The Sinclair Method: What It Is & How It Works

What Is the Sinclair Method?

The Sinclair Method (TSM) was developed by Dr. John David Sinclair. Sinclair engaged in animal research that highlighted how naltrexone blocked alcohol’s reinforcing effects in animals. In time, animals trained to consume alcohol lessened or stopped drinking if they always took naltrexone beforehand. Sinclair concluded that if people took naltrexone before drinking alcohol, the drinking itself would not produce any pleasure.¹

Alcohol use disorder (also commonly known as alcoholism) continues to be an epidemic in mainstream society. It’s estimated that nearly 30 million Americans ages 12 and older (1 in 10 people) had an alcohol use disorder in the past year.² Medication-assisted treatment entails using medications to treat substance use disorders. Medication for alcoholism may include naltrexone, which is the key component of the Sinclair Method.

How Does the Sinclair Method Work?

TSM uses naltrexone to alter how the brain associates alcohol with its pleasurable rewards. Naltrexone works by blocking some of the physiologic effects of alcohol. Following TSM accurately means taking naltrexone at least one hour before drinking alcohol every single time. The lack of receiving feel-good sensations can help diminish cravings and change drinking patterns.

What Is Naltrexone?

Naltrexone is a medication approved by the FDA to treat both alcohol use disorder and opioid use disorder. It is available both as a daily pill and as an intramuscular injectable. Naltrexone is not addictive, and it does not induce withdrawal symptoms when you stop taking it. It blocks the euphoric effects of opioids and alcohol. It can also reduce alcohol cravings.³

What to Expect While on the Sinclair Method

The most essential feature of the Sinclair Method is the commitment to taking naltrexone before every drink. Such accountability can be challenging, and some people may find this commitment easier than others. With that, naltrexone is straightforward. People can take the 50-mg dose daily or receive a monthly injection. Some may take it in a targeted fashion before drinking.⁴

The steps to reducing drinking through the Sinclair Method include:

1. Take Naltrexone an hour before you begin drinking
2. Drink as desired
3. Feel blocked from the usual buzz or pleasure from drinking
4. Over time, feel motivated to drink less or stop drinking altogether

How Is the Sinclair Method Different?

The Sinclair Method is different from other methods in that it does not inherently recommend abstinence. It also does not suggest that people need to consciously try to cut down or stop their drinking. Instead, the focus is simply on committing to taking naltrexone at least one hour ahead of time should someone choose to drink. It’s important to remember that naltrexone does not protect from the harmful effects of drinking alcohol. People who drink excessive alcohol and use naltrexone will lose inhibitions, have impaired coordination, and slow response times to the same extent as they would without naltrexone.

The distinctive features of the Sinclair Method include:

TSM Requires No Prior Detox

People can take naltrexone if they are abstinent from alcohol or have a desire to be abstinent from it. The only exception is that you can’t take naltrexone if you’re currently taking opioids (there needs to be an established detox period). This can make the Sinclair Method an accessible option for people who want to start medication-assisted treatment immediately.

TSM Allows for Selective Extinction

Selective extinction refers to the gradual decline of a conditioned response. This leads to the reduction or full extinction of a certain behavior.⁵ As it relates to the Sinclair Method, people using this approach may naturally decrease their drinking or stop drinking altogether. This is because, when adhering to the naltrexone requirements, they won’t derive any pleasure from alcohol.

TSM Can Continue Indefinitely

It’s possible for someone to use the TSM indefinitely. This can be beneficial because it simplifies one’s treatment. That said, it’s worth noting that naltrexone was only approved for medical use in 1984. Although many people have used this drug to successfully treat both opioid and alcohol use disorders, there is limited research on its long-term effects.

How Effective Is the Sinclair Method?

In his 2001 research, John Sinclair discovered that 78% of individuals reached extinction after several months of using naltrexone before drinking. Many people who engage in this method drink less at a time when they might typically drink more.⁶

With that, it is crucial to mention that the Sinclair Method has not been thoroughly studied. Addiction is complex, and it is challenging to accurately measure the effectiveness of various treatment methods. Drop-out rates can be high, and people may downplay or omit information about their substance habits, thus altering the accuracy of research results.

What Are the Drawbacks to the Sinclair Method?

The main concern of the Sinclair Method is compliance. People must hold themselves persistently accountable to take naltrexone if they want to drink. This has to happen every time for the method to work. But if someone consumes excessive alcohol, they can still break through the ‘naltrexone wall,’ a point where alcohol generates pleasure again.

Naltrexone for Alcohol Dependence

Naltrexone is an opioid antagonist. Opioid antagonists work by preventing natural opioid receptors from being activated. They block some of the recreational effects of opioids and alcohol. Compared to buprenorphine (which is often used for treating opioid addiction), naltrexone isn’t addictive. However, there is a heightened risk of overdosing if using opioids like heroin, fentanyl, or oxycodone while on naltrexone.

Some of the potential side effects of naltrexone include:

• Stomach cramps
• Anxiety
• Headaches
• Sleep issues
• Nausea
• Vomiting
• Joint and muscle pain
• Loss of appetite
• Increased thirst
• Dizziness
• Skin rashes
• Decreased sexual desire and potency
• Skin irritation

TSM Requires User Compliance

TSM doesn’t require that someone quit drinking to treat their alcohol problems. However, it does require strict compliance. This can certainly be a challenge if someone forgets to take their medicine. It can also be difficult when someone has strong cravings and consciously decides to forgo taking their naltrexone because they want to enjoy the effects of alcohol. In addition, if someone fails to be compliant with naltrexone, their drinking may worsen.

TSM May Not Treat the Root Cause of Addiction

Many people drink to self-medicate underlying symptoms of depression, anxiety, or trauma. Alcohol becomes an unhealthy coping response to manage various stress or emotional responses. TSM does not necessarily address these issues, meaning someone may be more susceptible to either a relapse or “switching” to another addiction.

What Therapies Work Well With TSM?

If you’re considering trying TSM, it’s helpful to work with a therapist specializing in alcohol use disorder. They can provide you with support, and they will also help treat the factors maintaining addictive behavior. While there are many treatment methods that target addiction, motivational interviewing, cognitive behavioral therapy, acceptance and commitment therapy, and dialectical behavioral therapy are common.

Finding the right therapist can be the first step toward a sustainable recovery. Therapists provide both in-person and online therapy options. You and your therapist will work together to establish your treatment goals and the frequency of sessions. They can also provide wraparound care with your doctor or psychiatrist if needed.

Where to Get the Sinclair Method

Any healthcare provider, including physicians, physician assistants, nurse practitioners, and psychiatrists, can prescribe naltrexone.⁷ If you’re interested in learning more about this medication, talk to your doctor. In addition, individual programs, such as WorkIt Health,

Ria Heath, and Monument offer structured treatment via the Sinclair Method. You can also get started by consulting with an addiction psychiatrist.

In My Experience

The Sinclair Method has both its advantages and drawbacks when it comes to alcohol use disorder treatment. If someone does not want to fully stop drinking (or does not feel ready to stop), this may be a viable harm reduction approach. With proper compliance, it can also lead to gradual extinction. That said, it’s important to note that alcohol use can be progressive and insidious. If you are struggling, consider consulting with a therapist to review your best recovery options.