Selincro - sucking the joy out of life next couple of days - stop taking or reduce dose

Overall my my intake has dropped like a stone .  I've had two bottles of wine in a week over 2 tablets instead of my one or two bottles a night.  Need to focus on that.  

Have a a good weekend :-) 

Hope you're weekend goes well :-)

It sounds as though you're drinking on days you're having a break from Selincro? You do know that's the exact opposite to what you're supposed to do?

The only rule is that you must take Selincro every time you drink.

Not judging you, just wanted others reading to know that's not how Selincro works.

Are you living in the UK where it has only recently become available on the NHS. There are guidlines and the criteria for prescribing is :

Nalmefene (also known as Selincro) is recommended as a possible treatment for people with alcohol dependence who:

are still drinking more than 7.5 units per day (for men) and more than 5 units per day (for women) 2 weeks after an initial assessment and

do not have physical withdrawal symptoms and

do not need to either stop drinking straight away or stop drinking completely.

Nalmefene should only be taken if the person is also having ongoing support to change their behaviour and to continue to take their treatment, to help them reduce their alcohol intake.

I do not need or want to stop drinking, just to reduce to safe levels. My understanding was that you could stop taking it on the days you want to have a drink.  NO way can I have a drink when taking it,

Happy for you to provide more evidence for me to say I am doing it wrong !

That absolutely is the wrong advice. Selincro should ONLY be taken on the drinking days and only not be taken on the days off.

Have you read the info on The Sinclair Method or seen any posts on here from health worker Paul?

Selincro blocks the pleasure receptors of the brain when drinking alcohol therefore stopping your brain seeing alcohol as the pleasure it once was. If you take it when you're not drinking you're blocking pleasure from non drinking activities.

Please research even a little bit of The Sinclair Method online and you will find this information to be the opposite of what you are doing.

All the best.

Here is a link to the Guide lines here in the UK.

https://www.nice.org.uk/guidance/ta325

ray

Even on my prescription label it says 'To be taken as required on each day there is a risk of drinking alcohol'.

I have been researching quite a bit of material since yesterday about the Sinclair Method and the background to granting the UK licence of Nalmefene.  The two seem to conflict in some ways in that TSM is a life long commitment of taking Nalmefene. All the material I have read through NICE Guidlines and the Granting of the UK licence discuss options of shorter term us and caution of prescribing after 12 months.

You may have read some of my other posts on various threads over the past week since I started Nalmefene.  I fit the Nice guidlines as someone with a mild dependancy with no physical dependancy on alcohol. I did not wake up craving a drink , I did not require a drink during the day, unless on holiday or a special occassion. My problem was slipping into a routine of sitting in front of the TV each evening and consuming ' on average ' 1.5 bottles of wine, occassionally a beer first and occassionally a spirit to finish. However, usually just the wine. It became a habit difficult to reduce.  I don't want to stop drinking altogether. I want to enjoy a drink on weekends when in company and or  other special occassions that occur during the week. Generally though I want to cut down and have several days free of alcohol for health reasons.

After 5 days of taking Nalmefene I just could not face a drink. The side effects saw to that. My main issue  ( as I have documented here before ) was a heaviness in my chest probably associated with the expected muscle spasms that was playing havoc with my Hiatus Hernia. On Thursday I planned to have a drink but could not face it. Friday and Saturday was always my plan to have a drink. I had thought it okay to stop the Nalmefene on these days but apparently, certainly under the The Sinclair Method , that is a NO NO !   Friday evening I had three small glasses of wine with a meal. Saturday I only managed 2.5 small glasses.  I intend to recontinue the Nalmefene today . 

Now given that the granting of the UK licence to prescribe Nalmefene does not adhear to The Sinclair Method am I doing wrong ( as as been suggested by odishon , well meaning I am sure )

One thing I read that does worry me is TSM states if you come off the drug the brain adapts and the pleasure of alcohol increases there causing more problems than you started with. I had no intention of taking this drug for life so this is becoming an issue for me. 

I hope PaulJTurner1964 reads this as he is a RMN working in this field in the UK.   I am retired now but have  life long experience in the NHS in both mental and general health.  That accounts for my drinking then lol

I would highly recommend reading Dr Eskapa's book 'The Cure For Alcoholism'. It is meant to be taken for life unless of course one stops drinking for ever.

I personally read about the Scottish Trial in the press and waiting for NICE to pass it for England and Wales. I approached my GP in March who had not a clue about it. I of course had to jump through the hoops before being prescribed Nalmefene last week. In the mean time i was educating my support worker that i was required to see. Lol

Firstly, they talk about it being for women who drink 5 units a day and men who drink 7.5. The first reaction to that is 'THEY don't need it!!'

The guidelines are sketchy. My colleague and I, who use The Sinclair Method with our clients believe that there are a number of reasons for this, the most important one being that if a person was drinking say a bottle of vodka a day, and they took Selincro and found they didn't want to drink at all, there is a very high risk that they would go into withdrawal from alcohol which could be extremely dangerous and even fatal in some cases.

NICE qualify this by saying that this level of drinking (5 or 7.5 units) is TWO WEEKS AFTER the initial assessment. That suggests that they believe that a person should reduce to this level before starting on the drug. This would minimise the risk of withdrawal symptoms.

The way we work is that we offer a detox first to those who are drinking way in excess of the 5 or 7.5 units per day and then start Selincro after that, when they are drinking 0 units. We then tell them to take a pill IF they are going to have a drink and NOT if they are not going to drink that day.

The important thing to know is that Selincro blocks the opioid receptors in the brain. These receptors are stimulated by endorphins that are released by the body when people drink alcohol. Some people get a far greater reward when these receptors are stimulated and these are the people who get into difficulty with alcohol. By blocking the receptors before drinking, a person who has difficulty controlling their alcohol intake will no longer get that additional reward. They will simply react in the same way as healthy drinkers do. They will still enjoy the taste, they will still get drunk if they drink too much and they will enjoy the atmosphere and less inhibited conversation associated with social situations where alcohol is available. Over 2-3 months, if they take a pill and block those receptors every time they drink, their body will learn not to expect that additional reward and they will be able to have 1 or 2 drinks and not get that urge to carry on drinking. They will also wake up the next day without the desperate need for a drink. Throughout that 2-3 month period, some people will find that they reduce their drinking after the first pill and others will find it gradually reduces.

Once this period has passed and they reach the point of 'pharmacological extinction' - the point when they have unlearned their addiction, they would be at risk of re-learning it if they drank unprotected. For that reason, they must ALWAYS take a pill 90 minutes to 2 hours before drinking (until somebody comes up with an even better treatment option).

It is also important to know that there are many healthy activities which release endorphins which stimulate the same opioid receptors. These are things such as eating certain sweet and spicy foods, riding rollercoasters, extreme sports, exercise, having sex, cuddling babies and stroking animals. For this reason, the pleasure of these activities would be diminished on days that they took a pill. It is therefore necessary to avoid drinking and Selincro on the days they do these other activities if they want to gain maximum pleasure from them.

Some people report a feeling where they get no pleasure from anything in life when they first start taking Selincro. It is an effect which WILL wear off over the first few times they take it, along with the other side effects of nausea, sleepless nights etc.

The 78% success rates in Finland refer to 78% of those using The Sinclair Method EITHER cutting down their drinking to much lower levels OR stopping drinking altogether because they simply don't get the same reward from it (and some were addicted but never actually liked the taste that much anyway.)

The Sinclair Method is the most effective treatment method available in the world today. The 78% success rate in Finland compares with less than 10% success rate for rehab.

So my expectations were that i take a tablet each day that would help me not to feel like a drink or restrict the amount. On the two days a week i wanted to drink, i.e. in company with friends, i would not take the tablet. I now discover that this is not the way it should be.

The information i have read over the past couple of days on the Scottish Trials and UK licence indicates no reasearch evidence for continuing to take the drug for more than a year. In fact on prescribing in the UK it advises caution. I recall also reading that the granting of the UK licence was not based on The Sinclair Method. Am i correct on that or have i misread ?

My understanding at the time of the two weeks after assessment in the NICE guidlines was that this was people like me drinking at that level before and after assessment. My whole interpretation of the introduction of Nalmephene in the UK was that it was aimed at those individuals such as myself. Not those heavier level drinkers requiring detox.

So how do i proceed giving the longer term implications that i was not aware of when starting out on this journey. I guess i don,t really have an option. My plan that i would be on these tablets a few months and stop does not seem realistic hearing what i am hearing here.

Paul, is there someone in the UK involved in the licence / Nice whome i could correspond with to discuss further ?

Nalmefene is aimed at anybody who is drinking too much and the guidelines of what they should be drinking immediately before starting on it are for safety. In order to make it accessible to people drinking a lot more, we give people detoxes to get them to a point where we can do it without breaching guidelines but that doesn't mean that everybody who can benefit from Nalmefene needs a detox.

You will not find many experts in the UK. You can talk to me via private message. I know you said you had trouble sending me one before, I will send you one, see if you can reply to that.

I can't talk too much about what I do in this public forum as it would be seen as me promoting my business.