I'm a newbie here and wanted to find out what thoughts are on daily Naltrexone dosage vs. The Sinclair Method. I've been taking the medication daily for three months now and haven't had a drink in that time - and zero cravings - but I'm worried I may be shutting off other "highs" that are more natural, such as those that come from physical activity and whatnot.

Whigged -

You'll find that very concern well covered in "The Cure for Alcoholism" by Dr. Roy Eskapa.

That is indeed the core difference that sets TSM apart, taking the pill (an hour before you drink) only when the desire for alcohol actually moves you to drink, aka "The Golden Rule" or "The One Hour Rule". This not only teaches the part of the brain (that powerfully compels you to drink) that the pleasure from alcohol is missing, it allows you to replace the compulsion with healthier activities by using "Selective Extinction" to take advantage of the increased sensitivity of your opioid receptors on non-drinking days.

In study after study, taking Naltrexone daily while maintaining abstinence worked no better than placebo. Check out Chapter 3 of the book "The Hard Evidence Behind the Cure":

https://www.dropbox.com/s/60fs7gmvbyzs1 ... m.pdf?dl=0

Whigged,

I believe Angie was taking nal the same way before she started TSM. She did say she weened herself off the alcohol and then stopped the nal, but the cravings came back and she felt like she was white knuckling it. She has a progress page, and I believe she started a Facebook page as well. If you are interested on her input on the subject maybe reach out to her. Even though everyones experience is different with TSM and alcohol, it is nice to talk to someone that has been in the same place.

I would never suggest for you to start drinking again because it sounds like your desires/cravings for alcohol are no longer an issue; however, if that changes you may want to be prepared. Get all of the information that you can to make a rational decision.

Taking a holiday or days off from the nal would not be an issue (IMO), but be prepared for that endorphin rush, and what would trigger you to drink could be stronger on those days off (especially since you have not extinct those triggers). If you do decide to take a holiday off the nal, and you find yourself thinking about drinking please take the nal! When/if you take that holiday keep the nal with you at all times and never leave home without it. Drinking when you are off the nal would be worse than taking the nal without drinking because of the up-regulation of the opioid receptors.

You have to know yourself, what your triggers are, and how strong your support system is to trust yourself without the nal. Since I have an alcohol problem I know that I lie to those around me and myself, not because I want to, but because it is the nature of the beast, so not taking the nal on those day would be an excuse to slip for me. I am not saying that is you, I am only sharing how I am. Know yourself and be honest.

Good luck,

Jaba

Jaba,
My ears must have been ringing. haha I haven't checked in here in a month or so and this was the first thread I read.

Whipped,
Jaba is correct. I didn't know about TSM when I first started so I was taking it to merely ween myself off alcohol safely. After weening myself off, I abstained for a month and during that time, I came across TSM. By then the ADE (Alcohol Deprivation Effect) had kicked in (craving and white knuckling) so I decided to continue on according to TSM. I started in December and was doing excellent, having a 1-2 drinks every 20-30 days until last month were I went non-compliant. BAD BAD BAD
BUT I'm back on track! ALWAYS follow the Golden Rule!!!

Yes, there is a closed FB group if you're interested. https://www.facebook.com/groups/livingalifeofchoice/
I think we're now at 130 members.

Thanks so much for everyone's reply! I think though my main question about Naltrexone is, are there any negatives to taking it daily as opposed to when I get cravings for alcohol? Other than the fact that it has to be taken everyday of course. Am I denying myself other endorphin rushes?

Naltrexone daily blocks ALL endorphins and is to be avoided in my opinion. Doing so with abstinence shows negligible results. To be clear when people begin TSM they are often taking it daily before a drink, but the aim is to have AF days as soon as possible so positive endorphin release can resume.

Whigged,

I think that is what my problem is and why I am not yet cured. I started out doing TSM, but then I started taking the nal without drinking once I thought I had control. I was doing fine and then the cravings came back. They are not as strong before TSM, but doing any more than 3 AF days was beginning to be difficult. Before taking nal daily I was at a point that I could do a month or more without drinking or thinking about it.

Everyone is different and this is a personal experience for everyone. I never felt the difference of endorphins on or off the nal, so I didn't think it mattered. I am an outlier, for I feel better on the nal than off. I suffer from a lot of headaches and body aches off the nal.

Do I think the same would happen to you, or your body would have the same reaction to the nal without drinking? Only time will tell. Does it matter? Only you can say.

A lot of people have opinions, and the studies that are out there are done a small groups and some a short time period. There is a research paper that lists the studies for comparison (if that makes sense). It is unbiased opinion of how the studies where done and the outcome; it just lists the facts. One thing it points out is taking nal and not drinking has no benefit at all, but some studies have come to the conclusion that drinking on the nal has no benefit (that study was a short time period). Some people have had great results using the vivitrol pellet (slow release nal) and there is a long term study on that (I think there is a link somewhere on this forum for that), but that is not considered TSM.

TSM is different for everyone. Nal responds differently to everyone. You will have to find what works for you. TSM is a great method for people that realize that without the nal they would be drinking themselves to death, and it is for life.

Most likely. Nal does block all endorphins for 24-72 hours after you take the pill. The only way that you could find out is by stopping the nal (without drinking of course) for three days and see how you feel. If you feel different, food tastes better, sex is better than it was before, you can get a rush from exercising, then you will know you are denying yourself of those endorphin. If you cannot last 3 days without cravings take the nal and drink, for it isn't worth white knuckling it to see if those endorphins will come.

When I started taking the daily I would take 3 days off, and I would have to say that I did feel the difference, but not like Sinclair states. Again, I am an outlier, for most people do feel that difference.

Again, you will need to find what works for you.

Jaba

Here is a link that Dr Eskapa answered this question: viewtopic.php?f=15&t=81&p=515#p515

Here is another one that explains it as well, this is a post by Dr. Eskapa from Sinclair: viewtopic.php?f=7&t=1942&p=22746#p22746

Sinclair's clinical trials even show that those who take Naltrexone daily often actually get worse results. The reason is because what you are doing is essentially the 'prison' treatment. When an alcoholic gets arrested and goes to prison for 5 years as soon as he gets out he has a drink and Boom! Right back at it again. It's also the same thing as AA. In other words you are trying to treat your alcoholism with abstinence and not the process of pharmaceutical extinction. Our opioidergic system is simply in waiting. You are not going through the process of reversed learning.

The theory behind TSM is that alcoholism is a learned behavior. Unfortunately for us we were born with the predisposition of being really fast and smart learners... Yay us! So going way far back to when you had your first drink at 9 or 10 or 15 years old that first drink triggered your first learning experience of how awesome it is to fill your brain full of endorphin. The evolutionary mechanism there has probably got something to do with learning in general. You know that 'feeling' you get for example when you are studying a new concept and you finally get it? Commonly referred to as the light bulb going off? Well that is probably an endorphin injection and that pleasure sense actually helps build physical connections in the brain, cells that join together to make a sort of neural highway to the memory banks of your brain so that you will now know and retain what it is you just learned.

Well after many many years of drinking and learning how to become a good addict you have built neural super highways in the brain and they don't just simply go away. That's what abstinence does. It just sort of leaves everything in place. But if you drink in accordance to TSM then what happens is that you take your drink and the opioidergic system kicks in. That is to say the alcohol molecules reach your central nervous system which 'rewards' you for drinking by sending out endorphin into the blood stream which goes very quickly to the brain. These little endorphin molecules are like little keys and they only fit in one lock and those locks are the opioid receptors and then the endorphin unlocks that then the brain triggers pleasure. It's the same mechanism that heroin works under. Only now under Naltrexone those receptors are blocked so the endorphin molecule just bounces off and keeps circulating around doing nothing.

As a result of that your brain gets kind of confused. It used to know that if you drank then it was rewarded only now something is different. So it very quickly starts to learn, or rather unlearn, that drinking this stuff is pleasurable and it literally starts to physically alter those neural networks. It's like sending in the highway wrecking crew and they demolish the road. When that starts to take place then simple things like a family member or friend who has a drink in front of you does not trigger a craving in you to drink. A beer sign on the highway no longer becomes a bother. Having no alcohol in the fridge at home is not a dire emergency, and so on.

The book does go into great detail about it and anyone doing TSM ought to read a copy.

Good luck!

I fully agree with Ocean and concur that reading the book is pretty important if you're doing TSM. by not taking Nal daily your brain WILL be less confused. good luck!