Hi, guys!

Before I comment on the "JameCT vs Proof for TSM" discussion, let me introduce myself:

I am two weeks away from one year on TSM. A very brief summary: 12-15 US units per day essentially 24/7/365 for at least ten years. Experienced two-fold drop within a week of TSM start, reached plateau at around 100 days and hover around 2 +/- 1.5 US drinks/day ever since. No further decrease is evident, no cravings that I can't easily deal with but rarely more than 2 AF days/week. I.e., far from cured but close to "normal" life - even if it means popping pills for the rest of my life. For which I am very grateful to David Sinclair and TSM community that disseminates the idea. I i]believe[/i] that TSM works.

That said, as someone with a neuroscience background trying to be objective, I'd like to state that, alas, current evidence for TSM does not hold up to the rigorous standards of modern evidence-based medicine. Far from it! I've read the entire "JameCT" thread and he is absolutely correct most of the time.

- Yes, the direct and controlled clinical evidence for TSM is essentially one paper co-authored by Dr. Sinclair and a couple of papers by Dr. Kranzler (if one accepts "targeted naltrexone" paradigm as TSM - which is reasonable
in the first approximation). That's it. The rest may be suggestive, intriguing or completely irrelevant - depending on the point of view. And even these scant papers leave A LOT to be desired.

- Eskapa's book is no more evidence of anything than his previous book "Bizarre Sex" (available on Amazon) is evidence of anything clinically relevant to serious medical practitioners.

- That TSM "makes sense" is undeniable - but again, it in no way means that it must work.

- That naltrexone is safe and was used with rather abysmal success for a long time in non-TSM settings is also at best only tangentially related to what TSM is or isn't.

So, why am I writing this? Two reasons:

1. As it stands, TSM does not "look good" to the outsiders. I've told couple of my friends about it (one of them alcoholic) and they politely laughed at me. Which is to be expected! Trust me, to most scientifically-minded folks
(and that includes most medics) TSM now looks no different that any of the zillion other magical cures for everything from acne to cancer. Same common traits: little hard evidence, no acceptance by establishment, grandiose claims made by a cheap book with a sensationalist title written by a completely unknown author without proper credentials, a community of hard-core believers and, of course, numerous examples of cured "before" and "after" people. (Please don't take offense - I am not trying to disparage anyone here; just describing how it looks to many people out there; particularly non-alcoholics).
Why is this a problem? Because it is precisely the medical establishment that holds the power to study, improve and make TSM widely available to ALL the people who may potentially benefit from it. Unless we look rational, reasonable and free from fanaticism, they won't take us seriously. And we need them more than they need us (sigh).

2. False hopes. False hopes kill - just ask any cancer patient who opted for snake oil remedies. I must admit that this board so far is very good about it - but it won't always be this way as rumors of TSM spread and it attracts
many more believers. So setting the record straight and explicitly stating that no one knows anything about effectiveness of TSM with any degree of certainty would be a positive development IMO.

One thought I had is how wonderful it would be to start accumulating some hard statistics from users here. Obviously, the more the better. As many old-timers here noticed, there are some general hints popping up and it
would be great to be able to support them with hard numbers. One difficult problem is selection bias though (enthusiasts who feel it working collect and report data preferentially over those who don't gain as much from the
treatment). I am not sure if it is possible to adequately deal with that. But we can ask around. There are some seriously drunk statisticians out there, that's for sure

OK, that's it for now. Please no flames - I am your fellow TSMer, I aim at no one personally and I want TSM to work for as many as possible.

Valid points, but we only need to worry about how TSM looks to outsiders if our goal is to proselytize. Although I admit the feeling of wanting to shout TSM from the rooftops after my rapid success, I've come to think that TSM works best when people find it partly on their own-- it gives them "ownership" of the method and weeds out people who aren't serious about reducing their consumption. At most, we should get the word out that it's an avenue alcoholics should explore.

I would love to start a nonprofit dedicated solely to spreading that message. It's difficult to spread the word, though, because of the stigma of alcoholism. Many of us jeopardize our jobs and health insurance by admitting to the problem.

TSM changed my life. There's no way that was a placebo effect. It worked for me, and it clearly works for some people. Eventually the medical establishment will be forced to take more notice.

good post nutella

AA, and other organisations, have been (rightly in my view) criticised on here for being hostile to any questioning, in essence to a deep suspicion of any intellectual examination. To the great credit of those who run this site, this has never been the case here.

That is as it should be, in my opinion - healthy and respectful debate is the way by which our knowledge advances, and our understanding deepens. The more we know and understand about TSM - its strengths, its weaknesses etc, the more we can help each other and others, and the better chance we have helping those who are currently in the 'AA or no way' dilemma.

Like you I'm on TSM a significant amount of time (some 15 months in my case) and while not 'cured', I have a radically different (and better) life than I had beforehand - for which I'm eternally grateful. That doesn't preclude me from critically examining the why, the how and the when of the method.

nutella: A very level-headed objective post.

You mention your level of drinking has not reached a what you would consider to be a "cure" level (if I read your post correctly), but you do say that your life is better under TSM and that you fell it does work. May I request that you post you weekly numbers if you have them recorded? I know that your personal numbers are still anecdotal evidence, but they are not anecdotal for you; just as my posted numbers are not study-grade evidence but they real for me.

In my email to Agent Orange, this direct quote is my personal view of TSM:I still stand by it. In reality, the truth may be "In some people it appears to work. In most people, TSM works partially and goes no further; these people are mostly very happy about their improved lives nevertheless". (changes in bold)

I also agree studies must be conducted that directly address TSM treatment methodology in a double-blind study involving hundreds of people who must be monitored for TSM compliance (which I have no idea how you would accomplish).

nemo: You and I have had a similar experience. There is no way TSM did not work for us. Have you posted your numbers? I know it's not scientific, but they are as real as you are.

1-4-the-road: I know you've been on TSM for a very long time, post your numbers, and remain an active participant. I admire that. What I apparently haven't picked up on is the fact that you consider your life to be "better" than pre-TSM. ( I am chronically forgetful and I don't read everyone's posts). Do we know anyone for which TSM has not worked at all and their life is not better? I'm thinking there must be... houtx, maybe?

BTW, I am editing my Eskapa response post from yesterday to remove the "get the hell out of here" comment because after reading more and thinking about that statement, I feel that I exhibited AA/12-stepper style behavior. We are allowed debate here. My emotions and persistent headache yesterday got the better of me and for that I apologize. For the record, if I had been a moderator yesterday, I would not have removed or censored any posts from anyone, and I would not have banned anyone as is commonly done at other sites.

Bob

Re: My drinking numbers.

I was hoping there is a way to attach graphics here but there doesn't seem to be one. Anyhow, I keep records religiously, constantly updating graphs for daily and weekly consumption as well as AF days. Weekly numbers:

Pre: 80-100 US units/week
Weeks 01-10: 43.0, 35.0, 28.0, 33.0, 31.0, 26.0, 23.0, 17.0, 28.0, 16.5
Weeks 11-20: 16.0, 13.5, 21.5, 27.0, 13.5, 14.0, 13.0, 14.0, 13.5, 10.5
Weeks 21-30: 10.5, 12.5, 23.5, 13.0, 12.5, 10.0, 11.0, 04.0, 01.0, 12.0
Weeks 31-40: 11.5, 13.5, 12.0, 08.0, 12.0, 17.0, 14.0, 12.5, 11.0, 17.0
Weeks 41-50: 20.0, 09.0, 13.5, 22.0, 12.0, 04.5, 16.0, 15.0, 21.0, 13.0

I DO consciously control how much I drink. I.e., I am trying to keep it around arbitrary number of "safe" drinking at 2 daily/14 weekly. Some would argue it goes against TSM idea. Maybe, maybe not. If I have a strong urge, I drink no matter what. But if yesterday was a six units day and today I can easily not drink at all, that's what I'll do. By default though, I tend to have a glass of wine for dinner and sometimes another one later in the evening. I find that the necessity to take NAL an hour before forces me to make a decision about drinking well before the situation occurs (dinner, friends visit) and I can find out my actual craving level. So the approximate weekly cap that I set serves simply as a guide in making such decisions.

Nutella, those numbers don't look "far from cured" (your words) at ALL. Those look like the numbers of a guy who's fully in control of his drinking.

Cured doesn't just mean those like who now drink 0 like Bob3d (although I am extremely glad for his success!).

Half of France drinks 1-2/day their entire lives. Do you think, even with effort, you would have been able to maintain those kind of numbers for 50 weeks without NAL? You could do it, but you'd be white-knuckling.

Hey Bob

thanks for the compliment. Regarding my life being 'better' - there is simply no comparison. As I posted elsewhere, if my potential in life was on a scale of 0-10 with 0 being worthless/rock-bottom and 10 being 'couldn't possibly be better' I'd say I've gone from a 2 to a 7.5. For the record I doubt I've been past 8.5 ever in my life, so TSM has absolutely been a massive positive for me. I'd go so far as to say that if I was drinking at my current level and had never heard of TSM, wasn't taking Nal etc, then I'd be entirely unconcerned about my drinking, other than some vague knowledge that I was above a theoretical level (in common with almost everyone I know! LOL).

However, knowing what is possible at the end of TSM, and what the effect of significantly overdrinking consistently is (and I gave it a good crack for 15 years odd!) as well as knowing that I was out of control before taking Nal, I'm pushing for more. Call me greedy

Regarding your question - I think possibly Virgil and maybe houtx are the only ones that spring to mind.

Good posts, all of them. Questioning TSM is definitely part of the process of getting it out there. I don't know why they don't do more studies, the problem with James, in my opinion, was not that he questioned, but that he was insulting and non-supportive. I really don't think he was doing TSM as he clearly (IMO) came here to prove TSM doesn't work.

thank you for your thoughtful post, and I hope to hear more from Eskapa re: studies

We probably have different definition of "cured". For me, cured means I can drink like all non-alcoholics - moderately and not ever even thinking about it. That's not where I am. yes, I am in control and it's an easy control but if I always drunk whenever I wanted however I wanted, even with NAL my averages would more than likely be at least a bottle a day. I do think about wine. Daily. And I would love to drink it daily and stopping not because I know I should stop but because I don't want to drink any more. What I have now is not white-knuckling (because it's easy) but it's not "natural". Hence, not "cured". (No, I don't believe I would have been able to control it like that without Nal. I sure tried that many times before without a slightest success).

Also, nemo, I wanted to comment on your

Not so easy. Brain is very complicated and placebo is very powerful. For example, for most "soft" conditions (chronic diseases, almost all mental disorders, etc - almost everything except surgery and antibiotics) in absolute value the placebo effect is higher above baseline (no treatment) than the effect that effective and currently most commonly used drugs produce above placebo response. And placebo can be very weird and mysterious. To give another example, placebo burn (when subjects were sure they will be burned) activated exact same brain regions and lead to the release of equivalent amounts of the same neurotransmitters as the real burn. It's like brain was able to reconstruct/emulate material reality!

All I am saying is that none of it is simple and easy. There are many, many, many caveats before one can conclude something with certainty when it comes to complex systems. I "know" Nal is helping me but, rationally, I can't conclude that it is not a placebo. Neither can you.

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(sorry double post)