Hello Dr. Eskapa,

During the past few weeks, I've discovered that a 25mg dose of Naltrexone appears to be just as effective at eliminating my desire to drink as a 50mg dose, and also dramatically reduces problematic side effects. That curious fact prompted me to research medical journals, where I stumbled across a couple of peer-reviewed articles regarding the "Duration of Occupancy of Opiate Receptors by Naltrexone" for various dosages. The results indicate 25mg of naltrexone provides a complete opioid receptor blockade for at least 12 hours -- which is more than sufficient to eliminate the endorphin rush during my typical evening beer-drinking session (between 1 and 5 hours maximum). I realize 50mg is the standard dosage recommended in The Cure for Alcoholism (and substantiated through research), but I'm wondering if that particular number is due to the fact 50mg results in an opioid blockade for a full 24-hour period -- thus ensuring the drinker is always protected -- whenever they choose to drink. Would you please comment as to whether you think my lower dosage may be detrimental to the long-term success of program -- taking into account the unique (daily/evening-only) drinking pattern I've disclosed? So far, I've had great success with TSM (better than I ever hoped!). I'm approximately 7 weeks into the program with a 60% reduction in average consumption, experienced my first AF day this past week, and have no side effects whatsoever.

If you are responding well to 25 mg naltrexone 30 minutes to an hour before drinking then by all means proceed. There are individual differences in metabolism and absorption of the medication. Some doctors prescribe 100 mg naltrexone ... but the studies reported are based on 50 mg, as you said. In this case taking a larger dose will not speed up the de-addiction process. As long as the opioid receptors are blocked so that there is no reinforcement coming from the endorphins released by alcohol, then you will be extinguishing the addiction. Just as the addiction is not learned overnight so the de-addiction (pharmacological extinction) process takes time.

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