Josh Lee is a clinician and researcher with a focus on medication-assisted treatment of alcohol Sinclair method and opioid use disorders. He has conducted multiple clinical trials examining the use of naltrexone in primary care and other community settings. As a practicing physician, Josh helps manage the NYC Health + Hospitals/Bellevue addiction medicine clinic in adult primary care. When a person drinks alcohol, their brain releases endorphins (natural opioids), which activate the brain’s opioid reward system. Over time, the idea is that drinking becomes less rewarding and more of a neutral or even unpleasant habit, which reduces cravings and helps the brain unlearn the compulsion to drink. The Sinclair Method was developed by Dr. John D. Sinclair and is based on the idea of ‘pharmacological extinction’ – that is, gradually weakening the brain’s learned association between alcohol and pleasure.

Years of Progress & Support

• These treatments complement the pharmacological benefits of naltrexone and concentrate on the psychological and behavioral features of AUD.
• The brain’s reward system becomes hijacked by the alcohol, reinforcing the drinking behavior and making it a compulsive activity.
• For decades, the cornerstone of AUD treatment has been the complete cessation of alcohol consumption, a principle deeply embedded in programs like Alcoholics Anonymous (AA) and widely endorsed by the medical community.

Research supports that this theory may work, with up to a 78 percent long-term success rate over 120+ clinical trials. TSM is a proven and effective way to regain control over drinking, but having the right support is key. TSM is more adaptable and customized, catering to those who may not be ready or able to achieve immediate abstinence. It combines medicine with potentially supportive therapy to address the underlying neurobiological causes of addiction and the psychosocial variables that contribute to alcohol abuse. This is in contrast to AA, which emphasizes a community-driven, abstinence-first paradigm based mainly on group support and a structured program.

Key Takeaways

In clinical settings, naltrexone is sometimes combined with other treatments, such as therapy or counseling. These treatments complement the pharmacological benefits of naltrexone and concentrate on the psychological and behavioral features of AUD. Regular patient monitoring by healthcare professionals helps them assess the success of treatment and make required changes depending on reaction and development.

Additional Treatment Options for Alcohol Misuse

Compared to long-term residential rehabilitation programs, the Sinclair Method is relatively cost-effective. Naltrexone is generally affordable, and the need for intensive therapy or prolonged stays in treatment centers is minimized. Family Systems ApproachFor many, Sober living house family tensions or codependent relationships fuel alcohol misuse. Involvement of spouses or parents in psychoeducation can reduce conflicts and better support the TSM approach at home. They can encourage naltrexone compliance, celebrate incremental progress, and deter triggers.

Other symptoms experienced on Naltrexone can include nausea, headaches, low energy, etc. and are usually mild and will decrease over time. Most people on TSM will notice a significant decrease within a few weeks. The most important thing is to always take the pill before drinking and to track your results. For most TSM patients, it took years to develop their addiction and may take many months to get it under control. Naltrexone blocks the effects of all opiate based pain medications (Vicodin, Percocet, hydrocodone, oxycodone, Fentanyl, Buprenorphine, etc) and heroin. Patients currently taking these drugs will need to discontinue them before safely starting on the Sinclair Method.

Alcohol use disorder

Freedom from alcohol in 90 days​ with clinical, community, and coexisting issue support. Use of this site constitutes acceptance of Sober Recovery’s “Terms of Use”, “Privacy Policy”, “Cookie Policy”, and “Health Disclaimer”. The material on this site is for informational purposes only, and is not a substitute for medical advice, diagnosis or treatment provided by a qualified health care provider. TSM works for both daily and occasional drinkers—as long as naltrexone is taken before drinking.

Change Your Relationship with Alcohol

If routine is helpful for you, you may prefer daily naltrexone dosing to TSM. Also, if a person is taking any opioid medication or substances, like Percocet, Oxycodone, or Vicodin, the use of naltrexone may cause dangerous or even life-threatening withdrawal symptoms. Because of the individual nature of treatment, it’s always recommended to speak to a trusted healthcare provider about your options. The naltrexone-based Sinclair Method works by reducing the reinforcement that people get when they drink alcohol. When we consume alcohol, our brain’s reward pathway is activated, releasing chemicals that create feelings of pleasure and euphoria.

Where can I find more information or support for TSM?

Those negative experiences can create the urge for more alcohol to escape the perceived punishment and regain the reward (11). Before starting naltrexone (or any medication), it’s essential to get medical clearance. A doctor or specialist should assess liver function, possible contraindications, and whether the method is a safe option for your circumstances. The Sinclair Method has scientific backing, uses a medication that’s generally safe and non-addictive, and helps many people reduce their alcohol use substantially without residential rehab or forced abstinence. You can continue to drink, but do so more consciously, and with a tool to gradually reduce the brain’s incentive to drink.

Breaking Down Alcoholism: Am I an Alcoholic?

It’s important to note that many patients who use naltrexone daily, instead of the Sinclair Method, also choose to take their naltrexone pill before their usual drinking time. Regardless of whether you’re using the Sinclair Method or daily naltrexone dosing, it’s important to check in with a physician to discuss your progress and ensure your safety. Research suggests that the Sinclair Method can be very effective in helping people reduce their drinking. According to research, the use of naltrexone to treat alcohol use disorder can have a 78% efficacy rate. Several studies have found that acamprosate effectively helps people reduce alcohol use, even after the medication is stopped.