What is The Sinclair Method?

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.”

Background

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.  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.  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.  This is the same system where morphine, heroin, and endorphin produce their effects.

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. They then had the learned behaviour extinguished when the food reinforcement was no longer given after the bell was rung.

Opioid Medications

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.

The Sinclair Method

The Sinclair Method was confirmed, first in a large body of laboratory studies, then in over 90 clinical trials around the world.  And most recently in personal reports by people using it. 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