Hello all-
I have been lurking for awhile now. My husband has been on Naltrexone (50mg) and TSM since October 2013. About a year ago, upon deciding that his drinking had gotten out-of-control and become detrimental to our relationship and our family, he decided to go AF. This was a roller-coaster ride of wonderful alcohol-free periods and terrible bingeing periods when his behavior was erratic and unpredictable and he was horribly depressed. After starting TSM, he initially had lower numbers due to the honeymoon period, but since then his overall numbers have stayed pretty much the same. He consistently logs about 70 units a week (mostly light beer) and is now in his 16th week on TSM. He is 34 years old and has been a "serious" drinker for about 15 years. Alcoholism runs in his family.

We have had positive experience with the Nal, even though his drinking has not decreased much. Even while drinking, he retains fairly rational thought and control over his actions (which he did not have prior). He is not easily angered as he was before and is no longer depressed. He also does not have nearly as many days with extremely high units (22+). He has not missed a single day of work since starting Naltrexone and is usually able to postpone his drinking until much later in the day than he was previously able.

So the plan is definitely to continue with TSM on the Nal, but I'm now curious about increasing his dosage and/or adding baclofen. I think his doctor would be willing to do both, even though he is not knowledgeable about TSM.

He says he wants to decrease his drinking to a healthier level and possibly be strictly AF, but seems to have a lot of difficulty following through on that goal, especially since his drinking is so much more controlled now compared to the way it was before the Naltrexone. Its hard for him to see the benefits to decreasing his consumption since he's already experienced so many positive changes. I know that a LOT of his drinking is due to habit. He also has some deep emotional issues that sometimes cause him great difficulty in coping with stressors.

He always follows the "golden rule." Although he acknowledges that taking ownership over this process (tracking units, researching, etc) would help, he is not typically the kind of person who is so inclined and I have been doing it for him. This is not the best arrangement, as his drinking causes me a lot of anxiety and my attempts to control it often cause arguments between us.

So that's his (our) situation in a nutshell. Any insight or advice would be appreciated.

-R

We're happy to help "debug" things which might be going wrong with the process, but it'll be hard to do when we have to go through you as a proxy.

You said that he always follows the golden rule of one hour, and that's usually our first question.

There are a number of things which could be wrong, depending on how long his drinking sessions are and how many opioid receptors his brain has and about a zillion other things.

Can you show him this flow chart? It doesn't address everything possible, but it covers the most usual areas of trouble.

It would be awesome if he joined us here, so that we could give him more person advice.

An additional thought -- we've been having a lot of discussion recently about why and how we got addicted in the first place. Maybe it would help if he examined that period in his life when his drinking started to get out of control. Perhaps he has emotional "unfinished business" which he needs to sort out before he's comfortable ditching the bottle.

rlbcarr I suppose the good thing is that he's disciplined enough to try this and stick to the "Golden Rule." Some people have success with Baclofen, so I don't see how it can hurt. 50mg is not likely to help as this amount generally "maxes out" the effects of Naltrexone for the average person (i.e. it occupies 100% of the opioid receptors, which is all this drug does -- it has one simple mission, and 50mg almost always accomplishes that).

For the rest of my opinion, I sent you a PM! (See "1 New Messages" above)

Melissa-

I discussed the flow chart with my husband. He says that taking the Naltrexone definitely changes the way he feels about drinking. It does not awaken any desire to drink more, but he is still not always able to "take the reigns" and choose to drink less a lot of the time. He feels that once he starts (especially on weekends or holidays), the habit drives him and he does not feel compelled to stop.

He does often drink past the 4 hour mark, so he should probably start taking a second (half dose) of Nal at this point.

As far as his emotional issues go, he has a horrific past even that haunts him and he has tried to deal with them through therapy, although nothing consistent or particularly effective. The severity has decreased over the years but is still very difficult at particular times of the year. Alcohol has long been his way to cope and its a hard habit for him to break.

I feel like I'm repeating the word "habit" a lot as I write, which leads me to think that the Naltrexone is doing its job and he needs to do some research and work towards changing his habits. Any recommendations on this front? Books?

The good news is that he had a great week last week. He decided to take control of tracking his own numbers and managed 2 AF days and a weekly total of 55, which is significantly less than the 65-75 he's been logging

Barry-
I'm working on a reply to your PM.

rlbcarr,

I have been on NAL/TSM since April of last year and I am one of the slow responders. But I have stuck with it and I am finally seeing the progress that I had hoped for when I started. So there is definitely hope for you two. One of the mistakes that I made was violating the golden rule and drinking before the hour. Since I have been following that protocol I have had much greater success over the last two or three months. You can also make the mistake of drinking past the medication and getting reinforcement that way. I also increased my dosage for a period of (first to 62.5 MG and then to 75 MG) about two months and I think that helped.

I can definitely state that much of my current drinking is simply out of habit. There are situations, times, places, etc., etc. that trigger the desire to drink. Before NAL I didn't have much in the way of coping mechanisms to battle those situations. Over the last few months I am beginning to see those much more clearly and I am getting to the point where I can rationalize those situations and have the strength to battle through the mental cravings. It would be great if your husband did join us here. We are a bit like a mutual support group even though we don't meet face to face. Best of luck and please keep us posted.

Hi rlbcarr and hubby,


I don't think you need to worry too much at this point. I know 16 weeks does feel like a long time to be on TSM but you are both seeing changes which means that it must be working. The quote above shows that he is making good progress.

It sounds as though you're worried that he's happy with the progress that he's made and that he'll decide that he doesn't need to go any further along the road to recovery but I think that only time will tell. It can be a bit overwhelming to think that you'll never drink again, and so he might not relish that idea. He might just want to take it slowly. Being AF might be scarey for him at this point in time, but it may be more tangible as he gets closer to it. My original goal was to get to a healthy drinking level but as I've gotten ever closer to that, the thought of not drinking doesn't scare me half as much as it did in the beginning. Subtle changes take place over time and as I've seen success it's made more success possible.

Some of us just take longer to get to our end goals than others. I have been doing TSM for 30 weeks now and it has been a slow, steady process but I am definitely in a much better place than when I started. Even when the Nal takes away the craving, there are often a lot of ingrained habits which remain and which can take a while to change. It would have felt overwhelming to tackle all the ways in which I used wine all at once and so I've slowly but systematically worked my way through them all, changing them one by one. First I broke my association with a lunchtime glass of wine, then I went down to lower alcohol wine, then I went to smaller glasses, then I cut out the "glass of wine to relax" at the end of the day, then I forced myself to sit through some difficult situations/conversations without a drink, and I'm currently working on my biggest challenge which is always having a glass of wine with dinner (a habit that's been ingrained over many, many years). Over time I've learned to sit with my feelings and not run away from them or drown them in alcohol. For me, it's worked to try and break things down and be successful at each change.

Please keep us updated as to how he's getting on.

Thanks Ruthy-
Your response makes a lot of sense to me.



We have definitely seen progress and he also has a list of goals that he's trying to accomplish in terms of his drinking. He has many alcohol-related behaviors that will need to be addressed and changed and you are very right, it would be overwhelming to tackle all these things at once. Right now, the two goals he is focused on are not drinking for a hangover and not drinking while driving. He is doing fairly well at the not drinking for a hangover goal by not allowing himself to drink before 5pm. He has been able to adhere to this most of the time. The drinking and driving is a bad one and is what he does to escape when he is upset. I feel he has some very deep-rooted issues he has not been able to overcome that continue to cause him inability to cope. I do think that until he addresses these issues, "cured" is unattainable.

We have a date tonight to discuss his progress and ideas for how to continue to improve. I'm definitely going to discuss with him the things you talked about as I know he gets just as frustrated as I do.

Thanks for the input!

I have read the last posts with interest as I too am feeling like the habit is holding me back.

I'm taking baby steps, and yes, may be there is the fear of never drinking again?

Who knows, only time will tell.

I am going to continue to take my NAL and plod on......unless the doctor prescribing will not do it any more.

My first lot, I went to Spain to buy it as that was cheaper than buying it in the UK at that time.

I wish everyone all the best of luck, and I suppose it took us all lots of different timescales for the alcohol to become a problem, and that it will be different for all of us to get to distinction!
I'm so blooming impatient!

Aha!! So if I start drinking at 2:30 pm I need a booster at 6:30 pm. This is my first post. Thank you for the flow chart. I have made the observation on several occasions, "Why does my chardonnay taste so good now? It didn't earlier." I often continue until bedtime which might be midnight. This is an eye opener. The book never mentioned a booster! I can do this easy but just did not know. OK, time to modify the Golden Rule based on my own practice.