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The Sinclair Method for Alcohol Addiction

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

Try the Sinclair Method online with Ria Health

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.1 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 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. Instead of requiring people to quit drinking immediately, it uses targeted doses of the drug naltrexone to help them reset their drinking habits. Many people find that they can eventually drink moderately, or even lose interest in alcohol completely, after enough time on TSM.

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 is steadily gaining 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.2 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 Does “Pharmacological Extinction” Mean?

Within TSM, “pharmacological extinction“ means a person’s addictive relationship towards alcohol has come to an end. Essentially, their addiction has become “extinct.” 

Alcohol use disorder develops in part because of the reward system in the human brain: When we do something that feels pleasurable, our nervous system remembers it, and encourages us to do it again. If we repeat this behavior often enough, it becomes a learned pattern, and harder to break. This is especially true when it comes to substances, and is one of the main reasons people continue having strong cravings for alcohol long after physical detox is complete. 

The reason TSM works for so many people is that it reverses this learning process. The brain unlearns the connection between alcohol and pleasure, day by day, week by week, until it no longer craves alcohol. This is the exact meaning of “extinction” within the Sinclair Method.

What To Expect on the Sinclair Method

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

  • Take naltrexone one hour before you intend to start drinking
  • Drink as you normally would
  • 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 TSM 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.

How Long Does the Sinclair Method Take?

The Sinclair Method can take anywhere from a few months to a year or more, depending on the person. Some people feel an immediate reduction in alcohol cravings after their first time drinking on naltrexone. For others, it is a gradual process. However, the majority of people who follow TSM eventually lose interest in drinking the way they had been, and are able to achieve moderation or abstinence.

No matter how long you have been on TSM, however, you will always need to take your medication if you wish to drink any alcohol.

The Sinclair Method With Ria Health

Ria Health offers support for the Sinclair Method among our many treatment options. Our version is essentially “The Sinclair Method Plus.” We add medical consultation, full coaching support, and digital progress tracking tools to the TSM approach, helping you stay the course and adjust to a new relationship with alcohol. We also offer several other medications besides naltrexone, so if TSM isn’t a good match you can try something else.

What is it like to follow TSM with Ria Health?

  • Meet with a member of our medical team to discuss your drinking patterns and goals
  • If the Sinclair Method is a good fit, you’ll receive a prescription for naltrexone
  • Begin taking naltrexone one hour before you start drinking, and follow the usual TSM protocol
  • Unlike following the Sinclair Method on your own, you’ll have access to professional medical advice on how to do TSM effectively
  • As a Ria member, you’ll also get weekly meetings with one of our coaches to discuss your progress and work through challenges
  • Use the Ria 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 TSM 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.

In other words, the Sinclair Method is very compatible with Ria Health, and our program serves as an excellent support system for any person who wants to try this approach. Adding medical support, coaching, and digital tools to your TSM journey can boost your chances of success, and make the whole experience much smoother.

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

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Will the Sinclair Method Work for Me?

The Sinclair Method 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

The Sinclair Method may not be right for you if:

  • You want to quit cold turkey
  • You want an immediate solution (you’ll need to have patience through the process)
  • You’re taking an opioid-based medication, or any drugs that interact with naltrexone (in this case, another anti-craving medication like baclofen or gabapentin may be prescribed)
  • You struggle with self-motivation to take the medication or monitor your progress
  • You’re part of the 10 percent of people for whom naltrexone’s normally mild side effects are too severe (again, there are other medications you can take)

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.

Is the Sinclair Method Effective?

The Sinclair Method has shown a 78% long-term effectiveness rate in clinical studies, significantly more than most mainstream approaches to alcohol treatment. While there are some people for whom TSM doesn’t work, overall the Sinclair Method is one of the strongest options out there for alcohol recovery.

Why Isn’t the Sinclair Method More Well Known?

The Sinclair Method is already widely prescribed in several European countries. And although it is less common in the US, more and more doctors are willing to prescribe naltrexone for alcohol addiction.

Several factors may be limiting the wider embrace of TSM in the United States. Among these are the widespread belief that abstinence is the only solution, stigma around alcoholism 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 the Sinclair Method. This is a major reason why Ria offers treatment via telemedicine—to make TSM 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?

On the Sinclair Method, as long as you continue to take naltrexone as directed, it is possible to relearn to drink moderately. This is a major reason why many people choose TSM: It helps you reset your relationship with alcohol and regain choice. That said, many people who stick with the Sinclair Method for long enough report a total loss of interest in alcohol. Around one quarter of those on TSM become completely abstinent from drinking.3

Read more about Moderation as an Option

Sinclair Method Success Stories

People who discover TSM after years of struggling with traditional methods often describe it as miraculous. Many report finally feeling free from a cycle of cravings and relapse that they thought would never end. Listen to Joseph and Rich K discuss what TSM was like for them following Ria’s program:

Other Common Questions About TSM

Is TSM Covered By Insurance?

Depending on which program you choose, and your specific plan, the Sinclair Method may be covered by insurance. Check with your provider to see what is available. Ria Health’s online program currently accepts Anthem, Blue Cross Blue Shield, Optum, and United Healthcare, among others. Get in contact with our team today to verify your insurance, and see what’s possible.

Can I Follow the Sinclair Method By Myself?

For some people, this may be achievable. But for most people it helps to have some supervision. TSM is a long process, and doing it yourself requires strong self-discipline, a positive outlook, and patience. We often see better results from people who have coaching support, and professional medical advice. Ria Health offers the Sinclair Method plus coaching via telemedicine, making it more accessible for you.

If you choose to do TSM on your own, make sure you follow the correct instructions. And be sure to get your naltrexone from a reputable source. Ordering naltrexone online without a prescription carries many risks, including excessive cost, customs delays, and unseen additives.

Learn More About the Sinclair Method

Interested in learning more about TSM? Get in touch with our team or check out some of our many videos on the subject:

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Other Medication Options for Alcohol Use Disorder

TSM 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

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