Alcohol, Naltrexone, and the Magic of Pharmacological Extinction

Introduction
 
The drug naltrexone has been approved by the FDA for the treatment of opiate addiction since 1984 and for the treatment of alcohol problems since 1994. Although many doctors have prescribed naltrexone for alcohol problems since it was approved by the FDA, naltrexone has not proven very effective when prescribed according to the FDA's recommendation to take it daily while abstaining from alcohol.
 
However, David Sinclair PhD, a research scientist working in Finland, has discovered a different way of prescribing naltrexone which has shown an 80% success rate with patients who are prescribed naltrexone and a 90% success rate with patients who take the naltrexone as directed. This method of prescribing naltrexone has come to be referred to as The Sinclair Method. 90% of patients who take naltrexone according to The Sinclair Method either quit drinking or become moderate drinkers in the space of three months. No inpatient treatment is required and naltrexone is available in a cheap generic form which makes this not only a highly effective treatment for alcohol problems, but a one of the least expensive as well.
 
What is The Sinclair Method?
 
According to the Sinclair Method patients should only take naltrexone when they intend to drink alcohol and should never take naltrexone when they intend to abstain from alcohol. This is in sharp contrast with the FDA's recommendation that naltrexone should only be given to patients who promise to abstain from alcohol and that it should be administered daily. Moreover, when naltrexone is taken according to the recommendations of the FDA it is only slightly more effective than a placebo--a sharp contrast with the 90% success rate of The Sinclair Method of using naltrexone. In addition, some research suggests that the only patients who benefit by taking naltrexone as prescribed by FDA guidelines are those who cheat and drink on the naltrexone, and that those who abstain while taking the naltrexone not only have greater alcohol cravings than those who get a placebo--but are also more likely to relapse into severe drinking problems in the long term.
 
The Sinclair method says to take 50 mg of naltrexone one hour before drinking every time that you drink for the rest of your life. Naltrexone taken according to The Sinclair method is safe even for drinkers who are heavily physically dependent on alcohol since the naltrexone causes them to gradually drink less and less per day and thus taper off of the alcohol with no withdrawal symptoms whatsoever.
 
How does The Sinclair Method work?
 
According to David Sinclair, alcohol addiction is a conditioned response. People become conditioned to drink alcohol because of alcohol's actions in the brain in much the same way that Pavlov's dogs became conditioned to salivate at the sound of a bell. This is because every time that one drinks alcohol, endorphins are released in the brain. Endorphins are chemicals which are responsible for learning new conditioned responses. Normally this is a good thing because the conditioned responses which we learn help us to survive. However, in the case of alcohol addiction, the conditioned response leads people to perpetuate a bad habit. The endorphins which are released into the brain when people drink alcohol reinforce the drinking behavior, and this can lead to addiction to alcohol.
 
Naltrexone totally blocks the effects of endorphins in the brain. If you take naltrexone before drinking alcohol then the drinking behavior will not be reinforced. When a behavior is not reinforced it eventually disappears. Psychologists refer to this process as "extinction". Since naltrexone is a pharmaceutical, using naltrexone to extinguish drinking behavior is referred to as "pharmacological extinction". Pharmacological extinction of problem drinking by using naltrexone is The Sinclair Method.
 
When we understand that problem drinking is a conditioned response and that this conditioned response can be extinguished by using naltrexone according to The Sinclair Method, it becomes very obvious why the FDA's method of using naltrexone is not effective. If a person takes naltrexone every day then the naltrexone will tend to extinguish every pleasurable behavior which results in the release of endorphins, not just drinking behavior. This includes everything pleasurable from reading to jogging to sex. Moreover, if one abstains while taking the naltrexone, then drinking will be the only behavior which is NOT extinguished by the naltrexone.
 
Why Isn't The Sinclair Method Popular In The United States?
 
Since The Sinclair Method has shown a great deal of success in Finland, why hasn't it been generally adopted in the United States?
 
There are a couple of reasons that this may be the case. Since naltrexone is now available as a generic, the pharmaceutical companies will not make any major profits by promoting it. Moreover, American addictionologists seem to generally shy away from anything which does not involve complete abstinence and surrender to a "Higher Power". Moreover the 2009 edition of The Physician's Desk Reference no longer lists oral naltrexone as available for prescription in the United States--only 30 day implants are available. 20 day naltrexone implants cannot be used for implementing The Sinclair Method. It is unfortunate that our pharmaceutical companies have taken such a giant step backward just at the very time an extremely effective method of using oral naltrexone has been discovered.
 
Fortunately there are a few professionals in the United States who are now promoting The Sinclair method. We can only hope that this grass roots movement will grow and that more and more people we become familiar with The Sinclair Method and put it into practice to help eliminate the alcohol problems which continue to plague the United States.
 
REFERENCES:
 
Anton RF, O'Malley SS, Ciraulo DA, Cisler RA, Couper D, Donovan DM, Gastfriend DR, Hosking JD, Johnson BA, LoCastro JS, Longabaugh R, Mason BJ, Mattson ME, Miller WR, Pettinati HM, Randall CL, Swift R, Weiss RD, Williams LD, Zweben A; COMBINE Study Research Group. (2006). Combined pharmacotherapies and behavioral interventions for alcohol dependence: the COMBINE study: a randomized controlled trial. JAMA. May 3;295(17):2003-17.
 
Eskapa, R (2008). The Cure for Alcoholism: Drink Your Way Sober Without Willpower, Abstinence or Discomfort. Benbella Books. Dallas, TX.
 
Heinälä P, Alho H, Kiianmaa K, Lönnqvist J, Kuoppasalmi K, Sinclair JD. (2001). Targeted use of naltrexone without prior detoxification in the treatment of alcohol dependence: a factorial double-blind, placebo-controlled trial. Journal of Clinical Psychopharmacology. Jun;21(3):287-92.
 
Medical Economics Co. (2009), Physicians' desk reference : PDR. Medical Economics Co., Oradell, N.J.
 
Sinclair JD. (2001). Evidence about the use of naltrexone and for different ways of using it in the treatment of alcoholism. Alcohol and Alcoholism.Jan-Feb;36(1):2-10.