melissa1928 wrote:
If you're accustomed to drinking in order to combat irritation, anxiety, etc., then you may be drinking for GABA effects (or for the combination, since TSM did help you).  TSM won't do anything for people addicted via GABA receptors.  You might need a different approach for that.  That would mean that alcohol, even on naltrexone, is giving you an addictive reward.
This would be my guess, since it sounds like you're using alcohol like a medication.  Eskapa doesn't address this in the book (he seems to think that endorphins are the whole picture), so I'm not sure that you can rely on a textbook response since you don't seem to be a textbook case.
If it were me, I would probably order some acamprosate (Campral).  It's a GABA agonist and can be taken several times a day.  I took it years ago.  It didn't help with the drinking (I wasn't addicted via GABA), but it did make me feel really chill.  There are probably other things that will help raise your levels of GABA or sensitize your GABA receptors.  I would do some research were I you.  Non-alcoholic beer has been shown to raise GABA levels due to the hops, so you could try that (or just eating some hops, but that sounds gross).
You might also be self-medicating a serotonin problem.  Ondansetron (off-label use) has shown promise with reducing alcohol intake, and it has been tested in conjunction with naltrexone for cue-exposure (
http://www.ncbi.nlm.nih.gov/pubmed/18391135).
Quote:
Consistent with animal data that suggest that both naltrexone and ondansetron reduce alcohol-stimulated dopamine output in the ventral striatum, the current study found evidence that these medications, alone or in combination, could decrease alcohol cue-induced activation of the ventral striatum, consistent with their putative treatment efficacy.
Or, you could just try taking some 5-HTP or l-tryptophan to raise your serotonin levels.  Just be careful if you're also on an SSRI.
Lavender oil has been shown to work as well as Ativan for generalized anxiety disorder (
http://www.ncbi.nlm.nih.gov/pubmed/19962288), so it would probably be worth a try.  Or you could just try smelling some sweet orange essential oil (
http://www.ncbi.nlm.nih.gov/pubmed/22849536) when the urge to drink hits during the day.