u/RubicsCubensis

I've been involved with The Sinclair Method, and writing about it for 10 years, after using it to reach pharmacological extinction 10 years ago. I want to have a discussion about this.
In that time I have written numerous posts and articles about it on Facebook, and here recently. I have formulated my thoughts on it and what I have come to is this. Alcohol Use Disorder is primarily behavioral, it has a physiological component that causes dependence. As such TSM is primarily a behavioral modification system or protocol, which uses an opiate blocker to treat the physiological craving, and Alcohol Deprivation Effect.
This is in contrast to what the long held belief about AUD being a progressive, fatal, and incurable brain disease, as promoted by 80 years of abstinence only recovery programs. We also know it's not a matter of character defects, weakness of will, or powerlessness over alcohol, and once an alcoholic always an alcoholic is an old myth. Because time after time I have seen people over the last 10 years come to TSM, and use it to successfully return to a state of control.
What abstinence recovery has failed to understand is that the reason for relapse is not character, or will power, it is not a failure to avoid people places and things, which always makes me laugh because those are nouns, but most of the times in my life I get in trouble because of the verbs. AA, and other abstinence programs think is once you detoxify someone with AUD they are then free from alcohol, and the only thing that have to do in attend meetings, do steps, work with a sponsor, be of service, and carry the message. I other words AA works primarily by distracting the person with AUD long enough that they don't think about drinking long enough to get drunk. As I said they failed to understand the main reason for relapse isn't failure to do all those things, it is because of something they don't know about and that is Alcohol Deprivation Effect. Now I'm going to describe ADE as best as I know it, it is a process by which our opioid receptors are upregulated during a period of abstinence to become more sensitive to our endorphins. This leads to increased craving, and eventual relapse over time. This understanding is something I doubt the abstinence recovery world wants to admit, and come to grips with, because it throws their whole model of detoxification and abstinence with a program of steps and meetings into question.
So if we understand the basic mechanism by which TSM works, taking naltrexone or nalmefene 60-90 minutes before drinking, and repeating that over time leads to the reward signal being blocked, and the reinforcement to do the behavior being blocked over time the behavior returns to it's original state of not being addicted, TSM makes perfect sense.
What continues to be a difficult is getting the word out for TSM in a treatment setting, and that is obviously because all of the other methods that are abstinence only, is it's incompatible. We could also say a reason TSM is not more widely known is because not only is there no money in a treatment we can do in the privacy of our own homes, but that eventually we wouldn't need revolving door rehabs, because people will no longer be addicted. I throws the whole 12-step model out the window, and would make AA obsolete over night, unless they changed their whole program, which is something they would never do, because they haven't changed anything in the first 168 pages of the Big Book in 80 years.

So that's what I wanted to talk about, what does everyone think, does what I say make sense, can I maybe explain it better, what would you add?

It's a short article, but give it some love.

I'm a veteran,
For the last few years I have been volunteering online as a peer support advocate for The Sinclair Method, a medication assisted treatment for alcohol use disorder.
Recently I found out the VA is going to have a trial of using GLP-1 medicine for AUD, while this is great to see the VA interested in more advanced treatments for what remains the single most costly addiction in the USA, effecting 400,000 veterans.
I have a request, how can I get in contact with a decision maker at the VA to look into a pilot program to trial The Sinclair Method at the VA?
I used The Sinclair Method 10 years ago to achieve pharmacological extinction of AUD, it changed my life, and freed me from the debilitating cravings, mental obsession, and compulsion to drink, it saved my life. Over the past few years I have worked with hundreds of average people from all around the world online through Facebook groups where I have an audience of over 9,000 people from many countries. With people in daily Zoom meetings which I host six a week, and more recently I've worked with people on Reddit, to educate people about The Sinclair Method help them get started, or help them if they are stuck, on r/naltrexone and r/SinclairMethod.
The Sinclair Method is simple, effective, and cheap. It uses an inexpensive off patent drug in the VA formulary, naltrexone, it costs much less than Ozempic, and long term it will be more effective. Because in order to treat AUD with Ozempic it will have to be administered regularly for as long as the person lives. The way The Sinclair Method works is naltrexone is only taken one hour before drinking every time a person drinks, and they don't need to take it when they don't drink. So for instance using The Sinclair Method I stopped drinking 6 years ago, but I haven't filled a prescription for naltrexone with the VA in 10 years, because as I used The Sinclair Method I drank less, and less, so I took naltrexone less and less. Therefore I didn't need naltrexone any more, I still have 3 unopened bottles sitting in my bedroom from 10 years ago.
Let me explain how The Sinclair Method works, we call it TSM.
In people with Alcohol Used Disorder AUD, when we drink it triggers a release of endorphins, when the endorphins are released it triggers dopamine, this combination is seen by the nervous system as a reward for a behavior. This reward is felt as euphoria, a very stimulating and excited state of mind and body, it serves as a short cut for the brain to learning a behavior. Unlike what many people think about AUD it is primarily a behavioral issue, not a disease of the mind, it is a neurological learning problem, it's not a moral problem, or willpower failing either.

With TSM we use an opiate blocker, most commonly naltrexone, but in Europe they use nalmefene. As I said drinking releases endorphins, the reward for drinking that reinforces the behavior of drinking, this is why for the person with AUD they crave the second drink more than the first drink, and so on. When naltrexone is taken one hour before drinking it blocks the reward, and therefore the reinforcement of the behavior of drinking. Over time continued use of naltrexone one hour before drinking blocks the reward, and diminishes the behavior of craving the drink. Done over the space of a few months usually for most people the treatment covers six months, they drink less, and less, until one day they don't want to drink any more, we call this pharmacological extinction.
Now with TSM we offer our users two options, you can continue to drink as much or as little as you like whenever you like, just as long as you take naltrexone one hour before drinking every time you drink. Or the other option is the stop completely if they want.
Once pharmacological extinction is achieved it is essentially a total reversal of the addiction of AUD, as close to a cure as I know. Because I haven't craved alcohol in 10 years, I haven't obsessed over it, I haven't found myself compulsively going to the liquor store at all hours of the day like I used to. Like I said 6 years ago I quit, because of two reasons, first and foremost drinking after taking naltrexone and waiting an hour had become boring to me, it was a non entity to me, second for health reasons, I have Bipolar type two, and my medications just work better for me with out alcohol.
I want to get the VA to look at The Sinclair Method as seriously as they are going to look at Ozempic. I want to help my fellow 400,000 vets who are out there still suffering.
So please can anyone get me in contact with someone at the VA who can help me start a trial for this, I know it will help so many people, and probably save some lives for those who are chronic relapsers, and those facing liver disease because of alcohol.
Like I said, it changed my life, and I want to give back by helping to change other peoples lives.
Thank you,