Dr. Eskapa, I have battled with social anxiety disorter my entire life. As a teen and into my 20's I self medicated with alcohol, the only way I could feel normal, fit in, function. A binge drinker. In the end the anxiety from the hangovers made it all worse. By my mid 20's I quit drinking, smoking and did all I could to try to find a way out of the disabling hell of anxiety, but nothing worked and little was known of these disorters at the time. By my mid 30's doctors began treating me with new anti depressants, but no success, however I was still sober. At 37 I found a leading reasearcher/pschiatrist on GAD and SAD who suggested Nardil or Klonopin, probably the only two medicines I hadn't tried. We went with Klonopin and for the first time in my life I was calm, functioned normally, more social, started a business, had a life, got married had children. Within 5 years I wondered if I was missing out on drinking, enjoying a glass of wine with dinner. I wondered if my early life drinking was just self medicating or if I was a problem drinker. So I started to drink a little here and there. Long story short, 15 years later I'm still on klonopin which is what keeps me functioning (I've tried to get off slowly several times and all my original symptoms returned), however I'm am now and have been for 10 years a full fledged binge drinker. Once I start drinking I typically can't stop until smashed. I have had no luck finding a way to quit drinking, though have yet to try any medicine to stop. I recently read the book and just picked up a perscription for Nal, haven't taken my first dose as I'm 2 weeks since my last binge though I know history will soon repeat.

My question/concerns are:

1. You've indicated in posts that taking naltrexone and a benzo like klonopin will hinder the process and I'm not sure to what extent or if I should even try TSM. I don't seem to have any other option to function normally without klonopin (2mgs a day trying to drop to 1.5mgs). After being elated that I'd found a possible cure with TSM, now I'm discouraged because of my klonopin intake. I was wondering if you might elaborate on this, give me suggestions or perahps clear up any misconceptions I may have.

2: Assuming it makes sense to start TSM while on klonopin I was also wondering how being a binge drinker would affect success. I assume I won't have as many opportunites for extintion as I may only drink 4 times a month or so, but when the urge hits me out of the blue and I drink until I'm smashed, swearing it off for weeks, then doing it all over again. My plan was to just carry naltrexone with me and when the urge hit, I'd take the pill and drink as usual. I will say the occasions I do drink come with strong cravings. How will drinking this infrequently affect extinction?

Please advise. Thanks so much for your time. I need hope and direction..

I received an email response from Dr. Eskapa. Here were some of his comments. I thought some of you might find it useful. I guess it's time for me to give nal a try. I got drunk last night and am pissed off that today is a total waste as I'm so hungover:


"I see no reason for you not to take naltrexone before you drink.
It can help - even though you are on the BDZ. We simply do not have enough data to say that BDZs negate the Sinclair Method ---- one Kentucky psychiatrist believes that the Sinclair Method works even for those on
BDZs..... no studies yet. Your story is not that unusual and I have seen similar cases with a positive resolution!"

Wow, you have no idea what this post means to me! I never received a positive response such as this from either doctor and I am very happy about it!!!! I have always thought that this would not work for me and that counting my units and having to post is what was keeping my units down. Now I have more hope, thank you so much for all of this. I too take Klonipin although I plan on doing a very slow taper in spite of my anxiety disorder! Good luck to you!!!! Please keep posting for all of us. It is so important for us to share our experiences.

I have managed to drop from 2mgs klonopin to 1.5mgs. I took my time, took me a month to get there. I have stayed at 1.5mgs for a few weeks to give my body time to settle. I had been on 2mgs for about 15 years. After dealing with some withdrawls like insomnia and increased anxiety, I now seem to feel better than I did on the 2mg dose. It really feels like a huge success for me. Tonight I begin the next phase to get to 1mg. I have it mapped out to be another 1 month process dropping down in 3 phases about a 10% reduction each 10 days, then ending at 1mg and leveling for a few weeks. I hope that I will have the same success when I get to 1mg and my original anxiety from years past doesn't rebound. If not, I'll keep doing the same thing until I'm off it. At the very least I want to take the smallest effective dose and this is the only way I know to accomplish that. Anyway, I emailed Dr. Eskapa and received additional feedback including info on benzo's. I told him I dropped my dose to 1.5mgs, asked some other questions and this was his response. I found it very interesting and encouraging and thought I'd share. Here's what he wrote:


"I will attach a reply by David Sinclair specifically for another reader but may be of relevance (end of this email to you). I also recommend http://www.benzo.org.uk/manual/ as a responsible way of coming off BDZs. However, I appreciate how tough it is to get off benzodiazepines (BDZs) and one should proceed as you are - with respect, caution and discipline. Discipline refers to sticking to the 1.5 mg dose and not raising it back "just for a day" ... bear with it.

Having said that, given your style of drinking I would aim to take the full dose 50 mg naltrexone before drinking (30 mins to an hour). You may try 25 mg on the first drinking occasion. I have tried naltrexone with and without alcohol just to see what the side-effects some folks (less than 8 %) report - generally nausea I had none ... and I am relatively 'med sensitive myself ... Do not expect side-effects. If they occur they are usually nausea associated and pass. You could try 25 mg but note David Sinclair on dosing in an email today: I underlined what he said about the dose of 25 mg. Point is that if you binge once a week the duration of your binge may not be covered by opioid blockade with only 25 mg. In this case take the 25 mg soon before drinking (30 mins) then drink then if you are continuing after say 4 to 5 hrs take the rest 25 mg) and that should take care of things. Here is David's quote for a forum reader:

"I don't think the final answer is in yet concerning dose. Theoretically, it should not matter. There should not be a normal dose-response curve for doses of naltrexone above 25 mg. A dose of 25 mg should be sufficient to produce 100% blockade of mu receptors for several hours. 50 mg should also produce 100 % blockade for about 24 hours. 100 mg should produce 100% blockade for 48 hours. If patients are being careful to comply in taking naltrexone an hour before drinking always, all of the doses should have the same results. If patients are frequently not taking naltrexone before drinking, the larger doses should be producing better effects, but also more side effects and more extinction of healthy opioidergic behaviors. If patients are being told to abstain and at the same time take naltrexone, the larger doses are likely to be more useful because they will be still active when the people relapse to heavy drinking.

We have not found significant differences between men and women in the effectiveness of naltrexone in either our clinical trial or in the Finnish clinics. Of course, a failure to find significant differences does not mean there are no differences. We did find that the liking for strong sweets was higher in men than women, and higher in alcoholics with a family history of alcoholism than in alcoholics without the family history. From this, one would expect better responsiveness to naltrexone in alcoholics with a family history of alcoholism - which has been found repeatedly including in our studies. One also would expect to find more responsiveness to naltrexone in men than in women, which as I said was not found to be significant in our results - but maybe just because we needed more subjects in order to get significance.

Many many people are benefiting from the Sinclair Method - using naltrexone properly - no reason why you should not be one of them."

Starting the TSM that was good to read among the all formats or it has some formation on it that was useful to read. I collect the data now I have to pay someone to write my resume so I can submit that at my institute that was required by the management.