Nigel -

I would say that as long as the average is on a downward slope you're winning, so carry on. You're seeing a difference between 50mg and 75mg, so it might be worth a trial at 100mg to see if you get faster progress. I've seen more than a few cases where that made the difference and my own TSM doc told me that some people do indeed need a higher dose.

If you want to accelerate your progress beyond that, it's time to look at an adjunct, which may be adding in another med, cultivating enhanced conscious control or some of each. One idea for a med might be Baclofen, as addiction happens via GABA pathways as well as Opioid pathways (though they end up at the same place, by futzing with subconscious survival/reward imperatives in the Striatum).

WRT conscious control, this can get to be a bit of an art of watching for what comes up as you're drinking throughout the evening. If you don't intercept a stressor and the conscious processes go "tilt", it just gets handed off to the Striatum, which is going to do what it did last time (compel you to pour another one). As alcohol tends to anesthetize the frontal lobes (where conscious control originates), it gets harder to react to recognize the stressor and select a satisfying conscious alternative that keeps the situation from ending up in the Striatum's lap. And we know how that old song and dance goes. Or to steal a quote from the Big Book:

"You don't have a problem, you have a solution that you don't like."

So aside from setting a trap and watching for what comes to take the bait, perhaps check in to something like SMART Recovery or Moderation Management, both of which have online communities. I think in both cases you have to register for an account to see much of the content. SMART doesn't always tolerate "moderation", but I think they're getting to realize that no matter how you spell strict abstinence, it fails for most people. They do have a handbook on Amazon that's pretty inexpensive and some have said that it's easier to learn the SMART tools that way, then hit the online forums. I haven't dealt with Moderation Management at all, but it would seem that it would be a natural for a TSM'er that wants to boost the results they're getting with Naltrexone.

What say you?

Joe,

many thanks for that detailed reply.... there is a fair bit to think about.

I think in the back of my mind that the next step will actually take some sort of work on my behalf... what's stopping me isn't lack of energy, more that when I have tried to do my own thing over the last 20 years its always failed, and that has included already moderation management, and abstinence as well as a plethora of own made up and other tools. In fact that's what made TSM so appealing the idea that its not all on your shoulders and you simply follow the golden rule; however you are correct that if after so long this is where I am at then I need to take it further myself.

I am sticking with 75mg and last few weeks have looked a lot better, I am wary of 100mg just the whole drug amounts, same goes for baclofen.

it looks from above that I am in denial and saying no to all, but I am not, I am pondering them all.

thanks again

Good show, it's all to be considered (well, alcohol is a drug too...).

There's also the school of thought that if (say 75mg) gets you results, you're not going to get more by upping the dose and that hauling the frontal lobes (conscious mind) out to preside over things more and more is the best game plan.

In any case, you seem to be getting there! I'll be keen to hear how it goes in the coming months and what you discover!

I would stay the course with your results as they are. Nal on!

I was told by Joe to look at your thread. I have been on this medication for 16 months and don't see it working. I even tried upping but it didn't work. I don't know what to do. The doc all say, just give it up.