This article will be a basic step-by-step guide for how someone can get started on the Sinclair Method (TSM) in order to treat alcohol addiction – or the more accurate term "alcohol use disorder" – AUD. Let's jump in!
What is the Sinclair Method?
The Sinclair Method is an evidence-based method for unlearning the behavior of alcohol use disorder that has a 78% success rate. This method involves taking a medication called naltrexone 1-2 hours before the first drink of alcohol for the day. The medication blocks the endorphins, or the "reward" a person gets from drinking alcohol. When these endorphins are blocked consistently over time, many people find that they regain control over alcohol. As a result, people report that they can drink less in one sitting, find that they crave alcohol less, are less pre-occupied with it and can more easily have days, weeks or months without alcohol. Many even report that they simply "lose interest" in drinking or even forget to drink.
It's important to note that a person can still get intoxicated on this method – and they can even still enjoy drinking. Naltrexone is not like Antabuse where it makes a person sick when they drink. But rather, it simple blocks the reward on a neurological level – which breaks down the pathways in the brain that have been hard-wired to crave and binge alcohol.
How to Start the Sinclair Method
Below we'll provide a basic step-by-step guide for how someone can start on the Sinclair Method.
1. Get a prescription to the medication naltrexone or nalmefene.
Because TSM works only by taking this medication 1-2 hours before drinking, getting the prescription is the very first step. You can find knowledgable Sinclair Method physicians to meet with via telemedicine here. These physicians are in all 50 US states, and in the UK, Canada, Ireland, New Zealand and Scotland. Unfortunately, there are not yet doctors available on this site worldwide, but the list is always growing. You can also find in-person TSM physicians more globally here. Lastly, you can always ask your general practitioner or psychiatrist to prescribe the medication to you. They may or may not be willing to for various reasons – mainly because they may just be unaware of this medication for treating AUD. Here are some resources that you can bring to your physician about how this method works.
2. Begin the Sinclair Method
Once you have your prescription, it's time to begin the method! Below are some basic steps for how to start on TSM (note, this is not medical advice. Please talk to your doctor before starting on TSM).
Take the naltrexone medication 1-2 hours before the first alcohol drink. Important note: most TSM doctors will have their patients start at a 1/2 of a dose – or 25mg the first few times they take it. This is just to help mitigate any side effects that may occur.
Once the medication has been in the system for at least 1 hour, it's time to have the first drink of alcohol.
Drink like you normally would – but pay attention to what is different. What do you notice? Does it taste differently? Is the buzz different? Are you enjoying it?
Log your drinks. This can be helpful to track your progress on the method. You can find drink log resources here, or you can simply use a pen and paper, or any other drink log app you prefer.
When starting out on TSM, you do not need to try to "not drink" or try to resist the urge. In fact, this method works because you are drinking (always combined with naltrexone). So, there is no need to "white-knuckle" urges to drink on TSM but rather surrender to the craving by taking the naltrexone, waiting an hour and drinking.
3. Give it time to work
Some people may notice a reduced desire to drink after their first dose of the medication. Others may not notice much of a difference at all. Both situations are totally fine and doesn't necessarily mean it's working better for one than the other.
For most people, this method takes time to work. The average length of time for pharmacological extinction is nine months. Some may reach it sooner, and others it may take much longer.
Extinction is the "end goal" for this method – and it does not necessarily mean abstinence. Rather, extinction means that a person's brain has been restored to the state it was in before they had AUD or a dependence on alcohol. That means that they are no long pre-occupied with alcohol, they no longer crave it and can have much more control over when and how much they drink. Most people who go on TSM have a goal to drink moderately – they want to have the option to still drink if they want to, or to save it for special occasions. This is entirely possible with TSM so long as a person continues to take naltrexone before they drink – and never skip a dose. For others, once they reach extinction they can more easily choose abstinence because their interest in alcohol has faded away and they just can't be bothered to drink anymore. This is what happened to me – and it's sort of amazing! 🙌🏼
4. Work alongside the medication
The Sinclair Method is about so much more than "popping a pill and letting it do all the work for you." Yes – the medication is an extremely powerful component of this method, but it's not everything. In fact, when I see people who are struggling on this method it's often because they are relying on the medication alone and not doing anything else to change their relationship with alcohol.
The longer that a person is on TSM, they may begin to see how much their drinking routine is habitual – something they do at a set time without giving it much thought – or that it's used as a quick coping tool to deal with stress, anxiety or any other uncomfortable emotions.
The medication will not fix these things.
In my experience, these changes are best approached gradually over time. When we try to do too much all at once, we are relying too much on willpower and that will fizzle out over time. That's why it's important to start with small changes – master those – then add to them over time.
For example, when someone is just starting out on TSM – getting used to taking the pill before drinking and logging drinks are two big changes in the drinking routine. I often tell my clients to focus on these areas alone for the first 30-60 days of TSM. When they master that then they can add more small changes to their TSM journey (more tips below).
5. Follow the Golden Rule
The most crucial part for success on TSM is taking the naltrexone medication 100% of the time and never skipping a dose. When people skip doses of the medication and drink without it – even just sometimes or on occasion, it throws off, stalls and even reverses progress.
Commitment to taking the pill 100% of the time – and always waiting at least one full hour before drinking alcohol after you've taken it are the first steps to success on this method. If a person cannot do this, their journey on TSM will not work.
6. Get support
Having support on this journey – in whatever way is best for you – can really help with success on this method. Support can look different from person to person. For example, it might be seeking a therapist, enrolling with TSM coach, reaching out to friends or family who will be your cheerleaders, joining some of the online TSM groups through Facebook or Reddit, joining the online free TSM Meet Up zoom calls, going to SMART meetings, go to church, take a self-development class or anything else that feels supportive on your TSM journey. Whatever you do, don't go at it alone.
7. Consider these tips!
There are so many things people can do to set themselves up for success on TSM. Once they've mastered taking the medication, here are some other ways they can help change their habits and coping behaviors around alcohol.
Approach changing your relationship with alcohol with a curious mindset – as opposed to a restrictive one. For example, instead of saying "I'm only going to allow myself to have two drinks tonight" you could say "what would it feel like if I had two drinks tonight?" This type of mindset shift can help bring more expansive insight to the experience.
Read books on habit change. I like Atomic Habits by James Clear – there are many others. Learning about techniques to change habits can be a perfect compliment to TSM and help you to change your habits around alcohol.
Try drinking your lesser-favorite alcoholic beverage – you may find that you drink less when you do this.
Try adding in non-alcoholic drinks before or between your alcohol drinks.
Try drinking your wine or alcoholic beverage out of an old coffee mug – it may make it less appealing.
Take breaks between drinks. People often report if they take a 30 minute break after their second or third drink, their desire for the next one fades away.
Interrupt your usual habitual drinking loops. For example if you always have your wine next to you while you watch Netflix, can you instead keep your glass of wine in the kitchen and make yourself get up to get it every time you want a drink.
Experiment with other coping tools. I know – alcohol is such a quick and easy coping tool for many of us. However, if you're on TSM it likely means that you don't want to rely on alcohol to cope like you have in the past. This is a process that takes time and experimenting with different ways to cope with stress, boredom and even happiness. If you notice you are reaching to alcohol to cope – try something else first. Try taking a bath, going for a walk, listening to music, having a snack...whatever you want to try. This doesn't necessarily mean you won't drink after that – but it will give you a chance to try other methods of responding to your triggers to drink. By doing this consistently, you will create new habits and methods of coping other than alcohol.
Try for an alcohol-free day or days – when you're ready. Some people have AF days right away on TSM, while others it takes more time and effort. When you're ready, having an AF day or days can really help break up the drinking routine, and allow your body to experience natural endorphins from other activities (since you won't have naltrexone in your system).
Be mindful before, during and after your drinking session. For many of us, our relationship with alcohol has been someone "mindless." We find ourselves craving a drink, so we have one. By adding in mindfulness to your TSM journey – it can help bring insight to the experience, and ultimately help change habits and behaviors around drinking. Here's what this might look like in practice: Mindful before drinking: examining the craving – how strong is it? What triggered my craving? Am I using alcohol to cope? Am I drinking out of habit? What need to I have that I am turning to alcohol to meet? For example, you can use the HALT-B exercise: am I Hungry, Angry, Lonely, Tired or Bored? Mindful during drinking: be curious about the drinking experience. How does this taste? How do I feel? How much do I want that next drink? Can I drink more slowly? Should I take a break? Mindful after drinking: Did I drink more or less than I intended to? Did I feel like I had control over my drinking – why or why not? What did I do well with that drinking session? What could I do better? What did I learn?
Lastly, here is a video I made a while back that covers the basics of getting started on TSM!
Wishing you all the best on your TSM journey!