Alcohol can produce both psychological and physical dependency. In other words, you can become dependent on the psychological rewards that you experience when drinking alcohol, and your body can also become physically dependent on alcohol.
This is why you can experience unpleasant withdrawal symptoms when you have access to alcohol.
Because of the powerful psychological and physical effects of alcohol, it can be easy to become dependent on it. 38% of men and 19% of women in the UK aged 55 to 64 usually drank over 14 units in a week. 
If you are looking for a way to reduce or eliminate your alcohol dependency, there are several different options. Most treatments such as Alcoholics Anonymous promote an approach of complete lifetime abstinence.
In other words, in order for these treatments to work, you have to never have another alcoholic drink again. If alcohol is causing problems in your life and you want to eliminate it altogether, this can be a useful treatment option for you.
These treatments can be effective for many people, but if you have tried them in the past and they haven’t worked, or if you aren’t willing to never drink again, a different approach might be needed. 
Another option can be to use medication-based approaches that work to limit how much you want to drink, without you having to promise to never touch alcohol again. The most popular of these is the Sinclair Method (TSM).
In contrast to the abstinence treatment options, the Sinclair Method (named after its creator, Dr John Sinclair) encourages you to carry on drinking. In fact, if you want the treatment to work, you need to drink alcohol.
Of course, the goal of the Sinclair Method (TSM) isn’t to carry on drinking to excess. The goal is to reduce alcohol intake to a non-damaging level, or to no alcohol at all.
The core of TSM is to break the connection between alcohol and dependency to make you not want to drink. Sinclair proposed that alcohol dependency could work in the same way as Pavlovian conditioning.
When you drink alcohol, it releases endorphins in your brain. These endorphins then bind to opioid receptors, causing them to release dopamine. When a large amount of dopamine gets released, you experience a rush of pleasure.
Over time, your brain starts to make a stronger and stronger connection between alcohol and the feeling of pleasure, and this can lead you to become dependent on alcohol.
Once you become dependent on alcohol, you may start to feel discomfort when you don’t have an alcoholic drink. Drinking alcohol can reduce this discomfort, which strengthens the connection between alcohol and pleasure.
Drugs such as Naltrexone and Nalmefene (they are slightly different but work in the same way) are opioid antagonists. They bind to the opioid receptors which then blocks endorphins from reaching them.
Over time, as you drink but don’t get a rush of pleasure, that connection between alcohol and pleasure starts to get broken. This is known as pharmacological extinction. Eventually, your drive to drink alcohol will be reduced, and you will no longer be dependent on it.
There is some evidence that it is more effective for people who have a family history of alcohol dependency, possible because of genetic factors. Because they are opioid antagonists, Naltrexone and Nalmefene are not suitable for people who take opioid-based painkillers.
Naltrexone (Reviva in the USA and Nalorex in the UK) can come in two forms: a pill form or an extended-release injection. Nalmefene (Selincro in Europe and the UK) comes in pill form. We will come back to the extended-release injection later, but most of the time they will both be prescribed in pill form.
The basic idea is that you don’t have to take the Naltrexone or Nalmefene pill every single day. You only take it one to two hours before you have your first drink.
Then, when the alcohol reaches your system, you won’t get the same rush of pleasure as you usually do. Over time, usually 3-4 months, you will begin to want a drink less and less.
For some people, the goal is to stop drinking alcohol altogether. For others, the goal is to be able to have a drink or two in social situations and stop there.
These medications can help you to achieve either of these. When you start the treatment, however, you do have to drink alcohol. The medications won’t be able to break the connection between alcohol and pleasure if you don’t drink any alcohol.
It is important to remember that while Naltroxene and Nalmefene stop the rush of pleasure you have when drinking alcohol, they do not stop you from getting drunk. They are both, however, non-addictive and they don’t give you any sort of high.
TSM is controversial. It takes a very different approach to most other treatment methods for alcohol dependency. Most approaches to treating alcohol dependency come from the point of view that once you have a dependency on alcohol, you should never have another drink again.
Because for TSM to work, you have to drink alcohol, it is directly opposed to the other alcohol dependency treatments. People who are opposed to TSM do have other reasons for their concerns, and we will go through them in turn.
With that being said, TSM does have a lot of support. Many people hail it as a scientific breakthrough in the treatment of alcohol dependency, and argue that there are benefits to many people of using this method instead of an abstinence-based one:
TSM can be most effective for:
TSM may not work for:
As with any drug, Naltrexone and Nalmefene do have side effects. The most common are:
Some people experience no side effects at all and some people do experience side effects but decide that the benefits of reduced alcohol consumption are worth it.
Most of the time, side effects disappear after a month, but some people are more sensitive to the effects of opioid antagonists and may experience severe side effects that do not go away. For these people, a different treatment option may be needed.
There are many treatment options available for people living with alcohol dependency. Finding a method that works for you, long term, is important if you want to move on from dependency on alcohol.
While approaches that encourage you to never drink again can work for many people, for others a medication-based approach that reduces the connection between alcohol and pleasure (and so can reduce how much you want to drink) can be the treatment option that is best for them.