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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.

Close up of glass of beer
Is the Sinclair Method effective?

How is the Sinclair Method supposed to work?

When using the Sinclair Method, patients take Naltrexone one hour prior to 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 by using medication to help patients gradually reduce their alcohol intake, they will experience fewer withdrawal symptoms. He also argues that this method will allow more people to get treatment, as the detoxification process can be a deterrent to people in need of care.

Selective extinction

Because the Sinclair Method tells patients to take the Naltrexone only prior to 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 in use.

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 using Naltrexone (only before drinking) indefinitely.

The Sinclair Method is meant to be paired with coaching or counseling to simultaneously help people cope with underlying drivers of their addiction and to develop strategies for dealing with cravings and triggers to drink.

Access should not be a barrier to help.

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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 are the side effects of Naltrexone?

Although serious side effects are rare, you should know what to look out 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:

  1. Abdominal or stomach pain (severe)
  2. blurred vision, aching, burning, or swollen eyes
  3. chest pain
  4. confusion
  5. discomfort while urinating or frequent urination
  6. fever
  7. hallucinations or seeing, hearing, or feeling things that are not there
  8. itching
  9. mental depression or other mood or mental changes
  10. ringing or buzzing in the ears
  11. shortness of breath
  12. swelling of the face, feet, or lower legs
  13. weight gain

More common side effects of Naltrexone include:

  1. Abdominal or stomach cramping or pain (mild or moderate)
  2. anxiety, nervousness, restlessness, or insomnia
  3. headache
  4. joint or muscle pain
  5. nausea or vomiting
  6. unusual tiredness

Long-term use risks include:

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 taking 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 with 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 timeline treatment for looks like, and the commitment level they need to have in order 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 for me. If I have to take a pill before I consume something for the rest of my life that has potentially harmful side effects, my preference is to avoid that substance altogether.

Proponents of TSM will 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 you have to take 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 really 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 towards 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.

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