C Three Founder Claudia Christian answers the most popular frequently asked questions.
FAQ - The Sinclair Method (TSM)
Q: How long does it take to see significant changes in alcohol intake?
A: Everyone is different. I have seen people on TSM for a little as 2 weeks go sober and I have seen people who were on it for 9 months have to up their dose of naltrexone to 75mg and then still take another 6 months to get their drinking 100% under control. It all depends on the person and if they drink for emotional reasons, habit and/or a myriad of other reasons.
Some people need to have therapy to deal with WHY they drink, others need to break the habit of “oh, it’s 6pm I need a drink!” other people find that the medicine on it’s own is sufficient to make them stop drinking. Please be patient; you did not become an alcoholic overnight so don’t expect to fix it in a day. It took me only a few times of taking naltrexone using TSM protocols to see a HUGE difference. I no longer thought about booze and my cravings were zilch, but other people take a little longer.
Hang in there, it’s worth it!
Q: Why haven't I heard of the Sinclair Method before?
A: The addiction industry is just that—an industry (and a huge business at that). Rehabs make billions of dollars based on a revolving door policy. Most people go back a number of times and they make, on average, 1,000 dollars per day per patient. Read Claudia's complete answer here...
Q: Where can I read scientific studies on TSM?
A: We have compiled links and citations to studies, articles and clinical trials right here on the C Three Foundation website. In an effort to provide you with the most accurate, up-to-date and relevant information, We have provided resources and divided our information into sections: One for those who struggle with alcohol dependency, one for the family and friends of those who struggle, and one for medical professionals.
Q: Will TSM prevent me from getting drunk?
A: No. Naltrexone does NOT block the effects of alcohol; you can still and will get drunk if you drink too much. Please do not drink and drive or do any behavior that is dangerous while drinking on naltrexone. That includes the long-acting shot Vivitrol - it does not block the effects of alcohol and one can most definitely get inebriated, so be careful!
Q: Are there any side effects to the medications used in TSM?
A: Some people experience nausea, sleepiness or sleeplessness. I felt a little blurred around the edges when I first took it but my system was VERY clean and it was not a feeling of being incapacitated in any way, just a little fuzzy headed.
Naltrexone is safe for the liver (the FDA removed the black box warning). Scientific studies suggest one would have to take doses over 300mg a day to do damage. Nalmefene (in the UK and other nations throughout Europe) is not passed through the liver so it is believed to be safe even for those with liver damage. The drugs are declassified, low level prescription drugs; some doctors believe that they should be available over the counter, that’s how safe they are. I have never heard of an overdose or a death from either of these drugs in fact they are quite similar to drugs used to bring addicts OUT of overdose from opiates such as heroin.
Here are some tips for overcoming side effects.
Q: Why did my doctor tell me to take my medication once a day and not to drink?
A: Most doctors are uncomfortable telling a patient to drink so they rely on the old misinformed way of prescribing naltrexone, which is to take it everyday and remain abstinent. Clinical studies have proven that naltrexone is not only ineffective when taken this way but also might increase cravings!
Q: Will the medication block all of my endorphins?
An opiate blocker blocks endorphins so if you take naltrexone every morning (or if you are prescribed the monthly time-release injection or implant) and then work out, make love, cuddle a baby, eat chocolate or spicy foods, or any other activity that you would otherwise find enjoyable, all of the good endorphins from these positive behaviors will be blocked, you don’t want that!
With TSM, you only take the medication before drinking, so on days when you are alcohol free, your body will experience what's called an "up-regulation" of endorphins.
We recommend doing positive reinforcement on your days OFF of naltrexone, like working out, etc. that way you are strengthening good behaviors while on your drinking days the naltrexone is deadening the bad behavior of drinking too much. We are actively trying to teach therapists and doctors to prescribe naltrexone and nalmefene correctly but this will take time.
Q: Why do I have to wait an hour before drinking?
A: Targeted extinction is just that: targeted. You want to target the alcohol in your system and it will be in your blood and brain one hour after taking the pill hence the “wait one hour then have a drink” rule.
Many people ask if it matters if they wait 2 hours or more after taking the pill and then drink. Technically, naltrexone will be in your body for about 10 hours so you are “protected” for 10 hours after taking the pill. However, if you engage in endorphin producing activities such as working out or sex PRIOR to drinking with Naltrexone in your system then you are blocking those “good” endorphins.
We want you to block the endorphins from the alcohol, not other activities. This is why it is important to follow the rules. If you wait 90 minutes or a couple of hours you’ll be fine but please try to stick to the one hour rule as best you can.
Q: How do I find a doctor to treat me using TSM?
A: The C Three Foundation maintains three lists to help you find a doctor near you:
Q: I've been on TSM for 2 weeks and I still want to drink. Why aren't I cured?
A: The Sinclair Method is not an overnight solution, nor is naltrexone a "magic pill." TSM only helps to treat the biological components of addiction and cravings. Chances are, you've been drinking for years or even decades. Real change takes time. If addiction recovery were made parallel to maintaining healthy weight, sudden abstinence would be likened to a "crash" diet and TSM would be gradual and sustained weight loss.
We have developed a drink diary that can help you chart your progress during your first year on TSM. It is free to download here on our website.
Q: If I'm on TSM, does that mean I don't need counseling?
A: There are several reasons why you may want or need professional counseling while on the Sinclair Method. For instance:
Q: TSM was working so well for me I started drinking without it. Now, I'm drinking more than usual. What happened?
A: It’s called human fallibility. Some people miss the “old buzz” they got from drinking, especially those who received a huge “reward” when drinking alcohol, i.e.; a feeling of an endorphin rush or a “high” that reached their toes and scalp. These people are “chasing the buzz.” Another reason people do this is because...Read Claudia's complete answer.
Q: Isn't using medication to treat alcohol addiction trading one addiction for another?
A: No. There are two primary reasons why this is incorrect:
Q: Is a person on TSM who experiences extinction at risk of developing a rebound addiction?
A: No, Dr. Sinclair saw no sign of that in the alcoholics treated with naltrexone at ContrAl Clinics nor in the 3 year follow up on those patients.
It also does not make make sense according to our understanding of addiction. The consensus is...Read the rest of Dr. Sinclair's answer.
Q: How can I talk to my doctor about TSM?
Q: If I took my medication in the morning, but didn't feel like drinking until late at night, is that okay?
As with any medication, naltrexone has what's called a half-life. It's based on the amount of time it takes for the average person to metabolize the medication and have it effectively removed from the system. (Even over-the-counter pain or anti-inflammatory medication is only effective for a certain amount of time.)
If you continue to drink 10 hours after taking the pill you would need to take another dose because the first one you took is done working. So if you take naltrexone at noon and drink until 10 PM and intend to keep drinking then you must take another 50mg at 10pm and wait an hour for it to properly disburse into your system.
Q: Can I buy naltrexone online without a prescription?
A: In most countries, naltrexone and nalmefene are regulated as prescription medications and, depending upon where you live, they can be ordered online. Please check the restrictions and regulations in your country, state, or locality to comply with laws. If your country makes naltrexone available as an over-the-counter medication, you will be able to obtain it without a prescription.
We have heard of online pharmacies that have medical professionals on staff to evaluate patients for alcohol use disorder. In such cases, the staff physician reserves the right to provide or deny a prescription for any contraindications.
Q: Do I need a doctor for tsm to work?
A: We are not medical professionals and, since excess alcohol use can damage your health, we strongly recommend you seek the advice of a doctor. Further, the medications used with TSM are only available by prescription in most countries.
You can do TSM in the privacy of your own home. It does not require expensive inpatient treatment. Whether or not you choose to use TSM with a doctor's supervision, I strongly suggest reading The Cure for Alcoholism by Dr. Roy Eskapa and watching the documentary One Little Pill.
Once you have obtained your prescription, TSM is about complying: Take medication one hour prior to first drink of the day every time you drink. (If you are taking nalmefene you must wait two hours prior to the first drink of the day as per the instructions on the label.)
Q: Does TSM require meetings? What if I want to talk to others on TSM?
A: TSM does not have any meeting requirements, although we have a digital peer support forum that is available to you 24 hours a day no matter where you live. Our Options Save Lives forum has hundreds of members. Members are free to create accounts using real names or pseudonyms, so you can be as anonymous as you like or as revealing as you feel comfortable.
Join the Options Save Lives peer support forum.
Q: Does naltrexone interact with my other medications?
A: We are not doctors, so we strongly suggest you either talk to the doctor who prescribed it for you, or your pharmacist. Most pharmacies will advise you about interactions over the phone--even if you do not have a prescription at that location.
If, for some reason, you are unable to contact your doctor or pharmacist, there is an online tool available for reference purposes only.