I think you are both right, but I also think it might even be dangerous to think I'm totally in control. That is what I genuinely thought before I had the set back. I think we all have to be wary of the possible dangers of alcohol even when things are going well for an extended period.

Je,

I am still amazed at you and your progress. You came back and broke the cycle of self-destruction. I am glad to see you back with us, but I am sorry about your set back. You have the courage to admit you have stumbled, you have dusted yourself off and swallowed your pride and came back. Everyday is a learning experience for all of us.

I see great success in your future!


Jaba

Thoughts on timing, half-life, dosage, multiple drinking days and up-regulation:

Since recently having a spike back up in my drinking after I had been drinking controlably for a while, it's had me thinking about a number of possible explanations or modifications.

First of all, I know the golden rule is to wait an hour and drink, but the issue of how long the Nal remains effective afterwards seems a bit more controversial. Some people say you're covered for 24 hours, but I find this impossible to believe because Nal has a half-life of 4 hours! So after 4 hours it's as if you had only taken 25 mg in the first place. In my recent slip up I know for sure that I took my pill a bit earlier in the day than usual (since I was going out and about) and had drinks over a longer, more extended period of time. When I was having success, I was pretty much always doing my drinking within a couple of hours after taking the pill. This also brings up the issue of dosage. I haven't experimented with taking more than 50 mg but I might. It may not be necessary to have more than 50 mg in your system if you drink exactly an hour after taking it, but taking, say 100 mg, would help with the timing issue because 4 hours after taking the pill you would be down to the needed 50 mg!

Another observation I made of my recent increase in drinking was that I was getting more of a pleasurable, buzzed feeling again than I had been for some time. The timing issue could be part of this, but I have also noticed that when I drink 3 or 4 (or more) days in a row, the amount I consume gradually increases and I think so does the pleasurable effect. I mentioned that in a post once before and attributed it to 'tolerance' , but I'm also wondering if Nal starts to lose some effectiveness the more days in a row that you drink with it. I definitely drank a lot of days in a row before the heavy drinking returned. I came across this old article that almost no one responded to, but seems very relevant to me.
http://www.thesinclairmethod.net/community/viewtopic.php?f=7&t=3876&p=47581&hilit=upregulation&sid=bbc7351a04246df72b71d048217d845f&sid=a3ae765dc7b3484224d5b6682b624949#p47581
This might suggest that AF days aren't important just for emotional reasons, but because they help Nal be as effective as possible.

I'm just throwing out musings on a lot of topics here. I know we all want our TSM experience to be as effective as possible.

There's a lot of overthinking and puzzling over TSM around here. I'm not sure it matters what does you take, as long as you take it,

Having done this for quite a while, I see no difference whatsoever between 12.5 or 50 mg ( except perhaps less side effects ).

Drinking daily likely does lead to less effectiveness with TSM. You remain habituated to alcohol, which you are trying to solve by taking Naltrexone.

Half-life means that half the drug is gone in that allotted time, so After four hours, half the drug is gone, after another four hours half of what was remaining is gone. So it still is around for over 24 hours
I
I'm never sure how to articulate this, but the Eureka moment for me was to know that drinking less was good, and drinking mindlessly was stupid. That never happened until I actually drank less. There is no doubt that is by far the biggest factor.

Yes but it clearly needs to still be around in a large enough quantity to be effective. And if it didn't matter what dosage, why even take 50 mg?

A number of folks on here have discovered that the 12.5 works just as well, the 50 mg is somewhat of an arbitrary choice by the people doing the original studies.

When I drank daily and took 50 mg daily, I felt like absolute crap.

Again, a lot of this is subjective. It is a fact however, that there will be a larger amount of naltrexone around for a longer period of time at the larger dose. Since that is presumably blocking the opioid receptors, and diminishing pleasure, that could be a downside to a higher dose.

I know I feel much better if I don't take any at all for a while

Why indeed? Nal is applied in combination with oxicodone for pain killing without addiction at the Ultra Low Dose level (.05mg).

Je,

After reading the research on that thread a couple of things came to mind.

1) The research was done on rats. Even though our reptilian brain is responsible for our addiction, we have a choice and nal. helps with that choice. Example: I still have the desire to drink I know I need to stop and/or slow down without the nal. I would still be drinking heavy. Rats have no cognitive thought process.
2) One of the research was for an implant and how the rats respond. I think they were trying to figure out the dose on the time release pellet (this is speculation for I did not have full access to the report).
3) per drugs.com In one study the serum half-life in adults ranged from 30 to 81 minutes (mean 64 +/- 12 minutest).
4) per chemm.nlm.nih.gov. The mechanism of the action of naloxone is not fully understood. The preponderance of evidence suggests that naloxone antagonizes the opioid effects by competing for the same receptor sites. It continues to claim that nal. does not produce tolerance or physical or psychological dependence. And oral administration for opiates of nal. generally does not precipitate withdrawal unless the dose is over 10mg. Even a 30 mg oral dose usually induces only very mild abstinence symptoms. Limited studies with radiolabeled naloxone indicate that 25-40% of an oral or IV dose of the drug is excreted as metabolites in urine in 6 hours, about 50% in 24 hours, and 60-70% in 72 hours. I believe the excreted metabolites is saying the drug is still in your system, I am unsure if it is still effective; however, with opioid users they say 30 mg can help with very mild withdrawal.
One of the things that keeps on coming to mind is "the mechanism of the action of naloxone is not fully understood." The brain is one organ that baffles science. I did read that if a patient has a strong desire for al then increase the dose (I did not want to post it for I am not a doctor and feel uncomfortable suggesting anything like that) but here is the link for that.

http://adaiclearinghouse.org/downloads/ ... ent-85.pdf

I can feel and understand your frustration and I think we all want our TMS experience to be effective. One thing I have to remind myself everyday is nal. is a tool. Would I try to dig a ditch without a shovel? Only if I was forced to!

Your are in my thoughts and prayers,

Jaba

Je,

Another thing are you drinking through the nal? I didn't understand what that meant until I realized that was what I was doing. Someone posted here the nal won't slap that glass out of your hand and the light bulb came on!

Jaba

jaba, thanks for all of your comments about those articles. I realize there is a lot to be skeptical about in them, but I thought the idea of possibly having to increase your Nal dose after a period of regular use was an interesting possibility. Who knows? I do know that things were going very well for me and I wasn't drinking much or getting much pleasure from alcohol, and then seemingly all of a sudden I was drinking more and getting more pleasure from it. So I'm open to ideas. Hopefully because TSM was working very well before it will work well again with proper use. I've decided, just because I'm too curious not to, I'm going to increase the dose and have a drink or x and see if my perception of what it is like is any different. I've tolerated the side effects well from the start so I'm not too worried about that.