Arete wrote:
Just registered, and just started TSM about a week ago. I am optimistic about this treatment, and I'm happy to have found an evidence-based approach for once. I just have a question about how selective extinction is possible when Nal works for 24 hours. To be more specific:
From what I understand, TSM uses 'selective extinction,' meaning that by taking Nal only before drinking, just the undesired behavior of overindulging in alcohol is singled out for extinction. However, I am also given to understand that Nal sits on the endorphin receptors for at least 24 hours. How, then, can extinction be selective, since the Nal blocks endorphin released from all activities/behaviors that normally release endorphin?
I hope my question makes sense. If not, I can elaborate.
Nothing in biology is all or none. It won't be completely "selective", as you correctly described, because any activity that releases endorphins will not result in any sort of "high" as long as there's enough naltrexone on the receptors. Although even that's not necessarily true, because that assumes that the naltrexone is completely blocking all opiate receptors in the brain, which it probably isn't. Also, just because it lasts 24 hours doesn't mean that it's peak activity is that long - it probably takes a certain amount of time to reach peak activity with regard to receptor blocking, and then after some time loses that effect. I don't know where the 24h number comes from, but that may be an arbitrary cut off. It may be working to some extent 24h after taking the dose, but perhaps significantly less so than say 2, 4 or 8 hours after.
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