Hi SBTS,

I wrote to Dr Sinclair (copy to Dr Eskapa) last Thursday, prompted by Greg's thread Does TSM work for heavy drinkers? I also asked about the relationship between time to cure and drinking history. As yet, I've had no reply, which is unusual.

V.

Hi Nick,

In my opinion, you have raised some very important, fundamental issues about TSM.

As you say above, we are the true pioneers. The TSM clinical trials were carried out on a group of people that have only limited similarity to many of us in this community. Whilst I can understand that people with a psychiatric disorder, for example, would have been excluded from the trials, it automatically means that people like me (with anxiety disorders) are left out on a limb. But, at least I can understand that. What I fail to understand is why those participating in the trial were drinking so 'little'. Surely, it must have been possible to have selected participants drinking a greater amount of alcohol, i.e. at levels that are commensurate with heavy drinking/alcoholism.

With reference to information that will hopefully be included in the next edition (?) of Dr Eskapa's book, I would like to see a section dealing with medications that may interfere with TSM - notably, the benzos and the Z-drugs. I also think the matter of naltrexone dosage needs to be discussed based on variations in individuals' metabolism of naltrexone. Finally, perhaps the science of genetics will have progressed further and may be able to explain why TSM does not work for a small minority of people - again, I would like to see this getting a mention in the book.

Thank you for starting this thread. I think it will prove to be valuable for 'old-timers' and newcomers alike.

Best wishes to you.

V.

I thought tens of thousands had been treated in Finland over a number of years? That it's the first line treatment in fact, did I pick up totally the wrong idea about this somewhere? Apart from one or two posts, I don't think ANY of these successfully treated Finns has come forward. I'm not suggesting they don't exist, but treatment on such a scale must have included folk who drank at very high levels, there simply must be at least anecdotal evidence for long-term heavy drinkers.

I agree, there must be, but it's not included in Eskapa's book, or any where else that any of us have found so far. LoOp our "resident geek", is a tremendous researcher and has not been able to help us with this point. Yet.

Nick, Dr Eskapa's book was surely written with firm knowledge direct from Dr Sinclair about the treatment program results in Finland.

If there'd been much variance from the three-to-four month timescale presented by the initial studies, why isn't this at least mentioned?

A doctor I have met who practices TSM told me that he's treated hundreds of people with tremendous success, and that it usually takes about 100 tablets (just over three months for a daily drinker) for a decent level of de-addiction.

I think we really need to get some sort of answer on this from Dr Eskapa soon.

The cats proved to be a good cure for our mouse problem.

Rephrase this sentence and the truth emerges which definition of "cure" we are talking about...

The Naltrexone proved to be a good cure for our alcohol problem.

I guess I am cured by this definition.

Still, it takes longer than claimed. The book does not address other common effects during treatment. Psychiatric ailments and their medications need to be addressed.

Bob

I might have stumbled on a paper about some of the questions we've been asking here about age, how long we've been drinking. Anyway below is only a bit of the report that I copied from the pdf. If someone can tell me how to attach the pdf we all could read it.

Only 2 of 14 RCTs to date have failed to demonstrate significantly
favorable effects of naltrexone: Kranzler et al. 2000 and, most
recently, Krystal et al. 2001.
Krystal and colleagues raised doubts about the utility of naltrexone in older patients with chronic, severe alcohol dependence. They studied a population of men averaging 49 years of age and 20 years of heavy drinking. However, their findings conflict with other RCTs, involving almost identical populations of older males with long drinking histories, which reported significantly favorable results for naltrexone in terms of relapse, frequency of drinking, and quantity of alcohol consumed (Morris et al. 2001; Oslin et al. 1997).

corkit

8 --

I would phrase the question the opposite way: if there is evidence that naltrexone works for people who consume 50 to 150 drinks per week and have been for twenty plus years, then why isn't that evidence presented in the book? And why do the graphs in the book -- which would presumably be the best evidence available -- only address people who consume 35 per week, which is peanuts in the grand scheme of severe alcoholism?

Don't get me wrong, I firmly believe that TSM works and it's working for me. And I've been abusing alcohol since I was 16 so I have thirty years under my belt. But I think the three to four month time frame is way off the mark for heavier, long-term drinkers. And my theory is being supported by virtually every anecdotal experience we have on this board. The vast majority of us are seeing major improvements -- just not at three to four months.

And for the record, TSM should work regardless of how long or how much you have been drinking, according to the book. I'm just questioning the time frames given our collective experience.

Lastly, I would agree with your doctor that a significant level of de-addiction occurs after three months. That was definitely the case for me. But I didn't drop to "healthy levels" at that time; I just had re-gained control over my drinking. So some of what we are arguing here is semantics. I agree that most of us have regained a great deal of control after three months on naltrexone. However, almost none of us are only having ten to fifteen drinks, or whatever is considered to be "safe", after that time period.

Maybe the evidence is presented in the book, just not as explicitly as could be helpful for those at the extremes.

Didn't Dr. E mention in one of the threads that the iconic graph was the average of all the results? If it is an average along both axes, might it be that 35 was simply the arithmetic mean starting point, not necessarily the modal starting point. So it could be that many heavier drinkers were included, along with some that were lighter problem drinkers, just as some extinction curves were shorter/steeper while others longer/shallower?

Nick,
Thanks for starting this thread. I am of course one of those who are way out beyond the 3 - 4 month mark and still not seeing progress. Starting week 30 as I write this. But I know there are many like me who are still waiting for our turn, so I am hopeful that for those of us paddling further and further downstream, that our time is still yet to come. I would probably go on until I have been at it a year before deciding it didn't work for me. Of course I hope that I will see success way before that time! Hopefully Dr. Eskapa will write in about this as I have stated in another thread. I guess if the studies didn't have people who had been either drinking more or drinking longer (or both), there may be no information out there other than speculation. For now those of us "oldies" will just have to keep going and posting our experience as the weeks go on. Well, it's been an hour so I am headed to the kitchen for my chardonnay.