Anyone who knows an alcoholic knows that treatment can be difficult.  Not every treatment is effective for every person, herd is a new and exciting approach to treating alcoholism.

The Sinclair Method (“TSM”) is named after Dr. John Sinclair (recently deceased) who started as a researcher in the U.S. and who was recruited to Finland by its National Institute for Health to research treatment for alcoholism (apparently alcoholism is very prevalent in Finland).

What he discovered is that heavy drinking behavior, which involves nothing more than a craving for alcohol, is a learned response (i.e., conditioned) the same way Pavlov’s dogs were conditioned to salivate when a bell rang, by numerous and repetitive sessions of pairing delivery of food with the sound of a ringing bell (and as we know after awhile the dogs would salivate simply from ringing the bell). The second half of Pavlov’s experiment that most people have not heard about is called “extinction.” Extinction is simply continuing to ring the bell but without food, and after numerous and repetitive sessions of the bell without food, the dogs would eventually stop salivating when the bell was rung. They would return to what I call baseline.

What Dr. Sinclair discovered is that consumption of alcohol releases natural endorphins upon our opioid receptors in our brains (the same receptors that are hit with heroin, morphine, and other drugs of abuse). Though not so relevant, the theory is that some people are born with a more robust opioid receptor system, hence making them more at risk for addiction. Either way, alcoholism is developed from numerous acts of drinking over the years (usually starting around 18-21 years old) which builds a reinforcement loop in the brain : Drink alcohol, endorphins are released, endorphins hit opioid receptors, brain feels reward, behavior is reinforced. Drinking behavior is repeated. Drinking behavior is strengthened. For the person predisposed to addiction, eventually this leads to an uncontrollable craving for alcohol that influences the alcoholic in almost everything he does, and which he cannot help (especially when a “trigger”, like seeing a bottle of wine, smelling beer, having emotional issues, etc. happens).

Dr. Sinclair thought that if the reinforcement loop could be blocked or extinguished, the craving for alcohol would diminish. He was right. He found that by pairing an opioid antagonist, which is a drug that binds to the opioid receptors and blocks anything else from binding to them (e.g., endorphins, heroin, morphine), with drinking, he could slowly and steadily decrease the craving and hence behavior of drinking alcohol. Some of you might be familiar with a drug called Narcan, which is also an opioid antagonist that emergency responders will give intravenously to persons who have overdosed on heroin, and in about 1 minute the patient fully wakes up from the heroin stupor.

TSM is used in clinics throughout Finland and is apparently the go-to method there. It claims a 78% cure rate, and of the 22% that are not cured, about 10% is attributed to non-compliance with taking the medicine while drinking (called “extinction sessions”). As such, when a patient is faithful with the process he can expect a 90% chance of being cured (supposedly the average time is 4-6 months). The other 10% that do not respond to TSM are thought to have a slightly different opioid receptor system. The “Golden Rule” of TSM is to always take a Naltrexone tablet 1 hour before drinking (to get it into the blood system), and not to use it when you are not drinking, (i.e., daily / prophylactic use which is the way it is prescribed here in the U.S. without much, if any, success). Apparently one tablet is good for about 24 hours.

There are clinics in Florida using it, which I think has to do with the fact that a Dr. Roy Eskapa, who has written a book called the Cure for Alcoholism, and who seems to be the main voice for TSM, apparently lives there. There are doctors all over catching on, and at the cthreefoundation.org site you can find some local L.A. doctors (also on google) prescribing Naltrexone for TSM. Apparently doctors unfamiliar with TSM will not generally prescribe Naltrexone with the idea of pairing it with drinking to cause progressive extinction (TSM calls it “pharmacological extinction”). So, best to go with an enlightened doctor already familiar with TSM.