I have learned to stay sober for 3-4 months, but then it just "hits" me that I want to drink. Unfortunately, during those drinking sessions they a horrible! They turn into a 3-4 day 27/7 drinking binge. I am afraid to pick up a drink in order to use the medicine. And if I only drink every 3-4 months, will it even work? My goal is abstinence. Thanks for the guidance.

As you await a reply from Dr. Eskapa, you might want to do a search of the board for "Alcohol Deprivation Effect".

Edit: I did a search and came up with this. Eskapa referred the question to Sinclair and posted Sinclair's response. This MAY actually answer your question, indirectly. Hope this helps.

viewtopic.php?f=15&t=481&p=5500&hilit=alcohol+deprivation+effect&sid=d0ab4b87c310d7869821c3b661b80067#p5500

I'm amazed how in my case the Naltrexone manages to keep The Beast in its cage, but I'm new to this. At the very least I'd want to have some Naltrexone around, and keep it on my person; hopefully the next time it "hits you" (I know the feeling) you'll have an hour window to take a naltrexone first.

This is not a recommendation that you do anything, but when mine came in the mail, I was in a pretty jittery between-binge state and didn't want to drink (the previous had been really, really bad), mine were more like 2 weeks apart and one night long. I set aside some time and drank anyway, in the safety of my home, to see if this was going to have any effect at all. The Beast slept through. I had 3 drinks, not 12, and woke up without a hangover. It seemed like the Naltrexone immediately brought back the old ability to put the brakes on. I spent the evening drinking and reading posts on this website, which was a good way to spend the time. Two more drinking incidents have passed without catastrophe since then. I am feeling a lot less freefloating panic, I think this is going to work, but I'm taking it one Naltrexone at a time

Again, I don't recommend you do anything, this is just one data point (mine) I'm giving you.

-Ned

Good luck kkae - we have totally differrent drinking routines, but I welcome you here and hope you find the answer to your questions. Hope this works for you. Are you in a 12-step/AA program and falling off the wagon-type thing? Just wondering...going 3-4 months is pretty awesome, but of course, the bingeing counteracts that, I suppose.

Good luck and wishing you all the best! Keep us posted -

Thanks everyone. Perhaps, this will be another tool in my arsenal against this ravenous disease that I've been battled for so manner years. Attended AA for several years, then on to WFS; amino acid supplements; etc. etc. I am anxious to hear Dr. Espaka's response. Thanks, too, for the link on the previously related post. That was helpful!

The Alcohol Deprivation Effect (ADE) first described by Sinclair three decades ago is now widely accepted in the alcohol and addiction field. Deprivation effects apply to a wide range of compulsive behaviors (e.g. gambling) and compulsive alcohol and substance use. This is explained in the book The Cure for Alcoholism - see http://www.thecureforalcoholism.com .

The ADE accounts for why it is possible for alcoholics to remain abstinent for weeks at a time - 3 months seems around the point where relapse often happens as the biology (opioid receptors and system) drives the craving forward. All it takes is one drink, one stimulus to gamble, one trigger and the already addicted person has no control over the behavior. The ADE means that the longer you deprive the addicted individual the great the craving and it explains why binging happens with just one drink even if you have been abstinent for months or even years.

It is very likely that most alcoholics are genetically predisposed (through the mutation on the mu opioid receptor - which can be tested, though not commercially available just yet)** to learning the addiction and that most of them will be protected from going on a 'bender' if they take naltrexone before they have that first drink. It is a practical matter - you have to carry the naltrexone with you at all times even if you are consciously trying to be abstinent. One can aim for abstinence - that is an excellent and healthy choice - but the addiction is not rational and operates at primitive brain levels. So if you find yourself abstinent and managing that is a positive thing. If you find that yourself about to drink again or have even already just had that first drink that leads to a binge take your naltrexone immediately as prescribed - preferably of course before you do the drinking. The medication will block the opioid system in your brain and usually 'first drink effects' - which are powerful triggers in the already addicted to carry on drinking .... Of course a single drinking session on naltrexone will not reverse the addiction. But the naltrexone may help prevent a bad episode - it may reduce the intensity of the drinking and help protect you. Just as it took many sessions to learn the addiction so it takes many sessions of drinking without reinforcement to the opioid system (on naltrexone while drinking) to unlearn - or eventually extinguish it. Sinclair coined the term pharmacological extinction because opioid antagonists are used to block reinforcement to the opioid system in the brain.

see also http://en.wikipedia.org/wiki/Sinclair_Method

** Dr Stephen Cox (Psychiatrist in Lexington, KY) is working on a simple mu opioid mutation DNA test that could make it possible to test by mail order.