Sinclair Method - Treatment

Treatment

Unlike alcoholism treatments/methods such as Antabuse (disulfiram), Temposil (calcium carbimide), and Alcoholics Anonymous, which all promote abstinence from alcohol, the Sinclair Method treats alcoholism by combining medication with continued drinking. Naltrexone is available in multiple forms, including tablet and injection. For tablet form, a patient following the Sinclair Method takes a 50 mg tablet one hour before every drinking session. Patients who achieve success with the treatment experience a reduced urge to drink over time.

The treatment is based on the theory of pharmacological extinction. It involves the use of competitive antagonists to endorphins being taken before alcohol consumption in order to block the endorphins from being used by the drinker's system. When the patient drinks without the endorphin reinforcement, it causes extinction. Use of this effect has been standardized into a technique called the "Sinclair Method", named after the man who first developed it, Dr. John David Sinclair.

As of April 2010, the most comprehensive reference on the Sinclair Method written for the patient is The Cure for Alcoholism by Dr. Roy Eskapa, published in 2009. Until more sources become available, much of the information on the Sinclair Method comes from this source.

The Sinclair Method has two steps: ingestion of an endorphin blocker, followed by drinking. Naltrexone is the most commonly used endorphin blocker because naltrexone is readily available and approved by the FDA for treatment of alcoholism. Other medications such as naloxone and nalmefene may be used in the future, but are not as readily available. The Sinclair Method prescribes drinking "as you normally would" while taking naltrexone.

The effects of the Sinclair Method can take from two weeks to several months before they become noticeable. This period increases if the patient abstains from drinking, or largely drinks in an environment other than that in which they acquired their addiction. Taking naltrexone without drinking will result in a small decrease in craving while the naltrexone is being taken, but will not result in extinction.

The goal of the Sinclair Method is to return a person's desire for alcohol to their rational control over a period of three to 15 months. They may continue to drink because they perceive rational benefit to drinking, but will no longer be driven to drink by uncontrollable urges. Once the patient is no longer drinking on a daily basis, administration of naltrexone is reduced to just those days during which drinking is expected, an hour before the drinking occurs. Taking naltrexone before drinking will need to be done for the rest of the patient's life, otherwise the endorphin conditioning will re-establish itself.