I have been lurking here on and off for the past couple of years. After reading many of the stories here I decided to start TSM January 1, 2016. My dearest friend and my best drinking buddy joined me in this journey, and started TSM on the same day. My story:

I guess I would be considered your typical high functioning alcoholic. I always show up for work, although some mornings it is a struggle and I feel sick most of the day. On those days I have a glass of wine immediately upon arriving home and feel better right away. I am not a daily drinker but when I do drink I do not stop until I fall into bed dead drunk. My friend who started TSM with me was a daily drinker and although she often drank way too much when drinking, she did not end up drunk every time she drank. We both started counting units and discussing ways to lessen our dependence on alcohol.

At the beginning we had a similar response to the naltrexone. We both had a brief honeymoon period and then our drinking went back up and then gradually down to the point where we were drinking half of what we had before. Then we got stuck there. At about four months in I noticed that my friend was having a glass of wine and not finishing her second glass. There were times that I offered her a glass of wine and she turned it down. Now, a year after starting TSM, she has no desire to drink. Over the holidays she had one glass of champagne, and we attended a lot of parties together with our husbands. I am still drinking less than I was before, do not get drunk every time I drink although many times I do, but alcohol still has a strong pull on me.

I have read the book and much written here and I have a question about benzos and TSM. I know that the thought is that they can interfere with TSM. I have a hip issue that for the most part has been controlled with acupuncture and chiropractic care. Occasionally, though, I will go through a tough period and will take 25mg of alprazolam to sleep. By occasionally I mean sometimes twice a week and sometimes twice a month. It really does help me sleep and my life is much easier when I have slept. For the first six months on TSM I did not use them at all and since I started using them again my consumption has not gone up.

I am feeling very frustrated that I am not cured after one year, especially when I look at my friend's progress. Reading here, though, I know it has taken some people longer. What is your opinion about the alprazolam? Could that small amount be impeding my progress?

The truth is no one knows. You may have seen my post some time back first stating definitive complications between TSM and benozs 'hampering extinction'. This was sourced from an archived Dr. Eskapa post. dating quite far back. I later managed to get the question to the man himself who had a change of tune. Specifically, only a maybe. There have been no studies on the matter so we truly don't know. All we know is theoretically the two operate with the same receptors if I understand the matter correctly.

Personally, I say if you can avoid benzos. Only you can decide, but I would think you could find an alternative easy enough. Sorry it's not more clearcut. Oh, and TSM could simply be taking longer for you.

Bardo, thank you. I have tried all numbers of natural alternatives for the sleep issues that my hip pain sometimes causes. I managed the first six months without benzos so I guess I could do it again, although the days are long after two to three hours of sleep.

The other thing I do differently than my friend is that I often take the naltrexone more than one hour before drinking. When working with clients I never know if a post meeting drink will be in order and have been in the position of having to stall before drinking my drink. So, sometimes I take the nal at 4 and may not have a drink until 7 or 8. Everything I have read however leads me to believe that is not a problem.

I wonder about some of the people whose struggles I identified with and whose stories I followed who just disappeared. I wonder if they disappeared because they were successful or if they are struggling. I am happy that my friend has found success, but I feel very alone right now.

CeCe, a couple things. First, when I eliminated benzos to practice TSM I started taking Trazedone for sleep. I'm 6'1'', 205lbs and 100mg puts me out though I have taken as much as 200mg on a given night. If you're so inclined run it by your PCP.

As for taking Naltrexone so many hours before actually drinking. This is definitely an issue in my opinion and runs counter to the standard advice we offer on the Options Saves Lives board. But for a few exceptions you want to take Naltrexone at the onset of a craving, then wait the hour so that your brain connects the craving with the unrewarded drink. That is a true extinction episode in my opinion. Additionally, by doing what you're doing it really doesn't provide the opportunity to say, "Do I actually want this drink". Instead, you're setting your routine up rather than actually deciding if a drink is what you want or need. Lizard Brain stuff which we're trying to avoid.

As for the people who disappear the school of thought I've understood is, 'why keep going to the hospital if you're not sick'? Or, perhaps alcohol has become such a non-issue in their lives why continue carrying on about it. This practice is definitely not like AA where folks are perpetually in recovery. It's a finite conclusion that one is 'recovered'. Of course there are those who this simply doesn't work for for any number of reasons non-compliance being the primary one.

I'm sorry you're feeling alone with your friend having a more successful conclusion or perhaps more apropos an earlier conclusion. Yours is still right around the corner. You might be well advised to read through this link on 'mindfulness' for a bit of a refresher:

http://optionssavelives.freeforums.net/thread/645/mindful-drinking?page=1&scrollTo=6921

Bardo, for a while, when the pain was really bad and I was having great difficulty sleeping, my doctor gave me Ambien. It worked great. I slept really well and woke up feeling refreshed. I did not take it daily, however, because I did not want to become dependent on it. Then there was some bad press about Ambien so she switched me to Trazedone at my yearly check up. With Trazedone my sleep was fitful and I woke up feeling hungover. It did not work at all for me. That is when we discovered that a small dose of alprazolam relaxed me enough to allow me to sleep. I have not used it the last week and sleep has been ok. I lasted six months without it and I can do it again.

Point taken about the lizard brain. I will have to work on that. A refresher about mindfulness never hurts, of course. Thanks for your input, Bardo.

CeCe, I'll 2nd what Bardo is saying, indeed the amount of time that TSM takes varies by the individual. You're getting a good reduction in your drinking and I think the timing of your dose and the mindfulness aspect would be two good areas to work on. I'd suggest working on your normal starting time, to see if you can build some conscious options there, to see if there's a "soft spot" in the habit. Also try breaking up the usual drinking habit by taking a sip and then putting the glass down and walking away from it so you can't see it. Get up to some little task, then see if you're driven to take another sip or if it's "optional". Tell the old Lizard Brain "OK, ok, I'll get you another sip... in a minute." Keep on working that angle throughout the night. Figure out other ways to throw a hard pause in the normal drinking routine, question it's authority, question how "genuine" it is. Make it "make" you take the next sip and notice how that urge feels. Experience it, notice it, get familiar with it.

This is all to give the conscious mind a chance to surface and say "Enough for now (or enough for tonight)". It helps you get to the feeling of "Meh" towards the next drink. The "Lizard Brain" is where Alcohol Use Disorder lives. Naltrexone per TSM helps quiet it down and mindfulness/consciousness techniques help shift the balance of power to the part of the brain that isn't "in love" with alcohol like the Lizard Brain is.

Alcohol also numbs the conscious faculties pretty quickly, so slowing the pace like this helps the conscious part of the brain surface and vote on the goings on. It's used to being dissed about this, so it's gone off into the corner to sulk and eat worms because nobody will listen to it. Listen for it to pipe up and encourage it. Start rebuilding that connection. It might be a bit difficult to hear at first, so keep working on it by slowing the pace and breaking up the usual drinking routine. Another thing you might try is to switch from red to white wine or switch to a Kalimotxo.

And keep on checking in, we love to hear from you!