One matter of minutae here: the link to the "78% get drinking below the level of increased risk of morbidity and mortality." I'd really love to see the original if you still have the link, Yvain. Thanks.

This post is timely. I'm an alcoholic who just began the Sinclair Method today. Subjectively, I don't notice any anhedonia or lack of happiness. On the other hand, I'm still getting a buzz from the alcohol so maybe something's gone wrong.

I actually asked the MD on staff in my rehab exactly the same question - "if it blocks dopamine, how am I ever supposed to feel happy ever again?" And he reassured me that it only blocked the reward from alcohol (and heroin) specifically. This feels too good to be true, but on the other hand the Sinclair Method works and anhedonia or depression aren't commonly known side effects of Naltrexone, so it looks empirically plausible.

I'm kind of confused by the whole idea because I don't understand the lack of side effects. Knocking out the brain's learning system to cure alcoholism seems disproportionate, and I would also expect naltrexone to interfere with the ability to experience happiness (which many people seem to like).

From the Wikipedia article:

For tablet form, a patient following the Sinclair Method takes a 50 mg tablet one hour before every drinking session.

So it seems that the method is to time the disruption of opiod reinforcement to target when the person is drinking. Side effects may therefore be limited to other activities that typically coincide with drinking.

Though this also raises the issue of meta-akrasia, wouldn't people learn to not like taking the tablets if they don't enjoy anything they do for the next hour?