Most GPs just don't get TSM, because it goes against everything they've been trained about addiction.

When I first went to my GP to get a script, I really didn't tell him what I was doing. I just told him I wanted NAL to help with AL cravings. It was during a later follow up visit that I gave him a copy of the Chapter out of the book that is for medical professionals and told him in general about TSM. I have no idea if he ever read it or not, but I don’t think he really understood or tried to understand what I was telling him. He simple said “Your drinking was not severe. Some people just cannot drink under any circumstance.” Mind you, I didn't tell him how much AL I was REALLY drinking on a weekly basis out of fear he'd force me into a in-patient program.

A month or so ago, I went back in to get my script renewed. The nurse was reviewing my med list and asked what Naltrexone was for. I told her in a nutshell about TSM and how I was doing at the time and that my drinking was about 1/3 of what it was when I started. She said "Why don't you just stop drinking if you are having such a problem with it. I don't drink and I get along just fine." She completely overlooked the fact that I cut my drinking by nearly 70% and release from my addiction was imminent. Once again, these medical professionals just don’t GET IT…

Hopefully, in time, this will change.

Q

I just posted this on another thread but it is directly on-point to your post Q so I'll copy and paste it:

I have a very good, well-intentioned doctor. What I'm learning about her is that doctors -- even the few with humility like her -- absolutely squirm when they realize their patient is far more familiar with a certain treatment than they are. My doctor -- who is allowing me to proceed with TSM after consulting an addiction psychiatrist who told her that naltrexone is benign so why not try it -- tried arguing with me that TSM and AA would be a good thing hand-in-hand. I then had to explain that pharmacological extinction only works when the endorphins that cause us to have positive associations with alcohol are blocked when we drink on naltrexone and that AA directly contradicts the method with its abstinence-only rule. The resulting expression on her face looked like she got struck with a bad case of gas so I let it drop. But trust me, doctors are even more haughty than we lawyers, and they will welcome us like a case of herpes when we try to explain to them TSM.

And yes Q, it will change over time. One stubborn, superior physician at a time.

Week 4. hmmmm
For no apparent reason, like being triggered, my units for this week are more than pre-TSM.
I just dont feel any different.

It kills me - if this were an eating disorder, would someone say to an obese person, "You have a problem with food, why don't you just stop eating?"

Of course not! Sheesh - but it's alcohol we're talking about & it's different. I went out w/a man tonight whose ex-wife was a compulsive gambler...interesting similarities! We who are addicts know the drill, yet the medical community does not - many of whom are addicts of something, of course, they are human beings too - kills me though that these studied professionals are so closed minded in so many ways and on so many levels about treatment methods that are new and different and perhaps presented to them by a lay person and not through a medical venue...

I have had a couple of doctors admit that the internet has increased the knowledge of patients beyond their own in major ways - patients come in knowing more about their symptoms, illnesses, medications, etctetctec more than ever before. Doctors have to deal with this. Probably frustrating but we are not stupid out here and are taking more control over our own treatment.

Doctors are not the gods they were thought of in the past. It's a good thing that we patients are questioning treatment, and even more so, demanding same...especially in this case when the medication itself is so easy to prescribe w/ little to monitor.

Tuttle -- a week 4 spike is completely typical on this board. Looks like you had an initial reduction in drinking for a few weeks (the "honeymoon effect") and now you spiked back up to pre-nal levels and then some. This has happened over and over again here to people who eventually report dramatic decreases in consumption/craving. Bottom line: TSM is a roller coaster ride. The fact you had the reduction shows it's working for you. Now all you have to do is be patient and follow the formula, nal + drinking = cure. Good luck.

Thanks Nick.
I feel much better knowing that someone else has gone before me and I am walking in their footsteps.
I have been catching up on some bb reading this evening because I've been very busy of late and havent been online as much as I'd like.
I'm really happy to see ~Q~ declaring a CURE and I hope he sticks around to help us newbies.
I'm about halfway through reading the book which finally arrived. With every page I think of new ways I could approach my Dr with an explanation of TSM. I guess by the time I have finished the book I will know what to say. I'm lucky in that my Dr is about my age and we have a good rapore.
But then again ... do I have anything to gain by educating him as long as he keeps giving me scripts? I suppose I will wait and see. If he starts questioning the merit of NAL then I think I will educate him. Yeah .. that's what I'll do. lol.
Drinking today is a little different than pre-NAL. It's almost like I am drinking more out of habit and not from addiction. For many years I've known that I was addicted to AL similar to the way I was addicted to Nicotine. (I stopped the smokes 3.5 years ago and haven't had one since) Sometimes I get a slight feeling that I could stop drinking right now and have no more tonight ... but then I get another signal from my body that says I have to keep drinking until I cant keep my eyes open. If I'm lucky I will make it to bed before falling asleep.
I suppose the best thing to do is follow the rules ... take NAL one hour before drinking and drink as I normally would.

This is pretty common. Don't let your spike in drinking worry you. Most people experience spikes and valleys in their drinking levels as they progress through TSM treatment.

You are doing fine. Keep following the golden rule and set your sights 5-6 months out. The most difficult part of this treatment is staying positive and being patient. It is so easy to get down on yourself and question TSM. 3+ months into my treatment, I had a couple bad weeks (back sliding) and remember thinking that any gains I'd made were just me wanting it to work and that TSM was just wishful thinking. A few weeks later, my craving dropped significantly like someone flipped a switch.

There is no doubt, TSM does work!

Q

I am convinced that those big spikes are when the biggest relearning is taking place. The brain fights back against TSM, no doubt. Banging our head against that brick wall used to work, but it doesn't seem to be working now, so let's bang harder - something like that. I have used the analogy of learning to play guitar before: the greatest breakthroughs often happen after a period of frustration. Your muscle memory has to learn that what you have been doing is not working, but it it hard to look to that big reward when the small reward systems are still in place.

To go further with the guitar analogy, you may have a certain lick that sounds pretty cool, but you have played it a thousand times, and you would like to move on to something that breaks new ground. You tell yourself that you cannot play that lick anymore (like the denial of the pleasure pathway that Nal enables.). The stubborn fingers find themselves wanting to play that lick over and over again, but you persist in trying new ideas.

For a time your fingers may stumble, and you might feel like your creative days are behind you. Guitar playing might even begin to feel stale, like the fun has just completely gone out of it. But if you persist, sometimes maybe through the rote playing of scales ( or the rote following of TSM) you will reach a breakthrough point, where suddenly your fingers begin to fly in new and unexpected ways, and you begin to fall in love with playing guitar again. It is a feeling of excitement that is hard to describe, yet I'm sure every musician and artist knows what I am talking about.

I have found that the unlearning of alcohol pleasure works the same way: sometimes I just feel like drinking 100 beers (playing that lick), but in that time of frustration, the learning, or unlearning is going on behind the scenes. When I wake up, dry mouthed and beginning to lose faith, I find that my brain has been working overtime to find a new way; a way that will soon be revealed to me if I just follow the formula:

Take Nal, wait 1 hour, drink (don't worry too much about the result). Repeat.

Given that I've just experienced my biggest week since I started TSM, I am definitely going on some major faith. But I have also been at this long enough to know how it works, and I can tell you that my finger are about to start flying!

Believe me, beautiful music is just around the corner for all of us.

Great analogy FB and I completely agree. No matter how you conceptualize it, there is a typically a honeymoon and then The Beast comes back, says "Hell no" and you drink more enthusiastically than before... It happened to me but I'm back to reduced cravings and more control. Just follow the formula, it works!

While it is nice to think these bad days are when the real gains are taking place, I don't think this is really what is going on. The real gains take place the more times one drinks on NAL. All these heavy drinking days are doing is giving you a bad hangover the next day.

From what Dr. Sinclair and Dr. Eskapa have stated, drinking your brains out on a given day isn't going to speed up extinction. As a binge drinker, I had a really hard time stopping until I'd consumed 15 or so units in a session. If I could have stopped at 6-8 units, I'd have gotten all of the benefits of extinction that day and would have avoided a nasty hang over the next day.

Q