Sinclair Method is the commercial name for pharmacological extinction of alcohol use disorder. It's an emerging protocol from Europe that produces unsurpassed results compared to other models. It forms the basis of the Alcure program.
Pharmacological Extinction was invented from research sponsored by the Finnish government two decades ago and the same method, using a slightly different medication, was approved for use in the European Union countries starting in 2014.
It involves taking naltrexone, an FDA approved medication, to temporarily block the primary reinforcement mechanism of alcohol that drives excess drinking and which eventually causes a physical urge or craving for alcohol. Established from PET scan medical studies (Positron Emission Tomography), alcohol consumption will cause a small release of the body's own version of an opioid, called "endorphins," with each sip. Though generally not noticeable, endorphins work as a primary biological reinforcement of behavior--creating a reinforcement "loop" in some people that gets beyond their control.
Naltrexone is taken only when you drink and temporarily suppresses the effects of endorphins released from drinking, disrupting biological reinforcement during alcohol consumption and allowing for an easy decline in the urge to drink over time. Medically, that's called "extinction." Patients report a gradual indifference toward alcohol and are able to restore control over drinking and eventually stop completely if they choose. There are no withdrawal symptoms. Most patients restore control in 4-6 months.
Extinction is the cornerstone of the Sinclair Method. It's a term from the field of Behavioral Science and refers to "conditioning" of behavior. Sinclair Method treatment involves the extinction of behavior shaped by Classical Conditioning.
Classical Conditioning was first discovered from the famous Pavlovian dog experiments where it was proven that you could elicit a reflexive response in an animal by associating a stimulus known to cause a reflexive response, like food, with what's called a neutral stimulus over and over in what are called "learning trials."
In the Pavlovian experiments, Pavlov paired the sound of a bell tone with spraying meat powder into a dog's mouth over and over. Meat powder would make the dog salivate reflexively. And, to be sure, the dog had no conscious control over whether it was going to salivate or not. It just happened because meat powder is food, a stimulus that, from evolution, innately triggers salivation in animals (including us).
By simultaneously spraying meat powder in a dog's mouth and sounding a bell tone over and over, the dog began to reflexively associate the bell tone with food. After many learning trials, Pavlov removed the meat powder and just sounded the bell tone. And what happened? The dog would salivate in response to the bell tone alone. What was once a neutral stimulus, the bell tone, was now physiologically significant to the dog. Once the bell tone was sounded, the dog would reflexively salivate.
So where does extinction come into the picture? An acquired, unnatural response such as salivating in response to a bell tone can be broken down through a process called extinction. If you were replicating the Pavlovian dog experiment, you would just "unpair" or disassociate the bell tone from the food powder consistently, over and over, and soon the dog's salivation response would taper down and vanish. The dog would return to what's called "baseline" behavior and the bell tone would return to being an insignificant, neutral stimulus.
With alcohol use disorder, the body releases endorphins as essentially an "immune response" to the intake of alcohol, which is a mild toxin. Endorphins are simple neurochemicals that reinforce behavior and are also released in response to pain. If you pair them with anything you can build-up, through Classical Conditioning, a reflexive response to what should ordinarily be a neutral stimulus, like in the Pavlovian experiments.
The Sinclair Method extinguishes alcohol use disorder by blocking, through the targeted dosing of naltrexone, a safe, FDA medication, your endorphins that are released each time you sip alcohol. In effect, by taking the medication consistently each time you drink, you are accomplishing an extinction session because you are "unpairing" or disassociating the alcohol from the effect of endorphins.
Patients report a gradual indifference toward alcohol over time and the frequency and volume of consumption of alcohol go down. Eventually, patients lose their strong desire or craving for alcohol and are said to have reached "extinction" of alcohol use disorder.
Some patients are baffled by how well the process works. But, you can now see that it's all based on simple, established science.
Targeted dosing of medication is also called "as-needed" dosing and contrasts with "constant dosing." An example of constant dosing is to take a pill once a day, or sometimes several times a day, but consistently on a daily cycle.
The idea with constant dosing is to keep a steady amount of medication in your system 24 hours a day so it can constantly be working its action on your body or brain.
Sometimes constant dosing is an ineffective use of medication and can be harmful because you have more medication in your system than you need producing an unintended effect, including taxing your body's system in eliminating the excess medication.
The Sinclair Method employs targeted or as-needed dosing, and in that way the medication is simply a tool to assist your body in readjusting its dependency on alcohol.
While the Sinclair Method employs naltrexone, a safe FDA medication to attack the physiological changes to brain chemistry caused by repeated consumption of alcohol, it's primarily a behavioral modification model, only not in the traditional sense where you start with talk-therapy or apply conscious, deliberate willpower to suppress cravings for alcohol, or work hard on other changes to behavior.
Instead, naltrexone works at the brain neuron level by blocking the action of endorphins that are released in response to drinking alcohol. Endorphins are basic neurochemicals that reinforce behavior in all animals including humans. By blocking them, patients slowly breakdown the physiological craving sensation for alcohol over time. That's called "extinction" in medical science and originated with studies done in the field of Behavioral Science over one hundred years ago.
Since alcohol use disorder involves an acquired learned response at the physiological level that involves core, reflexive neurological and biological processes in the human body, it's not something you can always consciously "will away" or control once it takes hold.
The classic sign of alcohol use disorder having taken over is when your body begins to crave alcohol if it's deprived of it for too long, often coupled with a difficult time stopping drinking once you start. Craving is simply an uncomfortable, strong desire for alcohol. It's the body's way of signaling it wants more alcohol, all caused by the unintended effect of alcohol repeatedly releasing endorphin with each sip. The body, in effect, is "tricked" over time by that unintended release of endorphin each time you drink.
By blocking that endorphin release in a targeted fashion with naltrexone, you begin the process of extinction of that acquired response and cravings begin to dissipate and control over drinking begins to come back. That's how targeted or as-needed dosing works. It's targeted, or timed to coincide, with the act of drinking.
Specific neurons, and their relationship to one another, play a pivotal role in alcohol use disorder.
Neurons are separate cells that reside close to each other in the brain but do not touch. Instead, there's a small space in between each neuron called the synapse.
Neurons talk to one another by transmitting neurochemicals from one brain cell to the next. Neurons have vesicles, which resemble water balloons, that release neurochemical molecules into the synapse that attach to neighboring neuronal "receptors" based on the shape of the molecule and the shape of the receptor site. In that way, neurochemicals find and "fit" to their respective receptor sites similar to how a uniquely shaped key fits into a unique lock.
We have many neurochemicals and they each perform different roles to regulate bodily systems. Several, for example, have a direct impact on our mood, such as serotonin, GABA, and glutamate.
Neurochemicals are released into the synapse from neuronal firing, which is an electrical impulse or charge inside the neuron. When a charge reaches a threshold the neuron will fire and release its neurochemical into the synapse toward a neighboring neuron's receptor sites, and that will perpetuate a "neuronal message" further down a neuronal pathway. Though neurons don't ever touch, they can strengthen their connections with repeated firing of the same neurochemicals over long periods of time. These strengthened connections are sometimes called pathways.
That's what happens with alcohol use disorder. Repeated and excessive consumption of alcohol will release endorphins more frequently and strengthen those neuronal pathways, in turn creating a dependency on alcohol.
You can use pharmaceuticals (drugs) to "tinker" significantly with neuronal activity, both in a good, therapeutic way or in a bad way that can cause addictions or other problems.
Think of a "cause" as a factor. It can be anything from a genetic predisposition, to a neurochemical reaction, to environmental factors.
Many factors may combine with another to cause a condition such as alcohol use disorder. It's impossible to attribute alcohol use disorder to any single cause. But you can categorize causal factors as primary and secondary.
One of the most common secondary causes of alcohol use disorder is environmental stress. A dictionary definition of stress is "a state of mental or emotional strain or tension resulting from adverse or very demanding circumstances."
We function in a world filled with stressors. These range from money issues, to family or partner issues, job issues, and so on down the line. Some are recent, some are situational meaning they come and go, and some are chronic, such as an adverse childhood event or trauma from an incident or set of experiences. Sit down for a few minutes and brainstorm all the large and small stressors in your life and you'll probably end up with a sizable list.
Accordingly, one of the best ways to attack alcohol use disorder is to eliminate stress from your life, or learn how to reinterpret stressful events. Stress generally arises from the ancient "flight or flight" mechanism we still retain from millions of years gone by of evolution when we were evolving from primitive primates.
Stress can seem overwhelming but with proper techniques and mindsets, or in harder cases proper therapy, stress can be mitigated significantly.
At Alcure, we take secondary causes of alcohol use disorder head-on with our accelerator videos. We introduce you to a host of techniques to eliminate or reduce stress by addressing core behavior patterns that, when not practiced correctly, bring about stress without you realizing it.
Stress is tied to alcohol use disorder for the simple reason that people often use alcohol to "self-medicate." Alcohol is a drug, meaning it's just a molecule that affects our brain and body, and replicates in a crude way many common prescription drugs such as anti-anxiety medications and, due to the release of endorphins with each sip, common opioid-based medications.
There are many other ways to address secondary causes of alcohol use disorder we address in our accelerator videos (module three is where we explore the topic in great detail). But in general, our approaches fall under the umbrella of "wellness."
One of the most important things you can and should do when tackling a drinking issue is to realize that nobody is judging you.
Better stated, you shouldn't care if anyone is judging you, even if they might do so.
Most people go about their daily lives concerned they are being judged and focus more on what people might be thinking about them rather than on their own purpose and goals -- and it stifles many people.
It's a much healthier outlook to simply realize that most people aren't judging every move you make in life, and even if they were it shouldn't make a difference to you.
That's an empowering mindset to employ and once you get a handle on it you'll take a great deal of pressure off yourself that shouldn't be there in the first place. Why make it harder for yourself harboring a perception that people are going to have opinions about what you do or what you decide not to do. Who cares? You can even take it one step further and realize it's really none of their business either.
Okay, so you've embarked on a journey to cut back on drinking either to reach control or to stop completely. You've signed up for treatment and your drinking pattern is adjusting downward. Drinking episodes are spacing out more and the volume of alcohol you drink is less with each episode. You are going through the process of extinction.
You're showing up with friends at dinners or house parties, or at happy hours, and you're simply not drinking as much. You're saying words and phrases like "I'll pass" when someone offers to buy a round, or "I'm trying to cut back," or more plainly, "I quit drinking."
How will these friends and acquaintances, or family members, react?
With most it will be with indifference. The conversation may go something like this:
Friend: "Would you like a drink?"
You: "No, thank you, I stopped drinking."
Friend: "Oh okay."
That's it. "Oh okay." And their attention shifts.
Now you may run into folks that are intrigued. They will ask "why" you stopped or are cutting back. And they may pepper you with related questions such as whether you had a bad experience before, whether it's been difficult, is this just a phase, etc.
When you get the "why" question is when you employ the mindset of realizing that nobody really cares, but they're just curious.
In other words, don't feel you need to explain and justify your decision. In fact, some of the "why" questions may be put to you because the person asking the questions is contemplating cutting back or quitting as well.
Another common reaction is to support you. Example:
Acquaintance: "Do you want a drink?"
You: "No thanks, I quit a month ago."
Acquaintance: "Oh cool, I bet you save money and feel healthier -- I should stop too. That's awesome!"
By the way, a small hint of what we discuss in our accelerator videos, in module three, is that you should be cultivating a good community around you and cutting loose those people that don't support you in the things you do. Those that aren't in your corner. Those that don't respect you and your choices. It's called setting the correct boundaries. Cool people stay in your life. Toxic people get a bigger boundary. The test is whether they add value to your life.
The last reaction you'll get is adversity, and you can simply dismiss that reaction as coming from people harboring their own shortcomings and attacking you to compensate.
Aside from some mild teasing as being about the only acceptable negative response to cutting back or stopping drinking, anyone who persists in attempting to roast you for your decision is acting juvenile and controlling, insensitive and lacking in social awareness. If it persists call them out on it and consider adjusting your boundaries with that person.
Cutting back or stopping drinking is like deciding to finally get around to exercising regularly and eating a better diet. Only good comes from it. As such, it aligns with the knowledge that nobody is really judging you about the decision, and even if they were you shouldn't care. After all, it's your life and not theirs.
"Wellness is a state of complete physical, mental, and social well-being, and not merely the absence of disease or infirmity." – The World Health Organization.
The key phrase in the World Health Organization's definition of wellness is "well-being, and not just the absence of disease .. ".
Wellness is a way of looking at your overall health from a standpoint of achieving growth and buoyancy, as opposed to just avoiding illness.
When we think of health, we usually think of physical health and usually in the sense of avoiding the negative. Wellness focuses on improving from a state of already being in reasonably good health. And, it addresses broader areas of life instead of just focusing on physical health.
Here at Alcure we add to the World Health Organization's definition of "wellness" by including emotional and financial health. We tie emotional health with mental health, and we include financial health since poor financial health is a major cause of stress which, in turn, contributes to alcohol use disorder.
So what does a wellness lifestyle look like for most of us?
A wellness lifestyle is pretty much what your family doctor would tell you to do when it comes to diet and exercise, what a counselor would tell you to do for reducing stress and improving relationships, and what coaches in various other core areas of life would tell you to do to improve in those areas. We'll break it down more.
When it comes to diet, it's all about reducing the intake of fats, salts, sugars, and processed foods, and reducing caloric intake in general.
When it comes to exercise, it's about compensating for the sedentary lifestyle we've become accustomed to with some level of regular exercise that gets your heart and lungs going.
When it comes to social and emotional well-being, it's about developing assertiveness, drawing personal boundaries with others, engaging with genuine people that bring value to your life and avoiding toxic people. It's about investing in yourself, paying attention only to what matters and not letting things get under your skin, so to speak.
And when it comes to financial health, it's about avoiding conspicuous consumption and overspending while investing in what earns you money without stressing yourself out.
What does wellness have to do with the Sinclair Method?
The Sinclair Method uses naltrexone as a tool to leverage you out of the physiological aspect of alcohol use disorder. Remarkably, it breaks down your physiological craving or strong desire for alcohol without too much effort until you reach "extinction."
While the Sinclair Method does some heavy lifting for you, it stops there. And that's where wellness comes into the picture to complete the Alcure program.
Alcohol use disorder is anchored in a physiological craving or strong desire for alcohol, to the point you'll feel physically uncomfortable if deprived of alcohol. But it starts with outside factors, the most common being stress.
So, as we reverse alcohol use disorder by starting with an attack on the physiological craving component and optimizing on the Sinclair Method, we need to also introduce strategies for reducing stress in our lives as well, and that's where wellness comes in.
The Sinclair Method will surface you from what can be some dark depths. But then you're just there, at the surface. You're breathing air again but you're also treading water. It's a relief, but there's much more to accomplish.
Think of accomplishing extinction from the Sinclair Method as reaching a gateway that leads to many other areas where you can improve. And by improving on those areas, you replace some of the old patterns of thinking and behavior that resided right alongside your alcohol use disorder with much better approaches and behaviors.
By gradually weaving wellness into the process of extinguishing your alcohol use disorder, you propel yourself an "ocean's distance away" from it and not only get to the surface, so to speak, but now you can climb and gain altitude.
You not only beat a condition that was holding you back, but you start to achieve self-mastery. And things only get better from there.
Most of us know that drinking alcohol in excess has negative consequences to our health. Namely, we know that our liver processes alcohol, and when we drink too much, our liver has difficulty processing the toxins and flushing them from our system. In fact, the liver can only process one ounce of liquor (or one standard drink) in one hour.
Consuming more than that saturates your system, and the additional alcohol will accumulate in the blood and body tissues until it can be metabolized. Consistent alcohol over-consumption, which is also known as alcohol use disorder or AUD, can ultimately lead to complications such as fatty liver disease or worse, cirrhosis (scarring) of the liver, that can become irreversible. Reducing drinking before this happens can help ensure your liver stays healthy.
But there are a myriad of other health benefits we can enjoy when we reduce our alcohol intake over time—some more obvious and others more subtle. Some of these benefits lead to additional positive consequences, including better mental clarity and quality of sleep, which in turn lead to more productivity, ability to accomplish goals and relief from other symptoms such as anxiety or depression. Here are four big health benefits you will enjoy when you drink less.
Your heart will thank you
Drinking can be very bad for the heart and the pulmonary system. Particularly in people who may be prone to pulmonary conditions, as consistent overuse of alcohol can increase the risk of heart disease. Alcohol increases the amount of fat in the bloodstream. Specifically, it raises the number of triglycerides, which produce higher cholesterol levels. Fatty blood slows down the speed at which blood moves through the body making your heart work harder to pump blood. Over time, high cholesterol may result in heart failure and a number of other conditions. One of the greatest benefits of quitting alcohol, therefore, is a healthier heart and a longer life.
You will look better
Alcohol is a diuretic, which means that it dehydrates you. Chronically dehydrating your system from alcohol overuse will cause your skin to dry out and be less elastic, and that can cause you to look older. Alcohol also causes inflammation. If you have ever seen anyone get a red flush in their skin when they drink, you have witnessed inflammation from alcohol. Even though the red flush goes away in people who don’t overuse alcohol, constant inflammation can cause damage to the skin.
Research also suggests that drinking can age the body’s cells, which means it cuts short the lifespan of the cells in the heart, liver, skin, and other organs. Overtime, your skin can show this deterioration.
You will find weight loss much easier
Alcohol is full of empty calories. In other words, it can cause you to pack on extra pounds by introducing extra calories that have little or no nutritional value or vitamins and minerals. The body processes and then stores alcohol as sugar. Too much extra sugar can ultimately convert to fat. In fact, in many studies, people who overuse alcohol are more likely to carry extra weight. Reducing drinking is an immediate way to reduce extra calories and shed weight.
Additionally, when you drink less, you are more likely to want to be active. You might trade drinks after work for a long walk in the park or a trip to the gym. Waking up without a hangover makes it that much easier to want to go for a morning run. Of course, it is important not to trade the alcohol in for other unhealthy food choices, and exercise is also important to maintaining a healthy weight. But, if a person is looking to lose some weight, they should start by not drinking. Weight loss is a great benefit of giving up alcohol.
You will sleep better
Most people don’t realize how much drinking affects their sleep habits. But, it does. According to the Sleep Foundation, alcohol triggers “delta activity” in the brain. Delta activity is a type of deep sleep that helps with learning and memory restoration.
But, alcohol also triggers “alpha activity”, which is brain activity that usually only occurs when someone is awake. These two opposing brain activities, when they happen at the same time, fight against each other, so to speak, making it impossible to enter into a deep sleep cycle. This means people who overuse alcohol are less rested than they can be, even though alcohol can make you fall asleep more easily. Once someone quits alcohol and their body adjusts, they usually find that they gain significant benefits from higher quality sleep, including sharper mental clarity, more energy and overall improved mood.
If you want to improve your health, but find that AUD is preventing you from drinking less, we can help you with a proven approach to ending AUD using the Sinclair Method—all delivered via a supportive, confidential telemedicine platform. Get started today at alcure.me.
"Having worked in the emergency department for over 30 years I certainly agree with Dr. Green’s comments [regarding alcohol related problems seen in the ER]. I would also go as far to say that more than 50% of the problems we see in the emergency department are substance use disorder related (alcohol, opiates, tobacco, stimulants, etc).
While the office practice of medicine is less dramatic, alcohol use disorder has a heavy footprint here as well. While most medical conditions are made worse by unsafe alcohol use the following is a partial list of conditions that quickly come to mind: neurological disorders (seizures, neuropathies); sleep apnea; diabetes; obesity; heart disease (especially arrhythmias such as atrial fibrillation), diabetes; obesity, psychiatric disorders (depression, anxiety); GI disorders (GERD, gastritis, stomach ulcers) and liver conditions.
It is hard to overstate the effect of alcohol on the practice of medicine. Any treatment that is effective will have tremendous personal and public health benefits. Medication assisted treatment with naltrexone, The Sinclair Method, appears to be the most effective treatment for alcohol use disorder at this time."
Dr. Clifford Fields, October 2020
We all get started from uniquely different backgrounds, experiences, and traumas. Coping mechanisms and defenses develop from an early age to protect us and allow for our survival. Oftentimes, these can mutate into something that haunts us as we grow up, and unfortunately, we can carry these wounds of our pasts into our future relationships and interactions with the world.
The dynamics of my upbringing forced a sense of early adulthood and an overarching necessity to care for others in a way that often harmed me. This tendency morphed into over-parentification and eventually led to my early addiction to alcohol, substances, and people. I took hostages along my journey, but held myself the most captive.
At my physical and emotional bottom, an untenable level of despair led me to finally ask for help. This step, though brutally painful, was life changing. I began on my journey to self-discovery, acceptance, and a dedication to understanding my ability to change my behaviors and patterns in life. With the gentle assistance of many (including professionals), I dedicated myself to staying abstinent from substances and alcohol. Once I was relieved of my obsession to use substances, I finally had the capacity to begin the work healing the triggers and traumas of my past and restructuring the dynamics of how I related to myself and others.
Now that you’ve decided to seek help, you will need to summon the bravery to look deeper within yourself for answers, so that you can balance and build healthy relationships in your life. I believe that you have your own story to tell, and that the help of a trusted person and / or team, can assist you in finding that voice, and give name to your hidden truths so you can become the person you’ve always meant to be.