Hey Boozer,

What everyone said is true. One hour before, and if no booze no drug. Day two if still no booze, no drug and do something enjoyable as Opiod upregulation will give you a greater sense of satisfaction because of temporarily having more receptors, hence giving the event an even greater satisfaction. Your pick the activity. You get more receptors I guess because they've been blocked and the brain tries making more to make up for not having them available (is that right board?)

We're finding that extinction hasn't happened doing enjoyable activities while on Naltrexone, and if sex for example (a big one talked about), was extinguished, it would come back after doing the activity off of Naltrexone, but nobody seems to have had any adverse effects in regards to that or rather activities we like.....Although I will say possibly muted has been my experience,,,,

Good luck to you, we all wish you the best, Jim

Why is naltrexone widely prescribed as an anti-craving med? Because that's what doctors have been told it is. Why is it popular? It can have anti-craving effect for the first few days or even weeks. We here refer to it as the honeymoon effect, because it wears off quickly as the body gets used to the drug and the real work of extinction is taking place in the brain on a level we cannot consciously feel. But it probably has a placebo effect and lasts longer if we are told it is an effective anti-craving med. Given that it works this way even for a short period, it is better than nearly everything else on the market. Every alcohol treatment is measured for effectiveness by the length of time the subject resumes drinking, as nearly all inevitably will. So both patients and doctors are conditioned to have very low expectations for a treatment.

When TSM, on the other hand, has been measured for long-term results, the opposite is true: patients actually continue to IMPROVE for diminished craving for as long as three years after the onset of treatment.

Campral was shown by the COMBINE study (the largest study of treatments for alcoholism, published in JAMA) to be pretty much worthless. But is remains wildly popular as an anti-craving med. Why? Its patent only just expired in July of this year, meaning it has been VERY profitable and so the pharmaceutical salespeople (the chief continuing ed source for many m.d.'s) pushed it.

Patents often are renewed by inventing a new formulation for a drug. The most frequent is a time-release formula. When naltrexone's patent expired, a time-release injection, lasting about 30 days, was patented as Vivitrol. It costs thousands of dollars per injection!!!! It is not bad for the first month or two of TSM, when most are still drinking pretty much every day. But you will read about selective extinction, done to reinforce positive activities, which requires two consecutive AF/nal-free days. This is an important component of TSM, and not possible on Vivitrol. You mentioned you are able to have AF days so you will be able to practice selective extinction early on.

Those results your doctor told you to expect after a week? The honeymoon effect. Eskapa calls it an artifact of treatment and it is essentially meaningless long-term, except as a little preview of what life will be like after several months, when true extinction has taken place.

Bob, that could purely have been coincidence, couldn't it, or are you sure that for you personally it was a crucial factor?

Yes, it could have been a coincidence. I agree.

The doctors (Eskapa and Sinclair) suggested that Benzos may interfere with the extinction mechanism, esp. since Benzos stimulate many the same receptors that alcohol does. So, I decreased them methodically according to a "titration schedule" so as not to have Benzo withdrawal, which could be really horrible. I was on my way down to zero mg/day, when my cravings and drinking dropped dramatically, but erratically. Since TSM was beginning to be successful in those weeks, I froze the dosage at 2.5mg/day so as to minimize any external changes that may affect my recovery.

So, I'll never know if it was a factor or not. But, I thought it was best to be on the safe side.

Bob

Many thanks for the clarification Bob! It will be fascinating as more of us benzo users progress on TSM to see the results. We are the real life case-studies in this regard, I believe, and hopefully will guide the way for others in the future.

Hi Everyone

I have recently been prescribed Naltrexone (circa beggining of Dec) in the UK by an alcohol & drug worker, I was also told to take one per day (50mg) if drinking or not but was also told some people only take it at weekends. Only after having 2 very heavy sessions over the holidays with quite horrific consequences did I start searching the web and found TSM. It now makes a lot more sense to me & I now hope to start taking it properly.

A big problem for me is that if I've had a lot to drink in an evening and wake up early (as I generally do at 5am) and there's drink around I will carry on. I read somewhere on here that you should carry on with old habits but after taking a Nal to alter that learned behaviour. Does this sound familiar to anyone & has anyone got any advice on this?

Thanks

K

Hi all. I am new to Naltrexone too. My doctor had no experience with it, but I told him about my research, and he put me on 25mg for the first three days and 50mg thereafter. It seems that I just need to take it right before I plan on drinking. With that said, if I plan on drinking at lunch and then again at dinner, do I take it twice? Also, 25mg has taken me from 750-1500mg of red wine PER NIGHT to 1 to 2 glass per night (and maybe under two because I dumped part of the second one out!!! SO NOT ME!!!) It appears that 25 mg is really working my way, so do I really need to up it to 50mg, or can I just see how 25mg works for me for awhile (I am 5'2" and weigh 120lbs). What do you all think? I appreciate in advance all that you guys are doing!!!

noahmd, if the 25mg is not giving you trouble you really should up it to 50mg which is the dose that Dr. Eskapa recommends for extinction. Hope this helps.


corkit

Crap. Only 12 hours? I may have just shot myself in the foot, then.

Without thinking, I just woke up and for no good reason decided to pour one, when I haven't popped a Nal since yesterday morning (18 hours ago).

I quickly ran to my cabinet and took a Nal now, but am I too late?