The Sinclair Method: Naltrexone-Based Alcohol Treatment Explained

What Is The Sinclair Method?

The Sinclair Method is a pharmacological approach to alcohol use disorder developed by Dr. John David Sinclair, an American neuroscientist who conducted research at the University of Helsinki in Finland. TSM uses naltrexone — the same FDA-approved opioid antagonist used in conventional alcohol treatment — but with a specific targeted dosing protocol that differs from standard practice.

The core principle: take 50 mg of naltrexone exactly 1-2 hours before any drinking occasion. Do NOT take naltrexone on days you do not drink.

The logic behind this protocol is pharmacological extinction. When you drink alcohol with naltrexone blocking your opioid receptors, the brain does not receive the endorphin-mediated reward it expects. Drink after drink, session after session, the learned association between alcohol and pleasure weakens. Over months, the compulsive drive to drink gradually fades — not through willpower, but through neurological relearning.

On days without drinking (and without naltrexone), the opioid system functions normally, allowing natural rewards — food, exercise, social connection — to produce their normal pleasurable effects. This selective extinction targets only the alcohol-reward association while preserving normal reward function.

How TSM Differs From Standard Naltrexone Treatment

Standard US treatment protocol prescribes naltrexone daily, regardless of whether the patient drinks. The goal is typically abstinence, with naltrexone providing craving reduction. TSM prescribes naltrexone only before drinking, specifically requiring that the patient drink on the medication. The goal is extinction of the drinking urge over time — which may result in abstinence, dramatically reduced consumption, or controlled moderate drinking.

This difference is philosophically significant. Standard treatment views any drinking as failure. TSM views drinking (on naltrexone) as the mechanism of treatment — each drinking session with naltrexone is a "treatment session" that weakens the addiction.

The Evidence

Dr. Sinclair published research showing that targeted naltrexone use reduced alcohol consumption by approximately 78% in Finnish clinical trials. A large randomized controlled trial in Finland (the "Finnish Naltrexone Study") supported these findings. Several subsequent studies have confirmed that naltrexone, taken before drinking, significantly reduces alcohol consumption.

However, the evidence base for TSM's specific targeted protocol versus daily naltrexone is limited. Most major clinical trials used daily dosing, and mainstream US addiction medicine guidelines recommend daily naltrexone. TSM has stronger advocacy in European addiction medicine and in patient advocacy communities.

What to Expect on TSM

Months 1-3: Patients continue drinking but notice subtle changes — less urge to have a second or third drink, less pleasure from the alcohol itself, easier ability to stop once started. Some sessions may still involve heavy drinking, which is expected.

Months 3-6: Drinking frequency and quantity typically decrease measurably. Many patients find they naturally skip drinking days or forget about alcohol entirely for periods. The psychological pull toward alcohol weakens progressively.

Months 6-12: Significant sustained reduction. Some patients achieve pharmacological extinction — a state where alcohol holds no more appeal than any neutral beverage. Others maintain low, controlled consumption. Both outcomes are considered successful.

Ongoing: TSM advocates recommend keeping naltrexone available indefinitely and taking it before any drinking occasion. If extinction is achieved and the person has no desire to drink, no medication is needed — but if a craving emerges, naltrexone should be taken before acting on it.

FAQ

Is The Sinclair Method FDA-approved?

Naltrexone itself is FDA-approved for alcohol use disorder. However, the specific TSM protocol (targeted dosing only before drinking) is not the FDA-approved dosing regimen. The FDA-approved approach is daily naltrexone. Some physicians prescribe naltrexone using the TSM protocol as an off-label application, which is legal and within medical practice standards.

Can I just do The Sinclair Method on my own?

Naltrexone requires a prescription. You should work with a physician knowledgeable about TSM — they will monitor liver function, adjust treatment as needed, and provide support. Self-treating with illegally obtained naltrexone is not recommended. Additionally, many people benefit from combining TSM with therapy, as the medication addresses the neurological component while therapy addresses behavioral and psychological patterns.

Does TSM work for everyone?

No single treatment works for everyone. TSM's reported success rate of approximately 78% means roughly 22% of patients do not respond adequately. Individual variation in opioid receptor genetics, co-occurring conditions, and treatment compliance all affect outcomes. If TSM does not produce sufficient results after 4-6 months of consistent use, alternative or additional treatments should be explored.

References:

• Sinclair, J.D. (2001). Evidence About the Use of Naltrexone and for Different Ways of Using It in the Treatment of Alcoholism. Alcohol and Alcoholism.
• Heinala, P. et al. (2001). Targeted Use of Naltrexone Without Prior Detoxification in the Treatment of Alcohol Dependence. Journal of Clinical Psychopharmacology.
• Eskapa, R. (2012). The Cure for Alcoholism: The Medically Proven Way to Eliminate Alcohol Addiction.
• National Institute on Alcohol Abuse and Alcoholism. (2024). Medications Development Program.

Valley Spring Recovery Center Editorial Team

This article was reviewed by the Valley Spring Recovery Center editorial team, comprising licensed therapists, medical professionals, and addiction specialists dedicated to providing accurate, evidence-based information about substance use disorders and treatment options.