Remarks, Findings & Conclusions by David Sinclair, Ph.D.

In his own words.....

Remarks, Findings & Conclusions by John David Sinclair, Ph.D

The Sinclair Method (TSM) uses the nervous system’s own mechanism, called “extinction”, for gradually removing the interest in alcohol and the behaviors involved in alcohol drinking. Therefore, the technical term for TSM is “pharmacological extinction.” (Note: in layman's terms-- this is the "extinction" of one's cravings and desire for alcohol)

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 [1], [2] . 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 behavior[3]. 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’.” And society calls them alcoholics.

Laboratory studies indicated that in most cases, the reinforcement from alcohol involved the opioid system, i.e., the same system where morphine, heroin, and endorphin produce their effects.[4]

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.
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[5].

The Sinclair Method was confirmed, first in a large body of laboratory studies[6], then in over 90 clinical trials around the world[7],[8],[9], 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

Links to Cites & References

[1] Sinclair, J.D. and R.J.Senter. Increased preference for ethanol in rats following alcohol deprivation. Psychonomic Science 8: 11‑12, 1967.

[2] Sinclair, J.D. The alcohol‑deprivation effect: Influence of various factors. Quarterly Journal of Studies on Alcohol 33: 769‑782, 1972.

[3] Sinclair, J.D. Rats learning to work for alcohol. Nature 249: 590‑592, 1974.

[4] Sinclair, J.D., J.Adkins, and S.Walker. Morphine‑induced suppression of voluntary alcohol drinking in rats. Nature 246: 425‑427, 1973.

[5] Sinclair, J.D. Method for Treating Alcohol‑Drinking Response. USA patent 4,882,335 Nov. 21, 1989.

[6] Sinclair, J.D. Drugs to decrease alcohol drinking. Annals of Medicine 22: 357‑362, 1990.

[7] Heinälä, P., H. Alho, K. Kiianmaa, J. Lönnqvist, K. Kuoppasalmi, and J. D. Sinclair. Targeted use of naltrexone without prior detoxification in the treatment of alcohol dependence: A factorial double-blind placebo-controlled trial. Journal of Clinical Psychopharmacology: 21(3): 287-292, 2001.

[8] Sinclair, J.D. Evidence about the use of naltrexone and for different ways of using it in the treatment of alcoholism. Alcohol and Alcoholism, 36: 2-10, 2001.

[9] Eskapa, R. The Cure for Alcoholism, Dallas, TX: BenBella Books, 2008, 2012.

[10] Christian, Claudia. Babylon Confidential, Dallas, TX, BenBella Books, 2012.

Sinclair Method for Treating Alcoholism

Alcohol Problems & Solutions

Online Since 1997

Sinclair Method for Treating Alcoholism: An Effective Medical Treatment

The Sinclair Method of alcohol abuse or alcoholism treatment is unique. It enables most alcoholics to drink in moderation. The technique uses naltrexone or a similar substance.

I. The Sinclair Method

Taking a pleasure blocker prevents the brain from having the pleasure of a high. Pharmacological extinction (operant conditioning) then reduces craving for alcohol. Surprisingly, few people in the U.S. have heard of the Sinclair Method.

The U.S. Food and Drug Administration (FDA) first approved naltrexone decades ago. Now other pleasure blockers are approved and can also be used.

Some Specifics

The Sinclair Method treatment lasts for three to 15 months. After that, the patient needs to continue taking naltrexone before drinking. This prevents positive conditioning from occurring. Otherwise, the pharmacological extinction will reverse itself.

Some Advantages of The Sinclair Method

Simple and easy.
No withdrawal symptoms.
Detoxification unnecessary.
Rehab facility unnecessary.
No disruption of employment or family life.
Can be followed with a person’s own doctor.

Avoiding a rehab is a major advantage. There is no travel, high expenses, safety concerns, or anxiety about living with strangers.

Effectiveness

Dr. John David Sinclair developed the method. It is the one used throughout Finland and widely used elsewhere. The reason it’s not widely used in the U.S. is unclear. It may be the very strong influence of Alcoholics Anonymous. A.A. insists that alcoholics can never learn to drink in moderation. However, much scientific research for decades has proven that most alcoholics can and do learn to drink in moderation.

Most clinical trial evidence suggests that The Sinclair Method may have a success rate of about 80%. 1 That’s much higher than the apparent 5% success rate of A.A.

Why Isn’t the Method More Widely Used?

On the Psychology Today website, addictions expert Kenneth Anderson raised an important point. “It remains difficult to understand why so few American physicians, therapists, and addiction counselors are familiar with The Sinclair Method.”2

Another observer wrote that it will take some time for the Sinclair approach

“to gain wider acceptance, especially in the US, where the treatment industry seems dominated by 12-step ideology. The Sinclair Method is becoming popular in other countries. It’s now available on the National Health Service in the UK. It’s also being used extensively in Scandinavian countries such as Finland, with great success. It is gaining popularity in underdeveloped countries that don’t have a pre-existing 12-step recovery treatment industry, too. It is a much cheaper solution compared to inpatient rehab and this will be attractive to countries without the infrastructure to support hospitalization for many people.”3

A third suggested that:

“The medical community has been largely unconvinced of the effectiveness of this cure because of the extreme shift in mindset necessary to accept a treatment for alcoholism that involves continued consumption. To further cloud the matter, many studies have been done involving using naltrexone to help enforce abstinence – a purpose for which it is poorly suited at best. Although their “failure due to relapse rate” has no bearing on the Sinclair Method, most doctors see a “this drug failed” result and don’t look to see how it was used….”4

The reasons for the general lack of awareness of The Sinclair Method are unclear. But sound science is the basis for the process. More important, clinical research proves its effectiveness.

II. Resources on The Sinclair Method

Podcast by Dr. John David Sinclair

Sinclair, J. The Sinclair Method for Treating Addiction. Shrink Rap Radio

Extinction of Craving Alcohol "addiction"