Some researchers have reported that naltrexone can be effective as an anti-craving medication if one takes it while abstaining from alcohol. Dr. Sinclair claims that naltrexone is not effective as an anti-craving medication when used with alcohol abstinence. We at HAMS remain neutral on this topic as we have not yet seen convincing evidence. What is clear, however, is that naltrexone used with an extinction protocol has far greater effect than when used without one.
In pharmacological extinction (also known as the Sinclair Method) one always takes a dose of naltrexone (50 mg) an hour before drinking alcohol. One never takes naltrexone unless one intends to drink.
Pharmacological extinction works because alcohol addiction is an example of operant conditioning. When you drink alcohol, endorphins are released and reinforce the drinking behavior. Drinking is learned behavior. More precisely, drinking is an example of operant conditioning.
Operant conditioning is normally a good thing because it helps us to learn new behaviors needed for survival. However, in the case of alcohol addiction it has led us to learn a maladaptive behavior
Pharmacological Extinction works to undo this operant conditioning. You take naltrexone one hour before drinking alcohol. The endorphins are still released, but they cannot bind to the mu receptors because these receptors are blocked by the naltrexone. There is no reinforcement for the drinking behavior. In the absence of reinforcement, the behavior becomes extinguished.
The Sinclair Method takes three months or more to achieve its full effect. However, you should not stop taking naltrexone merely because the alcohol habit has gone into remission. You should always continue to take the naltrexone before you drink for the rest of your life. If you stop taking the naltrexone and drink then the drinking habit will simply re-establish itself.
After three months or so of naltrexone treatment you should be drinking at either moderate levels or abstaining with no difficulty and no craving for alcohol. Naltrexone alone cannot eliminate or reduce alcohol craving. Alcohol craving disappears only when people drink after taking their dose of naltrexone.
It is important that you do not take naltrexone unless you intend to drink. Otherwise you will wind up losing interest in healthy activities like sex or learning or sports. Naltrexone can lead to the extinction of any behavior that is reinforced by the release of endorphins.
For more information about naltrexone, pharmacological extinction, and the Sinclair Method please read Roy Eskapa's book The Cure for Alcoholism: Drink Your Way Sober Without Willpower, Abstinence or Discomfort.
You may also visit our scholarly article on naltrexone on the HAMS web site.
You can read David Sinclair's article on naltrexone here: Evidence about the use of naltrexone and for different ways of using it in the treatment of alcoholism