The Sinclair Method (TSM) for Alcohol Use Disorder

This information is provided by C3 Foundation Europe, a charity that works alongside the USA non-profit, C Three Foundation, to raise awareness of The Sinclair Method – a clinically proven medical treatment for Alcohol Use Disorder (AUD).

This information is intended to provide an introduction to the Sinclair Method for those with alcohol misuse issues, and their loved ones.

There are many people for whom abstinence-based or moderation management methods have proved successful, but for those for whom they have not and/or those who are seeking an alternative, medically-based method grounded in scientific research, and which requires no belief in a higher power or attendance at group sessions or meetings, the Sinclair Method may be of interest.


Dr David J. Sinclair, an American doctor who dedicated more than 20 years of his life to studying AUD, discovered that using an opioid-blocking medication prior to consuming alcohol interrupted the brain’s reward mechanism, thereby causing pharmacological extinction of the craving and need for alcohol.  The national health service in Finland, where Dr Sinclair conducted much of his research (with partial funding from the Finnish National Public Health Institute) has offered the Sinclair Method for the treatment of people with AUD.

The prescription-only medications required for the Sinclair Method are the NICE-approved medication, nalmefene (brand name Selincro), or the FDA-approved generic medication, naltrexone.

Clinical Trials

Over 120 clinical trials of these medications have been conducted, the results of which are available from The Sinclair Method – Clinical Trial Evidence.  The results show that not only are these medications effective for 78% of those who use them in compliance with The Sinclair Method, but that both medications are safe and non-addictive.

The Method

Under the Sinclair Method, nalmefene or naltrexone is taken 2 hours or 1 hour, respectively, prior to consuming alcohol, on every day that alcohol is consumed.  If no alcohol will be consumed on a given day, no tablets are required, thus leaving the person free to enjoy the usual endorphin rewards gained from normal life events and activities.

When the endorphins released by alcohol consumption are blocked by the medication, and hence unable to attach to the receptors in the brain, a ‘short circuit’ in the brain’s usual reward mechanism associated with alcohol consumption occurs.

When employed repeatedly, this process gradually resets the brain back to its pre-addicted state.  The length of time taken to achieve this re-setting process may vary and may take several months for some people.  The absence of reinforcement by the endorphins generated by the presence of alcohol in the brain causes a reduction in cravings.  This process occurs over time – typically over 3 to 4 months, but in some cases, over as long as 9 or 10 months – and compulsive drinking no longer holds the same importance as it once did.  The Sinclair Method has been shown to be effective in achieving either total abstinence or controlled, safe, occasional drinking within World Health Organisation safety limits – eg, in social settings – offering an alternative to total, life-long abstinence, if that is what is desired.

Opioid antagonist medications, such as nalmefene or naltrexone, are not, in themselves, anti-craving drugs and they will have no anti-craving effects if used in conjunction with abstinence.  Using the tablets in conjunction with abstinence will, furthermore, prevent the process of pharmacological extinction from occurring and will consequently not achieve the desired aim of eliminating excessive drinking.

Therefore, users of either of the medications must, in the first instance, consume alcohol after taking a tablet in order for the extinction process to work as described.  As treatment progresses, a decline in alcohol consumption and an increase in alcohol-free days occur.  This indicates that the treatment is working.

In Europe

Although not generally referred to as The Sinclair Method, the method has now been approved for use with nalmefene (Selincro) in all of the European Union member states, and a Europe-wide roll-out of the medication began in February 2013.

Naltrexone is also approved by the health authorities of Europe, but is generally only prescribed to help manage cravings in those that have already achieved abstinence.


Naltrexone was approved for use in cases of AUD during the 1990s but generally only as an aid to cravings management in those who are already abstinent.  In view of the generic status of the medication, it is unlikely that any pharmaceutical company will be willing to spend the money required to change the prescribing instructions to reflect The Sinclair Method.

Content used with permission from C3 Foundation Europe and copyright for this leaflet is with C3 Foundation Europe.