Melissa suggested I post notes from time to time. I am simultaneously ending my alcohol usage, which effort commenced (in regard to going AF) the day I nearly killed myself on a motorcycle. I am not sure my reflections are worth much to others, but I will attempt to tie them to the subjects of naltrexone and alcohol use.

To summarize the backstory, I experienced immediate, beneficial effects from nal last summer, and stopped drinking. Then I stopped taking nal. Then I resumed 'moderate-to-light' drinking. Then I was back on the freight train and doing at least a pint of whiskey, per night. I resumed nal six weeks ago, and decided to go AF on May 14. That night, sober, I high-sided an 1100 cc sport bike on a deserted airport runway (I have a house in the deep country); I do not know how I survived, except that I bounced first on my torso prior to bouncing off my head. I walked back to my hangar from the end of a runway, drove myself to the local hospital, which immediately ordered a helicopter to deliver me to an urban trauma center. The irony of this event, and its timing, was reinforced by a cop who (while I was being stabilized, pumped with narcotics, and having my head sewn up) kept entering the operating theater demanding a breath test. Net, I incurred at least 12 rib fractures, a hemothorax, pneumothorax, fractured clavicle, fractured scapula, fractured left orbit, and a concussion beneath a long gash across my skull. I was in the hospital for 10 days, with an IV drip of nonstop morphine, during which time I also had a titanium plate and some screws installed to reassemble my clavicle. The pain, and I have been injured and wounded more than most, is off the charts. I get vertigo and the room spins madly if I move awkwardly, such as trying to get out of bed. I live alone. My girlfriend lives in DC and overseas. I have lost 12 pounds in two weeks. If my ribs do not improve I'll have to have several of them fixed with more metal and screws.

So as I write this tonight I am 15 days AF. I have no cravings for anything but the companionship of the farm tavern I used to frequent, and the bustling joy of Adams Morgan lounges in DC. I have six medications, two of which are painkillers and one of which is an addictive narcotic. I drove my truck for the first time tonight, and was fine, but nearly passed out waiting for my refills at the pharmacy yesterday. It's a small town and the whispers have already started about me.

I have been outspoken in our forums about the role of choice in my view of cleaning up; now I get to see if I have the backbone to walk my own talk. While I dislike almost everything alcohol did to me, I am comfortable saying as well that the only drinking in my lifetime, that I did not enjoy, was the drinking I did an hour after 50 mg of nal. My brother, who flew in from Germany to look after me for a few days, and whom I haven't seen in five years, is recovering from a breakdown and suicide attempt; it now appears that he drinks as much as ever. (Mental illness defines my family, with three of six sporting long hospitalizations and chronic illnesses.) It would seem that I am taking care of him at least as much as the converse. May, for me, has been a month of unpleasant ironies.

My work tends to isolate a man (some of it being work that one doesn't discuss) and this evening I am feeling that isolation. I am unable to even open a pill bottle without pain, so I am unable to distract myself with the gardening, or shop activity, or long walks that otherwise would displace nightly drinking activity. It hurts to type this or hold a novel. I can't sit comfortably for more than a few minutes. The painkillers work well enough to allow me to make coffee but not handle a cast iron skillet. I believe that a lifetime of rationalizing drink and pursuing achievement have left me at this crossroads. I found myself rationalizing a quick glass of wine an hour ago. My hands need to be busy but I need help to button my jeans; there's not much my hands can do. Tonight I fabricated a requirement to visit the supermarket, visited, drove past the neon lights of the taverns, and 'rest' now in a lounger. There will be no drinking tonight, again, but I need to improve quickly so that I am not an ambidextrous victim of my own choices: ambidextrous in that I could very easily begin drinking again, stirring the glasses with hydrocodone, and slowly (and probably quite comfortably) completing my own destruction.

Again, I'm not sure my commentary is worth anything to TSM adherents, but I offer a few observations:

a. there is no viable life that is not an observed life. It is the tension between the hindbrain and its appetites, the hippocampus with its enlaid habits, and my rational side that wishes to choose health and achieve it, that is the high-tension wire I traverse (with no safety net).

b. I'm sure the years of drinking damaged my reflexes and mechanical skill, so that I wrecked a bike after 40 years of riding, for no apparent reason.

c. I am here because I want to live. Just as, apparently, I had a rote response to get up off the concrete, walk .7 miles to my truck, and drive the five miles to the hospital room. I have no idea how I did that. Yet I have pursued and ensured premature death in work and play for two decades. There's probably no future if I cannot reconcile my desire to live with my skill at self-sabotage.

d. My submission to alcohol for so many years is mimicked in other, more insidious submissions and failures, creating more impetus to destroy another day in the delight of unself-consciousness. I cannot separate the failure to manage alcohol from my failure, say, to better manage my professional and personal relationships. A lazy mind here indicates a slothful mind there.

I am not taking naltexone now, and I have less interest in taking it than I do alcohol. My goal is complete abstinence. I wish to relegate alcohol to a hazy distant memory carrying no emotional weight. And it's probably now or never.

My brother just came downstairs, after falling asleep in late afternoon. He poured himself some chardonnay and returned to bed. The chilled wine rests in the refrigerator, two rooms away. All is silent. Three more hours, I say to myself, before my next pill-drop. Breaking up with alcohol offers only future benefit, and few in the present moment; drinking makes the present delightful and the future an easily-ignored abstraction.

BV It sounds rough. A few comments from me...

**In my experience working with hordes of ill people, cravings for addictions are a sign of health. In the hospital, while ill, smokers almost invariably say they lost their cravings and are going to quit; drinkers do the same. Once you regain your health (and recover from your brush with death), you're likely to be flooded with some super-intense cravings for alcohol. Just something to prepare for...

**And, what's the deal with pain meds and Naltrexone? I assume you are going to have to wean yourself off pain pills until you could ever even take a Naltrexone.

**For someone reading both your and my story, they're likely to ask, Why don't they just take the Naltrexone and drink since it seems to work so well for them? You certainly had a strange approach to it all -- I recall you "forcing" yourself to drink after taking Naltrexone, even though you didn't get pleasure. Are you totally done with Naltrexone -- such that it's now a do-or-die attempt to stay sober?

**Just a word of encouragement. I did the same pattern: Used Nal successfully -- Got off Nal and began binge drinking again -- stopped by will power alone. I've NEVER experienced the freedom from alcohol that I have now. A tiny longing here and there for alcohol-related activities (e.g. talking with friends outside, beach bar,etc...), but really not so much for the actual alcohol. It very well may be that when you regain health, you truly will not crave alcohol and will have a new inner-strength you didn't have before.

I'm not quite ready to declare an attempted "alcohol free year" (a long-standing 'dream' of mine), but seriously considering it.

Agreed, Barry, I'm sure that when I can sit up again without the room spinning from the pain, I will have that hindbrain beast cheering me on, saying, "Now's the time to celebrate, big guy, you haven't had a drink in three months, reward yourself!"

My deal is achieving personal sovereignty, which includes self-conquest. And that means functioning without crutches, canes, pills and hooch. So I don't just want to be free of pain pills, I want to be arrogant in my freedom from alcohol and hence nal. This is the only visualization of my former and future self that I value.

My view of your situation resembles that of mine: I think we both love the bonhomie of the casual, boundary-free indulger of alcohol: think of any charming rogue we see in the movies, packing a flask and a portfolio of anecdotes, jokes and good cheer, trailed by women who fall for a rule-breaking man who flouts convention. For some, alcohol creates a faux-buzz of charismatic personality, which is a side of myself that is normally parked in the closet as I make my way carefully and skeptically and quietly through life. But it is clearly a false idol, that personality, and it probably stopped being true, if it ever was, sometime in college.

I really have no idea why I had that accident, if it was an accident (I don't really think it was). I do know that I'm lucky not to be an enigmatic statistic -- a guy who died for no apparent reason, embarrassing his friends, children, and colleagues. The only lesson I can draw is that there won't be any more lessons, just obliteration. I have run out of things to sacrifice to my self-medicating habits. Much as I love the "don't touch me zone" that a good alcohol jolt provides, I've arrived at a juncture in the road that says "No through traffic." It's time to backtrack and plot a path that requires, and is fueled by, a constructive sobriety.

It's also the only way I'll have viable relationships, it seems. I have been everyone's provider and provisioner for so long that they can't imagine a version of me that isn't. Even my little brother, who flew over this week from Germany to "help", can't see the broken me from the lifelong unbreakable me (he defers to me, and it's even reflected in how he behaves in the house: *I'm* doing the cooking and making all the plans).

Summing, I think that when someone like us states that he has "problems with alcohol" he is just promoting another self-deception. The deception promises recidivism because we are assigning existential issues to a substance-abuse box: blaming one's issues on alcohol is a bit like blaming chemo because one has cancer. It sucks that I will have to next manage opiate withdrawal with one hand while stiff-arming alcohol with the other. But no one else drove me to this point in space and time, and there isn't any logic tree to analyze: it's time to get clean in all ways, or give it up.

Thanks for commenting, Barry.

From what I've seen, unless you're prone to narcotic addiction, weaning from pain pills is relatively easy since you can just taper off over several weeks. 10mg this week, 7.5 next week, 5 next week, until you get to zero. And there are all sorts of ancillary meds to help with side effects -- Ativan, etc...

I think you'll do good. Remember "freedom from" alcohol = "freedom to" do other thinks that weren't really possible before. "Not drinking" is not really an activity, but a lack thereof. I like the Hindu ideal of old age (you know, the last few decades of life) being a time of simplicity, meditation, and asceticism. Spiritual and philosophical pursuits are what I'm aiming for. I'd personally love to do a month long Zen retreat, or spend a month in a Trappist monastery -- I'm figuring that's what life's going to be like when I'm approaching 60 or so and am free from direct child rearing and constantly gaming my wife for sex.

bv,

cheering for ya, mate. thanks for the insight into what's going on for you.


callum

I've seen that charming rogue you speak of on TV and in the movies, but that rogue in real life never seems charming.

I know that, because there was at least a few times I thought I was that witty, clever, scallawag.

How stupid is that!

It doesn't even have to be that dramatic. On how many sitcoms do the characters spend many happy hours in their favorite bar? [Answer: lots] Everyone's drunk, everyone's having a great time, and the worst possible consequence is a funny hangover.

I wish I could be like those people . . . but I can't, because nobody can. They aren't real. I can no more be like them than I can be like Harry Dresden the wizard. That life just doesn't exist in the real world. Real people who spend every night in a bar are pretty sad cases.

So we're at day 19 AF. I'm now an alert human instead of a human plotting his first hit before finishing my first pot of coffee. One of the things I'm most embarrassed about (being a perpetually-aspiring intellectual) is how an alcohol habit overwhelms thought. We often affirm alcohol's value in eliminating for a few hours self-awareness. But in my case alcohol destroys both time-awareness as well as any day-following-day continuity of thought. As Barry notes with some insightful precision, "not drinking" is not an activity. It is a divergence, and it is a beneficial divergence in which one recalls yesterday's ideas, today's plans, tomorrow's aspirations. All three are wiped out with a nightly (or daily) cloud of Liquid Numb.

As I mentioned, my brother flew over from Germany to look after me for a few days. (I'm still in a state that causes the room to spin wildly, if I sit up or lie down, and my chest cavity has to resettle, and I still see stars if I so much as hiccup.) My family has been, essentially, destroyed by its own history and management of mental illness, and we are unable to spend time together without inadvertently replaying and reliving our early days, when my mother and her schizophrenia controlled the household. In this toxic context, I am usually the target of both my mother's, and my siblings', anger; I have always been the vessel to which their rages (both reactive and medical) go to rest. The first few days he was here, my brother again (out of habit, I should say), went victim on me, and I was treated to his monologues on his illnesses, our father's refusal to protect us when young, his passivity (asking me what I was offering him -- one-handed -- for dinner and the like). He was sleepwalking each night, and frightened me each night because anger is the current he swims in when uninhibited, and he didn't know where he was or that I am injured. He broke my bedside lamp one night as he raged at me in his sleep and I had to fend him off with one arm. He also made numerous severe errors driving, as though my very presence reduced him to his eight-year-old self again. I admit to being afraid that one more punch to my torso now (I have multiple lung punctures) could be fatal.

I'm quite sure that had I been drinking I would have exploded in anger at the ridiculousness of his flying 5000 miles in order to have me take care of him, terrorize me in his sleep, and drone on endlessly about the unfairness of his life. I'm sure I would have asked him to leave, for I was fighting that impulse, even sober. I did withdraw to my room on day three of his visit, closing the door for eight hours, fighting not to react. I then, however, was able to sit with him for a few moments and say, "I need your help, and I cannot help you this trip except to provide a few days of reticent brotherly love. Please help me." Drunk, I would have simply raged at his contradictions and selfishness, thoroughly shaming him. He would have immediately packed his things and departed. And I know I wouldn't have seen or heard from him for years, as a result, for this has been our pattern for the past 20 years. Sober, I reached a new equilibrium with him, and he has been a quiet friend the past two days, and made me coffee and prepared our simple meals, and taken a few shuffling walks around the neighborhood and the lakeside park.

Despite the narcotics, therefore, I am more sentient than when "healthy" and practicing the functional alcoholic lifestyle; I am more in command of my emotions, as well, and can intellectualize our past instead of fighting and reliving it. I don't need my checklists each day to remember what I have to do, and I carry thoughts from day-to-day without benefit of my journals. While alcohol is wonderful for dulling acuity, it is also wonderful for enhancing a beneficial acuity.

Last night, alone in the midnight hour (brother had gone to bed) in my living room, I thought how fine a glass of riesling would be, knowing that there remained several bottles in the kitchen that I had purchased for my guest. (My brother is both medicated and a bottle-or-two a night guy.) I had spent the evening bingeing on a serial cable drama (Deadwood), trying to understand what I view as a new dramatic form (the serialized movie: I view them as, say, 16 hour movies). I want to rewrite a play I wrote long ago, the star of which has turned into an Oscar-winning actor who once said he would produce the play as a movie. I, for a few hours, then, was the man I always thought I would be: the quiet man alone with words and an abstraction, while the world slept.

But also, at midnight, I walked to the kitchen and pulled a bottle of riesling from the fridge, examining myself as though from on high: I watched myself lie and say, I can have one cool glass of this wine, it means nothing as regards my future and future consumption, I 'deserve' a simple reward for managing the emotional chaos of my family and my brother's presence, I 'deserve' a good high as I have withstood the debilitating pain of the past two weeks plus. When I observe myself in this way I even observe the hindbrain usurpation of my own reason, for I know that there is never going to be one anecdotal drink, and I have often taken it knowing -- observing -- the reality of that lie. I put the bottle back unopened. I rest now in a lounger in the living room, enjoying every note my brother plays on his french horn. I'm sure the same voice, tonight, will urge me to the kitchen once I am alone with my thoughts.

***

Barry, thanks for the notes on narcotic-weaning. The two times previously I have been on serious opiates were when I was overseas, and the withdrawal process was abrupt and immediate: I was hospitalized until I didn't need them, and then had the benefit of the long flight home and other change-of-scenery cues to cut off the habitual medication. There was some fidgeting but I quickly forgot them. Here the challenge will be effecting the same transition while inhabiting the same space. I suspect I will have to simply flush down the toilet the meds once I can function without them. I'm glad that they will be easier to reject than a whiskey habit. I too think I am entering a phase of life where I will have little patience for gaming anyone or anything. I will either do a better job of living within my head, or simply drinking myself into the river, not bothering, even, with an attempt to swim to the other side.

When the voices start making excuses, its time for nal plus a drink. It sucks (in addition to the rest) that you cant take nal at the moment either since you are on painkillers.

BTW, you know not to take nal on painkillers, right?