The Sinclair Method: An Innovative Approach to Reduce Excess Drinking with an FDA-approved Medica...

Welcome to the Living to 100 Club Podcast. Here's our host, Dr. Joseph Casciani.

Well, hello to everyone joining us today on our podcast. You're listening to one of the public episodes this month on the Living to 100 Club program. And I'm your host, Joseph Casciani. Each week, our conversations educate and inspire, helping you get the best out of all the years we're given, regardless of what obstacles come our way. These public episodes air twice a month. With our premium club membership, paying subscribers can listen to all episodes. So subscribers have access to 2 additional episodes per month. All episodes share educational and inspiring stories with practical tips and strategies for aging well. Premium episodes are for subscribers only, so be sure to sign up today at livingto100club.supercast.com. Today's program is about an innovative way to reduce alcohol use using an FDA-approved medication in an off-label way. Brian Noonan is our guest. And he describes the Sinclair Method, now available in 35 states, using the medication naltrexone. This physician-prescribed medication is typically used to treat an alcohol use disorder during a period of abstinence. The approach that our guest describes, the Sinclair Method, reduces the pleasurable or euphoric effects of drinking But without the abstinence. First, a little background. Passionate about helping to control the alcohol epidemic, Brian earned his nurse practitioner degree from Vanderbilt University with specific training at the Vanderbilt Institute for Treatment of Addiction. For the last 15 years, Brian has helped thousands of patients to decrease their alcohol consumption using the Sinclair Method. As well as treating many other general psychiatry patients, including those with depression, anxiety, ADHD, and more. He now focuses on spreading the word about the Sinclair Method so that more people can break free from their negative alcohol use patterns. Brian, welcome to our podcast today.

Yeah, thank you very much. It's a pleasure to be here today.

Great. Great. Glad to have you with us. Looking forward to our conversation. I always like to open by asking our guests to tell us a little bit about the journey that brought you to where you are today. I mean, I covered some of the highlights, but maybe just, uh, share what led you to the Sinclair Method.

Well, actually, it sort of— the first step on the path was by, uh, circumstance, happenstance, I guess you could say. Uh, I was back at, uh, this is in 2000, I was at the University of Georgia studying psychology, and they just happened to have openings for student psychology majors at an addiction treatment center. It was kind of what I think of now as kind of an old-fashioned kind of 30-day inpatient treatment. And I was what was called a residential counselor, which mostly involved kind of transporting people to and from AA meetings and essentially just having a staff there. But that was kind of my first introduction to addiction. And I guess kind of subsequent to that, it being on my resume and kind of my first kind of semi-professional experience just kind of led me down to the path. So each subsequent opportunity I had kind of built on that until it was kind of what I ultimately ended up focusing on a decade later. But kind of in between, or kind of, I guess, concurrently with some of that, I did have quite a significant experience at treating severe mental illness, which involved even working at state hospitals, Oregon State Hospital, including schizophrenia and some other severe illnesses. And but I guess maybe the past 5 or 6 years it's mostly been actually, uh, high-functioning, kind of the opposite end of the mental health spectrum, uh, really kind of high-functioning adults who have issues with depression or anxiety, sleep, or kind of today's topic. They kind of have drink in some kind of concerning way. So, so I've kind of worked the full gamut. I used to teach at, uh, you know, the faculty at Seattle University, uh, for I guess that was 3 years. So kind of have a broad background, but really kind of, I think, the most interesting kind of work I do is the Sinclair Method. It really is something novel and it is, you know, highly effective for most people. So it really is exciting to be kind of at the forefront of it, I think.

Great. Yeah. So yeah, we'll talk more about the Sinclair Method, but first let me ask you about naltrexone. It's used in the traditional treatment for an alcohol use disorder, but that's, that's different from the way you're approaching it. So what's the traditional approach?

Yeah, that's right. You know, the naltrexone is now a generic and it was FDA approved back in 1994, actually, for alcohol dependence and kind of, kind of approved in the traditional way that you would think of, which is to promote abstinence. So the kind of the original instructions that were part of the FDA approval process and then kind of subsequent use of it were that you would essentially take the medication daily, take the naltrexone daily, and then kind of essentially go as long as you could without drinking. And even kind of more than that, it was a requirement that you not have had alcohol 7 days prior to the, to the beginning of treatment. So, so you would have to abstain from alcohol for 7 days, take the medication on a daily basis, and then go as long as you could without drinking. And, you know, all the measurements in terms of outcomes for these original uses were How long did it take for the person to relapse, or how long did these types of measurements?

So marginal effectiveness, would you say, or?

That's right. And in fact, in 2001, which was, I guess, 6, 7 years after the FDA approval, the largest study done on naltrexone, and this was published in the New England Journal of Medicine, actually, was negative. I think There are about 200 people in that study. So a good-sized study, a random controlled trial. And they concluded that the study did not support the use of naltrexone for chronic alcohol dependence. And it was kind of in tandem with just kind of the general consensus that it didn't work very well. It was something that if you're in psychiatry and especially if you were treating addictions, of course, you were aware of naltrexone. It wasn't like some off-the-radar type of thing, but it was just thought of as not really worth it in some sense. It might be kind of a last-ditch effort, or it just really was not used at all because it was thought of as not being very effective.

And the reason being that people couldn't abstain, or what were some of the roadblocks to success?

Yeah, well, yeah, that's right. And so kind of even success, part of it was just kind of how they were thinking about what success was. You know, success being how long could you not drink. So what's important to know about Naltrexone is kind of how it works and that, and you can kind of think about, well, it's hard to kind of understand of how it would help in the first place using the traditional method. The medication itself is actually an opioid receptor blocker. So it blocks opioid receptors. So if a person were to take, let's say heroin or morphine or any type of opioid, the naltrexone blocks those receptors, so it would not work. So if you took, you know, let's say, just say morphine, you had a prescription for morphine, but you also took naltrexone with it, there would be no effects from the morphine because the naltrexone would be blocking those receptors. But what most people don't realize, and what's really interesting about alcohol, is that the reason we like it, the reason for the buzz and why it's reinforcing, is is because it releases endorphins, which are our natural opioids, essentially. So if you take naltrexone prior to drinking, we'll say, for example, the naltrexone block the effects of alcohol, and which we'll, we'll get into a little bit, but kind of, so in advance of the Sinclair Method, people were just taking naltrexone, not drinking. And so it's kind of not obvious why it would help very much. One of the theories for why it kind of had this marginal benefit in some of the early studies was that we do have sort of a, we can have these kind of endorphins released in response to, say, anticipation of drinking, or sometimes environmental cues can cause these kind of, kind of, you know, very kind of low threshold releases of the endorphins. And the idea was that, So let's say, for example, you have alcohol dependence and you see a TV commercial about a beer or something like that, or, you know, there's some kind of, some type of cue in your environment that this would cause some release. And it's based on association. And if you were taking naltrexone, it would block that from having some effect, which would then kind of further your interest in the alcohol. So, oh, uh, and so that it had an anti-craving effect based on this idea. Yeah, but otherwise it's kind of hard to kind of piece together kind of the theoretical basis for it, you know, that, that just blocking your opioid receptors on a daily basis, why that would make you less interested in drinking.

Yeah. Interesting. Yeah. As you described the release of the endorphins with just the commercial or thinking about the alcohol use, that's sounds almost like a placebo effect where They're not actually taking in the substance, but it's the association, as you said, that's producing almost the same effect. Wow.

That's right. It's like the association's there. So you're still getting this kind of chemical release. And, uh, you know, I think the kind of that basic idea, there is some kind of, we actually see that kind of even in the process of doing the Sinclair Method, we do have people report that kind of even in advance of drinking, there is that anticipation, kind of like, let's say you're off of work and your mind is already kind of geared towards that first drink. It's kind of, as you get closer and closer to that first drink, the frequency of thoughts related to it. And so you kind of have this priming in a sense. So, so there's some kind of endorphin release in advance of that. And so, so there, so that makes sense, but you know, that's a very small effect and which is why you see that in practice it doesn't work, doesn't really have that big of effect. And as I mentioned, these subsequent studies have really been not really— they've been negative studies, you know. And of course, clinically, clinically, providers had no confidence in it as well.

Yeah, well, thanks for that explanation. That's helpful. So let's jump into the Sinclair Method. You mentioned earlier, by the way, that you've had some recent publicity on Is it Good Morning America, or—

that's right, there was a— in the American Journal of Psychiatry, it was actually published— the original article was published in December of '22, and so I guess it took a little while for it to make the news cycle. But in February, earlier this month, there was a story, a New York Times, and then kind of based on that, the Good Morning America picked up on it as well. So there was a kind of a video piece that was about 2 minutes on Good Morning America. And they don't actually call it the Sinclair Method. What they refer to it as was targeted dosing of naltrexone. And so they referenced the study. It was not quite— there were some elements of it that were not quite kind of the— it wasn't the full Sinclair Method. It was kind of a component of it. So it was very exciting because at least the naltrexone and the as-needed— the benefits of as-needed dosing. As-needed dosing were kind of publicized. So they talked about the study, which was a positive study where they gave people the naltrexone, and if they were going to drink, they took the medicine and it decreased the frequency of bingeing and it decreased the size of the bingeing episode. So, you know, there was some percentage reduction instead of— I don't know the exact numbers were, but instead of like 6, we'll say there were— the average binge was 4 drinks instead of 6 or something like that. So it had some positive. And they said the benefits were enduring as well, that up to 6 months they were seeing these effects. So that was great. Uh, you know, they kind of didn't talk about the long-term unlearning that takes place with repeated exposures, where that a person, whether they are just binge drinking or daily drinking, they can really kind of reverse all interest in drinking over time. So it was kind of a limited application of it, Uh, but I still think it's exciting that it will trigger some interest in naltrexone and hopefully kind of see that its potential lies in combining it with alcohol, that abstinence, it will simply won't work if you're not drinking.

Yeah. Yeah. So, uh, very similar variation, maybe a variation of Sinclair method, but this journal, American Journal of Psychiatry, did it mention Sinclair method or just as targeted?

Yeah, yeah, it describes the Sinclair Method, uh, but does not mention— doesn't— does not refer to it as the Sinclair Method. In part, it may have been because, again, it was, it was specifically about kind of binge drinking and kind of, again, it was a component of what we think of as the Sinclair Method, but not kind of the full, kind of the bigger application of it. So, so it was essentially— it was the truth but not the whole truth, in the sense that they kind of didn't, didn't realize that actually this has a broader application than what they they were. So it was a very narrow— I'd say it was very just narrow, a true but narrow, narrow application of the medicine.

Okay, the heavy binge drinking, that one slice of the alcohol use disorder. Yeah, but that's not the whole picture, of course. That's good. So it's considered an off-label approach. Can you help our listeners understand what, what you mean by that?

Yeah, you know, it's interesting, the FDA, when you hear something, and sometimes you'll just hear the phrase, a drug is approved, they'll drop the FDA. But what they're referring to is the Food and Drug Administration has a process of approval. And I think it's really kind of a misleading term and people probably don't quite know what it means or what it doesn't mean. I think most people's minds, we have that phrase kind of conjures up the idea of maybe something like Consumer Reports, where Consumer Reports tests all the toasters. And then they decide that, you know, this is the best value or this is the best one that has various features and then they give their recommendations or something like that. It's really— the FDA really is really a passive agency. It doesn't do its own testing, for example. The drug manufacturers do their own testing. So it's not that the FDA is testing all these medications for some particular benefits and then after, you know, subsequent to their testing, they're releasing their approval for various drugs. The drug manufacturers submit the studies, but the studies are very— what they're seeking is a very specific indication. So for example, a lot of times what you'll hear on like television commercials, they'll say if you have moderate to severe eczema, for example. So what that means is in the approval process, they did not seek approval for mild cases of eczema. It just means they only sought this, or sometimes you'll see ages. It's FDA approved for 18 and up. So someone who was taking the medication, if they were 17, it would technically be off-label. So the drug companies seek very narrow, very specific uses for these medications, including the directions that are, that are part of it. So in the case of naltrexone, it was FDA approved for alcohol dependence based on these initial studies. But part of the studies or part of the kind of the indication was, you know, based on abstinence, uh, must wait 7 days and all these, these other factors. So it's really easy for a drug to be prescribed off-label. And sometimes people are kind of maybe concerned by this, this label, but it really is not something to be concerned by because again, if they only saw indication for that specific problem, even if it is wildly helpful for mild eczema, It's not FDA approved for that, even though there might, could even be more helpful for myeloma.

Yeah. That's a, but yeah, that's a great, great explanation. It's not that off-label means it's harmful. It only means that off-label is that age or that particular severity was not studied. It was not researched and it wasn't reported to the FDA when it might be just as effective with other ages or other groups or whatever. But it's just, it's not that it's harmful at all. It's just like with the approval of naltrexone, it was studied as a, you know, only with those who are following abstinence procedures and it wasn't studied with partial abstinence or no abstinence as the Sinclair Method does. That's what makes it off-label. Yeah.

That's, that's great. And off-label, the other kind of, the other side of that is off-label also doesn't mean not approved. You know, it's like mostly the FDA is silent on different, different things. So the fact that it doesn't have approval doesn't mean it has disapproval. It doesn't, it doesn't mean that the FDA has rendered a verdict on its lack of effectiveness. So the other thing too is, and just kind of briefly, is that once a drug, a drug has to have at least one FDA-approved indication to be marketed, but that doesn't mean, of course, it can't be prescribed for other things, but it at least has to have one indication, one FDA-approved indication to even be kind of marketed and sold. But once it has that, then it can be used for various other things. So oftentimes, you know, kind of part of the motivation for getting FDA approval for beyond just kind of the first entry into market is that if a drug is found to later be helpful for another indication, if it is either one, kind of determined that seeking that approval will not be profitable in some way. So it's quite expensive, hundreds of millions of dollars to get to obtain FDA approval. So if this process of seeking FDA approval for, say, a second indication, if that's not going to result in X number of sales or something like that, then it won't be sought. The other thing is, once the medication is generic, then there's really no financial incentive whatsoever. To seek FDA approval. So no matter how many studies or how widely prescribed it is and commonly prescribed for a given indication, it will still be officially off-label and not FDA approved.

Wow. So even though it might be very effective with other age groups or other populations, it's never studied, never reported, and never used in a lot of cases.

That's right.

Yeah. Wow.

That's right. Yeah. Now, now it could be studied, but, but the FDA, because the FDA is not an active agency in that regard. They're not— they themselves aren't assimilating data and say, you know, based on 20 years of studies and widely prescribed use, this actually is, you know, a good starting point for some treatment. It would just simply remain off-label.

Well, so the abstinence is a big problem with traditional use of naltrexone. And you also mentioned when we spoke earlier that somebody is taking naltrexone daily or on a regular basis, and as soon as they stop, there's no resistance built up. There's no other benefit. There's no ongoing benefit. As long as, as soon as the drug is stopped, the person could resume abusive drinking. Is that right?

That's right. It really, I mean, to the extent that it might help them once they stop taking it, Yeah, it doesn't really kind of do anything. You know, I would argue it doesn't really do much even while taking it. But yeah, there are certainly no lasting effects from once it's discontinued and essentially kind of it's in part because abstinence itself doesn't really— is not really a treatment for alcohol addiction. You know, one thing that AA says is that that is correct. Is that you can go 5 years, 10 years, however long it is without drinking. But if you pick back up, you're going to pick up right back where you left off. And what that kind of demonstrates is that abstinence is not really a treatment. Time without a drink does not really do anything about the underlying issue. So that's kind of the, kind of the basic answer to your question, which is, you know, if you stop the naltrexone, you were absent the whole time, essentially you're just back in a similar place.

Yeah, it's just a hiatus, just a break. So how does, how do you apply the Sinclair Method then? I mean, why does it work? Why is it more effective than this total abstinence picture?

Yeah, so one of the things is that it is an active treatment, you know, it actually targets and changes the specific issue. So one way to think of naltrexone is as a buzz blocker, you know, it's like if you take the medication, it blocks these endorphins from being released when you drink. So you don't get the buzz, you don't get the good feeling, the reinforcement, you know, the effect that you're looking for is essentially not there. And it really is kind of— it's operant conditioning, something that many people just kind of learned in Psycho 101, or just something—

they're just—

it's a basic learning model, which is that any behavior that is rewarded, you're going to get more of that behavior. And then kind of the other side of that is any previously rewarded behavior. If you take away the reward, you're going to get less of that reward. So what happens is over time you're drinking alcohol, you're engaging in the same behavior that you were before, but you're not getting this reward. So you drink, there's no buzz. You drink, there's no reinforcement. You drink, there's no buzz that you're getting. And so essentially you're unlearning, you're, you're kind of breaking that association between the behavior of drinking and the reward of these endorphins. And because it actually reverses this neurological association, as you go forward, the brain actually is changing. The interest in drinking diminishes. The thoughts related to drinking decrease. It just becomes kind of a movement towards indifference. As it relates to drinking. It's just not something you could drink, but you could also not drink. It's not something that is— that doesn't occupy much space in your brain because that association and that reward has been extinguished.

Yeah. So how does that interact with the blood alcohol level and intoxication? I'm assuming the BAL can still go up with more alcohol. You just don't get the pleasurable effects from it.

That's right. And that's really an interesting effect because it's not— alcohol is not a kind of a uniform substance. It doesn't have a single effect. So that's exactly right. The medication is not an alcohol blocker. It simply has this one very narrow, specific effect of blocking the buzz. So your blood alcohol level remains the same on a per-drink basis. The impairments that alcohol can cause— slurred speech, loss of balance, these types of things. So basically, anything that can go wrong when you drink, that might go wrong when you drink, those types of things could still occur. So you still have to be a responsible drinker. But what's interesting about it is people find that all these kind of impairments aren't really— they aren't that fun, you know, that it's, uh, these things are not good times, simply not being able to speak coherently.

That's a great, um, explanation. They're not the desired impairments, that intoxication, third speech, whatever. It's blocking a lot of the pleasure that comes from that drinking.

Yeah, that's right. That one specific effect. And that's important because essentially all the behavior, you know, the other kind of behaviors of drinking are still there. But the reinforcement that underlies the compulsion and the interest in drinking, that's the one. So there's one variable that's different. You're not getting your brain and really, you know, so you're not getting that neurological reinforcement. And so we do this behavior and we actually see a pretty immediate reduction. And kind of, this is kind of what the recent study picked up on. We actually see pretty quickly, we see a reduction in the size of the drinking sessions. You know, it's like, so let's say a person drinks every day and they have 6 drinks every day. Pretty quickly we see that they start drinking 4, you know, maybe the next month it's 2 or 3, you know, something like that, maybe 25, 30% reduction. So that's kind of the initial response where you just, in and of itself, you're not getting that. It's not a pleasurable experience. So, so naturally you're just gonna kind of lose interest in it.

Hmm.

But then the next day, because you've had how many years or decades of drinking, of getting this reward, of course the next day your brain is still interested. You know, it's like, drink sure would hit the spot after work. So you do that. So that underlying interest is what takes longer. And that's what eventually, eventually If the person continues to drink without reward, continues to drink without reward, eventually that underlying interest, that is what will be extinguished. And that takes about 4 to 6 months. And that's kind of what these recent reports have kind of not picked up on, is that yes, it can, it can decrease the size of a session, a bingeing session or any session. But really, with sustained use, it will extinguish the interest in drinking. Altogether.

Well, so how often, what's the dosage like? I mean, who prescribes it? When do you start? How long do you stay on it? What are some of the—

well, so it's, it is, it does require a prescription. So whoever prescribes normal things could be a physician, psychiatrist, nurse practitioner, physician assistant, kind of whoever would normally prescribe medications. A lot of primary care providers, you know, kind of family doctors or types of things, that's kind of hit or miss in terms of how comfortable they will feel. A lot of times we hear people say they just have no— either they just have no idea about naltrexone, or if they do know about it, they only know the FDA-approved. It's kind of like the Sinclair Method is, is off their radar. So, so, but that's sort of true though. I would say even kind of working your way down into specialties. I mean, it's not necessarily the case that all psychiatrists would be familiar with it. And then, you know, kind of even addiction people would not necessarily be— again, they would know of naltrexone and what it is and all these kind of things and promote abstinence. But at this stage, whether they would know, uh, kind of how to use it the way that was established by Dr. Sinclair, it could be kind of a coin flip. But again, it is, it is giving some more publicity. It was on NBC News. I think the best story actually was a couple years ago that really kind of picked up on the broad application of it on NBC News, and you can, you can Google Sinclair Method NBC News. It was like a 10-piece story where they do talk about not just decreasing the size of the binges, but the sustained effect of eventually extinguishing the whole entire interest together. So, but as far as the dosing goes, it's actually also quite simple. Of course, this is basically true for any med. You want to start at a low dose.

Sure.

So usually we would prescribe, tell people to take half a tablet for a couple You definitely wanna take it with food. What's interesting, I think a general point here is that most of the things that we think of as brain chemicals or neurotransmitters like serotonin and dopamine and norepinephrine and also opioids, we think of them as brain chemicals, but really most of the receptors and most of those chemicals are manufactured in our GI tract. So that's one of the reasons that all of these, you know, it's like antidepressants and anything that affects those receptors, Nausea, vomiting, diarrhea, these are very common side effects. It's also one of the reasons that this idea with probiotics and this kind of the brain-gut connection, there really is something to that. I think a lot of times people are kind of suspicious of that because it is a new emerging field. And I'm certainly not supporting every claim that's ever been made about that, but the basic idea that our neurotransmitters that we think of as modulating our mood and all these other things, they really are. Their origins really are in the gastrointestinal tract. So the same is true with naltrexone. We have most of our opioid receptors in our GI tract. So you definitely want to take plenty of food at the beginning, but most people are fine one way or the other. And so basically one tablet— there's, there's only one strength of tablet made, 50 milligrams, and probably 95% of people are on that tablet. So, so the basic idea is that if you're going to drink, you take the medication at least 1 hour before your first drink. The drug has to be kind of in place. It has to be metabolized and kind of make its way to, you know, the proper receptor before the alcohol gets there. So the instructions are at least 1 hour in advance of drinking, but it could be 2, 3, 4. If you know you're gonna be drinking later, you can take it at lunch or something like that. But, uh, you take the medication before you drink and, uh, it blocks the buzz. And, and so you get, you get a benefit very quickly. And then the more you do that, I go unwind the interest altogether.

So it's kind of taken PRN as needed. If you're not gonna drink, you don't take it.

That's right. Yeah. It's kind of, there are a couple ways to think about it. One is for people who are lactose intolerant, they can't have dairy products. You can just get what's called Lactaid, which is essentially just an enzyme that helps them process dairy foods. So it's like people who are lactose intolerant, they don't take Lactaid unless they're gonna have a bowl of ice cream or yogurt or whatever. Whatever it is, something like that. So the other way I think about it too is just kind of like a seatbelt in a car. It's like, are you gonna drive today? Well, no. Okay, probably not gonna wear, I'm not gonna wear a seatbelt, but, but if I am gonna drive, I'm always gonna wear my seatbelt. And so that's kind of a common response that we give in terms of people wanna know how long am I gonna have to take this? And so the answer is you're gonna have to take it essentially indefinitely prior to drinking. So if you drink once a week, you'll take the medication once a week. If you drink once a month, you take the medication once a month. If you only drink on New Year's, then you only take the medication on New Year's. So it's sort of, kind of, if you think of it like a seatbelt, something like that, it's as-needed dosing.

Great. Well, that's great, great information, Brian. Does health insurance cover this medication?

Yeah, it's FDA approved. So it's, you know, it's covered by insurance. I guess that was the only thing. So it is, it's definitely covered just like any other drug. Every, I mean, it's a, it's a normal standard drug that you would find at any national or any, really any pharmacy. I don't think I've ever ordered it and they didn't carry it. The only, I guess, you know, you definitely want to be concerned with when you use insurance, you want to be careful about some types of the implications of that in terms of say life insurance, for example, or who might have access to this information. So that's, uh, that's something to be aware of. A lot of times people don't want to use insurance because of privacy issues. So that's something. And to the extent that— that it's hard for— to really know, kind of. I think the basic concern definitely is, is, is reasonable, like what, what's going to happen to my information. In terms of what actually happens, or, or kind of the size of that risk, I don't really know. But, but that is one consideration.

Sure, sure. Yeah, that's helpful. That's helpful. Thanks. We're just about out of time. So let me ask you, what's the takeaway for our listeners here? What would you hope our audience remembers from this conversation?

I think that there is an effective treatment that allows you to drink socially. Most people don't want to be abstinent. This is an effective treatment if you want to work your way towards abstinence. But drinking is a normal behavior. It's, you know, Drinking is not a problem in and of itself. Problem drinking is a problem. So if you're, if you're drinking normally, which is something that you can do with the Sinclair Method, so it's really kind of an optimal outcome. You can still go to sporting events and happy hours and be part of the social group. It's a normal part of our, of our socializing kind of rituals. The other thing is just that it doesn't require you to hit rock bottom. It doesn't require you to be on the verge of divorce or get a DUI or anything like like that. If someone thinks they might have— they're drinking in a way they're not happy with, I would seriously consider this. Uh, the bar kind of is very low. And in fact, I don't even require a diagnosis. Like, you don't have to meet some formal diagnostic criteria. If you think you're drinking more or in a way that you're not happy with, just take this tablet before you drink. And, uh, it really is about 80% effective. Of course, nothing works for everyone, but it really is it's very, very likely to work for you and allow you to drink in a way that doesn't concern you, that you think is appropriate for your social circumstance. And then the other thing is on the days that you're not drinking, you're not micromanaging it. You're not, I'm only going to drink on Tuesday, Thursday, you know, it's like, it's just not an issue. It's not something you think about. It's not something you have to regulate. It's just, uh, you can have a very matter-of-fact relationship with alcohol.

Wow. That's great. Do you have prescribers then available at Sinclair or—

Yes, Sinclair Method, sinclairmethod.org. We have a psychiatrist, psychiatric nurse practitioners, and it's all via telehealth. So we have video appointments. You can sit in your living room. We have people sit in their cars. We have people out in hiking trails sometimes, you know. So it's kind of wherever you might be, you can have your appointment. The nature of prescribing laws are such that you have to have a license wherever the patient is, right? Which is why we only, we only, we can only help 35 states because a provider can be, you know, in Australia or somewhere, but if the provider's only licensed in New York, then the patient has to be in New York. Yes. So most of our providers, I'm licensed in about 15 states, so I can help, I can serve about 15 states. And most of our prescribers, or at least I think 5 would be the fewest, that the least amount that any providers prescribe. So we have about 35 states, but it actually makes up about 80, 85% of the population because we're mostly in the largest states.

Yeah. Well, SinclairMethod.org. Okay. Well, looks like we're out of time for today, Brian. Before I wrap up, I just wanna remind our listeners to visit my website, LivingTo100.club, sign up for my email list, download a free copy of my 9 Tips to Make Living Longer Enjoyable. You'll also see an option to contact me with your questions and comments. I welcome your feedback. Finally, be sure to subscribe to this podcast series as a premium club member so you don't miss any episodes. Maybe the episode that could seriously affect your decisions, your outlook, or your actions. Sign up at livingto100club.supercast.com. Brian, thanks so much for being a guest on our show today. For those who might want to contact you, they can do that through your website, sinclairmethod.com.

Yeah, yeah, sinclairmethod.org. And we have— you can either email, we have the chat box, all the various ways to reach out that I'll be happy to talk to anyone.

Yeah, well, terrific. Thanks so much for being a guest on our program, and thanks to all of our listeners for tuning in. Hope to see you next time.

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