Thanks Revert. The bit you posted about drinking it anyway "because that's what I do", and pouring one out pure habit sums things up for me. For the three weeks I've been making an attempt to incorporate willpower without objective success, I'm afraid. After discussions with my Dr., we agreed that the plan would be for me to attempt to abstain and take a Nal. every day, but two if I thought I was going to drink - my idea was to only take a Nal if I was going to drink, and not take one otherwise. Initially I 'did it my way' and found a pattern of 1-2 days off, then a bender (with a Nal); now, I'm doing what we agreed and not finding any objective difference.

I've got objective logs going back almost a year; they show a slow but continual decline in drinking until December, a peak over the holidays, and then another steep decline until February when I started having problems both at work and at home. Following that, there's been a distinct pattern change with less AF days and more drunk on the drinking days. Most worrying for me is that I've finally started to have hangovers on weekdays which are sufficient to prevent me from doing my job properly which is quite frightening.

Currently, I'm wondering about taking a very radical course of action and _stopping_ Nal for a month or so, then drink without the medication that's not having any measurable effect atm; after that, maybe the upregulation caused by the Nal might have reverted and starting Nal again could give me a 'do over'. Not having any pharmacological training beyond the very basics I really don't know - gut feel says that the upregulation is probably permanent, but with luck it'll be an exponential decay curve rather than a constant.

Revert - thanks again for your support, I appreciate it very much. My next appointment's on Friday next week, when I'm hoping to get the ultrasound results. The blood tests are a bit 'off' atm (ALT at 57 IU/l c.f. 40 nominal) but by no means disastrous - there's still time to turn it around .

Just dropping in to say that I'm still Nal'ing on, and that things are looking up a bit on the alcohol consumption front having upped the Nal to 100mg. For the last couple of weeks my units have been close to 'recommended' guidelines, and I had the very pleasant realisation on Saturday morning that the 'bender' on Friday night had (1) stopped spontaneously because I didn't want to drink any more, and (2) the total consumption was one unit higher than the _target_ I'd agreed with my doctor some months back. Seemed like a bit of a ray of sunshine. In other good news, the verdict from the liver scan was that there're fatty changes but it's not permanently damaged yet.

Ah, very good to get that report, BWD! Good anecdotal evidence, as well as the clinical results. Sounds like it's coming together for you very well.

Just me again with another update. Drinking has been up since the last post, the chart is rather uneven because I'm working on a "death march" project at the moment which doesn't leave much time for booze - my doctor thinks that it's positive that I'm not finding time to drink anyway, though I'm less convinced because I have a desire to work and do my job properly and drinking doesn't fit well with that. Regardless, the 2-month-rolling-average trend is in fact still down, though the weekly average is up quite a bit.

In other news, I'm now "officially" diagnosed as autistic which is a big relief because it at least helps to explain why things are how they are . It was very interesting to note that my brother said "well, that would explain a few things..." when I told him of said information.

Hi BWD,
Just checking in after many months and glad to see your trend is downwards, and that you've been getting medical attention that you probably needed all these years!
May the progress continue :0

My results continue to be mixed but with a (very) gradual long-term downward trend. Christmas was not at all good because I fantasised about the pleasures of being drunk, planned to do so (without taking Nal so I could enjoy the drunkenness), and duly encountered the negative aspects in a very heavy way. Following that I started being serious about the Nal again, and watched my consumption decline with concomitant benefits.

My birthday was at the tail end of April and I was looking for an opportunity to drink to 'celebrate'. It happened that I had an appointment with the alcohol team just before that, and the person with whom I had the appointment mentioned that he had other patients who took very occasional 'days off' the Nal for special occasions - he didn't recommend this at all, but did talk about other people's experiences and the long-term prognosis c.f. short term compliance. Following this [sort-for excuse], I chose not to take my Nal before going out for my birthday... big mistake! The consequences on the day itself/day after were fairly standard or even mild [managed to get home before passing out ] , but the big problems for me have been those following. Even though I had just about all of the 'standard' drunken consequences that most of us are familiar with, both physical and mental, I'm really struggling now to force myself to take Nal again - far worse, I'm lying that I'm not taking it (and so I'm reinforcing the spiral slope downwards...). Bluntly, the pleasure of being drunk is a siren-call that I'm finding really hard to resist.

I'm not particularly looking for input from anyone else, but hope that my experiences can be useful.. tonight is zero Nal; 17 UK units so far; 3 bottles of beer lined up; and it's staring to change from 'this is fun' to 'why me...'.

Hey BWD,

As you aren't looking for advice, I won't lecture you. I do think that your experience is CRITICALLY IMPORTANT for everyone on nal, beginning or not, to understand and I thank you for sharing it. If nal works the way that it is advertised to work, these "nal holidays" where you go off it for a weekend seem to be able to erase a lot of progress. It's what I call the "stray cat theory." As drunks, our brains get a shot of dopamine when we drink. The more we drink, the more dopamine we get, which is a major reason that we can continue to seek out alcohol in a completely blacked out stupor. When everything but the lizard brain has gone nighty-night because of the sauce, that lizard brain still knows how to hit that happy button, and won't stop doing it until lights out.

So the stray cat thing - our brains are like stray cats looking for milk. You give the cat milk one lousy time, and he's showing up at your doorstep meowing and howling, looking for that milk. You hold out, you say no 99 times, and then the 100th time you give in and give the cat more milk... and now you own a cat. You may deny your brain the dopamine bath 99 times out of 100, but if you take these weekends or holidays off of the nal, your brain knows to just keep meowing and howling and eventually you'll give it what it wants. Just like the cat, your experience (and the experience of many others I've read here) indicates that you have to take nal 100.0% of the time for it to be truly transformative.

Anyway, thanks again for sharing. Best!

I'm not sure why you want to take a holiday. I drank too many Wed. night with the pill in me, and I'm pretty sure I was drunk and buzzed. The pill for me has helped me achieve more AF days and many times, caused me to drink less. But if there is a "drinking event" with buddies, about half the time, I will still end up drinking at their pace.

Time for a rather more positive update on a couple of fronts!

Firstly, after the May debacle I re-applied myself by sticking very strictly to the one-hour rule (after 100mg of Nal) and am really pleased to say that there's been a considerable decrease in consumption which is now down to some 3 units per /week/, and has been for a couple of months. I am now pouring away more beer than I'm drinking, because it just doesn't taste or feel good any more . Secondly, following the recent NICE decision and at my request I've now been prescribed Nalmefene by the NHS alcohol team instead of Naltrexone which is pleasing because of the lower hepatotoxicity.

It's far too soon to be declaring myself 'back in control', but at the moment it feels as if that may finally be in sight - I think that I'll be satisfied that it's not just a particularly good phase when I've reached a year without either getting or wanting to be out-of-control drunk. I do have a concern that I'm smoking a lot of dope atm and worry that when it runs out there could be a rebound effect, but on the other hand the dramatic decrease in consumption started a couple of weeks before I got it.

If anybody else is struggling to get Nalmefene prescribed by the NHS, there are a couple of reasons that I'm aware of:

1. It's 3 times the price of Naltrexone
2. The eligibility criteria are different from Naltrexone - in particular, it's not available to people who are believed to be drinking at a physically dependent level.

NHS objection #1 was reasonably easy to overcome by pointing out the relative costs of Nalmefene vs. treating liver damage from Naltrexone; there is also an argument available by means of the longer half life which can have benefits.

Thanks for checking in. 3 units per week is amazing. I would be ecstatic to get my daily intake down to 3. Keep at it. Are you taking nalmefene every day or just on drinking days?