Alcohol is currently the fourth-highest preventable cause of death in the United States, responsible for prematurely ending the lives of approximately 62,000 men and 26,000 women each year. Despite this, the most common treatment for alcoholism is still, essentially, little more than complete abstinence and group therapy. Surely, there’s a better way?
For some people, there is: Naltrexone. A controversial treatment because it still allows the patient to drink, it forms the basis of what’s known as the Sinclair Method, a system for tackling alcoholism developed by addiction specialist David Sinclair.
It works like this: Any time the patient wants to have a drink, they take a pill containing Naltrexone, an opioid blocker, one hour beforehand. This essentially shuts down the brain’s reward pathways, so the immense rush of reinforcement that would normally accompany that drink — in the brain of an addict, at least — is almost entirely absent, along with the compulsion to drink more. The end result is, in ideal cases, an almost immediate end to the devastating cravings that ordinarily would derail any attempts for an alcoholic to quit. The downside is that, theoretically, you would need to take this pill indefinitely (assuming you wanted to keep drinking). But since the Sinclair Method claims an 80 percent success rate in treating alcohol addiction (compared to between 5 and 1o percent for more traditional programs), many would consider it a fair trade.
Following Sinclair’s death in 2015, his work has continued to be championed, most notably by actress Claudia Christian. Perhaps best known for her role in the long-running show Babylon 5, Christian battled alcohol addiction for years before discovering the Sinclair Method. Astounded at the results, she’s since dedicated her life to bringing it into the public consciousness by producing a documentary on the subject; starting her own nonprofit dedicated to treating and counseling those with alcohol dependency issues; and giving a TEDx Talk about her experience.
I recently talked with Christian about why the Sinclair Method is still relatively unknown, what its acceptance might mean to traditional rehab and 12-step programs and whether the method’s critics might actually have a point.
As the Sinclair Method’s most visible proponent, you’ve obviously had great success with it in terms of battling alcohol addiction. What was going on in your life when you first encountered it?
Back in 2009, I suffered one of the worst relapses I’d ever had. I didn’t know how dangerous it was to go cold-turkey — I stopped drinking and started to go into a bad, seizure-type withdrawal. I was afraid I was going to stroke out, so I called a doctor and they took me to a medical detox, which was probably the most horrific medical experience of my life. The people were horrible and very uncaring and cold. I checked myself out after about six hours.
On my way out, I saw a little pamphlet for Vivitrol, which is a shot that costs $1,000 a month. I thought, At this point, I’ll try anything. But the detox center wouldn’t return my calls to set up an appointment, so I Googled this shot and found that the active ingredient was Naltrexone. I searched to see if I could just buy it, and lo and behold, Dr. Roy Eskapa’s book, The Cure for Alcoholism, came up. I ordered the book, and I immediately realized that this was for me. I come from a family of doctors and scientists, and it made complete sense.
I called my doctor, but he refused to give me a prescription for Naltrexone because he didn’t know about it. Even though it was FDA-approved for alcohol use disorder, he wouldn’t do it! So I ordered it online from India, which meant it took three months to get to me. The night it arrived, though, I tried it and drank, like, half a glass of wine. Just like that, I discovered that more wine didn’t interest me at all.
And that was that? You were, for want of a better word, cured?
Well, the first three years were glorious and easy, because I was very disciplined about my compliance. I was just crazy fastidious; I would take my medication everywhere. Then I had a couple of bumps in the road, when I got cocky and thought that I didn’t need it. That wasn’t good. I learned my lesson in that regard. It was actually good at the end of the day, because I can now tell people how important compliance is — not to screw around with it and not to take it lightly. Taking the pills is a lifetime commitment if you decide to continue to drink.
I knew I had reached extinction — the day when you wake up and you realize that you haven’t thought about alcohol in weeks — when I drove by a billboard that used to trigger me to want to drink. It was a picture of a steak and a big glass of red wine, which was my poison. Every time I drove by that billboard, I used to think, I’d love a glass of wine. But this time, my brain just said, “That’s a billboard.” There’s no other way to explain it. It was a completely standalone moment in my life when I realized, “I’m over it.”
What was your reaction to that?
I pulled my car over and wept. I’d been suffering for so long, and I’d ruined so many relationships, as well as my own body, my sense of confidence and sense of self. Alcoholism scared the hell out of me. It’s frightening; it’s like having an alien in your body, like somebody else is controlling you. So in that regard, I just wept with relief. I was so happy it was over: Finally, I could have myself and my life back.
How much do you drink now?
I go months and months with no drinking. When I go back to London and go out with my friends, I definitely have a pint. When I do sci-fi conventions, I’ll go out with the actors and have a drink or two. I don’t drink at home, really. Also, being an actress, there’s vanity — you can’t look puffy. So I would say maybe a couple drinks a month at this point — three or four months of sobriety, usually, and then I’ll go out with a friend.
So one major benefit to this is that it allows people who are in all other respects sober, to have a social life?
Yes, that was horrible. The times when I’d get sober before finding the Sinclair Method, I was judgmental and bitchy. When I’d be in social situations, I’d be like, “Look at her, she’s loaded.” (Laughs.) I was like one of those ex-smokers; I just wasn’t fun to be around. I was holding all this resentment and anger inside of me.
The hook to your documentary is, “What if everything you’ve ever been told about alcoholism is wrong?” For you, what are the biggest misconceptions people have?
That alcoholism is a moral failure — that it means you’re a bad person and that you’re weak. I don’t believe any of that is true. As Dr. Sinclair said, “I’ve never met a bad rat.” And he had a whole stream of alcoholic rats! The moral issue comes from a society that had Prohibition and that’s been reliant on the 12-step program since the 1920s. It’s 100 years of a very conservative, abstinence-based message.
Despite how well it’s worked for you and others, and despite, as you say, it being approved by the FDA for the treatment of alcohol addiction, Naltrexone and the Sinclair Method are still relatively unknown. Why do you think that is?
Because there’s no monetization of it. Rehab is a multibillion-dollar industry in this country — it’s becoming an investment for investment bankers and so forth because it turns around so much money. It’s a revolving door. People go more than once and pay $1,000 to $2,000 a day. So when I say, “You can offer the Sinclair Method for free — apart from the cost of the medication),” of course they’re not going to be interested, because I’m cutting into their business.
Plus, people and institutions are incredibly resistant to change. I understand that telling somebody with an alcohol problem to drink is an extremely difficult thing to wrap your head around, I get that. I always said it would take 10 years to really reach people, and right now, I’m in my fourth year of running my nonprofit. So I think it’s just going to take a little more time.
Continued alcohol use does seem to be one of the more prominent criticisms of the Sinclair Method, the suggestion being that allowing an alcoholic to drink at all, in any amount, is inevitably going to lead to a full-blown relapse. Is that a valid concern?
My counter to that is, how well is abstinence working for us? Is the death rate for alcoholism going down? No. Are rehabs having more than a five percent success rate? No. Does Alcoholics Anonymous claim more than five to ten percent success rate? No. I personally have a nearly 90 percent long-term success rate with people on the Sinclair Method. The clinical trials prove 78 percent long-term success rate. One hundred and twenty clinical trials worldwide prove the efficacy. So do the math!
Taking somebody out of their job for 30 to 90 days and sticking them in a glorified home with Tai Chi, yoga and green juice isn’t going to fix their addiction. Once they get out in the real world and there’s a bar at every corner and their friends are partying, they’re going to relapse. That’s because these places are fancy versions of 12-step treatment, which isn’t really treatment; it’s just talk therapy and working these steps that some guy in the 1930s wrote. It’s antiquated and barbaric, and quite frankly, it’s not effective for the majority of the people who try it.
Moreover, I just don’t understand why people would spend their time denigrating a treatment that’s clearly saving lives. What benefit are they getting out of that? It’s not helping AA; it’s making them look mean-spirited. I’m not denigrating AA; I’m in love with a man who goes to AA every week. I have nothing against it. All I’ll say is — and I state this very clearly — it didn’t work for me. I’m not putting it down. I’m just saying that it didn’t work for me.
Can you talk a little more about your own experience with AA?
Let me preface this by saying that I’m all for anybody getting better however works for them. But for me, I felt it denigrated the addict. If you relapsed, you were the failure, not the program. And I don’t believe that: I believe that the program failed the individual, the individual isn’t failing the program.
The other thing is that some people go to a meeting every single day for the rest of their lives, but I didn’t want to keep standing up and saying, “I’m an alcoholic.” I wanted the alcoholism to be gone. It’s like, if I had cancer, I wouldn’t want to go around for the rest of my life saying, “I’m a cancer survivor. I have cancer!” I’d be like, okay, that’s a part of my life that I want to close the book on, and I’m healthy now. I wanted to be able to stand up and say, “I’m Claudia, and I used to be an alcoholic.” That was my goal — to be able to say that I used to have a drinking problem and now I don’t.
I just never felt that AA was helping in any way, shape or form. In fact, when I did go to meetings, it would trigger me to want to drink, because it was just so boring, repetitive and negative. And let me say this again: I have nothing against it — it’s helped lots of people. If anything, I believe in my heart that the Sinclair Method and AA would be a wonderful combination because people could meet sober, like-minded people. [With the pills] they won’t have cravings and won’t be white-knuckling — they can actually listen to the meeting and make friends.
That’s the thing, when you’re consumed with the thought of alcohol and drinking, you can’t listen to your therapist, your psychiatrist or AA speakers, because you’re thinking about drinking, or not drinking. So why not have people get rid of the cravings, and then work on themselves? It just makes sense to me.
You’re saying, basically, that there’s a better way to do this.
There are combination therapies: Some people on the Sinclair Method don’t need a psychiatrist, while other people are in desperate need of one. Some people are strictly biological addicts: They take the pill, they’re done. I had one fellow who was on it, and he hasn’t had a drink in four years. He killed his addiction and didn’t need any therapy or anything else. He’s been happily sober, and he’s had no cravings — nothing. That’s an ideal situation. On the other hand, I’ve got other people who’ve been on it for nine months and they’re still having heavy drinking days.
Everybody’s physiology is different, and everybody’s genetic makeup is different. Some people absorb the pill faster than others. It’s a myriad of things. There isn’t one treatment that’s perfect for every single person. That’s why I advocate for options. That’s the most important thing to me, that people have options. Because I know personally I tried everything I thought was available, and nothing worked until I found the Sinclair Method.
Nick Leftley
Nick Leftley is MEL's senior editor, or something like that, it's not entirely clear. He writes and edits stuff, and has been doing so since print magazines were actually a thing. He smells pretty good.
