The Sinclair Method Frequently Asked Questions

Is the naltrexone prescription addictive?

Naltrexone is a non-addictive medication that blocks the opiate receptors but does not activate any of the usual euphoria or high one receives from addictive drugs. TSM patients are highly urged to take the medication before drinking for the rest of their life, however if they choose to stop drinking and stop the naltrexone, they will not have withdrawals and the only risk would be a potential relapse if they start to drink again without taking the naltrexone first.

Is there any interaction with other drugs or medications?

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. Patients on Naltrexone therapy need to make their physician, surgeon, or dentist aware that they are on naltrexone therapy, so they can provide alternative non-opiate pain relief for procedures or injuries.

What happens if I take naltrexone if I’m currently taking opiate pain drugs or heroin?

Naltrexone will cause a precipitated withdrawal in patients taking opiate drugs or heroin. Symptoms of opiate withdrawal such as nausea, vomiting, bone and joint pain, chills, fever, etc will be similar but more severe than normally experienced in withdrawal without naltrexone.

How long do I have to be off opiates or heroin to use naltrexone?

Each patient starting on TSM will be given a urine drug screen prior to receiving their prescription as this is the only way to be certain the drugs are out of their system. On average, this occurs 7-10 days after stopping opiate pain relievers and heroin, 10-14 days after stopping buprenorphine, and 14 days after stopping methadone.

How long does it take to reduce alcohol consumption after starting TSM?

Every patient responds differently. Most people on TSM will notice a significant decrease within a few weeks. Others take longer (up to 6 months or more). 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.

How is this different from Vivitrol?

Vivitrol is an injectable form of naltrexone that reduces cravings for alcohol for up to 28 days. Our experience is that this method does not accomplish the same level of extinction that we observed in taking the oral naltrexone 1 hour before drinking.

If the Sinclair Method is so effective, why haven’t I heard of it before?

A similar but slightly different question would be “If abstinence and 12 step programs have such a poor success rate, why are they still the standard of care in alcohol recovery?” These questions are interesting conversation starters but shouldn’t be a reason to avoid TSM treatment.

Will naltrexone prevent me from getting drunk?

No. Naltrexone blocks the opiate receptors but someone on naltrexone can still get drunk. This is also true for Vivitrol and Naltrexone pellet implant therapy.

Are there side effects caused by Naltrexone?

Naltrexone is safe for the liver (the FDA removed the black box warning). Original studies suggested one would have to take 6 times the normal dose (300 mg) to cause problems with the liver. Even those that experienced liver problems at this level fully recovered when stopping the high dosing levels. Compared to the long-term damage alcohol has on the liver, Naltrexone medication using TSM is extremely safe. Other symptoms experienced on Naltrexone can include nausea, headaches, low energy, etc. and are usually mild and will decrease over time.

If I am being treated using TSM, does that mean I don’t need counseling?

We highly recommend that all TSM patients work with an addiction counselor as they work towards sobriety. People pursuing TSM with counseling will tend to receive more benefit from their counseling sessions as their therapy will gradually be directed to the underlying reasons why they drink rather than dealing with the physical addiction to alcohol. Our office can refer you to therapists that are familiar with TSM. We have also had some patients whose addiction was primarily biochemical that were able to reduce their drinking without extensive counseling or therapy.

Are there peer-reviewed scientific studies supporting The Sinclair Method?

Kranzler, H. R., Tennen, H., Armeli, S., Chan, G., Covault, J., Arias, A., & Oncken, C. (2009). Targeted naltrexone for problem drinkers. Journal of Clinical Psychopharmacology, 29(4), 350–357.

Heinälä, P., H. Alho, K. Kiianmaa, J. Lönnqvist, K. Kuoppasalmi, and J. D. Sinclair. Targeted use of naltrexone without prior detoxification in the treatment of alcohol dependence: A factorial double-blind placebo-controlled trial. Journal of Clinical Psychopharmacology:

Grant BF, Saha TD, Ruan WJ, et al. Epidemiology of DSM-5 Drug Use Disorder Results From the National Epidemiologic Survey on Alcohol and Related Conditions–III. JAMA Psychiatry. 2016;73(1):39–47.

Jonas DE, Amick HR, Feltner C, et al. Pharmacotherapy for Adults With Alcohol Use Disorders in Outpatient Settings: A Systematic Review and Meta-analysis.JAMA. 2014;311(18):1889-1900.

Pettinati HM, Anton RF, Willenbring ML. The COMBINE Study—: An Overview of the Largest Pharmacotherapy Study to Date for Treating Alcohol Dependence. Psychiatry (Edgmont). 2006;3(10):36-39.

Foa EB, Yusko DA, McLean CP, et al. Concurrent Naltrexone and Prolonged Exposure Therapy for Patients With Comorbid Alcohol Dependence and PTSDA Randomized Clinical Trial. JAMA. 2013;310(5):488–495.

Darren R. Quelch et al. Nalmefene Reduces Reward Anticipation in Alcohol Dependence: An Experimental Functional Magnetic Resonance Imaging Study, Biological Psychiatry (2017).

Can I go to 12-step meetings while I’m utilizing TSM?

There is nothing that would prevent a person utilizing a 12-step recovery program from being treated with TSM, however since 12-step requires and expects abstinence, many of our patients prefer Smart Recovery or Rational Recovery programs.

If I have elevated liver enzymes from chronic alcohol consumption, can I still be treated using TSM? In most cases, treatment is not only possible, but it is also highly recommended.

Will treatment affect my liver enzyme levels?

Patients with elevated liver enzymes (AST, ALT, GGT, etc) on a blood test will often see these numbers decrease or return to normal after decreasing their alcohol intake. Dr. Nelson is an expert in Naturopathic Medicine and can provide additional liver support if needed to help in this area.

If I have been diagnosed with cirrhosis of the liver, can I still be treated using TSM?

We will evaluate each case to make sure the patient can pursue this treatment. Anyone with cirrhosis should stop drinking because alcohol will only worsen the problem. The liver is the only organ in the body that has been shown to regenerate itself and often will respond to a comprehensive Naturopathic liver support program.

I’ve been an alcoholic for many years. Will TSM work for me?

Our office has seen TSM help people that have had problems with alcohol for decades and also with people that recently realized they are alcoholics. In fact, we have also worked with people that are worried about their increased alcohol consumption and want to prevent their consumption from getting worse.

I was prescribed Naltrexone previously and it didn’t work, or my doctor said he’s tried oral Naltrexone with patients without success. How is TSM different?

Naltrexone was previously prescribed by physicians and told patients to take it every day and to totally abstain from alcohol. This method is not effective as it does not allow the extinction process to take place. Extinction only works if the alcoholic takes the pill and continues to drink. This process will cause extinction.