This topic, to me, is an outrage. I didn't realize until yesterday that we addicts basically have to manipulate or lie to our doctors in order to get a prescription for naltrexone. If we want to take nal while drinking -- the only way that it will extinguish our addiction according to the latest, most viable and accepted science -- we basically are out of luck with most doctors. It appears that the vast majority of doctors in the US, for some very warped and medically unsound justification, will only prescribe naltrexone if we take it while abstaining. And the studies ALL show conclusively that taking naltrexone while abstaining serves no purpose and is, in fact, counter-productive to achieving good health. This raises two HUGE issues:

1. What is the best way to get these doctors educated so that they can fulfill their Hippocratic oath and prescribe the most effective treatment for their patients?

2. In light of the reality that these doctors are hesitant to prescribe naltrexone period, what is the BEST authority patients can direct their doctors to in order for the doctors to feel comfortable prescribing naltrexone?

Eskapa's book is a good resource BUT there is no single study in it that clearly shows naltrexone should be used while drinking. The COMBINE study did not specifically address the issue of prescribing naltrexone with instructions to take it one hour before drinking. The best study I could find domestically (and I believe domestic studies are necessary; our doctors are going to quickly poo-poo studies that took place outside the US) is this one:

http://journals.lww.com/psychopharmacol ... ior.6.aspx

I would love to hear other people's thoughts regarding the above-two questions. This would appear to be the initial hurdle to opening up TSM as a viable option for a huge population that is currently being wrongfully denied access to a very effective treatment.

Nick -- There ARE studies that show nal + drinking is best. I got into some sort of battle to the intellectual death with someone over at MyWayOut on this issue, and I don't feel up to repeating that here. I think the very first annotation in Eskapa's biblio is a meta-analysis (i.e. a synthesis of a series of studies to extrapolate findings based on a pattern), which is quite valuable research.

There's a fascinating backstory here, st out in Eskapa's book (no time to find p#). Sinclair got a patent on his research in behalf of his employer, mainly to try to work w/ a pharmaceutical manufacturer to have input into the prescribing information. The pharama co. ended up end-running him and his patent by using prescribing info based on research other than Sinclair's -- in other words, the anti-craving instructions we see now. That left Sinclair to wonder whether his patent strategy -- calculated to spread the word about TSM -- backfired. MD's get their continuing education from pharmaceutical salesman and the PDR. We on this board must take up the slack, but not at the expense of our own well-being.

That may be an outrage, but it is what it is.

Nick, Lena,

Just the other day my psychiatrist gave me a 50 mg script for Naltrexone. I purchased my first batch online ($320). I went to see her 6 weeks ago and told her what I was going to do. I asked her to read up on TSM. She is very
open-minded and said she is a firm believer that one size does not fit all. When I went back to see her on Monday, I basically gave a synopsis of my posts here. While she doesn't like the term cure, she could not deny that I was better. She than agreed to give me the script and is arranging for a therapist for me who is not a 12 step, don't ever drink again guy. I hope that I am cured in a few months and that she will become a TSM promoter in the greater NYC area. I guess my point is that I was honest with her and it seems to be working out. However, I must say that one of the reasons I have been seeing her for 3 years is that she was never an 12 step fanatic.

Naltrexone + Drinking = CURE.

Best Regards,
Tom

Pre: 46 – 80+ units
Wk/Units/Craving
1: ...44 .....10
2: .. 40......10..2 AF
3: ...40......9...3 AF
4: ...31......9...4 AF
5: ...20......7...5 AF
6.....33......7...2 AF
7.....44......7...3 AF
8....in progress

I've got a brain storm (fart?). How about appealing to medical professionals who have a drinking problem, and who have not successful with 12-step programs? Offhand, I can think of one such local person. Perhaps some sort of article in a medical journal. Ad?

Thoughts?

G4M

it was probably a fart ! lol

I got my script by telling my Cenegenics Dr. about the program..I felt that he had some of the same issues from prior conversations,
after he read the book and requested some info on the clinical trials..he called me because he was so excited about TSM.

Most Drs are not as open as he is and you can bet the farm that none of them will admit to being in a 12 step program unless they
have absolutely hit rock bottom. In the end we have to do whatever it takes to get the script ..that's a shame and shouldn't be that
way, but it is. Due to the huge amount of monies at stake here w/ rehabs-ins-psych drs-pharm cos-etc. I doubt that we will see
TSM embraced as a "cure" in our lifetime. On the plus side, we know about it and can share this info w/others via this site as well
as one on one conversations with others and hopefully the wellness "thing" in Oct/Ca will reach some other people.

Take Care

I know my MD would be excited about TSM; he is supportive of me finding my own solutions to health issues. I also know I cannot afford to have any reference to alcohol dependence on my medical record. Someday that will change. [Oui, on peut.] Many on this site are in my boat. Many of us cannot share this journey candidly with a loved one, let alone a health care professional. We will join you when we can in spreading the word. Meanwhile, we will depend on our community here to share, and for those of you who can to spread the word as Tom and others do.

What many may not realize is that, with some of us, our alcoholism was caused by our employer's unreasonable expectations and coercion and there are many lawyers who would take our case if we asked them to defend us from our employer. Personally, I am not at this point now, but I would welcome the chance to tell the world about current business practices that cause such extreme stress that some of us who are genetically predisposed to alcoholism eventually succumb to. We would win. But unfortunately, we are ruined in mind and spirit, until TSM finally relieves us, with no thanks from our employers or the medical profession.

Bob

Hey mclanet0326, if you're still on this forum I would love to get the name of your doctor in the NYC area that I could contact who might be Naltrexone friendly.

Thanks!

Mfreetofly