, at least partly manufactured. I don't wanna put all the blame on on that, right? yeah, the the the TV ads made me do it. but you know, but you if you think about like the amount of science that goes into a Big Mac at McDonald's, right? So that it

Frank Spinelli (01:09:56.201)

Partially.

Kevin (01:10:10.272)

melts in your mouth immediately and the all the I mean, you know, it it is kind of I like that idea I like that thought that he threw out there, but that was just something that stuck with me.

Frank Spinelli (01:10:20.553)

Good one. I'll have to check out that book. Well, Kevin, good luck. Can't wait to see how this unfolds and learn more about it. We'll be waiting.

Kevin (01:10:24.387)

Yeah.

Thanks. And thanks, Frank, for sharing all of this information with us today. and you host a I'll do a little plug here, you host a typically weekly meeting related to Notrexone.

Frank Spinelli (01:10:40.623)

Yeah, on Wednesday, Wednesday evening, yeah, on medical interpret which will now expand to include GLP ones soon enough.

Kevin (01:10:48.162)

Nice.

Kevin (01:10:52.908)

to mark this because I just got signed out of my Google Drive where my outro is. Shit. Sign back in.

Frank Spinelli (01:10:56.66)

Frank Spinelli (01:11:09.3)

sh.

Kevin (01:11:13.622)

Mm.

Frank Spinelli (01:11:15.309)

god, I hate those passwords.

Kevin (01:11:24.622)

make sure, please, Pasky, continue. there we go. I just have to do this. All right.

Kevin (01:11:36.494)

All right, we're back.

Kevin (01:11:47.726)

All right, mark again.

Yeah, thanks, Frank. and yeah. Thank you all for listening to another episode of the Reframable Podcast brought to you by the Reframe app. Reframe is the number one iOS and Android app to help you cut back or quit drinking alcohol. It uses neuroscience to reframe your relationship with alcohol and unlock the healthiest, happiest you. If you're enjoying this podcast, please like, subscribe, and share with those you you feel may benefit from it. I wanna thank you all again for listening and be sure to come back for another episode. Have a great day.