Firstly, congratulations to those who have been cured by TSM, and best wishes to those still struggling. What I am about to say is NOT a criticism of the method, but simply a question about how widely applicable it may be to alcoholics who drink large amounts on a daily basis.

I was dismayed when I first heard that at least one study of TSM involved patients whose average WEEKLY alcohol intake (i.e. before treatment) was only 35 units. I don't have Dr. Eskapa's book in front of me right now to be able to directly quote this, but one of our members quoted this weekly amount from the book in a question to Dr. Eskapa. I have read the reports of others here who are on TSM or have been cured by TSM, and I think I'd be safe to say that none were drinking only 35 units/week upon starting. With respect, I don't think many people drinking 35 units/week would consider themselves alcoholics or be regarded as alcoholics by anyone else...even my mother drinks more than this, without problems and with normal liver function test results (as part of recent blood tests she had done through her doctor). I repeat that I'm not directly quoting from Dr. Eskapa's book or from Dr. Sinclair's trials, so hopefully 35 units/week has never been a validfor success of TSM.

Let's get serious about the subject of alcohol intake. From my own experience and that of almost everyone I have ever met through AA, detox, counselling programs, and every other form of alcoholism treatment (and even the regular drinkers in pubs/clubs who aren't seeking treatment), the average weekly intake of people who admit to having a serious alcohol problem is in the range of 100 to 150 units per week, and those with a long history of daily drinking frequently drink 150-200 per week or even higher. My own weekly intake is around 180-190 units. It's not something I am proud of.

Many people who have started TSM have posted initial weekly amounts that were way below 100. Some stated a high number to begin with but then stated they had reduced their intake before starting TSM. I have many questions about this, but I will just ask one question...

Is there any evidence that TSM has enabled seriously dependent alcoholics (100-200 units per week prior to starting) to become cured? I certainly hope there is. I am about to undertake another detox to lower my alcohol dependence, and have a doctor willing to prescribe Nal and monitor me after the detox...after previous detoxes my drinking level has shot back up to huge levels and Nal has not seemed effective in preventing this. There has been no honeymoon period.

I'm also posting this on behalf of several friends who have severe alcohol dependency and who have been to AA and tried all the conventional treatments.

Hi Greg,

I will probably reply in more detail but one factor that needs to be taken into account is the worldwide difference in what is meant by a unit of alcohol. We have several interested parties here - including, but by no means limited to the UK, USA, Canada, Australia, France and, of course, Finland. The following table indicates the difference in worldwide standard units of alcohol:

http://www.drinkingandyou.com/site/uk/biggy.htm

V.

Welcome - you'll get lots of great help here, and some answers to your specific questions but as I'm here now I'll start. (opps, I see the ever vigilant Virgil has beat me to the post ha,ha.)

Two things: First, going through detox, then taking Naltrexone while abstaining is NOT TSM. The whole point is to begin to take Nal while drinking regardless of whether you cut back or not. Dr. Sinclair maintains that detox will occur naturally as the Nal aids in the cutting back. While you go through a forced detox your addiction cravings are driven UP not down, so naturally you will drink huge amounts again. Check out the book on Alcohol Depravation Effect.

Second, alcoholism is NOT dependent on the amount drunk. I'm one of those who drink very little, however I CANNOT STOP DRINKING THAT LITTLE BIT. Hence I consider myself an alcoholic. After one month on Nal I am seeing changes but still MUST have my little tipple every night. I panic at the thought of not drinking it. Your Mum, God bless her, might sing a different tune if she were deprived for some reason of what drinking she does - or she could be one of millions who just is not an alcoholic. Volume is irrelevant IMO.

From what you'll read here, and from what others in your same situation will tell you, very heavy drinkers may take much much longer to be "cured" on Nal. Please read the stories of people here especially in the weekly reports and you will see a variety of drinking volumes, and a variety of ups and downs towards the cure. Good luck.

Welcome Greg and thank you for the very thoughtful post.

I believe the answer to your question can be answered by theory and reality. In theory, everything I've read about natlrexone indicates that it should work regardless of the amount you drink or how long you have been drinking. There is nothing in Eskapa's book or in any of the studies I've seen that says TSM will not work for heavy drinkers. In theory, it should work for all drinkers, regardless of how much or how long you've been drinking.

However, in reality, I have not seen any studies to date where people who were drinking at the levels you describe have been cured of alcoholism. To my knowledge, the issue simply has not yet been addressed. Or if it has, I haven't seen it. We are the pioneers here and so most of the evidence of naltrexone's effectiveness is being discovered right here on this board.

You can look at the cured list and read the histories of the people who have declared themselves cured. I know Tom was a member who used to drink high numbers and has declared himself cured. I believe SpringerRider had big numbers also. There may be others but you should check the list and the histories for yourself.

IMO, you have hit on a major flaw of the studies and Eskapa's book. And this is no insult to Eskapa -- his book is just a summary of the studies and there don't appear to be many of them -- at least not in the US. But to my knowledge, there is zero analysis of two key variables regarding TSM and its efficacy: the amount of drinks people consume and the amount of time they've been drinking alcoholically. I believe that the more one consumes and the longer one has been an alcoholic, then the longer it will take for extinction to occur. However, that is my personal theory based upon what I know about classical conditioning and you will not find any support for that theory in the book. Also, the book contains an extinction graph which includes a three to four month cure period for someone who consumes 35 per week. And I agree with you: many people who drink five per day do not even consider themselves as having a problem and almost all of us here drink far more than that, or did pre-TSM anyway. We are slowly discovering here -- anecdotally anyway -- that the three to four month estimated period for the cure is a wildly enthusiastic time frame for heavier drinkers. Personally, TSM is definitely working for me and my consumption/cravings have been drastically reduced and I'm grateful for the method. However, I am still not cured as evidenced by my bender last night and I just hit the five-month mark. My estimated weekly consumption pre-TSM was about fifty per week as I was a binger and did not drink on a daily basis. And my pre-TSM habit of about fifty per week is about average on this board (according to LoOp's statistics) and is a fraction of the numbers you and many other serious drinkers consume regularly. And while I feel close to being cured, I'm not there yet at five months.

So I wish I could give you a definitive answer to your question but I haven't seen anything in the literature or the studies that specifically addresses your question. Dr. Sinclair and Dr. Eskapa would tell you that TSM works, regardless of the amount you drink. But the literature doesn't address this issue (to my knowledge) and the evidence of the "real world" is scant and being developed on this board. I believe the best you can do is study up on the progress reports of the people here. If others have more information, opinions or information, it would be of great value to this very important topic.

Thanks again Greg, welcome and good luck!

My best,

Nick

Hello Greg,

Well to your question. I never experienced a honeymoon period on nal. I also didn't experience very much in the way of side effects. From the first day I took it though, I noticed a difference in how alcohol affected me. My head stayed clear and I didn't get that irrational feeling of "must consume more". Although I still had the physical affects of loss of coordination and other motor skills, I was still thinking clearly. Also, I still enjoyed drinking still. It felt like I would feel after about4-6, maybe a few more, drinks.
Regardless, like you said most of us drink way more than 35. I may have understated my pre-tsm, I just figured a 12 pack a day, probably less on weekdays and more on weekends. It may have been closer to 100 or so. Thes are US units.
Some of the lower starting levels may be due to the fact that as we got here, at least some of us were pursuing other avenues to the goal. I personally went thru intensive outpatient ~4 mos prior to starting tsm. It didn't work. 12 step based.
Heck if I wasn't in certain situations I could probably take the levels I am at now. My wife might agree, she definitely has been appreciative of the progress I have made. The thing is I don't get loopy drunk. When I drink too much, I pretty much get tired. Again not the irrational mind of a drunk. I feel like, what I believe to be, what normal people who drink feel like. I just, so far, over do it more often than them.
I have felt outstanding. I am regaining my health, my family, and my sanity.
I definitely recommend trying it for maybe a year if you have to.
I think you will agree that what I have described, so far, is worth it. And this is just a small piece of what is going on.
Also, you will find that a lot of the studies pointed to for the success for TSM, the success happened accidentally. Numerous studies were done using natrexone and the instruction for abstinence. It was the subjects who didn't follow the abstinence protocol and took the nal who showed the best results, reduced drinking, reduced heavy drinking, etc. It is hard to find direct evidence. A lot of the thought is that there is no money in it for pharma companies. Not much in it for the Dr.s. And the fear of medical practitioners to ask alkies to drink. Plus the resistance of the addictions industry.
We are trying to figure mor of it out, day by day.

Hi Greg! From our common experience her we have gleaned that TSM has the potential to work for almost everyone. We do notice that it takes longer for some. And frankly, it takes longer than the minimum 3 to 4 months for most of us. We have informally (i.e. non-scientifically) concluded that the longer you have been drinking heavily and the more you drink, the longer it is likely to take. The important thing is that it DOES work for most of us.

Why not start? It is likely to help, and it won't hurt. You might as well, as long as you're drinking anyway . . . .

Whatever you decide, it's good to see you droppin in on us. Please let us know how you're doing.

I should probably copy & paste this because I keep repeating it but...

Greg,

I was drinking in the 100's (US Units) last year prior to Oct & went to my doc to get help because I didn't want to morning drink but the withdrawal was high anxiety & scary to think I might have a seizure. So after I detoxed at home on diazepam I stayed sober & took Nal 'for craving prevention' from October until June. Then I started to drink again and continued to take the Nal daily. I never got back up into the 100's but was into the 60's -70's or so. My hangovers were horrible with the Nal. That was the first difference. But all of a sudden I came across this The Sinclair Method & wow. I had everything in place to do this right. So I started to take Nal 1 hour before drinking instead of everyday in the morning as a daily medication. The result is amazing progress. I am down to having this week at most 4 12oz 4.6% beers and that is almost too much because of the way I feel in the morning. This is indeed a gift. Besides the slogan Nal+Alcohol=Cure is the freedom to entertain a craving without fear of making an ass of myself or going out & driving drunk or what ever. Already, not cured, I am free. So try this the way we are trying it. It really, really works.

Here is a modified chart of my units by week average progress...the reason the 10/31 is so low is because this week isn't done yet!

Hi Greg! Great to hear from you and I am so glad you are still in "the Battle."
I know how distressed this makes all of us, so you are not alone,
I really wish you the best. (OO)
ART

Hi Greg,

Your question is such an important one. So much so that I have just written to Dr Sinclair (with a copy to Dr Eskapa) drawing their attention to your thread. As soon as I have a reply, I'll let everyone know.

Best wishes.

V.

Thank you everyone for replying. I will try and answer your comments; sorry if I do not address everything you have written.

Thanks, I do realise the difference in the measurement of alcohol quantities in different countries. Here in Australia we count alcohol as "standard drinks", and according to this measurement my weekly intake is currently 145-150 standard drinks. In terms of "units", this becomes 183-190 units. I know that such high drinking levels are not necessary to be a true alcoholic, especially in female drinkers. I'm sorry if I was minimising the problems faced by people who drink lesser amounts but are still experiencing addiction and serious problems. I had many alcohol-related problems myself when still drinking at far lower levels.

I fully understand that detoxing and taking naltrexone only while abstinent is not TSM. My first experiences with Nal were back when it was first promoted as an almost magic cure for cravings, both for alcoholism and opiate addiction. I had no knowledge of TSM/pharmacological extinction all those years ago, so naturally I took it during abstinence...and naturally it did not work! Since learning more I now have no intention of ever taking Nal again while abstinent. I did try it within TSM but only for a few months, and gave up when I didn't get quick results. I didn't post here because I didn't want to discourage others.

To be honest I have baulked at taking Nal again, even via TSM, due to my alcohol intake. I have been looking into quick-fix options such as very high-dose baclofen and even cannabis substitution, out of desperation to get my drinking levels way down very quickly. However these methods have problems of their own. I know TSM will require many, many months or even years to work in my case and I'm worried about my ability to keep going at this high alcohol intake. It will remain very high for a long time if I go ahead with TSM again, as there is no other way of undertaking the method (i.e. to do it requires drinking as I normally would). The doctor I'm currently seeing is also willing to go ahead with Antabuse + high dose baclofen after my latest detox, as an alternative to TSM, and I have been considering this seriously for a long time...even more so now that a doctor is actually willing to prescribe for me. Maybe after a while I could then restart TSM at a far lower alcohol intake. My thinking was similar with the cannabis idea...just a temporary reprieve from constant alcohol cravings and constant high intake.

Thanks again to everyone who replied, and sorry I haven't individually named you. I would be very grateful for any further info about TSM and heavy daily drinking.

Finally I wish to point out that I am NOT promoting the use of cannabis, and I do not use it (or any other illegal drugs) myself. I was just pointing out how desperate I feel for a quick cure for my drinking, and how I'm sometimes willing to consider outlandish ideas out of desperation once everything else has failed.