This New Year’s, millions of people will decide that this is it. This is the year they will finally quit drinking for good.
A few of them will actually do it. But for others, quitting drinking isn’t just difficult, it’s nearly impossible.
Katie Lain was one of these people. Lain, now 35, realized she had a drinking problem in 2011, while sitting on a beach in California drinking a warm vodka and Diet 7UP. She liked to drink cocktails while tanning and would often end up passing out and leaving the beach with a nasty sunburn.
On that particular day, she says, “It dawned on me that I couldn’t even remember the last day that I hadn’t had a drink. It had been more than a year, but I honestly couldn’t remember it.”
The realization scared her enough that she decided to take a weeklong break, but it wasn’t easy. She took sleeping pills to get through the night and wondered how people tolerated life sober. Once the week was over, she returned to drinking just like before. It was the first of countless breaks and sobriety attempts, but no matter what she tried—from AA meetings to 30-day challenges, workshops, cleanses, and spiritual retreats—she could not seem to quit.
It got to the point where she was hiding her drinking from her husband, nipping into the kitchen to take sips of whiskey or vodka she’d hidden in a cabinet behind vitamins and supplements. She also kept a stash in her car.
Like most people, Katie assumed that the only path out of Alcohol Use Disorder (the preferred term for “alcoholism” these days) was abstinence. Once an addict, she thought, always an addict. But despite the ubiquity of the abstinence-only model and programs like AA, millions of people try it each year and fail. Some studies show that AA has a long-term success rate of between just 5 to 10 percent. Of course, AA has helped countless people quit drinking and has saved an unknown number of lives, but for the vast majority of people, including Katie Lain, it just does not work.
Katie struggled to quit for years, but even when she could manage to take weeks or months off, she was consumed by her desire to drink. The longer she went without, the more that she wanted it, and she knew in the back of her mind that she would eventually relapse. She prayed for a rock bottom so that something would finally force her to quit. It’s a type of disordered thinking that is common among alcoholics—I’ll just wait until I need a liver transplant, then I’ll really quit. But despite the hangovers, the lost hours, and even a near-DUI, that rock bottom never came. She just struggled, secretly and miserably, on her own.
And then Katie stumbled across a little known treatment that upends all conventional wisdom about alcoholism. It’s a treatment that would change her life—and, if it were more well known, could change lives for the millions of people who struggle to control their drinking.
In 1972, an American scientist named John David Sinclair moved to Helsinki to work at Alko Laboratories, one of the top research facilities for alcohol abuse in the world (and now a part of Finland’s National Public Health & Welfare Institute). Sinclair knew all about the success rates for rehabs and abstinence-based programs, and he went to Alko with a bold idea: It was possible to find not just a more effective treatment for Alcohol Use Disorder, but a cure.
At Alko, Sinclair began to test his theory on rats, but the fundamental premise comes not from rats but from dogs: Pavlov’s dogs, in particular. Ivan Pavlov, famously, conditioned dogs to salivate at the sound of a bell that signaled feeding. After a while, the bell alone would make them drool. But less often discussed is what happened to Pavlov’s dogs next: If he repeatedly rang the bell without rewarding them with food, eventually, the drooling would stop. It’s a sort of reverse conditioning, or what scientists call pharmacological extinction.
Sinclair wondered if this same effect could be achieved with alcoholics because he’d realized something important during his studies: If he gave rats alcohol over long periods of time and then took away their access to it, when given access again, they binged. Abstinence seemed to make their cravings grow not weaker but stronger.
Sinclair called this the Alcohol Deprivation Effect, and it explains why it is so difficult to stay sober after a period of abstinence—and why the prospect of abstinence is so daunting for some drinkers. This feeling is probably familiar to any addict. You manage to stay clean for days or weeks or even months or years, and then, well after the alcohol is out of your bloodstream and any physical dependence has waned, the cravings are back, stronger than ever. This is exactly what Katie experienced each time she tried to get sober, and the stronger the craving, the harder it was to resist. Satisfying it becomes a compulsion, one that, under the abstinence model, the only choice is to fight. Addicts call this internal battle white-knuckling it.
Realizing that abstinence actually increases the desire to drink, Sinclair had an idea. What if there was a way to stop rats (and then people) from getting the expected reward from alcohol itself. Would they then lose the desire for it?
To test this, he gave rats that had been bred over generations to like alcohol an opioid-blocker called naltrexone before they drank. That way, when they consumed alcohol, they wouldn’t get the high, the euphoria that keeps people (and rats) coming back to the bottle.
After just five sessions, all but one of the rats abstained if given the choice to consume alcohol or not. They’d reached extinction. The behavior, once learned, had been unlearned. The drooling had stopped.
But could this translate to people?
In short, yes. Of the first 147 human subjects tested at Alko Laboratories in the late 1990s, 115 significantly reduced their drinking over just three months if they strictly followed the protocol, or what’s now known as The Sinclair Method. Since then, these findings have been replicated in clinical trials.
The Sinclair Method is simple: Take an opioid blocker (typically naltrexone or, in some places, nalmefene ) at least one hour before drinking and then proceed to drink as normal. Gradually, the blocker retrains the brain not to expect the reward associated with alcohol and so the desire to drink is either greatly diminished or entirely stops. And the success rates are shockingly high, especially compared with abstinence-based programs like AA: Nearly 80 percent of people who follow the protocol see major reductions in drinking. They are able to do something many clinicians and doctors think is impossible after addiction: control their drinking. They are able to drink like non-alcoholics.
For some, that’s the goal—control. They want to be able to have a glass of wine with dinner instead of the whole bottle. Others get entirely sober, including Katie Lain, who hit extinction after nine months and has now been sober for four years. She’s such a believer in TSM that she changed careers and founded Thrive Recovery, a coaching and support service for people doing TSM. People, that is, just like me.
Drinking came naturally to me. I’m almost 40 now, but I started drinking in high school with lukewarm bottles of Zima, the beverage of choice for girls and gays in the late ‘90s. By the time I was out of college, I’d moved onto beer and liquor and was a full blown barfly, parked at the bar before dark. At some point, I was no longer drinking because it made me feel good but because not drinking made me feel awful. Like Katie Lain, I could not imagine how people would stay sober or why they would want to in the first place.
I finally realized the extent of my problem in 2007 after being fired from another job and destroying another relationship. I knew that if I didn’t do something alcohol would eventually land me dead or in jail (maybe both). Yet I just could not seem to stop.
I spent 15 years living like this, bouncing through 12-steps and SMART Recovery and talk therapy and Moderation Management and weekly group sessions where I learned to make prison wine from someone who had just gotten out. (Get a Honey Bun and some orange juice from the commissary, mix together in a plastic bag, let it ferment until it has the approximate smell of baby poop, and enjoy.)
I read all the quit lit and followed all the recovery accounts and listened to all the podcasts and every morning that I woke up with an ache in my head and a mouth that tasted like something had died in it, I told myself that it was over. This time, I meant it. Then my hangover would fade and my cravings would kick in and I’d just have one drink, just one, and before I knew it I would wake up pissing in my own backyard. This actually happened. Twice.
I repeated this cycle over and over. The worst part wasn’t the physical symptoms of alcohol dependence—the shakes, the nausea, the ache in my side that I’m pretty sure was my liver—the worst part was mental. I thought about drinking constantly. It absolutely consumed my mind, clouding everything else out until I inevitably gave in. Then I would wake up at 3 AM, racked with shame and regret, and spend the next morning googling how to get sober.
It was during one of these endless internet searches that I ran across an Atlantic article about The Sinclair Method by Gabrielle Glaser, the author of Her Best-Kept Secret: Why Women Drink—And How They Can Regain Control. While Glaser herself didn’t have a drinking problem, she ordered naltrexone online just to see what it was like. (Her doctor refused to write her a prescription just for an article). She says it made a second glass of wine seem as appealing as a glassful of Dimetapp. That’s what I wanted—to look at a second drink and think, I’d rather not. I was skeptical, but realizing this may be my last hope before I would have to sell a few lesser organs to pay for rehab, I decided to give it a try. The worst that could happen is that it would work.
Naltrexone was not hard to get. I just asked my doctor. She had never heard of The Sinclair Method but was familiar with naltrexone, which has been FDA approved to treat both alcohol and opioid abuse for decades. The problem, however, is that it’s only approved in conjunction with abstinence. So, if taken as prescribed, the patient takes a pill every morning and then doesn’t drink. This, however, is just not that effective. It’s also not The Sinclair Method, which requires the patient to continue to drink while on the medication in order to reach extinction. In other words, you basically drink yourself sober. I knew this sounded akin to curing diabetes with donuts, so I decided not to tell my doctor that I planned to keep drinking on naltrexone. She wrote my prescription, no questions asked.
I started the protocol on a sunny afternoon last April, the kind of day when I liked nothing better than to sit on my porch with a drink. Normally, I’d have at least six drinks on a day like that, often more. But as soon as I took my first dose, my stomach started to feel queasy and a dull ache bloomed at the back of my skull, not unlike a hangover. By the time the hour waiting period was up and I had my first sip, my beer tasted like the last inch of a Michelob left under a stadium seat for a week. Still, I powered through it and finished most of my six-pack.
Over the first few months, I struggled with the side effects of naltrexone, which can include headache, nausea, exhaustion, sweaty feet, and, oddly, a compulsion to stretch. For most people, side effects are minimal and dissipate in a few weeks, but mine stuck around until I learned that microdosing naltrexone at night greatly alleviated the symptoms when I took a full dose. Still, it wasn’t always easy. Hangovers on naltrexone (also known as nalovers) are supercharged even when you drink less than normal. And there was a bit of a mourning period. I felt like I was in a long, slow breakup with a beloved but toxic partner, but when I didn’t feel like taking the pill, I reminded myself that the alternative was worse. I really did not want to wake up pissing in my backyard again. I don’t think my neighbors wanted that either.
Gradually, my consumption started to drop. I still had cravings, but the compulsion more muted. Drinking was just less pleasurable, like riding a bike with a flat tire. I still got drunk, but I didn’t get buzzed.
The pill was only part of the process: Katie Lain advised me to religiously track my drinks, to schedule alcohol-free days, and to form new habits and routines. She also said to find hobbies. This wasn’t easy either—I had spent so many years drinking that I didn’t even know what I liked.
Progress on The Sinclair Method isn’t linear and it’s common to have spikes in consumption. But as I tracked my drinks, slowly but surely, they trended towards zero. After four months, I had my first sober week. Then my first two sober weeks. Then my first month. And then, after eight months on naltrexone, when my partner invited me to a holiday party at a colleague’s house, instead of making some excuse so I could stay home and get loaded in peace, I said yes.
That’s when I knew it was over—if I would rather go hang out with my partner’s co-workers sober than stay home and drink, I was well and truly done with the demon that had plagued me since before I was old enough to vote. I was free.
If The Sinclair Method is so effective, why doesn’t everyone know about it? Why can I get better information about naltrexone from Facebook groups and YouTube videos than I can from my own doctor? This is the question that has been on my mind now for months.
The answer, according to Glaser, has a little to do with money and a lot to do with culture. Because naltrexone is a cheap generic drug, she says, there’s just no money on it. There’s no promotional push.
“Drug companies aren’t sending doctors to getaways in Fort Lauderdale to convince them to prescribe naltrexone,” she told me. “There’s no pen with the word naltrexone on it.”
There’s also the fact that widespread use of TSM could undermine the recovery industry, which was worth an estimated $42 billion in 2020 alone. One treatment program, Origins, claims to have “debunked” TSM on its website. I won’t speculate on their motivation, but if TSM were the first line of defense against AUD, it could put rehabs out of business.
But it’s not just about money. After Glaser wrote her article in The Atlantic, she received a surge of hate mail, including death threats from people who swore that this was all snake oil and AA, the one true path forward. AA has been ingrained in our culture for almost a century, and TSM goes against the basic principle that once someone is an addict, the only path forward is abstinence. And for some people, that works. AA offers something TSM doesn’t: accountability, community, fellowship, all of which can be hugely important in getting clean. While there are Facebook groups and online meetings for people doing TSM, it’s largely a solo effort. You just take the medication and drink. Some people need more than that, and they find it in AA.
But as Glaser pointed out, the gold standard treatment for opioid abuse isn’t talk therapy or 12-steps; it’s medications like methadone and suboxone. So why has society accepted that medication works best for opioid addiction but not for alcohol?
For one thing, it’s counter-intuitive, says Keith Humpreys, a drug policy advisor and psychiatry professor at Stanford. ”Most people, including the FDA, think of the purpose of medication as getting people abstinent. Some clinicians even think no one should go on naltrexone until they are abstinent, or they tell their patients not to drink when they are on it. But unlike meds like methadone for heroin, there is a benefit of using the substance while on the medicine. That's backwards to how most people think.”
Sometimes backwards is what works.
As of today, it’s been 70 days since my last drink. Since starting TSM, so much has changed in my life. I’m healthier, less depressed. I’m not having anxiety dreams about my liver and I haven’t woken up in a sweaty panic in months. I’m a better partner and worker, less distracted by the desire to drink. I’ve saved money and lost weight. I even, God forbid, started to jog. But the biggest change is mental: I’m no longer consumed by the thought of drinking, and for the first time since alcohol took over my brain, when I say that I’m happy, I actually mean it.
This New Year’s, my resolution isn’t to stay totally sober. It’s simpler: if the old itch comes back and all I want is to sit on my porch and drink, I’ll do it. But I won't do it mindlessly. I’ll take the pill, wait an hour, and then drink. Because Dr. Sinclair was right: A cure is possible. If only the world knew about it.