Dear Dr. Eskapa,

I was in my eighth week on the Sinclair Method when I got seriously ill and required hospitalization and surgery. I was too sick to drink for a week or so before going into the hospital. I had not expected my first alcohol-free days in many years to be spent like that, but I was able to get the naltrexone cleared for several days before I was given pain meds (iv morphine several days post-surgery). A couple of days after I got home I refrained from taking the pain meds (percocet tabs) and took an otc pain med instead so I could take a nal and have a drink that evening. I must have had plenty of rx pain med still in my system, because I reacted badly to the naltrexone. I sent you a pm with the details and won't repeat them here. Suffice it to say it is quite apparent to me that nal & pain meds do not mix. The only guidance I found in your book was a mention that nal can send heroin addicts into withdrawal. I doubt I was taking pain medicine long enough to be addicted, and my symptoms did not seem like withdrawal. My concern had been that the nal might render the pain meds ineffective, which is why I waited to see if I was able to tolerate a few hours without it. I was not prepared for what I experienced, and would caution others to avoid mixing nal and synthetic-opioid-type pain meds. Do you have any guidance as to this issue?

Also, I still am not able to go without percocet, nor am I able to go without drinking. I will be able to get back on the nal in a few days (pain-med free) but in a few weeks will need more surgery. I'm drinking little (3 or so a day) but it's so sad I can't take the nal. How long before the additional opioid receptors go away? In other words, although I have no choice, am I now "super-reinforcing" my drinking? Should I just stay off the nal until I am off the pain meds from my second surgery? I'm inclined to refrain from nal, because I recall reading (nal prescribing info for m.d.'s?) in your book that patients already on nal can have reduced benefit from opioid pain meds for a few days following taking the nal. Thankfully that did not happen this last time.

Will my first few weeks on naltrexone retain some benefit, or will I be starting back at square one?

I will get back to the Sinclair Method and see it through no matter what. Do you have any insight as to how to best deal with this? Surely I am not the first, nor will I be the last to face this challenge.

Thanks again for your brilliant work and for contributing here.