Hi all - this is my first post. I've been lurking for a couple months, and have read hundreds of your posts, and followed up with a fair bit of research on TSM on my own. I decided to order naltrexone about 2 months ago, and finally received the drug last week. I can tell already that it will work. It takes all the 'fun' out of alcohol, leaving only the sedative properties, and sating the addiction. Already, I'm drinking less, and feel no urge to overdo it, chasing the 'high' until I've drunk myself into a coma. I was (am) a 50+ unit/week drinker, with no self control stopping once I had the first drink.

I think something that many may have overlooked is the importance of introducing alcohol free days as soon as possible, within a few weeks if you can do it. Several here have done this, and it appears that those that do see success in extinguishing their addiction sooner. Those that don’t appear to see a reduction in their drinking fairly soon, but hit a sustained plateau where things don’t change much.

What is fascinating to me about this treatment is that it works by starving your brain of endorphins; that extinction is achieved by your subconscious ceasing to relate alcohol consumption to the pleasurable feelings of those endorphins. And that, further to this, that your opioid receptors increase in number/become more receptive once naltrexone has been ‘washed out’ of your system. Herein lies the danger with drinking without the harness of naltrexone – the reward pathways become doubly reinforced if you do, wiping out the pruning of those pathways that happened while drinking with NAL. However, we’re driven by these endorphins. They make us happy (we wouldn’t have become alcoholics in the first place without them). And there are many healthy pursuits (good food, sex, spending quality time with loved ones, achieving life pursuits, etc) that produce them. My reasoning is this: if you can get to the point where you can have an Alcohol Free Day, and enjoy these activities without naltrexone suppressing your enjoyment of them, you will soon(er) replace your cravings for alcohol with cravings for AFDs. Further to this, if you never have AFDs, and always have NAL harnessing your endorphin receptors, it becomes harder (or at least take longer) to break out of the plateau achieved through NAL with no AFDs. Each day is just as grey (emotionally), as the one before – you’re just drinking less (though this is a major achievement in and of itself). With AFDs, allowing the NAL to ‘wash-out’ and get those endorphins through healthy activities, you ‘let the light in’, and perhaps(?) accelerate your cure.

Others have pointed out the value of letting NAL ‘wash-out’, and enjoying other pursuits. The point I’m trying to make is that it may be essential to ‘push’ it, to shorten recovery plateaus, and hasten the cure.

I’m interested to hear what you all may think on this, particularly from those that may be experiencing AFDs for the first time, without naltrexone in their system. Though, of course, I’m eager to hear from anyone on this specific topic.

You’ve all been a terrific inspiration for me. You’ve given me hope! Hope in the idea that I can beat this, without a lifetime in AA (a miserable prospect, almost as miserable as dying, alone, in a gutter from alcoholism), but also hope that it can be done without the white-knuckling, tiger-doing-pushups agony that strict abstinence entails. And that you’ve had success, and have this excitement and joy in seeing it. (endorphins! it's not a bad word, unless your source of it is ruining your life)

Thank you, all, for giving this hope to me.

Welcome. As a weekend binger, I always had AF days even before TSM. So, I was lucky in that forcing one was never an issue for me. It's a tough question, "drinking as you normally drink" versus forcing an AF day. If you read the book, it says nothing about pushing for an AF day. That being said, I don't disagree with your analysis.

I would say this, however. As someone who has drank without naltrexone, I believe the risk of really enjoying drinking through upregulation is more of a theoretical concern than one based in reality. My experience -- which occurred after I had regained control and over a year after starting TSM -- was that drinking without naltrexone was less pleasurable than drinking off of naltrexone before I started TSM. My buzz still felt dulled, presumably because of extinction. I have also read numerous accounts of others here who forgot to take the naltrexone and not one person reported some super-fantastic, amplified buzz. And since I see opponents of TSM are making the argument that we boozers are likely to purposely create a super-amped buzz, I think it's important to diffuse what I believe is an over-blown concern.

Hey Corpus,
I think I agree with you about AF days. Like Nick, I've always been a binger, so it wasn't rare for me to have AF days, but it WAS rare for me to socialize/celebrate without alcohol. I am pushing myself to try and do that sometimes just so that I don't always associate alcohol with certain activities. In terms of upregulation...in the first week on nal, I sort of misunderstood the rules about TSM, and didn't take the pill in one situation where I knew I wasn't going to get out of control....and I had exactly one drink. Nothing felt better or worse than normal, pre-nal. Of course that was very early on, but I think it's probably more of an issue that you could build back UP to pre-nal levels of endorphins or higher, but it's going to take a whole lot more than one drinking session without nal to do it.
Good luck with everything and keep us posted!
EL