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Dear Dr. Roach: What do you think of the Sinclair Method for dealing with an alcoholic? -- M.D.
Answer: Naltrexone is approved for the treatment of alcohol use disorder under the Food and Drug Adminstration. (The terms "alcoholic" and "alcoholism" aren't used in a medical sense anymore. They seem to be judgmental and downplay the fact that this condition can be successfully treated.)
The Sinclair Method uses naltrexone, a medication that is often used for the treatment of opioid use disorder, to reduce the enjoyment people get with consuming alcohol, which makes for less cravings and more control over drinking. A major advantage of this method, which is used by many programs, is that it does not require total abstinence.
This can be beneficial for some people who feel awkward in social situations where drinking is considered normal. The treatment only works as long as people are using naltrexone. In the Sinclair Method, naltrexone is not necessarily given every day, only when a person is going into a situation where they will be drinking. This can be especially helpful in a person who intends to have one drink but ends up drinking more than they want to, especially when they "binge" (4 or more drinks for a woman, 5 or more for a man).
Naltrexone can be given every day by mouth or as an injection every four weeks. Although most people have few side effects, some side effects and liver problems can occur, so monitoring blood tests periodically is recommended when people are using naltrexone daily.
Naltrexone cannot be given to people who are being treated with opiates for pain as it will make the opiates ineffective. Naltrexone is also given to people with opioid use disorder for the very same reason it is used for alcohol: to reduce the pleasure "reward" from using it. It has been used in other situations as well, such as gambling and overeating.
In my opinion, medication therapy is underused for people with moderate or severe alcohol use disorder. The long-term consequences of continued heavy drinking are immense for a person's physical and mental health, their social and family life, and employment. Naltrexone is one of several medications that are effective at helping people reduce or stop excess alcohol use.
Many regular doctors are comfortable prescribing medication treatment for alcohol use disorder, but an addiction specialist is the expert in this case.