AMA VICDOC_Spring 2026_09.09.2026 - Flipbook - Page 22
"For most people accessing treatment,
A person only takes a tablet on days that
there's the presumption that they want or
they plan to drink – one tablet, an hour
should want to become a teetotaller. But in
before a first drink. Naltrexone blocks
a world where you can't walk down the
the opioid receptors in the brain that are
street without being inundated with signs
activated by the endorphins released when
and images glorifying alcohol, and where
alcohol is consumed, helping to reduce
alcohol is legal and available, that's a
cravings and the urge to drink. An hour
difficult treatment goal to achieve. We see
down the track, when the person has the
a lot of people who try complete abstinence
fail,” says Dean.
"For some people inpatient withdrawal is an
important component of their treatment
plan. However, when people access our
AOD system it seems to be routinely offered
as the default treatment, often when there
aren’t even clear signs of physiological
dependence. When that treatment doesn’t
work for them and they relapse, there is a
great sense of personal failure. This sets up
a cycle of shame and guilt, which can lead
to disengagement from treatment.”
first drink, they no longer experience alcohol
as rewarding. Not a drinking day? No tablet.
Over time, the pleasure response and
craving for alcohol are extinguished. Alcohol
loses its appeal, and the brain learns to
create new reward pathways.
Paul and Dean have found that most
patients report a positive change within
days or weeks, often including a significant
reduction in their drinking. Over following
months, drinking tends to continue
to reduce and, with the right first-line
pharmacological suppor t in place, many
manage to sustain abstinence.
Naltrexone and the
Sinclair method
The colleagues are in favour of the Sinclair
method, a protocol for targeted use that
doesn’t just allow someone to continue
method, as people get less reward from
drinking, they drink notably less. Eventually,
they reach the point where their relationship
with alcohol is normal, or non-existent,”
says Dean.
drinking alcohol at the beginning of
“For people who have a genetic
treatment – it depends on it.
predisposition to alcohol, drinking can
Named for Dr John Sinclair, an American
researcher working in Finland, the Sinclair
method recognises problematic drinking as
a learned behaviour and retrains the brain's
response to alcohol through the targeted
naltrexone use.
Here’s how it works.
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“Over weeks and months using the Sinclair
trigger a reward pathway mediated by
endorphins in the brain. Naltrexone taken
prior to drinking blocks this pathway.
The reward is reduced and each time this
occurs the pathway developed in the brain
becomes weaker. Around 50-70% of
people who take naltrexone in this way
will dramatically reduce their drinking –
and their desire to drink.”
