Sinclair Method

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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. 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. Nalmefene was approved for the treatment of alcohol dependence within Britain's National Health Service in November 2014.[3]

Mechanism[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. An antagonist not only produces no high, it prevents highs from drugs such as heroin by preventing them from binding to their receptors.[1] In addition, opioid antagonists such as naltrexone and nalmefene prevent opioid-system reinforcement of alcohol consumption. Normally, alcohol triggers a release of endorphins (endogenous morphine-like hormones) in the brain; opioid antagonists block endorphin receptors and prevent this reward. The result is a gradual unconscious process of pharmacological extinction, in which patients not only drink progressively less but also experience significant reductions in craving for alcohol.

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 and 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. 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 John David Sinclair, who published descriptions and results of his treatment method in 2000 and 2001.[2][4] 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.[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]

Naltrexone has been shown to decrease heavy drinking.[5] Sinclair published evidence on this in 2000 and 2001.[2][4][6]

Side effects[edit]

For most people the side effects of taking naltrexone are minor. 10%-15% of patients report passing irritability, headaches or nausea.[7] As a treatment that takes several weeks the Sinclair Method is unsuitable for people who need to stop drinking straight away or to stop drinking completely.[3]

The drug naltrexone should not be taken by pregnant women, people with acute liver diseases or individuals physically dependent upon opiates.[7] Nalmefene, the alternative drug, probably should be used by people with acute liver diseases.[3]

David Sinclair[edit]

Sinclair died on 6 April 2015 at his home near Helsinki, Finland.

See also[edit]

References[edit]

  1. ^ a b c d Kenneth Anderson, "Drink Your Way Sober with Naltrexone", Overcoming Addiction Blog, Psychology Today, 27 July 2013, accessed 10 August 2014
  2. ^ a b c d Sinclair, J.D. (January 14, 2000). "Evidence about the use of naltrexone and for different ways of using it in the treatment of alcoholism". Alcohol and Alcoholism (Oxford Journal of Medicine) 36 (1): 2–10. doi:10.1093/alcalc/36.1.2. PMID 11139409. 
  3. ^ a b c "'Nalmefene for reducing alcohol consumption in people with alcohol dependence [TA325]'". NICE website. National Institute for Health and Care Excellence. November 2014. Retrieved 15 June 2015. 
  4. ^ a b Sinclair, John David (June 2001). "Targeted Use of Naltrexone Without Prior Detoxification in the Treatment of Alcohol Dependence: A Factorial Double-Blind, Placebo-Controlled Trial". Journal of Clinical Pharmacology (Oxford Journal of Medicine) 21 (3): 287–292. doi:10.1097/00004714-200106000-00006. PMID 11386491. 
  5. ^ Rösner, S; Hackl-Herrwerth, A; Leucht, S; Vecchi, S; Srisurapanont, M; Soyka, M (8 December 2010). "Opioid antagonists for alcohol dependence.". The Cochrane database of systematic reviews (12): CD001867. PMID 21154349. 
  6. ^ Alternate link to full text of JoCP study on Erowid
  7. ^ a b Contral Clinic treatment FAQ

External links[edit]