I think naltrexone/TSM has really done something great for me. When I heard people talking about 25-35 weeks before seeing any results I got a little worried. This was before I began the regimen. I wasn't getting much out of 50 mg, so I asked my doctor to step me up to 100, and he did. Now, I really can't ever have more than 8 drinks in one night, and that's a stretch. Last night was still better I was able to drink only 4! Compare that to my pre-tsm 10-16 and I'd say I've come a good long way in just over 3 weeks.
Anyway, I've noticed that after 1,2, or 3 drinks, I still crave the next. Will I ever really extunguish that feeling?

Have you read Eskapa's book? Naltrexone is not an anti-craving med. Any short-term anti-craving effect is incidental to treatment and not related to the dismantling of neural pathways that cannot consciously be felt and takes several months. Upping your dose to 100 mg does nothing except to extend the half-life of the drug in your system, which is unnecessary if you are taking it daily. Fifty is sufficient for a complete opioid receptor blockade, except in a very few, rare individuals. And only after months on naltrexone is without significant improvement is a person advised to try upping the dose from 50 mg. For our 24/7 drinkers, Eskapa has suggested a dose of 50 mg every twelve hours to ensure a complete blockade, but this doesn't sound like your drinking pattern.

If your doctor is like most, he/she got her information about naltrexone from the package insert. That information is inaccurate and misguided, as Eskapa explains in the book.

I'm not trying to hawk the book. There are links several chapters for free on this board. My point is that you need to be self-reliant about learning how naltrexone works under the TSM protocol, because your doctor is not likely to be a reliable source.

Keep letting us know how you're doing, and remember: Patience is a critical component of success. Expect ups and downs in the process.

You said "I wasn't getting much out of 50 mg" and I'm not sure what you mean. If you mean that you still wanted to drink this is no surprise as you've only been taking nal for 3 weeks and that's way too soon to see any results other than placebo effect (honeymoon).

You could mean you have had no side effects and if that's the case you don't have to worry - the drug will still be working away in your head without your knowing it.

You have begun to see improvement on 100 mg, but you might have seen that improvement on 50mg if you had been a little more impatient.

The only dosage difference I encountered was when I took .25 instead of 50 because I was running out. I did find that I was not having the same result - when I went back to 50 I noticed a difference.

Anyway, keep going - sounds like you are making good progress. Do a bit of study on your own so you and your doctor can educate each other.

I don't know about a placebo effect. I take the 100 mgs at around eight at night and start drinking about an hour later. I was on 50 mg, and noticed some difference in my feelings during drinking, but it just wasn't enough to make me want to cut back to the point where I wouldn't do stupid things. Now, after no more than 8 drinks, I just get tired of it. I'm either to sick or to tired to continue. That, on top of the fact that the alcohol isn't giving me much of a rush or high is enough for me to just pour that last one down the drain and go to bed.

Please take the time to learn about naltrexone and TSM.

We didn't say it was a placebo effect. What you're experiencing is incidental to the more serious effect naltrexone has on the brain. The effect you describe is, for most, fleeting and is followed by a resumption in drinking at or above your pre-TSM levels prior to experiencing meaningful long-term change.

We have compiled a wealth of information on this board about TSM, so feel free to have a look around.

AND if they make a fortune saving millions of peoples lives and save countless relationships, I hope they become trillionaires!

PS who said not to trust your doctor?

Scott - seriously, there is no reason to take 100mgs before about 6 months taking 50 and following TSM. I don't know why you felt the need to up the dose so soon. Plus I don't know why you are so sortof defensive about it. Do what your Dr. tells you and that's fine. BUT - we are here w/ our experiences...mostly saying 50 mgs works for the first 6 months.
Then see and possibly up your dose to 100 mgs and see if that makes a difference.

Sorry, but chances are it won't. If 50 mgs don't work, chances are 100 mgs won't work either. Just saying - and then drop back to 50mgs after 6 months on 100 mgs just to cover your bases. Consider using Baclofen after that, and go on. Many of us on this same road. Hope I made sense -
XO

Wow.... yeah, there's another example of how irritable I get while drinking on naltrexone. Sorry. I didn't mean to sound so abrasive. Well, I did, but that's cause I was all messed up in the head. I guess it would be difficult to open a forum for people who are trying to get rid of their drinking problems and have them all get along like little angels all the time. I was going off on all kinds of people online last night after drink 6 or 7. Yeah, thanks for all ur help though.
I have the Eskapa book, I just haven't read it yet. I think that's one of my pet peaves about alcoholism treatment. They always want to give you something to read.

Love you guys.

As far as the 100 mg thing, I did see a big difference when I switched from 50. Maybe I'm a rare case, but on 50, I was still able to drink quite a bit. I wasn't gaining much control, and was still getting really stupid when I drank. I really Really wanted that problem to stop, so I asked about the 100 mgs. Now, since upping it, that mild hysteria you saw from me last night is about as bad as it will get before I just realize that the alcohol isn't making me feel good. I got to about 7 last night, and poured the entire eigth down the drain right after opening it. I haven't run into any sort of problems with my own comliance yet either.

I always look at the time of the post if someone sounds cranky . I helped to set up this board and one of the things we decided is to leave open-ended the poster's capability to edit a post. If you could do a search by time and if you knew the location of the poster, well you probably can imagine what you'd find . Some of the rants are actually hilarious looking back.

I know it can be hard to get your head around the fact that the immediate, short-term effect of naltrexone, while quite real, is essentially meaningless, and soften wear off quickly. When it does wear off (as it does for most), you risk disappointment and the mistaken belief that it's stopped working.

I know exactly what you mean about reading materials on addiction. They generally are preachy and try to explain that it is a disease; but, between the lines they guilt you into focusing on that 12-Step character defect crap. Most of us here have experienced a progressive resolution of many of the problems in our lives as our drinking waned. Crown86 is a great example of this. And that happened quite naturally, without baring our souls to a bunch of strangers who reek of stale cigarette smoke in a church basement.

I'm going to post a few quotes from Eskapa to hopefully entice you to read it and get a good insight into the science of TSM.

"[N]altrexone may block the pleasure -- if any -- from drinking. But pleasure is not why alcoholics continue drinking. . . . .
Your subjective sensations, feelings and emotions hardly change when you drink while taking naltrexone. However, the pathways controlling your drinking are incrementally weakened each time you do it. This occurs at the microscopic level of trillions of connections between neurons in the brain. Just as you cannot feel the metabolic processes in your liver or kidneys, you do not feel the de-addiction process as your nervous system is restored to normal." P. 106 (italics his).

"The Sinclair Method advocates a non-judgmental position with respect to addiction. . . . It is imperative that you try to avoid the stigma, taboo, and shame so often associated with the label addict, alcoholic, or drunk." P. 97.

"Be alert that, even very early in your treatment, you may occasionally experience a surprising ability to stop after only a couple of drinks. However, this decrease in drinking and craving is merely an artifact of the treatment. . . . It is a beneficial but weak effect. The powerful effects from pharmacological extinction develop much more slowly and cannot cure you in a week or two. It took a long time to reach your current drinking and craving levels and it will take at least three or four months to reverse the addiction. Some people take longer before the neurological scaffolding -- the addictive wiring in the brain -- is brought down, reduced, and returned to its normal, healthy, pre-addicted state." Pp. 117-118 (italics his).

Some of us here -- especially those on the youngish side -- had some immediate reduction and just progressed downward from there. But most of us felt this early anti-craving effect for a while, only to have their drinking shoot way back up, sometimes higher than pre-TSM levels, before the decrease begins. You'll see as you follow threads that, time and time again, newcomers are admonished by the "old-timers" to expect a roller coaster ride rather than a smooth downward path.

My impression is that you are very bright. I hope I've piqued your curiosity and that you grow inquisitive about the nuances of TSM. Knowledge is power, and will prepare you for the almost-inevitable ups and downs you'll experience in the process. Many of the questions you've posted in various threads are answered in the book. There is even more information on this board.

Patience is one of the most difficult aspects of TSM. That's where we can really support one another on this board. One common complaint about the book is that it subtly sets the expectation of cure at 3-4 months; many if not most of us find that it takes many more months. Still, I suspect that after you've read about naltrexone's pharmacological mechanism, you'll revisit your decision to up the dose to 100 mg. If not, we won't hassle you about it, especially if you are making an informed decision.

Let us know how you're doing.
(edited to fix italics code and add a sentence)