Now TSM has been used for some time it has become obvious, as Nick so often reminds us, that the 3-4 month time scale is way out and time frames for heavy drinkers (which many of us are) not addressed. However, I can’t get out of my head Mabelees Startling Discovery, which I think is now on page 5.

“It's just that I happened to notice that people's usage (from an EXTREMELY small sample size) seems to decrease at a rate of about one US unit per day per month, and because of that I want to encourage the heavier drinkers to keep pursuing the program, knowing that it might take significantly longer than 4 to 6 months. ’’

Of course this would be a very rough guide, if only because it is based on pre TSM numbers which, I imagine, are not very accurate and the formula is unproven.

My sons consumption which is 104 units (US) per week
1/7 x104 = 14.85
Fifteen months to cure??
Quite a time, but as this is the only indicator that he has, he will keep going and who knows, if he loses his addiction before this, how happy we will be. The thing is, this formula has given him what could be, realistic expectations.

He’s been doing TSM for about three months and although numbers are not much reduced I can see great changes in his behaviour (for the better!)

I was so pleased to see Mabelee back again. Thanks for your Startling Discovery. I think that you may have saved me from a lot of disappointment.

We have great faith in this method, so onward we go.

Nick,
As always an incredibly written, intuitive, and intelligent observation. I know you are a practicing attorney, but I think you should give serious thought to writing a book! You have such an observant, analytical mind and your posts always point my mind in another direction. I am also one of those who are not "cured" after 4 months -- on Week 27 and still waiting. Thanks for being a positive voice here.

Nick,
Once again, you cut to the chase for many of us here, especially us "old-timers". Yeah - what is the deal??!! What are we to measure ourselves against, hope for and expect?! Oddly, I was just thinking back tonight on the way home, as I was thinking about that cold chardonnay in the frig, wishing I WASN"T thinking about it, why I do, what about TSM...how long it's been, how many months now on 100mgs (3) and if it is EVER going to kick in. Thinking I will stay on 100 mgs til my 1 yr anniversary Feb 6th and then talk it over w/ my psychiatrist/drug dispenser...see what next.

UGH - I, too, remember so well going into Barnes & Noble last January to the self-help aisle, looking for something to help me deal, figure out, bring hope or answers to my life & my heavy drinking. So sick of it. When I found the book, I too, thought the whole premise was "selling snake oil" but I had NEVER heard of using medication to treat alcohol addiction. My real therapist (who I don't see anymore) is a total devotee of AA and not licensed to dispense meds, but still...what a disservice not to know of and suggest his clients seek medication of any kind! No - just stupid therapy. Ha ha - he was learning and getting more from me than the reverse!! tsk tsk

I was soooooooooo excited and hopeful when I started. This forum, meeting all you good people has changed my life...but alas, the use of Naltrexone has not. I never had the honeymoon period, never had any side effects. I have perhaps been drinking less just because I'm keeping count (mostly - have slacked off in the last few weeks). But really and truly, my feeling is, unless something radical happens, I am in the 20%. But you know what, while I was thinking about all this on the way home tonight, I also thought about something else. Perhaps, I may need more time and a higher dose. I will go with 100mgs until Feb., the 6 month mark and then talk about upping it again. Remember it's not dangerous until 300 mgs... so there is plenty of wiggle room.

I am not throwing in the towel. But sure, I feel discouraged sometimes. I have not done much of anything to cut back except take these pills and continue to drink..had episodes, but am keeping a journal and hoping should I die an untimely death, at least my loved ones will know I was TRYING...LOLish

It's really not enough. I am worried and sometimes disheartened at my lack of success, but I LIKE the idea of being a pioneer. Maybe that's it! Maybe we really are being the new frontier of unofficial successes on TSM. I hope so!! Wish the good Drs were more helpful and informative, but truth be told, as has been said, this is all new...to them too.

Thanks Nick, for addressing the questions and doubts out there so nicely again. Speaking to what so many of us have said all over the place. Again, I find great comfort, support, and hope logging on here. Wish I had time to address at other places, but it gets overwhelming sometimes. Don't know how you do it, but thanks so much for the help, support, and wisdom you offer here. It's appreciated very much! We WILL prevail and it WILL work - I just know it!!
The best thing is, this forum - everyone here, the talking, etc, so therapuetic! Thanks all -

XO

Hi 8,

I couldn't agree more. As you will probably be aware, I sent an e-mail to Dr Sinclair (with a copy to Dr Eskapa) exactly one week ago asking about this very issue. I've not had a reply, which I find disappointing. I will therefore chase a reply. I have to say that this is unusual. Perhaps, neither Dr Sinclair nor Dr Eskapa have been available over the last week.

V.

Or perhaps there have been insufficient documented studies which address the issues of how long a person has been drinking and how much a person has been drinking impacts the amount of time for extinction to occur. I have a feeling this is the answer to why we get no answer to this question. And if there are studies that conclude what the book implies, namely "that extinction occurs within three to four months for 80%, regardless of how long or how much a person has been drinking" then our experiences here would very much bring into question the legitimacy of those studies.

I am guessing that the answer is that these issues simply have not been specifically addressed in the studies, hence the crickets we are hearing in response to these questions.

Hi Folks,

Firstly, I invite you to check the figures that I present below.

I'm now confused as to why the time-to-cure on TSM is quoted as being three to four months (12 to 16 weeks). Referring once again to Figure 3 in The Cure for Alcoholism, I have extracted the following data:

Average drinks per week at outset = 37
Average drinks per week after 4.75 months (19 weeks) on TSM = 15
Average drinks per week after 7.5 months (30 weeks) on TSM = 12
Finally settling after 10.5 months (42 weeks) at 9 drinks per week.

Note: a month = 4 weeks, not a calendar month. It is my understanding that, although the data in Figure 3 were produced from a Finnish trial, 1 drink = 1 US unit.

Furthermore, after four months on TSM, the average consumption of the trial group had fallen by about 50%. So, in summary, a more realistic timescale for this (relatively low intake) group was time-to-cure[*] = 30 - 42 weeks, i.e. approximately twice as long as the four-month figure.

I've taken the data presented in Figure 3 and gone one stage further. But, I'm now heading into somewhat uncertain territory. However, should anyone feel inclined to do so with your own data, I postulate an equation that may define the exponential decay characteristic as seen in Figure 3 and others' graphs. The equation is:

n = N exp (-t/140) + c

where N = consumption at commencement of TSM
n = consumption at time t
t = number of days since starting TSM
c = an unkown constant

Yes, I know this is a bit ambitious and I may well be proven completely wrong - nothing ventured, nothing gained. I invite you to check it out.

V.

[*] I have defined time-to-cure as a 70% reduction in alcohol consumption, but this precise figure is open to debate.

google "NTXWPFinalPDF.pdf" to find this article--thanks corkit!

It's a good paper, and Dr. Sinclair was a contributer/reviewer. It doesn't address the age/length of addiction issue though.

"Only 2 of 14 RCTs to date have failed to demonstrate significantly favorable effects of naltrexone: Kranzler et al. 2000 and, most recently, Krystal et al. 2001.
Krystal and colleagues raised doubts about the utility of naltrexone in older patients with chronic, severe alcohol dependence. They studied a population of men averaging 49 years of age and 20 years of heavy drinking. However, their findings conflict with other RCTs, involving almost identical populations of older males with long drinking histories, which reported significantly favorable results for naltrexone in terms of relapse, frequency of drinking, and quantity of alcohol consumed (Morris et al. 2001; Oslin et al. 1997). A critical factor in the RCT by Krystal et al. was the adjunctive use of strictly abstinence-based therapy focusing on 12-step facilitation counseling. In prior research, this was not found to be effective in combination with naltrexone. Still, these researchers did observe that naltrexone treatment extended the time to relapse by nearly 70% and this might have been a significant benefit clinically. A survival analysis of the sort shown in Figure 2 was not reported."

There were also several flaws found in the Kranzler study which probably contributed to the lack of effect. You can read about them if you google the paper.

I thought twice about posting this, but here goes.

Many people here are ordering their Nal from online suppliers. Not every online supplier has, shall we say, a top reputation. Presumably the subjects of Sinclairs study were using the 'real thing'. Maybe some of the people here have been using 'lower grade' medication?
Also - do the studies in the book refer exclusively to 50mg/day of Nal? Was there any other 'weeding out' that took place in the subject selection that doesn't apply here?

I too am curious as to why the average consumption is 35 units - that strikes me as quite low for an average - I would have expected maybe 40-50 as an average (possibly higher).

Hi Folks,

As an addendum to my post above, isn't it interesting that the results from participants in the Finnish study (depicted in Figure 3 of the book) showed a final settling at 9 drinks/week, on average? Does that mean that [1] total extinction didn't occur or that [2] some people still enjoyed a drink but had zero cravings? I suspect the latter. BTW, this is why I added the '+ c' bit to my proposed equation; it simply allows for the fact that, even after many, many months on TSM, it may be that a few drinks are still being consumed.

V.

Good points AJ. I'm also applying effort to controlling my intake, not so much in grunting and straining every minute to keep from taking a drink, but more in mental exercises, such as savoring every moment of sobriety. I love to lie in bed for just a few minutes every time I wake up not hungover and just relish how good it feels to know my day is not totally fucked. Add self-hypnosis, meditation, a little mental toughness, visulisation, and such and you get the picture.

I was lured by the promise of a cure with virtually no effort on my part, but I have learned that every time I go chasing after a free lunch I end up hungry! But, TSM along with some of the techniques mentioned before - this seems to be working a lot better.

Interestingly, I've been trying to "cure" myself for years using "mind magic" alone and to no avail. TSM has turned out to be the missing ingredient for me.