The Sinclair Method vs Daily Naltrexone: What's the Difference?

Beginning naltrexone treatment for alcohol use disorder (AUD) can be a bit confusing, especially since there are different ways to take the medication depending on your needs. The Sinclair Method, for example, involves a specific approach that many find effective. Naturally, a few common questions tend to come up:

• Should I take it every day?
• What time of day is best?
• Should I only take it when I plan to drink?

The best way to use naltrexone depends on several factors: your drinking style, your personal goals, and your doctor’s advice.

With that said, I’d like to share some thoughts on these questions based on my experience and the insights I’ve gained from clients over the years. Recently, Dr. Joseph Volpicelli—a leading expert on naltrexone—also offered valuable perspectives on daily vs. targeted naltrexone use, which I’ll incorporate here to give a fuller picture of the options (you can watch the full video above).

The Sinclair Method and Targeted Naltrexone Use

The Sinclair Method was designed for targeted use, meaning you take naltrexone only before drinking, typically an hour before. This protocol has been clinically proven as one of the most effective ways to treat alcohol use disorder (AUD) with naltrexone.

When taken an hour before drinking, naltrexone reaches peak levels in the body as you begin drinking, blocking the brain’s opioid receptors to reduce the pleasurable effects of alcohol. Over time, this can help the brain “unlearn” the connection between alcohol and reward, lowering cravings and drinking.

In the video above, Dr. Volpicelli explains that targeted naltrexone can work well for people in the early-to-mid stages of problem drinking or those who are binge drinkers but haven’t developed a full dependency. He mentions that people with a family history of AUD—who often feel energized instead of sedated by alcohol—may benefit greatly from this approach. Targeted naltrexone can help them avoid “craving boosts” after a few drinks, making it easier to stop at one or two.

When Daily Naltrexone Might Be Beneficial

Some people find that daily naltrexone suits them better, especially if they plan to remain alcohol-free and want something that may help with alcohol cravings. It can benefit others who drink heavily every day or struggle with consistent adherence to a targeted regimen. Dr. Volpicelli shares that daily naltrexone can provide constant support, eliminating the need to decide on a dose before drinking—particularly helpful for those struggling with cravings that may impact medication adherence.

Daily naltrexone might also work for people who tend to rationalize drinking without taking the medication later in the day, even if they initially planned not to. Dr. Volpicelli suggests that people like this could benefit from taking a daily dose in the morning, when their cognitive, “long-term-thinking” brain is more in control than the impulse-driven, “feel-good-now” brain.

My experience: Some people I’ve worked with start with daily naltrexone for stability and gradually switch to targeted use as their drinking decreases over time.

Why Targeted Naltrexone May Help Habit Change

One advantage of the Sinclair Method’s targeted approach is that it allows for “natural rewards” on alcohol-free days. Unlike with daily use, naltrexone is not in the system on days without drinking, allowing the body to release endorphins and dopamine from enjoyable activities like exercise, good food, and time with loved ones. Over time, this can reinforce positive habits and make the shift from alcohol to healthier activities smoother.

Example: When I started on TSM, I drank daily, so I took naltrexone daily at first. As my cravings declined, I naturally drank less often and didn’t need to take the medication every day. This let me feel the rewards of other activities without interference, which many people find refreshing.

Does Naltrexone Block Other Pleasures?

A common question is whether naltrexone will dampen pleasure from other activities like exercise or enjoying food. The short answer is that it doesn’t! The pleasure pathways for food and exercise are different from those related to alcohol. While naltrexone blocks the opioid receptors linked to alcohol-induced euphoria, it doesn’t interfere with endorphins from activities like working out or eating. This is crucial for long-term habit change, as you’ll still experience the “reward” from healthy habits.

Choosing Between Daily and Targeted

Dr. Volpicelli provides a helpful breakdown, but each person’s needs are unique. If you have mild-to-moderate AUD or binge drink occasionally, targeted naltrexone often works well. For those drinking heavily each day, or who struggle with adherence, daily naltrexone or even an extended-release injection may be a better choice.

If you’re considering starting the Sinclair Method or would like guidance, our program at Thrive offers support from specialized telemedicine doctors, coaches and therapists to ensure you have a tailored approach.

Medical Disclaimer: The Content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this platform.