Hello,

I wanted to keep this short, but that's difficult for me. I just registered today, and provided detailed information in my original post in the 'New user' forum, but have duplicated some of it here. I've taken Naltrexone pretty much every day since sometime last summer, supposedly to PREVENT cravings during my 'recovery'. I don't think I've been sober for even a whole week since. I knew nothing of the Sinclair Method until finding it a few days ago. My psychiatrist clearly doesn't either, as I was told to just take Naltrexone every day and NOT drink. I have several questions:

1) WHY NO EFFECT? - If I was taking Naltrexone every day, even if not drinking every day, shouldn't I have seen some effect? In reality, I've been "sneaking" almost every day since taking Naltrexone, because my family expects that I try to abstain. I believe the "sneaking" factor intensifies my cravings, because I feel compelled to drink secretly every chance I get, fearing I might not get the opportunity again. Could this sabotage results, since I'm still drinking in desperation? I guess I should also mention that I'm taking other meds for a mild bipolar condition - Wellbutrin and Lamictal, but they've never interfered with other drugs before.

2) HIGHER DOSAGE REQUIRED? - I've read some articles that suggest people react differently to Naltrexone, and increasing the dosage my help in some cases. One example I found was in Science Blog, but there are others I can no longer recall. Is it possible that I need a higher dosage, and since it is safe, would it hurt to try? FYI - I've rarely responded to drugs easily. If I'm in pain, I need 3 or 4 Ibuprofen when everyone else gets results with one or two.

3) HOW MUCH/HOW OFTEN FOR RESULTS? - Since I want this to work as quickly as possible, does the amount and frequency of drinking matter? Does the brain respond sooner if I drink more often at the beginning, and how much is enough to "count"? If I only drink once a week, could this still work in the typical 3-4 month period? It seems I'd have to repeat the ritual many times before results would appear. Right now, I'm purposely drinking some every day (I always want to, so I'm not really forcing it), because I want to kick-start the process.

4) DOES STILL BUZZED = NOT WORKING? - If I still get and crave the 'high' after strict compliance, is it not working, or do I have to wait longer to see results? I wonder why it hasn't had any effect so far, even if I sometimes took the pill without drinking. Should it matter so much that I sometimes took it several hours before (AM) that first drink (PM)?

5) WILL THE BRAIN FORGIVE BLUNDERS? - If don't take the pill, hoping/believing I won't need to, but then cave in, what if I can't wait an hour before drinking? If I've already blown it because I couldn't quench the craving, I need it NOW - screw the rules! Does it ruin everything if I can't wait an hour, or would it best if I take it "just in case" when I know I'm going to face a high pressure situation?

Sorry for the length, but I tried to warn you. I don't expect answers to all my questions, but I really appreciate the opportunity to put them out there. Bless you and all the others here that offer the support so desperately needed by non-AA types like me, who often feel there is nowhere to turn. Thank you SO much for your time and wisdom!

Hi KrazyKris - reply

1) Why No Effect ?

First off, the Sinclair Method - like so many treatments - is not 100 % effective. Sinclair tells us that there is a 12 % non-response rate. There is a possibility that the 12 % of those who do not respond are not addicted so much through the endorphin or 'opioid system' in the brain but that though other effects alcohol exerts on the brain and nervous system. For instance some non-responders are thought of as "GABA alcoholics" - which means they are motivated to drink not so much because of endorphin release but through a motivation to replace reduced GABA - a neurotransmitter that benzodiadepine drugs (like valium, librium, Baclofen) artificially raise in the brain. Another reason is that you say you have been taking naltrexone with drinking - not with abstinence! The Sinclair Method - see the book The Cure for Alcoholism - calls for only taking the medication an hour before drinking. Only that way can you achieve a slight degree of extinction (weakening of the opioid pathways and a reduction in the receptors driving the addiction) each time you drink on the medication. Your mention of the 'sneaking factor' may exert a paradoxical effect and be a 'trigger' for drinking. However, you stand an 80 % + chance of reducing the craving and actual drinking levels if you take your medication at least half an hour before drinking.

2) Higher Dosage Required?

This is a possibility --- you say that you normally need higher doses of medications for them to be effective. Most of the research has been done using 50 mg naltrexone and it is this dose that we get the positive results from. The maximum dose of naltrexone is 300 mg per day .... and for certain other conditions, like gambling, the dose has been 150 mg. Some people report better results with 100 mg / day but there are no decent data on this. It would not hurt if you tried but you should obtain approval from your prescriber before you do.

3) How Much and How Often?

You cannot speed up the extinction (biological de-addiction, weakening of the opioid system) by taking the medication and drinking more. It took months and years to learn or etch the addiction - the super-strengthened endorphin or opioid pathways into your brain) and it will take at least 4 months to extinguish (weaken) this system. Individuals respond at different rates. If you are deliberately drinking every day, make sure you take your medication a hour to 30 minutes (at least) before you do. If you do you will be complying with directions set out for Naltrexone + Drinking = Cure (3-4 months) and Naltrexone + No Drinking Allowed (Abstinence) = Failure.

4) Still Buzzed = Non Working?

Naltrexone is not a 'get sober' medication. You can still get 'drunk' if you drink on it. Never drink and drive or operate machinery even if on naltrexone. Naltrexone may block the 'first drink effects' (initial warm fuzzy sensation/lightheadedness etc) in many people but it certainly - for most - does not block the intoxicating effects. It is always best to take naltrexone 1 hour to 30 mins before drinking. In your case, if you took it in the early morning and drank in the evening then it is possible your particular metabolism will have washed much of the medication - hence its endorphin blocking effects - out of your body. You should NOT take the medication without drinking. This can 'upregulate' (supersensitize) the opioid receptors (billions in the brain) if you take naltrexone without drinking. Then if you do drink later without coverage you will receive an especially strong jolt of reinforcement from the endorphins released into your brain as a result of drinking alcohol thereby strengthening the craving and addiction - loss of control over your drinking.

5) Will the Brain Forgive Blunders?

No it will not. If you drink without naltrexone you will simply be reinforcing the addiction - getting reinforcement to your opioid system from the endorphins released each time you do so. The brain obeys the laws of biology - of reinforcement and extinction. Most people are able to follow the simple directions of taking the medication an hour before drinking. If you find yourself suddenly unable to control your craving and drink - then it is best to take the medication when you do. However, this is not standard. Sinclair's clinical trials are based on folks taking naltrexone an hour before drinking.

Best take the medication one hour before drinking.

(You may want to look up The Sinclair Method on Wikipedia: http://en.wikipedia.org/wiki/Sinclair_Method

or listen to an interview with Sinclair at:

http://www.youtube.com/results?search_t ... ethod&aq=f

under A little Known Cure)

Hope this helps.



I hope

Thank you for answering all of my questions! I am seeing my psychiatrist tomorrow to discuss increasing my dosage - I would just like to try 75 MG in case I might need a little more than others. However, since I wasn't taking the medication properly before (because I was given the WRONG instructions), I think it may have contributed to what I saw as no effect. Plus, if I also sometimes drank without taking Naltrexone at all (also since it didn't seem to be working anyway), then I imagine that I could have totally confused my brain by sending mixed signals. Sometimes I would be trying to reduce the craving, then at other times, I was inadvertently strengthening it. At any rate, I understand what to do now, and tracking my progress will also be helpful.

I just finished the book yesterday, and asked my husband to read it - he has gotten through a few chapters already. This is very significant for me, because if I can be honest with him, then I think the 'sneaking' factor can be diminished or perhaps even eliminated. Just knowing that I don't have to deal with the thought of 'never being able to drink again' - this will remove the desperation, and keep me from hurrying up and drinking in secrecy whenever I have a window of opportunity. It's such a relief to not feel like a loser because of deceiving my family! Getting my husband's understanding is the first step, but explaining this to my children will be another hurdle. However, it will be a whole lot easier with him on my side - I must say they trust him more than me when it comes to the subject of my drinking!

Thanks again for your help! I am so grateful for you and the support of all these wonderful people. Having hope again feels fantastic!

It should be noted here that it appears as though The Sinclair Method is working quite well for Krazy1 and extinction is beginning to set in.