Hello, everyone!

I have quite a detailed and long story tonight, and I'm sharing because I'm confident you will understand what others in my life might have a harder time relating to.

A little about me: I am a 24 year old male living from Norway, studying medicine. One of my favourite "hobbies" have been drinking, obviously, but I am also into exercise, hiking, music, deep conversations and having fun.

I always tried to explain my excessive drinking in a rational way:
- I rationalized that I would drink excessively to drown my sorrows (and I do have quite a few), or celebrate my accomplishments. Sorrows would be a more powerful rationalizer, but I do drink a lot when things are going relatively well aswell. Except I would be better at following "the social etiquette".
- I rationalized that I can drink moderately if I wanted to, because many times I could have 1, 2, 3 or 4 units and go home. And it could work a couple of times. And I could drink only 2-3 beers at home (especially if I didn't have any more available), but really I was just postponing the binge.

Since May I acknowledged to myself (even if I deep down, I had a suspicion all along) and some others that my drinking was out of control. Basically what happened is I went on a binges lasting a couple of days (when others were binging), except I would be drinking more and a bit longer. Suddenly I went on a 7-day binge in May, drinking alone one some days while going on social drinking events on others. A reason why, could be that a lot of my positive driving force in life had been eaten away by a lot of stress from life (failing an exam, trouble in the family, rejection), so I felt extra compelled to dull negative feelings. However, my drinking has nonetheless increased steadily over the years (with some fluctiations), and it probably was just a question of time before something like that would happen. Since I started drinking regularily at 17-18 years; I would drink alone at times, and I would drink for the sake of getting the endorphine-high. I didn't like the idea of binging alone, and so I would try to "schedule" my binge-drinking to when everyone else was drinking. And I became really good at it, until last spring.

Following this, I had a serious talk with friends (who have noticed) and family (who have detected the warning signs). I then went to my GP and we discussed the alternatives. I would, of course attribute drinking to bad events. We decided the best idea would just to abstain for a period of time, and that I should seek psychological therapy for my problems (which has been beneficial, but probably hasn't done a lot to change my drinking habits). I abstained for 16 days until another event was coming up. And since I wasn't the one to black-out, and because I drank less than usual, and since I didn't need to start again next morning, I figured I was good. Until a couple of drinking events later. So I began to schedule in how much I would drink, and make a lot of rules on how, what and how much to drink. The silliest rule I made myself was that if other people (who were also intoxicated) didn't think I was too drunk/offered me, I would drink it. Of course that worked out well for my unconcious urge to drink. Eventually there came a time when I altered the rules yet again to drink alone, and ended up going on several more drinking binges.

But there really is nothing rational to it. It has been so embarassing to nearly always end up drunkest. It feels terrible to be critized for "choosing" to drink so much, or for lacking self-control. I have exhibited a lot of self-control in other areas of my life, but against alcohol, it just doesn't work. On one side of my family, there is a lot of addiction (around 50% have had serious addictions to drugs and/or alcohol, and most drink more than average). So the idea that one inherits the 'addictive wiring' is a great comfort. A culture where socializing revolves drinking, partying around binge-drinking, and drinking a little along with dinner, is terribly hard for people who have this kind of addictive wiring. I have been told by non-addicted people to "just drink less, slower or lighter beverages" (which works for the majority of people) or quit altogether (which most people aren't willing to themselves, because they don't have an actual problem), but they clearly can't imagine how hard both solutions must be. I can't imagine going the rest of my life without ever drinking again. It would require a huge conscious effort to remove myself from all the "triggers" for drinking, which are plentisome in my life at the moment, and maybe nearly as much for people who have managed to quit for a long time.

In the middle of all this, I did a lot of research, and I came over Claudia Christian's TEDx talk. I read more and more about it. While it sounde to good to be true, it made perfect sense to everything I know about medicine and psychology, and I thought it was an ingenious solution. And I eventually figured out it had become available for treating AUD since 2013 in Norway. Following 2-3 weeks of abstaining, I went to a consultation at my GP yet again, and I was lucky enough to get a prescription for Nalmefene.

Of course I was very excited. The same night I was invited out, and so I followed the instructions. I started drinking at home before going out. The first thing I noticed was that while eating dinner, I had a major drop in appetite, and felt a bit nauseated and dizzy through the evening. When I came home I started drinking another beer, but at some point I had this sudden feeling that I just didn't care for more, and so I went to bed and left the beer on the kitchen counter.

And I would continue following the rules for quite some time. Unfortunately, the side effects weren't were pleasant. The nausea would last for the day after, and I also noticed I could have a lot of problems getting enough deep sleep. It's like my body just wouldn't want to sleep. The next day I would feel sleepy, but unable to sleep properly aswell. And my muscles would feel a bit tensed aswell.

After 1 1/2 months, nalmefene + drinking definitely had reduced both actual drinking and interest in drinking. The units I would drink in a night went down, and more importantly, I wouldn't feel like drinking the day after. That was when I made a major mistake. I somehow tricked myself into believing I would be able to moderate my drinking better even if I didn't take nalmefene, and I would also get rid of the side effects. It worked for several drinking sessions, but for every session, I would take one step back to where I had been. And each time I would stubbornly try to make another attempt at drinking moderately. Now, after having been through three binges this fall, I believe the side effects are worth the results. I hope that the side-effects will lessen, but I have to give it more time, and I believe I should be more mindful of my drinking. I believe there have been times this fall when I have tried to drink through the medication (because of negative feelings from different causes, I'm working at them), and I only end up with both side effects and being sick from alcohol.

I have had some cravings this friday evening, not having drunk since sunday (last weekend-long binge). I am trying to avoid giving into it before the next social event on Sunday, because I have a lot of things to do this weekend. But I am now terrified of not taking nalmefene 2 hours before starting drinking. And what I'm more terrified of, is that I won't be able to cure this, because then I'm almost certain to fail my planned career and planned life. That's why I joined this forum - I think I need a strong reminder not to take alcohol into my own hands without Nalmefene, and to seek advice from those who have gone through/are going through the same as I. All the people who have managed to solve this problem are such an inspiration, and I am so grateful there is a cure for this.

Thank you! <3

Well done for getting started on TSM, Fred! I'm sure you can see now that all the rational self-talk in the world has only a limited effect when you're dealing with a disorder that's based in the Striatum, an unconscious part of the brain that has no capacity for rational thought. The Reward System helped us advance through the millennia, but it certainly has it's faults and limitations. OTOH, once you start treating the problem from with the right approach, the results can be stunning! You can also understand that, with operant conditioning, how important it is to be relentless in your approach and never skip taking the medication except when you aren't going to be drinking that day. When you get the notion that you can drink without the Selincro, really feel that sentiment and realize it's coming from the addicted part of the brain. It can really be a master at working around your workaround, but stay conscious and know your enemy well.

Now you are armed properly. Now the correct plan is not to try to delay or deny the craving, but to attack when the opportunity presents itself, so be sensitive to how you're feeling and realize when you're craving. That's the prime time to apply the Golden Rule by taking the Selincro waiting the two hours and having a TSM drinking session. Only one drink is needed to move you a notch closer to Pharmacological Extinction, so if you aren't completely sold on the idea of a second, third or fourth drink, leave it in the bottle and switch to a non-alcoholic beverage for the rest of the evening.

Sorry the side effects of the Selincro are such a pain. If you can get Naltrexone instead, people seem to have an easier time getting used to it. It cuts the waiting time to an hour as well.

Nal On, Fred!!

Hi, Joe! Thank you for taking your time.

I will discuss the possibility of switching to Naltrexone with my GP the next time I meet with him to renew my prescription. Naltrexone is usually indicated for abstinence when it comes to alcohol here in Norway, so while he might be reluctant, it's worth a shot. I'm a bit more worried what he'll think of me not complying 100% with taking the medication, although I think I can convince him that I've realized my mistake and that the main effect of drinking on the medication has been profound.

Tomorrow evening I will definitely drink, so I guess I will find out if the side effects were as bad as I remember, and whether they will dissipate over time. I will also try to be more mindful and switch to something alcohol-free if I don't feel like drinking. I'm excited to get started again, and to prove to my family and friends that this works and that I can beat my addiction.

Regarding cravings - how strong should they be before one submits to them? At the moment I'm at the level of "It'd be awesome to drink, but I don't have to." If I had beer in the fridge (I have stored it somewhere else, on purpose), I would propably drink it. Usually when I have alcohol around I will be thinking about how nice it will be to drink it. My rational mind has avoided stocking up on alcohol for quite some time, because it only wasted me money (alcohol is taxed heavily here in Norway) because I would take one drink or two, and then I'd binge on it. I guess I could try next weekend to have alcohol at home and take a pill at the first indication of craving.

You're welcome, Fred!

think for bingers the best approach is to err on the side of drinking that day, but if you can manage to only have one, do that. So keeping a limited amount in the house might be a good plan, if that doesn't make you anxious. Some people do quite well with that, so it's up to you. Try be aware of when you tend to lose control and the ability to walk away from it. Is it a line you cross at 2 or 3 or 4 drinks? Notice that and stay behind that line if you can.

Norway may go by the NICE guidelines which say Selincro is used for reduction and Naltrexone is used for abstinence after a detox. Private clinics are willing to prescribe Naltrexone off-label in the UK at least, I don't know if that's allowed in Norway.