Wow, Jaba, I see your point. Not only regarding alcohol, but regarding weight loss. Suddenly my candy metaphor in the other thread is reality.
I know I sound like a broken record, but if the goal is extinction of any opoid rewarded behavior, like drinking OR eating, then exposure to the reward on an intermittent basis is going to strengthen the behavior. It's literally creating the opposite of permanent extinction.
So yeah, you can probably train someone to quit chocolate ice cream because it's not rewarding while on Nal. But after they lose 50 lbs, and stop taking the Contrave, then unless they avoid chocolate ice cream forever, they will just be rewarded again.
Honest to pete, as an animal trainer, this is HOW you train a strong, motivated behavior that is highly resistant to extinction--you reward it in on a random, long interval schedule of positive reinforcement.
It's kind of starting to drive me nuts. I realize most doctors probably don't get the educational background to understand this, but psychologists should know it inside and out. To create a medication for weight loss without taking it into account is pretty whacked, imo.
IF Nal is only blocking reward (and that's what we're told over and over in the research) then using it HAS to be a behavioral training intervention. So it has to follow the well understood decades of research on training in the lab, not to mention the dogs that do the hula and the killer whales that splash the audience on cue and the dolphins who plant underwater mines for the Navy. We know this stuff! We know how it works in practice! It's not magic.
I read the forum and I see how hard you all are trying, and how desperately you want to succeed, and the same confusion and difficulties in so many threads, it really kinda pisses me off that you can't get the clear help you need but have to struggle along trying to figure it out by yourselves, or even get misled by the instructions from the doctors.
Sorry for the rant, but I'd never heard of Contrave and after checking it out from this thread, I'm just gobsmacked by the lack of basic behavioral understanding that it indicates.