JMS, I certainly don't have the answer but I can understand your frustration. When I started out on TSM, I thought it was quite a clear cut, no nonsense method that in 3 to 6 months would have me rid of the obsession with drink. Compared to others on here, my consumption wasn't huge, but I knew it wasn't healthy and more than anything I wanted to be free of the voice in my head that said "have a drink" on a daily basis. I'm on week 24 and that voice is still there. It's quieter and less insistent, and on some days with a bit of effort I can ignore it, but as yet it hasn't gone away. I don't know when it's going to fall silent, but I have to believe that it will.

Maybe by messing with the golden rule in the past you have set yourself up for some intermittent reinforcement, which will mean that it's going to take a bit longer. Maybe it's taking a while for this increased dose to be effective or perhapes you need to up it to 75mgs. Maybe when you are having your AF days, you could alternate them (rather than trying for a few days in a row) so that the alcohol deprivation effect doesn't kick in.

sideeffect makes the point about "drink as you normally would" and habit. This is a tough one, which I have found myself grappling with and which I'm not sure that anyone really knows the answer to. The "drink as you normally would" comes from Dr. Eskapa's book which I've always thought of as the instruction guide to TSM. I've taken it to mean that if we still want to drink then we should and this will lead to extinction. However, people on here have said that there comes a time when we do have to put in a bit of effort too and force some reduced consumption. Only you know which of these applies to you, but it may be something to consider. Are you still drinking because you have to or because you want to?

Back at the begining of december you said this

Maybe this another one of those times and in a few weeks the higher levels will abate and you'll settle into another period of reduced consumption.There are quite a few people on here who have taken a long time to get to their goal, but by plugging away they have got there in the end. IMHO, I don't think you're one of the 20% for whom this doesn't work. If that were the case then surely you wouldn't have seen any reduction or had any changes in your response to alcohol. As frustrating as it is, I think it's going to be a question of time and patience. Tighten up on the golden rule, tweak your dosage, be honest with yourself about whether any of this is more habit than craving and keep nal-ing on.

The 20% arent immune to TSM. They arent doing it. Compliance is always an issue.

http://en.m.wikipedia.org/wiki/Compliance_(medicine)

If you read it, 80% is actually a really good compliance rate. This was as a part of a supervised study, and Im sure they had constant reminders to follow the golden rule, etc.

There's a 20% compliance failure rate and a 10% just-doesn't-work rate, leaving 70% of the total who are successful.

The 10% apparently have an addiction which works by some other means. Research is ongoing. People who are in that 10% probably wouldn't even see their addiction touched, though, so I don't really think JMS is in that group.

I'm guessing JMS will see much faster progress now that he has upped the dosage for full blockage and has vowed to follow the Golden Rule faithfully.

Thanks to everyone for their responses and support! It really means a lot. I have certainly been lax on the golden rule in the past, so perhaps some level of intermittent reinforcement has crept in a bit. I'm just the typical alcoholic that assumes the rules don't apply to me or that I'm different. It has been about a week since I re-increased (is that a word?) my dosage up to 62.5 MG, so maybe it is just beginning to kick in. And I did have one day without NAL just prior to that period and one day on a very reduced dosage. Those don't help. I still somewhat feel the effects of the alcohol, so maybe I need to try 75 MG to see if that works.

In terms of the cravings, they are just like Ruthy explained. It's that voice in my head that is saying to have a drink. It starts at me first thing in the morning and gets louder and louder as the day goes on. I'm sure that all of us have heard some version of it. That's what I want to be rid of and that is where the counter-intuitive aspect of this program comes into play. I've had long periods of sobriety, but the voice never left. So the hope with TSM was that it would cause it to go away. I'm not a morning drinker and my episodes are all very controlled and I haven't had a situation since I've been on TSM which is good news. I still remain hopeful. To Melissa's point, my unit volume is way down from where I started and my five week averages are way down as well (72/52/52/40/49/38/42). There is definitely some seasonality going on right now, so I just need to remain vigilant and patient. Thanks again for the responses!

Reading back over your thread the craving really does seem to be a big issue for you and I had an idea which I wondered whether it might help. It might not be a good idea...it might be totally inappropriate or even a very bad idea... but I thought I'd put it to you to see what you and everyone else thinks.

Naltrexone is usually prescribed by Drs to be taken once a day as an anti-craving drug. Obviously on TSM we take it before drinking. I'm wondering...if it really does have anti-craving properties (and people do report that it has) could you do both? Take a Nal in the morning as an anti-craving and then take another an hour before drinking? If you're sensitive to Nal side effects this won't work, and I understand that we all have to be careful about our livers so you would need to be mindful of that, but I just wonder if it might start to kill the craving for you.

Obviously, try the strict golden rule and increased doseage first, but if in a month or so that damned voice isn't getting quieter maybe this could be something to think about?

Happy Boxing Day to our fellow Canadian travelers. Christmas is behind me, thank God for that! Units were way up last week as a result of numerous festivities. I've decided to adopt Ruthy's approach and not worry about these two weeks. I will just try and enjoy them and stick to the protocol and hope that there is some extinction on the other side. Otherwise I am going to drive myself nuts thinking I am a complete failure.

I am hoping that this time next year alcohol won't be consuming as much (I hope none!) of my thoughts as it is now. I am truly looking forward to the day where that little devil isn't sitting on my shoulder prodding me with that pitch fork to have a drink. What would that be like? Have a safe and Happy New Year everyone! Here is to a better 2014!

Happy New Year to everyone! Here's to extinction working for one and all! I was doing some simple math today and came to the conclusion that I'm a fat flipping pig for one reason and one reason only. Booze! I've been consuming roughly 5,000+ calories a week for the last four months. That's another two plus days of eating a week for a normal adult active male. Pretty tough way to maintain a reasonable weight doing that. I knew in the back of my mind that it was a lot, but putting actual calorie numbers into my handy dandy Excel spreadsheet really brought it out into the light. I'm not blessed with one of those fast metabolisms, so I have to fight to keep the weight off and I have not been helping my cause one bit.

If I can eliminate drinking I'm thinking that I can pretty much eat what I want and stay relatively thin. I'm pretty active, so I shouldn't have much trouble. Yet another reason to become AF. After doing that exercise, I decided to make a list of the benefits of going AF. Not really a list of New Years resolutions, just some thoughts. Well, maybe a little bit of resolve. Here they are:

Health (No more railroad spikes in my skull/reduced blood pressure)
Finances (I've been spending about $100/week on alcohol)
Weight (Drop 30 pounds)
Spousal Relationship
Family Relationship
Work (Build my Business)
Energy to Do Some Self Improvement (Learn spanish anyone?)
Clearer Thinking
More Positive Attitude
Better Sleep (My heart won't pound at night any longer)
Time to Help Others

This list could go on and on, but I won't bore everyone. I found this to be a great exercise that gave me some hope at the start of the New Year. Putting it in writing somehow made it a bit more real. I truly hope that 2014 is a wonderful year for everyone!

Happy New Year, JMS! That's a great list. There is not one negative or neutral item on it. Go for it!

Here's my recent understanding of the fat flabbery I inflict upon myself via alcohol.
One bottle wine (white) roughly equals 500 calories. Prior to TSM I was drinking between 5-7 bottles per week, consistently for four years. That's up to 1lb a week excess calorie intake. It is not surprising that I'm 40lbs overweight. And I resisted dieting because I didn't want to (read: didn't think I could) give up alcohol!

This time next year I am going to be 30lbs lighter too!

Yay us!

Don't get too excited. I haven't had any alcohol in weeks, and I haven't lost a pound.

Not to discourage you or anything. It's just not as simple as that. I'm just sayin'.

Happy New Year JMS! I hope it's a good one.

The first time I gave up alcohol in my 20's the weight dropped off, but now in my 50's, not so much!

I've been doing low carb though which has helped me lose weight, though that's gone to hell in the past month.

I have a renewed commitment today to both low carb and taking Nal before I drink. (That's a bit of a conflict but I can still lose weight if I'm not drinking a lot.)

Good luck!