I'm a 50 year old male who started drinking again after 6 years abstinence in a 12 step program. I had more or less ventured out of AA a year prior; I liked most of the people in the program, but found the overall program a bit confining and not quite compatible with my spiritual beliefs. About a year prior to that again, I met a wonderful woman who is a very moderate drinker. However, she's a chef and I really missed being able to share a bottle of wine with her over a good meal. On vacation last October, I decided to see if I could drink moderately, and that worked very well for a couple of months. However, I found that my alcohol consumption crept up gradually, to the point where I was drinking every day. Although I was not drinking anywhere near the quantities I was drinking years before, it made me feel guilty and uncomfortable. I also noticed that my depression, which I had suffered from before getting sober and which had periodically reappeared during my abstinent years, seemed to get worse. I also gained a lot of weight. However, worst of all, I would wake up feeling jittery and anxious, and I felt that I was now walking down a path that seemed familiar and that something had to change. Last week I had a medical appointment (not my regular doctor, in fact she was a PA). She expressed concern about my high blood pressure, and it was at this point I decided to tell her about my drinking. I told her that I did not feel that I was drinking alcoholically like I had been before, but that the drinking probably did not help and I'd like to cut back. She asked me how much I was drinking, and I told her about 3-4 drinks a night 3-4 days a week. That's probably a low estimate, as I had been drinking that quantity (and occasionally a bit more) pretty much every day. She told me that given my history, I really should not run that risk, and she asked if I was willing to try Naltrexone. I had never heard of it, but I said yes. She was running to the next patient, so she gave me a printout from a web site (webmd?) and told me that I would have to read up on it. The prescription said to take one a day. I found out later that day that the medication was not covered by my insurance, but I asked the pharmacist if she thought it would be worth it to pay for out of pocket (about $115 for 30 tablets, 50 mg). The pharmacist simply said that her customers who come in with this prescription generally keep refilling it, which should indicate it's working. She said she could give me 15 tablets, then I could try it out. This was last Thursday, and keep in mind, at this point I thought I was supposed to abstain and take the Nal medication every day. I took one tablet that evening, didn't drink, kind of wanted to but no big deal. What I did do, which I'm glad I did, was to do a bit more research on Nal. I found an article from Psychology Today about the Sinclair Method, followed the link to the Amazon book (which I ordered) and read some of the Amazon reviews. This led me to the blog by someone named unchainedmouse, and then to this board. I suspected there must be a forum like this one, with people sharing their experiences. After reading quite a bit on this board, it started to dawn on me that to be successful with this method, total abstinence is not the way to go. I still have a lot to read, but I think I'm at least starting to get a general idea about pharmaceutical extinction works. The next day I had a dinner appointment with a friend (who also likes to drink!), and I took my Nal medication exactly one hour prior. I started out with a glass of red wine before our meal. I can't say that I felt that different from drinking while not being on the medication, but my glass lasted a lot longer than his; and I usually finish my drink a long time before anyone else does! The dinner lasted for about 2.5 hours, and when my friend ordered a bottle of white wine, I only had one glass. At that point, I felt as if I were to have another glass, I would get sick! I really thought that I would not want anymore to drink that night, but later we were supposed to meet up with my fiancee and some friends of hers, and since my friend had bought dinner, I was buying drinks. I had one glass of red wine, and surprisingly it tasted good this time so I kept drinking with my friend until we all left, I think I drank 5 or 6 glasses of wine in total that night, over 5 hours or so and with plenty of food. That would normally not be enough to give me a hangover, but the next day I felt nauseous and unwell in general to the point where I couldn't even eat until late at night, and then only very little. I read on this forum about the Nalover, so I figured it was a good sign. I definitely could not stomach alcohol, even the thought of it made me more nauseous. The third day we met up with some friends in for dinner late in the afternoon, and I figured there was a good chance that there'd be some drinking, so I took my Nal medication 1 hour prior, figuring that there was not reason for me not to drink, that in fact I was supposed to. I had two 12 ounce IPA's with dinner, I ordered a third one, but could not finish it, proving there's a first time for everything! No real hangover the following day, but still some nausea. Monday I did not feel like drinking at all, and today I could go either way. I feel that the nausea is due to the Nal working, and I'm also on Wellbutrin, and I read something on this board about the combination working as an appetite suppressor. If that's the case, no problem, as I need to lose weight anyway. I'm feeling hopeful, but also a bit guilty....thinking about what my AA buddies and society as a whole would say; things are not supposed to be this easy; just swallowing a pill and drink as usual. Then again, I don't believe that things necessarily are that easy...I still have to work on the reason why I started drinking too much in the first place. Primary suspect is the recurring feelings of depression, and anxiety. I've just ordered a book about something called Mindfulness-based Cognitive Therapy (MBCT) and plan to do an 8 week self-help program to deal with this issue and see if it helps. Sorry for the long post, I'm a fast typist. If any of the regulars on this board have read this far, I guess I do have a question. I understand that you're supposed to drink as usual when starting out, but the problem is that I don't feel like drinking every day anymore. Keep in mind that I've only been a daily drinker for about 4-5 months, then 6 years abstinence prior to that. Will this method still work for me if I only drink, say 1 to 2 times per week or on social occasions only? Alternatively, I could drink just one glass of wine per day, but then I would have to take the medication every day, and there's the nausea to be put up with. Thanks in advance for any advice, and thank you to you all for contributing to this resource!

Welcome to the forum and congratulations on getting started with TSM! Good job on digging up the info that led you here!

NG, it sounds like the nausea might well pass, many of the SE's pass within two weeks, although some do get the Nalover frequently. Sometime it works to switch what you're drinking, so maybe stay away from the red wine. You might also want to cut back to half a pill until you're feeling consistently ok with the Nal, then try bumping it back up to a full pill.

As far as starting out, it might be a good plan to drink 4 times a week for the first couple of weeks, but you only need one drink per session unless you actually crave more. That's the general guidance for bingers, but it seems if you drink only once a week, that's more like a binger's schedule. Daily drinkers should stick to their regular starting time and of course would be taking the Nal every day.

As you're paying out of pocket, if you're in the US you can use GoodRx.com "coupons" at local pharmacies to get the Nal for about $40, if you're around a Costco you can check their price too. I don't think you need a Costco card to use their pharmacy (or their optical dept).

Too bad your insurance company doesn't cover you on this. They could save a huge amount of money with TSM. I've heard Kaiser is prescribing oral Nal to be taken an hour before drinking, so at least one ins co is catching on...

Wishing you much success, my friend!

Thank you both for the welcome and Joe for your advice! Yeah, 4 times per week seems reasonable; I had 5 drinks yesterday and the nausea wasn't bad today. Thanks also for the advice on the coupons, I will check it out. I'm glad to hear that Kaiser has started prescribing Nal to be taken along the lines of the Sinclair method. I went through their Chemical Dependency Recovery Program around 7 years ago, and their program worked for me, back then. However, one of my counselors told me that their recovery program only had about a 5% success rate, and most of my intake had been there several times before. It was covered by insurance, but KP had some billing issues back then and a copy of the bills for one of my group therapy sessions were sent to my home address. I don't remember exactly what the amount of the bill was, but I remember being shocked. In fact, I worked in finance at Kaiser's regional headquarters at the time, and couldn't help but think to myself that "recovery" must be a booming business. If the treatment works, but only well enough that people relapse after a while, then that is even better business. I'm not paranoid enough to believe that the big HMO's and the recovery industry in general are so sinister that they do this by design, but I can also see that there is no financial incentive for them to find a cheap "cure" for alcoholism. Yes, the Sinclair method would be much cheaper for them to administer, but on the flip side they would not be able to charge big bucks for the treatment. One would only hope that the doctors in these clinics have the patients' best interest at heart and will choose the course of treatments that's best for the individual. The people who treated me seemed to be genuinely caring, but also a bit "jaded" from seeing people relapse over and over after leaving treatment. Once they discovered that they had "a live one," i.e., someone who embraced the program and did everything they were asked to do in order to get well, they were very supportive. However, like I said, this was years ago and I don't think Nal was available for the treatment of alcoholics back then. The same things goes for AA and the other 12 step programs. Here there is not profit seeking incentive , and I think the proponents of the 12 step programs genuinely care. However, although in theory their literature and teachings acknowledge that there are different types of alcoholics and problem drinkers the only "cure" is total abstinence, for life. Although this approach has worked for a lot of people over the years and certainly is a whole lot better than the virtual non-existent treatment options available prior to AA, it's a well known fact that it does not work for the great majority of alcoholics and heavy drinkers. It works for the people it works for, but the downside is that the people who don't get well using their approach are left feeling guilty for being "failures." One is told that the program "works if you work it, " and the implication is that if you fail, it's because you weren't being serious diligent enough or serious enough about you recovery. AA is known for it's many slogans and expressions, many of which are quite ingenious and oftentimes very funny. One such expression is "When you only have one tool in your toolbox, and that tool is a hammer, then pretty soon everything starts looking like a nail!" This is a great expression, but I also find it a bit ironic that people in a program that encourages such wisdom generally seem critical of any pharmaceutical based treatment options and holds up a spiritual approach and total abstinence as the only solution! I use the term generally, as I don't think there's such thing as an official AA stance on this. That being said, I think it's important not to get to judgmental about people being a bit narrowminded; as human beings we're prone to black and white thinking. If something has worked for me, then it has to work for you too, or it could mean that I was wrong about it working for me in the first place! That goes for more scientific methods, as well, just something to keep in mind. I'm sorry if I got a bit off on a rant; I've only completed a week on nal + drinking, so what do I know about this even working for me in the long run!? However, your shared experiences on this board are very encouraging and motivating, and I guess only time will tell if it will also work for me. Thanks again.

Cool! Sounds like you're on your way, keep on checking in and letting us know about how it's going for you!

Here's a link to an article written by a certified alch abuse counselor at CThree Europe, contains some useful info:

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

Also, it's not unusual for drinking levels to pop back up after an initial dip, there seems to be a "Honeymoon Period" for many people. If that happens, don't worry. Just stick to the Golden Rule and your intake should start dropping again.

Thanks, Joe, I learned a couple of things from that little article. One is that the endorphin blocking effect of Nal lasts for about 10-12 hours. I was wondering about what happens if you have a drink, then feel like not having more, and then feeling like having more in a couple of hours. Looks like that's OK for up to 10 hours (to be on the safe side). Also very interesting that she introduces mindfulness about drinking. I'm guessing that just mindfulness on it's own might not do all that much by itself if you're addicted, and maybe it's not necessary for TSM to work, but I can see how combining the two can perhaps speed up recovery.

Anytime, Nightgardener!

"... and maybe it's not necessary for TSM to work, but I can see how combining the two can perhaps speed up recovery."

Zactly!

I've been on TSM since the end of April, so I think a bit more than 5 full months. Therefore I thought it would be a good idea to follow up on my post in case people think I'd given up. I have to admit that there were time when my number of drinks approached pre TSM levels but most of the time I'd say I drink about half of what I used to drink. So instead of 8 or so drinks, I'll have 3-5. Still, this is more than I wish to drink for the rest of my life, but it seems like even when I'm trying to slow down and be mindful, I always feel like having that 3rd or 4th drink. I'm following the protocol to a T. There have been times when my fiancee and I went out and I had forgotten to take the pill, and she asked if I wasn't going to drink, and I said no. I feel I have to give it 100% for two reasons. First, I really, really want it to work for me, and I'm taking an educated guess that the best way of ensuring that is to follow what people who have been successful with TSM did. Second, in the case that it turns that TSM did not work for me, I don't want there to be a shadow of a doubt that I didn't give it 100%. However, I do believe it will work, and I'm already reaping benefits. One great benefit is that although I'm still a daily drinker (actually lately I've been having a rare AF day here and there), when I'm done with that last drink, I'm done. I go to bed, and don't worry about my drinking or think about it until it's time to have my first drink the following evening. Before TSM, I would try to curb my drinking (I had started drinking again after 6 years of sobriety), and I would go to bed wanting to drink more, but was restraining myself. So all in all, there's already a tremendous benefit. I have to say, there are more and more occasions when I feel that the Naltrexone has taken the "fun" out of drinking. Usually, I get that warm and fuzzy feeling at drink #2, maybe even drink #3, but drink #4 is almost always "Meh! " So I definitely think there is some progress.

Having said all that, I've had some side effects this week, and I do feel it's related to the Naltrexone, but I could be wrong. I've been having a cold, so that might be part of it, but last night I only managed to drink a couple of drinks on the medication, and it made me feel nauseous. Today I felt nauseous all day, but I managed to eat two meals, and decided to take an AF day. I'm not whining here or being overly concerned, I'm just wondering if someone have had side-effects re-appear later in the treatment? The feeling is similar to the side effects I encountered when starting out. I feel this is related to the medication, but isn't it a bit late in the game to have side effects? I'm not asking for a medical explanation here, just want to see if anyone else experienced this and how it worked out.

Another question I have, in case one of the "graduates" read this....I wonder...what did extinction feel like when you got there? It crossed my mind today that maybe this was it for me, since I've really found it difficult to stomach alcohol the last few days, but drank more out of habit. I'm sure it's a bit different for everyone, but it would be nice to hear from some of you what the experience was like for you. I always expected extinction to be a positive event with rainbow and unicorns, but it just occurred to me for the first time today that maybe it's not? Hopefully I'll hear from some of you.

I also want to thank everyone for helping me when I started out...Joe Sixpack and others...you guys are pioneers and really making a difference with the time and effort you contribute. I came back to the board after a few weeks of absence, but it had been shut down. Luckily I had also found the C3 foundation, and I asked some questions over there. In any case, I'm glad to see you guys are up and running again!

So I plan to give this at least a year to work for me, and plan to stick around.

Have a continued great weekend, everyone!

So good to hear from you again, Nightgardener! It sounds like you are indeed getting steady benefit from TSM, odd thing about the nausea though. I hear about side effects showing up again after someone has had a string of AF days, perhaps it is the cold making your stomach a bit tender. Are you taking any flu medications? Maybe someone else will pop in with their experience.

I'm right on the edge of calling extinction myself and really, it's just the "meh" happening most every day. I get a brief waft of the old memories, the "booze porn" lighting up my brain cells for a few seconds, but then it's gone. I more often remember how I felt about beer as a kid, how it stank. I couldn't understand why the grown ups were drinking it. Any glorified memory of alcohol is mostly erased. I liken it to getting a crazy yen for something to eat, then opening the refrigerator door and not seeing anything that would satisfy the yen (despite the six-pack that's been there for a few months now). I'm more likely to crave a glass of water or a mug of Rooibos tea. "The thrill is gone", as the old tune goes.

I agree that you will get to a point where the romance of AL is just gone. it's only going to get so "good" drinking, then it's kind of just work!