Explanation of the Sinclair Method TSM

I am very keen to highlight the effectiveness of the “Sinclair Method (TSM)”, for helping people beat alcoholism, as I feel it could really improve the quality of life for so many people, who struggle to break free of addiction. If you have read other parts of the site, you may have realised that I stopped drinking, by going abstinent, some years ago. This was difficult, and I saw many people have problems with the traditional methods of recovery, such as the AA, “12 step” solution which is still used by many rehabs as a core part of their “treatment”. I certainly think there is a role for support groups in recovery, especially for those, who use alcohol to mask problems in life, but feel that the “12 step” method is out of date, and does not motivate everyone to recover. It is important to choose a solution that will help you, not simply one that you have heard worked for somebody else. As I cannot really test this solution for myself, I am very happy that other people who have benefited from it, have been in touch and have written about their positive experiences for me. Earlier in the week I had an email from Claudia Christian who wrote about how she was helped that I put on the site, (she also set up http://www.cthreefoundation.org), and I now have this great piece from Joanna who runs http://cthreeeurope.com/ who has written about her experiences in beating alcohol using the Sinclair method, as well as reflecting on some of the poor information that has been broadcast about this solution.


Joanna from http://cthreeeurope.com/ explains The Sinclair Method (TSM):

The Sinclair Method (TSM) is the process of taking an opioid-blocking medication, one hour prior to the first drink of the day, in order to break the learned behaviour of Alcohol Use Disorder (AUD). It is named after Dr David John Sinclair, an American doctor who moved to Finland and dedicated his career to studying alcoholism. The technical term for this process is Pharmacological Extinction. Repeated drinking on the medication blocks the endorphins that are released during drinking, preventing them from reaching the opioid receptors in the brain, and thereby breaking the cycle of drinking reinforcement and, eventually, making the cravings and compulsion to drink disappear.

I stumbled across TSM more or less by chance, but I embraced the science behind the method after I read about it and understood why it works. Before I had could even get started, however, I hit a brick wall in terms of getting hold of the opioid-blocking medication required. Eventually, I found a clinic in Scotland (I live in England) that would prescribe for me on a private basis, but as a result it was expensive.

My journey to recovery began and can be read about in more detail here http://cthreeeurope.com/joannas-tsm-journey/

TSM is not a new concept but has yet to be accepted by either the rehab industry, or some alcohol specialists or family doctors. In a world obsessed with the idea that abstinence is the only way, they are either unaware of the method OR it appears ‘controversial’ to them, because it is counter intuitive to tell someone with a drink problem to continue drinking, even though the end result for almost 80% of people is a very positive one. It is estimated that only around 8% of people will not respond to TSM as a medical treatment. Another 12% will either not comply with the rule of one tablet, one hour prior to drinking and no tablets on any non-drinking days, or will stop taking the medication at all for other reasons. So, if you happen to be a number-cruncher, the conclusion you can draw from of the 120+ clinical tests is that as long as you comply with the instructions and do not cease to take the pill for any reason, you actually have an incredible 92% chance of TSM working for you!

Two medications can be used with TSM, the first being the generic, off patent medication called naltrexone that was actually approved by the American FDA, way back in 1994. The second is nalmefene, which has been around since 1975, but for which the pharmaceutical company, Lundbeck, has recently acquired exclusive manufacturing and retail rights for the next 10 years and which is branded as Selincro.

Now I realise you are probably reading this and thinking to yourself, “So if it is THAT good, why doesn’t everyone know about it?”

Well, there are a number of reasons why, over and above the fact that the TSM approach is counter intuitive for those raised on abstinence. I have listed some of the reasons below, including my response to a recent BBC Inside Health radio interview in which the participating doctors’ comments quite clearly illustrate their ignorance of how TSM actually works.

1. Naltrexone is a generic medication, so any company can make it. No one company has exclusivity so there are no big profits to be made by the pharmaceutical companies. No company is going to invest millions in promoting a medication that has no exclusivity.

2. When naltrexone was first approved, the instructions said to take it once per day in conjunction with abstinence. Clinical testing shows that this can actually make the cravings worse and that to get the best results, it must be taken prior to drinking and not taken on any non-drinking days. When doctors did prescribe it, they did so in line with the original written guidelines and so both they, and their patients, found it didn’t improve the situation. As a result, based on their own evidence and experience, they stopped prescribing and concluded that opioid-blocking medication does not work.

Again, no one company is going to invest the millions that it will take to lobby to get the prescribing instructions amended.

3. The rehab industry is a multi-million dollar, revolving door treatment model that many patients go through time after time after time, and one that regards TSM as a threat to the vast revenues it generates. After all, why would they be interested in prescribing a method that has every chance of working first time for a fraction of the cost? Would they rather charge the likes of Lindsay Lohan etc. thousands of dollars a go, time after time, or provide her with an already approved medication that has a 90% or better chance of achieving a lasting result, straight out of the box, and which costs next to nothing?

4. Selincro has recently been approved across Europe and the company who makes it has been granted the exclusive rights to manufacture and sell it for the next 10 years, so thankfully, we are seeing more effort being put into getting this product out there. This is a good thing. The downside, however, is that in their efforts to get the medication approved in the first place, the manufacturers didn’t, in my opinion, go far enough. Yes, the instructions say to take it on an “as and when” basis, 1-2 hours before drinking, but they also insist on counselling – which might well be beneficial to the patient, but isn’t ESSENTIAL to the medication doing what it does.

As a result, and in England especially, we are now seeing the people who are authorised to prescribe not being given all the information about TSM that they need to properly inform their patient. Below is the link to the recent BBC podcast I mentioned. The podcast is almost 30 minutes in length, but the nalmefene discussion is in the first 10 minutes.

It is incredible to me that despite all the money Lundbeck are pushing into making Selincro a profitable product, it took just the first couple of sentences for the doctors to reveal their misunderstanding of what this medication does and what extinction is. The presenter, also a GP and hence someone who is supposed to be fully equipped to give this medication to his patients if they need it, is heard saying that it can be taken on an as needed basis, maybe at weekends to reduce drinking! No. That is wrong! For TSM to work, the tablet has to be taken prior to every drinking session with NO exceptions.

Listen to it and see what you think in the light of what I have written here. I would be interested to hear what you think, but to my mind this sadly highlights exactly the type of issues we are facing in getting TSM out there as an acceptable and effective treatment option. http://www.bbc.co.uk/programmes/b04xp4x7

My response to this.

I also found that the BBC radio interview was flawed, and this does not surprise me as the whole recovery industry is clinging onto old ideas as if they were sacred and not doing enough to embrace modern solutions, that could add to the numbers of people overcoming alcohol addiction. I pointed out this recent broadcast on Sky News  http://news.sky.com/story/1346499/3-pill-stops-you-wanting-second-glass-of-wine that has lots of positive information about TSM, but finishes with an interview from a member of staff from the “Priory” which is a rehab that is known for treating celebrities such as Amy Winehouse, with its 12 step solution and which has many 12 step members among its staff. I can see that the journalist has tried to balance the piece by including this, but sadly it may put people off trying a solution that could help them.

Joanne added.

I hadn’t seen this Sky report.  Again, it just highlights part of the big, brick wall we face.  What these people don’t want to admit is that by using nalmefene or naltrexone as per TSM, the cravings and compulsion disappears over months.  I think the current stats say that around 40% of people will then go completely abstinent, whereas the remainder either drink at safe levels on a regular basis because they can as long as they take the tablets first to prevent re-learning the compulsive behaviour.  Or, like myself and Claudia, we are basically abstinent now except for maybe a glass of wine at a celebration meal.
For me, I drink perhaps 4 or 5 units a month at most and sometimes none at all in a month.  Of course, to the rehab industry they would call my treatment a ‘failure’ because I am not 100% abstinent.  You know, to say to a youngish person that they can never touch a drop of alcohol in their lives again is quite an unrealistic thing to expect in most cases.  And also, if they are not quite ready to give up, wouldn’t it be better to offer them TSM and see if their opinion changes over the course of say, a year?  That would be true prevention.  And my experience of seeing people through TSM this past year has been that people’s attitudes do change.
For example, I was absolutely desperate to stop.  I was a mess.  But over the months the changes happened and I could sense them happening.  I learned that the naltrexone gave me access to my ‘off’ switch that I never had before.  Over time, I learned that I was drinking one maybe two drinks and that really was enough – I didn’t want anymore.  So, I decided that I would rather take the tablet in the same way that someone with diabetes accepts medical treatment and drink on special occasions, and I know I will not fall back into my old pattern ever.
But I would ask the guy from the priory, is it better this or to have me go through their rehab and end up relapsing back into heavy drinking and then rehab and then relapse….  you understand the score here because you too have seen how biased the rehab industry is.  One day I might get back after 3 or 4 rounds of expensive treatments and for some reason it (maybe) works, or I might not get back at all and end up dying in an alcohol related accident or something.
Of course, if they could accept that 40% of people go abstinent and the remainder drink well within safe levels, that could be taken as an admission that their treatment is a failure – so it’s going to take a monumental shift to ever make them accept that.  I don’t know if that will happen in my lifetime (I’m 44).
We are not saying that TSM is for everyone, but we do feel it should be provided as a safe, non-addictive and successful option for those wanting it.  Sadly, most will not ever hear about TSM from their medical carers and that is what we are working to change.

Some extra links about the Sinclair Method.











Commenting area

  1. Heather Warren October 23, 2016 at 5:43 pm · · Reply

    Hi I have just ordered Selincro over the net, my drinking is going to kill me and I cannot get some of the doctors to prescribe me these tablets. I am 61 and alcohol has now just become my worst friend. With these tablets do I take one every-day and is there somewhere I can get a doctor to prescribe these for me.

    I am so glad I have read this and The little Pill by Claudia.

    Many thanks


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