First let me premiss this by saying that yes I am an alcoholic. I am a 36 year old male who has been drinking steadily for the last 12 years. And while drinking over those 12 years I knew all along that I had a problem with alcohol, I was always able to hide my secret. Also, I am not sure why but the last 3 years had been the worst. I had been drinking very heavily (that was also when I made the switch from beer to vodka) Much more than all the other years in the past. Went to rehab twice in the last year and a half. After 2nd rehab went on Campral and Naltrexone with Abstinence and have been sober for almost 9 months now. I have the book and I know there is a statement that this program is not for people who are not currently drinking. My question is...why not? My biggest fear right now is that I have another relapse. And I figure that this program is my best bet to try and beat my alcoholism before is evetually beats me. That may not be in a couple months or even a couple years. But if I could follow this program and eventually get this beast off my back I would finally feel like a free man. Just looking for some of your thoughts on this. Thanks for your help.

Neaker

I too have wondered about this . If one is happily abstinent there'd be no need to do tsm . But short of that abstinence comes with all levels of discontent from occaisionl hankerings to all consuming fear of imanent drinking . An Alky will always want to drink even if they can impose abstinence . It seems arbitrary to say tsm is not for those who have stopped drinking , but in a way a barrier has to be placed arbitrarily ,( by who ? ) and each person just has to decide what they do with the barrier , stay behind it or smash it . At the end of the day you'll just have to decide
I don't think others can really help . Point is you say nine months abstinent , I think you should take a shrewd look at how bearble that has been especially right over the period especially last three months and then try to discount the obvious excitement that tsm hold out . Discount it because there's a part of you that would really like to drink and I'll bet that gets really quite excited at the thought of drinking again. The other part wants to be cured and without the desire to drink . Which of these two parts is motivating you most . If it's the desire to be rid of the desire
then the Neaker that wants to drink will go along for the ride and maybe disappointed because the desire will get extinguished .
Otherwise , remember that tsm won't work for say 22 percent of cases , but unless you know you are a "gabba alcoholic " how can you or anyone know if we're curable or not ?
If ever you do decide to drink again never do it without Naltrexone protection and make a commitment to follow tsm.
If you decide to remain abstinent , fear of relapse is something that needs to find a remedy . Personally I found Rational Recovery had excellent techniques to deal with this anxiety and put it in its place . Part of their website has free info .

There is a definite bias in the research towards the idea that extinction won't occur if you're not following your normal drinking habits. If you're attempting to maintain abstinence, then you are definitely not following your normal drinking habits, so it wouldn't be nearly as effective. I've seen this route taken by a few doctors and it's a fairly good route to take if you want to encourage long-term patient retention.

However, it isn't necessary to follow the entire process to the letter. Get yourself some naltrexone and start carrying a pill with you. Let it be your totem against drinking, like Sam Malone's lucky bottlecap in "Cheers". If you ever DO drink, the pill will keep your addiction from getting any worse, and it should prevent you from (oops!) accidentally winding up in the gutter three weeks later.

If you CAN stay abstinent and you're happy with the state, then it's a bad idea to risk the possibility that the technique won't work on you. If you happen to have a couple of months to kill and you think you can pick yourself up if the worst happens, then go for it.

But generally speaking, if you're tolerably abstinent then I'd personally recommend leaving TSM as a Plan B.

I feel for you. It's evident from your post that you're suffering the classic 'Alcohol Deprivation' that Dr. Eskapa describes so well in his book. Have you read the book? If not, I highly recommend you do so. Highly.

This syndrome is even apparent in addicted rats: remove the alcohol for a period of time, and their craving increases. When alcohol is reintroduced they drink more than ever. Their brains wiring demands it. . .and they (you/we) are powerless against it.

Now the good Doctor could not possibly advise you to go ahead and get Naltrexone, and get back to drinking. It would be unethical of him to say that to an abstaining alcoholic. But you nailed it: you are STILL an alcoholic, whether drinking or not. I concur with Robert: get yourself some Naltrexone so that if you relapse, you are immediately following The Sinclair Method, and have a plan for true, permanent recovery. You'll find that if you do so, your despair over drinking will not be nearly as great as it has been in the past.

My suggestion? Tell your doctor that you want the Nal to help fight cravings while abstinent. But don't take it until/unless you are overcome, and relapse.

One thing I would like to add to this. Definitely do not take naltrexone unless you intend to drink. The results of scores of tests demonstrate that naltrexone without drinking will only make things worse.

Hm... By what mechanism would naltrexone make anything worse if you didn't drink? I'm not buying it.

It isn't unusual to feel like a drink, take the Nal, and then decide you don't really feel like one after all.

I think in one of Dr. E's posts he said that was OK if we then didn't drink, but not to do it every day.

In this case, I'm talking about the rebound effect. The standard method of prescribing naltrexone for alcoholism involves giving them the pill, sometimes cocktailed with Antibuse, and telling the patient to not drink. If the person actually maintains the naltrexone with abstinence, then as soon as they go off the naltrexone they often rebound into heavy drinking. This is why naltrexone is in disrepute with most alcoholism specialists. There are lots of studies that say naltrexone makes alcoholism worse, and they all involve taking it to enforce abstinence.

So, right, Maribella. Taking your naltrexone habitually on days that you don't intend to drink (as part of TSM) is a good idea. Taking naltrexone when you never intend to drink is counterproductive.

Well thanks to those of you who have posted your opinions. They were exactly what I was looking for...someone else's ideas besides my own. I understand that Dr. Eskapa could not come on here and tell me it is ok for me to start this program after 9+ months of sobriety. I know this is a decision only I can make. and it is one I am still struggling with. But regardless of what I do I now have plenty of Naltrexone (just went to doctor) so I guess we will just have to see. And as far as motive goes deep down I think there are two main drivers here: 1) Yes I really do want this monkey finally off of my back. and 2) I would like nothing more than to be able to go out to dinner with my wife and enjoy a glass of wine... or meet a friend after work for a beer. Things like that are no longer realities in my life. And when I started to read how well people were doing on the program I knew that I could be one of the successful ones too. Thanks again for your comments.

Neaker

I also know no doctor is going to tell you to break for sobriety to try the method Neaker.

But I so understand your reasons for wanting to try it- although you are sober you feel you are missing out, that your life is incomplete, you will never feel entirely comfortable in social situations.

As you say it is your choice but if I were in your shoes, and I thought hard before writing this, I think I would try it.

Drinking for me these days just doesn't hold much enjoyment- it doesn't taste particularly nice and the effects are neither here or there. I miss the good nights out when I did enjoy a good drink with friends, but I so DON'T miss everything else that went with it- so I know I will probably never be entirely 'normal' but I can certainly live the the rest of my life very happily within these boundaries.

The great thing about it is the confidence I now feel around any social event- I know I can go, have a few drinks and that will be enough for me. I don't have to sit there completely bored to tears nursing an orange juice- but neither will I make a fool of myself or need to spend the following day sick in bed.