The Sinclair Method for alcohol addiction
What is the Sinclair Method (TSM) and how is it used to treat alcoholism?
What is the Sinclair Method and how does it work?
The Sinclair Method is designed to curb drinking. It is recommended to take naltrexone at least 30 minutes prior to drinking. The medication is an opioid antagonist that blocks the euphoric effects of alcohol. The goal is to retrain the brain to perceive alcohol as less pleasurable, reducing the desire for alcohol.
Usually, the enjoyable effects of drinking reinforce our habit of alcohol consumption. The Sinclair Method is designed to break that habit by overwriting the good vibes we associate with alcohol. The fancy name for this technique is “pharmacological extinction.” This process is moderation-based, with a focus on reducing heavy drinking days and regaining a sense of control, rather than abstinence-based.
What is the medication used in the Sinclair Method?
Naltrexone, in pill form, is the medication utilized for the Sinclair Method. Naltrexone fills and blocks the opioid receptors in the brain.
“The idea is that drinking alcohol causes pleasure by triggering the release of endogenous opioids in the brain,” Dr. Sarah E. Wakeman explains on Workit’s blog. She says, “Naltrexone, by blocking the opioid receptor, prevents these endogenous opioids from having an effect and that limits the rewarding and positively reinforcing aspects of drinking.”
Naltrexone is not a cure for alcohol use disorder, but it can be an aid for people hoping to cut down or totally stop drinking. The use of naltrexone can help decrease cravings, but it does not change the “ritual” or habitual behavior of drinking, so it can be helpful to include behavioral health support, like counseling, along with the Sinclair Method. Click here to hear author and actress Claudia Christian discuss the Sinclair Method on our YouTube channel.
Can Vivitrol be used for TSM like naltrexone?
No, but Vivitrol (a monthly injection of naltrexone) may be able to help you reduce your heavy drinking days. There is evidence that naltrexone in all forms can reduce cravings and decrease heavy drinking days. This includes its once-a-month injection form known as Vivitrol. In one study, treatment with Vivitrol resulted in 25% greater reduction of heavy drinking days than counseling alone. In another study, Vivitrol showed greater success with those who were totally abstinent from drinking for a week ahead of receiving the shot.
How is this different than The Sinclair Method? Jenny Williamson, Director of the C Three Foundation, explains: “TSM is technically called ‘targeted pharmacological extinction.’ Targeting the alcohol reward is the essence of what defines TSM and makes it what it is. Time-release methods of naltrexone are incapable of targeting … so while it is 100% true that there is the potential for Vivitrol to work for some people, there is never a case where Vivitrol can be used TSM on its own.”
As an injection, Vivitrol can also be more difficult for people to access than naltrexone in oral pill form, which most pharmacies are able to dispense with a valid prescription.
How long does the Sinclair Method usually take to work?
According to a survey from the C Three Foundation, more than half of the survey participants reduced their drinking by 70% in 6-12 months. Like any recovery method, The Sinclair Method isn’t an overnight fix, but a gradual solution.
What type of doctors prescribe naltrexone?
There are no regulations limiting what type of doctor is able to prescribe naltrexone in the U.S., so any licensed clinician is able to prescribe it. The more pressing question is whether they will, and whether they know how to administer and support medication-assisted treatment for alcohol use. Many doctors who do not specialize in addiction medicine are unaware that naltrexone can be used as a treatment for alcohol addiction, including for moderation.
Where can I go for treatment using the Sinclair Method?
Most inpatient treatment centers follow a traditional model of abstinence-based treatment, and won’t administer a moderation-based treatment. The Sinclair Method is more often supported in outpatient settings like medical offices. Workit Health offers naltrexone treatment utilizing The Sinclair Method for alcohol addiction in the states where we offer Workit Clinic. We serve these entire states via telehealth. If you aren’t in one of these states, you can refer to the C Three Foundation’s directory of in-person and telehealth naltrexone providers.
What are the risks and concerns about naltrexone?
Naltrexone is used to help people who have stopped drinking alcohol and using street drugs continue to avoid drinking or using drugs. Naltrexone should not be used by people who are still using street drugs or drinking large amounts of alcohol. Do not take any opioid medications or use opioid street drugs during your treatment with naltrexone. Naltrexone blocks the effects of opioid medications and opioid street drugs and can lead to precipitate withdrawal. Naltrexone may cause liver damage when taken in large doses. It is not likely that naltrexone will cause liver damage when taken in recommended doses. Other side effects may include nausea, vomiting, loss of appetite, headache, dizziness, mood changes, difficulty falling or staying asleep, drowsiness, and muscle or joint pain. For more information about naltrexone, see the naltrexone listing on medlineplus.gov, the full Prescribing Information, and Medication Guide, or talk to your healthcare provider. You are encouraged to report negative side effects of drugs to the FDA. Visit www.fda.gov/medwatch or call 1-800-FDA-1088.
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1. C. Garbutt, J.(2010). Efficacy and Tolerability of Naltrexone in the Management of Alcohol Dependence. Current Pharmaceutical Design, 16 (19), 2091-2097. doi:10.2174/138161210791516459
2. Umhau, J.C. (2020). How the Sinclair Method Changed My Mind About Naltrexone and Alcohol Recovery. Advances in Addiction & Recovery, 8(2), 17-21.
3. Sinclair, J.D. (2001). Evidence about the use of naltrexone and for different ways of using it in the treatment of alcoholism. Alcohol and Alcoholism, 36 (1), 2-10. https://doi.org/10.1093/alcalc/36.1.2
4. Drink Reduction Over Time. (2017). C Three Foundation. https://cthreefoundation.org/drink-reduction-over-time-using-the-sinclair-method
5. Naltrexone. Substance Abuse and Mental Health Services Administration (SAMHSA). https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions/naltrexone. Accessed November 2021.
6. Heinälä, P., Alho, H., Kiianmaa, K., Lönnqvist, J., Kuoppasalmi, K., & Sinclair, J.D. (2001). Targeted use of naltrexone without prior detoxification in the treatment of alcohol dependence: a factorial double-blind, placebo-controlled trial. J Clin Psychopharmacol, 21(3):287-92. https://doi.org/10.1097/00004714-200106000-00006. PMID: 11386491
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