Hi there. Thank you for all of the useful information here.

I have a few questions, and I have been checking out the board for a while and haven't found a few of the specific answers I needed. They may be here, so apologies if I am asking folks to repeat themselves.

1. My understanding is that with this method, exercise and sex are no-nos except on a no-drinks, no-Naltrexone day because they trigger endorphins and can be "extincted" or dulled (which of course we don't want). Is it necessary to have a full "cleanse" no-drinks, no-Naltrexone day BEFORE a workout or sexual activity on the next day, or is same-day okay? And is light exercise or sex (I'm smiling about "light sex" -- what is that?) okay on a drinking and Naltrexone day (for example, a two-mile walk with my partner)? Does this change over time? (What I mean is can I anticipate that a year from now, I might have Naltrexone, a drink or two, then sex? Or a workout, then Naltrexone, then a drink or two?)

2. Part of my reliance on alcohol comes from anxiety -- i.e., I've had a rough couple of years with a divorce and custody battle, and it helps me sleep. When I abstain, sleep is difficult. I've been off and on Temazepam for sleep for about a year, have never abused it and always titrate down dose when it gets higher than my prescription. I never use it with alcohol. My understanding is that the "-pam" drugs are not acceptable with this method. Can someone give a simple explanation of why? And is baclofen a substitute until sleep patterns are normalized by the method (I'm assuming one could titrate down until baclofen wasn't needed)? (I realize that your opinions are not a substitute for a doctor's -- asking for anecdotal information.)

I think that's it for now. Really appreciate the help!

On opiodergic nondrinking behaviors and naltrexone: as far as I can tell it isn't a complete catastrophe to do these things the day after (when the naltrexone is still in your system). Yes, you'll do them and won't get the endorphin rush and therefore these behaviors won't get reinforced, but then again they will on the occasions when it has indeed been 48 hours since you drank, and due to upregulation, on those occasions the reinforcement will be enhanced. So I took this advice as more "avoid" than "absolutely do not".

On baclofen: I've just started on it and find it *excellent* for that low-level uneasiness that would get me started drinking. I started on Sunday, now it is Thursday, and I'm only on 30mg (the starter dose). I have found it easier to not drink this week than I have in years. I also have some nerve damage in my back, making sleeping difficult due to pain, and baclofen definitely helps with this as well. So I'd say just give it a try... it is innocuous stuff, people with MS take mass quantities of the stuff for years and years without bad effects. I don't know anything about interactions with -pams, but it sounds like the baclofen might even do a better job for you than the pams. I'm kind of amazed... I'm calm in just the right ways but still very energetic, and don't feel like drinking. I've got *so* much accomplished in the last week!

-Ned

1) Nobody knows. The Book has one off-hand sentence dealing with this subject (and yes, it seems to suggest that you should not have sex/things you like on NAL days). The rest is anecdotal evidence. I don't think even the experts know yet.

I exercise almost every day and am sexually active. Naltrexone has had NO impact whatsoever on either. I've been on it 8 months. This issue is way over-hyped. Live your life and take the pill one hour before drinking.

I concur with nick. I actually have found sex more fun as I believe w/o the endorphin rush, probably, I have even more staying power and a good romp lasts a bit longer. If anything maybe I am in the mood a couple less time a week but better than going at it w/ whiskey d**k, and disappointing my wife.

I've said it before and I'll say it again - Dr. E really needs to remove that page from his book. It is causing so much concern to state that one should not have sex or exercise or cuddle babies for gosh sake. I have found absolutely NO difference with my sex life on Nal. And thinking that I need to wait for an alcohol free day to do so? I haven't had one of those in years. Ridiculous.

Like Nick said - live your life, take a Nal 1 hour before drinking ALWAYS.

I'm no medical scientist, but I'll offer a theory regarding why I think this concern about "extinguishing healthy behaviors" like sex is flat out incorrect. Naltrexone causes extinction with alcoholism of a LEARNED behavior: namely, the positive associations we have developed between whatever we are doing/thinking and our drinking. By cutting off the endorphin rush, ie, positive reinforcement for the association, this learned behavior is unlearned. None of us learned our sex drive, it is INHERENT in all of us. I cannot "unlearn" my sex drive because I never learned it in the first place.

I completely agree with Claremont: that passage in the book needs to be deleted. Too many people are not considering TSM because of this non-issue/concern. Caveat: this is my opinion as a member of this community and is not medically-based.

Thank you all! I am grateful for the support here. I agree re: sex and exercise (intuitively, of course, since I've no experience with either on the med yet): How can sex or exercise be any worse on the med than it is while sloppy-drunk or hungover? And yes, most of us learn to be drunks (at least in part) -- We don't learn to enjoy our basic bodily functions.

I get my nal in about a week and a half and hope to be posting regularly soon....