I have been on TSM for 18 months. I've been on and off this site since i started and have read lots of posts but haven't seen much with regards to this topic. i've religiously followed the golden rule, but have continued to drink almost daily (1 bottle of wine, more on weekends). I am a long term heavy drinker and struggle with AF days. I know my drinking is largely habitual and situational (unhappy union, etc.) so i am in therapy and working in other ways to tackle my problem. It has almost entirely eliminated my black outs, and sloppy situations, and i can drink socially like a normal person (or at least appear to), but beyond that TSM hasn't worked.

However, after getting my liver tests (SHOCKINGLY it came back last week as normal) and my doc agreeing to up my dosage, i am going to increase my dosage from 50 to 75 mg. I am hoping to hear any stories of others that tried this and what was the outcome? How long did it take to see a difference, if any? Please say some prayers for me that this may finally work as i can't continue on this path but want so badly to succeed. thanks all and happy holidays!

Even if that's all you get from it I'd say it worked, some progress in a safe direction is certainly better than nothing. I'd rather be there than in a cycle of ADE and relapse.



I'd continue if I were you, and I'm not clear on why you would want to quit? It's always been my understanding that Naltrexone is not a magic pill, it's a tool that you have to work with. For some it happens very quickly and easily but others have to put more effort into it. You might be an individual that has to put in more effort. Guapo the other day suggested Moderation Management in conjunction with TSM to someone, I guess as a way of learning to control the conscious side of addiction. Anyway, I read through a lot of the info on the MM website and found a meeting near me in St Louis. I'm giving it a shot next week. I'm not ready for the 30 days of abstinence yet, but I'm sure I can learn a thing or two, and it sounds like a safe learning environment.

I'm glad to hear your liver tests were good, and I hope you have success with the higher dose. Naltrexone is actually a pretty safe drug as drugs go.

Hi, just curious, how much did you drink before starting Nal/TSM? Because it sounds like you have done a pretty good job at overall harm reduction, but I understand the frustration at 18 months. Assuming 13% ABV and 750ml/25.3 oz in a bottle of wine, that's about 5.5 US drinks per day. If you were heavy drinking say 10 drinks a day 18 months ago, you can still hang your hat on that, and I'm sure your liver thanks you.

It does sound like you know yourself and realize the old habit coupled with ongoing stressful life events are keeping you drinking at higher levels than you would like, but stopping Nal and risking a major spike in drinking at this point will probably not help your liver or your relationships and will probably make matters much worse.

It does sound like it might be time to take your moderation efforts to another level.

Eli, it is definitely worth asking what your goals are.

A bottle of wine is not insignificant, but of course better than several bottles of wine a day.

TSM absolutely did not work for me, and I was drinking like you are, until I added moderation management. The reason, as mentioned above, is there is no magic pill, but it requires a change in behavior and a change in your way of thinking. NAL taken alone does absolutely nothing to change your thinking.


I've spent some time around the moderation management site and in their chat room, and I have to say their success rate is fairly low. That being said, very few there are doing anything except following the techniques, doing 30 days abstinence, and hoping for the best

Unfortunately, that is like white knuckling things, and using willpower, and struggling.

TSM doesn't require willpower, it does however require adherence to the golden rule. I can tell you my drinking dropped exponentially, once I decided to quit drinking as I wanted to, and started to drink sanely , which was significantly less than a bottle of wine nightly

When you drink every single day, And drink a lot every single day, your mind simply can't comprehend not doing that. Tapering down, with TSM, And adding moderation strategies, allows the fog to lift.

It sounds hard to believe, but you reach a point where you prefer days when you don't drink, to days that you do, because you feel so much better, and are just as happy . I know BarryB4 can attest to this. I think that's what's called indifference.

Many here advocate doing nothing except taking the pill, and letting things work on the subconscious. Well, are you happy with that concept and has it worked well for you?

Everyone has to make up their own mind, but there's definite value in looking at what other people are trying, (e.g. Baclofen (seems scary) , or 12 stepping, or moderation) and how things are going for them.

Or.... Maybe upping the dose will help

First of all, i want to thank those that responded, it TRULY makes a world of difference in this journey, and i am so beyond grateful for your comments. I really feel that this could be a positive momentum for me after reading these comments. My twin sister is the only person on this earth that i can really talk to about my situation, but god bless her, i want to work this out for us both.

To all41, i agree, the NAL has helped in such a tremendous way. I would be so scared to go back to my life before NAL (i've never once in the last year and a half drank without taking nal one hour before) It wasn't like i was totally at the rock bottom like many have described, but i hit a certain point where it was definitely heading in that direction. i have ZERO intention of stopping the nal, when i said i can't continue on this path, i meant the path of drinking (almost) every night, and feeling like living hell the next day, and being totally unproductive, and knowing that i can be such a different, much better person. I was in a bad, bad place right before i started taking it, and now, at least i can see alot more clearly what is going on.

To guapo, everything you say makes so much sense now to me. You are the only one on this forum that explained things to me in a way that i understand and that hits home. Of course i wanted it to be a magic pill, and i held on to that hope for a long time. but i realized months ago, that i was only taking it to keep things at a steady level. my goal is to be able to be in a social situation, and be able to have a drink. that's it. Ultimately, i would love to be able to never have a drink at all, but it so beyond my comprehension, that i feel like i need to set realistic goals first. Virtually everyone that i associate with, including family, are big drinkers. Never just one glass. So i'm always in a situation where there is lots of alcohol flowing. It's frustrating sometimes, but i'm also still drinking to the point where i feel the buzz, and i love that feeling. also, it's so hard for me to imagine being the sole sober person there, and being sober in general. Drinking on nal is definitely different, but i still chase the buzz, and when i get there, it feels sooo good. it's a place of comfort, and it's so hard to imagine losing that crutch of comfort. I drink to escape alot of the bad stuff that went down years ago, and that's no excuse, but it's a fact that i need to really start practicing the moderation approach. Setting goals of not drinking for x amount of days, etc. and not relying on it as a stress reliever to this extent. I realize now that i'm only doing half the work. i really want to be in a place where i'm able to have a drink or two socially, but i'm still doing all my old habits. I'm rambling now, and it's late, but please continue to give me advice and support. it gives me so much incentive to hear what everyone has to say. thanks a million

You know, if you don't like the moderation idea, don't do it.

It's another tool, and why not use any and all tools that can be helpful, as this is a tough problem to lick.

Increasing your dosage sounds like a smart move. Naltrexone is really a very safe drug when taken properly (as you are doing).

I'm concerned by your description that you are sometimes able to drink past the Nal and get that feel-good buzz....when you do that, you are providing intermittent reinforcement to your brain, so it will try even harder to get that reward. Increasing your dose will definitely reduce your ability to drink past the Nal. But it would be worth your time to do some soul-searching and make a conscious decision to slow down your drinking before you reach that buzz.

Nal is a tool, and a powerful one, but ultimately all it can do is give us back our ability to make choices. It can't stop us from making self-destructive choices.

elijones...some thoughts...

The whole issue of upping from 50mg to 75mg has come up before. Naltrexone is a dumb drug that does just one thing -- occupy opioid receptors. 50mg is the standard dose because it supposedly occupies 100% of the receptors in the vast majority of people. So, unless you're one of the outliers for whom it doesn't cover 100%, 75mg should theoretically make absolutely zero difference. It's not like taking a higher dose of a pain medicine or steroid. 1000mg of Naltrexone would do the same job as 50mg for most people. (Someone correct me if I'm wrong here.).

I think you should consider a couple very real possibilities. To begin with, after 18 months on 50mg, Naltrexone may already have done all it's going to do for you. By all means, keep taking it before you drink, but don't necessarily expect much more to happen in terms of how you feel towards alcohol, or in terms of how you feel while on alcohol. I'd also challenge you to consider whether your idea of "upping the dose" to 75mg is really just a stall tactic concocted in your foggy, addicted mind: "I've enjoyed alcohol for 18 months with 50mg, but still don't want to quit (and I'm kind of scared of sobriety) and I really, really like to get buzzed. So, maybe I can try 75mg for another 18 months and see how things go. I mean, I have a bad marriage, everyone around me drinks, I had childhood trauma, I don't like my job, etc...." I'd challenge you to not underestimate the negative power that a bottle of wine and 50mg of Naltrexone a day can have on your brain and ability to think in your best interest.

And, if health issues motivate you, I'd also challenge you to consider that, in all likelihood, you are indeed living a lifestyle that can easily (if not "probably") lead to major organ problems. Drawing some blood and not having elevated liver enzymes hardly means you're "in the clear." Cirrhosis, pancreatitis, and other consequences of high levels of drinking (and, in my opinion, 1 bottle a wine a day is getting close to "high", esp. if you're a woman [note: I'm assuming you're a woman.]) can lead to slow, persistent damage that can manifest one you're already in a later stage of disease. I'd say you almost surely have a fatty liver, which is the beginning of a cirrhotic (scarred) liver. If it helps to motivate you, become an expert in liver failure. It has definitely motivated me in my de-addiction efforts.

Finally, having experienced marriage problems myself, I can't emphasize enough how bad marriages and dysfunctional drinking feed off each other. The drinking makes you a much worse spouse, which leads to a worse marriage, which leads to more drinking, etc... If, like me, you get a lot out of forums and message boards, I'd encourage you to get involved with some so you can talk with others and get encouragement. In my opinion, avoid mumsnet and those type of whine-fests. Talkaboutmarriage.com is ok, but I always recommend marriedmansexlife @ vanilla forums. I haven't been on there in about 9 months, but it was extremely helpful to me. It's actually branched out to be for both men and women, and is (unfortunately) moderated mostly by women. But, you will get very focused, positive but tough marital advice, and it's a very active forum. You just go on, post a "triage" about your marriage, and you will get tons of great advice. The basic idea being, you can only change yourself. Becoming "the best version of you" is really all you can bring to a marriage. If, even then, it doesn't work, then you can move on at least knowing that you did all you could. Becoming this "best version" is a long process (years), and you're likely nowhere there yet. Most people find that, in the process of self-improvement, many of the marriage problems become a thing of the past and, when you get to the point of being your best, your marriage will likely be dramatically better. (Side note: it does have a basic principal that a man's transformation is way more powerful for a family and marriage than a woman's; a lot of such counter-cultural ideas are "offensive", but don't let them turn you off to considering them).

Best to you, and please PM me if you want to talk more offline.

I agree with BarryB that the 50 mg dose does cover 100% of the opioid receptors for the vast majority of people. However, elijones description of being able to drink past the Nal on a somewhat regular basis suggests to me that he or she may have more opioid receptors, or more actively cycling receptors, than most people. Upping to a 75 mg dose would make sense if that were the case.

Being able to drink past can also indicate that a booster would be useful, although increasing the dose would probably cover most of those cases as well.

FWIW, I think it makes sense to try a higher dose before giving up. Nal is a pretty safe drug, and if 50mg is fine then 75mg will probably be okay too.

I am not a doctor, etc. I'm just pitching in my two cents.