AJ,

I was also wondering about the effects of adding more AF days. I have only been averaging one a week and have lost quite a bit of my desire to work out (was very consistent prior to starting Nal) and even some other activities have been suffering.. just feel kind of blah and don't get my positive energy going until I've had a couple of drinks. Was justifying the lack of AF days in hope of a quicker cure but would be willing to try adding them if it would give me back my enthusiasm for physical activities.

Don't think the prescribed weekend days will work though... could try Monday - Wednesday to start... I'm starting week 8 today and wonder if that's in the program long enough to take it to the next level.

Thanks for sharing your thoughts on this topic..

Virginia

AJ,

I think you are on to something for people who drink daily, or nearly daily. I was was a binge drinker, so I could go a few days, then down 15+ units in a night. Do this 3-4 times a week and you are quickly up to 50+ units even though you had AF days. Bob was a daily drinker, so perhaps your theory applies better to his situation.

For me, it was quite literally a matter of extinquishing the craving. I believe this was a function of the number of drinking session while taking NAL, not AF days. AF days meant nothing to me until the craving was gone (or very low).

The 30 drinks per week threshold Bob and I were talking seemed to be a point where life got a whole lot better. This also represented a point where my drinking was well under half of where it was when I started. Essentially, extinction had wiped out most of my craving at that point. However, I'm not sure how much of a threshold this is for everyone. If you start at 35 units/week (like those in the Sinclair study group), dropping under 30 units/week is really just getting started.

Q

AJ -- That's not what Eskapa says at all. AF days, when we are ready for them, can be useful for selectively reinforcing positive activities as we rebuild our lives and fill the void alcohol has left. But there's no inherent harm in going without AF days. Many of us are unable to achieve them until months into the process. The ones who do (like SR and bob) had a pattern of AF days prior to TSM. Here's a post from me a while back on the topic, settout what Eskapa says on the subject.

Cutting back consciously is not part of the Sinclair Method, but does that mean we should avoid trying to cut back? Many of us want to do so for our own reasons.

A few weeks ago Dr. Eskapa replied to a post here in which he mentioned there's no harm in trying to use effort to taper down as long as we are able to manage the cravings.

I've noticed that, since then, there has been much discussion here about "trying" to cut back or have an AF day.

Eskapa reminds us that we need to think of drinking as "'good for me', or at least 'necessary for me to get better.'" (p. 103)

Eskapa emphasized Sinclair's findings that the number of drinking sessions is more important to the cure than the volume of alcohol consumed per session. "De-addiction happens slowly but surely with the research showing that the more often you drink on naltrexone, the more you weaken your addiction." (p. 107;emphasis his). "Sinclair insists: 'We want to be clear that we are not encouraging patients to drink very large quantities at one time. Large volumes of alcohol do not help (do not hasten the de-addiction process) and can be dangerous. But drinking frequently while on naltrexone is beneficial since each time drinking is an extinction session.'" (p. 107 fn* [Eskapa's parentheses]).

That seems to answer the question many of us have about whether it's okay to try to cut back the number of units consumed, or to tryto cut back the number of drinking days. The short answer is units, okay; drinking days, not so much.

Of course if an occasional AF day is very important to us as a subjective mark of progress, then it may be a motivational tool. We each must decide for ourselves whether the cost of a missed drinking session outweighs the benefit of that feeling we are taming the alcohol beast.

I've also noticed that, anecdotally, there is no apparent pattern of faster success by those of us who try to cut back. Our livers thank us of course. But there is nothing to indicate cutting back hastens our cure. We will know that we are cured when we have lost interest in alcohol -- after three to six months or so. If we stick to TSM, our drinking will go down all by itself. Remember, the sub-title of Eskapa's book is "Drink Your Way Sober Without Willpower . . . ".

No two of us are alike, but we all will get there. And it is so hard to get our heard around the idea that this cure requires no effort at all from us, apart from taking nal every time we drink!

There also is a thread on what Sinclair had to say about SR "teasing" with AF days, "Drinking Through Triggers for Extinction." Alcohol deprivation effect can be a trigger which binge drinkers need to extinguish, but again this really isn't an issue with daily drinkers.

The "key" to success is not this that or the other, except to take our nal, drink as we normally do, and be patient.

AJ, You are a bit early into this and, while we hope with all our hearts you've nearly got it licked, it may not be the linear path it seems to be now. You may want to read Craving's posts; we kind of set him up for a disappointment by declaring victory too soon.

AJ, I love your enthusiasm and your contributions. However, I could not disagree with you more on this point and completely agree with Lena. I won't bother recounting all of her cites from the book, but the bottom line is that entire theory of TSM is predicated on "drinking as you normally drink." That would exclude the notion that you should be actively seeking AF days. When you feel the urge to drink, you drink on naltrexone, the positive reinforcement (endorphins) is blocked, and the instinctive link you have made in your mind between drinking and the positive association is extinguished. On an anecdotal note, I regularly had 3 or 4 AF days before starting TSM. I continued that pattern until last week. Last week instead of having three of four AF days, I drank two beers instead. And I did this specifically because Eskapa notes explicitly that indeed extinction is sped up with the greater number of drinking sessions on naltrexone. Also, anecdotally, since dumping the AF days and having two beers and naltrexone instead, I subjectively am feeling less and less reliance on alcohol. So, in summary, my unscientific, anecdotal experience contradicts your theory. But of far more importance, Eskapa's book and the theory behind TSM refute your theory as well.

And let me say this AJ: I have been pissing people off left and right without intention on this board lately. You have made one fantastic contribution after another on this board and are an invaluable addition to the forum. Just because I disagree with you on this point does not mean I'm judging you, or ragging on you, or anything else negative. My experience as an adult tells me that I can disagree with someone and still completely respect the other person. That certainly is the case here. I disagree with your take on this point, but welcome your ideas and really value your contributions.

There are seemingly contradictory passages in the book as indicated by the above-listed quotes. Eskapa does say that a washout period should be encouraged in the two-page summary, "Pharmacologically Enhanced Reinforcement of Alternative Healthy Behaviors" on pages 207-208. However, he emphasizes that when cravings get severe, naltrexone should be administered immediately and there should be a resumption of drinking. This makes it clear that above all else -- including AF days -- that the key to the success of TSM is drinking your way through cravings. In addition, throughout the entire book, these thematic points are repeated over and over again: "drink as you always drink," "the more often you drink on naltrexone, the more you weaken your addiction," "TSM should require no effort on your part to abstain," "DRINK YOUR WAY SOBER WITHOUT WILLPOWER, ABSTINENCE OR DISCOMFORT" (on the cover), etc. And all of these points contradict the notion that we should be trying hard for AF days in order to get the endorphins back. My reading of pages 207-208 is a sort of footnote to TSM: that enhancing positive behaviors is an added bonus to TSM, but in and of itself, is not central to the success of the treatment.

I would also add that there is a form of TSM where naltrexone is released continuously into the blood stream for up to a month (page 102) which means no endorphins during that entire time. The book discusses the success of this treatment which would belie the notion that depriving us of endorphins is somehow weakening our response to TSM. The passage does go on to state that the disadvantage of continuous naltrexone in the system is the blockage of reinforcement for positive behaviors, but this to me is an entirely separate issue from whether AF days and the presence of endorphins are critical to the success of TSM.

So, I'm sticking with my previous answer and I agree with Lena. But AJ, you do make a viable argument in support of your theory. I just think the overall weight of the book draws a contrary conclusion.

The apparent contradiction is worrying to me. I'm still terrified (at five weeks) of trying for an AF day yet, for fear of failing - and possibly not taking the Nal in time, in the process.

I guess my hope was - and still is - that at some point the craving or simple expectation that I must drink every day will reduce to a point where I'll begin to feel that drinking every day is becoming more like work than pleasure and hey, why not take a vacation from the cure and STOP drinking, wash the Nal out, and reinforce some good habits? In essence I would not have to *try* for AF days, I would give myself *permission* to have them.

Then, after a short endorphin-filled vacation ... back to work on the cure (drinking + Nal). Presumably that would be the time in the process to start building in regular mini-vacations from drinking.

Then, perhaps a month or two further out, the thought of going back to "work" after vacation will begin to seem unnecessary. Essentially, being retired from the job of drinking. Hence, cured.

Anyway, that's what I've been telling myself.

I love spirited discussion! And I enjoy new thoughts, theories, and insights regardless of whether I agree with them or not. Thanks for your well thought out contribution, AJ!

Perhaps it is not "30" being the magic number, but as Q has stated, when you get below roughly half of your pre-TSM levels you gain a new found control of your addiction.

Q and I had different drinking styles. Q was a binge drinker and his "normal" drinking style had AF days right at the start. I was a daily drinker and had absolutely no control of when, if at all, I would have an AF day, until around week 8 with single AF days and week 10 with double AF days. Double and triple AF days were important to reinforce good behaviors without messing them up with alcohol. The important point I want to make here is that I was drinking like I normally did, just as Dr. Eskapa's book says to do (I won't quote chapter and verse). When I was able to have AF days, I took them and I believe that added to the progress, as did the days of drinking on Naltrexone. The combination was important for me as a daily drinker. And now, the vast majority of days I have no desire to drink at all, so I consciously decide to take a lot of AF days, but I don't have to. I am in full control, now.

Readers may notice I had 2 AF days during week 4. Also, week 8 and 9 the AF days were forced. These were forced and were not a part of my normal drinking regimen. The forced AF days eventually became planned AF days and then finally spontaneous AF days.

Bob

AJ_,

I think you are missing the point of what AF days do for you. Extinction is really a matter of the repetition of drinking on Nal over time. Think about it like this: There is some number of times you have to drink on Nal in order to cure your addiction (it's anyones guess what this number is and it's different for everyone). Whether you do this is 4 months or 6 months really doesn't matter -- you still have to drink x number of times on Nal. AF days have nothing to do with extinction.

The AF days help you get back to having a normal life again. IMO, this is what Eskapa was getting at in his statement in his book about letting Nal wash out of your system. Both Sinclair and Eskapa have said it is perfectly fine to take Nal everyday if you want. However, you will miss out on some positive, non-alcohol, endorphine experiences by doing this.

Q

That's an interesting theory, but it definitely doesn't fit my "cure" progression. In fact, I've never had more than two AF free days in a row since the start of TSM (and when I did that, it was always a pre-established goal to do so). If you view my consumption graph, you'll see it's almost a "textbook case" (and at about the 5-month mark, I consider myself cured). So, at least in my case, the consecutive AF day theory doesn't fit the outcome. BTW -- I still enjoy drinking 1 or 2 of my favorite beers with dinner, and I'm thrilled that I can continue with that "normal" pleasure without feeling obsessed about it, or desiring more -- my personal definition of successful moderation in action.

There are many issues here that could be debated, including your theory about our need for endorphins. I would like to focus on your original concern, namely:

I am concerned that there may be a perception that the more frequently one drinks, the more rapid the extinction, or perhaps I should say 'the cure'. That is, a view that one ought try to drink as often as possible.

As we have noted in our previous quotes, Eskapa explicitly states this very conclusion that you are now disputing: the fact is, extinction does occur more rapidly with more frequent drinking sessions. I won't go back and get the page number, but it's included above in Lena's post. This is the primary FACT that you are questioning and it's really not up for debate, assuming we are taking Eskapa's word as law and we have been for the purposes of this debate.

Your next observation, "a view that one ought to drink as often as possible" is not an accurate conclusion to be drawn from the fact that extinction will occur more rapidly with more frequent sessions. And no one is arguing that while on TSM one ought to drink as much as possible. The rule of TSM is that every time you feel the craving for a drink (i.e. are triggered), then reach for the nal and drink one hour later in order to extinguish the trigger. This is the fundamental rule of TSM. Your theoretical argument that we somehow need endorphins to succeed on TSM and therefore should force AF days completely flies in the face of the fundamental rule of TSM. The fact is, we alcoholics, especially the daily drinkers of ten, twenty and thirty years plus, will crave alcohol for months after starting TSM -- 3 to 4 minimum and probably far longer than that for the more experienced drinkers. The notion that these folks, who are still experiencing cravings and will be for several months, should somehow force an AF day because of their need for endorphins, is flatly incorrect.

Yes, Eskapa talks about eventually reaching the point where healthy behaviors dominate and AF days become the norm, but he is referring to the very last stage of the cure, when people no longer are craving alcohol.

Lastly, I've read the book several times and I've heard multiple clips of Dr. Sinclair. And never once has he offered a single sentence in the book or on video that suggests we need a healthy endorphin rush to succeed with TSM. And never once does he discuss the importance of striving for AF days in order to get an endorphin rush. And neither does Eskapa. If there were any legitimacy to your theory, I think it would be stated explicitly. The "healthy alternative behavior" portion of the book you cite is two pages out of a 300 page book. If AF days were such a prominent aspect of succeeding on TSM, there would be an entire chapter dedicated to this very issue and it would be explicit, IMO. But props to you for coming up with some very good arguments for an invalid point -- you'd make an excellent lawyer.