I write the following not as a moderator, but as a member of the TSM community. In other words, my words should carry no more weight than any other members and everything I say here is just IMO -- "In My Opinion", for whatever it's worth.

As many of you know, I am a huge proponent of TSM. Five months ago before I started it, I was in crisis. I had never been to treatment, but the cycle of bingeing, crushing hangovers and a few occurrences of the DTs made me realize that my life was spiraling out of control and that disastrous consequences were clearly staring me in the face if I did not get control of my habit.

Back in May I was sizing up AA, in-patient treatment and out-patient treatment. I have health insurance but was absolutely appalled when I heard that the price tag for out-patient treatment -- i.e., AA meetings a couple of times a week -- would cost me ten grand a month, of which I'd be on the hook for 20%. At about that same time my mother, fully aware of my situation, sent me that New York Times article about naltrexone. When I saw that it involved continuous drinking, I was irritated with my mother for suggesting it, as I had resolved to quit drinking entirely as of late May.

In May I was reading every drunk book I could get my hands on. And that's when I stumbled onto "The Cure for Alcoholism" by Dr. Roy Eskapa at Barnes and Noble. I had never seen the words "cure" and "alcoholism" put together before and immediately dismissed the book as a snake oil sale. But then I looked a little closer and saw the word "naltrexone" in the preface; and since I had seen that word in the New York Times article, I instantly realized that maybe this book was legitimate. Standing right there in the aisle I read half of the book as I could not put it down. It all made total sense to me and an overwhelming sense of hope was gradually coming over me, as I sped through the book, page by page.

Naltrexone benefited me immediately. I had the "honeymoon effect" and for the first time in decades, I could have one drink and not even think about having another. It felt like a miracle. Almost immediately, I drank a lot less and even when I got drunk, I would no longer act like the asshole I had become for the past several years while drinking heavily. Another miracle.

Five months later, if I had not read Eskapa's book from cover to cover twice, I would have absolutely nothing negative to say about TSM as it is clearly saving my life and has been since the day I popped my first pill. However, the book told me that there was an 80% chance that in three to four months I'd have little interest in alcohol. That's what the studies in the book indicate anyway, and Dr. Roy's book is really just a summary of the studies. The graphs in the book show that for those drinking 35 per week, the typical cure period is three to four months, minimum. However, these same graphs say nothing about how long these subjects had been abusing alcohol, a factor that I personally think is critical in assessing the length of time it will take for TSM to work. The book also says nothing about how long it would take for the vast majority of us on this board to get cured if we drink more than 35 per week. This is a glaring omission from the studies because the average pre-TSM habit on this board is more than 50 per week and for many of us, ranges well into the hundreds. I have a pedestrian knowledge of extinction theory. Based upon what I know, it stands to reason that the more you have been drinking and the longer you have been drinking, the longer it will take for extinction to occur. However, that theory is not discussed in the studies, or in Dr. Roy's book, leaving virtually all of us here entirely clueless about the answer to this absolutely critical issue.

About a month ago I was ready to declare myself "cured." In retrospect, I'm glad I did not. Recently my drinking -- due to some personal triggers -- has spiked. And during this time I was not craving to drink -- I just wanted to drink. And since the book makes it clear that having success while on TSM should be "effortless", I have made almost no effort to reduce my consumption during my recent spike.

There has been a lot of discussion on this board about drinking from "habit" or drinking from "craving." It is a very thin line. I didn't have to drink like the town drunk during this past week -- I had an urge, but it was manageable. But I drank like a fish anyway, rationalizing it and justifying it by the fact that I am supposed to drink when triggered. But I didn't have to drink and I will not be making the same mistake from this point forward.

At five months into the program TSM has given me the choice to drink or not to drink when the thought of alcohol comes into my head. That to me is proof positive that TSM works. However, this is not exactly "the cure" as advertised by Eskapa's book and Sinclair's research findings. Indeed, the vast majority of us on this board have seen a lot of improvement -- some more than others. Some of us, a small minority, are several months in with little to show for it. It tugs at my heart when I read your stories and all I can say is that I hope that time will change things for the better and that you will see some success. But we do know that TSM doesn't work for everybody and if the studies are accurate, about 20% of us are out of luck with this method. (Please don't give up -- there are other methods. Try every one of them before conceding yourself to an excruciatingly painful life, capped by a tragic death.)

After five months I have concluded that the word "cure" may not be applicable to me, or for almost all of us on this board. Rather, "gaining control over our addiction" would be a better description and may be the best that we can hope for -- which is still a miracle considering where we all came from. IMO, even after great success with TSM, it is still there, our addiction -- or a smaller vestige of it -- lurking in the background and I doubt that there will ever be a time in my life where I will not be susceptible to drinking like a fish if the right trigger comes my way. I think of it like this: consider the person who suffers a nervous breakdown. That person gets better through time and perhaps the benefit of a good therapist. But is that person entirely "cured" of their underlying issue? Probably not. If faced with certain life stressors in the future, that person, absent the proper support network, is a good candidate to have another nervous breakdown, if the correct protective measures are not taken. I believe that the vast majority of those "cured" by TSM will fall into this same boat.

I always speak my mind to a fault. After five months I am grateful to Dr. Roy's book for giving me my life back. But through no fault of Dr. Roy, the book is setting many of us up for possible failure with conclusions that simply are not reflected by the vast majority of us on this board. I have seen only a handful of people on this board who after a mere three to four months can simply "take or leave" alcohol. Bob would be the closest to the ideal, but he is definitely not typical of the type of success we have seen firsthand. AJ is another who comes to mind off the top of my head. However, more typically it's folks like Firebird, SpringerRider and several others who are reporting that even after declaring themselves "cured", they have to watch themselves in order to make sure that they do not slip back into prior bad habits. Thanks to TSM, they are equipped to make the right choice. But based upon my own experience and what I'm seeing on this board, it is not effortless and takes a lot longer than three to four months.

The book reports the ongoing benefits of TSM for up to three years. I am still holding out hope that the vast majority of us will see major results in that broader time frame. But the promise of an effortless cure for 80% after three to four months is highly unrealistic, based upon what I'm seeing from all of us here -- the true TSM pioneers. The bottom line from my perspective is that TSM works, but it's not the panacea it is depicted to be in the book. I think it's critically important to recognize this fact, in order to prevent people from having falsely high expectations that in a mere three to four months they can take or leave alcohol with zero effort. I think the real world may be a lot more complicated than that.

As a footnote to the above, I would like to add the following thought. There has been a lot of discussion on this board about why we aren't seeing results sooner. A bad batch of naltrexone? An incorrect dosage? The answer to the question may very well be none of the above. The answer may just be that the method takes a lot longer and requires more effort than advertised in the book.

Thanks for the 'mind speak' Nick.

I'm in weak 8. It's too early to tell. I am not on my home PC now so I don't have my chart & numbers handy, but it of late appears that it's working.

However, in the past few days I got curious about a bottle of something new on the market & have imbibed more than I have in the past week. But the big difference is the about of standard drinks. Much less. I have had a lot of horrible hangovers lately and this may be a dangerous experiment, but I cut to 25mg Nal & the desire doesn't seem to be any difference and I still fall asleep after the 3rd or 4th drink. I will go back to 50mg next time I drink. I read here on the board that 25mg=6 hours; 50=12 & 100=24. I don't know that to be fact.

As far as craving vs. habit? Hmmm vs discipline!? I feel like I'm on the edge of 'hey, just step up my resolve a little bit and dont' drink unless I really want to' seems more habit than crave.

In regard to how much & how long we drank...no stance here...could be a factor just as much as it is not. I suppose time will tell. I do know the way I drank from age 12-23 & age 49-54(present) was pretty much the same.

My wife asked me this morning if I had a hangover and I didn't. But I did have 100ml rum & 24 oz 5.2% beer. She left the bed for the couch because I stunk real strong. She asked why I drank last night? I said 'I dunno'. It was the truth. She doesn't know anything about TSM or my 8 weeks yet. I am waiting for the book in the mail. I want to screen the book & then introduce her to it, this board & my charts. We met in AA in 1989 with 10 years sobriety & kept going to meetings until 1999 when we got into a church. Then as that got weird I started drinking in April of 2003. She's now 30 years sober. I am not an ass when I drink, she actually thinks I cute and adorable because I do no harm.

So I do believe we are all an experiment of one.

As per usual, Nick and Xajere, your posts are quite thoughtful...

When I grabbed my book, you don't know how excited I was...not to dampen anyone's excitement as its a great read. However, to Nick's point, it's not quite the panacea that the good Dr. would make it to be. The stories are all storybook, Cinderella.

When I sold this program to the Mrs., I honestly believed it and said "I know it sounds too good to be true....but scientifically it makes sense". Well as many of you know, in week 7 or 8 I blacked out and tried grabbing her forcefully as she drove.

As I stated in counseling about the spike etc etc etc...She was thinking it was the medication. I had to explain to her that was a case of assholianism brought on by alcoholism not the meds. I was deeply ashamed and pissed off at TSM at the next day.

But recently some of you pioneer types started talking about a little self control. This is where I think the good Dr. Roy could do himself a favor and revise his book (and subsidize a better board for us with his millions,..with chat and a lounge and gaming for you gamers,..and all expenses paid for a conference and and ...ahhh I digress) to include a chapter about this very issue and those of us that have drunk more than 5 drinks a day? Are you kidding...at times we may be drinking 5 drinks an hour...(eyes rolling)....

Let me state as well though,...I was up all night last night working in my studio,..practicing. This has not happened in years. I drank yes, 1/2 to 3/4 bottle wine and 2 beers, and at the end of the night early morning (around 5.30 AM) I had about 4-5 ounces of vodka to help sleep. I tried to think it through but hte thought of being up was too overwhelming and I needed sleep to function today. (More my decision still though not the booze)

I say that because TSM is working for me in some respects. Will it work in time to save my marriage, I pray,...but it may not. I state that aloud so as to protect myself from the sudden onslaught of emotions if it is the case that we should part. I want to continue on my healthy path. Not self destruct and continue working out and being as happy as i can be....

So my 2 cents trying to keep it "Real" Estate (I flunked my real estate exam attempting to get out of music)......Best friends,...I anxiously await further posts to this thread, Jim

Ah, Nick!

Your post is a real gem and I can't wait to give it the attention that it deserves. Translate that to mean - tomorrow.

My best.

V.

I have to agree with Nick and X and Jim. The book is an excellent read and is scientifically believable, although TSM seems somewhat counter-intuitive. Outsiders have criticized this approach, feeling that we found yet another excuse to drink this time under the guise of treatment. Of course, nothing could be further from the truth. Although those close to us may disagree, it is we ourselves who have suffered the most with our malady. We sought and found a solution that appeared workable.

But the cure as presented in the book appears to be an over-simplification of reality, although I still must admit that it worked in my case. The durations to extinction are obviously longer. The decline in drinking levels is not a classic exponential decay extinction curve. Most of us experienced a honeymoon effect, something not addressed in the book. There seems to be a plateau after the honeymoon effect that moves further and further away from an exponential decay curve until extinction occurs. Even when it declines down to the classic curve, there is no way of knowing what kind of week we'll have and thus we have spikes and valleys. Another effect that some have but not all is that alcoholic beverages taste awful to me now. I do not enjoy them at all. I don't think that's in the book either. Thus, I am not a social drinker because I don't want everybody to see that grimace on my face my wife sees every time I take a sip of what should be an enjoyable experience. I only drink now for anxiolytic effects when my meds fail me.

So the book got me where I want to be. I am no longer addicted (a term I strongly prefer rather than "cured"). If I had a non-addictive medication that could rid me of my chronic mania and anxiety as good as AL, I would probably never drink again. I have no reservations for having undergone this journey. I have a life now, thanks to Dr. Eskapa's book. I do think a book revision is advised to address high unit drinkers, drinkers with psychiatric conditions, and the success rate appears to be less than 80%, but is still much much greater than AA's rate of 5%. What is our real success rate? We will not be able to compute it since everything here is anecdotal in nature. Some folks just disappear from this forum (did it fail or did it work)?

One other observation, often when it is "time to drink" and I take my Naltrexone and wait the hour, I no longer want a drink, the desire is gone, the anxiety is gone. This effect is what got Naltrexone approved as an anti-craving drug in the first place. But it has nothing to do with extinction and is not addressed in the book. Often I force myself to drink so the Naltrexone has something to extinguish, but do I really need to do that? Maybe I should just skip the drink, if the Naltrexone does the trick.

Anyway, another long-winded rambling stream-of-consciousness post has come to a close. Summary: TSM worked for me but not how the book implied that it would. The book needs revision to account for us real-life examples with regard to the time frame and intensity of the drinking. Non-sinclair effects need to be acknowledged as well (honeymoon effect, loss of interest in drinking after a dose).

My observations for what it's worth.

Bob

Nick

Thank you sincerely for yet another thought provoking post.

Very thought provoking post Nick.
I have a confession- I have never gotten around to reading the BOOK! So may'be my expectations were less fixed. Knowing a little about neuroscience the little i read about TSM seemed to make sense to me and was worth giving a try. I have taken all my info from this site and am grateful to all the useful info people have posted here.
It would be interesting to hear from Dr Eskapa or more particularly Dr Sinclair about the idea that the more people have drunk and the longer they have drunk has an impact on Naltrexone's effectiveness. Surely Dr Sinclair must have come across a wider range of drinkers over the years in Finland?
I suppose in my case my consumption prior to TSM was nearer the study level at 32 US units per week. Yet at 22 weeks i am still not quite there yet.
One of the things that strikes me is that without the information and support available on this board i imagine that many many people would have read the book, tried Nal and decided it wasn't going to work after 3-4 months.
I remember a while back there was a flurry of interest in publicising the potential of TSM in other quarters. Now given the vastly differing experience expressed by people on this site i would be much more hesitant.

Thanks SBS.

I agree and disagree with the last statement. On the one hand, given AA and its miserable 5% success rate and the fact that it is basically the only mainstream treatment being offered to 99% of the world, I still think that it is IMPERATIVE that any viable alternative method be given considerable national attention. TSM is definitely helping the vast majority of people on this board. With that being said, I agree that a wide-scale publicity tour that does not fully recognize that the three to four month cure period is not realistic for the vast majority who try it, could end up doing a lot more harm than good by establishing false expectations that will undermine the credibility of the method. Ideally, more and more people here will gain control over their addiction (I'm done with using the word "cure") and we can establish a more realistic timeline towards control. In fact, maybe that will be my new word for what we aspire to: "control" not "cure."

Just wanted to post this shortcut. One of the good responses by Dr. Sinclair.

viewtopic.php?f=15&t=481

Came across that the other night. About the book, I found it an easy read. Too easy. The examples were story like and not indicative of tens of thousands of examples. This is why I didn't take it to my physician. I believe a Dr. should be ecstatic about anything a patient can possibly do to get away from this addiction. Anyway, the book is not a very good example and needs to be revised. The concept and the proof in my life is more pertinent. Like my sister, a counselor, said "You'll be my clinical trial." I still appreciate this so much more than any 12 step program which I find to be miserable. Perhaps it is the numerous programs I have been in that is helping me along????

Just 2 cents for now.

$5 says you're gonna retract this thread within 3 months. Takers?

What you're going through falls right in line with addiction being a learned behavior and exactly in line with what Dr. Sinclair described as state specific learning. This is just another trigger that needs to be extinguished.