How the Sinclair Method for Alcohol Addiction Recovery Works

The Sinclair Method for Alcohol Use Disorders is a treatment approach that involves administering the opioid antagonist medication naltrexone as needed to reduce the pleasurable aspects of alcohol consumption. This approach was introduced by John David Sinclair, a researcher who discovered that naltrexone could be used to block alcohol-reinforcing effects. It is sometimes described as targeting naltrexone to use only when needed. The Sinclair Method is an option if you want to reduce your drinking, but don’t necessarily want to abstain from alcohol altogether. 

This article discusses how the Sinclair Method for alcohol addiction recovery works, the potential pros and cons, and some things you should consider before deciding if this approach is right for you.

Overview of the Sinclair Method

Unlike many traditional approaches to alcohol recovery, the Sinclair Method is a medication-based approach. By administering naltrexone prior to consuming alcohol, the pleasurable feelings that drinking usually produces are blocked. 

Because people feel less pleasure when they drink, they find it much easier to drink less. In some cases, they completely lose the urge to drink at all. While this approach is less common in the United States, it has become much more widely used in Europe. 

The Sinclair Method is not the only medication-based approach to alcohol recovery.

Campril ( Acamprosate) is another FDA approved which helps people stop drinking by reducing the craving for alcohol. Antabuse (disulfiram) is medication that has been used for many years which but it works very differently. Antabuse does not reduce craving but by making people sick if they drink any alcohol, it can help them stay abstinent

While naltrexone is also taken prior to drinking alcohol, it does not cause illness. Instead, it simply makes it so drinking no longer produces an endorphin rush or "buzz". Without those pleasant feelings, the brain eventually stops associating drinking with pleasure. 

This is known as pharmacological extinction. In operant conditioning, rewards increase the likelihood that a behavior will occur again. When it comes to addictions such as alcohol use disorder, consuming alcohol is the behavior and the release of endorphins is the reward. When the brain unlearns this association, pharmacological extinction occurs.

History of the Sinclair Method

Sinclair first observed the effects of naltrexone on drinking behavior in his animal research. In animals that had been trained to drink alcohol, they would press a lever repeatedly to obtain it. Sinclair found that if the longer they were deprived of alcohol, the more they would press the lever. He termed this phenomenon the alcohol deprivation effect, likening it to the increased alcohol cravings that make it hard for people with AUD to stay abstinent and avoid a binge.

He also discovered that administering naltrexone before drinking would eventually extinguish the drinking behavior. Later research also demonstrated that naltrexone had a similar effect on humans with alcohol use disorder who wanted to drink less.  

How It Works

The Sinclair method works by reducing the reinforcement that people get when they drink alcohol. One of the reasons why alcohol addiction happens is that people experience a rush of endorphins when they drink. Because drinking makes them feel good, they form an association between alcohol and pleasure. 

The actual process for using the Sinclair Method includes the following steps:

• Taking naltrexone one hour before consuming alcohol
• Consuming alcohol as usual
• While drinking, the naltrexone blocks pleasurable feelings and you may feel like drinking less
• Continuing to use naltrexone 100% of the time you consume alcohol
• Eventually, as you take your drinks, you will notice that drinking is less rewarding and you may drink less or stop altogether.

Researchers do not fully understand how naltrexone reduces alcohol cravings. It blocks certain opioid receptors in the brain and influences dopamine, a neurotransmitter, which is believed to help block alcohol's reinforcing effects.

Pros and Cons of the Sinclair Method

The Sinclair Method has advantages and disadvantages that you should consider before you decide if this approach is right for you.

Pros

The Sinclair Method can help people reduce their drinking without quitting drinking entirely. This can be a useful option for people who want to drink socially on occasion but want to cut back and gain greater control over their alcohol consumption. By helping people drink less, it reduces the harm they experience from alcohol.

It can also serve as a step toward sobriety while minimizing the need for medically-supervised detox in residential alcohol treatment. Unlike some other more expensive treatment options, the Sinclair Method is cost-effective and can be done at home.

Other potential benefits of the Sinclair Method:

• This approach can get people who are unwilling to completely give up drinking to drink at a safer level.
• Because it gradually reduces alcohol consumption, people are less likely to experience serious alcohol withdrawal symptoms, including delirium tremens (DT).
• It is a more affordable treatment alternative compared to more intensive and costly inpatient or residential treatments.
• Since people are actively involved in their treatment, it may help people feel more empowered and in control of their drinking and alcohol recovery.

Cons

Extinction takes time, and even occasional reinforcement can serve to maintain a behavior. In order for the Sinclair Method to be successful, it is important to always, without fail, take naltrexone before consuming any alcohol. 

Some other possible downsides of the Sinclair Method:

• People who drive when under the influence of alcohol may experience worsened coordination while taking naltrexone.
• Treating alcohol use disorder with medication only may remove someone's motivation for personal growth through other treatment methods, including 12-step programs.
• In some cases, people may mistakenly believe that their doctor condones continued alcohol use. 
• Some people may develop a false sense of confidence in their ability to drink safely without getting intoxicated.

As Verywell Review Board Member Dr. John Umhau notes in an article published in Advances in Addiction & Recovery, the Sinclair Method requires a lifetime commitment. While it minimizes cravings, it is important to remember that people also drink for other purposes, including social reasons, boredom, habit, and as a way to dampen emotional pain.

People can also relapse after pharmacological extinction. If a person consumes excessive alcohol to the point that it bypasses the “naltrexone wall,” a point at which alcohol use becomes pleasurable again, they may experience a relapse to alcohol use.

Regular naltrexone use can also increase the sensitivity of opioid receptors, a process known as upregulation. As a result, drinking alcohol can feel much more rewarding if naltrexone use is suddenly stopped. This can cause excessive drinking, which is why consistently using naltrexone before every drink is critical for success.

Side Effects of Naltrexone

While naltrexone is usually tolerated well, it can have side effects that can range in severity. The most common side effects involve increased nervousness, muscle or joint pain, headache, nausea, and upset stomach. In most cases, these side effects are mild and lessen with time as people become more accustomed to the medication or can be minimized by taking the medication with food.

More rarely, severe side effects can include blurry vision, diarrhea, confusion, drowsiness, stomach pain, and vomiting. 

Is the Sinclair Method Right for You?

If you are interested in trying the Sinclair Method, start by talking to your doctor. They can discuss your current drinking behavior, medical history, and treatment goals to better determine if the Sinclair Method might be a good fit.

The Sinclair Method might be a good option for you if you:

• Are committed to making changes to your alcohol use behavior
• Have adequate social support
• Are willing to adhere to your doctor's instructions and take your medication every time you plan to consume alcohol
• Don't have a seizure disorder
• Don't have liver disease

In some cases, the Sinclair Method can be a great start toward recovery. Because it engages people with alcohol-treatment professionals, it may help lead people to better recognize the extent of their problem while also giving them the hope and motivation to keep working toward giving up alcohol. 

If you are trying to reduce your alcohol consumption or quit drinking altogether, the Sinclair Method is one approach you might want to consider. Talk to your doctor about whether taking naltrexone every time before you drink might be an option for you.

While it requires consistent use of the medication, naltrexone may help you reduce your drinking over time. For some people, it can also be a positive step toward abstinence and connect them with treatment professionals who can support them as they work toward sobriety.