This is my first post here and I apologize if it is too long. There is a TLDR at the bottom.

Background/Intro:
I'm 25 yo male (born 1990) who has always been in good physical shape (racquetball, runner, soccer, cyclist and weight training). I had my first drink when I was 12 or so with cousins at a family reunion and became a regular occasional drinker (i.e. a few times a month) by age 15. By my senior year of high school (age 17) I was drinking heavily pretty much every weekend and sometimes during lunch with other "bad boy" seniors.

After high school, I went to undergrad in NYC, where my access to alcohol was pretty much unfettered in every sense - easy to obtain myself, no accountability (it's college - no babysitting) and a drinking culture. By my 3rd year (age 21) I was drinking a fairly large amount everyday - probably somewhere between 4 and 12 units on a weekday, with up to 18-20 on a weekend night. At this point I hadn't started bending (drinking as soon as I wake up) and my hangovers were never that bad (young blood!), but eventually my psychiatrist wanted to address my heavy drinking problem.

When I was 21 I started the Sinclair method with that psychiatrist and left school for a year to get my act together. After 3 months of naltrexone (I don't recall this part of my life especially well - which is why I'm posting here) I stopped drinking altogether and had 6 months of blissful AF sobriety during my leave of absence. I came back to school ready to finish on an upswing (I had destroyed my GPA with my alcoholism - coming in an hour late to 2 hour exams on a regular basis, not doing my homework, skipping classes, etc). After quitting for 6 months, I started drinking very moderately while still on my medical absence, before going back to school (1-2 drinks on 1 or 2 days of the weekend). I tried to continue the same pattern at school, but unfortunately I could only hold on for so long with the way my friends used to drink. Eventually, by the time I was ready to graduate, I was back to heavy daily drinking with the new found phenomenon of bending - drinking first thing in the morning and continuing to drink all day for multiple days at a time. My acceptance into a fully paid PhD program only exacerbated my drinking and I basically fell into my old habits during my last semester of undergrad.

The summer after graduation I struggled with my drinking - I had a lab internship for the summer and had regular 9am meetings with my boss and I lived 1 hour away from work. Some days I would have those meetings and I was still drunk. My girlfriend and I at the time used to fight a lot about my drinking as it was very out of control that summer. I continuously looked forward to the end of the summer when I would be moving to southern California for graduate school and naïvely thought that my alcoholism would disappear once I was in a place with better weather, nicer people, cheaper food and cheaper housing. I felt that I drank because NYC weather sucks, the people were mean and living was such a struggle.

Unfortunately, as soon as I arrived in graduate school, I gravitated towards the other boozers in my department and my drinking continued to spiral out of control. I've had a few sober days since I started my PhD program, but I guarantee those days number less than 60 (and I have been in graduate school for 2 years now - 730 days!). In a deep despair about my drinking, I went back to a psychiatrist a year ago and was prescribed naltrexone. I sobered up for 5 days and then started taking half a dose (25 mg) and much to my chagrin I woke up in the middle of the night and was vomiting for hours. It was miserable - I did not remember my first time as being so painful. I mustered up the courage again and tried it a second night only to be met with the same nauseating results. After those two failed attempts, I stopped taking the naltrexone, reasoning that it was just not worth it given the nausea and told myself I could handle my drinking. Boy was I wrong.

A few months after that, I started drinking heavily - I broke up with my SO and spent a year being single because I felt so jaded about my failed experiences with love, most of which were a result of my drinking . My realization about why my partners had left me - so many had given me the opportunity to change but I just never could, mostly because I didn't want to - exacerbated the problem greatly. Eventually I started drinking a fifth a day and if there's anything you should know anything about graduate students, it's that we are strapped for cash. I was drinking the nastiest cheapest bottom shelf garbage I could get my hands on. I started drinking 12 packs with strangers in front of liquor stores. I would skip days of work to go on benders with drifters and strangers. About 9 months ago I woke up at my friend's house with a pounding headache, still drunk, soaking wet from the rain with my bike at my feet, not knowing how I got there. My friend told me I had come to his house and drank nearly two fifths in front of him while espousing all sorts of unintelligible vitriol. He said he watched me choke on my vomit as I slept and turned me over. I didn't drink the day after that and went back seeking treatment. I decided I wouldn't take naltrexone or any other medications and would started CBT again which had helped me when TSM had worked before.

After 8 months with little to no success in CBT (2 3 day AF streaks, 5-6 single AF days), I decided with the support of my psychologist (who obviously cannot prescribe and is untrained in how it should be taken) that I would start taking oral Naltrexone again. However, due to changes in my insurance, I can no longer see the psychiatrist that prescribed the Naltrexone a year ago. Since I only took it twice back then and refilled the RX twice, I have about 60 50mg pills lying around, which I intend to take as they are not expired. The primary care doctor I have been seeing since I arrived in SoCal has been very unsupportive of me taking Naltrexone, telling me he doesn't prescribe it and begrudgingly ordering my liver panel because I told him I WAS going to start taking Naltrexone and that if I got sick or something it would be on him for not listening. Patients should have a say in their treatment. He preached abstinence but couldn't understand the resentment and FOMO (fear-of-missing-out) that many alcoholics experience in the first months to years of an abstinence regimen. He also didn't seem to understand how unsuccessful abstinence is for true alcoholics or the fail rates associated with it.

Anyways, that's my story and I'm sorry to the moderator if I've posted this in the wrong place - I know this is a lengthy post, but I do have a question:

I've started taking the Naltrexone again but I couldn't manage to get in any sober days before starting which I read in a study (O'Malley et al., 2000) greatly reduces the nausea associated with starting naltrexone.

I started out by taking 1/4 of a pill and I was able to tolerate it decently the first night (3 days ago) but still felt generally nauseous. I'm wondering if after tonight (the last 1/4 of that divided pill) I should try taking a 1/2 a pill. I've already noticed a decrease in cravings although I'm aware that this could just be a placebo effect - maybe someone can chime in here - but I'm not sure if 12.5 mg is even enough. The nausea from the second reboot a year ago was so bad that I missed 2 days of work/school which is what I'm trying to avoid doing again. So far on 12.5 mg I haven't missed anything and feel okay in the morning, just more tired than usual - another side effect I don't recall from before. If anyone has a good titration schedule or method to recommend for people who are easily nauseated, please post it below.

TLDR: I've taken naltrexone before, have a history of heavy daily drinking and am looking to mediate the nausea side effect with a good titration schedule that is still effective.

Sorry for the rant and I'm excited to have found these forums.

Works Cited

• O'Malley, Stephanie S., et al. "Naltrexone-induced nausea in patients treated for alcohol dependence: clinical predictors and evidence for opioid-mediated effects." Journal of clinical psychopharmacology 20.1 (2000): 69-76.

ttc,

I am sorry, I have skimmed over your post and will answer you more tomorrow (tired and hard time reading). But, I wanted to tell you welcome. I think I have the main theme of your essay and I want to tell you that there are other people here that have stopped and come back. I will try to find their threads and maybe you can reach out to them. I do remember someone else complaining about the side effects being less tolerable this time around and I will try to find that out who posted that. I did read some where to eat a small meal or a snack about 1/2 hour before taking the nal. I always take mine after dinner, or a copy hours after lunch (I eat lunch late).

You may want to look at the c-3 forum and/or options saves lives. They have a list of doctors using TSM, and that might be helpful. I hate hearing how closed minded doctors can be, and I have ranted about it in others post. Unless your doctor has or had a problem with al. they will never get it!

I do hope you will hang out and post your progress for we all really like reading how this process works with others,

Jaba

Hi there ttc - and welcome. I agree with Jaba - take the lesser dose until your body gets used to it - if necessary, dissolve it in water and take the lesser amount that way - it dissolves in water in about an hour. That way you can take really small amounts which then hopefully will get your body used to it and you will not have the horrific SE's. Steve takes Low Dose Nal and finds that it is enough for him, so it could be that the 12.5 is enough for you. And I would not worry about the AF days before starting Nal - if we could have AF days at will, I personally do not think that we would need the Nal that much! It is only after being many months in that I can have an AF day at will!

Keep posting and let us know of your progress - also we find it really helpful to track your drinks - are you doing that?

Hugs, Maggie x

ttc,

Okay, I have read your entire story...WOW! I have lived with someone like you and I am so glad that you realize your trouble is the al. (my guy thought it was me and not the alcohol). If you need some encouragement please read Generic's thread I reposted in general discussion. When I read that it brought flash-backs of my life with that boyfriend. Generic became cured. It did not happen over night and he did have a struggle to get where he is today. Generic also stated that coming back here is a reminder of how he would be if he ever stopped taking the nal. For it is a life time commitment!

I did find the person that has started again and is now having issues. It was bepresent and he/she posted in the cure section. If you want to you could send them an email because I have not seen them post in a while. They were experiencing nausea and headaches that lasted 2 day after taking it and they never had any side effects before. Also Retread came back for a second round, I did not read any of his issues with side effects, but newlife said that it took him 9 months to gain control again. I do not think anyone would mind if you reach out to them and asked questions. I think we all want to see others succeed in this process.

Now my questions for you:

How much were you drinking before you started on the nal?

Is it possible that you are not drinking enough and you are having withdrawal symptoms?

You said you started TSM, but you stopped drinking when you started it?

Have you read the book? (if not I can email you the pdf file).

Are the side effects so severe that you would rather be drinking?

The good news is that I do not believe that the decrease in cravings is from a placebo effect, I think it is the honeymoon phase.

I did start out with 1/4 a pill and worked up to 50 mg. There are some people that are fine taking just the 1/4 of a pill; however, protocol is 50 mg and since you are an all day drinking (I am assuming) I would advise you to try to work up to that amount.

I think I did read to avoid side effects take with a meal or snack start 1/4 a pill for three days or until tolerated; then increase to 1/2 a pill for three days and then a hole pill. If the hole pill is not tolerated, to go back to 1/2 a pill for a longer time until you feel comfortable in increasing to the full amount.

This coming up weekend would be a good time to up your dose since it is a holiday. I think the average time for side effects is about one month. I did look at the study that you cited. I could not read the entire study, but it looked like the female subjects complain about the nausea the most (I thought that was odd). I still would like to know if the nausea is so bad that you would rather drink? For me, I would take a little discomfort to become in control of this screaming demon. I am so sick of that FED ME! FED ME, NOW! from my booze brain!

Hope to see a post soon from you and remember to wait that hour,

Jaba

(Please remember I am not a medical professional and I am merely giving suggestions. Any medical questions should be directed to a physician or a medical advocate of TSM. If you do not have a physician to consult the c-3 or options saves lives can help.)

jaba,

Thanks for the detailed reply.


I'm sorry you had the unfortunate experience of dealing with a partner who was a boozer that couldn't admit it. I've unfortunately been aware of my problem for years and have struggled with managing it for just as long, as I mentioned in my initial post.

To answer your questions and get more help:

I was drinking about 3/4-1 fifth per day, sometimes a little less, sometimes a little more. Probably somewhere around 60-80 drinks per week.


I suppose, but usually my withdrawals from alcohol involve lots of crippling anxiety, lack of appetite, sweats and shaking. This past week I've only gotten very nauseous about 1-2 hours after taking 12.5 mg. I still haven't decided if I'll take 25 mg when I get home tonight. I might take 18.75 mg (3/8 a pill) because I still felt pretty nauseous last night, my 4th night of naltrexone


The first time I was prescribed Naltrexone was 4 years ago or so and yes after 3 months of treatment I completely lost interest in drinking and was able to stay sober for 6 months without naltrexone after that. So that means I had 3 months of moderate to light drinking on Naltrexone, and then 6 months dry. After those 6 dry months I was able to keep drinking moderately for 2-3 months, so almost 1 year in total of moderate/no drinking. This is my 3rd time taking Naltrexone, but only the second time being prescribed it (I was prescribed Nal a year ago but quit because of the nausea and am trying to work through the nausea again).
I realize my first post was kind of wordy and I didn't proofread - I will go back and fix that later tonight so it is more clear to others.


No, I have not read the book. I assume the book you are talking about is "The Cure for Alcoholism: The Medically Proven Way to Eliminate Alcohol Addiction" by Eskapa, Christian and Sinclair? Yes, please email me the book. Is there a way to PM message on this site? I can give you my email that way.


I'm not sure what you mean by this - would I rather be drinking than feeling nauseous? Yes definitely. Would I rather be drinking to the point of nausea? No. Would I rather be drinking heavily while feeling nauseous from the Nal? Definitely not - when I feel nauseous from the Nal I have almost zero desire to drink because of the nausea - it'd be like drinking after going on a merry-go-round or sailing on choppy seas. Barf. Would I consider stopping the Nal because of a few days of mild nausea? No - that is no longer an option for me. Alcohol is destroying my life, including but not limited to: personal goals, workplace achievements, intimate relationships, family relations and friendships.


What was your titration schedule? I feel like I might throw up tonight if I bump up to 25 mg even though I've been on 12.5 mg for the past 4 days. Will give it a shot anyways and update tomorrow. I didn't take my Nal with food yesterday, so that may be why I felt so ill yesterday.


This weekend being college football, I have some plans to drink with another grad student at his apartment. Because of this, I probably won't be experimenting with taking the 25mg on Saturday (9/5/15) night opting for 12.5 instead, but may try it on Sunday (9/6/15) and Monday (9/7/15) as well as tonight (9/3/15) and Friday (9/4/15) night. I will be going to a booze-filled academic conference next weekend which is what I'm really worried about. Hopefully by then I will be able to tolerate at least 25mg of Nal...

Also, jaba, if you want the full copy of the study I can email it to you as a PDF if you are interested. I understand you might not be interested since you've already started Nal and been on it for some time, but it never hurts to know more.

Maggie,


I see many people's signature has some kind of record of their drinking and alcohol free days but I don't know how to read them (i.e. what the numbers mean). What is a good way to keep track of your drinking? For me, since starting the Nal, I've drank:
Night 1 - 1/2 a bottle of wine + 1 25 oz can of rolling rock
Night 2 - 1 24 oz can of PBR
Night 3 - 1 25.3 oz can of Foster's
Night 4 - 1 22 oz bottle of Blue Moon

Looking at those numbers, which are much less than I was drinking before, some of my symptoms may be partially related to withdrawal, but I think that 4 days in those symptoms should be nearly gone. Maybe you (Maggie1929) or someone else can chime in on that (jaba).

Thanks a lot to both of you. Giving me hope!

Hi there - with my signature for example, wks 1-4, I have 1-4 - 37,32,28,29 /0 which means that I drank 37 units the first week, 32 units the 2nd, 28 the third and so on - the /0 means I had no AF days! Most of us here use US units - if you Google US drinking units you will get to a page that will tell you how many units your particular drinks are - I am lucky as I never change my drink - I drink Guinness and I know that a can is a US unit. I find it really good to track my units so I can see how my progress (or lack thereof) is going. US units are different to UK units though so be sure that you are on a page that gives you US units.

I would stay with the 12.5 mg until you do not have the SE's - there is no race - it took you a long time to get here and another extra week or two is not going to make a huge difference. Some folk find the 12.5 is enough to work for them. You were so lucky that last time you tried Nal, that it worked for you after 3 months. Hopefully the same thing will happen again. Did you start drinking without using Nal after that? If you read the book you will find that for the rest of your life if you have an alcoholic drink, you MUST take the Nal - otherwise the pathways will be opened up again and you will be back at square one. Once you have read the book you will understand it much better .....

At the bottom of each persons post, when you are signed in, there are three options - PM, e-mail or something else which I forget right now - click on one of those and you can contact any of us.

Good luck to you, Hugs, Maggie x

P.S. Before you get the book - the Golden Rule is that you NEVER EVER drink unless you took the Nal an hour at least before drinking ......

P.P.S. I have e-mailed you the book ......

Thanks for the run down! It all makes sense now... I was mostly confused by the /# - wasn't quite sure what those meant.



Yes, after I was "cured" (of the cravings only I suppose, not the predisposition to drink) the last time I was on Naltrexone, and was sober for those 6 months, I began drinking without Naltrexone. This makes sense to me that the pathways would be reopened again. At least I know that Naltrexone worked for me in the past, so it should work for me again in the future. I haven't come across anything in the scientific/medical literature that discusses people who have started Naltrexone, achieved sobriety, and then relapsed after a period of time. Maybe I can provide an anecdote for others in a similar situation over the next couple of months while I attempt my reboot.

Thanks for the quick reply and for sending the PDF. Much love.

Thanks Maggie,

I stepped out for a moment and there is a message!

ttc,

What I was asking about the nal. is because I suffered though the nausea because I new it was my only way out. I felt nauseate for the first week or so, and my drinking was down because the desire just wasn't there. And I forgot about that football is starting...my husband just had the playoff games on when I got back. I would stick with the 12.5 mg. But remember if you need medical advice you can go to the options saves lives website and one of the moderator maybe able to actual tell you hints that may help.

I started with 12.5 for 5 days and then I went to 37.5 mg for 4 days and then 1 went to the entire pill I believe. I look at my calendar and I was on another medicine I need to track as well so I can only tell you that I tracked the 12.5 and the 37.5. I knew that I went to the full dose after that because my goal was to get to that point and I had no other reason to track it.

Please keep posting and remember we are always here if you need anything,

As far as the withdrawals goes, I would have to say no. You are experiencing the side effects from the nal.

Jaba

Thanks for all the replies. I just took a 1/4 pill again, as I was still nauseous last night. I will be going to my friend's house for a beer in about an hour which will be the first time I've taken Naltrexone and drank socially/in front of someone since starting on Sunday. I made sure to make dinner first so I could take the Naltrexone with plenty of food and water.

I also found this super useful webpage: http://www.ncbi.nlm.nih.gov/books/NBK64042/

It has lots of simple and useful prescribing information:

I read some useful info regarding my prior use of Naltrexone and subsequent relapse. It seems I should be fine:


I also read this concerning nausea. I won't increase my dosage until the nausea is gone, which is what I believe maggie1929 and jaba both advised:

TTC,

That might be were I read that, or the options saves lives website, or both. I do a lot of on-line research, for I am a bored stay at home mom, and I have been out of the work force for 15 years(I like the title domestic sex slave, but my husband won't allow me to put that for my occupation with the I.R.S. something about they have no sense of humor...).

I am glad you are finding the help that you need. Think about starting a post in the "progress" section. I think your post is missed being in this section, for there are a lot of good people on this forum. We are all at different stages. As you noticed, I do not list my time or drinks. Time is irrelevant to me and, even though I am forcing my amount down, to me it's more about the booze brain screaming. So, I am finally able to get 3 af days, but my brain is still screaming, or I can have 8 oz. of wine and my brain is still screaming...you get the picture. The nal. has given me the "control" to stop, and/or fast, but I want the screaming booze brain to quit, and until that time I am always going to have the fear of backsliding (I am afraid of everything).

I do hope that you stick around and start posting a progress page. I think it will be very helpful to others that have left and are afraid to come back, or others that want to come.

Remember to take your nal. and wait that hour and try to do some mindful drinking,

Jaba