I'm about week 6 into this, but only 4 weeks of really keeping track. Had a bit of a honeymoon at first. Still below pre-TSM levels but not as low as I'd like.

When I drink with the naltrexone I feel sort of outside the experience, or like the Nal is keeping me from feeling drunk even though I am. Sometimes it fells like I'm observing myself from a distance.

But there is still the craving. I still head back for more because I can still feel the hunger back there behind the Nal curtain.

Is this how it feels for others?

I suspect that what's happening is that parts of the reward response in my brain are being blocked while the addicted part is still active and hungry.

It's an odd feeling.

Agreed! The experience of drinking on Nal is somehow different. Why is it so hard to put your finger on what's different? One can still get to intoxication and even say it is yet enjoyable, but something is missing. If we did not know the mechanism blocking the opiate receptors, we would not have the language to describe it. The fact that it is a subtle difference on Nal, allows the experience of intoxication to gradually become less and less appealing. I think you are well on your way to success. Nal-on!

Yep, sounds about right. Drinking on nal just doesn't have the excitement/rush/freeing sensation drinking otherwise had. It doesn't feel bad, necessarily (except when I am realyl nauseous) but it generally just feels BLAH to me now. In the beginning I think I definitely still chased the high, because I still had the craving behind the nal, as you said. Now I am doing that less and less because I know (both intellectually and chemically) that it is just not going to happen on nal. I might have fun drinking, but it will be because the situation is itself fun - not exclusively because of the alcohol. The few times recently that I've overdone it I have honestly felt like I was FORCING myself to drink. And I couldn't drink even half of what I used to drink in the old days.

Those feelings and thoughts are the same for me; the rush is just missing. I'm still driven to drink despite that, but it doesn't usually take long before I stop because the reward simply isn't there.

My suspicion is that I'm still chasing the high, which is why [like EL] I've actively forced it down; the receptor upregulation is there, and the addicted lower brain hasn't got the message yet that it's not going to get its reward. So, it's still supplying the drive to drink "go on, I need this, it'll make me feel good" while my rational higher brain knows that it won't. That produces a dichotomy in advance of drinking, which is amplified by the reality of not getting the opioid rush.

I also suspect that a lot of what I've associated with drink is NOT being drunk as most people feel it, but actually the high. So, when I'm drunk now, I'm feeling the effects of alcohol itself instead of the endorphins - so a totally different feeling. The concept of "had enough" is a very strange one to encounter!

Those feelings and thoughts are the same for me; the rush is just missing. I'm still driven to drink despite that, but it doesn't usually take long before I stop because the reward simply isn't there.

My suspicion is that I'm still chasing the high, which is why [like EL] I've actively forced it down; the receptor upregulation is there, and the addicted lower brain hasn't got the message yet that it's not going to get its reward. So, it's still supplying the drive to drink "go on, I need this, it'll make me feel good" while my rational higher brain knows that it won't. That produces a dichotomy in advance of drinking, which is amplified by the reality of not getting the opioid rush.

I also suspect that a lot of what I've associated with drink is NOT being drunk as most people feel it, but actually the high. So, when I'm drunk now, I'm feeling the effects of alcohol itself instead of the endorphins - so a totally different feeling. The concept of "had enough" is a very strange one to encounter!

BWD, you know I think you're aboslutely right - when we experience being drunk, I think it might be very different from what "normal" drinkers experience. I'm with you on the fact that now that nal is blocking the rush, the actual effects of alcohol and drunkenness are...unpleasant. I definitely no longer get the manic energy, super openness and clarity of mind that I used to associate with drinking - now if anything i get a little irritable!

i apologize if this is off topic for this thread, but i got my first Nal script last night and plan on using it for the first time after work, when i will have a couple beers (based on the stronger beers i like and the pint size, i would say two pints ends up being 4-5 units).

my question: should i just go straight for the 50mg dose from day one or start at 25mg? i'm not terribly worried about medication side effects in general (knock on wood i've always seemed to tolerate meds well), and i'm eager to get this process started. At the same time i do have an early and full day scheduled tomorrow and would rather not be keeled over with nausea!

FYI i'm also going to be having a few drinks tomorrow night and possibly Sat and/or Sunday. They're mellow social gatherings and i really don't see getting hammered at any of them (even off the Nal). i don't know if that matters, i.e. whether it gives me a quicker opportunity to ease up to the full 50mg...

thx.

Digs, most people start with 25mg for a couple days to a couple weeks because of strong side effects. I started off (accidentally) with 50mg and had very bad nausea and dizziness, but it passed within a few hours. I'm also prone to medication side effects. I would trust your gut on this. It doesn't really matter either way, as you'll likely have a honeymoon with 25mg or 50mg, and you'll eventually get to 50mg.

If you can start Nal over the weekend you will avoid dealing with possible side-effects that come in the first couple days. Moreover, you can expect a week or more of light-sleeping. It may be annoying but it goes away. Often TSMers experience that they feel the alcohol after even a couple drinks despite one's expected tolerance. If you jump in with 50 mg, do it on the weekend. That said, you must know that some don't experience side effects, and rarely some experience them terribly. To be forewarned is to be forearmed. TSM will require patience--- your eagerness to "get there" notwithstanding. Good luck.

thanks to both of you for the replies. it's a tough call. my gut tells me just do the 50mg since i've rarely had nausea issues, and i'm a pretty crappy sleeper as it is so this probably won't even register....but i do want to be able to make it through the work day tomorrow. i guess i'm just really anxious to see how i respond tonight and feel like i might obsess if i take a half dose. i have that type of restless OCD mind.

i know this is a long process which requires patience, and i'm sure once i settle into a groove i won't think about it much. but man, this past week was all about crossing fingers that my shrink would give me a Nal script, then getting it last night and being so pumped to get this started....

only gonna have two (strong) beers in an hour, an amount that usually gives me a solid buzz but well within driving safely....here goes nothing.

*EDIT - just downed the full 50mg*

i'll let you know tomorrow if i regret that decision...