The Sinclair Method

The Sinclair Method For Alcoholism

The Sinclair Method for alcoholism is an alternative, evidence-based approach to abstinence involving the alcohol treatment medication, naltrexone, to reduce alcohol consumption. Many people assume that everyone who struggles with alcohol misuse or an alcohol use disorder (AUD) needs to give up drinking altogether. A common misconception about alcoholism treatment is that people can only be successful in recovery if they are abstinent. However, abstinence is difficult to achieve for some and can be a barrier to treatment.

The Sinclair method is named after Dr. John David Sinclair, a researcher who determined that naltrexone could diminish alcohol-pleasure seeking and its reinforcing effects. Naltrexone is an opioid antagonist that binds to the mu opioid receptors in the brain and blocks the activity of both exogenous opioids (like heroin and prescription painkillers) and natural opioids (endorphins) that are responsible for the feelings of euphoria. When naltrexone is in the body, the dopamine-driven euphoric rush is diminished, which reduces cravings for pleasurable seeking drugs, specifically alcohol and opioids.

Sinclair found that when a person consumes alcohol one hour after taking naltrexone, they don’t get the pleasurable “buzz” from that first drink and, as a result, don’t crave a second or a third drink. Because people feel less pleasure when they drink, they often find it much easier to drink less.

A reduction in alcohol consumption can have a drastic and positive impact on physical and mental health and can decrease the likelihood of alcohol related injuries and deaths.

How The Sinclair Method Works

Alcohol, in the short term, makes you feel good, and you continue to drink to keep chasing that dopamine cycle. The goal of the Sinclair Method is to break that dopamine-euphoric cycle, eliminating the pleasurable effects of alcohol and therefore reducing the cravings and urges to drink, ultimately leading to a reduction in alcohol consumption. An example timeline of using the Sinclair Method to minimize alcohol consumption could look like this:

• If a person plans to drink, they will take naltrexone and wait one hour before consuming their first drink.
• While drinking, the naltrexone blocks pleasurable feelings, and you may not get that “buzz,” which will then reduce urges and cravings to have a second or a third drink.
• The person continues to use naltrexone every single time they consume alcohol.
• There are fewer rewarding and pleasurable feelings, which reduces the urge to consume more alcohol.
• Over time, alcohol consumption may completely cease because there is no more pleasure in drinking.

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Commonly Used Terms In The Sinclair Method

Naltrexone Wall

An hour after taking naltrexone, the blood concentrations of this medication are at their highest, meaning that the endorphin receptors are blocked, thereby preventing the euphoric feeling that occurs when alcohol is consumed.

The Sinclair Method was created for people to take their first drink after an hour from using naltrexone, creating a “wall” that prevents the alcohol induced euphoria or “happy drunk feeling”. This first drink, without naltrexone, usually triggers a craving for another drink and possibly even a third. However, with the buildup of the “naltrexone wall”, the desire for a second drink is less than the first, with the hopes that the person stops drinking because their cravings are greatly diminished.

However, after 4-6 hours from the initial dose of naltrexone, this wall becomes weaker because the maximum naltrexone concentration in the blood has worn off and is being metabolized. A second drink can break this wall, and a relapse can occur. Due to naltrexone’s concentration in the blood, some individuals may require a second dose of naltrexone or a higher initial dose to ensure this “wall” remains effective.

Extinction Vs. Abstinence

In the Sinclair Method, extinction refers to the learned process of gradually reducing a behavior (in this case, drinking) until it becomes minimal or disappears completely. Extinction targets the underlying cravings and weakens them over time. In contrast, abstinence is simply the act of not drinking. A person can be abstinent without having extinguished their cravings, which may make it harder to maintain sobriety. Abstinence is often linked to detox and participation in formal addiction treatment programs.

Slip Vs. Relapse

A slip is a short and isolated incident of using alcohol or drugs after a period of extinction or abstinence. Slips are considered temporary deviations and are not complete abandonments from the recovery process. A slip may involve forgetting to take naltrexone before drinking or drinking more than intended on one occasion.

A relapse is a more significant return to addictive behaviors that encompasses going back to previous patterns and behaviors associated with drug and alcohol use. A relapse may include not taking naltrexone on multiple occasions and returning to heavy, uncontrolled drinking.

Do I Have To Quit Drinking With The Sinclair Method?

The Sinclair method is based on the theory of extinction, which means slowly reducing the amount of alcohol over time. It does not mean that you have to quit drinking (unless you choose to) but instead focuses on reducing alcohol consumption in a healthy manner.

Pros And Cons Of The Sinclair Method

The Sinclair Method is an individualized treatment approach to help people reduce or even quit drinking.

Pros

One of the key benefits of the Sinclair Method is that it appeals to individuals who are not interested in quitting drinking altogether but want to reduce their consumption. Therefore, this method generally casts a broader net to help people embrace the health benefits of reducing their alcohol intake.

• Flexibility: The Sinclair Method offers a flexible approach, allowing individuals to continue drinking while using naltrexone in a controlled setting at a significantly lower level. It also allows people to continue with their daily routines, as this method can be done at home as opposed to requiring admission to a detox and alcohol treatment program.
• Accessibility: Naltrexone is easily accessible as any licensed medical provider can prescribe this medication, and it can be taken anywhere and at any time if the person is planning to drink. People can plan healthy dopamine activities, such as exercise and cooking, on non-drinking days and plan to take naltrexone on the days they do feel the desire to drink, giving patients accessibility and flexibility so that they can control their alcohol consumption in a healthy manner.
• Affordability: Naltrexone, when taken on occasion and in targeted situations, is more affordable compared to taking naltrexone every day or enrolling in an addiction treatment program.
• Active involvement: People must be actively involved and committed to the Sinclair method as they plan out when they will drink alcohol, because they must take naltrexone one hour before drinking. Since people are actively involved in this process, it provides a sense of empowerment and control over their drinking and recovery.

Cons

• Results take time: The extinction method used in the Sinclair method is a gradual process that takes time (3-12 months) and requires a lot of patience and control.
• Lack of community support: Unlike enrolling in the 12-step program or attending group therapy in an alcohol rehab program, the Sinclair Method does not require any group therapy or community meetings, which can often feel isolating. Addiction recovery is often based on a strong support system, and the Sinclair Method is not built around community support.
• False confidence: Using naltrexone to help reduce your alcohol consumption can give false hope that you are improving in your alcohol recovery process, but you still may need a lot of work, especially without the help of naltrexone.
• May prevent people from seeking psychological support: The Sinclair program uses naltrexone without any other avenues of alcohol treatment, such as group therapy or community groups. Oftentimes, people struggling with alcohol use may have underlying co-occurring mental health disorders, such as depression or anxiety, and may benefit from seeking psychotherapy.
• Impaired driving and coordination: Naltrexone can impair driving and coordination, and therefore, people who drive under the influence of alcohol may have worsening problems while using naltrexone.

Success Rate Of The Sinclair Method

According to the Sinclair Method website, this method has a 78% success rate; however, “success” is subjective in this context, as it is not measured by abstinence, but rather by how the person perceives their own success. If an individual feels they have cut down on drinking, that is deemed a success. If someone feels they have reduced cravings and urges to drink alcohol after being on naltrexone, that is considered success.

Who Is The Sinclair Method Appropriate For?

The Sinclair method is appropriate for anyone who struggles with alcohol misuse and wishes to cut down on drinking but may not be interested in complete abstinence.

The Sinclair Method is not for people who consume large amounts of alcohol and are at risk of alcohol poisoning or alcohol withdrawal. The following are also contraindicated:

• Those with poor social support
• Those with a seizure disorder
• Those with liver disease

How Do I Get Started With The Sinclair Method?

If you are interested in starting the Sinclair Method, consult your healthcare professional to determine if they are comfortable prescribing naltrexone to you or if they will refer you to someone who is.

While the Sinclair Method can help those who are sober curious or who would like to adjust their drinking patterns, it’s important to note that those struggling with severe alcohol addiction often require more structured alcohol addiction treatment that is found in inpatient and outpatient treatment programs. If you are struggling with alcohol addiction, explore our rehab directory or contact a treatment provider to explore your treatment options.