The Sinclair Method: Applying effort in place of willpower

Co-written by Michael J Haas

Many people share a common misconception about the Sinclair Method (TSM): because TSM doesn’t require willpower, they can and should ignore everything else involved in their addiction. This is simply not true.

TSM doesn’t require willpower the way abstinence-based methods do, but it absolutely does require effort – in compliance, in identifying and breaking unhealthy habits, and in addressing factors that make it “easy” to continue drinking even after the craving and physical need for alcohol have been satisfied (often referred to as drinking through the medication).

But what is the difference between willpower and effort? How does that difference translate into success using TSM? How can you apply the understanding of the difference to your own TSM journey? Let’s take a look.

The difference between effort and willpower

Abstinence-based methods for treating alcohol use disorder (AUD) require willpower. This is a form of self-control a person has to maintain constantly in order to abstain from drinking. It takes willpower to avoid the cues, behaviors and situations that trigger the cravings. It takes willpower to resist the temptation to take that drink when the bottle is right there in front of you.

Willpower doesn’t let you drop your guard. You have to maintain it 24/7/365. It’s absolute: to remain abstinent, your willpower has to be “on” all of the time. The high relapse rates in people who have tried abstinence-based recovery, estimated at 40-60% in the first year after beginning abstinence-based treatment, indicates this is extremely difficult for most people.

Effort differs from willpower in several key ways:

• You exert and focus effort periodically for certain lengths of time and specific purposes: exercising at the gym, cooking dinner for your family, preparing for a job interview, balancing that spreadsheet at work. Once you’re finished, you can dial back your “effort valve” and relax. Effort doesn’t make demands on you every waking moment of every day the way willpower does.
• Effort comes in different sizes. Efforts of any size can yield positive and visible results that give you a sense of accomplishment. Did you make an appointment with a physician who will prescribe naltrexone or nalmefene using TSM for AUD? Good job!
• Efforts also have cumulative effects. For example, the relatively small effort of complying with TSM each day you plan to drink — taking the pill and waiting one hour – can eventually accumulate in pharmacological extinction.
• Unlike willpower, which depends on sheer mental (and physical) strength, effort depends on resilience – the capacity we humans have to keep going after we stumble. We pick ourselves up, dust ourselves off and try, try again. Did you forgot to take your pill before drinking yesterday? OK, so admittedly that wasn’t your best effort; but you can do better tomorrow. Meanwhile, the world won’t end.
• Effort is manageable. There many ways to apply your efforts to get the most bang for your buck. This blog and website already include resources, tips and advice to help you get the most from your efforts, such a list of physicians who will prescribe naltrexone or nalmefene using TSM, and a blog post about telemedicine technology that makes it easier to connect with a physician – just to name two.

What the difference means for TSM

As mentioned above, understanding that TSM requires effort – not willpower – helps you break up the approach to your recovery into small, manageable pieces that positively accumulate over time. You’ll begin to see the results of those efforts manifest as drinking less, feeling healthier, having a better quality of life and/or enjoying activities you’d been missing before or discovering new, healthy ones. When you see the positive connection between effort and outcome, it gets easier to keep making the effort.

Of course, abstinence-based methods can also result in less drinking, better health, and so on – but maintaining the necessary willpower may actually get harder over time. And then, if you stumble, you could experience a major setback, due to the alcohol deprivation effect (ADE), which makes it even harder to start again.

With TSM, there might be days you don’t give your best efforts, or your best efforts don’t seem to have paid off. Nobody said it would be easy. You might stumble now and again, but without the same level of dire consequences. There is room and opportunity for renewing your efforts.

That said, there is more to recovery with TSM than just taking the pill and waiting an hour to drink.
In about 80% of people, TSM eventually extinguishes the endorphin-fueled reward you get from drinking. But it doesn’t automatically address other factors connected to your drinking behavior: what triggers the cravings in the first place; why you keep drinking after the craving has been slated; what habits you’ve developed over the years that reinforce your drinking behaviors. Recognizing and addressing these factors also requires effort.

What you can do

Start small. Look at how fast you finish an average drink. Commit to yourself that you will stretch the time it takes you to finish a drink by 5-10 minutes. If you finish faster, drink water, do something to distract yourself, or just wait until the time has passed. Each day, stretch that amount of time by another 5-10 minutes.

If you are trying to work your way toward your first alcohol-free day, you can apply the same 5-10 minute step in effort. Start by taking your medication 5-10 minutes later than your “usual” time. In a week, you will have delayed your first drink by 30 minutes to an hour…all by making small, manageable changes that build upon one another. Soon, you will discover that your first drink is projected to be later than you’d like to be drinking and so you’ll inch your way into a relatively easy alcohol-free evening.

If you have a friend or loved on who knows you’re doing TSM, ask that person to check in each day to remind you about your meds and drink log.

Find some activity to do during that hour between taking the pill and drinking. Prepare a meal. Do some housework. Read a book. Go jogging. Take a walk. Anything hat helps that hour go by more quickly and makes the effort of waiting feel less onerous.

Use technology to your advantage: If you’ll be out for the day and joining friends for dinner later, put reminders in your smart phone calendar to take your key chain (with your medication in it) with you before you leave home, and to take your medication an hour ahead.

If you are not tracking drinks in real time, find the best time of day to update your drink log, and make that part of your routine. Is it while enjoying your morning coffee before the day gets busy? At night before reading in bed? Find a positive association between keeping the log and the time of day.

Keep an “efforts log”: Each day write down at least one effort you made towards recovery. “Today I took my pill”; or “Today I drove home a different way to avoid seeing my previous hangouts.” Once a week, review your “efforts list” and think about where those efforts have made a difference for you.

On alcohol-free (AF) days, reward yourself – and retrain your reward system – by planning fun, healthy activities that maximize the fact your body is “primed” for endorphin re-uptake.

Keep looking forward

So, even though TSM doesn’t rely on sheer, constant willpower, it’s not carefree. You have to put effort into sticking with it, and towards recognizing and changing the patterns of your relationship with alcohol. Hopefully this article has given you some solid tips on how to think about, manage, and make the most of your TSM efforts.

TSM isn’t always easy; but every effort you make, however big or small, can take you closer to pharmacological extinction and recovery. And along the way, you can enjoy your victories without fearing the worst will happen if you stumble.