Sinclair Method
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2008-03-10T18:17:07Z
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/* History and Theory */ fixed broken reflink, but the ref doesn't contain much information?
The '''Sinclair Method''' is a treatment for [[alcoholism]] that involves the use of [[opiate]] [[Receptor antagonist|antagonist]]s such as [[naltrexone]] or [[nalmefene]] in order to decrease the craving for alcohol over time, while the person continues to consume alcohol. It relies upon a mechanism called pharmacological extinction, where involuntary impulses are reduced through the introduction of a stimulus without the subsequent reward.
==History and Theory==
In the 1970s, [[Finland]]'s National Public Health Institute developed a breed of [[Wistar rat]]s called the AA line which were more prone to alcoholism. <ref>[http://www.ktl.fi/portal/english/research__people___programs/mental_health_and_alcohol_research/research/ KTL (National Public Health Institute, Finland) - Research]</ref> The research facility determined that this tendency was caused by an increased reactivity of their [[endorphin]] system to the consumption of alcohol. Both [[effects of alcohol on the body|human]] and [[brown rat|rat]] biology reacts to the presence of alcohol by releasing endorphins, and these rats produced more endorphins in that event than a typical rat.
Endorphins are part of the body's reward system for performing healthy behaviors. Sex, exercise, eating, and risk taking generally result in the release of endorphins. The endorphins "teach" the body that the behaviors that were performed prior to the endorphin release are behaviors that should be repeated. The link between the more active endorphin system and alcoholism in rats suggests that the release of endorphins by alcohol teaches the body to believe that drinking alcohol is an activity that should be repeated.
[[Classical conditioning]] suggests that, should you perform a behavior and be rewarded, then the urge to perform that behavior becomes stronger. Furthermore, if you perform a behavior and are not rewarded, then the urge to perform that behavior gets weaker. This effect is referred to as the extinction of that behavior.
Based on the [[Ivan Pavlov|Pavlovian]] classical conditioning, the addict must perform the behaviors that they are attempting to extinguish and not be rewarded by the endorphins. Tests with the AA rats confirmed that this effect involved not only the actual consumption of alcohol, but also the sensory stimulus that the creature experienced while consuming alcohol.
==Treatment==
Dr. [[John David Sinclair]] used these results to develop a treatment for alcoholism for humans. For it to work, the patients need to take a drug which prevented endorphins from rewarding them for drinking. Naltrexone was originally used, although other drugs are now available for this purpose. The patients also needed to expose themselves to the conditions under which they developed their addiction. This means not just drinking alcohol, but consuming it in the same environment in which they developed their addiction.
This resulted in an extremely simple treatment for alcoholics. A daily dose of naltrexone effectively blocked endorphins. Beyond that, it was just a matter of the alcoholics going about their life as usual. They drank when they had the urge, and the urge was extinguished over roughly a three month period. Periodic psychological counselling improved the speed and effectiveness of the treatment considerably, although the frequency of this counselling varies more based on the budget of those paying for it than on the level of effectiveness.
==Obstacles==
This treatment was approved by the FDA for use in the US in 1994. Since then, its adoption has been slow and spotty. Dissemination of information of the treatment has been blocked by all of the existing treatment organizations.{{Fact|date=February 2007}}
Project Combine, the largest controlled clinical trial in the alcoholism treatment field, published in the ''[[Journal of the American Medical Association]]'' in May, 2006, has shown "that while naltrexone was effective in its own right, combining it with the specialized counseling added no more effectiveness than naltrexone by itself" according to Dr. Raymond Anton, the coordinator for the trial. Naltrexone had been approved by the FDA for use within a comprehensive program of alcoholism treatment. The new results should lift this requirement, allowing doctors to prescribe naltrexone with only medical supervision but without intensive therapy.{{Fact|date=February 2007}} This confirms findings from earlier smaller trials with naltrexone in Australia and with nalmefene in Finland.{{Fact|date=February 2007}} Of course, other forms of counseling may still add benefits, but the pills do work alone.
The medical community has been largely unconvinced of the effectiveness of this cure.
==Notes==
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==External links==
* Episode #64 of the [http://www.shrinkrapradio.com/2006/12/03/64-the-sinclair-method-for-treating-addiction/ Shrink Rap Radio] podcast features an in-depth interview with David Sinclair, discussing the research, history, practice and application of the Sinclair Method.
* Episode #6 of the [http://www.intellectualicebergs.org/ Intellectual Icebergs] podcast contains a very instructive interview with Dr. David Sinclair about this method.
* [http://www.ktl.fi/portal/english/osiot/research,_people___programs/mental_health_and_alcohol_research/contact/ Dr. David Sinclair]'s contact sheet at Finland's [http://www.ktl.fi/portal/english/ National Public Health Institute] (listed here as a solid starting point for further research, not for the purpose of direct contact)
* A video by Dr. David Sinclair talking about how the program works is on Beverly Rayfield's web site at [http://www.sinclairmethod.com/ SinclairMethod.com]
[[Category:Alcohol abuse]]