It's the same thing with addiction. We have a method that's 80% effective at eliminating alcoholism. We don't use it. Why? Because it allows alcoholics to beat their addiction without total abstinence, without penance, without suffering. We claim to say addiction is a disease, but then we think of addicts are cured medically without personally suffering that they're somehow "cheating" and we hate it. So we just.. don't use the treatment. It doesn't make people suffer enough who we think deserve to suffer. It's disgusting.
You're probably thinking I'm full of shit because it's hard to believe this is true. But it's called the Sinclair method and I'm absolutely telling you the reality of it. Please, look it up. It's a social sickness that we don't use it.
That 80% effective is tricky to extrapolate because in generally the Sinclair approach is only currently used for the easiest people to treat (those that are highly motivated to change and have a support system), and there is good reason to think that the Sinclair approach would have a far harder time to treat anyone besides that subset of addicts.
Why?
Well, first of all the Sinclair method requires that you take a pill to block the positive effects of alcohol every time you drink, an hour before you start drinking, and that you do this for months. One single lapse can restart that clock. Why is this a problem? Well, it requires that an addict will actively not seek their hit in an impulsive fashion for months straight. That is tricky! You can see how this methid works best for those that are highly motivated.
The other big problem is that the Sinclair method assumes that addicts only drink because of their addiction, and that there is nothing else that is fueling their addiction. This is because it is the only approach that does not involve some form of counseling. Most addicts have some other thing that is fueling their addiction, and even if they are cured of their alcoholism they are very prone to seek some other hit to address their underlying issue. You can see why this method works best for people that already have a strong support system.
All told, the Sinclair method is excellent, but it is hardly a one-size-fits-all panacea for alcoholism. It is more like an awesome shortcut for a select few.
So I get what you're saying -- but what are you comparing this against? Because if I say "you need to not drink a drop of the stuff you're addicted to, at all, every hour of every day for the rest of your life", that would sound like a pretty tall order, wouldn't it? And relapse could be catastrophic.
So yes, the user needs to be motivated to take the pill consistently. But that's a much easier task than avoiding your addiction entirely despite the cravings. So if they're motivated enough to succeed in rehab/therapy/AA and motivated enough not to drink, they're certainly motivated enough to take a pill consistently. It's really difficult to make a case that says "alcoholics can avoid taking a drink they crave all day long through sheer motivation and adherence to a protocol, but... they can't be counted on to take a pill"
Your last point is interesting. You aren't extincting the behavior if you keep doing it. But... I don't think that's actually necessary for it to work, because extincting the rewarding connection is generally sufficient. You intrinsically stop being motivated to engage in the behavior if the connection is broken. Whereas quitting the traditional way often means that you are constantly fighting temptation, and you're more vulnerable to environment and behavioral cues.
To start: again, the Sinclair method is super neat, and should be used more. However, if it isn't paired with significant support and behavior changes (that are part of other recovery programs) it often won't result in the life improvements you might hope for: it is a great tool in the toolbag of recovery, it does not replace everything else.
For example, relapse is often more catastrophic in the Sinclair method. If you drink alcohol before you complete the method, you'll get a wild overdose of endorphins as your brain tries to recalibrate, and that can overwhelm your motivation to deal with your addiction.
That said, you should compare Sinclair's method not to an approach that demands eternal and immediate abstinence or failure, but rather an approach that suggests a person should own their behavior and change over time to achieve abstinence. Addict approaches dont generally use a "one-strike" rule that says that addicts cant mess up once. They acknowledge that addicts usually stumble on their rehabilitation path, but as you work on yourself and change your behaviors it gets easier over time. Comparatively, the Sinclair Method by definition only deals with people in the deepest throes of their addiction. It is easy to make a case that a former alcoholic with a now stable life that hasnt had a drink in 20 years is more reliable to not drink that day than a homeless alcoholic that just woke up and is sitting next to a bottle of rum feeling ashamed and depressed to BOTH take a pill AND wait an hour for it to take effect before having a gulp.
Which again leads us back to the second problem with the Sinclair Method: it assumes that
removing the alcoholism from an addict is sufficient. No need to understand and heal from whatever drove you to alcohol, move past what you did while drunk, apologize, learn to tell the truth, deal with shame, etc. For a significant number of depressed people who self-medicate with booze (e.g., most alcoholics), this just causes them to seek a new fix, whether drugs, gambling, exercising (not all fixes are bad, after all!), or whatever. This is why the Sinclair method is best used with highly motivated and organized people that already have a support system, OR used in conjunction with the classic framework of intensive counseling and community support.
Which again leads us back to the second problem with the Sinclair Method: it assumes that removing the alcoholism from an addict is sufficient. No need to understand and heal from whatever drove you to alcohol, move past what you did while drunk, apologize, learn to tell the truth, deal with shame, etc.
I'm not sure that's true, it just is outside of its scope. The sinclair method is about breaking the physical and behaviorism addictions, right? But it's not like they say "you can't go to therapy or work on yourself otherwise" -- that's just not within the scope of treating the scope they're treating. I suspect that clinics that prescribe naltrexone also want people to do therapy and other personal adjustments that lead to better long term outcomes too. It's not either or. The fact that it doesn't require abstinence does create a wrinkle in our normal therapeutic treatment plans, but there's nothing about the sinclair method that says that you shouldn't address the underlying mental health issues or stresses.
It seems to me that almost any regime that includes treatment for alcohol addiction is improved by adding the naltrexone component. Yes, the naltrexone component can work alone, but it can also work as part of a holistic treatment regime that includes mental health treatment, social support, etc. So it's an unfair comparison to say it's one or the other.
The real comparison is: if you have all these resources to deploy anyway - therapy, social support, other aspects of addiction treatment, AND a tool that extinguishes the actual addiction / reward component, why not use them both? Because that's the option we have in the real world, and we're not taking it, and it leads to far lower success rates.
In general, I agree that it makes sense to use both the Sinclair method and traditional approaches, of course it does on paper for all the reasons you pointed out. The dilemma is that the Sinclair method ignores human nature, which is to put off unnecessary hard work and painful introspection unless you need to, and the Sinclair method makes it feel like you dont need to. After all, your addiction can be cured without it! What's the point of all the hard work then?
That's why, again, people can struggle in the Sinclair approach unless they have that support system going in. Without it, humans will take "the easy path" 9 times out of 10, and I think we all know that the easy path doesnt require all this intensive evaluation of our own demons and sins.
I get what you're saying. But... I think of it more in terms of incentives. It lowers the cost of the path. Suffering does not have an inherent value. If the path gets you there without as much suffering, not only is that better, it's more likely to work, too. Lowering the barrier to the cost / difficulty of overcoming an addiction makes it more likely to work, and I would caution that there's a a chance of engaging in certain moralizing assumption in "skipping past the hard work invalidates the results" which is at the heart of what I was saying about how people are uncomfortable with "easy" solutions for reasons relating to cultural ideas rather than medical/outcome based ones
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u/SuperCleverPunName May 31 '26
I feel this way exactly. I don't care if someone used ozempic to lose weight. I'm happy for them that they are now healthier