smiling woman on beach

The Sinclair Method for Alcohol Addiction

What is the Sinclair Method (TSM) and is it for you?

Medically reviewed by Dr. Paul R. Linde, MD on February 18, 2021

If you’re struggling to drink “normally,” but don’t want to quit drinking altogether, you should know that abstinence isn’t the only option. There’s also the Sinclair Method (TSM).

The Sinclair Method can significantly reduce your drinking without requiring you to quit cold turkey. Although it’s only just starting to gain traction in the U.S., it’s affordable, has a 78 percent success rate, and can be done at home. People can use TSM to quit drinking completely, but many who use this method also find that they can relearn moderate drinking if they wish. This makes it a very flexible and realistic option, especially for long-term recovery

Ria Health is committed to evidence-based treatment for alcoholism. We offer support for TSM among our many options. Learn more.

Medically reviewed by Dr. Paul R. Linde, MD on February 18, 2021

Table of Contents

What Is the Sinclair Method?

The Sinclair Method (TSM) is a medication-based approach to alcohol addiction treatment that uses targeted doses of the drug naltrexone to help reset drinking habits. Many people find that they can eventually drink moderately, or even lose interest in alcohol completely, after enough time on naltrexone.

First developed in Finland by Dr. John David Sinclair, TSM is now commonly prescribed in several parts of Europe. And although less common in the US, it has gained a loyal following amongst those who have struggled with traditional treatments.

How Does the Sinclair Method Work?

The Sinclair Method works by blocking the reinforcement or reward that people get from drinking. This can help people unlearn their addictive behaviors around alcohol.

Part of the reason alcohol addiction happens in the first place is due to brain chemistry. Your body releases endorphins when you drink, and endorphins make you feel good. Over time, your brain remembers this, and can start to connect alcohol with pleasure. You may start to drink to get that same euphoric feeling. Even if you know it’s not healthy, it’s hard to stop because the craving now seems uncontrollable.

If the problem is a connection between pleasure and alcohol, then we need to break that connection. One way of breaking it is by using a medication to block endorphins when we drink. That’s what naltrexone does. People on the Sinclair Method are instructed to take a single dose of naltrexone one hour before drinking. Once this dose takes effect, they are free to consume alcohol if they wish.

If someone drinks a large amount after taking naltrexone, they may still feel the negative impacts of being drunk—from reduced motor control, to having a hangover the next morning. But many report that drinking on naltrexone just isn’t as satisfying. Over time, this reduces a person’s motivation to drink.

What Is Naltrexone?

Naltrexone is a non-addictive opioid blocker, which can help people unlearn certain types of addictive behavior.1 It’s been approved to treat opioid addiction since the 1980s, and turns out to have a similar effect on the endorphins your body generates when you drink.

Unlike disulfiram (also known as Antabuse), naltrexone doesn’t intentionally make you feel ill when you drink. Instead, it reduces your motivation to drink by blocking the reinforcement or reward of alcohol. It does this by limiting the endorphin rush many people get from drinking. This starts to retrain your brain not to expect anything from alcohol—eventually resulting in a phenomenon called “pharmacological extinction.”

Learn more about naltrexone

What To Expect When Taking Naltrexone

Interested in trying Naltrexone? Here’s what you can generally expect from the process:

  • Take naltrexone one hour before you intend to start drinking
  • The naltrexone will block some of the pleasurable impacts of alcohol, making drinking less rewarding
  • Stay consistent in taking the medication every time you drink
  • Over time, you’ll experience less and less desire to consume alcohol
  • Some people eventually relearn moderate drinking this way, while others lose interest in alcohol completely

While naltrexone can help you reduce cravings, there may be other areas you need to tackle before you can fully mend your relationship with alcohol. These include:

  • Managing drinking triggers
  • Underlying causes of addiction (including mental health, genetics, etc.)
  • Learning new, healthier coping mechanisms
  • Communicating with family and friends about the changes you are making

Often, these issues cannot be addressed by medication alone, which is why Ria Health combines Naltrexone with counseling. In addition to anti-craving medication, Ria members get access to a personal recovery coach. Your coach can teach you techniques, track your progress, provide encouragement, and guide you through setbacks, boosting your chances of long-term success.

Treatment at Ria Health

Ria Health offers support for the Sinclair Method among our many treatment options. Our version is evidence based use of anti-alcohol medications. We add medical consultations and management, full coaching support, and digital progress tracking tools to help you stay the course and adjust to a new relationship with alcohol.In addition to naltrexone we use acamprosate, baclofen, gabapentin, prazosin and topiramate so if naltrexone isn’t a good match you can try something else.

What is it like to get treatment with Ria Health?

  • Meet with a member of our medical team to discuss your drinking patterns and goals.
  • You’ll receive a prescription for naltrexone or another anti-alcohol medication.
  • Begin taking naltrexone on a schedule best suited to your drinking pattern with support and management by the Ria Health team.
  • Unlike following the Sinclair Method on your own, you’ll have access to professional medical advice on how to take naltrexone most effectively.
  • As a Ria Health member, you’ll also get weekly meetings with one of our coaches to discuss your progress and work through challenges
  • Use the Ria Health app and the included Bluetooth breathalyzer to track your drinking and access written resources and videos
  • We’ll support you through the process for however long it takes. And if naltrexone doesn’t work for you, we won’t leave you hanging—we have five other medications we can prescribe, as well as different ways to take naltrexone.

Ria Health, and our program, serves as an excellent support system for any person who wants to try medication to reduce or quit drinking. Adding medical support, coaching, and digital tools boost your chances of success, and make the whole experience much smoother.

Get in touch with our team to learn how we can help.

Ready for a change in your relationship with alcohol?
Schedule an appointment to speak with a Ria Health team member to get help.

Will the Medications Work for Me?

Medication assisted treatment may be right for you if:

  • You have cravings for alcohol
  • You feel motivated to change your habits
  • You want to drink less or not at all
  • You have a healthy liver
  • You have a family history of alcohol dependence

Whether you’d like to drink less or stop completely, your goals are in reach! Start our at-home program today to begin seeing results.

Why Isn’t the Sinclair Method More Well Known?

The Sinclair Method is already widely prescribed in several European countries. In the US TSM is a subset of Medication Assisted Treatments. Over the last 30 years much has been learned about how best to deploy naltrexone and other anti-alcohol medications. Ria Health clinicians are up to date on all medication management strategies for alcohol use disorder.

Several factors may be limiting the wider embrace of anti-alcohol medications in the United States. Among these are the widespread belief that abstinence is the only solution, stigma around alcohol use disorder which hinders open discussion, and reluctance among some to take medication for this issue. It can also be hard for some people to find a doctor nearby who knows about modern treatments for AUD. This is a major reason why Ria Health offers treatment via telemedicine—to make medications easier to access.

Aside from this, as Dr. John Mendelson explains, changes in medicine simply take time. But as the evidence continues to grow, TSM is slowly but surely gaining a following in the USA.

Is Moderation Really Possible?

With medications, psychosocial support, and monitoring of drinking behavior many patients achieve moderation in drinking. This is a major reason why many people choose naltrexone and other anti-alcohol medications – they help you reset your relationship with alcohol and regain choice. That said, many people who are treated for long enough report a total loss of interest in alcohol. Around one quarter of those on anti-alcohol medications become completely abstinent from drinking.

Read more about Moderation as an Option

doctor holding assorted pills

Other Medication Options for Alcohol Use Disorder

Naltrexone has a high success rate, and is effective for many people. But if it isn’t a perfect fit, there are many other options. If it’s hard to remember to take your medication an hour before drinking, for example, there are other ways to take naltrexone. There are also several other medication options if naltrexone doesn’t work for you.

Ria Health offers a fully flexible, online program that tailors treatment to your specific needs. If one solution doesn’t work, we’ll keep trying until we find one that does. Best of all, you’ll never have to put your life on hold or disrupt your daily rituals to get treatment.

Learn more about medication for alcohol use disorder

Ready to get started with Ria Health?

Schedule an obligation-free call for more details.

man on tablet standing by the window


Is My Drinking Normal?

Take our short alcohol quiz to learn where you fall on the drinking spectrum and if you might benefit from quitting or cutting back on alcohol.