Sinclair Method

From Wikipedia, the free encyclopedia
Jump to: navigation, search

The Sinclair Method is a treatment for alcoholism based on the use of opiate antagonists, such as naltrexone or nalmefene. It differs from other treatment in that patients use the drug while continuing to drink. Dr. John David Sinclair has found this treatment to be more effective in reducing overall alcohol use by addicts than in asking them to try to achieve abstinence, even when combined with naltrexone and psychosocial counseling. The Sinclair Method, specifically, has been adopted in Finland as a standard treatment protocol for alcohol dependence.[1]

Naltrexone and others have been shown to create pharmacological extinction of addiction, resulting in a decrease in the craving for alcohol over time, but is less successful in achieving abstinence. Supported by studies in the early 1990s, naltrexone was approved by the U.S. Food and Drug Administration (FDA) in 1994 in the United States for treatment of alcohol dependence with the goal of abstinence.[2] Pharmacological extinction works by blocking the positive reinforcement effects of ethanol-triggered endorphin in the brain.

Pharmacological extinction[edit]

Main article: Naltrexone

Naltrexone is an opioid competitive antagonist which has been approved in the United States by the FDA since 1994 for the treatment of Alcohol Dependence. An opioid antagonist is a drug which blocks the opioid receptors in the brain and prevents opioids from binding to them. An antagonist not only produces no high, it prevents people from getting any high from drugs such as heroin, since it prevents them from binding to the receptors in the brain.[1]

Proponents claim that thousands of patients have been cured of alcoholism by the Sinclair Method since the early 1990s, but it is dependent on allowing patients to continue to use alcohol in a normal range of behavior.[2]

Unlike alcoholism treatments/methods such as Antabuse (disulfiram), Temposil (calcium carbimide), and Alcoholics Anonymous, which all promote abstinence from alcohol, the Sinclair Method treats alcoholism by allowing patients to continue drinking. Naltrexone is available in multiple forms, including tablet and injection. For tablet form, a patient following the Sinclair Method takes a 50 mg tablet one hour before every drinking session. Patients who achieve success with the treatment experience a reduced urge to drink over time.

The treatment has been standardized as the "Sinclair Method", named after Dr. John David Sinclair, who published results of studies in 2000 and 2001 in peer-reviewed journals related to his treatment method.[2][3] He found that giving alcoholics naltrexone daily and telling them to abstain from drinking was not effective, even with counseling. By contrast, giving alcoholics naltrexone and telling them to take it only before drinking alcohol was highly effective in reducing the amount of their drinking, and could be considered to cure Alcohol Dependence.[1]

The goal of the Sinclair Method is to reduce a person's desire for alcohol in order to allow the person to regain rational control, generally achieved during a period of three to 15 months. The individual may continue to drink based on a perception of rational benefit to drinking, but will no longer be driven to drink by uncontrollable addiction.[1] Once the patient no longer drinks daily, he/she takes naltrexone only on days in which he expects to drink, an hour before the drinking occurs. The patient needs to continue taking naltrexone before drinking for the remainder of life, or the endorphin conditioning will be re-established.

Theory[edit]

Alcohol triggers the release of endorphins into the system, reinforcing drinking behavior. Continued consumption of alcohol strengthens this reaction. The theory suggests that for those with a strong endorphin reaction (generally due to genetic factors), the pro-alcohol conditioning exaggerates the strength of arguments for drinking, and perpetually keeps drinking in the person's mind as a favorable option.

Operant conditioning suggests that gaining rewards for behavior increases the desire to perform that behavior. Without rewards, the urge to perform that behavior gets weaker. This effect is referred to as the extinction of that behavior. This was demonstrated in the research by Edward L. Thorndike and later, B. F. Skinner.

In the case of alcoholism, the behavior is the consumption of alcohol, and the reward is the flush of endorphins in the brain related to drinking. By this theory, if the drinking behavior occurs, and the neurons do not receive their flush of endorphins, then the pro-alcohol conditioning should be extinguished. In practical terms, if the individual drinks but the endorphins are blocked from stimulating the neurons, the desire to drink is reduced. By this means, the urge to drink, that drives alcoholism, is reduced, provided the alcoholic continues to take the endorphin-blocking medication as recommended, prior to every occasion on which alcohol is consumed.

Evidence of efficacy[edit]

Sinclair published evidence for this treatment in 2000[2] and 2001, the latter an article entitled "Targeted Use of Naltrexone Without Prior Detoxification in the Treatment of Alcohol Dependence: A Factorial Double-Blind, Placebo-Controlled Trial"].[3][4] In this study, patients were divided into four groups. The first received naltrexone and was given counseling to encourage moderate drinking. The second received a placebo and was given counseling to encourage moderate drinking. The third received naltrexone and was given counseling to support abstinence. The fourth received placebo and was given counseling to support abstinence.

Although all groups in the study achieved a decrease in drinking, the group who received naltrexone in combination with a goal of moderate drinking were far less likely to relapse into heavy drinking than the other three groups. In the 32-week run of the study, 27% of those who combined naltrexone with drinking never had a relapse to heavy drinking, compared to 3% for those who combined naltrexone with abstinence.

Roughly a quarter of the participants of the study became completely abstinent and stayed that way. Overall, four-fifths of the participants reduced their drinking to healthy drinking levels or below. In three- and five-year follow up studies, roughly half of those who had benefited from the program continued to take a dose of naltrexone before drinking. For all those who continued the program, there was zero incidence of relapse.

The Sinclair Method is used extensively as an outpatient treatment at the Contral Clinic in Finland. By 2000, they had treated tens of thousands of patients with a claimed success rate around 78%, with 25% reducing their drinking to complete abstinence[5] with little or no craving.[2]

See also[edit]

References[edit]

External links[edit]