The Sinclair Method: Everything You Need to Know
When it comes to recovery from alcohol addiction, there is no one-size-fits-all approach that works.
Although I personally believe that an abstinence-based approach is best in the long term, it doesn’t mean that other methods can’t (or won’t) work for individuals with different needs.
The Sinclair Method is a medically assisted approach to reducing alcohol intake that has gotten a lot of buzz in recent years. Here’s what we know.
What is the Sinclair Method?
The Sinclair Method (TSM) is a treatment for alcoholism that uses medical intervention to help people drink less.
It is the brainchild of Dr. John David Sinclair and operates on the premise that taking the opioid blocker, Naltrexone, while drinking can teach the body to drink less. It is an alternative alcoholism treatment to abstinence-based programs.
How is the Sinclair Method supposed to work?
When using the Sinclair Method, patients take Naltrexone one hour before drinking. The medication blocks the opioid receptors in the brain from receiving the reward of alcohol.
Our brains associate alcohol with pleasure. Naltrexone blocks the pleasure receptors in the brain, which dulls the rewarding effects of alcohol.
You can still get drunk on Naltrexone and feel a “buzz” of sorts. However, the longer a person is on Naltrexone, the less pleasurable drinking becomes.
Advocates of TSM say that with this method, users will eventually desire alcohol less and may even quit drinking altogether.
Three distinctive features of TSM
In his clinical trials, Dr. Sinclair noted three distinctive features of the Sinclair Method that differentiated it from other alcohol treatment programs.
No prior detoxification
Because Naltrexone can be taken while still drinking, there is no requirement for patients to go through alcohol detox before starting treatment.
Dr. Sinclair suggests that using medication to help patients gradually reduce their alcohol intake will experience fewer withdrawal symptoms.
He also argues that this method will allow more people to get treatment, as detoxification can deter people seeking care.
Selective extinction
Because the Sinclair Method tells patients to take the Naltrexone only before drinking, it eliminates or reduces the potential for medical interference with other pleasurable experiences like eating delicious food or sex.
This allows users to limit pleasurable activities to days when alcohol and Naltrexone will not be used.
Treatment continues indefinitely
Patients using TSM will continue to use Naltrexone when drinking indefinitely.
In Dr. Sinclair’s preclinical trials, rats that stopped Naltrexone eventually returned to pre-treatment drinking levels.
Clinical trials in humans showed similar results. Therefore, the Sinclair Method recommends indefinitely using Naltrexone (only before drinking).
The Sinclair Method is meant to be paired with coaching or counseling to help people cope with the underlying drivers of their addiction and develop strategies for dealing with cravings and triggers to drink.
What is The Sinclair Method’s success rate?
In the initial trials, Sinclair found that patients were able to quit drinking within 4-6 months, and 78% of participants were able to quit.
To put that into perspective, the success rate of AA is under 50%, and some critics have argued it may even be closer to 5-10%. However, there is nuance to this discussion as some people relapse and then return to AA to continue their sobriety. Does that count as a failure?
It’s also important to note that in both cases, people who combined TSM or AA with traditional in-person counseling faired much better in the long term, so it’s hard to examine efficacy in isolation.
That being said, the success rate for TSM is impressive.
Naltrexone for Alcohol Dependence
Because Naltrexone is integral to the Sinclair Method, here are some commonly asked questions and answers about the drug you should know.
What is the success rate of Naltrexone?
Clinical trials have shown that participants who completed a 12-week treatment program that included 50 mg of Naltrexone and counseling saw significant improvements.
Of the 54% of participants who completed the program, 39% abstained from alcohol by the end of the program. Within the same group, 86% of participants who continued drinking while taking Naltrexone consumed less alcohol after 12 weeks.
This is to say that people who stick with their program experience promising success rates. That means consistently taking Naltrexone before drinking and attending counseling or coaching sessions.
Is Naltrexone the same as Suboxone?
No, it is not.
Naltrexone is an opioid inhibitor that can be used long-term and is non-habit forming. Suboxone, on the other hand, has two main ingredients: Buprenorphine and Naloxone.
Like Naltrexone, Buprenorphine acts as a partial opioid inhibitor but is also classified as an opiate. Naloxone works to reduce the effects of opioids. It is primarily used to treat opioid dependency.
Suboxone is mostly used to help opioid-addicted people manage withdrawals and prevent relapse and overdoses.
Unlike Naltrexone, Suboxone can be habit-forming and is not for long-term use. It is a Schedule III controlled substance and can only be prescribed by doctors with special training and certification from the federal government.
What are the side effects of Naltrexone?
Although serious side effects are rare, you should know what to look for and when to seek medical attention. The Mayo Clinic provides a comprehensive list of known adverse effects of Naltrexone.
Serious side effects of Naltrexone include:
- Abdominal or stomach pain (severe)
- blurred vision, aching, burning, or swollen eyes
- chest pain
- confusion
- discomfort while urinating or frequent urination
- fever
- hallucinations or seeing, hearing, or feeling things that are not there
- itching
- mental depression or other mood or mental changes
- ringing or buzzing in the ears
- shortness of breath
- swelling of the face, feet, or lower legs
- weight gain
More common side effects of Naltrexone include:
- Abdominal or stomach cramping or pain (mild or moderate)
- anxiety, nervousness, restlessness, or insomnia
- headache
- joint or muscle pain
- nausea or vomiting
- unusual tiredness
Long-term use risks include:
- arthritis
- respiratory problems
- liver damage
Critiques of the Sinclair Method
With advocates boasting an 80% success rate, it begs the question, “Why doesn’t everyone use the Sinclair Method to treat alcoholism?”
There are a few reasons.
First, alcohol dependence is not a purely physical phenomenon. Whereas Naltrexone looks promising for helping people manage the way alcohol interacts with their brains, the drivers of alcohol abuse are more complicated than that.
The Sinclair Method acknowledges this by recommending psychological therapy or coaching in tandem with Naltrexone. In this regard, compliance is critically important, especially in the early days. The success of TSM relies heavily on two things:
- Patients religiously take Naltrexone before drinking, and
- Doing the psychological work to deal with underlying drivers of drinking and learning how to cope with triggers.
Naltrexone may be an effective tool for teaching the brain to disassociate alcohol from pleasure, but it isn’t a magical pill. Taking Naltrexone won’t make the urge to get drunk or avoid problems by drinking disappear overnight.
The efficacy of Naltrexone takes time. It’s important for patients to have realistic expectations for what TSM can and cannot do, what the treatment timeline looks like, and the commitment level they need to achieve results.
Should you try The Sinclair Method?
I can’t answer that for you. Is it a miracle cure for alcoholism? No. Nothing is.
Can it be an effective treatment for alcohol use disorder? A 78% long-term success rate suggests that it can be. However, this is something you should discuss with a trained medical professional.
Personally, I choose complete abstinence from alcohol because that is what makes sense to me. If I have to take a pill before consuming something that has potentially harmful side effects for the rest of my life, I prefer to avoid that substance altogether.
Proponents of TSM say that taking Naltrexone before drinking is akin to diabetics requiring insulin for the rest of their lives. I find this analogy disingenuous.
Nobody needs to drink alcohol to live.
By choosing TSM, you are saying that you want to continue to drink, even if it means taking an opioid blocker beforehand for the rest of your life.
That being said, I also see the appeal for someone who has tried and failed multiple times to quit alcohol cold turkey. Maybe it could work for them.
It depends on the individual patient.
TSM is not magic.
If you are looking for a miracle cure, this will not work. Nothing will work because there is no miracle cure.
There is no pill we can take to turn off the desire to drink heavily.
We still have to show up to do the work, actively make better choices, and dedicate time to managing and seeking treatment for comorbidities like depression or anxiety.
There is no reason to think TSM could not be a pathway toward abstinence from alcohol. Nor is it the case that Alcoholics Anonymous or other 12-step programs are the only solutions for people who want to get sober or change their relationship with alcohol.
Ultimately, this is a decision you need to make with a trained medical professional who can help you weigh the benefits and costs of different approaches and make an informed decision based on your individual needs.
Want more resources on quitting drinking?
Hello,
I am an addiction professional who is seeking certification in TSM.