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The Sinclair Method (TSM) for Alcohol: What Is It & How Does It Reduce Drinking?

Updated: Jun 11

A medication combined with behavioral science is generating curiosity in alternatives to alcohol abstinence.

The Sinclair Method for Alcoholism
TL;DR: The Sinclair Method (TSM) is a medication-assisted approach to treating alcohol use disorder through a protocoled use of Naltrexone, a prescription opioid antagonist used to reduce alcohol cravings.

If you’ve been drinking for years, you’re likely familiar with the stubborn craving patterns of alcohol. It becomes a hard-to-break habit, one that is triggered by people, places, emotions, events, and much more.

 

For this reason, some choose to cut alcohol out of their life outright; the black-and-white rules of sobriety leaves no room to negotiate with those nagging urges to drink. Others try alcohol moderation, a type of controlled drinking where individuals practice building and maintaining boundaries with alcohol to keep their drinking within self-selected limits—but this approach can pose challenges to those susceptible to cravings.

 

And that’s where the Sinclair Method comes into the picture.



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What Is the Sinclair Method (TSM)?


The Sinclair Method (TSM) is a treatment for alcohol use disorder that strategically uses medication to break the association between drinking and pleasure. The prescription opioid antagonist, Naltrexone, blocks the pleasurable effects of alcohol, which helps the brain to unravel the connection between alcohol and reward. In theory, this means someone will gradually feel less and less compelled to drink because it doesn’t feel good like it used to.  


The Sinclair Method is based on operant conditioning, a behavioral learning process based on the premise that we tend to increase or decrease actions in response to rewards and punishments. For example, rewarding your kids for the chores they complete incentivizes them to repeat those chores. Taking away privileges when they hit their sibling may discourage the behavior.

 

For many people, especially those with a family history of alcohol use disorder, drinking bestows an immediate reward: endorphins, which bind to the body’s opioid receptors to produce pleasure. Despite the negative longer-term consequences, it’s this immediate reward paired with the sensory experience of drinking that can keep us firmly stuck in the loop of alcohol abuse.

 

By blocking these opioid receptors through the use of Naltrexone, the rewarding effects of alcohol are removed and it becomes more neutral stimulus—meaning there’s not much there to incentivize repeated and prolonged drinking.

 

So how exactly does this look? 


How Does the Sinclair Method Work?

what is the sinclair method for alcohol

While all questions should be directed to your medical provider, here’s the gist of how The Sinclair Method works:

 

The Sinclair Method process begins with a prescription for Naltrexone, the medication that blocks opioid receptors to diminish the pleasurable effects of alcohol. According to the protocol, Naltrexone is taken one hour before consuming alcohol every single time you drink. Back to operant conditioning, this consistency is necessary to keep pleasure and alcohol separated.

 

As this dosing process is repeated over time, it weakens the association between alcohol and pleasure, therefore reducing pleasure-driven motivations to drink. According to The Sinclair Method’s founding researcher and developer, it requires a lifelong commitment: that means, in order to maintain treatment efficacy, one would need to continue taking Naltrexone an hour before every drink for the long-haul.

 

Extinguishing cravings through The Sinclair Method is said to often take between 3-12 months, sometimes longer. Alcohol patterns are often carved over years and decades, so the process of unlearning requires commitment and patience.


What Are the Potential Benefits of the Sinclair Method?


For so very long, there has been one prevalent approach to alcohol use disorder: Abstinence.

 

Recovery programs and peer support groups have deep roots in abstinence-based approaches, and there’s no doubt that total sobriety has saved countless lives. Even among those who have tried The Sinclair Method, there are still many who prefer to go back to total sobriety because that’s what works for them and their bodies.

 

And, it is the nature of medicine to continually evolve and expand approaches to treatment. Depression may be treated with cognitive behavioral therapy, SSRI medication, transcranial magnetic stimulation, or ketamine infusions. Cancer may be treated with surgery, chemotherapy, stem cell transplant, or immunotherapy. We develop multiple treatments for complex conditions because it’s often not possible to successfully treat everyone with a one-size-fits-all approach.

 

That being said, some of the potential benefits of The Sinclair Method include:

 

  • The ability to still engage in treatment for alcohol use disorder for those unwilling to maintain abstinence.

  • Eventual extinction of drinking urges or cravings that previously precluded heavy drinking relapse.

  • Endorphins are only blocked when Naltrexone is used, allowing one to still experience pleasure with other activities when it is not taken.

  • Increases access to alcohol use disorder treatment, especially if time and finances are a barrier.


What Are the Risks and Common Criticisms of the Sinclair Method?

the sinclair method tsm benefits

As is true for all treatments, The Sinclair Method will not work for everyone and will inherently have a few downsides to consider:

 

  1. It can be hard to let go of alcohol’s pleasurable effects.

 

Some people are ready to give up drinking because it’s a habit that has truly lost its luster. But for others, pleasure is the point: Alcohol might still be a tool to numb pain, soothe anxiety, or euphorically lift depression for a brief time. Naltrexone can block the pleasurable effects of alcohol, but it can’t block the emotions that might have led you to drink in the first place. Mental health factors aside, it can be hard to give up the thrill and excitement of drinking, especially if it’s still embedded in your social lifestyle.

 

If you notice that adhering to The Sinclair Method is challenging, it might be worth exploring your attachment to alcohol’s pleasurable qualities. Building emotional regulation skills, practicing alternative coping strategies, and expanding your identity beyond alcohol are all ways to potentially improve your readiness for TSM.



2. It may bypass opportunities for personal growth.

 

One common criticism I hear about The Sinclair Method is that pharmaceutically-driven approaches may circumvent important opportunities to strengthen skills, relationships, and a sense of self.

 

As a counselor, I’m obviously a biased believer in the power of therapy and community to nurture lasting transformation; I’m regularly in awe of the bravery of my clients who are willing to hold their toughest emotions and memories long enough to feel the fear turn into strength and compassion.

 

I don’t think we’re ever “finished” growing. And I do think that we all have capacity to deeply benefit from insight, reflection, and self-exploration. But personal growth comes in many forms. Maybe it’s possible to utilize medication-assisted treatments and engage in your personal development. Maybe the Sinclair Method allows you to build a better relationship with alcohol then unlocks a better relationship with yourself.

 

Something to think about.

 

3. It might encourage someone to break abstinence.

 

No doubt there are people who have tried the Sinclair Method after bouts of sobriety. It’s natural to feel drawn to the idea of eliminating cravings that put one at risk of heavy-drinking relapse. If you are currently sober and curious about TSM, you may consider talking to your trusted loves ones or care professionals. It’s a decision worth thinking through with careful considerations of the pros and cons.


Who Shouldn't Use the Sinclair Method?


Anyone considering the Sinclair Method should consult with their doctor, but the Sinclair Method is generally discouraged in the following circumstances:

 

  • If you are driving: Naltrexone blocks the pleasurable effects of alcohol, but your motor function will still be impaired after consumption. Don’t do anything you wouldn’t normally do while drunk, such as driving. You are still at risk of a high BAC and DUI.

  • If you take opioid medication: Naltrexone will block the effects of opioid medications. Consult with your doctor if you currently take opioid medications.

                                           

For all questions regarding the safety, efficacy, or appropriateness of Naltrexone and the Sinclair Method for you, please consult your prescribing doctor and medical care team.

 

If you’re struggling with substance use, help is available. For immediate support and local resources, call SAMHSA’s National Helpline at 1-800-662-4357.


This article is written for the sole purpose of providing information on mental health topics. It is not medical or legal advice, nor a substitute for medical intervention or professional mental health counseling, diagnosis, or treatment. It should not replace or alter any treatment or care you are receiving without direct consultation from your mental health or medical providers. Any questions regarding your treatment should be brought directly to your professional and medical practitioners.

 

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