First Week Using Naltrexone 50mg per TSM - Advice Needed

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So tomorrow will mark one week that I've been using Naltrexone 50mg tablets per The Sinclair Method. I've been drinking since the age of 16 and am now 35. I've lost countless jobs due to my alcoholism as well as ruined many relationships. I'm currently married to my high school sweetheart and we have two children (one together). We've been married almost 2 years now and my drinking has really brought us through the wringer! I've tried AA, rehab, high-dose vitamin regimens, religion, etc. They all work to keep me sober for several months and then I end up going right back into the cycle of binging, sober several days, slowly ramping up consumption, binging again, etc. I'd researched TSM for several months, read Dr. Eskapa's book, watched One Little Pill, read all the user reviews on Naltrexone, etc. I'm in the US and was about to order the medication online but found a doctor listed on the C3Foundation website near me who was very accomodating and prescribed me a 6 month supply of Naltrexone on the first visit. He seemed impressed by my knowledge concerning Naltrexone and TSM =) So granted, drinking is the last thing my wife wants to see me doing but she got behind me in support of TSM and we began the first night by taking one tablet 1 hour prior to our kids going to sleep and then once they were in bed, I started drinking my usual vodka / Gatorade mix. I got about 3/4 of the way through a 1/2 pint of vodka when I got extremely ill which caused the drinking to cease for the night. Extreme unease and nausea followed me throughout the next day. Again, the next night, rather than taking a full pill, I took 1/2 a pill and although I had no interest in drinking, I wanted to continue moving toward pharmacological extinction so I drank the remaining 1/4 of the 1/2 pint of vodka rather begrudgingly. The nausea was markedly less severe on this trial. The following night, I again took only 1/2 a pill but this time switched over to beer which I do enjoy but was only able to finish about a 1/4 of the beer, if that, prior to losing interest but experienced no nausea. On the 4th, 5th, and 6th night, I have moved back up to taking a full 50mg tablet and continued to drink beer starting 1-2 hours after ingesting the Naltrexone. In those 3 nights, I've never made it beyond a single beer before completely losing interest!!! I couldn't be happier with the results I'm experiencing on the naltrexone! But my question currently is this: At what point is it safe to stop the nightly extinction trials and only take the medication when I'm experiencing a craving? I do think it helps me with cravings throughout the day (I can't recall consciously experiencing them) knowing that I will be able to drink at night after the kids are in bed so I'm not in a rush to screw around with what seems to be working exceptionally well for me. My logic is that I want to get as many nightly extinction trials under my belt as possible. Am I doing any damage to TSM effectiveness by taking Naltrexone and drinking on a nightly basis as opposed to only when a strong craving hits me? I know the medication is working as I no longer have that compulsive drive to DRINK DRINK DRINK until I'm drunk when I take that first sip? Do any of you see any harm in continuing my nightly trials until I simply no longer have any interest in doing so? As it stands, I find I rather enjoy the ritual, if that makes sense...... I'm whoeheartedly looking forward to your feedback! Thank you so much for taking the time to listen to me ramble =)

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  • Posted

    Congrats on your progress so far.  The fact that you are having less interest shows that this method will work for you long-term, as long as you always maintain compliance over the coming months, despite whatever you may feel.

    Many doctors suggest that someone take the medication and drink every night for a week - this enables them to adjust to the medication and get any side effects out of the way.

    Once you feel you can take naltrexone and feel fine, then that is the point at which you should switch to taking the naltrexone at the first sign of a genuine craving, wait, and then drink mindfully.  Allow yourself to appreciate that the sensation is different to what it used to be, the compulsion to continue is not as strong, and then work towards interrupting your drinking when you can.  Only one drink is needed to release the endorphins and cause an extinction session, so look to have that drink to satisfy that urge you had, then work towards doing something else for 10 minutes, or drinking a non-alcoholic drink.  Ask yourself if you really want the next drink and when your brain says no, put the drink down and stop.

    Having spoken to Roy Eskapa and Dr Sinclair about this prior to Dr Sinclair's death, they explained to me that drinking every day to try and cause extinction is not beneficial unless someone is an every day drinker anyway.

    Basically, TSM works in your brain to extinguish triggers that usually prompt you to drink.  That is the 'learned behaviour'.  So, it cannot extinguish triggers from a behaviour that has not already been learned.  Dr Sinclair told me that trying to force more extinction sessions will not speed up the process, and doing so does not allow you to explore the good sensations of endorphin release without alcohol.  (That is called Pharmacalogical Enhanced Learning and is explained in the book).

    You are experiencing a trigger to drink when you experience a craving or urge to drink.  That is how your brain has learned to respond.  Hence, TSM can't be forced to extinction, but will happen naturally if you answer each craving or urge with the tablet, the wait and then the drink.  Your brain is dissapointed that it didn't get what it was expecting.  Repeat this over many months and your brain will stop expecting it and your cravings will lessen.

    It took me 8 months in total, but it might take you less or longer.  So what?  You know things are improving week on week so allow yourself to accept that it will take what it takes.

    The other advantage with 'targetting' the specific cravings like this is that it will leave you free to enjoy endorphin releasing activities at other times.  Your brain will no longer receive a good endorphin reward from alcohol but will receive that reward from other activities.  This also helps your brain to switch from wanting alcohol to wanting other good, rewarding activities.

    Lastly, do remember that the pathway in your brain that associates alcohol with chemical reward is very strong because it has been activated and strengthened by a number of years of drinking.  You will have ups and downs as you move along the weeks/months.  Some months you may feel your drinking levels are much reduced.  Other weeks you may feel dispondent because it feels like your drinking is higher again.  Track your drinking (there is a free tool on the C3 Foundation website) so that you can see the overall trend. 


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    • Posted

      Thank you very much for your pointed, detailed response to my question, Joanna! This gives me a timeline on which to work and build. Tonight will be my last nightly session (makes 7 days) and then I will move forward with only doing an extinction trial when a craving hits. Yes, things are definitely improving day by day. My wife mentioned my fingernails to me last night: I'm a chronic nail biter. And my nails are looking healthy again. I hadn't noticed but I've stopped chewing my nails since starting naltrexone. Having an answer to something that has plagued me for so long, working on "the cure", gives me hope and an overall general feeling of ease and relaxation. I will prepare myself for the ups and downs, the lows and highs along the way. Thank you for addressing the issue of targeting the behavior specifically. I didn't want my ritual to become just another routine in my brain that leads to drinking. I think it will be a more effective approach to target the craving rather than just taking a pill and drinking at a set time so my brain can better associate the reward not being gained as a direct result of the craving and not just a planned activity, if that makes sense. Food for thought and a much-appreciated nudge in the right direction. My wife and I surely thank you!

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    • Posted

      You are very welcome!

      There are a number of others using this method on this forum too, so I am sure they will be along very soon to give more reassurance and suggestions that have worked well for them.

      Should you, or your wife, feel the need for any one-to-one support or encouragement - or even just a chat about the method as the weeks progress - feel free to contact Claudia Christian at the US C3 Foundation site.  I operate C3 Foundation Europe and since I am in the UK, there would be quite a time delay between us, but both Claudia and I are accredited counsellors and support people on this method with as little, or as much, help as they feel they need.


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