• Can I just get the prescription?

  No, every SMUK client pays the same £595 for the full programme, with no prescription-only or reduced-fee route.

  The medicine on its own doesn't do what most people think it does. Naltrexone is the lever; the supervised protocol is what makes the lever work. The published evidence on unsupervised naltrexone for alcohol is consistent, people take it, see nothing obvious in the first month, stop, and conclude it doesn't work. The 78% extinction figure that defines TSM comes from compliant cohorts on supervised protocols.

  What your coach actually does is read your notes and catch the signals you can't see in your own pattern (selective extinction, dose-timing drift, habitual and behavioural re-wiring), walk you through the plateau weeks where unsupported clients drop out, and our clinicians help manage the first-fortnight side effects using SMUK's own dose-timing methodology, and our coaches are the one person you can message when a wedding's coming up or a hard week's knocked you off track. Most clients start sceptical about the coaching and finish saying they wouldn't have made it through without it.

  The medication does the pharmacological work. The coach is what keeps you on the protocol long enough for that work to land and achieve pharmacological extinction.

• What if I get a prescription somewhere else and dispense it at my own pharmacy?

  One practical point worth knowing on top of all this: even with a private prescription in hand, mostly all UK community pharmacies do not stock naltrexone for alcohol use disorder, and the few that can source it typically dispense it at prices up to £250 per 28-tablet pack — they have no established buying relationship for the medicine and pass full retail cost through. SMUK works exclusively with partner pharmacies who have supplied us for years, source the licensed product at significantly better rates, and dispense reliably to clients across the UK.

• Can my NHS GP prescribe naltrexone for this?

  In almost all cases, no and the reasons are structural rather than your GP being unhelpful.

  Naltrexone is licensed in the UK for alcohol dependence, but in NHS primary care it sits on most local Integrated Care Board formularies likely as a red-listed medicine. Red-listed means it is not prescribed in primary care at all and must come through specialist services. Amber-listed means it can only be initiated by a specialist, with the GP taking over prescribing under a shared care agreement that, for naltrexone in AUD is rarely in place.

  In practice, the route into NHS naltrexone is via an NHS alcohol service which takes weeks or months to enter, which operates on the abstinence model: daily dosing alongside total cessation. That is a different protocol with a different goal.

  TSM specifically uses targeted dosing, naltrexone one hour before drinking, on drinking days only. This is off-label use of the licensed product. Off-label prescribing is legal and routine across UK medicine, but it requires the prescriber to take personal clinical responsibility for the decision, clinical governance, extensive training on The Sinclair Method and the right clinical oversight on that protocol. Our Sinclair Method clinicians have treated over 6,000 patients to date collectively. Another note is that every few NHS GPs will take that on for AUD, both because it falls outside their formulary and because the targeted-dosing protocol is not something most have been trained in.

  So the realistic answer for 9 out of 10 people asking their GP is a polite decline. You are very welcome to ask, but the structural reality is that targeted naltrexone for AUD sits outside the NHS primary care pathway as currently commissioned.

• Can't I just order naltrexone online from overseas?

  You can find sources, but there are real serious reasons not to. Imported overseas naltrexone arrives without UK regulatory oversight on quality, storage, or supply-chain integrity. You cannot verify what's actually in the tablet, no support if side effects emerge, and no recourse if something goes wrong.

• Why does SMUK only use the licensed naltrexone product?

  This because it is the product the entire TSM evidence base is built on, every published clinical trial, from Sinclair's original research onwards, used licensed naltrexone. It has been through MHRA approval for quality, safety, and efficacy: manufacturing to defined standards, characterised bioavailability and pharmacokinetics, and batch-to-batch consistency. Pharmacological extinction is precisely dependent on these properties the right amount of active drug, absorbed in the right way, at the right time relative to drinking. The licensed product delivers that reliably, which is why we will not work with anything else.

• Do I need to stop drinking to start? Won't it work better if I'm not drinking?

  This is the moment that throws almost everyone. You've spent years being told that drinking is the problem, and now you're being asked to keep doing it. The relief, once it lands, is significant. TSM doesn't ask you to white-knuckle through your evenings, doesn't ask you to fake your way through dinners and weddings, doesn't ask you to begin again every Monday. You carry on as you are, with the medication on board an hour before your first drink, and the protocol does its work quietly underneath.

  What most clients describe in those first weeks is a strange ordinariness, they're drinking roughly what they would have drunk anyway or less (as many people are quick responders), but something is shifting. Then, somewhere after a short few weeks, the first moment lands: they notice they didn't finish the second glass. Or they walked past the wine aisle without thinking. Or Sunday came and the usual evening pull just wasn't there. That's the protocol doing exactly what it's designed to do and it can only do it because you've kept drinking. Stop drinking, and the unlearning has nothing to work on.

• I'm worried I'll drink more if the buzz is blocked.

  This is one of the most common worries, and it makes intuitive sense, if the reward is gone, surely you'd just chase more of it? What actually happens tends to surprise people. Without the endorphin reward, alcohol becomes oddly uninteresting. Clients describe the first time they noticed it: ordering a glass of wine and forgetting it sitting on the table. Pouring a second and leaving it half-full. Standing at the pub baffled at the bottom of the first pint about whether they actually wanted another.

  It is a quiet, steady falling away of the drinking. Not because you're forcing yourself to drink less, but because alcohol genuinely stops being as compelling.

• What if I drink without taking the medication?

  Some people do this at some point, compliance is key but it happens… you forget. A drink appears at a wedding. Someone hands you a glass at a barbecue. You went for a coffee and ended up at the pub. This happens, and it isn't a failure — of the protocol or of you. It's part of being human and doing something new.

  What actually happens is straightforward: you mention it to your coach, they help you make sense of it, and you carry on. The protocol is robust to occasional slips; what it doesn't tolerate well is regular drinking without the medication, because that reinforces the old pattern rather than unwinding it. If it happens once or twice, you adjust. If it's happening every week, your coach helps you build the routine that makes the dose stick. Many clients have succeeded with the right tailored coaching, and always remember you're not navigating any of this on your own.

• What if I drink and don't feel anything? Does that mean it's working?

  This is one of the most exciting moments in the whole protocol and one of the most common messages we get from clients. "I had a glass of wine and I felt nothing." "I'm three drinks in and I'd normally be flying — what's happening?" Yes, this is exactly what's meant to be happening. The endorphin reward, the buzz, the lift that was reinforcing your drinking, is being blocked. The alcohol is still entering your bloodstream (you can still become impaired, still lose coordination), but the part of your brain that lit up at it is going quiet.

  This is usually the moment when people first realise the protocol is genuinely working on them, and it tends to come earlier than they expected. It is the strongest indicator based on evidence that if these signs appear it’s not a matter of ‘if’ you’ll reach extinction but ‘when’. From there, the changes accelerate: drinks become easier to leave, evenings end earlier, the automatic pour-another reflex starts to fade. The "I didn't feel anything" moment is the beginning of all of that.

• Will naltrexone stop me getting drunk?

  Naltrexone blocks the reward from alcohol the buzz, the lift, the pleasurable pull, but not the intoxication itself. You can still get drunk in terms of the physical effects: impaired coordination, slowed reaction times, slurred speech, a positive breathalyser. So please don't drive after drinking, regardless of how little you feel.

  What clients consistently describe, though, is that social drinking feels different. Without the reward driving the next round, the pressure to keep up isn't there in the same way. The build-up across an evening that used to be inevitable just doesn't build. You can have one and stop. You can be at the table without the glass being the centre of gravity. That shift, more than the absence of getting drunk is what people notice.

• How long until I see results?

  Sooner than most people expect, and over longer than most people realise. The first signals are often small and easy to miss until you look back: leaving a drink unfinished, forgetting to top up, a Tuesday evening that came and went without the usual glass of wine. For most clients these start to appear very quickly in the first few days or weeks.

  The more substantial shifts, visibly drinking less, going days without thinking about alcohol, noticing your sleep is deeper, waking up clear on Sunday mornings, having your evenings back, usually build across the weeks and into a few short months. The shape is rarely smooth; you'll have plateau weeks where nothing seems to be moving, and then a week where everything seems to shift at once. Your coach is there to help you read your own curve, because reading it on your own is genuinely hard.

• Three weeks in and nothing's happening. Is it working?

  This is one of the most common moments of doubt, and almost everyone has it. Three weeks in, you've taken the medication faithfully, you're still drinking, and you might be wondering whether you've just signed up for an expensive version of what you were doing anyway. What's usually happening is that the unlearning has begun but hasn't yet surfaced (we have had many cases like this) your brain is in the early phase of unhooking the reward, and the visible changes are still to come.

  When clients describe this moment in hindsight, they almost always realise that small things were happening at three weeks that they hadn't registered: a slightly different feel when drinking, a moment of taking it or leaving it, a quietly unfinished glass. The coaching matters here precisely because it helps you spot what's already shifting before it becomes obvious, and it stops you walking away from a protocol that's actually on track.

• What does success actually look like?

  Most clients describe success in terms of what their week looks like, not in units or drink counts. They describe waking up clear on a Sunday. Going out with friends and having one and being done. Forgetting to pour the 7pm glass of wine because the thought didn't come. Being properly present with their children, their partner, their work. Sleeping through the night. Booking holidays that aren't quietly built around the bar. The morning brain fog that they'd come to accept as normal, gone.

  In numbers, success is sustained, significant reduction in drinking, for some, to moderate occasional drinking they're entirely comfortable with; for others, to no drinking at all, arrived at without willpower because the pull simply stopped being there. The protocol doesn't decide which of these is right for you; you do. What changes is the underlying compulsion. Once that's gone, your relationship with alcohol becomes a choice rather than a fight.

• Will I need to take this forever?

  Most clients stop thinking of it that way once they're in. The medication becomes a small routine, a tablet an hour before you drink and as drinking becomes less central, taking it becomes less frequent. The published guidance is straightforward: as long as you drink alcohol at any level, you take naltrexone an hour beforehand. If your drinking naturally falls to zero and stays there, you don't need to take it.

  What that looks like in practice for most clients is a long maintenance phase where they take it only on the occasional drinking days they have: a wedding, a holiday, a dinner out. It stops feeling like medication and starts feeling like a tool you reach for when you want it. Not a lifelong burden. An option that sits on the shelf for whenever you choose to use it.

• If TSM worked, my GP would have heard of it.

  This is a fair instinct, and one most clients arrive with. You've spent your life trusting that the medical mainstream knows what's available, so when you hear about something you've never been told about, suspicion is the sensible first reaction. We'd rather you held onto that scepticism for a moment than dropped it too quickly.

  What people tend to find, once they look properly, is that TSM isn't fringe, it's just outside the NHS primary care pathway. Naltrexone is an MHRA-licensed medicine, in published research for over thirty years. The science was developed by Dr John Sinclair, an American researcher who spent decades at the Finnish Foundation for Alcohol Studies, where TSM has been a standard treatment for alcohol dependence for years. The protocol was brought into wider clinical use through Dr Roy Eskapa's book The Cure for Alcoholism. All of our staff have been trained under Dr. Roy Eskapa, one of the founding fathers of The Sinclair Method. None of this is obscure or contested in the scientific literature, what hasn't happened is integration into UK NHS primary care, where addiction services are commissioned almost entirely to the abstinence model and most GPs are trained accordingly.

• Why isn't this more widely known if it works?

  If you've felt confused that something this effective isn't being talked about everywhere, you're not alone, and the answer has several parts that together explain it.

  The first is timing. TSM is, properly understood, a generational shift in how alcohol problems are framed and generational shifts in medicine move slowly. The dominant cultural model, built up across the twentieth century and anchored by AA, treats alcohol problems as a moral and willpower issue best addressed by total abstinence. TSM contradicts that frame at its foundation: it says the problem is a learned reward response in the brain, the solution is pharmacological, and you don't need to stop drinking to recover from it. That's a paradigm shift, and paradigm shifts in medicine routinely take decades to mainstream: statins, SSRIs, and Helicobacter pylori treatment for ulcers all faced the same slow journey from "controversial" to "obvious."

  The second is that awareness is actually changing fast. TSM has been a standard alcohol treatment in Finland for years. In the US it became publicly visible after the actress Claudia Christian made her documentary One Little Pill about her own recovery, and through the work of the C Three Foundation. In the UK it's been growing year on year — more clients, more clinicians, more press, more partner pharmacies. You're not catching this at the start. You're catching it in the part of the curve where the conversation is opening up properly.

  The third is that people for whom TSM works tend to quietly disappear from the visible "people with drinking problems" pool. They stop having GP conversations about it. They stop appearing in addiction services data. They stop mentioning they ever had a problem. The protocol's effectiveness becomes invisible in exactly the way the failure of traditional approaches stays visible — because failure generates ongoing demand, and success generates silence. The result is that the most successful AUD treatment available is also one of the quietest, until clients start telling their own story.

• It sounds too good to be true.

  You've probably tried things before. Cutting down. Taking Mondays off. Dry January. Maybe AA, maybe private therapy, maybe both. The reason "too good to be true" is your first instinct with TSM is because every previous attempt taught you to lower your hopes and a protocol that says keep drinking, take a pill, your brain rewires itself, alcohol stops being interesting breaks every rule you've internalised about how this is supposed to work.

  What it does have, which previous attempts probably didn't, is biology on its side. You're not relying on willpower and the published one-year success rate for willpower-only approaches to established AUD sits in low single-digit percentages, which is roughly the figure your own experience has probably already taught you. With TSM, you're using a licensed medication, supported by a TSM coach trained under the lineage of Dr. Roy Eskapa (one of the founding fathers of The Sinclair Method and close colleague of Dr. David Sinclair), working with the way the brain actually learned to drink in the first place. That's why clients describe the first months in remarkably similar terms: a strange sense that drinking is becoming uninteresting on its own, without them having to fight it.

  It isn't too good to be true. It's a real protocol with real evidence and real limitations too with non-compliance.

• Isn't this just swapping one drug for another?

  The worry underneath this question is rarely about the pharmacology, it's about identity. We’ve all grown up in a culture that treats needing medication for an alcohol problem as a kind of failure: real recovery is supposed to be willpower, supposed to be strength, supposed to be done on your own. You may be carrying shame about reaching this point, and "swapping drugs" may be the shape it's taking in your head, or in something your spouse or family has said. It's one of the most common things we hear at the start.

  What clients tell us once they're actually taking naltrexone is that it doesn't feel like anything. You don't get high from it. You don't get sleepy, foggy, calmed, or altered in any way. You take a tablet, an hour later you drink, and you carry on with your evening as you would have done. On the days you don't drink, you don't take it and there's no craving for it, no withdrawal, no missing-something feeling, because there's no reward attached to it for your brain to want. Pharmacologically naltrexone is a blocker, it sits on the same receptors alcohol uses, but does nothing at them. The closer comparison isn't to any drug you'd think of in the addiction sense; it's to medications people take without a second thought, like the antihistamine you'd take for hay fever or the statin you'd take for cholesterol.

  Most clients describe being genuinely surprised by how nothing-like-anything naltrexone actually feels. By month three they often forget they're "on" anything. It quietly does its job underneath, and the thing you end up with is the thing you actually want — alcohol losing its pull, your evenings becoming your own again, the preoccupation fading. Nothing about that is "another drug." It's the opposite of what one would be.

• AA worked for my friend/dad/uncle or someone I know. Why don't I just do that?

  What's worth knowing honestly is what the published research actually shows about AA's effectiveness. because most people carry an assumption that AA has a uniquely high success rate. AA's measured one-year success rate for established AUD sits at around 10%, which is almost exactly the same rate at which people who try to stop drinking on their own, without any help at all, also succeed.

  What AA offers is the framework around an attempt: meetings, the abstinence requirement from day one, the spiritual model, the lifelong identity as "an alcoholic," the public disclosure. For a subset of people that framework holds, and the recovery sticks within it. For the rest, most people who pass through AA it doesn't, and they either disengage or cycle in and out of meetings without sustained change. That isn't a comment on those people; it's a comment on the fit between the framework and them.

  TSM is a structurally different proposition. You're not working with a 1-in-10 outcome rate; you're using a licensed medication, supervised by a clinician and supported by a coach, with a published extinction rate of around 78% among compliant clients. It works with the underlying neurochemistry directly rather than relying on willpower against it. It doesn't require you to identify as anything, attend meetings, or stop drinking from day one. Most clients who tried AA first describe the moment they find TSM as a relief, the realisation that they hadn't been failing as people, they had been trying to recover with the wrong tool.

• I want to do this naturally.

  This is one of the most common things people say at the start, and the instinct underneath it is one of the most respectable in this whole conversation. You want to do this on your own terms. You want to feel like you got yourself out of this, not that you needed a pill to do it. You don't want to feel reliant on something and you may have absorbed, somewhere along the way, a wider message that anything involving medication is less worthy, less real, less you. None of that is wrong to feel, and we wouldn't argue against it.

  Here's the thing about "natural" that's worth sitting with for a moment, though. The drinking pattern you're trying to change isn't natural either. It's a learned response that got built up over years, reinforced by neurochemistry that did exactly what neurochemistry is supposed to do, strengthen behaviours that produced reward. Willpower wasn't designed to unlearn that kind of response. The published one-year success rate for willpower-only attempts at established AUD sits in low single-digit percentages, and most people reading this have probably already experienced that statistic personally. A lot of our clients arrived having spent a year, two years, three years trying the "natural" route first. Almost all of them say afterwards that they wish they'd come sooner, that the time they lost was the real cost.

  There's a reframe worth considering. TSM doesn't override anything natural in you. It lets your brain do its own unlearning extinguishing a response the same way the brain extinguishes any conditioned response when the reward stops coming. The naltrexone takes the reward off the table; the unlearning is your own brain, your own biology, doing what brains are designed to do. Many clients that TSM has actually felt more natural than the willpower attempts ever did, because nothing was being forced. Drinking just quietly lost its grip on its own, the way it would have if it had never become reinforced in the first place.

  If you'd genuinely rather try non-medical approaches first, that's your decision and we respect it entirely. TSM is here whenever you'd like to take a different angle on it.

• I'm not sure I'm 'that bad.' Is TSM for me?

  This is one of the most common opening lines we hear, and it almost always comes from people who would never describe themselves as alcoholics. You hold down a job, probably a senior one. You're present for your family. You don't drink in the morning. You don't drink at work. The picture in your head of "bad enough" is someone visibly out of control, and that isn't you. You function. You're capable. You just happen to drink more than you'd like, more than you used to, and recently you've noticed that the glass at 7pm has stopped being a choice and started being a reflex.

  A meaningful proportion of our clients are exactly this person. They have full lives that look fine from the outside, and from the inside they're carrying a quiet awareness that something has shifted with their drinking that they don't quite want to name yet. They wouldn't ever stand up in a room and call themselves an alcoholic, and TSM is the protocol that fits because it doesn't ask them to. No label, no identity, no public disclosure, no requirement to wait until things get worse before you qualify. The threshold is simply: the drinking is more than you want it to be, and you'd like to change that.

  What clients describe in the first conversation, often, is a sense of relief at being met without the framing they were dreading. You're not being asked to confess to anything or accept anything about yourself. You're being asked whether the pattern is one you'd like to shift and if it is, here's a protocol that does that.

• I only drink wine. It's just a glass or two most nights.

  A "glass or two" of wine across most nights of the week, poured at home rather than measured at a pub, almost always lands between 30 and 70 units a week once it's actually counted. The NHS guideline for low-risk drinking is 14 units. A standard bottle of wine is around 9–10 units. Most home wine glasses pour 175–250ml rather than the 125ml a pub would serve. None of this is a moral judgment — it's where the numbers usually land when people sit down and do the count properly.

  What clients commonly describe at the first conversation is the moment they actually add it up. The "glass or two" turns out to be most of a bottle most nights, and the most-of-a-bottle has been quietly creeping up over a few years. That isn't failure, it's how alcohol works. The pattern strengthens itself slowly across time, and the language used to describe it tends to lag behind the reality by quite a few units. TSM doesn't care whether it arrived in a wine glass or a pint glass; the protocol works on the underlying learning, not the container. What matters is whether the pattern is one you'd like to bring back into your control.

• My partner says I have a problem. I don't think I do.

  If your partner has prompted this call, there's likely a mix going on, possibly some resentment, possibly some quiet pressure, possibly an undercurrent of wondering whether they might be onto something. A fair number of calls start exactly here, and we're not here to take anyone's side.

  The honest position is that a partner is in the room with your drinking far more than anyone else, and partners often notice patterns that the drinker has been unconsciously working around. Sometimes they're seeing something real; sometimes they're worried about something that doesn't warrant intervention. The only way to find out which one is happening is to actually look at it.

  What a consultation does and this matters if you're feeling pushed into the conversation is take both impressions off the table and look at the actual data: units, frequency, context, what it's affecting and what it isn't. Some people we assess are drinking within patterns that don't need intervention, and we say so clearly. Others discover that the picture their partner has been seeing is closer to reality than the one they'd been telling themselves. Either outcome is useful. You aren't committed to anything by having the conversation, you're getting an honest reading you can take or leave.

• Will my NHS GP be told?

  No. SMUK is a private healthcare provider, your treatment with us is confidential and we don't share information with the NHS, your GP, or any third party without your explicit consent. Your record with us stays with us. Nothing flows anywhere automatically. The reason a lot of clients ask this question is the fear that "alcohol use disorder" or "naltrexone treatment" could end up sitting on an NHS record where it might affect life insurance reviews, employment vetting, or DVLA. None of that happens unless you decide to share it yourself.

  The one practical point worth being aware of and we'll go through it properly in your consultation is that naltrexone blocks the effect of opioid-based pain medication. So if you ever need surgery, anaesthesia, or strong pain relief, the clinical team treating you needs to know you're on it, otherwise the pain relief they prescribe won't work as expected. Others carry a medical-alert card in their wallet or a note on their phone they can show to a clinician if needed. Both approaches are fine. The choice, like every other choice in your care with us sits entirely with you.

• Will my employer find out?

  No, and this is one of the most common worries from senior professionals, regulated practitioners, and anyone whose career is sensitive to what sits on a medical record. Private healthcare records are confidential, they sit with the provider and are not shared with employers. If you fund any part of this through private medical insurance, claims information flows to the insurer, not the employer; and within insurer relationships, specific diagnoses aren't routed back through corporate channels in the way many people fear they might be.

  A meaningful proportion of our clients are in roles where this question matters significantly clinicians, lawyers, pilots, directors, regulated professionals. The reason to mention that is so you know you aren't the only person carrying this concern through the decision, and so it doesn't sit unanswered while you're weighing whether to take the next step. It doesn't appear at work. That isn't a soft reassurance; it's how the system is structured.

• I'm on antidepressants / blood pressure medication / other prescriptions. Can I still do TSM?

  Some people asking this are quietly worried they're about to be told no, that the medications they're already on will close the door. The reassuring answer is that for the vast majority of people, the door stays open. Antidepressants, blood pressure medications, statins, thyroid medications, diabetes management, allergy treatments, hormonal contraception, asthma inhalers, acid-reflux medication — almost every common prescription a UK adult might be on sits comfortably alongside naltrexone with no clinical issue.

  The one interaction that matters is with opioid-based medication — things like codeine, tramadol, morphine, oxycodone, fentanyl, or buprenorphine. These need careful handling before starting naltrexone, but even this isn't usually a disqualifier; it's a timing and coordination conversation, and if you're on opioid pain relief for a chronic condition the prescriber will work with you and your other clinicians to find a path through.

• I've had liver issues. Is TSM still possible?

  Almost certainly yes and this is one of the most common worries we hear, often from people whose liver concerns are exactly the reason TSM would be most valuable. If your GP has flagged raised liver enzymes, if you've been told you have fatty liver, if a recent blood test showed your ALT or AST creeping up, the instinct that you might be the one person who can't do TSM is almost always wrong. Liver involvement is not a disqualifier in itself. It's a reason to be in properly supervised care rather than self-managing or doing nothing.

  What changes is how the protocol is configured, not whether you can do it. SMUK has a range of clinical options for clients in this position — standard-dose naltrexone, nalmefene (a related opioid antagonist with a slightly different metabolic profile, sometimes a better fit for clients with hepatic concerns), adjusted dosing approaches, and tailored titration schedules. The prescriber chooses what fits your specific liver picture, your wider health, and your drinking pattern. Layered on top of that is more frequent LFT monitoring throughout the protocol, so any shift in your liver function is caught early and the medication or dose can be adjusted before anything becomes a concern. This is the kind of nuanced clinical oversight that distinguishes a properly supervised TSM programme from a prescription dispensed in isolation and it's exactly where having that supervision matters most.

Information on this page is for general guidance only and isn’t a substitute for medical advice. Your prescribing clinician will confirm suitability and next steps for you.