What Is the Sinclair Method for Alcohol Addiction?

Alcohol can have a powerful grip on us. What starts as a seemingly innocent habit of drinking a glass or two of wine after a stressful day can spiral into a dependence on alcohol to function. While it might not seem all that problematic in the beginning, our mental, emotional and physical health often suffer as we consume more alcohol — and the longer we consume it.

Thankfully, we’re not entirely helpless. There are ways to reduce our alcohol consumption and take back control of our health. The Sinclair Method — or TSM — is one such option, and this post discusses what it is, how it works, and how effective it is in treating alcohol misuse. Let’s get started!

What Is the Sinclair Method?

The Sinclair Method is a form oftreatment for alcohol use disorder thatfocuses on reducing alcoholconsumption rather than abstainingfrom alcohol altogether. It’s namedafter John David Sinclair, a researcher who discovered that the medication naltrexone could be used to block alcohol’s pleasure-inducing effects. Naltrexone and the Sinclair Method are, therefore, intimately linked.

He first observed the effects of naltrexone on drinking behavior in animals, finding that the longer animals who had been trained to drink were deprived of alcohol, the more they would press a lever to obtain it. Sinclair termed this phenomenon the “alcohol deprivation effect,” comparing it to the increased alcohol cravings experienced by people with alcohol use disorder.

From there, Sinclair discovered that taking naltrexone before drinking would eventually cause animals to stop drinking. Over time, research found that naltrexone had a similar effect in humans with alcohol use disorder who wanted to cut back on their drinking.

What Is Naltrexone?

Before we continue, let’s take a moment to better understand what naltrexone is and how it can help reduce cravings for alcohol.

Naltrexone is an FDA-approved medication for alcohol use disorder. It’s what’s referred to as an “opioid antagonist.” What does this mean? In simplest terms, an opioid antagonist is a substance that obstructs the opioid receptors in the brain. It's like a key that fits into a lock but doesn't turn it. It's there, it fits, but it doesn't activate the lock. By working in this manner, naltrexone blocks alcohol’s euphoric effects and feelings of intoxication, letting us reduce our drinking or even halt it entirely.

When administered, naltrexone attaches itself to the opioid receptors in the brain. This attachment creates a barrier, preventing substances like alcohol from accessing these receptors and triggering the release of pleasure-inducing chemicals. So, even if we consume alcohol, the rewarding effects are diminished or entirely absent because naltrexone is blocking our brain’s access points.

How Does the Sinclair Method Work?

The naltrexone-based Sinclair Method works by reducing the reinforcement that people get when they drink alcohol. When we consume alcohol, our brain's reward pathway is activated, releasing chemicals that create feelings of pleasure and euphoria. This stimulation triggers our opioid receptors — key players in this pathway — which results in the sense of satisfaction that makes drinking so appealing. This pleasure-reward feedback loop can encourage repeated alcohol use, ultimately leading to misuse or dependence.

By taking naltrexone prior to consuming alcohol, the pleasurable feelings that drinking typically produces are blocked. Without those “feel good” feelings from alcohol, we’re less inclined to drink. Over time, as people continue to take naltrexone whenever they drink, they can break free from alcohol misuse.

Here is what the Sinclair Method looks like in action:

1. We take naltrexone one hour before consuming alcohol
2. We consume alcohol as usual
3. While drinking, the naltrexone blocks pleasurable feelings, and we probably feel like drinking less
4. We continue to use naltrexone every time we consume alcohol
5. Eventually, as drinking is no longer producing the desired effect, we may drink less or stop altogether

How Effective Is the Sinclair Method?

So, what is the Sinclair Method success rate? Research suggests that it can be very effective in helping people reduce their drinking. According to Sinclair’s research, the use of naltrexone to treat alcohol use disorder can have a 78% efficacy rate. While some people feel an immediate reduction in alcohol cravings after their first time drinking on naltrexone, it’s usually a gradual process that can take anywhere from a few months to a year.

In fact, part of its success can be attributed to its gradual approach. By slowly reducing alcohol consumption, people are less likely to experience serious alcohol withdrawal symptoms, including delirium tremens (DT). It’s also beneficial because it lets people be actively involved in their treatment, which can help them feel more in control of their drinking and recovery. Furthermore, the Sinclair Method is much more affordable than more intensive and costly rehabilitation centers.

On the other hand, treating alcohol misuse with medication only can remove someone’s incentive to pursue a comprehensive treatment plan that might include things like behavioral therapy or 12-step programs. Plus, to be effective, it has to be used consistently. It’s important not to view the Sinclair Method as “cure all” for alcohol misuse. To truly overcome alcohol misuse, a personalized, comprehensive treatment plan is often most effective.

Should You Try the Sinclair Method?

So, how do you know if you should try the Sinclair Method (and naltrexone)? If we’re interested in trying it, it’s important to talk to a doctor first. They can help us assess our current drinking behavior, medical history, and treatment goals.

In general, the Sinclair Method is a good option for those who are committed to making changes to their alcohol use. However, it’s most effective when combined with other treatment options, such as support groups or talk therapy, to get to the root of our alcohol misuse. While naltrexone can help reduce cravings, it’s important to understand why we’re drinking in the first place. For instance, many of us turn to alcohol out of boredom, to numb our feelings, or for social reasons.

It’s also important to be aware of naltrexone’s side effects. While the medication is generally well tolerated, it can have side effects that range in severity. The most common side effects include nausea, muscle or joint pain, headache, nervousness, and an upset stomach. Some of these side effects can be curbed by taking the medication with food and may lessen over time.

However, naltrexone can also cause more serious issues, such as blurry vision, diarrhea, confusion, increased blood pressure or heart rate, and liver failure or acute hepatitis. (So naltrexone could be dangerous to take if we have liver disease.) This is why it’s vital to talk to a medical professional to help determine the right course of action for us individually.

Pros and Cons of the Sinclair Method

While the Sinclair Method has worked wonders for some, it’s certainly not for everyone. Let’s look at the pros and cons of this approach in more detail.

Pros:

• A structured approach. For those committed to reducing their alcohol dependence, this method provides a structured way to stay on track.
• No decision fatigue. The beauty of the Sinclair Method is in eliminating “decision fatigue.” Once we make a decision to take naltrexone before drinking, the rest is a matter of chemistry.
• No feeling of deprivation. By reducing the pleasurable effects of alcohol rather than eliminating it altogether, we allow our brain to gradually see alcohol in a new way — as something we no longer need or desire.
• Active involvement. The Sinclair Method puts us in the driver’s seat — we decide whether or not to take the medication every day, and ultimately the power is in our hands.
• Reduced costs. When it works, the Sinclair Method helps eliminate extra costs associated with inpatient treatment or even daily use of naltrexone.

Cons:

• “Sanctioned” drinking. Because the method allows us to continue drinking (after taking naltrexone), we might subconsciously hold on to the belief that it’s “allowed” by our physician.
• Side effects. Like any medication, naltrexone has side effects (even when not taken daily).
• False confidence. We might feel as if it’s “safe” to drink as long as we take naltrexone before it. In reality, it’s still very possible to overdo it and even end up with alcohol poisoning.
• Narrow scope. There are many psychological and emotional factors involved in alcohol misuse, and it’s important that they don’t get ignored.

Other Medications for Alcohol Misuse

Apart from naltrexone, there are other medications that can be used to stop alcohol cravings and help treat alcohol misuse. Here are 3 of them:

Acamprosate

Acamprosate is another popular choice for people with moderate to severe alcohol use disorder (AUD). It’s FDA-approved and often used instead of naltrexone for people who can’t take naltrexone, such as those of us with liver problems or who use opioids.

Acamprosate helps rebalance chemicals in the brain that may have been altered by drinking too much. More specifically, it works by interacting with two chemical messenger systems in the brain: GABA (gamma-aminobutyric acid) and glutamate. GABA stifles certain nerve cells and may help control the fear or anxiety we feel when those cells are overexcited. Glutamate, on the other hand, stimulates nerve cells. These systems become imbalanced if we’ve been drinking heavily over time; acamprosate is designed to level them out.

Several studies have found that acamprosate effectively helps people reduce alcohol use, even after the medication is stopped. The usual dosage is 2 tablets 3 times a day. However, this timing and dosage might make it difficult to take properly, lowering its effectiveness.

Disulfiram

Disulfiram, otherwise known as Antabuse, is the oldest FDA-approved medication for alcohol-use disorder. While naltrexone and acamprosate are the most popular medications for reducing drinking, disulfiram might still be a good option for some of us.

The medication is an alcohol blocker: it prevents alcohol from being metabolized by the liver. If we drink alcohol while taking disulfiram, it causes an unpleasant reaction that helps discourage drinking. For instance, we might experience flushing, nausea, vomiting, difficulty breathing, sweating, low blood pressure, or heart palpitations. These symptoms usually last for about an hour and can happen as long as 2 weeks after our last dose of disulfiram.

Research has shown that disulfiram can help people reduce drinking. However, some studies show that it’s more effective when taken under the supervision of a family member, friend, or as part of a program.

Topiramate 

Topiramate is FDA-approved to treat seizures and prevent migraines. However, some doctors also use it to treat alcohol use disorder (AUD), as it helps rebalance chemicals in the brain and correct the electrical activity of brain cells.

While topiramate is not FDA-approved for alcohol-use disorder, studies have suggested that it can reduce alcohol cravings and withdrawal symptoms. In fact, the American Psychiatric Association recommends it as an option for moderate to severe AUD, including for people who haven’t had success with naltrexone or acamprosate.

Topiramate comes as a tablet and sprinkle capsule. It’s generally advised to avoid drinking alcohol when starting the medication, even though it’s been shown to be safe and effective in people who are still actively drinking.

Additional Treatment Options for Alcohol Misuse

Since naltrexone should be used as part of a more comprehensive treatment plan for alcohol misuse, it’s important to look at other treatment options we can pursue. Here are 4 effective options that can be used in combination with naltrexone:

1. Join a 12-step program or other support group. Alcoholics Anonymous (AA) is one of the most common treatment options for alcohol misuse. Support groups are beneficial because they allow us to spend time with others facing similar problems. They also provide advice on staying sober and help reduce our sense of isolation. Studies show that the social connection provided by these groups helps us build confidence in our own ability to avoid alcohol in social situations and supports our sobriety.
2. Try behavioral therapy. Individual, group, and/or family therapy can help us identify the root causes of our substance misuse, repair damaged relationships, develop skills to stop or reduce use, and learn to deal with triggers that might cause us to relapse. Cognitive behavioral therapy (CBT) is particularly effective, and it’s one of the many types of therapy for substance misuse.
3. Go to residential treatment or “rehab” facilities. Both inpatient and outpatient treatment centers provide intensive treatment for substance misuse. Choosing which type largely depends on the severity of our condition. Inpatient facilities are more intensive, requiring people to stay at a special facility for 30 to 90 days to receive treatment such as detox, therapy, and medication. In outpatient treatment, we would attend set rehab appointments during the week but still reside at home.
4. Consider alternative treatments. Alternative treatments like acupuncture aim to restore balance in the body and have been shown to reduce cravings and withdrawal symptoms. It's based on the concept that our health is determined by the balanced flow of life energy, "qi" (pronounced "chee"), throughout our bodies. One popular method is auricular acupuncture, which involves inserting needles into specific points on the ear. This form of acupuncture has been commonly used for substance use disorders since the mid-1970s.

Keep in mind that alcohol misuse can be a complex, complicated matter. By taking a holistic approach and combining different treatment options, we’ll be better equipped to get healthy and maintain sobriety.

The Bottom Line

The naltrexone Sinclair Method can benefit those looking to reduce their alcohol consumption or quit drinking altogether. While it requires consistent use of the medication, it can help curb cravings and gradually reduce our drinking over time. Those of us interested in trying this approach should speak with a medical professional who can help us assess our personal situation. Since alcohol misuse can be highly complex, pursuing a comprehensive treatment plan can help enhance our overall health and promote long-term sobriety.

If you want to quit drinking but don’t know where to start, consider trying Reframe. We’re a neuroscience-backed app that has helped millions of people reduce their alcohol consumption and develop healthier lifestyle habits.