Last Updated on June 10, 2026

The question of which naltrexone protocol to follow—The Sinclair Method (TSM) vs. daily naltrexone—comes down to how you drink, not which protocol is objectively better. Daily naltrexone, which Sunnyside Med offers, provides consistent craving coverage and fits well for most people. The Sinclair Method works for planned, predictable drinkers who can commit to taking the pill before every drinking occasion without exception.

You got your naltrexone prescription. You started taking it every morning, like your doctor said. Then you went online and found forums, Reddit threads, entire communities saying you’re doing it wrong— that The Sinclair Method, taking naltrexone only before drinking, is the real way to use this medication.

So what’s the truth?

The real question isn’t which protocol is better in the abstract. It’s which one fits the way you actually drink, and what kind of support you have around you. Naltrexone is an effective medication. But how you take it, and whether you keep taking it, does make a difference.

We prescribe daily naltrexone at Sunnyside Med, and that’s because we believe in that approach. Our co-founder has had great success with it, as have thousands of Sunnyside Med customers. But we also believe the Sinclair Method is a legitimate approach for the right person. This article is an honest look at both.

How The Sinclair Method And Daily Naltrexone Work Differently

Same medication, two dosing strategies. The difference comes down to timing and coverage.

In a broad sense, naltrexone works by blocking opioid receptors that play a role in alcohol’s rewarding effects. This reduces some of the reward associations the brain might have with drinking, which can make cravings less intense. Studies have shown that naltrexone can reduce heavy drinking and support long-term changes in alcohol consumption.

How Daily Naltrexone Works

If you opt for daily naltrexone, you take the pill every day approximately 60 minutes before your cravings typically begin or you plan to have your first drink, regardless of whether you plan to drink that day. Because you take it every day, the opioid receptors involved in alcohol’s reward signal have more consistent blockage throughout the day and week. Cravings feel weaker or less urgent over time because the brain’s reward response to alcohol–and even thoughts of alcohol–is consistently dampened.

That’s one reason Sunnyside Med prescribes daily naltrexone. Taking the medication at a similar time each day locks in a consistent routine, making it easier to build a lasting habit and stay protected when unexpected drinking opportunities arise. Combined with coaching, drink tracking, and ongoing support, daily dosing gives many members a simple, comprehensive place to start.

How The Sinclair Method Works

The Sinclair Method takes a different approach. You take naltrexone approximately 60 minutes before drinking and only before drinking. The idea is something TSM advocates call pharmacological extinction: Each time you drink with naltrexone on board, your brain experiences alcohol as less rewarding than it expected. Then, over time and consistent use, the brain’s conditioned response may weaken. The urge to drink gradually diminishes as the reinforcement loop becomes less powerful.

There is a real mechanistic difference between daily dosing and TSM. Daily dosing creates a consistent baseline of receptor blockade, providing ongoing protection whether or not drinking occurs. The Sinclair Method pairs receptor blockade with each drinking occasion. 

Both approaches reduce alcohol’s rewarding effects. They simply do so on different schedules.

What The Research Says

Daily naltrexone has the deepest evidence base, especially when it comes to randomized clinical trials. A 2014 meta-analysis published in JAMA, which reviewed dozens of studies, found that naltrexone reduced risk of returning to heavy drinking compared to placebo. This is the study many prescribers point to.

Targeted and hybrid dosing has a growing but smaller body of evidence. In 2006, Hernandez-Avila et al. found that targeted dosing was associated with reductions in drinking compared to placebo. In 2023, Santos et al. ran a randomized controlled trial using a hybrid approach (daily followed by targeted) and found reduced heavy drinking in sexual and gender minority men with mild-to-moderate alcohol use disorder.

To be frank, daily has more studies around it because it’s been studied longer. Targeted evidence is smaller but growing. Neither protocol has been proven definitively superior to the other.

What does seem to matter most is adherence. While not everyone responds to naltrexone the same way, consistently taking the medication is one of the strongest predictors of success across both approaches.

When Daily Naltrexone Tends to Work Better

If your drinking is unpredictable or habitual, daily naltrexone is likely the better fit.

Consider someone who drinks three or four days a week but not on a schedule. Monday might be fine. Tuesday, something stressful happens, and they pour a glass at 6 pm. Thursday, they’re out with friends, so their drinking is more likely to escalate. There’s no reliable moment to take a pill 60 minutes beforehand, because the drinking isn’t planned. This can cause compliance issues.

By contrast, daily naltrexone is likely to work better when:

• Your goal includes significant reduction or abstinence
• Cravings surface throughout the day/week, not just when a drink could be imminent
• You’re early in the process and need consistent coverage
• You’re not sure if compliance with targeted dosing is possible

Addiction researchers often distinguish between long-term goals and the brain systems involved in reward and habit formation. You may plan to take naltrexone before drinking, but that plan can become harder to execute in the moment when alcohol cues and cravings are strongest. Daily dosing reduces that friction by turning medication into a routine rather than a decision tied to each drinking occasion.

Naltrexone Taken Daily Tends to Be the Safer Default

Daily naltrexone provides blanket coverage. It works even when drinking is unplanned, emotional, or habitual. You don’t have to predict when cravings will hit or when a casual evening will turn into something harder to control.

Sunnyside Med uses daily dosing for this reason. It’s the approach most likely to work for the widest range of people.

When Targeted Dosing (The Sinclair Method) Is A Good Option

If your drinking is predictable and planned without much deviation, targeted dosing may be a good fit. You know you’re likely to drink on Friday or Saturday night, and you can reliably take naltrexone 60 to 90 minutes before your first drink.

For some people, that pause becomes part of the process. Taking the pill before drinking creates a moment to check in: Do I still want this drink? How much do I actually want? What am I hoping it will do for me?

Targeted dosing is usually used by people who want to moderate their drinking, though some people eventually lose interest in alcohol altogether. Over time, repeated drinking with naltrexone on board may weaken the reward loop that keeps cravings active. But the protocol only has a chance to work as intended when the medication is taken consistently before drinking. It depends on taking the pill before every drinking occasion.

Myths About Daily Compliance

There’s a lot of misinformation online about daily naltrexone. Some of it comes from well-meaning TSM advocates. Some of it is just wrong.

• MYTH: Daily naltrexone can’t lead to extinction. It can. Every time you drink with naltrexone in your system, the same underlying extinction mechanisms are engaged. Daily dosing means you’re always covered, so every unplanned drink still happens with naltrexone on board.

• MYTH: It will block all your pleasure and dopamine. Naltrexone reduces the brain’s reward response to alcohol specifically. It doesn’t flatten all joy. One Sunnyside member put it this way: “The buzz is different for me on naltrexone. I feel like the naltrexone gives me back my ‘brake pedal’ on drinking.”

• MYTH: Naltrexone is addictive. Naltrexone has been FDA-approved since 1994 and is safe and non-addictive. You can stop taking it without experiencing withdrawal symptoms.

• MYTH: You have to take naltrexone forever. Many people use naltrexone for a defined period while building new habits, then taper off with their clinician’s guidance. (Do not change your dose or stop the medication without consulting a clinician first.) Others choose to stay on it longer. All valid!

• MYTH: Naltrexone is only for people with “serious problems.” Naltrexone is used across the spectrum. You don’t need a particular diagnosis. If you’re drinking more than you want to and you want to cut back, it’s worth looking into.

A Hybrid Approach: Starting Daily, Then Transitioning

There is a potential middle ground here: Start with daily naltrexone. Then, once your drinking is stable and your habits have shifted, transition to a version of targeted dosing that works best for you. (Of course, don’t change your dose or stop/start a medication without consulting your clinician first.)

The logic is simple. Daily dosing provides consistent coverage while you’re:

• Starting out, and things are a bit more unstable
• Building new routines
• Figuring out which (if any) naltrexone side effects are happening
• Learning how you respond to the medication itself

Once things settle, some people move to as-needed dosing for specific situations. One Sunnyside member described their evolved approach: “I will take naltrexone when there is risk or temptation to drink for as long as I need to; I am done lighting up those circuits in my brain.”

That’s not TSM in the traditional sense, and it’s not strict daily dosing, either. It’s a personalized strategy built on a foundation of consistent early use. Starting daily gives you the information and stability to figure it out safely.

Again, please keep in mind that at Sunnyside Med our protocol–the protocol that our doctors support–is daily dosing. Please talk to your doctor or care team before making any changes to your dosing or dosing schedule.

I Started on Daily Naltrexone, Tried Targeted, and Went Back to Daily

This is a personal note from Sunnyside Med’s co-founder Ian Andersen, who has been taking naltrexone daily for nearly two years, and was Sunnyside Med’s first customer. 

I’d already cut my drinking way back by 2024, but I still had one piece I couldn’t crack: binge drinking. Once I started, stopping was hard. So I tried naltrexone.

I was a fast responder. The alcohol noise went quiet almost immediately. I stopped thinking about drinking so much, and started thinking about everything else more. Nearly two years later, I drink less than I ever have. A couple times a month, on my terms, and I can stop when I want to. If you’d told me that ten years ago when I was white-knuckling my way through cutting back, I wouldn’t have believed you.

After about a year on daily naltrexone, I got curious. I’d heard so much about the Sinclair Method online that I decided to try it: stop taking it every day, and only take it an hour before drinking. Same medication, different timing. I figured it was worth an experiment.

It didn’t go well.

The first thing that happened was I just… stopped taking it. I wasn’t drinking much, so I stopped medicating. Then a weekend rolled around, I decided to have a drink, took my pill, and overdid it. More than I wanted. So I kept trying. But what I noticed was that throughout the week, this anticipation of drinking was quietly building up in a way it hadn’t before. And when I did drink, even with the naltrexone on board, I drank more than I intended.

There was also this mental gymnastics thing I wasn’t expecting. Every time I thought about having a drink, I had to decide: do I take the pill or not? When you’re dosing daily, that decision doesn’t exist. It’s already handled.

The Switch Back to Daily

After a few weeks, I went back to daily. I talked to Dr. Volpicelli about what I’d experienced, and he confirmed it’s a real phenomenon: when you’re not consistently blocking the reward signal, cravings can build up a kind of reserve. That tracked perfectly with what I felt.

I also did a gut check on long-term use. Naltrexone doesn’t blunt my joy or my dopamine in any other area of life. If anything, I feel sharper and more present, because I’m not spending mental energy on alcohol. I got bloodwork done. Everything came back clean. After two years on naltrexone, I’m healthier than I’ve been in a long time.

Alcohol use disorder runs deep in my family. For me, naltrexone isn’t just a tool for cutting back, it’s a preventative measure I feel genuinely good about. Someday I’ll probably stop taking it. Maybe I’ll quit drinking entirely. But right now, alcohol barely crosses my mind, and when it does, I’m the one in charge. That’s the whole thing, really.

Consistency, Adherence, and Sunnyside Med’s Approach

The daily-versus-targeted debate can make it sound like the hardest part is choosing a protocol. For many people, the harder part is actually just taking naltrexone consistently.

That matters because adherence is one of the biggest barriers in alcohol medication treatment. In a 2018 study, Dermody et al. found that people were more likely to take daily naltrexone on days when they completed mobile support check-ins. Fortunately, this is exactly what we offer at Sunnyside Med: daily support check-ins via our text messaging and mobile app support.

Percy Menzies, a pharmacist and alcohol treatment specialist, put it this way in an essay on Dr. Joe Volpicelli’s Substack: “Naltrexone [has been] not so much a failure of its pharmacology as a failure of its delivery … If adherence limits efficacy, adherence becomes the intervention.”

In other words, naltrexone can help. But getting people to keep taking it is often the real challenge.

How Sunnyside Med Tackles Adherence

That’s where support matters. Among active Sunnyside Med members with 50% or more app engagement, 78% achieved a meaningful reduction in drinking. Engaged members also refill at 3x the rate of members who just take the medication. Individual results vary.

The likely mechanism is not mysterious: daily tracking, coaching, check-ins, and the habit of opening the Sunnyside app all create more chances to stay connected to the goal.

“I’ve noticed that I now get a feeling that I’ve had ‘enough’ and at that point I absolutely don’t want any more,” reports one Sunnyside Med member.

Sunnyside’s Co-Founder Ian Andersen put it this way: “I connect with dozens of customers weekly in our private Zoom calls. In every meeting, customers encourage others to take advantage of everything we have to offer, from our podcast, to our coaching, to our in-app challenges. I don’t even have to bring it up, because the support we offer around the medication is so beloved. It’s amazing to watch people engage with every tool we offer, and maximize their naltrexone results with the support we offer.”

The Sunnyside Med approach includes daily compounded naltrexone, clinician-guided protocol, app-based tracking, and coaching. It’s 100% online, waiting room-free, and private. If you’re wondering how naltrexone could fit into your life, take a free 2-minute assessment at Sunnyside Med.

Naltrexone is a prescription medication. This content is educational and should not be taken as medical advice. A licensed clinician reviews every Sunnyside Med application.

Sunnyside Is the Perfect Companion for Your Naltrexone Journey

Sunnyside is the #1 mindful drinking app. Since 2020, we’ve been honing our harm-reduction approach and have helped over 400,000 people cut out 22 million drinks from their baseline habits. 96.7% of our members report success drinking less, and in a third-party study, our approach was demonstrated to reduce weekly drinking by 33% after 12 weeks. 

Think of Sunnyside as the front door for anyone who wants to change their relationship with alcohol. If you want to drink less, we can help you get there. If you want to eventually quit, but want to take a gradual approach, we can make that happen.

When you sign up for Sunnyside, you’ll take a quick 3-minute personalization quiz, then hop into the app. It’s as simple and quick as that. 

We’ll give you weekly plans to gradually reach your drinking goals, and we’ll provide nudges, coaching, exercises, and advice to help you get there. 

We have daily tracking and journaling tools, including the option to chat with a real human coach. And, of course, we have great analytics so you can track your progress over time. 

Sunnyside is a full-featured mindful drinking app, and thus the perfect companion for your Naltrexone journey. Naltrexone will actively help you reduce cravings around alcohol, and Sunnyside will help you understand your triggers and patterns, giving you a healthy system for habit change. 

Everyone who signs up for Sunnyside gets a free 15-day trial, then the subscription is $8.25/month, less than the cost of a fancy drink. And the best part is our members save an average of $50 per month, easily paying for the cost of the subscription.

Whether you’re currently taking naltrexone or just doing some research on alcohol moderation, we’d love to have you sign up for our 15-day free trial today.