Thanks for sharing the link to the NPR article. I read all the comments. It was difficult to do so: so much misinformation! I often feel like our little group here is privy to the greatest secret ever kept.

I'm new but I do have a suggestion. Perhaps you could emphasize the type of drinker who is most likely to see benefit from TSM.

For example, high-dose baclofen helps many alcoholics to quit drinking compulsively. Baclofen didn't work for me at all. I think that the reason is because, based on my subjective experience, I don't drink for GABA effects, which is what baclofen targets. Similarly, if someone is an alcoholic who drinks for the GABA (like the doctor who discovered the off-label use for baclofen), I imagine naltrexone is unlikely to work.

I just hate it when treatments for alcoholism are bandied about as if we are all hooked for the same underlying reasons. The medical treatments for compulsive drinking will all become much more mainstream if we all get the most appropriate medicine for our physiology.

I've mentioned baclofen, but as a sort of fallback for those who didn't get results from TSM (or to combine with it). I've never investigated it in depth. Perhaps I should. Thanks for the pointer.

My post was not about baclofen, per se, it's just that I think we need to be careful, especially when we are *ahem* on the radio, about talking about this as a cure-all. (Not saying you would, especially since you have experience with real people on this forum, but I've heard it talked about that way.) Everyone who has reached - in the parlance of the book about it - "indifference" taking baclofen says that every alcoholic should be given baclofen. People - in the parlance of the book - "cured" with naltrexone say that alcoholism would be rare if only alcoholics were to use TSM. AA attendees who stopped destructive drinking say that every alcoholic needs AA. Meanwhile, there are tons of real people who have tried these things with no luck. What will help people is to know their options and to be given clues to figure out which one is most likely to benefit them.

My own personal opinion is that if a person started drinking compulsively after a traumatic event (e.g. rape, combat, etc.), they need therapy. If they drink to quell anxiety or relax, they need Campral or baclofen. If they drink to get high, they need naltrexone used with TSM protocol. Of course, this is simplified and there will be people in overlapping categories, but that's my take.

There is a forum called my way out, where baclofen is way more in favor then naltrexone for people. (probably about 10 to 1)

That site seems mostly about abstinence, although there are a few people trying moderation, but they are in the extreme minority.

You're right on the money, Magda, as people are all over the place with what works for them.

Naltrexone works super good for me, I don't have any belief whatsoever in the word cure, but I do have belief in the concept that it can help to control and improve destructive drinking behaviors.

A lot of the baclofen people say the same thing, and I wouldnt be interested in trying it as naltrexone works, but some of their discussions are pretty compelling. it's funny though, that they never call it a cure.

I say, whatever helps is good, whatever you want to call it.

That seems like a pretty good summary, actually. I wouldn't try to "prescribe" for a given individual without knowing a lot more, but that sounds like a reasonable way to enter the right ballpark.

I guess I'd have to disagree about therapy as a viable route, though. If existing therapy for PTSD and cPTSD actually worked . . . well, a lot of things would be different.

I have the impression that, in general, people who encounter TSM online have more realistic expectations than those who encounter it through The Cure for Alcoholism.

Good point. I should have said that if someone is drinking compulsively because of an underlying mental illness or psychological problem that those problems should be the focus of treatment.

Although correcting abnormal drinking behavior just by abstinence and taking pills is generally ineffective, as there is certainly a reason people drink wrongly, and that needs fixin'.

That actually tracks with my research.

From the studies I've read, the people who will benefit from TSM are those who have a copy of the 118G allele. The prevalence of it varies by ethnicity, but it's a minority of the population for every ethnicity. However, the prevalence of it doubles for those who drink compulsively. But it's still a minority of alcoholics. I think the idea the TSM works for 90% of alcoholics is unfounded. From my research, it works for nearly 90% of those with the gene variant (118G), but not for 90% of the general alcoholic population. The 90% figure, from what I understand, was taken from using TSM on so-called "low bottom" alcoholics - a population very likely to have the gene variant. So, the majority of alcoholics are drinking for the GABA effects of alcohol and would most appropriately be prescribed baclofen (or Campral).

This is the problem with "alcoholism." Alcohol is no one trick pony. It helps schizophrenia, bipolar mania, chronic anxiety and - for some - it can flat out get you high. If you're drinking because of the GABA effects, blocking an opioid receptor will do you no good whatsoever.

I'm troubled by posts on these forums encouraging people who don't see any difference drinking on or off Naltrexone and have been at it for months to keep going. Clearly, they are drinking for rewards that Naltrexone isn't blocking. In my humble opinion, if you drink on Naltrexone and don't notice a profound difference, you need to get yourself some Campral or start ramping up on high dose baclofen.

Excuse my rant, but I'm pissed because I spent lots of money on baclofen when I'm a much better candidate for Naltrexone. I'm sick of people arguing over the best treatment for alcoholism as if all alcoholics are the same. We have to get more targeted. People need clues to - as Melissa said - at least enter the right ballpark.

Sorry for the long, off-topic, post. Whew! I feel better.

Magda, have you tried Naltrexone? The Baclofen sounds interesting but very complicated, difficult to procure, difficult to titrate, and you apparently must obsess about it DAILY.

Since NAL just decreases perceived drinking reward, it is simple and easy. I only take it about every 3 or 4 days, always before drinking anything, and it works well.

Interestingly, even some Centers using Naltrexone for therapy use it daily for it's "anti-craving" effect, and advise you NOT TO DRINK !!, which is nonsense as that was soundly disproven by good studies.

I say whatever works, but unless someone trying to get better does some good research on their own, there is not going to be a simple one fits all answer.

I've been educating myself for over 6 months and am only now getting a good grasp of the whole issue, and I am a Medical Professional !!!