Why Isn’t The Sinclair Method Used More Often?
By Michael D.
Originally published on June 3, 2015 on addiction.com
I was really sorry to read that Dr. David Sinclair, who did so much research in the area of treating alcoholism, passed away at the beginning of April after a battle with cancer. The Sinclair Method is named after him and I hope that one day he will be as famous in the recovery world as Bill Wilson, the founder of AA.
In my opinion, the Sinclair Method is a system that could help so many people if more realized it existed and it was offered more often by treatment providers. In fact, I wish I had used it myself and been told about it by doctors back when I was struggling with alcoholism. It could have saved me a lot of pain and helped me control my drinking earlier, before I hit my rock bottom.
The Sinclair Method involves taking a simple pill, such as the prescription drug naltrexone (brand names: Revia, Vivitrol), an hour before you consume alcohol. Over time, the medication diminishes the desire to drink. The pill has no diminishing effect without alcohol (so if you don’t drink nothing will happen) and it is non-addictive.
How the Sinclair Method Began
Dr. Sinclair started his research in America during the 1960s. He established what he called the “alcohol deprivation effect” as a driving force in alcohol addiction. He later moved to Helsinki, Finland, to take his research forward using specially bred rats genetically predisposed to becoming alcoholic. The conclusion of Sinclair’s experiments? That alcoholism is a learned behavior. When a response or emotion has been “reinforced” with alcohol over a period of time it is learned. Some people (and some rats) have genetic traits that lead them to feel a lot of “reinforcement” from consuming alcohol, which eventually creates uncontrollable cravings.
Sinclair was influenced by the work of the physiologist, Ivan Pavlov, famous for making dogs salivate when a bell was sounded. Once conditioned, dogs rewarded with food after a bell had been rung would salivate at the sound of the bell itself. Over time, Pavlov would ring the bell, but he stopped rewarding the dogs with food; the salivating tapered off. This is called “extinction” and Sinclair thought the learned behavior of an addiction to alcohol could be removed by extinction, too.
Following his early research, Sinclair hypothesized that alcohol produces reinforcement in the brain in a way that’s similar to opiates. His research indicated that alcohol produced reinforcement by releasing endorphins that bind with opioid receptors in the brain. So a solution to stopping the reinforcement cycle might be to block the receptors every time alcohol was used. Sinclair tested his theory on rats using naltrexone, an opiate blocker, and after that he conducted clinical trials in people. The results encouraging.
The solution discovered by Sinclair effectively means you have to drink yourself sober! This would surely be the perfect solution for many alcoholics and is probably a solution I could have excelled at. “Extinction” of the impulse to drink takes place over time and works for around 80% of people who use the method properly. It’s important to note that you take the pill an hour before drinking, not simply when you feel like it. Over time, the desire to consume alcohol will diminish and people end up abstaining most of the time or occasionally have a drink when they wish. You need to continue taking the medication before drinking, even when you feel things are under control.
There are a few people who don’t seem to respond to the medication, and others may have too much liver damage to use this treatment, but this is very rare. (They will do much more damage to their liver if they carry on drinking.) The Sinclair Method is not an instant solution and can take a few months to have the desired effect.
A Better “Cure”?
This may be the future of alcoholism treatment. It is common in the U.S. to call alcoholism a “disease” and this seems to be treating it as one. It will take time for people to accept such a radical concept, as it does go against the complete abstinence approach that most treatment centers advise people to use. Abstinence is great if you can manage it, but sadly, most people with a serious problem do not always do well. People I talk with who use the Sinclair Method often say how they struggled with the more traditional solutions; I can understand that. I wanted to stop many years before I finally managed abstinence and was nearly dead by the time I got my act together. I was lucky that I managed to stop with the support of others.
I think Bill Wilson would have approved of Sinclair’s work; after all, he himself experimented with niacin and even LSD in an effort to improve recovery from alcoholism. In chapter three of the AA Big Book it states, “Physicians who are familiar with alcoholism agree there is no such thing as making a normal drinker out of an alcoholic. Science may one day accomplish this, but it hasn’t done so yet.” That was written in the 1930s and Sinclair may well have finally achieved this. I think if this solution had been discovered in Wilson’s lifetime he would have probably endorsed it. Unfortunately, AA does not seem to endorse any of the newer solutions that have been developed since Bill passed away, which is sad, as it is the perfect organization to reach the largest number of people needing help.
In reality, I think it will take time for this solution 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 and is now available on the National Health Service in the UK, as well as 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.
There are some useful resources that explain the Sinclair Method in much more detail than I can do so here. The actress Claudia Christian has produced a great film explaining how the solution works, called “One Little Pill.”
The best book I have found so far on the subject is by Roy Eskapa, PhD, and is called The Cure for Alcoholism.