Hi, all. Long-time lurker, first-time poster here. I'm 43 years old, and I've been what I call a "very experienced drinker" (my tongue-in-cheek term for drinking 6-7 units of hard liquor each day) for close to 20 years. I've attempted to quit cold turkey numerous times without success.

I discovered Dr. Eskapa's book in late 2009, and finally started the regimen a little over a year ago. I experienced the initial side effects (mild nausea and a sort of mental fog), which passed quickly --- along with that "honeymoon period" the first week where I wanted to drink only very little. I've been extremely consistent in taking 50 mg of Nal each day --- missing only two or three times in the last year. On those few occasions when I drank without Nal, I could tell the difference --- the alcohol hit me much faster and harder without the Nal. At the end of a year on the program though, I'm still drinking essentially the same amount I was when I started.

Here's my question. With a year of consistent Nal use under my belt, what's next? Do I keep on doing what I'm doing? Do I increase my dosage? Do I make a more concerted effort to cut down on my daily units of alcohol? From the beginning, I've been terrified that I'd turn out to be one of the few for whom TSM wouldn't work. Now, I'm beginning to have major second thoughts. Has anyone else experienced something similar?

k-sure, welcome and thanks for posting. You represent an unknown quantity in the TSM universe. Those who are doing TSM but not visible and otherwise unaccounted for...until now. A couple of questions. Did you track your units and craving during the last year? How do you know your units aren't less? Are you buying the same amount of booze? Is it lasting the same amount of time? Human subjects are notoriously poor when it comes to retrospectively remembering things like what they ate or drank. In diet studies people always underestimate their calorie consumption. We can probably expect the same with alcohol consumption except there is cognitive impairment that goes along with alcohol consumption so it may be even worse. You said you feel a difference when you drink off nal, that is probably a good sign that it is having some effect. Have you tried some AF days? Is alcohol causing you exactly the same kind of problems a year later or have things gotten any better? Less black outs and brown outs, less confrontation with significant others over drinking? Your age and drinking history is not that different than many others on the board and it sounds like you had an initial response to nal. I think nal can help with the craving part of alcoholism but we have to be willing to apply some effort to address the habit part of drinking and that means changing what we do in the evening (if you are a daily, nightly drinker) so that you are not doing the same thing every night that always leads to drinking. Best of luck and thanks for coming forward and posting. It may help someone else who is lurking.

Sorry to hear about your continuing struggle. But it does make me wonder why, after an initial apparent response to Nal it seemed to quit working. May I ask you: Is there a history of serious alcoholism that runs in your family?

I have read other threads which have uped the dose and evern tried balcafen. I trust some of these members will have some solid recommendations. Good luck.

Saint V's questions are spot on. It's hard to give reliable feedback to your question without an examination of these questions. If you are having fewer blackouts, hangovers and bad behavior, it may be worth it to keep going. Also, from what I've seen on the board, drinkers of 20-plus years typically take anywhere from six to 18 months before extinction occurs.

I hope things get better for you.

My best,

Nick

Thanks for all the responses. I really appreciate your taking the time to post. I did want to attempt to answer some of the questions posed by those who responded, saint-vincent in particular, and to paint a more accurate picture of my current drinking.

> Did you track your units and craving during the
> last year? How do you know your units aren't less?

Sadly, I have not tracked my numbers over the last year. (I'm terrible with this type of record-keeping --- my accountant can tell you all sorts of stories.) That said, I'm a very consistent drinker. I drink every day, but I never drink before 6:00 pm, and I never drink beyond 10:30 pm. I typically will make mixed drinks, and most nights drink between 8 and 12 oz of hard liquor during those hours --- and that hasn't changed over the course of the last year. But, while my consumption doesn't appear to have lessened, my cravings have diminished substantially. When I first started the program, my cravings were so strong that I'd start counting down the minutes until "cocktail hour" by around 3:30 pm. Now, I sometimes don't even think about having a cocktail until 7:00 pm.

> Are you buying the same amount of booze? Is it
> lasting the same amount of time?

Yes, and yes.

> Have you tried some AF days?

I really haven't, since I thought they'd just sort of naturally, magically happen. I may make more of an effort now, since that seems to be a strategy folks have proposed.

> Is alcohol causing you exactly the same kind of
> problems a year later or have things gotten any
> better? Less black outs and brown outs, less
> confrontation with significant others over drinking?

I'm a pretty high-functioning drinker, so I never really had these kinds of problems --- nothing beyond the occasional hangover (or forgetting what happened at the end of CSI). These have remained fairly consistent over time.

> I think nal can help with the craving part of alcoholism
> but we have to be willing to apply some effort to address
> the habit part of drinking and that means changing what
> we do in the evening (if you are a daily, nightly drinker)
> so that you are not doing the same thing every night that
> always leads to drinking.

This, really, is the crux of my question. I've read the book a couple of times, and it left me with the impression that you would naturally moderate your drinking over time with no effort. I think what I'm hearing is that it may be time to concentrate on trying an AF day here and there, as a sort of "practice" (for lack of a better term).

With all due respect to Dr. Eskapa, there are numerous problems with the conclusions in the book, based upon the experience of approximately 800 people here over the past two years.

1. Side effects. The book has one paragraph on the subject and concludes "the majority of patients taking naltrexone report few or no side effects" and that side effects "are rare and include symptoms like mild itchiness or transient nausea." In fact, the vast majority of people here experience major side effects initially, including nausea, feeling "spacey", fatigue, sleepiness and major sleep disturbance. Several members were forced to quit taking naltrexone due to severe side effects. It is true that the side effects are usually temporary, but to say the book overlooks a major aspect of TSM, namely significant side effects, would be a major understatement.

2. Time to "the cure." The book claims a 78% complete cure of alcoholism, with a complete elimination of cravings, within three to four months. Of the 800 members here, there have been a handful -- maybe three to five tops -- who have reported a complete "cure" in just three to four months. The vast majority report substantially diminished cravings and a return to a normal life after 6 months to a year. Moreover, the vast majority on the "cured" list all site ongoing occasional cravings and triggers that must be dealt with, well after they have regained control.

3. The book says the path to "the cure" is effortless. Again, the vast majority of those who regained control of their habit here have reported that after several weeks on the method, they imposed a certain degree of will power to reduce their numbers and that it was essential to their success with the method. Many people here have reported that they are waiting for a complete lack of interest in alcohol with no effort, and it never happens (or hasn't happened yet).

Trying an AF day is not really "for practice." The reason to try an AF day is that almost all of us continue to drink out of mere habit -- as opposed to craving -- after pharmacological extinction has occurred. We are bored and we drink because that's what we do -- drink. But if you don't apply a little effort to do something else, you can continue to drink indefinitely not out of addiction or craving, but out of habit. Many of us -- probably the majority on "the cured" list -- have found that if we purposely do something else to keep us busy and do not drink, that the AF day comes surprisingly easily after many weeks or months on the method. In addition, having an AF day means no naltrexone and that positive behaviors can be reinforced on these days. Also, your body will be grateful for the break from alcohol, both physically and mentally, and so there is that positive reward for going AF that will be reinforced every time you go AF. Pretty soon you'll feel so much better when you are AF that you will recognize that the costs of drinking outweigh the benefits of being AF.

So, the book is invaluable and it saved my life. Thanks again Dr. Eskapa and Dr. Sinclair. But it is not entirely accurate and should not be taken as gospel.

I second everything Nick says. I read your post earlier today and was going to respond but Nick has done such a good job clarifying "The Cure for Alcoholism" I don't have much to add other than the book is a good start and this board is more like the insiders guide to the Sinclair Method.

Toxic Girl has declared herself "cured" with the help of effort. She explains it better than I can here:

http://adventuresoftoxicgirl.blogspot.c ... chive.html

Thanks for the responses, everyone --- and especially for the kick in the ass. I'm glad I came out of the shadows and posted my question. Doing an AF night tonight!

Awesome, every long journey starts with the first step. Way to go.