Can you retrain your brain to stop excessive drinking?

Are you concerned that you're drinking too much but reluctant to give up alcohol entirely? A little-known strategy called the Sinclair Method may be worth trying. It relies on naltrexone, a drug that dampens alcohol's euphoric effects. Over time, this practice gradually dials down the powerful cravings some people experience that compel them to drink excessively.

Unhealthy alcohol use is a common, serious problem in the United States (see "Dangerous drinking patterns"). The possible short-term harms - which include injuries, motor vehicle accidents, and violence - pose a threat to those who drink to excess as well as the people around them. Over the long term, drinking more than moderate amounts of alcohol raises the risk of numerous health problems such as liver disease, high blood pressure, and several types of cancer.

What is the Sinclair Method?

The Sinclair Method relies on targeted use of naltrexone, a drug originally developed to treat opioid use disorder. "Naltrexone blocks or dampens the pleasurable response you get from using opioids or drinking alcohol," says Dr. John F. Kelly, professor of psychiatry in addiction medicine at Harvard Medical School. In 1994, naltrexone was approved for alcohol use disorder, taken daily or several times per week to prevent relapses.

The Sinclair Method, pioneered in the late 1980s by scientist John David Sinclair, requires taking naltrexone an hour or two before you drink alcohol - every time. The science behind the method is known as pharmacological extinction. In effect, the drug retrains your brain to stop linking alcohol with pleasure, which blocks the cycle in which one drink creates the desire for the next drink. Over time, this causes the unwanted behavior (excessive drinking) to become extinct, Dr. Kelly explains. The timeline varies from person to person; some people notice their alcohol cravings diminish within weeks, while others require many months. Some people continue to drink in moderation, and others stop completely.

Possible downsides

There aren't many clinical trials comparing the Sinclair Method with other treatments for problem drinking, such as cognitive behavioral therapies or self-help groups like Alcoholics Anonymous (AA) or SMART Recovery, notes Dr. Kelly, founder of the Recovery Research Institute at Massachusetts General Hospital. But for people who are motivated to cut back on their drinking, the Sinclair Method can be a useful way to curb hazardous alcohol use, he adds. You can ask your health care provider for a naltrexone prescription or use an online telehealth program that offers prescriptions and coaching.

Possible side effects of naltrexone include nausea, headache, dizziness, and trouble sleeping. The standard dose is 50 milligrams (mg), but you can start with 12 or 25 mg and increase it as needed, says Dr. Kelly. The side effects may diminish as your body adjusts to the drug. In rare cases, naltrexone can cause liver problems, but mostly in people who already have liver damage from excessive drinking. "If naltrexone helps people drink less, the net effect is often beneficial," says Dr. Kelly.

One criticism of the Sinclair Method is the absence of a dedicated peer support system similar to AA meetings. However, a free online peer support group, Moderation Management, can be a good option for people trying the Sinclair Method, says Dr. Kelly.

While many experts believe there may be no safe level of alcohol consumption and that complete abstinence may be a better option for problem drinking, cutting back still offers meaningful benefits. "If the Sinclair Method reduced heavy drinking by just 1%, at the population level that's potentially 1,000 lives saved each year from reductions in alcohol-related car crashes alone," says Dr. Kelly.

Image: © Prostock-Studio/Getty Images