Hi All,

So I've started TSM as of 10 days ish ago, and it's already made a noticeable difference in my drinking habits and general disposition. Since it's really hard to find doctors to talk to, I do have a couple questions for the hive mind:

1. If I take the pill an hour before drinking like today (watched football this afternoon out and about) then want a glass of wine with dinner several hours later, do people generally supplement and take another pill? Or do the effects extend awhile?
2. Is there any damage in taking the pill and then not drinking? Thinking in terms of habit formation.
3. If I wait 45 minutes instead of an hour, is that a deal breaker? Not consistently, of course, but if I wind up going out on a whim I've noticed that's possible.

As you can see, most of my Q's are logistical; just not used to the timing, since a lot of my drinking is/was somewhat spontaneous. I already have the Nal on my keychain and I'm super excited to have 4 drinks be an excessive evening, rather than a "light Tuesday".

Thanks!

Hi Tyrion! Welcome to the community and congratulations on getting started on TSM!

Here we go, by the numbers:

1. Nal will protect you till the 12th hour after your first dose. If you're going to be drinking beyond that time, the recommendations that I've seen say to take another dose in the 10th hour or earlier and wait another hour before resuming.

2. Taking the pill and not drinking suppresses your endorphins needlessly. The optimal situation would be to set up a Selective Extinction session. See Chapter 9 of The Cure for Alcoholism:

https://www.dropbox.com/s/60fs7gmvbyzs1 ... m.pdf?dl=0

3. Always wait the full hour to ensure your opioid receptors are fully blocked. Doing otherwise can send the addicted part of the brain a mixed message. It's relentless about pushing you to drink, you have to be more relentless about denying it the endorphin reward it's seeking. Think "Pavlov's Dogs". That experiment wouldn't have worked to stop the salivating unless he consistently offered no food after ringing the bell.

In any case, it sounds like you're doing well! Just be aware that most of the time there is a Honeymoon period and your drinking may well climb back up, then roll off more slowly. These higher and lower drinking levels generally continue throughout TSM, as the addicted part of the brain gives up, then fights back, then gives up, etc. It can be a bit dismaying but don't let it throw you, it's perfectly normal. During the upticks can be a good time to practice active reduction techniques, like leaving your drink out of reach (or even in another room) and interspersing sips with little tasks. If you tend to drink more when you're watching the TV or talking on the phone, that might be a great time to switch to a NA drink and ban the booze to some other room. Habit-busting techniques in general can be useful in flattening those peaks, so whatever tricks you can come up with are all fair game.

Do keep track of your drinks too! Here's a combo spreadsheet/graph that a lot of people use:

http://optionssavelives.freeforums.net/ ... graph-tool

Some like using phone apps too, like AlchoDroid.