Personally, I believe the cold turkey scare is way overdone. True, it can be dangerous for some people but I've never experienced anything worse than about 2-3 days of feeling uncomfortable with some jitters, after which everything returns to normal. I have some friends who have cold turkeyed at times, one who drinks way far much more than I, and also no prob.

However, better safe than sorry. I realize that sudden withdrawal, depending on the individual, can cause DT's, seizures, permanent brain damage and even death. IMHO, that's very rare. It's a CYA kind of warning. So, to C my own A, I don't advise it except for myself.

Best,

Mike

I've been following Dr. Joesph Volpecilli's (MD, PhD) work with naltrexone, which he began in the 1980s and is separate and distinct from Dr. Sinclair's but with similar conclusions, with interest for several years but it wasn't until Dr. Eskapa's book that I took it upon myself to obtain a naltrexone script.

Here's a good summary of Volpecilli's work (and the rejection he initially faced), dating from 2001! :
http://www.upenn.edu/researchatpenn/article.php?483&soc

I found the following passage of special interest:

"...treatment over nine months rather than three months yielded better results. 'It's like the treatment of hypertension, diabetes, or asthma,' says Volpicelli. 'You stop the medication and people's symptoms come back. So it looks like alcoholism is like other chronic medical diseases in which you need long-term care as opposed to just going away for 30 days and expecting that people are going to get better.' "

Mike

Thanks for posting the link to Volpicelli's work. I read it all but don't remember a reference to continued alcohol use while on Nal...did I miss it? I was going to print this off for my doctor, and pharmacist, but without that "hook" it's value is lessened.

As far as I can tell, the article does not mention the issue of continued drinking on naltrexone. I believe that's Sinclair's singular contribution so far (which is exactly why this paradoxical and somewhat controversial method of using naltrexone is named after him).

The mainstream thinking is still that naltrexone should not be started for 7 days or so from the beginning of abstinence (wrongly fearing sudden withdrawal symptoms otherwise), combined with psychosocial intervention. If abstinence can't be maintained during treatment, harm reduction should be the goal, conventional wisdom says.

Volpecilli doesn't weigh in on either side as far as I can see. His studies simply show that naltrexone is a valuable and important part of reducing the reward from drinking. The article also mentions the effect of acomprosate in blocking rebound activity of the excitatory NMDA neurotransmitter system when alcohol leaves the system, and baclofen for supplanting depleted GABA levels. All pieces of puzzle that is slowly coming together.

Mike

I wonder if Eskapa in his book mentioned any cases showing progress only after the 6 month mark, like 8 or 9 months or longer. And if this may apply to long term heavy drinkers whom have not seen any progress in the usual 4-6 months period.

Eskapa's book references continued TSM benefits lasting up to three years on page 119, figure 8.