I know TSM is not suppose to be rocket science but my BIG question is if you took Nal and drank what amount of Alcohol may make a difference at each sitting in the re-wiring of your brain? I know there may not be a certain amount but does it matter if it is one drink or ten? I ask this as many of us ask how often you should drink with Nal to kick start extinction. I am of the thinking that the more I take Nal+Drinking the sooner my brain will be re-wired along with taking Nal+Drinking more drinks in an alotted time period may re-wire my brain.
Sorry but this is not covered in the book and if Dr Eskapa could tell me Nal + 1 drink would do it each session then I would not have to go through the hell of hangovers (nalovers) and try so much harder at TSM.

Joanna from Options Save Lives Forum asked Dr Eskapa and replied with this:

Central to the concepts of learning and extinction is generalisation of effects. Thus if one went away to a beach in Goa and only drank while on naltrexone ... on returning home to the old cues and stimuli associated with drinking (triggers) the extinction that had happened in Goa might not be present ... and craving and drinking might surge ... it depends. This was noted with many Vietnam Vets who were addicted to opiates but on returning to the US the addiction diminished.... again this is Pavlovian physiology and psychology and was pointed out by Sinclair.

I do not believe that extinction can be sped up beyond a certain speed. But if one tried abstinence and then spaced out drinking sessions with an opioid antagonist every time 'relapse' occurred .. there would be extinction but it would progress very slowly.

The central concept in TSM is to drink as one normally would - and there are huge individual variation in how the drinking was learned (weekend bingers. daily heavy drinkers, etc) always with the medication to prevent reinforcement to the opioid system. Again, some people respond faster than others. It is probably a matter of genes, physiology and duration of the unwanted learned behaviour. Sinclair suggests that people do not drink to the level where alcohol poisoning becomes a problem.... even with the opioid antagonist.

The idea the more you drink on nal the faster the rewiring (or de-wiring) will occur I do not think has been tested and as I said the rates of response vary among the 80% who can be helped. Claudia was one of the lucky ones who responded quickly.. others take 10 months no matter.

I think you have to take Eskapa's statement drink as you normally would literally. Don't change your habits in any way, don't change beverage of choice, don't change the environment you drink in, etc. Repeated sessions where you are denying your brainthe reward that you are accustomed to is what counts. AF days or extended periods of abstinence might slow the process, but won't make the end result any less inevitable if you're compliant with the protocol.

With respect to the amount you drink at each session, again, drink normally...........at first.

But it should go without saying that if you don't crave it, don't drink it. Reduced craving is the product of TSM. Reduced consumption, gradual detox, and drinking at safe levels or (abstinence) is the goal, and if you don't put the reduced craving to work you won't see measurable results towards the goal.

I can't see how continuing to drink when you don't crave it would serve any beneficial purpose, but there's most definitely a downside.