I'm a long time lurker to this forum, but posting for the first time. I started TSM 3-4 weeks ago after many failed attempts over the last 10 years at abstenance including rehab and AA. My husband and I have noticed, since starting TSM, an increase in not only number of days drinking but also quantity. Naltrexone seems to increase my anxiety and thereby my desire to drink. I have been faithful to the TSM protocol. My husband and I are both concerned about the increase in alcohol consumption. I still find drinking pleasurable, anxiety releaving. Does all of the above indicate that naltrexone is not working?

Gotego -

That is rather unusual, perhaps the old timers on this board have heard of it before and will jump in, but let me ask you some questions. Let's take it by the numbers:

1. What was your drinking habit like before you started TSM?

2. Where are you getting the Nal and what brand is it?

3. Do you have a TSM doc?

4. Are you taking the Nal an hour before you drink?

5. What other medications are you taking?

Even when you take Nal, alcohol still affects your GABA and Glutamate receptors, so you'll still get the "warm and fuzzy", relaxing and anxiolytic effects from it. I didn't really notice much of any difference in how beer felt to me when I started TSM, but I've dropped from about 84 standard drinks per week to 17 per week over a 3 month period. It's more that it stops the addictive part of your brain from "remembering" that alcohol = pleasure. That's the part of your brain that actually drives you to drink, it remembers the pleasure and also remembers how to compel you to obtain the alcohol and get it down your gullet.

In any case, welcome to the forum! I hope we can help you along the way here.

JoeSixPack thanks so much for your reply. To answer your questions:

1. Attempting to narrow down my average, over last 5 years my drinking has varied significantly. When I was going through a number of SSRI anti-depresants I believe I drank close to 70 units per week. I haven't taken any anti-depressants in the last year and probably averaged 30-40 units per week (drinking 3-4 days per week) in the 12 months prior to starting TSM.

2. I am getting nal from my psydoc. He prescribed it as an every day med and I took it as such for a while but I was dealing with constant anxiety as a side effect so I considered not taking it until I stumbled on TSM and thought I'd give it a shot. However, now I'm practically drinking every day, thus taking the med every day anyway. I'm not sure of the brand but I'm in the US and getting it from a regular pharmacy.

3. My doc isn't TSM, although he is pretty progressive and open to the idea of non-mainstream medical alternatives. He was the first doc that I met that had even heard of Baclofen for alcoholism treatment, and was willing to prescribe me the same dose that I had been ordering from overseas which is much higher than the FDA approved amount.

4. The last 3-4 weeks, I haven't faltered a single time in taking naltrexone an hour before I drink, every time.

5. I take Baclofen as an anti-craving medication. 140 mg per day. I started that journey a few years ago and never reached the elusive indifference that Dr. Amiesen had (my typical anxiety reaction to medication prevented me from increasing dosage) but I still believe it helps with cravings or extreme excessive consumption. I also take Lithium 300 mg per day.

It's nice to know that someone felt the pleasurable effects of alcohol and still benefited from TSM. My husband is behind this idea, and rooting for me, so there is a sense of permission that I didn't have before. I'm hoping that that is why I'm drinking more, and not just that the nal isn't working.

Thanks for the response! It's interesting to note that your consumption was higher on antidepressants, if you google SSRI Alcohol Craving you'll see a number of reports about this (antecdotal) as well as an article on RxISK on the subject. The odd thing is that for some, drinking will go down, others see no change at all, so it's just as peculiar to the individual as choosing the right antidepressant in the first place. The other thing that can cause problems for TSM is benzodiazepines, so keep that in your notes.

Sounds like the Baclofen is doing you some good, do you notice that it eases your anxiety? As I understand it, it also acts on the GABA receptors.

Are you taking 50mg of Nal per drinking session at this point? Keep in mind that it only covers you for 12 hours, so if you're still drinking after that, you'll need another dose.

Have a look at Joanna's post here and consider using the mindfulness exercise:

http://optionssavelives.freeforums.net/ ... hints-tips

The trick here is to start to get in the habit of getting your conscious mind involved while the unconscious part of your brain is motivating you to drink. For me, it's all about poking around and finding a soft spot in the habit, wherever you might uncover it. That way, you'll be working it from one angle while the Nal is working it from another. One thing that worked for me was putting off the start time, just 15 minutes or so to begin with. Another was having a couple of sips of my first beer, then putting it back in the fridge and getting up to something else, again just for 15 min or so at first.

You might also want to nab a copy of The Upward Spiral by Alex Korb. It talks about the different parts of the brain and how they're involved in depression and anxiety. It's another opportunity to invite the conscious mind to the party so you don't fall victim to unconscious habits so much. I hear that lithium increases the volume of the amygdala, which plays a big part in anxiety along with portions of the prefrontal cortex.

Well, stay the course with the Nal for now and see if you can alter the behavior some. Does your doc have anything for you that might help with the anxiety level?

I'm not a medical professional, so take my advice with that in mind....

I'd say you're very early in, and your experience is not totally unusual. I too had drinking spikes early on, though anxiety wasn't a huge factor.

I'm tempted to advise you to go another 2-3 weeks, making attempts to start drinking later in the day. with your husband's support, you might start to see a different pattern.

good luck to you in your journey.

Hi Gotego, I think how it is going for you is just how it is going for you! I don't mean to be passé but it is different for everyone. If it's any reassurance I had some heavy spikes in the first 2/3 months, but my drinking pattern was totally different to yours. Your body is adjusting, your brain is adjusting, just keep going. Are you keeping a drink diary? Your post reminded to look at mine (I still record every day) and so I looked back to the beginning which I haven't done in a while, and it is truly amazing the progress I've made. But I was a daily drinker (rarely missed a day LOL) and a binger. Please don't be tempted to compare yourself to someone else, this is a weird but wonderful treatment. I was on Nalmafene and had horrendous SEs for the first 3 months, really horrendous first 3 weeks I was just indoors/in bed couldn't do anything, had anxiety, dread feelings, nausea, aches pains the lot, but I am so so glad I stuck with it. I now only have a small drink every 3/4 days (well for last 2 weeks) I don't really like the taste, but I still feel I need the drug because I'm not totally confident that I've reached extinction. Life is so much better now, keep the faith and I'm so glad you have your husbands support. My partner was not supportive in the early days and just thought it was a way for me to keep drinking, but I think now sees that it has worked. Sorry I'm waffling. Good luck, keep us posted. If you haven't already done so plug into the C3 Foundation I think Joesix mentioned that.

as Boo said, it is really quite different for everyone. I hope it gets easier for you soon and keep tracking and following the GR....

I agree with Boo and Zontar. Do not take a 3-4 week time period and think that it has not worked for you. Just keep doing what you are doing and stay the course. If in a couple more months if you still feel the same (drinking more than pre) then it may call for a slight increase in your dose. BUT you are early in.

I was on a terrible streak of drinking when I first started and it took a couple of months before I felt any sense of control. Take a look at my tracking below in my signature and you will see it took time for it to "work" for me. But it always seems like it is taking too long when you are starting out - because we want it to work so badly! Now when I look back I see that in just a short 10 months I have changed a life time of addiction.

Sometimes we are quick to judge our success based on some lucky people that have an instant honeymoon and are cured in a few months. But like the good looking athletic genius with a humble attitude - those people are few and far in between. The rest of us common folk are not so lucky. We have to wait several months to really see a difference and maybe a year or more to get to where we want to be. But even with that time frame - it is some what of a miracle that you can take a pill, wait at least and hour, drink and in the end get control of AL.

keep the faith! And take the pill - what is there to lose?!

These two statements are somewhat conflicting. Are you taking it every day like any regular medication or are you taking it one hour before you have your first drink in accordance to TSM?

Studies show that patients who follow the every day regimen have no positive results or can even get worse then following the TSM protocol.

In any case it's not unusual for drinking to increase before starting to taper off. Also you will still feel the affects of alcohol whether it's pleasurable or not but it should block the absorption of endorphin. That's the primary function of TSM. Alcohol can trigger pleasure in other parts of the brain so it could be that is what you are focusing on. One good question that may help is the concept of the chase. Prior to TSM when you had your first drink did you feel an insane compulsion to have more? Almost like you absolutely HAD to have more and then that next one would trigger the desire for another and so on?

If you answer yes to that then you know what the chase is and that is the primary treatment of Naltrexon. It blocks the endorphin rush which causes you to drink more and more. IT doesn't block the other affects of alcohol. So it's possible to still get drunk and even desire or perhaps even be addicted to those other affects.

TSM is often a 4 to 6 month process (or longer) for most people before they began to feel its working. Its quite common for many people to often get discouraged within that period as they think its not working or their drinking even increases before it begins to work. 3 or 4 weeks is way too short to reach any conclusions about its effectiveness.

However, one good sign that can indicate it will work is the so called 'honeymoon period'. This is when you first start out on TSM and you feel a reduced desire to drink which usually lasts 3-7 days. After that, drinking often goes back to the way it was (and sometimes can even increase a bit) before TSM begins to take effect a few months later.

However, some brands of generic Naltrexone (notably Nodict) have been reported as not working well for some. My guess is its bad batches of it or does not dissolve well in ones system (big thread on it somewhere here). Naltima seems to be more consistent and is probably the favorite of the generic Nal brands which most report positive results with.