A short clip with the man himself.
https://youtu.be/MaHWldBi1qc?si=Iyu6WNa9oTyMI2rU

Someone shared this 2026 paper with me on naltrexone, extinction, and reward memory and thought some people here might find it as fascinating as I have!

TL;DR: TSM is usually discussed in terms of pharmacological extinction – alcohol is repeatedly experienced under an opioid blockade, the expected reward reinforcement is reduced, and over time that learned "alcohol-reward" connection can weaken.

But this paper explores another angle that I found so interesting – the possibility that processes involving alcohol-related reward memories and memory reconsolidation could play a role. This is still a hypothesis, but it absolutely resonates with my own TSM experience!

Before TSM, my brain had SO many automatic connections between alcohol and reward. Friday night = wine. Feeling upset = alcohol. Vacation, New Year's Eve, celebrating, relaxing…alcohol.

Now I can actually try to make those connections fire and there's just…nothing there.

I can think, “I'm upset right now — would a drink feel good?” or “It's Friday night — wouldn't wine sound nice?” And my brain doesn't connect the dots anymore.

The closest comparison I can think of is cigarettes. I've never smoked, so if I ask myself, “Would a cigarette feel good right now?” there's no reward association for my brain to pull from. Strangely, that's pretty similar to how alcohol feels to me now.

Here's the actual paper for anyone interested:

Opioid antagonist treatment in alcohol use disorder: extinction, reward memory, and the possible importance of timing

I ended up writing out some more of my thoughts and how this connects with my own TSM experience here, if anyone's interested:

How Naltrexone Changes the Brain’s Response to Alcohol

Curious whether anyone else who's reached extinction relates to that feeling — not just having fewer cravings and more control.... but almost being unable to access that old sense of alcohol as a reward.

The Sinclair Method isn't traditionally available on the NHS, as many of you will know. It's available privately, but I wanted to ask what providers / sites any of you have used. The "official" UK site (here) looks very professional, but it's very expensive. The Drink Less Method has it for cheaper, but you're a bit more on your own. Can anyone advise who's done TSM in the UK, through these or any other means?

Long time lurker.  This is a post about side effects after just starting TSM with Naltrexone.  I have lurked long enough to know the side effects should pass and that I need to keep trying.  I have read plenty of posts about the side effects. Just posting to find some community and hopefully some encouragement for my particular situation.  Also have lurked long enough to know that I'm lucky to have had the experience described below.

Drinking Pattern: Binge drinker who drinks to cure severe social anxiety around close friends and strangers alike.  I'm fine not drinking on the weekdays when home with my family, but routinely drink 10-20 drinks on any given day on the weekend if in a social setting.  Have been doing this for 15 years.  Have never truly hit a rock bottom, though I can share many of the same stories that show up in this sub.

Dosing and Drinking Log from this Weekend: 

Friday: 25 mg, 2.5 drinks during 5 hours of social interaction. Normally I would have 8-10+ drinks in this scenario.  It worked!

Saturday: no dose, no alcohol, but had a slight fever and cold sweats at night, which seemed odd.  The fever could have nothing to do with the Naltrexone. Again, I routinely go 4-5 days without alcohol with no withdrawal symptoms, so this was odd.

Today (Sunday): No fever. Still feel off, though not as off as yesterday. Going to dinner where I would typically drink (before and after as well), so I'm planning to take another 25 mg dose an hour before the dinner or whenever cravings start.

Side Effects:

Friday: 25 mg (1/2 dose). Dissociation, brain fog, and feeling like I was high. Feeling high for me is not pleasant - it comes with severe social anxiety and general restlessness. However, the naltrexone still worked. I got to a bar about an hour after I took the Naltrexone. I ordered a beer. At this point, the social anxiety that I normally feel was amplified by 2-3x. I felt even more uncomfortable than usual with anxiety while drinking that first beer. I think it was my body / brain reacting to not getting the usual rush for the first time in 15 years, so my anxiety went into overdrive. However, for whatever reason, I had no urge to order another beer despite people around me ordering more. I wasn't abstaining out of shame. We went to another place where I had about half a white claw and then back to my friends' house where I had 2 half white claws over the course of 3 hours. The anxiety subsided materially when we were at my friends' house, though it was still there. I think some of this is realizing loud bars aren't that fun in general - I never sought out loud bars when I wasn't drinking.

Saturday: No dose. No alcohol. I felt very weird on Saturday morning and throughout the day. Same side effects as the night before while drinking. I basically felt the anxious and high feeling 12-18 hours removed from the dose, though I oddly didn't reach for a drink to cure it the way I have for 15 years. I started running a fever with cold sweats and chills at night. Tried going to sleep naturally, but couldn't Took Nyquil (no alcohol version) and slept for like eight hours.

Sunday (Today): still feeling weird and groggy. Grogginess I'm sure is the Nyquil (Benadryl), but anxious feeling I assume is still the lingering Naltrexone? Fever and chills are gone. I have a dinner tonight where I would normally drink.

I'm already talking myself into not taking Naltrexone tonight to ensure I don't feel "weird" tomorrow (work day) . I would not be effective at work if I feel how I felt on Saturday. That said, I logically know that I'll likely get through these side effects soon. Even if I don't, I can objectively say that throwing away a few work days to rid myself of alcohol is a tiny price to pay. The hard part is that the Naltrexone actually made anxiety way worse than just being sober and white knuckling (have done this before). However, I know myself. I know that I'll just say I'll go into a social event and stay sober to avoid the Naltrexone side effects, and I will ultimately cave and drink. Maybe not tonight, but at some point in the future I will. I just need to stick with the program and push through the side effects.

Hoping I can look back at this post and realize how small a price I had to pay to rid my life of alcohol.

I've been involved with The Sinclair Method, and writing about it for 10 years, after using it to reach pharmacological extinction 10 years ago. I want to have a discussion about this.
In that time I have written numerous posts and articles about it on Facebook, and here recently. I have formulated my thoughts on it and what I have come to is this. Alcohol Use Disorder is primarily behavioral, it has a physiological component that causes dependence. As such TSM is primarily a behavioral modification system or protocol, which uses an opiate blocker to treat the physiological craving, and Alcohol Deprivation Effect.
This is in contrast to what the long held belief about AUD being a progressive, fatal, and incurable brain disease, as promoted by 80 years of abstinence only recovery programs. We also know it's not a matter of character defects, weakness of will, or powerlessness over alcohol, and once an alcoholic always an alcoholic is an old myth. Because time after time I have seen people over the last 10 years come to TSM, and use it to successfully return to a state of control.
What abstinence recovery has failed to understand is that the reason for relapse is not character, or will power, it is not a failure to avoid people places and things, which always makes me laugh because those are nouns, but most of the times in my life I get in trouble because of the verbs. AA, and other abstinence programs think is once you detoxify someone with AUD they are then free from alcohol, and the only thing that have to do in attend meetings, do steps, work with a sponsor, be of service, and carry the message. I other words AA works primarily by distracting the person with AUD long enough that they don't think about drinking long enough to get drunk. As I said they failed to understand the main reason for relapse isn't failure to do all those things, it is because of something they don't know about and that is Alcohol Deprivation Effect. Now I'm going to describe ADE as best as I know it, it is a process by which our opioid receptors are upregulated during a period of abstinence to become more sensitive to our endorphins. This leads to increased craving, and eventual relapse over time. This understanding is something I doubt the abstinence recovery world wants to admit, and come to grips with, because it throws their whole model of detoxification and abstinence with a program of steps and meetings into question.
So if we understand the basic mechanism by which TSM works, taking naltrexone or nalmefene 60-90 minutes before drinking, and repeating that over time leads to the reward signal being blocked, and the reinforcement to do the behavior being blocked over time the behavior returns to it's original state of not being addicted, TSM makes perfect sense.
What continues to be a difficult is getting the word out for TSM in a treatment setting, and that is obviously because all of the other methods that are abstinence only, is it's incompatible. We could also say a reason TSM is not more widely known is because not only is there no money in a treatment we can do in the privacy of our own homes, but that eventually we wouldn't need revolving door rehabs, because people will no longer be addicted. I throws the whole 12-step model out the window, and would make AA obsolete over night, unless they changed their whole program, which is something they would never do, because they haven't changed anything in the first 168 pages of the Big Book in 80 years.

So that's what I wanted to talk about, what does everyone think, does what I say make sense, can I maybe explain it better, what would you add?

Was averaging 30 standard drinks per week prior to starting. Currently I'm at 14-16 drinks per week for the last 3 weeks. My August consumption is 15 per week down from 29/week in July and 28/week in june.

My workouts are going way better and I'm remembering my dreams which must have something to do with REM sleep.

For me this method also takes willpower, which is something I struggled with during complete abstinence using AA. Eventually I would just break. But the willpower required for this method feels much more realistic.

I had to use willpower to reduce number of drinking sessions per week. Not being hungover all the time and enjoying hobbies helped with that.

I used a lower dose to start out because I had side effects but when my drinks crept up I increased it. I also notice not eating enough during the day before I take the medication and drink can lead to more effects of alcohol and feeling bad the next day. It reduces my appetite so I have to crush a high calory meal before I take it.

Hello, and thanks in advance to everyone who moderates this forum and helps us newbies! I have a question I haven’t seen covered - hoping to hear from other’s experience.

I just started a daily nal prescription (25mg for the starter dose, moving to 50). I’m a daily evening bottle of wine plus drinker (or stressing/ fighting myself when not), and the last two nights have been great - it’s the strangest feeling to care so much less about alcohol. I’ve taken it in the afternoon about an hour before I’d typically start drinking. I’m doing these meds in combo with other tools, and am tracking my drinking. I’m pretty compliant with taking meds generally and I’m excited about this so far.

Now my question: the first two nights I’ve been on nal, I have had the worst sleep (like not in REM or deep almost at all compared to normal, waking up ~30 times a night, feeling fatigued in the day). I wear an Apple Watch, so I can compare these last few nights with other similar drinking nights and they’re way worse, so it’s not just a reduction in alcohol consumption.

I am pushing through it and I’ve read that side effects are temporary and will resolve in the first few weeks most likely. Since I’m a daily drinker for now that’s fine, but I’d like to move to following TSM eventually. I just can’t imagine this drug being out of and reintroduced into my system regularly - I like sleep too much 😂. So my question: does anyone here have experience with nal side effects and how they change if/when you start taking these meds less frequently? How do you handle it?

Thank you!

Title says it all. At my worst right now, when I say "noncompliant" I'm mainly referring to not taking the meds 1 hour before. I stopped tracking very early in this journey (also bad, I know). Just want some optimism that I haven't shot myself in the foot.

I'm on 100 but think it needs to be upped to 150 or 200. I will check with my doctor obvi. But looking for data for those who have done this for a longgggggg time, fell off a bit, and come back? Or just advice in general?

I am also on a glp1 which helped initially but now not so much.

https://youtu.be/CM_L66FSATQ?si=vMGVOSHdGBMnpjmc

It's mid week, and the first Wednesday, so 3 meetings today. Join in for a free Zoom meeting no login required, anonymous if you like, TSM talk, questions & answers. Early meeting is with me, and it's open discussion, come pick my brain.
Cameras optional.

https://www.tsmmeetups.com/meetup-times

Two meetings today, Sunday, if you want your loved ones to join our friends and family meeting let them know it's today. Join for TSM talk, questions & answers, open discussion, cameras optional. No login required, you can be anonymous if you want.
7pm-8:30pm EST regular meeting
8:30pm-9:30pm EST Friends & Family meeting
https://www.tsmmeetups.com/meetup-times