Through experience and research, increasingly effective methods of alcohol dependence treatment are being developed. One relatively new method, however, can almost certainly be categorized as the most controversial of all – The Sinclair Method.
For a long time, alcohol addiction was considered by many to be ‘less serious’ that addiction to narcotics. We now know, however, that this type of addiction is one of the hardest to treat, has some of the most severe withdrawal symptoms, and if not treated correctly, can have a high relapse rate. This is why the most successful alcohol rehab programs begin with an in-depth assessment to discover the causative factors of an individual’s addiction and then offer the most suitable treatment options – addressing both the mental and physical components of addiction. The Sinclair Method offers a very different approach, which is why it’s attracted so much controversy.
The Sinclair Method
The Sinclair Method (TSM) is named after its founder, Dr. John David Sinclair. In the 1970s, Sinclair began studying alcoholic behavior. In addition to studying human subjects, the doctor also utilized laboratory animals in his research.
When he put forward his theory on alcoholism, it was a radical one. Sinclair’s hypothesis stated that alcoholism is a learned behavior akin to Pavlovian conditioning. For those unfamiliar with the latter concept, it refers to a groundbreaking study by Russian physiologist Ivan Petrovich Pavlov. In 1901, Pavlov noticed during experimentation that when a buzzer was sounded or a bell rang and then food presented to dogs in his laboratory, the animals would begin to salivate. Eventually, when the buzzer was sounded without the presence of food, the dogs would begin to salivate regardless as they now associated the sound with food. He called this the ‘conditional reflex’ (this would later become the ‘conditioned reflex’). However, after a period of time with food no longer following the buzzer, the dogs would no longer salivate at the sound.
Sinclair claimed that alcoholism works on a similar principle. He referred to the known fact that drinking initially causes pleasure by promoting the release of dopamine. He then asserted that, as drinking increases, alcohol more accurately removes discomfort (social, personal etc), but this is still experienced as ‘pleasurable,’ and that conditioning is reinforced. By the time a person is dependent on alcohol, Sinclair posited that an anticipation of pleasure is the main driving force behind alcohol consumption.
For example, an addicted individual will begin to get ‘the jitters’ after not drinking for a certain amount of time. They will experience the anticipation of removing these jitters until they take a drink of alcohol. Once they drink, the uncomfortable anticipation ends, and they experience a sense of pleasure. If, after a while, drinking no longer provided this pleasure, the craving response should go away. With this theory in mind, the doctor introduced his method – a method that utilizes an existing drug, naltrexone.
Naltrexone
Naltrexone is an opioid antagonist that binds to the opioid receptors in the brain. Critics of the Sinclair Method ask, how can this drug be used in connection with alcohol, which is not an opioid? Opioid receptors exist in the brain because our body creates its own ‘opioids’. There are different types but in this context, endorphins are the naturally occurring opioids we are interested in. Endorphins are most often released to deal with pain, inhibiting pain signals, which in certain amounts might otherwise prove unbearable.
Certain activities like strenuous exercise may trigger endorphin release. Drinking alcohol also causes our body to release endorphins. As the endorphins bond to their receptors and dopamine release is triggered, we experience a sense of euphoria. This explains why there is pleasure associated with alcohol consumption even though it acts as a central nervous system depressant.
Unlike opioids (internal or external), however, naltrexone does not trigger a dopamine release – instead, it causes a decreaseof the pleasurable feelings experienced during activities that would usually cause a dopamine surge. This helps reduce cravings – without the use of another potentially addictive substance (e.g. methadone for heroin addiction). Many well-regarded, established programs use naltrexone after withdrawal, some time after the individual has stopped using.
Dr. Sinclair said that to see maximum results, the medication needs to be a part of the actual drinking experience for someone who is addicted to alcohol. His reasoning was that, if an addicted individual took the naltrexone while abstaining from alcohol, they would not experience a decrease in pleasure related to drinking. Instead, he claimed, the person would be experiencing decreased pleasure related to other endorphin-releasing activities like sex or exercise. This, combined with the still present craving for alcohol, would increase a recovering alcoholic’s desire to drink. Essentially, they would still associate pleasure with drinking.
The Sinclair Method and Naltrexone
His method suggested a radical approach to recovery – continue drinking while using naltrexone. The Sinclair Method requires the individual to take naltrexone an hour prior to drinking – and onlywhen drinking. Therefore, if the dependent individual did not drink for five days, he would not take naltrexone on any of those days.
In a few months time, Sinclair claimed studies showed the individual would either decrease his drinking considerably or stop drinking altogether. This would be due to the brain reconditioning itself and removing an interest in alcohol – a process he coined “pharmacological extinction,” which is said to take place in about three to four months. Proponents say the method has a long-term success rate of 78% and that it is equally effective with or without therapy. Dr. Sinclair noted that a quarter of those using the Sinclair Method report 100% abstinence. The method also dictates that if an individual continues drinking, he or she must continue taking naltrexone as well – therefore if someone decides to continue drinking in lesser amounts for the rest of their life, they must continue taking the medication for the rest of their life as well.
Opposition to the Sinclair Method
As one would expect, the Sinclair Method has very vocal opponents who find most aspects of it extremely problematic. The argument that is often brought up first is that this method does not at all treat the underlying reasons for an addiction, nor does it address the resultant thoughts and behaviors. In conventional treatment, much effort is made to discover what experiences, thought processes, habits, and emotions have been instrumental in an individual developing an addiction in the first place. Then the focus is on helping to change the developed thought processes through some manner of therapy.
Most treatment professionals believe it is highly unlikely a person will successfully overcome an addiction without addressing all these things. With the Sinclair Method, the fear is that all these unresolved issues will eventually drive the individual to return to drinking without the naltrexone in order to ease their pain.
What may occur when a person on the Sinclair Method starts drinking again is another reason some people are strongly against this treatment type. This ties into the admitted necessity that an individual that continues to drink can never stop taking naltrexone. As the antagonist drug blocks the opioid receptors to prevent the feelings of pleasure that drinking causes, the brain does not simply ‘take this lying down.’ Rather, it responds by increasing the number of its opioid receptors, in turn increasing the brain’s sensitivity to the pleasure-causing opioid neuropeptide released during pleasurable activities.
The implications of this are obvious. Should an individual on the Sinclair Method ever stop taking the naltrexone and have an alcoholic drink, the pleasure derived will be even greater than before. This is not a matter of “really enjoying that first drink after a long time” – rather, their brain now actually physiologically receives more pleasure from the activity than it had the capacity to before. Professionals, therefore, often express concern that the Method can, in fact, result in individuals developing a habit worse than their original one.
The Sinclair Method’s opponents also take issue with the fact that it seems to ignore the beginning of the process – even if it could be effective, they say, the early stages are terribly dangerous for an alcoholic. Like many drugs, it takes some time before the medication begins to properly take effect. That means that an individual will be drinking and still feeling all the pleasurable effects at first – and knowing that this will change, may even increase their drinking as a ‘last hurrah.’
The main complaint the Sinclair Method’s opponents have is, of course, the most obvious one. The general belief is that the goal for an alcoholic should always be to completely abstain from alcohol. Those seeking help for alcohol addiction are doing so because it has wreaked havoc on their lives. Therefore any plan that promotes continued drinking, possibly indefinitely, is seen as unacceptable by many. Chronic heavy alcohol consumption greatly increases the risk of many ailments including:
- Anemia
- Cancer
- Cardiovascular disease
- Cirrhosis
- Dementia
- Depression
- Seizures
- Gout
- High Blood Pressure
- Suppressed Immune System (and infectious diseases as a result)
- Nerve Damage
- Pancreatitis
and more. While reducing alcohol intake is, of course, preferable to continuing an extremely heavy level of drinking, medical professionals will usually recommend abstinence after years of alcohol abuse to truly reduce the risk of these and other ailments.
Sinclair Method opponents also remind those in favor of the treatment that naltrexone does not change any of the effects of alcohol other than the pleasurable feelings. This means that compromised balance, cognitive thinking and motor control, loss of inhibition and decreased control of emotions will still occur, as will all the issues that stem from these things. Some will go even further to say that the drinker may be in even greater danger. Due to the different feeling, they charge that those who do not decrease their drinking considerably may actually think they’re not as drunk and will drink more in an attempt to compensate.
Support for The Sinclair Method
The Sinclair Method is not without its supporters. The majority of support for the method comes from those who found that the treatment worked for them. Most of these individuals seem to have followed the option of continuing to drink, and say that their alcohol consumption has been drastically reduced thanks to the Sinclair Method. Many of these tend to be younger people who report that they are ‘not prepared to never have an alcoholic drink again’ but have become aware that they have a problem. There are also older practitioners of the method that express their support, saying that conventional methods never stuck but this one has proven successful in at least allowing them to drink responsibly.
Perhaps the Sinclair Method’s most high profile supporter is Babylon 5actress Claudia Christian. She has credited the method with saving her life, has created a foundation that states its mission is educating people about TSM, and even has gone as far as producing and narrating a documentary about the treatment technique.
The method’s supporters claim that opponents’ complaints are due to ignorance, prejudice or ulterior motives. They point out that a number of those that speak out against the method have not researched it or heard feedback from its practitioners. They also point out that the fact that the method requires alcoholics to keep drinking and supports controlled drinking in a long-term sense immediately makes some people write it off as irresponsible. Lastly, some proponents even accuse opponents of having financial motives. They claim that recovery centers are threatened by the method, which says therapy does not affect its efficacy, and that pharmaceutical companies have reason to suppress the method’s success because other drug treatments are more profitable than one that requires only a single naltrexone pill whenever an individual plans to drink.
The Sinclair Method As Treatment
At the end of the day, the Sinclair Method is a relatively new treatment – and as a result, scientific data on its effectiveness is extremely scarce. The majority of those that report it as being a success have been using it for either a few years or even months. It is clear that more research is necessary to positively determine the extent to which it may or may not work. Further, it is simply not applicable to many, for who continued drinking is not an option (e.g. someone suffering from cirrhosis). As mentioned previously, the fact that the method ignores attempting to get to the root causes of the addiction is troublesome, as someone still emotionally suffering is not out of danger or living a fulfilled life.
Far from being stuck in the past, Riverside Recovery Center is dedicated to providing the best in proven addiction treatments. Our Vivitrol (extended-release Naltrexone) treatment administers the medication after a safe detoxing. It requires only one injection a month, and combined with a quality inpatient or outpatient program, has been shown to greatly help individuals meet their recovery goals. Contact Riverside Recovery Center today to start your or your loved one’s path to a healthy and long-lasting recovery.
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