Posted on November 22, 2010 by Laura Fuller
Contrary to what some might say, we at Origins Recovery Centers are actually not very rigid in our thinking. We do teach 12-step principles quite intensely and we believe that they have saved many, many lives. We don’t veer off the course of the original thought and intent behind the 12-step program (hence the name, “Origins”) as we do not believe it benefits the health and well-being of our clients for us to do so.
However, with that said, if in fact if there were a method discovered that were clinically, empirically and anecdotally proven to be superior to 12-step recovery we would change our name and adopt a completely new philosophy. Our business is not branding or ideology; our business is getting people well. In other words, we don’t adhere to the 12 steps simply to the end of loyalty; we adhere to them because we believe they work and much more so than any other method that currently exists.
It may not surprise you that we do not condone the Sinclair method of treating alcoholism. However, it is not just because it does not incorporate a 12-step approach or because it is also not an abstinence-model of recovery. In fact, it’s quite the opposite; it requires you to drink in order to be effective and the proponents of this method would have you believe that over time your use of alcohol will diminish until your level of drinking has reached normal to below normal amounts. No, we oppose this because it just does not work and we’ll tell you why.
However, we will admit that on the outset we were also quite intrigued at the prospect this method presented. You see, while we love the lives we are afforded by the spiritual program of action within 12-step recovery, it would be wonderful to have that and also be physically transformed to a point where we are no longer bodily dissimilar to our non-alcoholic brethren to where we could once again drink like normal people. That would be excellent in fact.
We are not so entrenched within our beliefs that we are not willing to consider those of others. Moreover, we are very open about the fact that we have “no monopoly on recovery” as is mentioned in the Big Book of Alcoholics Anonymous. As such, we have examined the information available on the Sinclair Method, casting aside contempt prior to investigation insofar as possible, and we have comprehensively examined the efficacy of this approach and determined, well, it is just entirely too problematic and it is predicated upon a faulty view of what alcoholism is. However, in the process, we recognized that dissection of the method and why it does not work is in fact a great tool for teaching what precisely alcoholism is.
The “Sinclair Method” of treating alcoholism seems to be gaining some degree of popularity concomitant with the rise in the number of people who get online for health information. It is, in fact, not a new concept and most of the research related to it was conducted in the 1980’s. It is named for the researcher who first developed it and helped it gain prominence in primarily Europe. The premise of it is in fact very simple, which probably is part of the appeal, and we will do what we can to present a layperson explanation of it.
Essentially, the direct action of the method involves taking a medication – Naltroxene, to be specific – prior to drinking alcohol, every time you drink alcohol. Naltroxene is an opiod antagonist and is most prominently used to block the action of synthetic opiods like heroin, opium, oxycodone, etc. within the body so that if a person ingests both substances the opiod is rendered useless as far as analgesia and euphoria. Naltroxene also works on endogenous morphine or “endorphins” which are released when someone drinks and are, in part, responsible for the feeling of euphoria associated with alcohol ingestion. Basically and theoretically, a person who drinks while on the medication will not experience the same chemically-fulfilling experience a person who drinks without it will.
From there, the method appeals to a permutation of Pavlovian conditioning referred to as “extinction” or, more specifically, “pharmacological extinction.” Over time, just as the alcoholic has become conditioned to crave alcohol both when they are not drinking and when they are, as both drinking at all and drinking more leads to increasing euphoria, absent this euphoria the reverse supposedly takes place, in that over time the alcoholic observing the Sinclair Method becomes conditioned to no longer obsess and crave alcohol since their neurochemistry now is set to believe that the ingestion of alcohol leads to no great euphoric benefit. So, the theory is that as long as one takes Naltroxene, over time the alcoholic’s addiction will wane and eventually dissipate to the point where they no longer drink on a dangerous level or even at all.
Critical analysis based on Sinclair Method proponent’s assumption of the nature of alcoholism
This method is clearly based upon the assumption that alcoholism is purely an affliction of the physical sort and therefore it can be fixed by changing addictive brain chemistry. We will expound upon why this is incorrect later on, however for now we will just assume that this basis is in fact valid so that we can point out some of the more obvious issues with this treatment that exist even if it rests upon sound assumptions (which, again, it does not).
So, supposing that this works in reality as in theory, what makes this approach impractical? For starters, why would anyone think that an alcoholic – who is addicted to the feeling they are afforded by alcohol – would be able to continually take a medication that prevents this feeling? In other words, why would anyone presuppose that an alcoholic would or even can comply with the proper medication regimen required of the Sinclair Method? Ask any addiction medicine specialist who has routinely prescribed “antabuse” – a medication that has a substantially negative interaction with alcohol and therefore, when taken, prevents a person from ingesting alcohol – what the biggest problem with “antabuse” is. They will tell you that people simply just fail to comply with the dosing schedule of the medication. As in, “I get sick when I take my antabuse and drink. Therefore, I just won’t take it then.”
Really, this could not be anymore intuitively obvious to us. You take a person who is hopelessly addicted to the feeling produced when they drink alcohol and you ask them to take a medication that will block that feeling and you think the addict will just go along with it? If they can do that, why don’t they just stop drinking? Then they wouldn’t have to deal with the cost of alcohol, the toll it takes on their body, hangovers, etc. They don’t stop drinking for the same reason they wouldn’t be able to comply with a medication regimen that inhibits alcohol’s full effect: they are addicts and they are necessarily addicted to the feeling produced by alcohol, and by definition, they are unable to neglect themselves of this feeling.
But let us continue down this path and just suppose that, miraculously, a person who has lost all power, choice and control over drink can force themselves to regularly take a medication that diminishes ones enjoyment of the drinking experience. Can we furthermore reasonably expect such a person to ALWAYS take the medication as directed? Surely not, and this is even more problematic because of a well documented phenomena that occurs within the brain when there is a large presence of opiod antagonists present called “up-regulation.”
“Up-regulation” is the brain’s natural response to being flooded with opiod antagonists like Natroxene. Basically, the brain in an attempt to maintain normalcy senses that in the presence of the opiod antagonists it has a diminished capacity to feel pleasure, and as such, in an attempt to compensate for this it actually increases the number of available opiod receptors. In the presence of Natroxene this is not a problem. However, if the alcoholic attempting the Sinclair Method misses even one dose of the medication and then drinks, they will be doing so with a brain now hyper-sensitive to the pleasurable effects of alcohol. There will be greater incentive to not only keep drinking, but to forego the Sinclair process permanently because not only will the brain be reminded of the pleasurable effects of alcohol sans Naltroxene, but it will in fact experience a more intense “high”, if you will, than it even knew before.
Evidence of this has in fact been observed in those employing the Sinclair Method; that generally a missed dose leads to a very intense binge drinking session or sessions as a result. In fact, the greatest proponents of the Sinclair Method even caution against ever missing a dose. Is this really realistic? To ask an alcoholic to not only diminish their alcohol high, but also to do it every single time they drink without fail, ever?
We think the answer is obvious, but again, let us just go along with this thinking and see where else it might lead us. Suppose an alcoholic can adhere to taking Naltroxene, without fail, for the rest of their life. What possible other consequences could this have?
The alcoholic substituting a new addiction for the old is also not a new concept. Such is especially true when employing a method like that of Sinclair which really doesn’t get to the heart of the problem (but more about that later). An alcoholic who has been able to chemically curtail alcohol’s effects in their body puts themselves at a very high risk of changing their particular drug of choice to something that will still work. For instance, while opiods would not be an option because of the Naltroxene, high levels of barbiturates (like Phenobarbital) and benzodiazepines (like Xanax) are known to often scratch the same itch that alcohol does. There are some inherent hazards with this course of action. For instance, barbiturates are known to be some of the easiest substances to overdose on (relative to alcohol) and both severe barbiturate and benzodiazepine dependence entail, anecdotally, even worse withdrawal symptoms than that of alcohol. So, furthermore, the Sinclair route seems a poor decision since it seems to logically create a separate incentive for the alcoholic to self-medicate through other means.
And finally, we have yet to touch on the following point yet, since it really is such an obvious argument against the Sinclair method that it almost goes without saying, but it still needs to be mentioned. A very large percentage of alcoholics are unable to admit that they have a problem at all until it’s absolutely and undeniably glaring; sometimes this comes as a 3rd DWI, sometimes this comes as the loss of a job and sometimes it comes as late stage organ failure secondary to alcoholism. Do we really want people who fall into this last category experimenting with their neurochemistry over the course of several months to try to induce pharmacological extinction through the concomitant use of Naltroxene and alcohol while their bodies is further poisoned to death? They very well may not have that long.
The point we are really trying to drive home in this section is that the Sinclair Method, even when you assume a lot of its proponent’s faulty logic to be correct, it is still quite, quite problematic. Even if alcoholism is just a mere physical affliction of unfortunate brain chemistry, it still seems highly unrealistic that you would be able to not only get an alcoholic to take a medication to inhibit the euphoric effects of booze, but also to take it without fail at the risk of an “up-regulation” bender, and also to take it without choosing to find an alternate substitution or without seriously jeopardizing their physical health in the process.
What alcoholism really is…
The fact of the matter, however, is that alcoholism is not just a physical affliction. There is that component of course. The body of the alcoholic does experience the phenomenon of “craving” once the substance has been put into it, which causes the alcoholic to no longer have control of the amount of alcohol they intake. But that is just one of three pieces present. As we have demonstrated above, it’s unlikely that the Sinclair Method in fact even addresses the physical aspect, though it claims to, but in the event it does, there are still two components to alcoholism that remain.
Alcoholism is often referred to as a “bio-psycho-social” affliction which attempts to indicate that it is a disease of the body, mind and spirit. The alcoholic has a mind that obsesses over alcohol constantly whenever the alcoholic is still in active addiction but is not physically drinking, a body that craves it once the substance has been introduced to the body and a spiritual malady that promotes substantial “inward unmanageability,” the symptoms of which are restlessness, irritability and discontentedness, which will always work toward getting the alcoholic to anesthetize these feelings with alcohol.
It’s this third component of alcoholism – the spiritual malady – that really defines why the Sinclair Method ultimately fails. While we don’t believe the following to be actually true, for the sake of discussion, we will concede that if the Sinclair Method did in fact remedy the physical aspect of alcoholism, then it could logically also eliminate the mental obsession. Again, this is the unproven theory behind the method, but if craving could be lessened and the mind taught to believe alcohol did not posses euphoric traits, then conceivably over time the mental obsession around alcohol would also lessen.
Unfortunately, that still leaves the most prominent and troublesome component of alcoholism – the spiritual component – and no amount of Naltroxene is going to remedy substantial and personally handicapping long-term inward unmanageability so severe it can really only be aptly described as a malady that is spiritual in nature. The only thing that has ever been observed to relieve such an ailment, and this was stated in no uncertain terms by the preeminent Carl Jung, is a truly transformative spiritual experience which is precisely what a properly executed 12-step program will recreate and precisely what a lot of Naltroxene and booze will completely neglect.
But it works for some people…
Yes, there are stories of “success” popping up on the internet of Sinclair Method individuals being “cured” of alcoholism. There is little clinical evidence of this, but rather a fair number of blog postings and videos on YouTube. We’d like to first suggest that most likely those individuals whom were supposedly “cured” by Sinclair Method intervention were possibly not true alcoholics in the first place; perhaps just really heavy drinkers.
And of those who have had supposed success who are in fact true alcoholics, we would contend that they aren’t “recovered” in the sense a person in long-term sobriety living the 12-step way of life are, but rather these Sinclair “success” stories are really the equivalent of what we call “dry drunks” or they are “white knuckling” it as we put it.
You see, alcoholics who can forcefully separate themselves from alcohol absent a spiritual solution, while rare, aren’t in fact unheard of. These poor souls take the brute-force method of recovery (which is not recovery at all but really deprivation) and the term “white knuckling” refers to the lack of blood in their knuckles as they clench a chair and greet their teeth fighting off the urge to drink.
Anyone who has been in the recovery community long enough has observed individuals like this; those alcoholics who don’t find solution through the spiritual experience afforded by the 12-steps and in fact just physically separate themselves from alcohol and live painfully through the spiritual malady or “bedevilments” that still remains in full-force constantly compelling the “dry drunk” to want to self-medicate. This is what the Sinclair Method alcoholics have done, in effect. While they haven’t separated themselves from alcohol like the dry drunk has, they have separated themselves form the euphoric effects of alcohol that act to temporarily alleviate the spiritual malady, which to us is in effect the same thing.
If there’s any question as to the veracity of our point here, please just look to the Sinclair Method drunks themselves. They seem to really like to post on the internet and most of the time they’re not delivering experience, strength and hope of an inspirational nature like that of many 12-step enthusiasts in long-term sobriety. No, most of them are besmirching 12-step fellowships as evil and weak-minded, in addition to a bunch of other poison they are spreading. We have even seen a few by one gentleman who self-designates as a doctor of some sort and his video which is supposed to be in support of the Sinclair Method is actually just him chain-smoking, drinking beer and slurring an ugly cacophony of nonsensical hate of various types. But really, can you blame him? He’s slurping down booze that no longer works.
Yes, it is a novel concept and theoretically quite attractive, but upon further review we find that this level of attraction is quite speciously so. The Sinclair Method represents just another easier, softer way, as referenced in the Big Book, that the alcoholic uses to try and control his drinking rather than looking to a spiritual solution to cease drinking altogether.
We would encourage anyone who has either experimented with the Sinclair Method or thinking about it to contact us as 888-U-GET-WELL or by clicking the contact button below.