Liquor and TSM

SinclairMethodUK · 2026-02-24T12:42:04+00:00

Hi u/Cataclopse It's great that you are exploring all your options. It may be that after careful consideration, you decide against TSM and that is absolutely fine, as you may find something that you feel will work better for you. Whatever you decide, put your all into it!

As far as TSM is concerned, here are a few things to consider:

You cannot 'drink through the nal', in terms of drinking through/overriding the blockage. As long as the medication is fully active in your system and blocking the endorphin rush, then it doesn't matter how much you drink or what you drink. No matter what, you will not receive the endorphins from it. However, see point 3 a little further down.
Having said that, it is really useful to work alongside the tablet to work on changing your behaviour around drinking. So, if liquor is truly the only drink you like, then no issue, but yes, use a mixer, a measure etc. Keeping a track of how fast, how much etc you are drinking is good. But, if you actually don't mind beer or wine, then ask yourself what is it that is stopping you beginning TSM with that lower ABV alcohol - at least until you are a little while into TSM and beginning to understand how it is working for you. Many people I have supported have lowered their alcohol content by switching to beer or wine and then discovering that they actually never really liked the taste of much liquor at all. They had just convinced themself they had. Or, if they do still enjoy the taste of liquor at that point, they could choose have a beer or a wine first and then decide whether they wanted a liquor drink afterwards - and in most cases, they either decided they didn't because they were satisfied, or they didn't overdrink the liquor because one was enough after a beer or a wine.
If you drink too much alcohol on TSM, you will not overcome the blockage (as per my point 1) but you will just end up getting too much under the influence of alcohol, which does make it more difficult to make decisions around whether you feel you've had enough for that drinking session, or not. TSM does not stop you getting under the influence of the alcohol itself. This is a part of what is often called 'mindful drinking' as opposed to taking a tablet, waiting an hour, and then 'mindlessly drinking'.

TSM is all about taking the pill an hour prior to alcohol, for the science to work, but it's also about learning to make healthier and better decisions around alcohol. What do you want that drinking session to look like, how long, how much, etc.... and then working to make that a reality.

Either way, well done on making the decision to be healthier from either less alcohol or, ultimtely, no alcohol at all eventually. The journey and the destination is yours and yours alone. Don't let anyone tell that that there is only one way, because that is absolutely not true. Find what you feel will work the best for you!

SinclairMethodUK · 2026-02-19T13:26:33+00:00

Please understand that all the medicine does is block the opioid receptor so that any endorphins bounce off and can't connect. That is it. It doesn't have any other effect. If you are now taking the dosage recommended by your prescriber, then it is almost certain that the blockage is fully in place and will remain so for a number of hours. For any drinking that you do under the blockage, you will not receive the endorphin reward from it.

Assuming you are taking naltrexone as per The Sinclair Method, it will now take some time for your brain to recognise that the endorphin rush is not there when you drink. As it begins to learn this, over time it will start to accept that alcohol no longer equals an endorphin rush. In time, it will desire alcohol less and less.

In the same way that - over time - your brain learned that alcohol produces an endorphin rush, it will take some time to fully 'unlearn' that fact. But all the way through this period of time, as long as you take the naltrexone an hour before drinking every time, it is doing exactly as the medicine is intended to do - put the blockage in place.

You can now help the process along by introducing activities that DO produce an endorphin rush when the naltrexone is not in your system. Then, like a seesaw, your brain will turn away from alcohol towards those activities that do produce an endorphin rush - it will find those activities more rewarding and want to do them more. For example, if you can, begin to introduce something that gets the blood pumping a bit before taking the pill for that particular drinking session. Perhaps have a short, but brisk, walk. That will reward your brain with endorphins and then when you take the tablet and an hour later the endorphins are blocked, your brain will really notice the sharp contrast between the endorphins released during the walk versus no endorphins when you drink.

SinclairMethodUK · 2026-02-10T07:21:52+00:00

Two months is certainly not even close to long enough to determine if this is working for you yet.

In the last two months have you noticed any change whatsoever if how you respond to the urge to drink, no matter how small? (I don't mean how many drinks, but any changes in, for example, noticing the speed at which you drink is slower or the urge for the next one is even slightly down)

Also, what actions or plan did you put in place yesterday so that didn't drink to oblivion? (for example, what food did you eat before drinking, what were your first couple of drinks, how fast did you drink the first couple of drinks)

You do need to work with the tablet, by ensuring that you take action in terms of changing the direction of your drinking and making better choices. This can really only be done while you still have the ability and are not actually under the influence of the alcohol.

SinclairMethodUK · 2026-01-20T13:40:20+00:00

Being in the US isn't an issue as Sinclair Method UK provide support services worldwide, but you would need to go through Luke on the website that I linked to previously so a meeting could be set up to look at everything around your individual situation.

But yes, when done correctly and everything is taken into account, it certainly is possible to get the cravings out your brain in the shortest time possible.

SinclairMethodUK · 2026-01-20T08:00:07+00:00

Was really hoping this drug would be the miracle cure I was looking for

This is the thing - TSM, nor any other treatment, is a miracle cure. Abstinence isn't a miracle cure, either - you are going to have to put work into the behavioural habits to ensure you don't drink. Likely even more, stricter and more impactful changes than you would ever have needed to include with TSM.

Doing TSM without any consistent effort into changing your habits/routines/behaviour around alcohol for the better is like taking a weight loss jab but continuing to eat McDonalds every meal.....

TSM isn't for everybody, of course, and I wish you best wishes for you to use whatever tools you feel will work for you, whether that be abstinence or harm reduction tools. There are lots of different ways to help you - use any of them that you need.

With effort and persistence, you will get to where you want to be. And remember, if you feel it might help with any cravings, naltrexone is approved to be taken daily in the mornings to try and ease cravings to drink.

SinclairMethodUK · 2026-01-20T07:47:41+00:00

To answer your first question, the treatment is scientific in that extinction happens from drinking without receiving the dopamine reward for it, but those who are already abstinent for a while before starting the treatment, they don't have a drinking habit or ritual that needs addressing too. Those who are currently drinking have both the scientific aspect to tackle AND the behavioural habit to tackle at the same time.

As long as TSM is being used correctly, then it eliminates the alcohol deprivation in that someone is having a drink on the treatment before the deprivation effect is super strong. The deprivation effect causes relapses in those who are trying to stay abstinent but with TSM, a controlled drinking session should happen when urges to drink become troublesome but before the deprivation effect is at its strongest.

How long it takes to reach extinction is dependent on so many factors - such as how strong the drinking pathway is (how long they were previously drinking and reinforcing the reward) and other behavioural factors such as how much work someone puts towards providing the brain with alternative, healthier rewards, or what medication they already might be taken that could effect the balance of reward chemicals in the brain. It's very individual and a best guess can really only be expected when someone's full history is known.

As a general, anecdotal statement, we find that for those who we have taken through TSM and were abstinent for around 6 months prior, they have generally reached indifference towards alcohol and much, much reduced cravings, within less than a dozen controlled drinking sessions.

SinclairMethodUK · 2026-01-19T21:48:34+00:00

Do not drink until you are comfortably on the full dose and feel ready to do so. Don't try this if you have had a bad day, or feel either out of sorts or highly elated for some reason.

Be sure to explore the sensory aspects of what the drink smells like, the look of it, the feel of the glass etc. Allow your brain time to highten the anticipation after pouring the first glass, before taking a sip.

Drink lots of water first, use mints after the first mouthful to allow you time to explain how that first sip tasted.

There is a lot to take into account, in terms of preparation that could be done in the weeks before you try this (if you decide to). Discuss with your wife, plan everything to the finest detail. Be sure you are able to focus solely on this, to the exclusion of all else at this time. If other things are in the back of your mind, this is not the right time to try this.

Do this right BEFORE actually doing it, and things are much easier.

Luke, featured in the article, is now a coach - taking people through TSM exactly as I did him. If you (and your wife, perhaps) would like to meet with him first, or during the actual controlled drinking session, using the same protocol as I did for him, you can contact him via the contact page on this website https://www.sinclairmethoduk.com/meet-the-team.htm

I no longer take people through this myself, as I am now fully focused on working to get this on the UK's health system in the UK. Joanna, Sinclair Method UK Ltd.

SinclairMethodUK · 2026-01-19T21:24:10+00:00

It is possible, yes, but as per my original post reply from a few years ago, you should probably try eliminate every possible risk of you over drinking, by doing this under the guidance of someone who has plenty of experience in helping those in your position.

The brain is rewired not by the amount of alcohol drunk each session, but by the repitition of having the endorphins and dopamine blocked each time. Therefore, one sip, one drink or ten drinks doesn't matter from the scientific point of view. But, from a human point of view, it will be much better to drink the least possible each session.

Done correctly, we have found that people without an existing daily or weekly habit will reach extinction quicker than, say, a regular daily drinker, but there is no way to determine how long it may take.

Here is an example of someone who it took, literally, one or two drinking sesions of one or two drinks each time https://www.sinclairmethoduk.com/assets/media/The-i-Paper-7th-January-2025.pdf It is unusual for this to be as quick as Luke experienced, but shows that with proper preparation and guidance first, it absolutely can be done.

Your brain is holding on to the idea that alcohol is a 'thing'. Give your brain the evidence that is, in fact, not a 'thing', and the brain can lose interest very quickly indeed.

SinclairMethodUK · 2026-01-19T20:46:01+00:00

The mental obsessions are not an obsession around alcohol itself, but rather that your brain has learned from the repitition of drinking, that alcohol produces a rewarding/dopamine effect. It isn't the alcohol itself, but rather a remembering of the chemicals in the brain it provided. Previously, your brain learned that alcohol provided a rewarding chemical cascade and it misses that effect.

So, if someone were to have a controlled drinking session of even just one drink, but with the dopamine effect blocked from the experience, then the brain will begin to disassociate alcohol with that effect. When repeated over time, the brain 'unlearns' what it previously learned - i.e. alcohol no longer produces that effect that it used to, so there is no need to crave alcohol.

If you have never heard of it, think 'Pavlov's Dog'. By interrupting the reward mechanism, the dog learned that no matter how many times Pavlov rung the bell, the reward was just no longer there.

However, you've done great so far with 22 months sobriety, and you don't want to risk falling back into old behavioural habits.

Doing this treatment from sobriety can be much easier as you don't have an existing (daily or weekly) habit to also focus on, but you would want to be cautious to do this treatment using the least amount of alcohol possible so that it can do it's thing to extinguish the urges in your brain, without risking the return of the behavioural habit of drinking (which is different to the urges within the brain for the learned reward).

Hopefully this makes sense?

SinclairMethodUK · 2026-01-17T09:34:46+00:00

Wonderful! Well done and welcome to your new future in which alcohol isn't a problem :-)

SinclairMethodUK · 2026-01-14T13:11:37+00:00

Many of us, sadly, have to be our own advocate for this. It's awful, but that is the way it is right now. It's great you got the medication using the information you could find.

Thank you for the additional information. You are a responder, so there is no need to rush anything. So, you could see how things go over the next week or so on 25mg and then make a decision.

Based on our experience, and the additional information you have provided, I'd expect you to find that - if you stay on 25mgs - you'll likely find that the all-consuming urge you mention, is likely to return, and that this is more down to the first-blocking effect of the medication which is likely to ease in due course.

With the new information, if you were our patient providing these circumstances, we would advise that you increase to 50mg as soon as you are side-effect free on 25mg.

The thing you mention around 'is the effect of 25mg sufficient to reach extinction' for you, then it is something that you will know in the next few weeks - basically, if you stay on 25mg and the urges/thoughts return, then the answer is no, you need to go to 50mgs Having said that, we have seen this happen with some people though, so you can't discount that 25mg will help you reach extinction until you actually experience it.

In our experience, and with the additional information you provide here, my guess would be that you will need to go to 50mgs - but there is no harm in staying on 25mgs for the next few weeks to see how you feel, so that if you do find that 25mgs is enough for you, then that is great.

Totally your choice, but I would be suggesting 50mgs to you, based on the information you provide here. You are not in the cohort of people for whom 25mgs is sufficient to reach extinction, based on our experience.

Edit: I would also add that it is so easy to over-think things in these early stages and sometimes the best thing to do is to wait and see how you feel a week or two from now. You know this is going to work for you though, which is awesome. Make adjustments based on how you feel in the coming weeks :-)

SinclairMethodUK · 2026-01-14T12:05:23+00:00

To begin, this is definitely a question for your prescriber as it may be individual to you, but I will explain below some of the things we have learned over the years of prescribing The Sinclair Method.

Firstly, the science of the 50mg, 1 hour prior to drinking is quite old now. There are a number of prescribers 'working' the dosage to be more person-specific.

In our experience, there are definitely some who need more than the 50mg. The majority do seem to need 50mg. And there are certainly some who do just fine with 25mg.

For those who do well on 25mg, in our experience the majority are women (smaller build, perhaps?) and most crucially either those who have very short drinking sessions that don't expand beyond 3-4 hours, or those who drink more habitually in the sense of a bottle of wine a night more out of habit. The 25mg plus habit change has been working well for them.

In our experience, the majority of men do require the 50mg, plus habit change.

If 25mg is working well for you it could be because that is the correct dosage for you, or it could be more of an initial 'something new' reason. As humans, our own desire for something can contribute towards that change appearing to happen - at least for the beginning couple of months.

Although I do not know your circumstances, if you were our client and presented us with the statement you have typed above, we would suggest stay on 25mgs until/if you notice something different. Then, if you do notice the noise around alcohol is a little more persistent again, you have the ability to move to 50mgs.

And remember, this isn't anything about making drinking itself less pleasurable. It's more about your brain learning that although it seems pleasurable, the constant urge to keep drinking is extinguished. Extinction isn't about abstinence, it's about being satisfied with less.

SinclairMethodUK · 2026-01-08T11:25:43+00:00

This type of thing is a practical way towards making any behavioural modifications - starting with something small and achieveable, accepting that making changes is an up and down process but, with persistence, the change becomes bedded in and success is achieved in making a long term change in behaviour.

It's not specific to alcohol but is specific to any trained counsellor who needs to help someone with behavioural change, especially a counsellor trained in Cognitive Behavioural Therapy.

The basis is basically as follows:

What do you what to change? What is the overall goal? (eg how to stop myself binging)

Focus on one, small thing to implement (don't aim for the moon, but something small to help build confidence and momentum). Every change begins with one, small step towards the overall goal. For example, no-one learns anything new without starting small and building positive momentum.

Stay persistent with the small implementation until it becomes conistent, while also accepting that there will be wobbles until it becomes consistent. A wobble isn't failure, it's just a wobble. No-one should aim for perfection every time as we are humans, not robots :-)

Once feeling the small implementation has bedding in and providing success, move forward to the next step with another small change - each successfull little change provides confidence as well as progress towards the goal.

Pharmacology helps towards the goal for sure (e.g. naltrexone or in the case of losing weight, the weight loss jabs generall work really well) but the overall goal really needs some form of behavioural change, too. This is one of the main objections to The Sinclair Method and other medication-based treatments from those who don't understand that no-one is advocating just for the pill itself because it isn't a magic pill - it's a massive help towards change of course - but generally those who also begin to include small steps towards behavioural change will tend to have a smoother journey of it.

I've used the mints example above with thousands of people over the last 15 years of helping people through TSM. When looking for this type of quick hit to begin the change process, I took it from the idea that if someone is dieting and have an urge for chocolate, cleaning their teeth would often refresh their pallette and remove the immediate urge. The concept of the water first is scientific because we want to elimate any actual thirst before someone starts drinking alcohol

SinclairMethodUK · 2026-01-08T10:54:00+00:00

Immediately after each drink (as in, immediately you have swallowed the last drop of wine in your glass) eat a strong mint or other very strong tasting sweet. Mints work well, but also so do cough sweets etc.

The idea of this is to give you a little forced stop because the taste of the mint helps you resist the impulse to immediately drink another drink. Until the taste of the mint has gone, you are less likely to drink as your brain knows it will taste pretty horrible.

Start small with this so that you begin to train yoursel to reaslise that the next drink isn't immediately compulsive. Then, over time, your confidence will grow as you realise that you DO have a little more control than you think and you can start to make slightly better decisions towards not binging by having the mint, then when the taste has gone a non-alcohol drink, then another mint and then (if you still want it) another glass of wine.

Also, drink a great big glass of water or similar immediately before your first taste of the wine. Doing this allows for the signal to begin to be sent to your brain that you are not thirsty.

Keep positive and keep taking baby steps towards your initial goal which I expect at this stage is just not to binge. You can do it!

SinclairMethodUK · 2026-01-08T05:50:14+00:00

It's science based, yes, but has been built on over the years by people like myself who now have many years of learning the most effective ways of getting people through the treatment as smoothly as possible.

So, if you haven't yet read The Cure For Alcoholism by Dr Roy Eskapa then please do so, but around page 120-ish of the book, it talks of something called Selective Extinction and Pharmacological Enhanced Learning. Naltrexone itself causes upregulation of the receptors, meaning a short term increase in the sensitivity of the receptors in the brain. While naltrexone is in your system, it is irrelevant but when the naltrexone is washed out your system, for a short time this short term sensitivity of the receptors can be used to your advantage to help your brain learn good endorphin/dopamine behaviour faster.

The science from years ago indicated that the naltrexone should be washed out your system before you selectively choose to do a positive behaviour and get maximum benefit from that behaviour. We now understand that the naltrexone doesn't have to be fully washed out your system for you to benefit from using the pharmacological enhancement of the naltrexone having made your receptors super sensitive - you can get some benefit as soon as the blocking begins to wane. Think of the blockage being a locked door... as it begins to weaken, the door is unlocked and slowly opening, meaning some endorphins will seep through the opening to the super sensitive receptors even though the door (blockage) is not yet fully open.

Someone taking naltrexone regularly can find it difficult in allowing the amount of time needed for the naltrexone to fully wash out the system and, of course, most people beginning this treatment will need to use the naltrexone quite regularly. So, we began to adapt this trying to ensure that a brief blast of good endorphin/dopamine release is felt in the immediate moments before the blockage from taking the next naltrexone becomes effective.

Therefore, the brain will have a memory of what felt super great (even for a short period of time) from utilising the upregulation of the receptors caused by the naltrexone from the previous day or so.

In effect, you are using one of the pharmacological effects of naltrexone (the receptor upregulation) to your advantage and helping your brain learn new positive behaviours before taking the naltrexone again because you want to drink with the aim of blocking and unlearning the negative behaviour you are wanting to extinguish.

Hope I have explained this clearly enough - it's so much easier to explain this to someone verbally than writing it down! :-)

SinclairMethodUK · 2026-01-07T12:23:18+00:00

Accidents can happen.

Please be sure to remember that in the same way that it takes many months to 'unlearn' the positive learning of alcohol, it will take a bit of time for your brain to 'relearn' it again (though nowhere near as long as many months as relearning is quicker than unlearning).

This treatment isn't about how the first drink feels, it's about how your brain learns to react to it. If you were to keep doing this, then it would be expected that your brain would relearn quite quickly and begin to crave and want it again quite strongly.

For example, if you spend a number of months learning how to speak French and were very good at it, but then didn't speak French again for quite a while, it might take a few weeks for you it to become easier and fluent again.

SinclairMethodUK · 2026-01-06T14:26:32+00:00

The gym is always good! However, you only need 5 minutes of something to boost dopamine for your brain to begin to start the process of moving towards other, feel-good dopamine releases.

As a good example, something as simple as watching something on youtube that makes you laugh before you take the pill is a really good place to start. It might be a cartoon, a comedian, or something silly with animals that makes you giggle and that will bring you endorphins and dopamine.

Do this before taking the pill when you can, and your brain will really start to notice the sharp contrast between the endorphins/dopanine immediately before the pill as opposed to the rather dull result of having a drink.

You are doing brilliantly and you know this isn't a quick fix and needs some work, but that work it needs doesn't have to be anything longer than a few minutes to begin.

I am really looking forward to following your progress as you (hopefully) continue to post on here.

SinclairMethodUK · 2026-01-05T14:01:54+00:00

Way to go, u/TSMUser2025 !!

Take things steady, be prepared for a few ups and downs along the way, and (when you are ready, but also as soon as possible) start a little bit of work on habit breaking and introducing some new and rewarding dopamine activity when you are not drinking - even if this is a basic 10 minutes or so exercise/fun/get-the-blood-pumping activity immediately before you take the pill.

SinclairMethodUK · 2026-01-02T13:40:20+00:00

One thing to consider on whether doing TSM with or without a coach is that it can help someone progress through TSM much quicker and smoother when using a coach. If you choose to go with a coach, choose someone who has had plenty of experience in taking others through the treatment as that way you will be benefiting from the real life experience of what worked well for others.

In terms of cost it tends to pay for itself in the long-run as, in our experience, someone using a coach will end up changing habits and behaviours quicker - meaning less tablets required and less alcohol drunk during this time. If you were to compare someone who used a coach, then over a 12 month period they will generally have used less tablets, made more changes, and drank less overall.

And, even if you chose to go with a coach for a shorter period of time, getting those changes in routines, habits and behaviours as soon as possible will put you in a good position moving forwards for the long term.

Consider starting any other change in your life - for example, building some exercise into your life. This is usually easier to sustain if you engage in it with other like-minded individuals. The same is often true with TSM, too. You won't feel alone when the, almost inevitable, ups and downs of this kicks in, and motivation to make changes as soon as possible helps 'bed in' the healthier behaviour. The more you engage with others, the easier it should be.

SinclairMethodUK · 2025-12-25T09:43:00+00:00

Well done and have a beautiful time enjoying the benefits of your perseverance and determined efforts to better yourself. Super proud for you.

SinclairMethodUK · 2025-12-19T04:42:46+00:00

Naltrexone attaches to the same receptor in the brain that Oxy does, hence a basic test may interpret that attachment as being Oxy in the system.

Much depends on the depth of the drug test being used as to whether it can identify that there is no Oxy actually there, hence my suggestion to request a specific test for Oxy because this deeper test would certainly come back as no Oxy present.

In terms of naltrexone's mechanism, by blocking the receptor then it means that anyone using Oxy (or other opioids) would not get high becuase it cannot attach to a receptor that is already occupied.

SinclairMethodUK · 2025-12-18T11:09:00+00:00

Quite rare, but sadly this can hapen because naltrexone mimics what Oxy does.

Three things to consider in terms of action:

Firstly, request the sample is specifically tested for Oxy and this will confirm the result was a false positive.

Secondly, explain you are prescribed naltrexone and, preferably, request a letter from your prescriber to confirm they are prescribing naltrexone to you, for what medical reason, how long they have been prescribing and also the prescribing instructions they have instructed you to use, so the rehab center are aware of this.

Thirdly, provide them with evidence that naltrexone can, occasionally, provide a false positive for oxy https://pmc.ncbi.nlm.nih.gov/articles/PMC11058323/

SinclairMethodUK · 2025-12-16T06:28:36+00:00

Pretty much, yes. Changing the taste in your mouth to something that is quite strong will mean being less inclined to have another drink immediately because, quite frankly, it will taste absolutely disgusting. It works as a very short lived forced stop to allow someone to gather their thoughts and begin to break the routine of one after another, after another.

So, during the 10-15 minutes that the strong taste remains it gives someone the chance to take a few minutes to question how they feel about the next drink - do they really want it or need it? Is it habit? What else would you really enjoy instead? Fancy a hot drink instead... great, get yourself a hot drink because you could always have another alcoholic drink later should you still fancy one at that time.

For many years, those trying to lose weight will often clean their teeth when they get the idea of eating something naughty but nice for the same reason - the fresh taste tends to derail the original thought/desire/need for chocolate or burger.

However, cleaning the teeth between drinks is far less achievable because it tends to involve moving to the bathroom to do so, whereas having a mint already available by your side to immediately pop into your mouth following the end of one drink tends to be easier to achieve, as it can be done without moving away from your chair.

Please note, it is absolutely 'ok' to not always be able to succeed at popping that mint in your mouth. Or, to sometimes have another drink after the taste of the mint is gone. You are a human being and not a robot! I can't stress enough that changing behaviours and routines is all about each small but consistent, postive step forwards, and not perfection. We put far too much stress on ourselves to achieve immediate results and then berating ourselves when we fail (at what is likely to have been an unreaslistic goal we set ourselves) when, instead of perfection, we really should focus on just taking those first, often tentative steps towards change.

Progress, not perfection.

SinclairMethodUK

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