Hi there,
I have recently been through my 3rd medical detox in 4yrs, followed by an 8 week residential program and I am about 3 weeks back in the outside world. I am 46 and have been a heavy drinker since I was 18, and a daily, start-in-the-morning drinker for the last 10. My partner died in an unfortunate accident while on holiday about 5 years ago, and I completely lost control of my drinking around then. She was a heavy drinker herself, but did slightly temper my drinking.
Before my last detox I was around 250 units p/w for about a year.

I am currently on Antabuse, and was prescribed Naltrexone for "cravings" while in the residential program. Once I left, my doctor said he was unwilling to prescribe it, so I left it at that, not sure that it was doing anything anyway. I have been going to a lot of AA meetings, but am craving alcohol, and already "forgetting" to take my Antabuse occasionaly in the morning. I've been there before and know where it leads..

After a few uninspiring AA meetings, I looked up alternatives online, and came across TSM. It almost sounds too good to be true.....

I am engaged with an agency called CADS here in NZ, and asked them about naltrexone. They looked up my details, and said that as I had it in rehab, I have a "special authority number" that is valid for another 3 months, and the very helpful nurse there gave me her number and told me to get my doctor to ring her if he had any problems with prescribing it.
Needless to say he wasn't keen, but it seemed like he couldn't be bothered ringing the nurse, and found the authority, so he prescribed it - 3 months worth fully funded.

I am currently 95 days sober, but I can feel and see the familiar signs of relapse.
Are there other people here using TSM who were drinking those quantities?
How much would I realistically have to drink for the method to be effective for me? I would like to only have a couple, but that's not really been my style in the past..

I am very excited, and nervous at the same time.
I will do some more research - I've seen "One Little Pill", but I am very keen to give it a try.

Welcome Roger - I am sorry that you have had all the problems that you have had. I do think that the nal could help you BUT I do not think 3 months worth will hack it - it took me nearly a year and I am not sure if you can order it online there or not? Joe will probably chime in later and he is pretty good at seeing if it is available in whatever country. The Nal is just a tool - you still have to WANT to stop drinking - although you do not have to actually stop with it - that decision was taken out of my hands - I just don't want to drink any more. no, I was not drinking the amounts that you are and I have no idea if the nal can help - I do not see why not though. But you would have to actually help it along. There are lots of tools to help you - Jaba is good at suggesting those - like mindful drinking etc.

Just wanted to post a reply to you for now and hopefully some more help will be along later! Hang in there .....

hugs, Maggie

Welcome to the forums, Roger! So glad you joined and decided to post!

Starting TSM after a period of abstinence seems to give pretty good results from what I've read here. Look up the threads by "Bardo" and "Angieridesnow" for a couple of stories along those lines. There's also a guy over in the UK, Paul Turner, who runs "Alcohol Home Treatment" that uses a similar method, i.e. a home detox period followed by reintroduction to alcohol while using Naltrexone. AA or similar can be an advantage here, as you gain skills to get control of the "habit" part of drinking, while Naltrexone works to erase the "craving". You might want to see if you can get his attention, perhaps he'll divulge some trade secrets as he can't operate in New Zealand anyway. He often posts in the "Alcohol Consumption" forums over on Patient.info.

Antabuse is unlikely to help you out here as it does nothing to stop the craving, and that seems to be exactly what you're experiencing right now. You may need to be at the ready to get Naltrexone from overseas, just in case your doctor decides to cut you off, but likely you'll be using far fewer pills than they have in mind as on TSM you only take Nal an hour before you drink, only on drinking days. I'm assuming that they're prescribing Nal to be taken while abstinent, correct me if I'm wrong.

Are you taking any other meds aside from the Antabuse?

Thanks for the welcome Maggie and Joe.

I have looked into importing Nal and it seems to be possible here in NZ, or at least there are certainly online pharmacies who say they will ship here.
I absolutely do WANT to stop - and have done for at least 2 years, I thought I did before that. I certainly have known I needed to cut down for a long time, and Nal would have been great a few years ago, because I wouldn't have had to wrestle with that "forever without a drink is such a long time" thing.
I can easily believe that drinking so heavily for so long, my synaptic reward pathways are very strong, and the cravings are hard to resist, and then after the first drink I crave more - that's exactly what it feels like.

Thanks for the advice Joe - Bardo's thread is very inspiring. I couldn't find Angieridesnow? I have seen a video of Paul's on youtube which was excellent. I strongly suspect Antabuse won't be effective for me long term, as it hasn't been 3x before...
You're right that they're prescribing daily Nal while abstinent to control cravings, and I understand why not to do that. I'll just keep it till I start TSM.

I'm cool with going to AA for meetings, I just struggle with the Higher Power thing, and my sponsor is big on that. As far as I can tell their "skills" to control the habit of drinking are to pray, go to meetings, and some EST type psycho babble which is heavy on dredging up the past (Sorry if I've offended anyone, just my opinion).

I'm only taking blood pressure medication apart from the antabuse. I have been prescribed anti-depressants, but I can't seem to take them (don't trust em?).
I'm feeling a hell of a lot better since I stopped drinking, and re-connecting with friends and family again is awesome (I have been a very isolated drunk), it's just the cravings and obsession that gnaw at me. Having said that, I went to a comedy gala last night and an after-party where most people were drinking, and I had a great time socialising while drinking water. Way more laughs than my recent AA meetings. The antabuse took drinking off the table, so I was relaxed about the situation. It's weird, but I was a lot more anxious recently when drinking than I currently am sober.

If Nal gets rid of the cravings, I am hoping for the same result. Relaxed and sociable without getting drunk, or even wanting to drink. I'm a musician, so avoiding temptation is not a good long term strategy for me (or I suspect many people), which is what is so great about TSM.

Cool. Seems like you know the program, so if you just stick to The Golden Rule (take the Nal an hour before you drink, without fail) you should be good . You've already taken Nal, so if you got along with/didn't notice any side effects, that's one issue to check off the list. You might want to start it when you're going to be at home for a couple of days, just in case there's a bit of antabuse left in your system.

Good for you for seeing the warning signs and making a plan, I think you'll do well with this. NB, the book mentions a 3-4 month timeline, but as Maggie says, many take longer than that. I think the most units I've seen in somebody's sig was around the 150-175/wk range, but as I recall they weren't going into it sober, so perhaps you're going to have an advantage there.

When you went back to drinking before, did you ease into it or did you pretty much go full throttle on the first day? I dunno if you want to make some plan to have only so much in the house or the like. Wouldn't want to put yourself in a position where you might get behind the wheel in search of more.

As far as AA goes, I don't think they're going to be too receptive of TSM. Maybe there's a Moderation Management meeting around that you could plug into if you feel the need from time to time. One guy was using a Smart Recovery meeting, but they seem to vary in their tolerance for moderation. The one he found seemed to get along with TSM ok.

Well, keep us filled in on how it's going for you and jump in with questions (or even just rants) whenever you feel like it. I'll be keeping an eye out for your progress reports, for sure!

Thanks Joe,
I do have some willpower beforehand (which is why I think I'll be good with the Golden Rule), but not really after the rush hits. I will certainly try to limit the amount I have in the house, and I am currently without a vehicle. That said, I have several liquor outlets within a short bike ride. It's very ubiquitous here.

The other advantage(?) I have at the moment is that I'm not currently earning, so I can't actually afford to drink much. That could be helpful? Hopefully it still works on 2-3 drinks a day?

I suspect you're right about AA and TSM. My sharing would have to have a startling number of omissions once I start, which isn't ideal for an honesty based program.

CADS (Community Alcohol and Drug Services) here in NZ have a harm reduction program, but they have said I am "only interested in that because I want to drink and that's not good for me". I'm pretty sure they don't approve/don't know of TSM.

I am doing their Maintenance and Action programs, which seem good, with CBT type skills talked about in a fairly informal small group setting with 2 counsellors. It's good for reinforcing what I learnt in various rehabs.
Once the cravings are out of the equation, I think I have been given some useful knowledge I can apply.

Once I've read "The Cure" cover to cover, I'll likely stop Antabuse, and start TSM a week after that. I'll certainly keep you updated!

Sounds good, Roger.

"The other advantage(?) I have at the moment is that I'm not currently earning, so I can't actually afford to drink much. That could be helpful? Hopefully it still works on 2-3 drinks a day?"

You actually only need one drink per "extinction session". If you really crave the next, go ahead with it, but check out what Joanna wrote about "mindful drinking", don't just toss 'em back:

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

Another thing you might try is to physically get the drink away from you and out of your sight after you take a sip, then get up to something else and come back to the drink in 15 minutes or so. Your drinking pattern is stored in your Striatum and it doesn't know the difference between a good habit and a bad habit. It just remembers alch = pleasure, and it remembers how to compel you to get the alch down your gullet. So break up that recording and get your conscious mind into the mix by putting the drink down and getting away from the cues.

Also, on your Alcohol Free days, after the Nal is cleared out of your system, work in an endorphin-releasing activity if you can (hiking, workout, sex, eating spicy food, get a good bellylaugh somehow, a really nice massage, etc.). Your opioid receptors are going to be primed and sensitive at that time (which is precisely why you don't want to slip with the Golden Rule, so keep it with you always) and you can use that to teach your brain a healthy activity, while on drinking days, the Nal is helping you "unlearn" the unhealthy one. So if you drink on Friday evening, no Nal and no booze on Saturday, then Sunday afternoon you're ready to use "selective extinction" to reprogram yourself to go for a healthy activity. Basically, you're getting 2 uses out of the same pill. You'll come across a description of that in the book

Great to see you on here Roger and you are getting good advice from other members. I think someone did chime in that for some people who start TSM after a period of abstinence it can work even more effectively, but try to ease yourself along, and control your expectations because it is different for everyone. The main thing is that it works! As others have said, drink slowly and mindfully. I wonder what dose you are on, maybe I missed that, it seems another important factor. I'm in the UK and I was prescribed Nalmafene which is the UK alternative to Naltrexone (which here ironically is only prescribed for abstinence)., I got my order of Naltrexone a week ago and I've only been taking half a 50mg tab., I'm female 56 been heavy drinker for 15 years about 80-100 units a week, although it's hard to know exactly because I was a monthly binger ie about once a month I'd binge for 3/4 days. I have had a few challenges in the process (started Nov 15)., and had a couple of relatively small spikes in the last month, but I'm now drinking well within safe limits and lots of AF days, to be honest and for example last night I had a small glass of wine, it took me all night to drink it, I didn't really want it, it was partly habit and partly I feel that I haven't totally reached extinct ing, so I'm having a drink about every 3 days after a Naltrexone. I'm still being prescribed Nalmafene by my Al Specialist Doc, I'll have a big stash at this rate! Anyway I just wanted to wish you luck and hope you feel empowered by the help and support from some of the excellent people on this site. Keep posting.

Thanks for the encouragement Boo.
I've been prescribed 50mg, so I'll start with 2 days of 25mg, then 50 from the 3rd.
I'm on my 3rd day off antabuse, so about a week to go...
I've read "The Cure" (not all of the appendices) and am very inspired right now.

Joanna's tips are very helpful thanks Joe. You said
You actually only need one drink per "extinction session".

I am very keen for this to work, and I have managed 14 weeks of abstinence, so please take the following as completely hypothetical and highly unlikely, bearing in mind my long history with alcohol. I'm "pink clouding" as they say in AA...

If only one drink per extinction session is needed, is the idealistic way to do TSM;
Take the pill at 5pm
Have ONE drink at 6pm (2 units)

Do this Thur - Mon. Have Tue off. Play tennis Wed evening.

... I realize it's extremely unlikely, but IF it was possible would that be the way to go?

I guess the main thing, is that with the large amounts I was drinking, It's hard to believe that ONE drink per session could cause extinction.

I will however manage my expectations as best I can, as Boo said.
Don't worry, I won't beat myself up if (when) I don't achieve it, I just didn't see in the book where it said only one drink was needed per session.

Excellent, Roger! Sounds like you've got things lined up pretty well!

Though you only need one drink per session to move the extinction a notch forward, if you really want the next drink, you should go ahead and have it. Just really invite your conscious mind into the proceedings and be listening for when you get the notion that you've had enough. The Nal will be moving that point closer and closer, so watch for it to come. At that point, pour out the rest of the drink or at least put it down and walk away from it. Don't provide any further visual or sensory cues, because that's what the automatic part of your brain triggers off of. With each drink, just keep using that test. If you come across a day when you have one drink and you're satisfied, you've held up your end of the bargain and the extinction has moved a step forward, so don't feel like you have to force more down for it to work.

The testing and the mindfulness aspect have been added to the mix since the book was published. Joanna tells me there's a revision in the works that will include mindfulness techniques along with other new information. Indeed, you'll end up wanting what you want and since you're hunting the craving now (rather than it hunting you) you don't want to waste a good opportunity to wither the beast further.

Play the dose by ear too, if you still have side effects after the first two days, stay on the lower dose until they pass. Aside from that, I'd say your plan sounds pretty solid!