Hello, I am posting this as a spouse. My hubby has been sober for over a year. He recently read about TSM, but clearly didn't absorb the rules. He has been experimenting with drinking. He has been taking Naltrexone every day for over a year. I am concerned about the interaction of the alcohol with Doxepin, apparently it can be very dangerous.

Also, I haven't been able to find anything about weaning yourself off of anti-depressants that have alcohol interaction, along with daily Naltrexone, so that you can properly try the TSM.

Help would be appreciated!

The whole thing sounds like a bad idea. Doxepin is an old school antidepressant that also makes you sleepy / drowsy, and alcohol can compound the central nervous system side-effects in dangerous ways. If he's on it for depression, he'll get more depressed all while consuming a depressant (alcohol). He'd be at high risk for a downward spiral of drinking and depression and insomnia, etc... I wouldn't think you have to "wean" off of daily Naltrexone use. Who knows, though, as it's a pretty mysterious drug in my opinion -- i.e. there could be all sorts of experiences he could have stopping daily Nal use and just switching to taking it before drinking. Doxepin, a TCA, definitely has to weaned off or he will get some bad side-effects.

Anyway, you probably know all this already. How has he done through this year? Has he been happier, more productive, a better person? Or...the opposite? Why does he want to start "experimenting" with alcohol again?

I agree it is a mess. He is also taking Celexa which is a no no with booze. He's been great the last year but apparently would like to be able to socially have a glass of wine or two.

His psychiatrist seems uninformed about the meds she is prescribing. Any resources you guys can suggest are appreciated. We are in Chicago.

I would imagine that, best case scenario, "socially having a glass of wine or two" would not require any need to do any big medical adjustments. I mean, if a glass of wine or two mixed with Doxepin routinely killed people, Doxepin would not be available for sale. In addition, Naltrexone can just be taken one hour prior to the hypothetical 1-2 glasses of wine and, voila, he's "doing TSM." Two thoughts:

(1) Good luck finding a psychiatrist willing to tweak his psych meds so he can start socially drinking. Maybe your husband is different, but I'm sure the average psychiatrist has been burned (or heard stories) about trying to accomodate a patient's desire to drink, only to get blamed as the patient quickly spirals out of control and a sh*t show ensues.

(2) I'm sure every problem drinker reading this thread has raised an eyebrow regarding your husband being able to pull off this hypothetical "1 or 2 drinks, just socially." Again, I don't want to be like the pessimists over at AA that think such a thing is impossible. But, in my opinion, TSM works best for heavy drinkers that have tried everything to stop and just can't, yet have high motivation. It's not really designed for sober people with a history of substance abuse (and mental illness, no less) to be able to go from zero drinks in a year to a glass of wine or two now and then. If you're new around here, every year we have several spouses (mostly wives) come here in similar scenarios, only to have their husbands (or wives) become quickly non-compliant with the method. You obviously can't control his every move, but I'm just trying to offer you a picture of why his plan might not be the best idea, and may be coming from a desire to do much more than just have a glass of wine (e.g. for me, 1-2 drinks is more frustrating than satisfying -- it's like taking just one bite of a cheeseburger).

Anyway, it's still a semi-free country, so he'll probably do what he wants anyway, so you're in a pickle as to how to proceed from a spousal position.

Thanks so much for the reply. Pretty much everything you have said, I have said to him, so your comments at a minimum are making me feel less insane.

After essentially being an alcoholic for 40 years, getting sober was a great accomplishment for him. After failed AA and rehab attempts, I found him a "swanky" rehab with a great treatment program, and meds that seem to work for him. I guess when you are an alcoholic you never lose the desire to be "normal", even when life is going well.

I too was gigging over the "1 or 2 glasses of wine". 5 shots of vodka later...not pretty I don't advise that on Doxepin and Celexa, for sure. He was lucky not to have stopped breathing, and while he didn't fall down or black out, he had very little recollection of a 12 hour period of time. If I was his psychiatrist I would have told him to get to the hospital.

I have no idea how this will all play out, but will keep everyone posted. I have to say it was nice though, not worrying about him all day, for almost a year.

I guess when you are an alcoholic you never lose the desire to be "normal", even when life is going well.

I always like to challenge statements like that because that's classic AA excuse making.

OPINION WARNING: If I were you, I'd NOT support him in this endeavor at all because it would have a very high likelihood of failure. At the same time, wouldn't it be great for him to get off these high-powered anti-depressants and daily Naltrexone AND still be sober and productive? Geez, I would imagine that these drugs completely change his experience of life in a negative way.

Best of luck. And if you haven't read rationalrecovery.com's scathing analysis of "recoveryism," I'd recommend it. It is a good counter-argument to AA and rehabs. A bit extreme, yes, but biting and thought-provoking.