The Sinclair Method for Alcoholism involves taking the FDA-approved prescription medication Naltrexone on an as-needed basis at least one hour prior to drinking alcohol. The medication blocks endorphins from being experienced by the drinker, which prevents the alcoholic beverage from causing a buzz.
Ultimately, the lack of reinforcement causes the brain to lose interest in alcohol, with corresponding reductions in cravings, preoccupation with use, and amount of alcohol consumed.
What is treatment success?
Although is important to know how others define success, it’s even more important to think about how you yourself define success. Traditional measures of treatment success in alcohol use disorders are:
Time to relapse: How long can you go without a drink?
Number of drinking days: How many days a week are you drinking?
Number of non-drinking days: How many days a week are you not drinking?
Average number of drinks per session: When you do drink, what is the usual amount?
One critical flaw in the 12-step approach is the emphasis on Days Without a Drink, to the near exclusion of any other experience you might have while trying to solve your drinking problem. After years of working with patients with problematic drinking, it is clear that just because you haven’t had a drink in a month, it doesn’t mean that alcohol has released its grip on you.
It doesn’t mean that you don’t continue to suffer when your brain won’t stop obsessing about taking a drink. And, just as importantly, it doesn’t mean that you won’t feel like an odd-ball at the majority of social events in the U.S. because you can’t drink.
Certainly, if your alcohol use led to legal troubles, liver injury, damaged relationships, or termination from your job, you’re better off counting the days of abstinence, even if you’re suffering much of the time and even if the fear of relapsing and returning to your old patterns weighs heavily on your mind day in and day out.
Yes, abstinence is often better than nothing, but it isn’t what freedom looks like. Or normalcy. Or anything what the optimal cure for alcoholism might look like.
Success is more than just Days Without a Drink – it’s the degree of freedom you have from alcohol.
Typical reasons the Sinclair Method does not work
1.Naltrexone Side Effects. It’s an undeniable fact that the body and brain can be hypersensitive to foreign substances, including food and environmental allergens, and therefore it is possible–not likely–that you will not be able to take Naltrexone due to side effects.
This can usually be overcome by starting with very low doses, over-the-counter medications, and time, but not always.
Genetic research is becoming a more practical and accurate tool to determine who might be more susceptible to side effects and benefits of medications.
2. Lack of Patience. The Sinclair Method is not an overnight fix. For some people, there are dramatic, rapid changes in drinking behavior within the first month. However, this should not be anticipated, and its absence is in no way suggestive of ultimate treatment failure. It can take 3, 6, or sometimes 9 months to see significant changes in alcohol use, decreased preoccupation, and improved control.
Your provider will discuss reasonable expectations with you, and encourage you to continue taking the medication and tracking your use, even when you feel discouraged and question whether the approach will work for you.
Given the suffering your addiction has caused, it’s understandable that you want an immediate change. But this emotional desire can be tempered by educating yourself on the mechanics of the program and by establishing a trusting relationship with your provider.
3. Inadequate Dose. The standard dose of naltrexone is 50 mg daily. However, due primarily to differences in the way your liver metabolizes naltrexone, you may need more or less. The variance is not usually due to the health of your liver or its overall level of functioning, but to your unique combination of liver enzmes that metabolize the drug.
Most people are average metabolizers of naltrexone and they require 50 mg. Others are fast metabolizers, which means they require a higher dose due to the relatively low drug levels caused by fast metabolism. Maximum doses are 100 mg daily.
Usually, however, it is patience that is required, not a higher dose.
4. Unknown reason. Sometimes, treatments just don’t work.
Changing a Preoccupation with Drinking to a Preoccupation with Not Drinking is no way to live.