The Sinclair Method Debunked
The Sinclair Method is a treatment for alcoholism that uses the drug naltrexone to disrupt the pleasurable aspect of drinking. Naltrexone is an opioid antagonist that binds to mu receptors in the brain. The endorphins produced by drinking have nowhere to land and so the pleasure of drinking is more or less extinguished. This process is known as pharmacological extinction.
The Sinclair Method requires you to take a naltrexone pill an hour prior to drinking every time you drink. Your brain gradually learns to separate alcohol from the reward of intoxication and so alcohol cravings gradually diminish. It takes about three months for the cravings to disappear completely, but you have to continue to take naltrexone prior to drinking. Advocates of the Sinclair Method claim the method has about an 80 percent success rate. If that’s the case, why isn’t it used more widely?
Criticism of the Sinclair Method
You may have already spotted the weak link: you have to take the pill an hour before drinking, every time you drink. That can be a big ask for someone who not only wants to drink, but wants to get drunk. Essentially, the only thing standing between an alcoholic and intoxication is voluntarily taking a pill. The main problem with another alcoholism “cure,” Antabuse, is that when a recovering alcoholic wants to get drunk, he’ll just wait two weeks for the Antabuse to wear off.
Following the same logic, what’s to stop someone from just not taking a naltrexone pill? Even someone getting a monthly naltrexone shot might wait a month so he can relapse.
Another problem is up-regulation. While you’re taking naltrexone, your endorphins essentially aren’t working, so your brain produces more. Then, if you relapse–without the naltrexone–you get an even bigger jackpot than you did before. This extra huge reward can make it harder to stop drinking again.
Finally, in alcoholism, alcohol isn’t the real problem. Naltrexone can help break the link between alcohol and pleasure, but it can’t necessarily remove the desire to be drunk. There is typically something else at work that makes you want to be drunk–anger, resentment, depression, etc.–and breaking the link between alcohol and that relief only solves part of the problem.
It has the potential to turn someone into a “dry drunk,” someone suffering from all the old resentments but unable to do anything about it. It might even create a new problem in the form of a different addiction.
At Hanley, our alcohol treatment centers utilize a different approach.
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