I'm a heavy drinker but not quite an alcoholic (IMO). ... maybe 40 drinks (mostly beer), go to work every day, rare blackouts.

Can I drink two-three drinks in the beginning with the medicine?

The recommendation is to drink as you normally would.

Some people say this means neck your usual amount.

I say drink as you feel - if you only feel like 3 or 4 then only drink 3 or 4, it doesn't really matter so long as you have the nal in your system you are breaking the link between alcohol and pleasure.

William,
Whether or not you're an "alcoholic" is up for debate, as there's no real clear definition of what that means (or, if there even is such a thing). I used to drink about as much as you, maybe less (I probably drank UP TO 40 drinks [beers, shots] per week, but that would have been a heavy week). At that level, you're definitely drinking at the "problem drinker" level or "alcohol abuse." As "The Cure for Alcoholism" suggests, the real measure of your relationship with alcohol is when you try to quit. If you can't stop drinking, are obsessed with drinking, can't abstain for any period, and have significant cravings, you're "addicted to alcohol" which some might call being an "alcoholic."

Regarding your question, which someone else asked yesterday, I personally don't think it matters if you drink two beers or twenty, if TSM works for you, it will be effective. I also think that it's much better to drink 2 versus 20 in the beginning, because you're also trying to change your habits when it comes to drinking. In my experience, in my 16th week, I've never even made it past three drinks in one sitting, and I wasn't even trying to limit myself. I simply can't do it (well, technically, I suppose I could have actually poured a drink down my throat, but it would have been akin to eating a big piece of pizza when you're really, really full).

Welcome William,

Fact: There is no doubt I'm an alcoholic. I would lie to my Dr. and tell him I "only" drank 2 cases a week. Somehow, I felt less embarrassed telling him that, instead of 4 or 5. I sometimes wonder when I secretly realized I was an alcoholic. I think it really hit home the first time I sweat the bed 1 or 2 nights in a row, after going AF after a bender. I would guess at 40/week, you're not experiencing that.

Opinion: That being said, I would speculate that 90% of the people reading on this site, and 95% of the people posting on this site, and 99% of the people ordering Nal and taking Nal for TSM are or were alcoholics. If you're here, you obviously want to drink less, and probably can't do it by yourself. (Yourself = without TSM or some other treatment)

I am far from cured, starting 4th month, but am pleased with my progress and ready to make more progress. IMO, I also believe I will always be an alcoholic, and never should drink without Nal. i have experienced plenty of Nal drinking sessions that have ended at a fraction of what would have been without the Nal.

So to answer your question, if you take the Nal, and feel like stopping after 3, then stop drinking after 3. For a hard core like me, I can't imagine the phrase, "take the Nal and drink like you normally would", should be interpreted to mean keep drinking even after you no longer want to. That would have meant after 9 last night, I would have had to force down 9 more. That would be silly. I have had the 18 plus while on Nal, but that event is getting less and less frequent.

William, the answer is yes. Take the nal, then one hour later drink 2 or 3 or whatever the number. Just follow the golden rule every time you want to drink: take the nal, wait one hour, drink. You may have many ups and down in the process, we don't know how long the process will take to work for you, but it's worth trying and there's nothing to lose for trying. My drinking is now in control thanks to following that rule. I hope TSM works for you!