TWO YEARS BEFORE THE MAST: SMOOTH SAILING

It has now been two years since I started on TSM. I am happy to report my sustained success. I am exactly where I want to be for well over a year 18 months. I was perhaps a “super-responder”. It does happen. TSM has indeed saved the quality of my life from the ugly ravage of compulsion. My pre-TSM= 70 units per week. Now I range from 0 to 7 per week. On rare occasion (three times in past year), the 7 drinks have been in the course of one night. I now frequently go alcohol-free 6 nights/wk without cravings.
Following my great initial success after only six months on TSM, I began experimenting with the dosage, moving from 50 mg to 25mg and finally settling on a quarter of what is typically prescribed: 12.5 mg. (Naltima from India ADC.) My unexpected reduced dosage regimen has granted me a stash of meds that will last years (up against the expiration date).
I have also further experimented: drinking without Nal on numerous occasions. Moreover, I have sometimes taken Nal after drinking to partial intoxication. In my case, Nal may have contributed to the interruption of the impulse to drink more. Overall, TSM has had significant effects in both radically reducing my desire to drink and my compulsion to continue to drink once I have started.

When I have toyed with dosage and timing of Nal, my desire and my numbers have increased in a very delayed fashion. In other words, I never noticed a one-to-one relationship between my dosage and the amount of drinking per particular occasion. This is what is expected because TSM is a learning paradigm of treatment and not a treatment intervention based on the immediate effects of Nal. When my drinking has modestly increased in frequency or amount, I took my nal more regularly to quash the opioid-based learning/reinforcement. I have seldom attempted to resist an increased desire to drink, but rather have taken the subjective presence of such desire as a sign/symptom that I need to initiate a number of full-blown extinction sessions over the next few drinking sessions. For me that meant, following the more standard protocol of taking either 12.5 mg or even (early on) 25mg one hour before my first drink; the dosage was determined by how strong my compulsion felt and how my consumption numbers looked. Over the course of two years, I have adjusted my regimen accordingly and today I feel in complete control of my drinking. I have no concern of full-blown relapse. I know what it is to drink normally again, i.e., the way I used to drink many years ago. I also realize that I can completely quit anytime I decide to do so.
Although I have experienced periods of a complete loss of interest in drinking, I have also become familiar with that strange temptation to toy with the cultivation/rekindling of desire. This is to be expected, I think, and it may even represent an objective danger of gradual relapse if carried too far.
Lastly, the experience of separating the dopamine reward, away from the experience of intoxication, arrived like a quasi-spiritual enlightenment. Who would have ever believe that it’s not the intoxication that we chase, but rather the tightly unconsciously learned sine qua non of dopamine reward. How could an aspect of experience that barely consciously registers, be that which one ultimately pursues? But it makes sense. Doesn’t it? Why else does one continue to drink after one has already become sloppy-drunk. It is not that one wants to get more and more intoxicated, no. What one craves is the chemical reward. Intoxication is merely a conditioned/paired side effect. This perspective presents a strange yet intelligible reductionism that works in other contexts, for example: Diane Nyad does not enjoy long distance swimming with stinging jelly fish, and the risk of shark attack, she enjoys the dopamine release her brain gives her as a reward for her physical exertion and psychological audacity. And so it goes with Marathon runners, gambling, and other so called rewarding/learned habits. Our top athletes, cultural heroes/heroines, and dare-devils are actually endogenous dopamine addicts. Ha!
Intoxication now feels sloppy, soul-squelching, and unnecessary. The experience of sobriety is now the norm for me, a new normal without an all-consuming itch to drink. The enjoyable improvement in sleep and in my daily mood is a bonus I had not expected. There is an old drunkard’s joke here: “I feel sorry for those who don’t drink. Because when they get up in the morning that’s the best they’re going to feel all day.” The joke is predicated on the fact that the drunk always starts the day radically depleted. I have also lost fifteen pounds and have kept it off for a year. It’s easier to manage calorie/carb restriction when you’re not drinking well over 1000 calories in alcohol a day.

Finally, I wonder why more people don’t try TSM. In fact, the friends I have turned-on to TSM have not followed through with it. Some have quit after the initial dose because they did not titrate the dose properly and consequently experienced brief but ugly side effects. Some have had promising initial reductions in drinking and yet quit the regimen, either because of the annoying initial mild insomnia, or because they ultimately wanted to continue to drink, they stilled paired intoxication with uncs dopamine release. The only others I know who have followed through with TSM belong to these message boards. For that reason, I consider the community support as almost essential for success for many. However, it must be understood that the learning paradigm that interferes with the reinforcement schedule of dopamine release, upon which TSM is based, takes time. This gap of time itself opens the door to all sorts of superstitious thinking about NAL. The message boards are rife with unsubstantiated claims, assumptions, and myths. It seems that the typical course of TSM treatment is a statistical ideality rarely instantiated in vivo. The wide rage of success and failure among individuals prompts a need to tell a story explaining why it works well here and not so well there, e.g.: “chew the Nal”, “only take Naltima”, “use only a particular pharmacy”, “you must chart your consumption”, “you must make an exertion to restrict drinking”, “drink only out of craving and squelch what feels like habit”, “do CBT in conjunction with TSM”, “adjunct TSM with other drugs”. The rationale for many of these tenets is as solid as any self-delusion. Some may be true for you, but do not apply universally. That’s why the golden rule cuts through all the BS and remains so simple: Nal + alc (+time) = cure.

I plan to visit the message boards over the next couple days, in case anyone wants to ask any questions. Then I will go back to by sober life and drop in next year to report any changes.
I wish everyone success.
Nal On everyone!

Thank you so much for taking the time to write such a thoughtful and thought-provoking post. Glad to read about another success.

digetic2, your post was a very interesting read. I find my enjoyment of drinking dramatically increases as my nal dosage decreases. When you say your dosage is determined by your compulsion, when do you determine that? Is it at the time of taking the pill or some other time when you might be less susceptible to having your compulsion influence your decision?

Thank you for that very informative post digetic.
I have been taking nal for 2 years also and after about 4 months I think I could have quit drinking if I put a little effort into it.My units were down a lot although I never kept count. The alcohol tasted awful and even the thoughts of a drink would make my stomach churn but I would force it even using mixers like juice to disguise the taste telling myself the 3rd one will go down easier and even though I would not want to continue drinking after a few I would keep going and drink through the nal.I force myself to drink especially when I'm happy.
Regardless,I always have more control when I take the nal because in the past few months I have gotten sloppy about taking it and have noticed a big difference,a lot less drama when I take the nal so for that reason i will always take it.For me I look on nal as a prescription med which I have to take when I drink.
I only drink about twice a week but it would be nice then if I could have 2 drinks instead of 22.


You have certainly put a lot more thought into it,maybe something I need to do.
Well done and I'm going to read your post again.

I just found this post by ~Q~ on a different thread,hope it's ok to copy it here.

"If you choose to keep drinking like a fish even after TSM releases you of the brain chemistry craving for AL because you have the "HABIT" of drinking, then you are still going to get intoxicated. TSM doesn't break the habit of drinking. TSM breaks the brain chemistry craving to drink. This is VERY VERY important. Let me repeat this: TSM breaks the brain chemistry craving to drink, not the habit we have personally developed to drink. It is still up to us to break our own habit of drinking. We have to make the decision not to drink nightly once TSM gives us the ability to overcome the craving to do this."

The habit is the big thing for me and that post makes a lot of sence.

Sorry digetic,i feel like I'm high jacking your thread.

Hey Curt,
The compulsion to drink is an uncomfortable feeling for me. This compulsion can be illustrated in terms of divided consciousness: I want to drink, but I don’t want this wanting to drink. When I identify with my “right mind”, I have no problem effectively taking the rational action and taking Nal to rid myself of the more ego dystonic desire for intoxication. If I identify more with the desire to drink, then there is no room for decision and I might drink without Nal. So whenever I find myself faced with a decision: Drink (without the Nal) or Drink (with the Nal). In either case I get to drink. It’s such a small step to pop the pill for protection. So that’s what I most routinely do.
The other action I take: Once I begin to drink without Nal and find myself wanting (or not wanting) to stop, I take Nal. This does not work nearly as well in the moment, but it does dampen down the endorphine reinforcement and grants some protection (but, more likely, this action pays off in terms of delaying my next drinking occasion. At least that’s how I think about it.) I have never strung together a significant number of drinking occasions without my Nal. Consequently, I have never felt like I was starting over again. At this point, I just don’t enjoy alcohol enough for it to be a problem for me. My default attitude is I’d rather not drink. If an occasion arises, I even feel somewhat reluctant to drink. Now I am free to do so or not. The more that I experience intoxication as a separate and different state from/than the subtle endorphine-reinforcement, the less I care to drink at all.
Good luck!
D2

[quote="dee"]I just found this post by ~Q~ on a different thread,hope it's ok to copy it here.

TSM doesn't break the habit of drinking.

Hey Dee,

In my experience, its hard to maintain the habit without some experience of reinforcement. If you're not getting anything out of it, you won't likely continue the behavior. I have had some experience with drinking through the Nal, but that was early on and prior to separating intoxication from pleasure. The cues/triggers to drink have fallen away in time. I had continued to see improvement even after a year of success.
Now I am no expert in your experience of TSM. I can only tell you what I have experienced and attempt to extrapolate according to TSM's learning model.
You sound like you are, nevertheless, happy with what you have accomplished. Nal on!

D2

This is the best, most thoughtful post onthe subject I have read in the last two weeks. thnak you for taking the time to type it out.

Hey, D2...I appreciate your reporting back w/ your update, and I'm happy for your continuing success. When I started TSM a little over a year ago, I bookmarked a number of your posts, as being especially helpful & inspiring to me, and I would re-read them from time to time when I needed encouragement...your posts have made a difference!

I ended up NOT being a "super responder", but probably pretty average, as it appears I hit the "cured" mark at exactly 52 weeks...I'm not officially declared as such, but waiting a few months to make sure I don't backslide. Recent posts about some successful people relapsing a bit have been very timely, and understandable, and it's interesting that you have also felt some of that, but not acted on it...it CAN be resisted, good to know!

I will bookmark your latest update as once again esp. significant for me as I move forward into the maintenance phase of TSM, about the variable dosage, etc. So...same time next year??? You're so right - this Forum seems to be the best/only game in town for people attempting the TSM journey and reports from the "other side" from people such as you are so very helpful.