Sinclair Method Frequently Asked Questions

Below is a list of the most frequently asked Sinclair Method questions. We're always updating this list – if you're looking for something that is not here, please let us know in the comments below. 👍🏼

Q: What is The Sinclair Method?

A: The Sinclair Method (TSM) for Alcohol Use Disorders stands as an evidence-based treatment pioneered by Dr. John D. Sinclair.

Diverging from traditional approaches necessitating complete alcohol abstinence, TSM uniquely allows individuals to continue drinking as part of their therapeutic journey.

Central to TSM's efficacy is the strategic use of the prescription medication naltrexone. By ingesting naltrexone 1-2 hours prior to alcohol consumption, it blocks endorphins, the brain's natural opiates, from binding to opioid receptors during alcohol intake. This blockade disrupts the reinforcement cycle associated with alcohol consumption, diminishing the excessive pleasure typically driving excessive drinking behaviors.

With consistent application, the brain gradually dissociates alcohol from its rewarding effects, leading to diminished cravings and enhanced control over alcohol consumption.

Crucially, to maximize effectiveness, naltrexone administration should precede the first drink by at least one hour. This strategic timing optimizes the medication's ability to disrupt the neural pathways underpinning problematic drinking habits.

Q: Where do I get a prescription to naltrexone?

A: When you join The Alcohol Freedom Program, we refer you to a telemedicine doctor for your naltrexone prescription. We've partnered with telemedicine doctors around the country to provide you with private, accessible and affordable access to the medication naltrexone. Learn more about your options below. 👇

✔️ When you join Thrive, the cost of your physician visit and naltrexone are additional

✔️ The cost varies by location and is generally pretty affordable

✔️ We'll refer you to the most cost-effective option for you

🔗 Click here to see the estimated cost of your physician and naltrexone when you join Thrive.

Q: Can I get a prescription from my general practitioner or psychiatrist? 

A: The short answer is yes – but it also depends. 

Some healthcare providers might not be fully aware of naltrexone's effectiveness in treating alcohol use disorder (AUD) or lack experience specifically with AUD treatment. This can lead to situations where they may:

• Refuse to prescribe naltrexone: Please remember, this is not uncommon, and you have other options.
• Prescribe it with different instructions: The specific protocol for naltrexone in AUD treatment, known as the Sinclair Method (TSM), requires precise guidance. That's why working with a specialist doctor can be helpful. When you join our program, we can refer you to a telemedicine doctor who specializes in the Sinclair Method.

However, some healthcare providers are open to prescribing naltrexone for AUD. To facilitate a productive conversation, consider bringing evidence-based resources regarding the science and efficacy of this treatment method to your appointment – you can find those here. 

Q: What are some common mistakes on The Sinclair Method?

A:The Sinclair Method (TSM) can be a valuable tool for managing alcohol use disorder, but some common mistakes can hinder its effectiveness. Here are some key areas where people often stumble:

1. Inconsistent Medication Usage: One of the fundamental principles of TSM is taking naltrexone as directed, typically before drinking alcohol. Failing to consistently take the medication before drinking can undermine its effectiveness.
2. Not Waiting Before Drinking: Naltrexone needs time to take effect in the body before it can block the endorphin release associated with alcohol consumption. Drinking too soon after taking the medication can reduce its efficacy.
3. Not Plugging Into Support: TSM often involves behavioral therapy or counseling sessions to address underlying issues related to alcohol use. Skipping or neglecting this type of support can hinder progress in overcoming AUD. Learn more about the program we offer to get supported on the Sinclair Method.
4. Ignoring Emotional Triggers: Many individuals with AUD have emotional triggers that lead to drinking. Ignoring or not addressing these triggers by gradually learning new coping skills can make it more challenging to reduce alcohol consumption effectively.
5. Overlooking Support Networks: Building a support network of friends, family, or support groups can be crucial for success with TSM. Neglecting to utilize these support systems may make it more difficult to stick to the treatment plan. That's why we have an awesome judgment-free community inside of our program! 😎
6. Expecting Immediate Results: TSM is a gradual process, and individuals may not see significant changes in drinking habits immediately. It's essential to be patient and persistent while following the treatment plan.
7. Not Monitoring Progress: Keeping track of alcohol consumption and any changes in drinking habits is essential for evaluating the effectiveness of TSM. Not monitoring progress can make it difficult to identify areas for improvement or adjustments to the treatment plan.
8. Ignoring Co-occurring Conditions: Many individuals with AUD may have co-occurring mental health issues or medical conditions that also need to be addressed. Ignoring these co-occurring conditions can undermine the effectiveness of TSM.
9. Relying Solely on Medication: While naltrexone is a key component of TSM, it's not a standalone solution. Combining medication with therapy, lifestyle changes, and support networks is often more effective in treating AUD.
10. Discontinuing Treatment Prematurely: Some individuals may discontinue TSM prematurely, either due to perceived lack of effectiveness or side effects. It's essential to consult with a healthcare provider before making any changes to the treatment plan.

We have a free video course that dives into more common mistakes on the Sinclair Method. You can access it for free here.

Q: When do I take naltrexone?

A: This is between you and your doctor and how they have advised you to take the medication.

According to book, "The Cure for Alcoholism" by Dr Roy Eskapa, The Sinclair Method involves taking naltrexone in a targeted dose 1-2 hours before drinking. The medication is only taken on days when drinking occurs.

• Important note: This is just general information and not medical advice. The specific way to take naltrexone will be determined by your doctor based on your individual situation.

Q: What is the dosage of naltrexone for TSM?

A: The dosage of naltrexone varies by individual and should be prescribed by a qualified healthcare professional.

Generally speaking, according to the research: 

• The typical starting dose for naltrexone in TSM is 50mg
• Some individuals may benefit from a lower dose, especially initially, to minimize potential side effects
• The dose may be adjusted over time based on a person's response to treatment and individual needs

It is crucial to remember that:

• Never take naltrexone without first consulting a doctor
• Do not adjust your dosage without your doctor's supervision
• Always follow your doctor's instructions carefully for taking naltrexone

Q: Are there any side effects to naltrexone?

A: Naltrexone is a prescription medical that should always be given under your doctor's guidance.

Thrive as partnered with telemedicine doctors who specialize in naltrexone treatment for alcohol use disorder.

Like with any medication, there may be some side effects to taking naltrexone. For most people, those side effects are mild and can include things like sleepiness, nausea, vomiting or upset stomach. According to Medical News Today, "Most side effects of naltrexone are mild and will go away as your body adjusts to the drug. They tend to be temporary, lasting a few days to weeks."

According to The Mayo Clinic, for others, there may be more rare or persistent side effects.

Please talk to your doctor if you have any questions about your dose of naltrexone. 👩🏽‍⚕️ 

Q: Do I have to take naltrexone every time I drink?

A: Here's what the book, "The Cure for Alcoholism" has to say about this:

"If you are a patient following the Sinclair Method you have only one absolute rule: take naltrexone before drinking. You must take your medication for the rest of your life—but only when you drink alcohol. Following this Golden Rule is easy to do. Always take your medication before drinking. If you begin to drink without the medication, you will undo the gains you have made.

If you drink without your medication, even though you have completed the full course of treatment and are “cured,” one can predict with a high degree of confidence that you will eventually return to where you began. On average, it will take you roughly three to six months to reach your original craving and drinking levels and become re-addicted—re-wired—if you drink without naltrexone.

Of course, a single drinking session without naltrexone will not re-addict you after completing the Sinclair Method. However, before you ever contemplate drinking without naltrexone, ask yourself if it is worth taking the first step back on the road to addiction again. Remember, extinguished behaviors can be relearned if they are made while reinforcement is not blocked, and the relearning is faster than the original learning. Naltrexone is your insurance policy against relearning the addiction, and therefore against relapse. Always take your medication before drinking—if you drink."

- The Cure for Alcoholism by Dr Roy Eskapa, Page 127

Q: Do I take naltrexone everyday? What about alcohol-free days?

A: Your doctor will advise you as to when and how you should take naltrexone for alcohol use disorder.

According to Dr David Sinclair's research, individuals were taking naltrexone in a targeted way 1 hour before drinking. They were not taking the medication on non-drinking days.

Q: How long does naltrexone protect me? What about re-dosing?

A: This is a great question for your doctor because everyone metabolizes medications at different rates. Things like age, weight and gender play a role. It is said that the half-life of naltrexone can be anywhere from 4-13 hours.  

Because everyone is different, this should be advised on an individual level based on your doctor's guidance. 

Q: Do I need to take naltrexone for the rest of my life?

A: According to The Cure for Alcoholism:

"If you are a patient following the Sinclair Method you have only one absolute rule: take naltrexone before drinking. You must take your medication for the rest of your life—but only when you drink alcohol. Following this Golden Rule is easy to do. Always take your medication before drinking." 

- The Cure for Alcoholism by Dr Roy Eskapa, Page 127

☝️ Of course, this is also something you will want to ask your doctor about.

Q: What is pharmacological extinction?

A: Actually, the technical term for TSM is "pharmacological extinction." Alcohol drinking is a learned behavior. 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 behavior becomes too strong. They cannot always control their drinking; they cannot “just say ‘no’.” 

For most people, the reinforcement or reward (endorphins) from drinking alcohol involves the opioid system in the brain. With repeated drinking over time, the brain associates this behavior (drinking) with a reward (endorphins). This is how the behavior of alcohol use disorder (AUD) is learned over time... and naltrexone blocks the effects of these endorphins. 

The brain has two primary mechanisms for changing its own wiring on the basis of experience. First, there is learning for strengthening behaviors that provide reinforcement. Second, there is extinction for removing behaviors 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, but then had the learned behavior extinguished when the food reinforcement was no longer given after the bell was rung.

If alcohol is drunk while naltrexone is blocking endorphin reinforcement in the brain, the extinction mechanism is activated, and it would then produce a small but permanent reduction in alcohol drinking and craving. Over time, the person will become less interested in alcohol. Eventually control over alcohol would be regained, and the person would no longer have AUD, and their interest in alcohol would greatly reduce. This information can be found in Dr David Sinclair's Definitive Statement on the CThreeFoundation.org.

Q: How quickly does The Sinclair Method work?

A: The short answer is – it varies from person to person. On average, most TSM doctors will advise at least 9 months to reach pharmacological extinction. Some may reach it more quickly, and others it can take much longer. The great thing about TSM is that for most people, they will see gradual changes and improvements the longer they are on TSM. These are great signs that a person is on the path to extinction. The most important thing is this:

Do not compare your progress on TSM to another person's. 

Because we're all so (awesomely) different – with varying stressors, triggers, environments, pasts, etc – some will respond more quickly and others more slowly. Just because you feel like you're responding "slowly" to the method does not mean it's not working. The most important things are to:

1. Stay compliant ✔️
2. Stick with it 💪🏻

Q: How effective in The Sinclair Method?

A: The Sinclair Method is shown to have a 78% success rate. 

Q: Can you still get drunk on naltrexone?

A: Yes, a person can still get intoxicated while taking the medication. The medication works to block the endorphin rush from alcohol, but it does not block the intoxicating effects.

Q: Help! My drinking is increasing on The Sinclair Method.

A: Fear not, this is actually a common occurrence in this method. There are a number of reasons this could be happening, including: old drinking habits, consuming hard alcohol (for some), using alcohol to cope with a stressful environment or situation, not fully complying with taking naltrexone properly, or not practicing awareness and mindfulness around your drinking. In some cases, this is just a brief occurrence that happens once in a while and it becomes a learning experience for the next time. For others, there might be more changes needed in order to make progress. If you need some support with this, feel free to connect with the Thrive Community 👋🏼 or submit this for our Weekly FAQ session. 

Q: What is the most important thing for achieving success with TSM?

A: There are 3 important factors that contribute to success with the Sinclair Method:

1. The most important thing for achieving success with The Sinclair Method is compliance with taking naltrexone every single time that you drink, and ensuring that you wait at least 1 hour before drinking. This consistency will help you achieve extinction more easily.
2. Next is to give this method time to work. TSM is not an overnight fix – and for most people it takes a while to see big changes. That's why it's so important to stick with TSM for the long haul.
3. Thirdly and equally important is to plug into a system of support that can guide you through the treatment, and help you make the necessary habit and lifestyle changes. Learn more about our program here.

TSM Resources

Here are some useful resources and information for your TSM Journey! 🙌🏼

The Cure for Alcoholism by Dr Roy Eskapa 📖 (also attached below)
A book about The Sinclair Method 

One Little Pill Documentary Movie 🎥
Documentary film by Claudia Christian about TSM

Keychain Pill Holders 💊
Great for always having your medication on you!

Drink log app or spreadsheet   
Courtesy of the C Three Foundation

Acronyms! 

There are some common acronyms that are used in the Thrive Community. Here's a key to help you out 😄

• TSM = The Sinclair Method
• AF = Alcohol Free
• PE = Pharmacological Extinction
• NAL/nal = Naltrexone
• SD = Standard Drink
• MEH = A feeling people get on TSM where they don't feel indifferent to drinking more
• ADE = Alcohol Deprivation Effect

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.

Change your relationship with alcohol, change your life 🎉