The Golden Rule - A Tale of Compliance, Complacency and Catastrophe

Last week I added a post here with an optimistic story of receptor upregulation, and Sinclair Method success, that told a positive tale.  It hasn’t all been just that easy though, and there were bumps in the road and lessons to learn along the way.

There is one thing we are always told, the Golden Rule - take naltrexone or nalmefene before drinking.  It’s just that simple.  But I think, no matter how often we read it, or are reminded of it, we all have to learn this lesson for ourselves.

Forums and groups are awash with the same story, and it has become my story too.

I was fully compliant for a year, always following the Golden Rule, and then a few things happened at the same time.

I got complacent.  Alcohol had lost its sparkle, and I felt like I could handle it again.

Drinking sessions were becoming infrequent enough that some of the side-effects, particularly the fierce irritability I’ve described elsewhere, began to emerge again.

I looked at the cost, and how little I would now drink in a session.  Where I could originally stack the cost of the pill against the bottle or two of wine that I’d save, the nal seemed to be getting more expensive, relative to the booze I’d not be drinking.

The online pharmacy I was using stopped prescribing nalmefene, which made securing a supply more complicated.

So I decided that on the nights when I was only going to have one drink I’d skip the pill.

I was cured after all.  I could drink like a normal person.

I don’t think I realised, and it’s difficult to judge objectively now, but I suspect if I’m completely honest, over the year that I drank without the pill my drinking nights probably did get more frequent, and the amount I was drinking probably did increase.

Not to pre-TSM levels, but probably an extra night or two per week, and maybe an extra drink or two (using slightly bigger glasses!).

It just creeps up on you, and there’s nothing more dangerous than complacency.

But then, in November 2017, it all went catastrophically wrong, and the real damage of a year of non-compliant drinking became clear.  My shields were down and the control I was maintaining over my drinking was, it turned out, illusory.

The details are unimportant (for this purpose) and not all of the story is my story to tell, so in the vaguest of terms...  In November I was hit with a kind of double emotional crisis.  In terms of immediate and local factors, I hit a major crisis in my personal circumstances which cast lasting doubt and chaos on every aspect of my life, and which continues to do so now.

At exactly the same time, some events way outside my life opened up some traumas from about 20 years ago that I thought I had resolved, but, it transpires, I had boxed up and stored away like some kind of mental health time bomb, sitting on a shelf, just waiting to explode.

And boom!  Without even realising I was doing it I found myself on a Tuesday night, alone in the pub, knocking back double gin & tonics at a rate I hadn’t drunk for over two years.

In the ensuing fog I got through Wednesday at work, and without evening thinking what I was doing, made a stop on the way home for a bottle of gin from the Supermarket.  I stashed that under the sink, waited for everyone to go to bed, and then sat in the dark drinking it on my own.

And there you have it.  In 48 hours I had completely relearned all my old drinking habits.  Drinking fast, drinking spirits, drinking doubles & triples, hiding booze, drinking alone, drinking furtively, drinking to feel in control, drinking to not feel anything else.

The lot.

Luckily, I suppose, how fast and how far I fell back in to the old habit terrified me.  Red flags went up, alarm bells sounded, and I asked for help.

Also luckily, people answered, and I guess that is a story for next time.

For now, I’ll just add my voice to the many who shout about the Golden Rule.

But more than remembering it now, when you break it - and the internet is littered with stories that suggest you probably will - remember it again then.

We may all have to learn this for ourselves, but when that time comes, may we learn it quickly, and learn it well.

Receptor Upregulation - Why I've been away, the The Sinclair Method's Achilles Heel

A quick update as it has been a long time since I’ve posted anything here.

In many ways that’s a measure of the success of The Sinclair Method, and possibly its achilles heel.

Thinking back to my drinking days I had plenty of time on my hands - let’s call it internet time.  I got the bus to work, I idled away lunch hours in front of screens, I sat up drinking in to the small hours of the morning after everyone else had gone to bed.

When I started on TSM, and my drinking tapered away other things started to change.  I switched to cycling to work, I’d go to the gym at lunch times, for the first time in my life I started to understand the value of a bedtime and early nights, and the free time I had left was more likely to be spent away from a keyboard or a screen.

This was partly a product of pharmacological reinforcement, or receptor upregulation - one of the biggest, but less well known side-effects of both nalmefene and naltrexone.

While the nal suppresses the the uptake of endorphins while we are drinking, on non-drinking days immediately afterwards our brains are temporarily more sensitive to reinforcement from endorphin release.  After taking naltrexone, there is a period of a few days when our opioid receptor produce more reinforcement whenever endorphins are released.

This ‘supersensitivity’ to endorphins means this window gives us more reward than ever for ‘good’ activities that release endorphins

This means that as we stop drinking, we can harness this side effect to replace our drinking with, in my case, a gym and cycling habit.

As Dr Roy Eskapa explains in The Cure for Alcoholism:

As You will find your interest and enjoyment will increase progressively for the healthy activities, helping to fill the vacuum as drinking decreases. Naltrexone offers a window of opportunity for pharmacologically enhanced learning of healthy behaviors. If you last took naltrexone on a Friday afternoon, Saturday is a washout day, when the medication is being removed from your body. Starting Sunday afternoon, roughly two days since your last dose of naltrexone, you are in a state where patients report that doing those alternative behaviors is especially reinforcing. A highly flavored meal tastes great. Even the first bite of chocolate is fantastic. Sex is more rewarding. Exercise feels marvelous. The supersensitivity gradually disappears over the next few days, so it is wise to make an effort to engage in the healthy activities during this window while you get more reinforcement.

It was also just what happened when I reclaimed my life from alcohol.  I started doing more things that were physical, and outdoors - things that didn’t lend themselves so well to sitting in a room alone, and things that were, consequently, less conducive to maintaining a blog.

And this, my friends, is a double-edged sword for The Sinclair Method.  AA is a life-long programme, replacing the pub with meeting rooms, and your drinking buddies with sober buddies.  It substitutes one ingrained pattern of thinking and habitual behaviour with another, and it replaces dying members with new ones, who keep those rooms and those meetings, and who go out to the world to spread its message.  Their sobriety sets them apart, and recovery becomes as much a feature of their life as their drinking was.

The Sinclair Method is a life-long programme - the nal is with you for the rest of your life - but you can keep going to the pubs and you can keep the friends you want to keep.  You don’t need to replace your drinking with new habits that keep you sober, and you don’t sign up to a lifetime of meetings.  You just become normal.

Neither your drinking nor your sobriety attracts attention, and neither is a feature of your identity.  But that does mean TSM is cursed with a kind of social invisibility.  It’s successes blend in, and by not being hooked in to an ever-expanding TSM community, it’s difficult to see how it will ever gain the recognition it deserves compared to methods like AA whose biggest flaw is, ironically, its great strength in terms of building a reputation based on numbers and return customers.

Gary bell captures this well in his post and I think my conclusion is the same as his - it is down to us to keep on speaking, to keep on being honest, and to spread the word.

And this is why I thought it was time to pop back up again.  But here’s a spoiler…  This has explained where I’ve been, and focussed on the success, but I’d be lying if I said it has all been plain sailing.  Next time some thoughts on compliance, complacency, and some bumps in the road.

The first big test – The festive drinking season

So with the week one down, and what side-effects I had in abeyance, peak drinking season began in earnest.

A couple of work Christmas parties, various festive celebrations with friends and family, Christmas and New Year themselves.  This must be the toughest time of year for anyone attempting an abstinence-based approach to managing their drinking.  There is alcohol everywhere, and it is the one time of year when even the most moderate of drinkers are excused for pushing the boat out.

Part of me was regretting making this change half way through December, but I did know that if I could get through the most difficult part of the year then I would always have that to strengthen my will in moments of doubt, and that I wouldn’t have it looming ahead of me next year.

Now I’d be lying if I said the Selincro was some kind of miracle drug that stopped me drinking to excess during this time, but there were some real differences worth mentioning – some real changes in the way I approached drinking, and some very tangible effects.

My biggest worry was my work Christmas Do, which seemed to be hurtling towards me apace, and I knew I needed a strategy.  My first fear was that when the day came I would lose my resolve, and decide to skip the pill and just enjoy a bingey night – for old times’ sake.

When the day finally rolled around I was astounded at how it unfolded – not so much because of what happened, but because of how I felt about it.

In a break from our traditional 1 o’clock Christmas lunch, and 14 hour drinking session, this year we were booked for a 7pm meal.  Undeterred, the first wave of drinkers left the office for the pub at 2pm, and there is no doubt that had it been two weeks earlier I would have been with them.

This time, though, I didn’t even want to go out so early.  It already seemed that The Sinclair Method working not only to help me reduce what I was drinking while I was drinking, but in just over a week this was the first clear sign that my relationship with booze more generally was starting to shift.  This was a turning point, being the first day when I felt like I was in control, and not feeling the urge to start drinking as early as possible and continue for as long as possible.

The next wave left the office at 4pm and this time I went to the gym, finally meeting everyone in the pub at 6.

I had one pint between six and seven, rather than racing through the first to make sure I could fit in a second and maybe third, and that’s when people started to notice that something was going on.

It wasn’t a light night of drinking, by any means, but I kept pace with people around me - no more buying an extra drink and knocking it back at the bar on my way to the toilets or when I was buying a round. 

This was my first proper night of drinking with nalmefene in a big group, and out of the house, and – more importantly – the first time since my late teens that I’d been out drinking in a group and drinking like a ‘normal person’.

I was watching other people bumping in to tables, spilling drinks, drifting in and out of groups without really focussing, and spotting people rolling their eyes as their really drunk colleagues approached. 

This was an entirely new perspective.

I was watching my old self, from the point of view of everyone I’ve ever been out drinking with.


Looking at the heavy drinkers that night, I realised that I was always one of the characters in the stories that turned in to standing jokes and lingered for weeks, months and years.  It felt like I was being shown a film of highlights of over twenty years of my drinking career, and it made for some uncomfortable viewing.

This is when it started to dawn on me that while I’ve made some great progress already on changing my drinking habits using The Sinclair Method, and while observing and reflecting on these changes is both interesting, and, to be honest pretty easy, I have a bigger journey ahead when it comes to reflecting on my behaviour over the last two decades because of those habits.

There is a whole other dimension to making these changes that I am going to need to confront next, and a balance to be struck between recognising and acknowledging what has gone before, and not getting drawn in to a world of retrospective shame and embarrassment when all I can change now is what happens in the future.

This, by @SoberRachel captures it all up beautifully.

Side effects

This is going to be a pretty short post from me as I’ve been pretty lucky in terms of side-effects.

For the most part there were a few anomalies, but it’s hard to tell for sure what was a genuine side-effect, and what might have been phantom symptoms because I had prepared myself and knew what I was looking out for.

For example, I had the strongest of the recognisable effects after taking the first pill, but even then they were pretty mild.  I had some odd sensations in my left arm, something between a tingling and some proper pain, and the same in both feet, and some hot rushes to the head.

None of this was all that uncomfortable or prolonged, and it’s hard to say for sure if they were real, or if I was trying to fit with what I had prepared for.  Equally, they were on a scale that falls within the acceptable level of shrug-offableness that a person on the verge of their forties generally experiences.

If I hadn’t taken the nalmefene they were exactly the sort of thing I would have just experienced, acknowledged, and thought I might worry about if they persisted or got worse.  Definitely not something I would have been concerned about straight away.

And that was it for those.

I was most surprised I hadn’t had any nausea, and hadn’t felt spaced out, as I gather these are very common experiences when people start on these pills, so I went to bed fully expecting that having ducked those two I was definitely in line for some insomnia, but none of that either.

Nothing when I took the second or third pills, and I thought I was out of the woods, but day four was hard work.

Again, it’s hard to disentangle what is cause and what is effect, and difficult to know what can be attributed to the pills, and what was just happening at the same time, but on day four I had no appetite at all.  I got through the day purely on tea and coffee, and not a scrap of food.

It’s not unknown for people to have a loss of appetite as a side-effect, but for me this was the only day this has happened, so I’m not sure if it really was because of the pills.

Then later I was knocked over by a crushing wave of nausea.  Here it is as difficult to identify the cause as with the others – it’s impossible to know if that was because of the pills, or from a day at work followed by an evening of solo-parenting (other half was working that evening) but either way I got the kids to bed and crawled in to be myself before 8pm.

On the bright side, it was my first dry day for a couple of weeks, and even if it was because of the nalmefene it was definitely an isolated incident.

The other common side-effect I dodged was full-blown insomnia, which others have reported in the first couple of weeks, though I did have some broken sleep and vivid and troubling dreams in the first week or two. 

Yet again, I can’t say for sure if this was a genuine side-effect attributable to the nalmefene.  It could equally be the result of drinking consistently less than half my usual daily intake of alcohol over the same period.  There is no way that that couldn’t be having a physical impact, and no way to know what was causing what.

And then there’s the last thing, and the one that had the biggest impact.  The possible causes…?  Was this the nalmefene?  Was it the reduction in the drinking?  Was it even a side-effect of the side-effect of the poor sleep?  I can’t possibly tell, but for the first two weeks I was indescribably irritable.

I had to leave the house to walk round the block because I couldn’t handle being indoors – or, more accurately, in company.  I had to leave my desk at work and hide in the toilets to avoid losing my temper with colleagues.  I had to get off the bus and walk the last few stops home because the presence of other passengers was pushing me to the edge.

Of course, it could have been that I was, by chance, surrounded by some excitable children, some particularly irksome co-workers, and some noisy passengers, and it was nothing to do with any of this. 

And that’s the rub.  Despite being so vigilant for side-effects so that I could report them honestly - or maybe because of being so vigilant - I really can’t separate general day to day physical and emotional events from what may have been exceptional.  I can’t tell what was because of the drugs, what was because of changing my drinking, and what was just happening.

Two major changes combined with the detritus of modern life means that despite my efforts I can’t speak with much clarity or insight on the reality of the side-effects, other than to say I think I dodged a bullet compared to others, and I have nothing to report that can be attributed without doubt, to the drugs.

That may be a valuable message in itself, I’m not sure, but in the name of balance I’d encourage you to read this story which describes a very different experience of a new nalmefene user.

Either way, no matter how tough the side-effects anyone experiences, it seems to be that even in the worst cases they don’t last more than a week or two.  And if that’s the price for changing from the drinking life I had before, to being able to have a drink or two and then stop without a second thought, I would take every side-effect on the list for a fortnight.

The first few days - A series of firsts

December 12th 2015 marked day 1 of my Sinclair Method experience.

It was with some trepidation that I took the first pill.  I’d read up on the potential side-effects, and there are some horror stories out there, but I got off pretty lightly - I’ll come on to those in a separate post.

I was braced for nausea, followed by sleeplessness, which seem like pretty commons side-effects, but I didn’t get either of those.  I got a much bigger surprise instead.

My first glass of wine - for at home it is almost always red wine – went down much more slowly than usual, and I didn’t get ‘that feeling’.  I can’t quite find the word for ‘that feeling’ because it was something I hadn’t really noticed before.

It is the sense that everything is returning to normal again.  The day is finished, work is done, the front door is closed, the kids are in bed, and, finally, that first drink.  Simultaneously a rush of comfort and relief, a sense that everything is okay in the world, and an immediate hankering for the next one.

The first glass is usually down and the second poured in ten minutes.  Then on a good night between one and two bottles.

On a night when I open a fresh bottle I’d drink that, and maybe open another.  On a night when I finish off a bottle from the previous night I’d usually finish that, and work my way through a second.

On a busy night – packed lunches, lots of washing up, and a couple of loads of laundry I’d often make it in to a third over a couple of hours.

And all the while it’s just to keep topping up that euphoric feeling.

I’ve never understood how someone could leave a glass unfinished, or go to bed when they could stay up another half hour and have another drink or two.

Why would anyone stop when they could have more of this feeling?

I don’t think I’d noticed it before, or if I had I certainly wouldn’t have tried to describe it, because I always thought this is just what drinking was like.  If anything I had always wondered what was wrong with other people.  Why don’t they just want to have this feeling every at every opportunity?


On 12th December 2015 I had a glass of wine, and it didn’t feel like that.  That glass lasted 40 minutes, and there was a 20 minute gap before I poured a second.  I just didn’t have that thirst for a second.

That finished a bottle, I opened a second and poured another glass out of habit.  I didn’t really want, or much enjoy, the third, and instead of finishing off the bottle and crawling to bed at 2am I called it a night and was in bed before midnight.

This was the first of many firsts to come.

On day two I was parenting alone as my other half was out at a Christmas do.  It was a fractious bedtime and I literally reached for the bottle a couple of times.  I held back and took the pill, and when I did get to have a drink there was definitely some comfort from the ritual but, again, that feeling, that surge of warmth and relief that comes with the first drink wasn’t there.

I’d be lying if I said I didn’t miss it, and two thoughts started to run through my mind.  The first was the dawning realisation that this is what drinking is like for normal people, and by extension, that my problem was more real, and more physical, than I had ever appreciated.

The second was that I missed it.  I started to worry about the temptation to just skip the pill now and again.  To allow myself that experience again.  I started to feel a sense of loss – grief even – at the prospect of never having that rush of joy again.

This was another three-glass night, but by the third I couldn’t remember ever feeling so ambivalent about a drink, and the idea of skipping the pill seemed ridiculous, almost alien, to me.

And another first – I went to bed that night with the same open bottle of wine on the kitchen work top that had been there the night before.  This would only have happened before if a dry day had followed a night where a bottle was unfinished.  The idea of the same unfinished bottle spanning two drinking days would have been inconceivable only a few days earlier.


Day three I was thinking of trying a dry day, but the urge to drink after work was all-consuming.  On a night like this I would have told myself I’d just have one, really knowing that once that was poured the brakes would be off and I’d plough through at least a bottle.

The difference this time was that after taking the pill the first half a glass lasted just over an hour, and in all it was another three glass night.

This is when I realised that, despite not infrequent dry days – maybe one a week most weeks, though mostly after a particularly heavy drinking day – this was the soberest I’d been for the longest period in well over 20 years.

And I was already starting to feel better.  While at that point only a week earlier I would be finishing the dishes, and the wine, falling asleep on the sofa, and crawling to bed in the early hours, now I was finishing the dishes, dancing in the kitchen, and heading to bed on the right side of midnight feeling good.

I think the energy has been the most surprising thing.  And the dawning realisation that I have a lot to learn about what normal is like. 

Getting started

December 12th 2015 marked day 1 of my Sinclair Method experience.

At least, that was the day of the first tablet.

Actually the story goes back a bit further, and it is worth explaining how I got hold of some nalmefene in the first place.

It is available on the NHS for people who meet some specific criteria in terms of their drinking habits, but is not widely prescribed by GPs, many of whom aren’t familiar with The Sinclair Method.  Also, even when it is prescribed, it sometimes comes with poor advice – some have been prescribed the drug, but advised to adopt a period of abstinence which completely misses the point of The Sinclair Method, and Pharmacological Extinction.

Also, the NICE guidelines surrounding nalmefene demand that it is prescribed in conjunction with some counselling.  Again, this is valuable for some, and may very well help with any emotional or psychological issues behind an individual’s drinking.  For my part, I’m not one for talking therapies, and don’t feel like I need this kind of counselling.  And besides, I know my drinking is a physical and chemical pleasure, as well as a long-ingrained habit.

This immediately builds in a series of obstacles.  For me, once I had made a commitment to myself to tackle my drinking, and having done the research had settled on The Sinclair Method as the way I was going to do it, I wanted to get the show on the road as quickly as possible.  It was particularly important to me to get things started, and get over any initial side-effects before the Christmas drinking season began in earnest.

In my GP practice there is one doctor who specialises in substance abuse, so I thought I would be a step ahead of many in terms of finding a sympathetic ear and well-informed prescriber, but I couldn’t get an appointment with him until mid-January.

After that initial appointment, there is a requirement that you go away and keep a drinking diary for two weeks that has to be reviewed before a prescription will be written, and even then many have found that where their GP is prepared to prescribe the drug, they have a further delay as waiting lists to see therapists for the associated counselling can be months long.

While for many the support that comes from this therapy will be important, I believe that if someone has got to the point with their drinking where they have identified The Sinclair Method as a possible solution, and made it to their GP, it is important to harness that momentum, and begin the process as quickly as possible.

There are a couple of ways to speed this along.  The most valuable of these is a counselling service offered in the UK by CThree Foundation.

CThree are a fantastic resource for anyone considering The Sinclair Method as an option, and they provide a number of very useful resources to help drinkers get the help they need from the NHS.

These include a letter for GPs who may not be familiar, which explains The Sinclair Method and how it works, and provides references to supporting research.  This can often overcome the initial barrier of doctors just not knowing what the process is, and should also ensure that the guidance you get with the drug is reliable – that is to say, it actually recommends that you continue drinking with nalmefene, rather than, as some have been advised, you take it while also trying to take an abstinence-based approach.

Once you can get your GP to buy in to the idea, they also offer a free counselling service that is designed to complement The Sinclair Method.  Again, their website contains a downloadable pack to take to your doctor which explains how this talking therapy works and includes copies of their counsellor’s accreditation.

This is an invaluable service, allowing you to overcome delays for counselling referrals within the NHS, and also providing a service tailored to The Sinclair Method.

Having said all that, I went for another alternative entirely.

I discovered, again through CThree, that it is possible to get hold of nalmefene privately in the UK through  In the time it took me to get the bus to work I completed their online consultation, and they allowed me to upload a two week drinking diary for the previous two weeks there and then, cutting out that delay.

As an alternative to face to face counselling – which some people might want to arrange separately anyway – the prescription comes with a referral for an online course designed to help users acquire coping strategies and knowledge to manage their alcohol intake.

I was able to order the pills straight away, and had them through my letterbox within a few days.

This means this is also kept off my medical records, which might be a concern for some people, but does have the downside of coming at a cost.

The price of the pills varies depending on how much you get at a time, with 14 costing £65 up to £306 for 84.  But at between £3.64 and £4.64 per pill, and given that I was generally getting through between one and two bottles of wine a night – and could easily blast through £40 or £50 on a night in the pub without really thinking twice about the fact that I couldn’t afford it - this is still pretty good value for money.

And finally, December 12th 2015 marked day 1 of my Sinclair Method experience.

What is The Sinclair Method?

While the message at large is still that AA is the only way to deal with a troubled relationship with alcohol, in reality things have moved on.  There is no doubt that at its inception, and for a number of decades since, AA was the best available option for many struggling to deal with problems with alcohol.  For many this is still the case. 

But there is also no doubt that science and medicine have moved a long way.  Somehow, through pure tenacity and its position of prominence in the ‘recovery industry’ this 1930s perception of how this problem works remains dominant, despite 21st century science, medicine and understanding being available to us.

For many AA is simply not the most appropriate route, particularly as we live in an ever more secular world where notions of a higher power are decreasingly plausible, and one in which notions of individual empowerment are less and less compatible with a treatment which defines the individual as powerless.

Depending on where you are in the country, and, to be honest, the level of knowledge and understanding of your individual GP, the alternatives vary, but what remains broadly constant across the UK is that those of us with problems with drinking are the last group left for whom the dominant treatment offered by the medical community is a spiritual one, recommending God as a cure for a physical phenomenon.

Among the more secular, and more strongly evidence-based alternatives, are options like SMART Recovery, Lifering and The Sinclair Method, and these are all worth exploring for anyone embarking on a journey to tackle their problems with drinking, or who is struggling with their own experience of AA.

I have tried to write this ‘What is The Sinclair Method?’ post a few times, but nothing I can come up with is as concise or illuminating as the Definitive Statement about The Sinclair Method by Dr John David Sinclair, available on the CThree Europe website.

I have reproduced it here, including references, but it can be found in context here.

For a much more thorough read, Dr Roy Eskapa’s The Cure for Alcoholism: The Medically Proven Way to Eliminate Alcohol Addiction is a comprehensive reference on the subject.

Some other valuable resources are also worth highlighting here.

The first is the One Little Pill documentary.  This talks about The Sinclair Method and how it works, looks at its reception in the US and the UK, and tells the stories of some Sinclair Method users.  You can see a trailer for the film here.

The second is the Alcoholism-Recovery-Radio podcast.  In this series there are currently two episodes that deal specifically with The Sinclair Method, discussing the method itself as well as the experiences of individuals who have used it with varying degrees of success.

This podcast also has a series of episodes which discuss AA’s twelve steps in some detail, and consider the merits of AA in the context of the alternatives that are now available.  These offer some tremendous insight for anyone embarking on changing their relationship with alcohol using The Sinclair Method, AA, or any of the other options that are out there.




Definitive statement about The Sinclair Method by Dr John David Sinclair

Dr John David Sinclair, Ph.D., Researcher emeritus

The Sinclair Method (TSM) uses the nervous system’s own mechanism, called “extinction”, for gradually removing the interest in alcohol and the behaviours involved in alcohol drinking.  Therefore, the technical term for TSM is “pharmacological extinction.” 

The key scientific discovery underlying the treatment was that, contrary to earlier beliefs, detoxification and alcohol deprivation do not stop alcohol craving but in fact increase subsequent alcohol drinking[1],[2].  The old idea that alcoholism is caused by physiological dependence on alcohol, therefore, needed to be discarded, and a new understanding of alcoholism developed.

Subsequent research showed that alcohol drinking is a learned behaviour[3]. 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 behaviour becomes too strong. They cannot always control their drinking; they cannot “just say ‘no’.”  And society calls them alcoholics.

Laboratory studies indicated that in most cases, the reinforcement from alcohol involved the opioid system, i.e., the same system where morphine, heroin, and endorphin produce their effects.[4] 

The brain has two primary mechanisms for changing its own wiring on the basis of experience.  First, there is learning for strengthening behaviours that provide reinforcement.  Second, there is extinction for removing behaviours 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 behaviour extinguished when the food reinforcement was no longer given after the bell was rung.

Certain medicines, such as naltrexone, naloxone and nalmefene, block the effects of endorphin and other opiates. I reasoned that if alcohol is drunk while one of these opioid antagonists is blocking endorphin reinforcement in the brain, the extinction mechanism would be activated, and it would then produce a small but permanent decrement in alcohol drinking and craving. The next day, the person would be slightly less interested in alcohol. Eventually control would be regained, and the person would no longer be an alcoholic; indeed, they no longer would be interested in alcohol[5].

The Sinclair Method was confirmed, first in a large body of laboratory studies[6],then in over 90 clinical trials around the world[7],[8],[9], and most recently in personal reports by people using it[10]. It has been found to be successful in about 80% of alcoholics.  This is very high for alcoholism treatment, but the treatment is not for everyone: some people apparently have a different form of alcoholism that does not involve the opioid system and cannot be treated effectively with opioid antagonists. 

The Sinclair Method is simply taking an opioid antagonist before drinking. Naltrexone, naloxone, and nalmefene are not substitution drugs similar to methadone for heroin addiction or Nicorettes™ for nicotine addiction. The opioid antagonists are not addictive, and they do not directly reduce craving for alcohol.  And unlike disulfiram, the opioid antagonists do not produce an unpleasant aversive effect. Indeed, the opioid antagonists do not do anything until after endorphin has been released. Then the mechanism of extinction is triggered, and the extinction mechanism in turn progressively but permanently removes the neural cause for excessive drinking.

John David Sinclair, Ph.D., Researcher Emeritus

[1]Sinclair, J.D. and R.J.Senter.Increased preference for ethanol in rats following alcohol deprivation.Psychonomic Science8: 11‑12, 1967.

[2]Sinclair, J.D. The alcohol‑deprivation effect: Influence of various factors. Quarterly Journal of Studies on Alcohol33: 769‑782, 1972.

[3]Sinclair, J.D. Rats learning to work for alcohol.Nature249: 590‑592, 1974.

[4]Sinclair, J.D., J.Adkins, and S.Walker.Morphine‑induced suppression of voluntary alcohol drinking in rats.Nature246: 425‑427, 1973.

[5]Sinclair, J.D. Method for Treating Alcohol‑Drinking Response. USA patent4,882,335 Nov. 21, 1989.

[6]Sinclair, J.D. Drugs to decrease alcohol drinking.Annals of Medicine22: 357‑362, 1990.

[7]Heinälä, P., H. Alho, K. Kiianmaa, J. Lönnqvist, K. Kuoppasalmi, and J. D. Sinclair.Targeted use of naltrexone without prior detoxification in the treatment of alcohol dependence: A factorial double-blind placebo-controlled trial. Journal of Clinical Psychopharmacology21(3): 287-292, 2001.

[8]Sinclair, J.D. Evidence about the use of naltrexone and for different ways of using it in the treatment of alcoholism.Alcohol and Alcoholism, 36: 2-10, 2001.

[9] Eskapa, R. The Cure for Alcoholism, Dallas, TX: BenBella Books, 2008, 2012.

[10] Christian, Claudia.  Babylon Confidential, Dallas, TX, BenBella Books, 2012.


A bit of background...

For longer than I’d like to acknowledge – though one of the features of this blog is that I’m going to have to acknowledge a few things I’d rather not – I’ve had a troubled relationship with alcohol.

I would never have identified as an alcoholic, mostly because of the culturally entrenched image of what being an alcoholic is.

I’ve never had a ‘rock bottom’.  I haven’t lost my partner, house or kids.  I don’t drink in the working day and I’ve never lost a job, or even missed a day of work or study, because of drinking.  I’ve never lost my license, or even driven drunk.

These are the things that we expect of an alcoholic, and the things that happened to someone very close to me before he went – with little success – through years of rehab and AA.  But that’s not my story to tell.

It does feed in to mine though.  I watched from the side lines as everything that we are led to believe is the only option for alcoholics didn’t work for him, and I knew it wouldn’t work for me.

The media and popular culture, as well as our health service and justice system, all know that AA is where you go if you have a drink problem.  The only solution is to find a group, and to never drink again.

You admit you are powerless, and you hand over responsibility to god, or God, or some other god as you understand it, and then never drink again.  Or you do all that and do drink again, in which case you have done it wrong.

That was never going to work for me.  For a start I don’t believe in God, so I am going to run in to problems pretty early in the steps.  I also don’t think that telling someone that they are powerless is a very empowering message.  I don’t believe you can ever give a person control over an area of their life that they are struggling to control by telling them that they can’t control it.

I don’t think AA is without some significant merits, but I know it’s not a good fit for me.

It is hard for any alcoholic to admit they have a problem with alcohol, but it is even more difficult to allow yourself to acknowledge it when you know that the only solution – the only hope - is not going to work for you.  Why would someone even bother?

So I have always found ways of masking it.  Through my twenties I surrounded myself with a heavy drinking and hard partying crowd.  It was always ‘social drinking’, but we were very sociable, and within that group I was definitely amongst the most sociable of all.

As we hit our thirties and started having kids people broke off from that scene, and I did the same, but what I didn’t realise is that while everyone else had changed their lives in the time I wasn’t with them, I was still drinking just as much, more even, but doing it at home, on my own, usually after my partner and kids had gone to bed.

I’d stay up to do the dishes, and laundry, and make the packed lunches, while quietly putting away a bottle or two of wine every night.

When we had company there’d be wine on the table, but there’d always be a separate bottle or two stashed in the kitchen.  I’d either keep topping up my glass so it wasn’t so obvious I was a bottle or more ahead of everyone else, or I’d just keep pace in one room, and be drinking straight from the bottle in the other.

When we went for drinks after work I’d always have a can between work and the pub, just to get started.  And I’d never consider a trip to the pub without a four-pack in my bag, just in case.

And it turns out that this isn’t how most people drink.

I think I might have always suspected.

And then, completely by chance, I stumbled in to The Sinclair Method and embarked on a journey that I am documenting here.

I hope that one day this might be useful to someone else.

I am tweeting using @NickyKatz where I’ve been keeping my drink diary, and recording my most immediate thoughts and experiences as I’ve been going through this process.  It’s riddled with typos and the immediacy means it’s also poorly curated, but it is honest.

This blog, on the other hand, is something that I hope will be more considered.  I want this to be a place where I can take some of the issues that crop up on the twitter account and flesh them out a bit.  Somewhere where I can add some context and explore the complexities a bit more thoroughly.  A place where I can challenge myself, and document the process and experience of changing my drinking using The Sinclair Method.

Above all, I want this to offer some hope.  I want anyone who reads it to know there are alternatives.  Alternatives to AA, alternatives to identifying yourself as powerless and inherently flawed as being the best you can hope for, alternatives to handing responsibility for yourself over to God (or a god), alternatives to the binary state where either abstinence or problem drinking are the only two routes available.

There is something else, in fact there are a number of other things, and I am doing one of them.