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.

As opposed to always having the Nal, which is the current "approved" way to treat alcohol abuse with Nal. Here you are selectively taking it when having alcohol, while NOT taking it while doing other enjoyable things without alcohol.

Granted, 24 hours is a long "selection" here, but with medicines like this, it can't be totally exact.

Right, so I guess it only starts being 'selective' when you start having more and more AF days to reinforce positive behaviors when you're off Nal. When you're still drinking every day, like I am, it's really not accurate to call it selective extinction, it seems. I could be wrong though. Thanks for answering!

hi Arete,

welcome to the forum

I think "selective extinction" is possibly overstating it a bit. I think it just means that you only have to take the Nal when you drink, rather than taking it every day regardless of whether you drink or not. in this way it becomes "somewhat-targeted extinction", although obviously other endorphin-producing activities, as well as drinking, are affected whilst you have Nal in your system

hope that helps

-badger

I think you would benefit greatly from reading the book, which I recommend. This journey is too important for you not to have all the facts, the book is cheap, and a short easy read.

Having said that: NAL takes away the wonderful rush alcohol gives us. And after a while our brains learn that that rush is no longer available, and we lose interest in alcohol because be no longer realize a benefit/reward.

free to read/download here:

https://www.dropbox.com/s/bihrkpsy7rfmo62/tsm-trend.xls?dl=0

Thanks for your responses everyone!

I actually bought the book and read it. That's where I learned what seem to be two contradictory claims: (1) Nal blocks endorphins for at least 24 hours, and (2) TSM works through selective extinction. These seem to me to be two mutually exclusive claims when Nal is taken daily.

But I do understand that it gets more 'selective' once you have more AF days.

Hi Arete,

I just got some advice from Clarion on my progress report noting that after 4 or 5 months it appears to be common that many of us have had very few completely AF days and we start to experience a general extinction with everything that triggers the same endorphin receptors (exercise, sex, etc) and that many of those who have done this advised her/him to start 'forcing AF days, once the urge to drink was diminished enough to make it reasonable, to start building back and just keeping the Nal working on the Alcohol. Clarion found that this worked well for him/her.

It makes sense to me and I can see that it is likely that I have a bit of that general apathy that is likely from almost daily Nal use over the past 4.5 months. I am a bit excited to be strategic about adding healthy behaviors back on my AF days and to get extra strong endorphin support for things like exercise and love making. Seems pretty win/win.....a little hidden silver lining to all this. All things considered, the extinction towards other things can all be easily undone after the alcohol use gets under control so it is a small price to pay. It isn't like you have an aversion towards anything, it just isn't as fun on some level. Apparently the receptors fire really strongly when you start having Nal free days so I am looking forward to some particularly enjoyable workouts (it will be a first but I'm an optimist ha!ha!)



Jephiner

Naltrexone is at it's highest dose 1-4 hours after taking the tablet. After that it's concentration drops by 50% every 4 hours.

That is possibly one way you get selective extinction.

Arete: I would also add that you need to wait and see how nal affects you. I have noticed no real change in how much I enjoy exercise (I don't really, but I keep doing it everyday anyway) or sex (I do, and that has not changed at all!). I don't notice feeling depressed because of taking the nal. I look forward to the day when I am not taking it very often, but mostly just because I don't like taking drugs at all and also because that will mean that I am not drinking every day.

Others do report feeling depressed or flat, but maybe that won't happen for you.

Nal on!! Newlife