Sinclair Method Frequently Asked QuestionsApr 15, 2022
Below is a list of the most frequently asked Sinclair Method questions. We're always updating this list – if you're looking for something that is not here, please let us know in the comments below. 👍🏼
Q: What is The Sinclair Method?
A: The Sinclair Method for Alcohol Use Disorders is an evidence-based treatment for problematic drinking developed by Dr. John D. Sinclair. Unlike traditional treatments that require complete abstinence from alcohol, TSM allows you to continue drinking alcohol as part of the treatment.
In fact, success on TSM depends on the continued consumption of alcohol in combination with the prescription medication naltrexone.
Naltrexone is at the heart of TSM. When you take naltrexone 1-2 hours before drinking, it blocks endorphins (the naturally occurring opiates in the brain), from binding to the opioid receptor when alcohol is consumed.
When the endorphins are blocked, there is no "reward" reinforcement from alcohol, and the alcohol doesn’t make you feel the same pleasure that drives you to drink excessively.
Over time, your brain learns not to associate alcohol with pleasure, resulting in reduced cravings and improved control over alcohol use. Naltrexone must be taken at least one hour before your first drink.
Q: Where do I get a prescription to naltrexone?
A: The C Three Foundation provides a directory of physicians in the US and around the world who are knowledgable about TSM and naltrexone (thank you, C3!). You can find a physician either through telemedicine or in-person.
It's important to note that each of these providers may charge a different consultation fee and/or offer different prescription options. For example, some telemedicine physicians may provide you a prescription only, while others will offer a higher level of care like counseling or a program. You can contact a few different providers until you find one that fits what you're looking for.
Q: Can I get a prescription from my general practitioner or psychiatrist?
A: The short answer is yes – but it also depends.
Many physicians may not be aware of naltrexone for treating AUD – and/or they may not be familiar with treating AUD at all. For this reason, some physicians may refuse to prescribe the medication entirely (don't feel bad if this happens to you – because unfortunately it's quite common), or they may prescribe it to you with incorrect instructions for how to take it (since TSM is a very specific protocol).
On the other hand, some physicians may be totally on board with prescribing it – it just depends. It can be helpful to bring materials to your doctor’s appointment that show the science and efficacy of this treatment method – you can find those here .
Q: What are some common mistakes on The Sinclair Method?
A: Mistakes are a part of any process of change. There are some common mistakes a lot of people face on TSM. You can prepare yourself for these with our free video course, 10 Common Mistakes on TSM. Access here.
Q: When do I take naltrexone?
A: Following The Sinclair Method, naltrexone is taken 1-2 hours before the first drink of alcohol of the day. Waiting at least one full hour to drink after taking naltrexone is imperative to the success of the protocol. This is to ensure that the medication is fully effective at blocking the endorphins from the alcohol.
Q: What is the dosage of naltrexone for TSM?
A: The standard therapeutic dose of naltrexone following TSM is a 50mg dose tablet that is taken orally. While most people do well with the standard 50mg dose, some people may need a higher dose of naltrexone. Talk with your doctor about what dose is right for you. 🧑🏼⚕️ It's important to note that most physicians will advise that people start at a lower dose – usually 25mg for the first few times they take the medication just to help mitigate any side effects that may occur.
Q: Are there any side effects to naltrexone?
A: Like with any medication, there may be some side effects to taking naltrexone. For most people, those side effects are mild and can include things like sleepiness or upset stomach. Thankfully, these usually go away within about 1-2 weeks on the medication. This is why most knowledgable TSM doctors will advise a person to start at a 25mg dose – just in case there are side effects.
For others, there may be more long-term side effects like persistent nausea or sleep interruptions. These are usually quite rare and if they do occur, they can often be mitigated with starting naltrexone at an even lower dose and very slowly increasing the dose. Please talk to your doctor if you have any questions about your dose of naltrexone. 👩🏽⚕️ For more information on side effects, you can visit the Mayo Clinic.
Q: Do I have to take naltrexone every time I drink?
A: Yes! An emphatic, yes. 🎉
Being 100% compliant with taking naltrexone every single time that a person drinks is truly imperative to success on this method. Skipping doses can slow, stall or reverse progress.
Q: Do I take naltrexone everyday? What about alcohol-free days?
A: Following TSM, naltrexone is only taken on days that a person consumes alcohol. If a person is having an alcohol-free day (yay!), they do not need to take naltrexone. Following TSM, naltrexone is only taken in a targeted dose 1-2 hours before the first drink of alcohol for the day.
Q: How long does naltrexone protect me? What about re-dosing?
A: Once a person has taken naltrexone, they begin to metabolize it. Everyone is different at how quickly the metabolize the medication. Things like age, weight and gender play a role. It is said that the half-life of naltrexone can be anywhere from 4-13 hours. This means that between 4-13 hours after a person has taken naltrexone, it has been metabolized by 50%, and therefore may be less effective at doing its job.
Many knowledgable TSM physicians will have their patients take a second dose of naltrexone if they are drinking over a long period of time. A common window we see is between 6-8 hours.
How this may look IRL: if a person takes naltrexone at 11:00am and has their first drink at 12:00pm – they're covered. But if they are also planning to have drinks with dinner at 7:00pm (8 hours after the first dose) – a TSM doctor may advise that the person take a second dose of naltrexone at 6:00pm (wait another hour), and have the drink at 7:00pm. Please talk with your doctor about what re-dosing method is right for you. 🧑🏻⚕️
Q: Do I need to take naltrexone for the rest of my life?
A: If you continue to drink alcohol, yes, naltrexone should be taken prior to drinking for the remainder of the time that you drink. This is because the behavior of AUD can be relearned even after a person has reached pharmacological extinction.
Q: What is pharmacological extinction?
A: Actually, the technical term for TSM is "pharmacological extinction." Alcohol drinking is a learned behavior. Some individuals (partly for genetic reasons), get so much reinforcement each time they drink, and have so many opportunities to drink and get reinforcement, that the behavior becomes too strong. They cannot always control their drinking; they cannot “just say ‘no’.”
For most people, the reinforcement or reward (endorphins) from drinking alcohol involves the opioid system in the brain. With repeated drinking over time, the brain associates this behavior (drinking) with a reward (endorphins). This is how the behavior of alcohol use disorder (AUD) is learned over time... and naltrexone blocks the effects of these endorphins.
The brain has two primary mechanisms for changing its own wiring on the basis of experience. First, there is learning for strengthening behaviors that provide reinforcement. Second, there is extinction for removing behaviors that no longer produce reinforcement. The best known example involves Pavlov’s dogs that learned to salivate to the sound of a bell when the bell was followed by food, but then had the learned behavior extinguished when the food reinforcement was no longer given after the bell was rung.
If alcohol is drunk while naltrexone is blocking endorphin reinforcement in the brain, the extinction mechanism is activated, and it would then produce a small but permanent reduction in alcohol drinking and craving. Over time, the person will become less interested in alcohol. Eventually control over alcohol would be regained, and the person would no longer have AUD, and their interest in alcohol would greatly reduce. This information can be found in Dr David Sinclair's Definitive Statement on the CThreeFoundation.org.
Q: How quickly does The Sinclair Method work?
A: The short answer is – it varies from person to person. On average, most TSM doctors will advise at least 9 months to reach pharmacological extinction. Some may reach it more quickly, and others it can take much longer. The great thing about TSM is that for most people, they will see gradual changes and improvements the longer they are on TSM. These are great signs that a person is on the path to extinction. The most important thing is this:
Do not compare your progress on TSM to another person's.
Because we're all so (awesomely) different – with varying stressors, triggers, environments, pasts, etc – some will respond more quickly and others more slowly. Just because you feel like you're responding "slowly" to the method does not mean it's not working. The most important things are to:
- Stay compliant ✔️
- Stick with it 💪🏻
Q: How effective in The Sinclair Method?
A: The Sinclair Method is shown to have a 78% success rate. This is astounding considering AA has about a 5-10% success rate.
Q: Can you still get drunk on naltrexone?
A: Yes, a person can still get intoxicated while taking the medication. The medication works to block the endorphin rush from alcohol, but it does not block the intoxicating effects.
Q: Help! My drinking is increasing on The Sinclair Method.
A: Fear not, this is actually a common occurrence in this method. There are a number of reasons this could be happening, including: old drinking habits, consuming hard alcohol (for some), using alcohol to cope with a stressful environment or situation, not fully complying with taking naltrexone properly, or not practicing awareness and mindfulness around your drinking. In some cases, this is just a brief occurrence that happens once in a while and it becomes a learning experience for the next time. For others, there might be more changes needed in order to make progress. If you need some support with this, feel free to connect with the Thrive Community 👋🏼 or submit this for our Weekly FAQ session.
Q: What is the most important thing for achieving success with TSM?
A: The most important thing for achieving success with The Sinclair Method is compliance with taking naltrexone every single time that you drink, and ensuring that you wait at least 1 hour before drinking. This consistency will help you achieve extinction more easily.
The second most important thing is to give this method time to work. TSM is not an overnight fix – and for most people it takes a while to see big changes. That's why it's so important to stick with TSM for the long haul.
Here are some useful resources and information for your TSM Journey! 🙌🏼
The Cure for Alcoholism by Dr Roy Eskapa 📖 (also attached below)
A book about The Sinclair Method
One Little Pill Documentary Movie 🎥
Documentary film by Claudia Christian about TSM
Keychain Pill Holders 💊
Great for always having your medication on you!
Drink log app or spreadsheet
Courtesy of the C Three Foundation
There are some common acronyms that are used in the Thrive Community. Here's a key to help you out 😄
- TSM = The Sinclair Method
- AF = Alcohol Free
- PE = Pharmacological Extinction
- NAL/nal = Naltrexone
- SD = Standard Drink
- MEH = A feeling people get on TSM where they don't feel indifferent to drinking more
- ADE = Alcohol Deprivation Effect
Medical Disclaimer: The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this platform.
Change your relationship with alcohol, change your life 🎉