Answers to the TSM Basics Quiz
We ran an 8-question quiz testing your knowledge about Sinclair Method basics. We had 101 responses with an overall average score of 86%. Below are the 8 questions and the expanded answers. Did you take the quiz? How did you do?
1) The scientific term for the Sinclair Method (TSM) is:
Answer (88% correct): Targeted pharmacological extinction.
We had a small number of people who said that TSM is naltrexone or nalmefene. The reason this is incorrect is because TSM is not, in itself, the medication used. Instead, it is a very specific way of using the medication to target the alcohol reward cues. Additionally, naltrexone is used to treat other medical and behavioral conditions. Just because a person is taking naltrexone, does not mean they are practicing the Sinclair Method.
We had a surprising number of people who answered mediation-assisted treatment (MAT). The reason this is incorrect is because there are many forms of MAT, including disulfiram, acamprosate, and time-released naltrexone combined with abstinence. “Technical terminology” can be swapped with the common name without changing the meaning of a sentence. And while TSM is a form of MAT, to say that MAT is the Sinclair Method is like saying since the grass is green, everything green is the grass.
2) TSM uses which of the following prescription medications:
Answer (57% correct): A & B (Naltrexone HCL (oral) and nalmefene)
If you were one of the 18 people who only said naltrexone HCL (oral), you were close. You probably don’t live in Europe where nalmefene is occasionally used to treat alcohol use disorder (AUD) and binge drinking.
We were a bit shocked, however, by the 25% of people whose answer included time-release naltrexone (injection or implant). Going back to question one, the core of what defines TSM is “targeted” extinction. Time-release forms of naltrexone are incapable of specifically targeting the reward response from alcohol because the medication is intended to be released and at a near constant level 24/7. That means that neither the injection nor the implant can be used with the Sinclair Method. (Note: We’re not saying that these forms of naltrexone are 100% ineffective because they do help some people. What we are saying is that they are never used as a part of TSM.)
3) TSM can be used to achieve:
Answer (93% correct): Both abstinence and harm reduction.
Some people use TSM to reduce alcohol consumption, some people use TSM to quit drinking alcohol entirely. Both choices are equally valid success measures.
4) The prescription medications used with TSM are pure:
Answer (83% correct): Opioid antagonists
It’s easy to get confused when talking about agonists and antagonists.
An agonist acts as a mimic, or substitute, on the receptors. Opioid agonists are often referred to as “replacement” therapy and include medications such as suboxone, which is a controlled and highly regulated drug.
An antagonist acts as a blockade. The only known pure opioid antagonists are naltrexone, naloxone, and nalmefene. To read more about the difference between agonists and antagonists, see this article on New Health Guide.
A handful of people answered opioid receptors. This is incorrect because the receptors are what the naltrexone and nalmefene attach to in order to keep the endorphins from drinking alcohol from attaching to them. Your brain is naturally full of receptors.
5) TSM is a “one size fits all” solution that works the same for everyone.
Answer (93% correct): False
People drink for different reasons, and they find TSM at different stages of their lives. A person who is becoming concerned about their alcohol use for the first time, before it becomes problematic, will respond quite differently from a person who has been a chronic, every-waking-moment drinker from decades. It would be unrealistic to believe that TSM works in the exact same way and time period for every single person.
6) Drink reduction with TSM (Check all that apply):
Answers:
(98% correct) – A: Generally happens gradually over many months.
(90% correct) – B: Can lead to eventual abstinence.
(85% correct) – C: May include occasional short-term increases.
The only false answer is “instant and permanent,” which was picked by 4% of respondents. Anyone who believes they are going to take a pill one time and instantly reduce their drinking once and for all until the end of time will rapidly be disappointed by the Sinclair Method, because it doesn’t work that way.
Pharmacological extinction takes time because it is a learning process that cannot be taught to your brain in one session. It is gradual, with most people taking 6-9 months before becoming indifferent to alcohol. There are some who take even longer.
7) TSM is often described as:
Answer (78% correct): Pavlov’s dog in reverse.
If you’ve watched the documentary film One Little Pill, this question should have been easy. Roy Eskapa talked about it about 10 minutes into the movie.
The basic premise is that Pavlov rang the bell and gave the dog food. Over time, the dog began to salivate at the sound of the bell. This is similar to what alcohol does in the brain. A person drinks and rewards are sent rushing to the brain. Over time, the thought of alcohol causes craving. Your brain is basically salivating for it’s reward.
When Pavlov continued to ring the bell and not produce food, the connection between the bell and the food began to weaken. This is also what happens when a person takes an opiate antagonist, waits at least an hour, and then drinks. The antagonist blocks the reward, gradually weakening the connection between alcohol and the anticipation of intense reward (also known as craving).
8) TSM protocol requires:
Answer (100% correct): Targeting alcohol rewards by taking an opioid antagonist at least 1 hour prior to drinking.
This is the heart of what makes the Sinclair Method unique, and also the key to its success.