For Your Doctor

On this page you will find common physician concerns and some helpful documents you can show your provider when talking about the Sinclair Method.  The C Three Foundation has created a separate website specifically for medical professionals along with more pages dedicated to key research at www.cthreefoundation.net.

"I'm not permitted to prescribe naltrexone."

This is blatantly false. Anyone who is legally permitted to write prescriptions may write a prescription for naltrexone and may do so for an unlimited number of patients. Naltrexone is an opioid antagonist, which basically means that it is an opioid blocker. The medication has been FDA-approved since 1994 specifically (but not exclusively) for use in the treatment of alcohol use disorder. In more than two decades of use, naltrexone has been determined to be free of any addictive potential.

In all likelihood, if a doctor says he or she is 'not permitted' to prescribe naltrexone or needs special permissions from the DEA to do so, they are confusing naltrexone with another medication such as naloxone, suboxone, or methadone. Do not be afraid to be firm with your doctor that he or she is mistaken. A good doctor who cares about your well-being will, at the very least, research the medication, even if they ultimately still do not feel comfortable prescribing it.

 

"You can't just fix addiction with a pill...or by drinking."

TSM is much more than just simply taking a pill an hour before drinking. It involves mindfulness (keeping a drink log) and actively training the reward system to replace alcohol with other, healthier, activities.

Abstinence is easier to measure success - you're either drinking or you're not.

The drink log serves as a way for the TSM user to objectively compare drinking over time. Like any long-term change, progress is seldom linear. I typically liken it to weight loss. If a doctor tells their patient they need to lose 100 pounds, it's going to take time. In fact, it's typically safer that way. If that person loses 75 pounds, and gains back 5 over the holidays, they don't start over with all progress lost. They look at what happened, learn all they can from it, and move on toward their goal. This mindfulness can help identify triggers, can help avoid guilt/despair situations that could otherwise lead to a full-blown relapse, and can serve as a communication tool in therapy or follow up appointments because there is clear data to back up progress.

 

"Naltrexone can dampen the reward system."

The reward system re-training happens when a user is able to have an alcohol free (AF) day. Since the medication is only taken when drinking, and the oral naltrexone has a limited half-life, on non-drinking days the body will be primed for endorphin re-uptake. This is a great time for the TSM user to exercise, eat their favorite foods, and do healthy things that will trigger their reward system. This is the key difference between TSM and time-release methods of using naltrexone such as the implant or shot. Time-release medication is designed to stay in your system evenly. It makes it impossible to target the reward system and activate learning.

 

"What about peer support groups?"

One of the reasons doctors like peer support groups like AA, Moderation Management, SMART, etc. is because science has shown that people are more successful at tasks they feel supported in. That's both good an bad (think peer pressure).

The C Three Foundation offers support to those on the Sinclair Method in many ways. We have a moderated digital peer support forum with nearly 1,100 members that is free to join and available 24/7/365. We provide free pill holder key chains to doctors in our network so that they can encourage patients to always carry their medication with them. This increases medication adherence. We are building support tools for the family of those in recovery, because we understand that AUD affects more than just the person drinking, and we work hard to encourage people to be straightforward with their doctors about their drinking and recovery efforts, because we have documented that when a person feels supported by their doctor, they are more successful with TSM.

Reference Documents

You will need Adobe Acrobat Reader or a supported browser to view the PDF files below. 

TSM 101 for Medical Professionals

This document is a "crash course" in TSM to give a medical professional with little to no familiarity with the Sinclair Method the bare minimum information about the benefits of treatment.

TSM Protocol for Medical Professional

Dr. Cox wrote this protocol so that other doctors can get a sense of the "whys" behind the Sinclair Method (TSM), which is known to some psychiatrists by the more formal term "pharmacological extinction."

How Opiod Antagonists Reduce the Craving for Alcohol

A paper written by Dr. Sinclair, et. al. that explains a bit more scientifically why using opioid antagonists in a target manner is more effective than having them constantly in the system.