Dear Dr. Eskapa,

There have been several questions posted about avoiding healthy activities while on Nal until it is out of your system for 2 days like your book promotes. In one of the posts, you reiterated what it says in the book and on another post you wrote,

"In practice I would not worry about the ON and OFF days. This comes much
later on in the treatment.

Right now you are consuming more alcohol than you want to and you would
like to extinguish the craving and the actual drinking levels.

If you drink every day - take naltrexone (start with 25 mg first few
sessions then up to 50 mg) 1 hour to 30 minutes before drinking (not 5 or 8
hours before) and do not take it if you are not drinking.

Please let me know how you get along.

All the best

Roy Eskapa, PhD"

So, my question to you to clarify once and for all is, what am I to do? I want to start TSM, I have read the book and am very excited, BUT I have a very healthy sex life and love to walk on the beach for exercise. I drink every day of my life. I can't imagine when I may potentially have alcohol free days. You say not to indulge in activities like sex/exercise/eating sweets while on Nal. It could be weeks or months before I have an AF day. My husband will likely be gone by then if I can't have sex while on Nal. I want to do this program exactly as prescribed. HELP !!!

Claremont

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MEMBERS, PLEASE FEEL FREE TO RESPOND TO THIS QUESTION AS THIS HAS BEEN DISCUSSED MANY TIMES.

I think extiguishing your dependence on al is of utmost importance. I have not noticed any reduction in the satisfaction I get from my sex life or other enjoyable activities. I too am a daily drinker. It may be that the euphoria from alcohol is so overpowering that that is what would get extinguished first. Then as you progress you start doing the targetted extinction.
In my opinion you have nothing to worry about when it comes to losing interest in the activities you mentioned.

yes, rapper, I think you're right. Yesterday my neighbour brought over her little granddaughter - what a cutie!! Babies are mentioned in the book as being endorphin releasers. I had taken my Nal just one hour before, and boy I sure got a lot of enjoyment when I cuddled that child!! Yet one glass of wine was more than plenty for me half hour later - could have done without. So don't worry!!!!

I finally found the following posts from Dr. Eskapa. I guess many of us were a little confused from what we interpreted in the book as having to avoid the other activities initially. I now understand that the selective extinction should be done after the drinking is under control. I see on page 120 it says that a few months into TSM, there will be some AF days and then we are to do things we find rewarding. HOWEVER, on page 121 it says "Make sure you do not participate in the healthy opioigergic activities while you are on Naltrexone......." I think this is what jumps out to many of us.

DrRoyEskapa Post subject: Re: SEX!!!Posted: Sun Mar 01, 2009 4:51 am

The experience in Finland where tens of thousands have used naltrexone (based on the number of prescriptions per capita - according to Sinclair and numbers in clinical trials using naltrexone in the US and other countries) is that those who have lost control over their drinking are focused on getting that control back. Initially most are drinking daily and taking naltrexone daily, an hour before drinking. Sex is generally not an issue at this stage. The overwhelming issue to to regain control over drinking so that one can drink within safe limits or abstain with ease, without craving, without white-knuckling it... Later on, when the craving is reduced there are days off drinking AND OFF NALTREXONE. On these days endorphine mediated (opiodergic) behaviors are especially good - so sex and chocolate should be better. Impotence and sexual dysfunction has not been reported in the clinical trials - so in practice not to worry! (Please see the section in The Cure for Alcoholism on 'Selective Extinction' -- pages 120 - 122.

DrRoyEskapa Post subject: Re: Extinction of positive behaviours during The Sinclair Method
Posted: Thu Mar 05, 2009 3:10 pm

Yes, it is covered in the book. The main thing is to extinguish the unwanted behavior - the addictive drinking. When that is under control you will be on selective extinction - days off drinking and naltrexone. You only drink with naltrexone and do not take naltrexone when not drinking - according to Sinclair. All the best!

Jim Clark Post subject: Re: naltrexone and sex, how important?Posted: Wed Oct 07, 2009 4:58 pm



Joined: Mon Sep 14, 2009 2:53 pm
Posts: 127
Location: Massachusetts From the Good Dr. Eskapa



"It depends on the extent of the alcohol addiction to begin with: if the addiction is overwhelming and very bad then this takes precedence over other behaviors. Yes, it is possible that sexuality will be extinguished at the same time as craving / addiction to alcohol. Once you have alcohol free days - washout days where there is NO naltrexone in your system and NO alcohol - on those days you should do positive / desirable opiodergic (endorphinergic) behaviors - like having sex and (see Selective Extinction in the book) on those days sex and opioidergic behaviors (vigorous exercise, spicy foods, sweets) should be even more reinforcing (enjoyable) because of 'opioid receptor upregulation' .... so once your craving has decreased and your drinking levels reduce to a point where you can go without drinking alcohol and NOT taking naltrexone on those occasions then these desirable behaviors should increase. However, addiction to alcohol must - because of its overt danger and the poor health consequences as a result of loss of control over drinking - be considered a priority. Do not worry that you will permanently extinguish your sexuality..... it will return (if for you it has diminished) when you are ready for selective extinction - i.e, washout periods when you are not taking naltrexone or drinking.

Roy

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