Alcohol use disorder (AUD) is a medical condition, and just like many other medical issues, FDA-approved medication can be an effective treatment option. Naltrexone is among the most popular and well-tolerated medication options for AUD. When discussing naltrexone benefits, you may have also heard about the Sinclair Method (TSM). This method is a form of naltrexone treatment where the goal is to change the brain’s associations with alcohol by consistently taking a naltrexone pill 1-2 hours before consuming an alcoholic drink. The Sinclair Method primarily supports goals for moderation, not abstinence. As a physician on the Monument platform, I often meet with patients to discuss if a medication-assisted treatment model, like TSM, is safe and appropriate for them.
Here’s some key information to help you gain a better understanding of the Sinclair Method and prepare for a conversation with your healthcare provider.
What is Naltrexone?
Naltrexone is a nonaddictive medication that has been proven to help decrease alcohol use.¹ Naltrexone works by blocking the opiate receptors in the brain in order to diminish the pleasurable effects of drinking alcohol. While alcohol is not an opiate, drinking alcohol releases endorphins, which are naturally occurring opioids in the brain. Repeated exposure to alcohol and the release of these “feel good hormones” causes your brain to associate alcohol with pleasure. When something feels good, the brain remembers that pleasure and encourages you to do it again, which can lead to alcohol cravings. By blocking the pleasure receptors, naltrexone minimizes the short-term euphoric effects of alcohol, which can decrease cravings over time.
Most of my patients take naltrexone daily at the FDA-recommended dose of 50mg. With a daily prescription, naltrexone is active in the system throughout the entire day, whether or not alcohol is consumed. Many people find this to be a more reliable and consistent treatment method. However, some patients don’t want to take medication every day if they don’t drink alcohol every day. TSM may be an appropriate option for them.
What is The Sinclair Method?
The Sinclair Method is a treatment approach that aims to break the connection between alcohol use and pleasure, and thus reduce heavy drinking, by taking a naltrexone tablet before any incidence of drinking. Dr. John David Sinclair, who developed this method, analyzed data from 8 controlled studies across 5 countries.² He found that when patients would take naltrexone one hour prior to their first alcoholic drink, they would experience decreased cravings for alcohol.
The goal of TSM is for you to willingly change your drinking habits with the support of naltrexone. For successful TSM treatment, patients must continue drinking on naltrexone while reducing their consumption. Therefore, the Sinclair Method is built primarily for those who are looking to achieve moderation, not sobriety.
How does The Sinclair Method work?
By repeatedly taking naltrexone with each drinking encounter, the brain’s associations between alcohol and pleasure weakens. This is because the rewards from alcohol get roadblocked by naltrexone, not reinforced. Many people find they’re able to regain control over their alcohol intake and be satisfied after one to two drinks. Others may go on to pursue a sober lifestyle after after experiencing the benefits of cutting back.
How to use the Sinclair Method
To use the Sinclair Method you must take naltrexone between one and three hours prior to drinking alcohol. This is the approximate length of time it takes for naltrexone to become active in your system. It’s important to note that many patients who use naltrexone daily, instead of the Sinclair Method, also choose to take their naltrexone pill before their usual drinking time. Regardless of whether you’re using the Sinclair Method or daily naltrexone dosing, it’s important to check in with a physician to discuss your progress and ensure your safety.
Sinclair Method success rate
John Sinclair, the originator of the Sinclair Method, did a study with 147 participants over 110 days to prove the efficacy of his approach. Of these participants, 78% were successful in achieving moderation, which the CDC defines as less than 9 drinks per week. 26% of the participants were able to maintain total abstinence by the end of the study duration.²
In addition to Sinclair’s study, medications such as naltrexone and acamprosate for alcohol use disorder are supported by randomized controlled trials. A meta-analysis published in The Journal of the American Medical Association in 2014 revealed both medications reduce the risk of returning to any drinking as well as return to heavy drinking.³
Is the Sinclair Method right for you?
The Sinclair Method is not for everyone. If you’re looking to achieve abstinence, this approach is not effective. You might benefit from daily naltrexone dosing, or other medication to stop drinking. Regardless of whether you’re pursuing abstinence vs. moderation, some people benefit most from daily routines and medication adherence. If routine is helpful for you, you may prefer daily naltrexone dosing to TSM. Also, if a person is taking any opioid medication or substances, like Percocet, Oxycodone, or Vicodin, the use of naltrexone may cause dangerous or even life-threatening withdrawal symptoms. Because of the individual nature of treatment, it’s always recommended to speak to a trusted healthcare provider about your options.
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If you believe you might be experiencing acute alcohol withdrawal, please contact your healthcare provider immediately and visit https://findtreatment.gov/ to find a location to get supervised detox near you. If this is a medical emergency, call 911.
Alternatives to the Sinclair Method
The Sinclair Method is just one form of treatment for alcohol use disorder. Some people use other forms of medication-assisted treatment, while others accomplish their goals through therapy and peer support, or a combination of all three modalities. Experts recommend using as many forms of treatment as appropriate to increase your chances of success. You should feel empowered to learn about all of your options and discuss with your physician which treatment plant works best for your unique goals and preferences.
Daily naltrexone
Many people find that naltrexone is an appropriate medication for them, but decide on a daily dose so they don’t have to coordinate the time they take it with a drinking event. Daily dosing can provide additional accountability and routine, and also supports goals for abstinence in addition to moderation.
Disulfiram
There are other medications to help stop drinking, such as disulfiram. Disulfiram is an FDA-approved medication that causes you to get sick if you drink alcohol. This medication is only for patients looking for a strong psychological deterrent in order to help them remain abstinent. You can learn more about naltrexone vs. disulfiram to understand the difference between these medications.
Therapy and peer support
Cognitive Behavioral Therapy (CBT) is another treatment option that is proven to help reduce heavy drinking days and overall alcohol consumption.⁴ Therapy can help an individual focus on the emotional and behavioral aspects to sobriety or moderation that aren’t addressed by the Sinclair Method. Peer support is also proven to help decrease heavy drinking and improve health outcomes.⁵ This can take the form of online alcohol support groups, online communities, and in-person meetings.
What else should I know?
Remember results aren’t always immediate
Using TSM can yield meaningful results, but because of the intermittent, non-daily use of medication, these results can take time. Some people feel an immediate reduction in their desire to drink after the first few doses of naltrexone. More commonly, it can take weeks or months for alcohol cravings and the desire to drink to significantly reduce.
Prioritize consistency
You also have to be consistent in order for TSM to be effective. That means remembering to have the medication available every time you know that you’ll be drinking. Patients who achieve Sinclair Method success must be motivated to carry out this method exactly as their physician prescribes. While many people are able to make a strong commitment to taking naltrexone every time they drink, others find that a daily prescription of naltrexone is easier to stay consistent with.
This is why physicians on the Monument platform, such as myself, typically find that daily naltrexone treatment is more effective than TSM. Daily naltrexone treatment doesn’t require as much planning, and puts less focus on the act of drinking itself, which allows people to explore both moderation and sobriety at their own pace. With that in mind, everyone is different, and everyone deserves a method that’s tailored to their needs and preferences.
Build your alcohol recovery toolkit
It’s also important to remember that no medication is a “magic pill.” Naltrexone doesn’t remove the ability to ‘get drunk’ or the underlying issues causing the urge to drink. Factors such as anger, stress, anxiety, depression, and pain can influence one’s drinking habits, and cannot be treated with naltrexone. Without addressing these underlying factors, some people feel discouraged from taking naltrexone before they drink, or may try to “drink through it” to seek relief.
There are many additional treatment options to help you work through the social and emotional dimensions to changing your relationship with alcohol. The more resources you have in your toolkit, the more likely you are to succeed. Specialized alcohol therapy can help you identify your goals, process thoughts and emotions, and address co-occuring mental health conditions. Therapist-moderated support groups can also provide a safe space to discuss your relationship with alcohol and learn new coping skills. Tracking your drinking over time to see your progress and talking about your goals with loved ones can also help empower you on your moderation journey.
Aiming to drink less is an incredible act of self-care. If you feel that The Sinclair Method may be right for you, I encourage you to do some more research and speak with a physician who can answer any questions. Popular resources include Claudia Christian’s Tedx Talk, and Annie Grace’s book “This Naked Mind.” You can connect with a physician on the Monument platform to discuss this method along with other medication options. We’re here to help you build a plan catered to your needs.
Sources:
1. Naltrexone for the Management of Alcohol Dependence, Raymond F. Anton, M.D., N Engl J Med 2008; 359:715-721, DOI: 10.1056/NEJMct0801733
2. Evidence about the use of naltrexone and for different ways of using it in the treatment of alcoholism, John David Sinclair, Alcohol and Alcoholism, Volume 36, Issue 1, January 2001, Pages 2–10, https://doi.org/10.1093/alcalc/36.1.23. Jonas DE, Amick HR, Feltner C, Bobashev G, Thomas K, Wines R, Kim MM, Shanahan E, Gass CE, Rowe CJ, Garbutt JC. Pharmacotherapy for adults with alcohol use disorders in outpatient settings: a systematic review and meta-analysis. JAMA. 2014 May 14;311(18):1889-900. doi: 10.1001/jama.2014.3628. PMID: 24825644.
4. Riper H, Andersson G, Hunter SB, de Wit J, Berking M, Cuijpers P. Treatment of comorbid alcohol use disorders and depression with cognitive-behavioural therapy and motivational interviewing: a meta-analysis. Addiction. 2014;109(3):394-406. doi:10.1111/ add.12441
5. Kelly JF, Humphreys K, Ferri M. Alcoholics Anonymous and other 12- step programs for alcohol use disorder. Cochrane Database Syst Rev. 2020 Mar 11;3(3):CD012880. doi: 10.1002/14651858. CD012880.pub2. PMID: 32159228; PMCID: PMC7065341.
Important Safety Information:
Naltrexone has the capacity to cause hepatocellular injury (liver injury) when given in excessive doses. Naltrexone is contraindicated in acute hepatitis or liver failure, and its use for a patient with active liver disease must be carefully considered in light of its hepatotoxic effects.
In the treatment of alcohol dependence, adverse reactions include difficulty sleeping, anxiety, nervousness, abdominal pain/cramps, nausea and/or vomiting, low energy, joint and muscle pain, headache, dizziness, and somnolence. This is not a complete list of potential adverse events associated with naltrexone hydrochloride. Please see Full Prescribing Information for a complete list
About the Author
Dr. Elizabeth Klenk graduated from the University of Toledo with a BA in Biology and from the University of Cincinnati with a Master of Science in Biological Sciences followed by her MD. She was a hockey player and played goalie for several high level mens' teams. Dr. Klenk also reads avidly and enjoys spending time with her children, playing music, hiking, and participating in cattle herding competitions across the country with her Border Collies. She lives on a working cattle ranch in Ohio with her family and is an active part of the farm in her spare time.