Pounding -
Unfortunately, yes, using Nal causes the receptors that you're trying to block to "up-regulate" and become much more sensitive. Usually per TSM you would leverage that into an Alcohol Free weekend (no Nal and no drinking for 3 days). On the 3rd day, you take advantage of those sensitized receptors and engage in a healthy activity that releases endorphins and your brain will "learn" that's an option to drinking. If you drink without the Nal, it will be like throwing the car in reverse and flooring the gas pedal. Well, mull over the AF weekend and see what you think, it might be useful to try it and see what your reaction to the Nal is on the 4th day.
This is where I'd suggest teaming up with a TSM doc.
You might also want to email Joanna at
joanna@cthreeeurope.com, likely she can give you some pointers. Her reply is likely to come from a different address, so keep an eye out for it and check your junk mail folder too. Joanna also has Dr. Eskapa's ear, he might have some useful feedback for you.
Before going to see a doc, go get some blood tests done. My doc wanted the following before he would prescribe:
CMP
CBC w/diff
GGT (not GTT, which is Glucose Tolerance Test).
Tell the lab you'll pick up the results yourself. Mine was quite readable and you'll be able to see if you have any results that are out of the normal range. Shoot the doc a copy before your appointment.
Aside from that, you're far enough into the process that you might have good success at being mindful during your drinking sessions. Try:
1. Having a small meal before taking the Nal and wash it down with a full glass of water.
2. Commit to sipping your beer, don't gulp it. Especially the first one. I doubt you smoke, but I do and noticed that I would drink most of a pint if I had it with me when I went out for a smoke. Leaving the beer in the fridge when I smoke fixed that one in short order. Now it's easy to make a beer last for an hour or more.
3. Try setting a quantity of beer that you're going to drink for the evening and see if you can make that stick. Kick the wine to the curb for now, maybe even get it out of the house. Buy a limited quantity of beer, so you have to go out and get more if you drink what you have. The Nal may help you "push back" on the urge to drink in that respect. Remember, you only need one drink + the Nal for the Extinction Event to occur.
You may also be able to cut the Nal back to 25mg, but try the above first and bounce the idea off Joanna if not your doc.
It may be that the Nal-overs are just going to be part of the program, I hope not. I'll let others with more Nal-over experience jump in here and let you know how they dealt with it.
I'll shoot you a PM with some other questions.