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.

 

 

WHAT IS THE SINCLAIR METHOD (TSM)?

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.