"If TSM does not show improvement after 6 months of meticulous adherence to the protocol then the person should try other methods ....... and not give up"

V.

Hi Virgil -- Thanks for sharing. Yes, it is very important; but as I parse it, the statement raises more questions in my mind than it answers.
-What constitutes "improvement"? Is any reduction at all "improvement"? Many who have not seen significant reduction in consumption nonetheless have reported a change in quality of life, such as reduced craving, change in attitude, and other subtle, difficult-to-quantify changes. Does this count as improvement?

-For those who should "try other methods . . . and not give up", does this mean they should continue to take naltrexone? Or abandon naltrexone in favor of other methods?

-In at least one study, Sinclair followed his subjects and found continued improvement for up to three years. Can those who show only minimal after six months expect continued improvement?

I honestly don't know the answers to these, although I have some subjective impressions, and I hope members weigh in.

It seems to me that reducing it to an absolute period is wrong. I believe it has to be the number of iterations that is significant, and not the number of weeks or months on the plan.

As someone who has been on NAL for seven months without much change in unit numbers this topic is of real interest. In fact I just posted about my progress. I have definitely felt progress but more a change in the way I think about alcohol and my need to be drunk than in number of units consumed. While science relies on easily measurable results, I strongly believe that focusing on the number of units consumed is just asking to be discouraged. For many people it takes six months or more for antidepressants to show results, and the results can be very difficult to measure in terms of numbers. Some of us have been drinking excessively for decades, and drinking is a way of life. That takes MUCH time to undo. I KNOW that there has been a change in my brain, even though my numbers aren't down very much. And I KNOW that alcohol affects me differently than it did seven months ago. What I need now is to add effort and intention toward sobriety instead of relying 100% on NAL to be the magic pill. I know some members will disagree but in my mind there is no magic pill. NAL works if we sincerely want to be sober or moderate. No pill can overcome our will to avoid the pain that led us to alcohol in the first place. For those (including myself) who show little reduction in consumption I ask: do we really want to be sober? Do we really want to give up our role as addicts? Are we really willing to face the pain rather than avoid? Just my belief, not a judgment of anyone.