“A Complete Miracle”: How Naltrexone Works on Your Brain

A beloved actress and friend, Claudia Christian once felt utterly hopeless.

For years, Christian had been battling a deadly addiction to alcohol, driven by genetics and a history of disordered drinking behaviors. And after seemingly-endless attempts to fix her drinking habits—each proving futile, one after the other—she felt as if she had hit rock bottom.

“I prayed until my knees were black and blue, and I still kept relapsing time and time again,” said Christian in a Tedx Talk at the London Business School. “Each relapse became…worse and worse.”

Photo: Alexander Andrews for Unsplash

Relief finally greeted Christian when she discovered naltrexone, a drug designed to reduce cravings for alcohol. By following a medication plan known as the Sinclair Method, Christian cut down her drinking over the course of several months, describing her transformation as “a complete miracle.” So what is the Sinclair Method and the secret behind it?

The Behavioral Drive Behind Alcoholism

At the heart of almost all habits is a concept known as “reinforcement,” which can be either positive and negative. For most of us, positive reinforcement is common sense: after being rewarded once for doing something, a person may behave the same way again and again in order to elicit the same favorable response. Thus, the person’s behavior is “reinforced” by the expectation of receiving a reward. Similarly, negative reinforcement means learning to behave a certain way to avoid a negative response

As it turns out, addiction is guided by the same two behavioral forces. But unlike most habits, the incentive to keep drinking comes from inside, not out. Once someone downs that first, sweet bottle of booze, a sea of “feel-good” chemicals floods the nervous system and generates a calm, euphoric feeling—one that makes it tough to resist another round. For some—especially those with genetic and psychological predispositions—this sensation is potent enough to turn bi-weekly trips to the pub into nightly manhunts through the liquor aisle, paving the way for full-fledged addiction.

While positive reinforcement dominates the early stages of addiction, negative reinforcement takes the helm as time rolls on. Once the rosy sheen of drinking wears off, heavy drinkers’ brains rewire such that they need alcohol to function throughout the day, lest they be slammed with withdrawal symptoms like anxiety, irritability, and general malaise. In other words, the consequences of not drinking become even more important than the gratification.

The Sinclair Method

Reinforcement may seem powerful and irreversible, especially when used to foster an addiction to alcohol. Luckily, there’s a flip side to reinforcement known as “extinction.” The idea is that, by losing the positive reward associated with a certain behavior, a person loses the desire to keep behaving that way altogether. And voila: over time, the person drops the now-unappealing habit once and for all.

One well-known example of extinction is Ivan Pavlov’s experiment. In 1903, Pavlov began ringing a bell before feeding his dogs, causing them to associate the sound with food. However, once Pavlov stopped feeding them afterward, the dogs no longer salivated in response. Or, to put it another way, their anticipatory response to the bell went “extinct.”

But the wonders of extinction don’t stop with dogs—a few decades ago, a doctor named David Sinclair came up with the idea of using extinction to cure alcohol use disorder (AUD), too. According to Sinclair, medications for alcohol cravings (like naltrexone) gradually blunt the pleasurable effects of drinking, discouraging problem drinkers from falling back into the bottle. In order to maximize the long-term effects of naltrexone, Sinclair recommended popping a pill one hour before drinking. After garnering popularity, this concept came to be known as the Sinclair Method, or “pharmacological extinction.”

Here’s the science behind the theory. Normally, each swig of alcohol stimulates the production of brain chemicals called endorphins, which calm the body in response to pain or stress (ever heard of a “runner’s high”?). Endorphins then bind to opioid receptors in the “reward center” of the brain, triggering the release of dopamine, a brain chemical responsible for the pleasurable effects of alcohol. Naltrexone prevents endorphins from taking effect by blocking off opioid receptors before any alcohol is consumed.

Although “pharmacological extinction” is the go-to term for the mechanism of naltrexone, the Ria Health team contends that extinction is just one piece of the puzzle. According to Dr. John Mendelson, Ria’s chief medical officer, naltrexone works both by reducing the pleasurability of drinking and rendering the adverse effects—like sickness and hangovers—more noticeable. As the thinking goes, naltrexone balances the positive and negative reinforcements for drinking, rather than simply removing the positive.

Dr. Mendelson also notes that, in most experiments, behavioral extinction only works after a new reward for a certain behavior is substituted for the old reward. For this reason, “pharmacological extinction” could be better described as “behavioral change,” at least in the case of naltrexone.

Sinclair Method Considerations

For the most part, medications for alcohol cravings work as well as they claim. A number of studies have already shown that naltrexone is a highly effective way to slash cravings for alcohol and, by extension, reduce alcohol consumption overall. Nevertheless, there are a few things to consider before diving into a naltrexone treatment plan for alcohol use disorder.

On one hand, naltrexone may not represent a “one-size-fits-all” approach to treating AUD. Recall that at some point, the consequences of not drinking alcohol—such as withdrawal symptoms—become more important than the positive rewards associated with drinking. For this reason, some researchers suggest the Sinclair Method may work better for moderate drinkers than heavy drinkers. That said, it’s important to discuss the potential efficacy of naltrexone for you with a physician.

What’s more, naltrexone can only do so much to help patients resist drinking triggers aside from cravings, such as boredom, stress, or social pressure. In the words of Dr. Mendelson, there are “a whole set of competing rewards around drinking, and intoxication is only one of them.” Therefore, naltrexone may work best for some in combination with supportive therapy. For more information, see our previous article on the benefits of supplementing your medication plan with in-person support.

Most Ria Health members enter our program feeling like Claudia once did: frustrated, hopeless, and exhausted. Yet many leave feeling optimistic, their drinking problems finally resolved. The Ria team recognizes both the behavioral and physiological roots of addiction, meaning naltrexone is just one of many treatments (albeit an important one) members receive to get their drinking habits back on track. Visit our website to find out how you can get your life back in shape.

Film and television actress Claudia Christian created the C Three Foundation in 2013, and is a member of the advisory board of Ria Health. Post author Kimberly Nielsen writes about health issues, and has written for various scientific newspapers and blogs. She is currently studying biology at the University of California, Berkeley, and plans to pursue a graduate degree in Public Health.

References

[1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4065474/

[2] https://www.the-sinclair-method.com/definitive-statement-of-the-sinclair-method-by-dr-david-sinclairphd/

[3] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC167184/

[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3064474/

[5] https://www.ncbi.nlm.nih.gov/pubmed/16361086

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