I just sent this question to Dr. Eskapa who was kind enough to offer correspondence via email:
"Dr. Eskapa, hope you are well. I am reading different reports at thesinclairmethod.com and wondering: should I be tapering off my drinking consciously or just drinking as I please while taking nal an hour beforehand? some cured folks claim tapering off helped them, and otherwise they couldn't have done it, while some claim the more you drink on Nal the quicker the extinction occurs. I have a hard time tracking craving because I can't quantify it. I don't fight cravings, so how would I guess how much craving there would've been, had I not given in to the initial craving in the first place? maybe i should fight a craving or two?"

I thought I'd like to see a show of hands, as it were, mostly from cured folks or people who've read the board for a long time and have a grasp on the goings on here. How many cured folks really fought cravings or consciously tapered off their drinking while on TSM, and how many just went balls to the wall until they were cured? DISCUSS.

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pretty much the same for me - once I started to make the (moderate to little) effort (and being prepared to 'fail' if necessary) to take an AF day, it became progressively easier.

I guess on one level you can test the difference between craving and habit by trying to do something else instead of drinking. If you are distracted mentally to some degree this is obviously easier (e.g. going to the movies). If you manage with little or no cravings then it might suggest a signficant habitual component in your drinking and once you've identified that it becomes easier to find ways to break it.

I consciously tapered off, using what I would call "awareness" - but no real effort.

After the all, the whole reason I started was to, hello, drink less. Why would I not regularly test to see if I was making progress?

I tried to use "awareness" as PV says. To some extent I used both methods as appropriate: when the cravings were just grabbing me I went with that and allowed extinction to run its course. When I began to feel some glimmers of control I would work it like a muscle until it became stronger. As TSM removed the roadblock of addictive reinforcement, it became easier to listen to my body. The body knows what is the right thing to do, but in a way addiction masquerades as the body's voice, telling you to drink. Once the addictive voice is silenced through TSM, the body's real voice can be heard loud and clear.

I've made no conscious effort and as a result have seen only glimmers.

I think that's the difference. I need to make conscious effort or I will be here forever. Maybe tonight.....Best, Jim

thanks guys. I've been corresponding with Dr. Eskapa and he basically told me just to take 50 mg before drinking period. He said the addiction is controlled by the primitive not the conscious brain. but from hearing about your experiences (I don't think Eskapa was a drunk) it may make sense at some point when I am drinking less for me to put on my big boy pants and try an AF day or 2 followed by exercise. For now though, it's Nal+Alcohol nightly.

one interesting thing: Eskapa told me that for some patients, upping the dosage to 75mg before drinking has helped, so that's what I'm going to do. I really want this to work and the side effects are minimal. He said he had just been in contact with Sinclair about this as well. Eskapa said he had seen some folks do well with 50 mg for a while and then upping it to 75mg. (a pill and a half) Of course he told me to confer with my physician about it, which I will.

I didn't really taper off so much as I used the control I was gaining to choose not to drink. That is, I chose to have more alcohol free days.

However, I was still binge drinking until very late in my treatment.

Q

I am not sure how to describe the experience of when you transform from an addicted person to an unaddicted person, but you can feel it and you know it when it happens. From that point on, free will (conscious tapering) is easy and effortless. You can do anything you want; keep the status quo, or choose something else.

I chose to continue to drink only if I felt like it and it didn't inconvenience me. (Making a trip to the store down the road is an inconvenience, but if I'm already there for other reasons, it's not). Last week, I was at a convention where there was an open bar every night, yet I still drank socially (with Naltrexone, of course) at a level that was much higher than past months but still a fraction of what I used to, and also less than my companions. This week, I've had nothing at all. There's nothing in the house and it would be a bother to get something from the store. These are examples of what an unaddicted person would do. They have a choice and they use that power of choice.

The important point here is that your brain needs to be cured of the addiction, before you make any of these conscious decisions. You will know when you are cured.

Bob

PS I think Joe is correct. Eskapa wasn't ever a drunk. I don't think Sinclair ever was either.

Part of me wishes they were...that was my attraction to AA...one drunk to another...but thats why i got you guys

My Best, Jim