Treatment for alcohol use disorders using Naltrexone.
The Sinclair Method
The Sinclair Method (TSM) is a treatment method for alcohol addiction that uses the nervous system’s own mechanism – known as ‘extinction’ – to gradually remove interest in alcohol and habit-forming behaviors. The method is named after Dr. David Sinclair who concluded that alcoholism is a learned behavior after conducting laboratory experiments on factors driving alcohol addiction and the effects of alcohol deprivation.
A key discovery Sinclair made was that detoxification and deprivation do not stop the craving for alcohol but actually increase subsequent alcohol consumption. The Sinclair Method sought to challenge the idea that physiological dependence on alcohol led to alcoholism, and propounded the concepts of ‘learned behavior’ and ‘pharmacological extinction’.
Some individuals get a lot of reinforcement every time they drink, and they have many opportunities to drink and get reinforcement. This manifests into a behavior that becomes too strong to resist, and they have a very difficult time controlling their drinking. Sinclair’s laboratory studies showed that the reinforcement from alcohol, in most cases, involved the opioid system. The system, which controls pain, reward and addictive behaviors, is also where morphine, heroin, and endorphin produce their effects.
There are two primary mechanisms the brain uses for changing its own wiring on the basis of experience. One is the learning for reinforcement-providing and strengthening behaviors. There is also extinction for removing behaviors that no longer cause reinforcement. Sinclair was inspired by the Pavlov classic conditioning experiment where the Russian physiologist’s dogs learned to salivate at the sound of a bell when it was followed by food, and then had the behavior made ‘extinct’ when food reinforcement was stopped after the bell was rung.
Medications such as naloxone, naltrexone and nalmefene block the effects of endorphin and other opiates. The Sinclair Method reasons that, if an individual drinks alcohol when one of these opioid antagonists is blocking endorphin reinforcement in the brain, the extinction mechanism would be activated, and produce a small but permanent reduction in alcohol drinking and craving. Over time, the desire to consume alcohol decreases and people either abstain most of the time or drink occasionally. It involves taking an opioid antagonist prior to drinking. Neither are the antagonists addictive, nor do they directly reduce craving for alcohol.
The Sinclair Method has been confirmed in more than 90 clinical trials around the world, and observed to be successful in approximately 80 per cent of alcoholics. However it is not an effective method in alcoholism behaviors that do not involve the opioid system.