75 mg is indeed useful for some people--I didn't see real results until I stepped my dose up, and I felt cravings come back when I experimented with dropping it back to 50. I'm not a big guy either.

That said, if you're drinking to self-medicate, the dosage isn't necessarily the problem. Other than my dosage issue, I had a very successful traditional TSM experience (I just lost most of my interest in drinking, and dropped the habit without active effort). You might not be able to break your own habit until you change your circumstances otherwise. It's good to hear that you're in therapy; is the person you're seeing a psychiatrist? Does she know about TSM?

can you give an update on the 75mg? My guy is 3 weeks on the 50mg. He noticed a difference the first week, but after that it seems nothing at all...

Love my man,

His honeymoon period is over. His units of drinking are probable picking up and they will decrease in a couple of weeks. Right now he is chasing that "ah" moment that alcohol (al.) is not giving him. Now He and you need to relax and let the naltrexone (nal.) do the work.

We have all been there, and actually I first posted here because I had a nal. over (worse than any hangover for me), and my units were up which scared me (which I am sure that you both are right now). But this is perfectly normal.

1) He needs to start tracking his al. intake if he hasn't done so yet

2) Make sure he waits that entire hour before he drinks

3) try to drink as slow as he can with those first 2 drinks, and if he can drink water in between those drinks it will help

He needs to work on mindful drinking now (actually slow drinking will let you feel the drug working). It will take time and some will take up to 8 months or more, so please give it time. I would not even thinking about upping someone dose without consulting a doctor, and I wouldn't think about talking about it with a doctor until he is past 10 months.

I do hope this answered some of your questions, and if anyone else can think of something I missed please chime in,

Jaba

thank you so much, Jaba.
I have read other things you have written in different threads on here that have been helpful as well.
He is under a Dr.'s care so nothing is being done without the doc writing the script.
He has not started tracking his drinks yet, I saw a chart the Badger uses, do you or anyone have anything in particular that you like? I can print him a simple sheet-he's not a computer guy. Someone mentioned an app that could be used for this purpose? He would do that.
His units/drinks have definitely been picking up, as has his irritability. I suppose that is the chasing the high that he isn't getting.
He is great about taking the nal exactly one hour before he drinks, but not drinking slow. That first tall Budweiser goes down like a glass of water, and the second and third too. His habit is to start right after work so he can drink on an empty stomach. Getting him to eat after that isn't easy, but when he does he is less sloppy.
This forum has been so helpful. I have been reading for months but just registered last night. I suppose I expected quicker results based on some people that noticed a big difference within the first month.
It's taken him years to get here, he was a cocaine addict before he became an alcoholic, and was able to kick that one on his own.
I would also add that he has no intention of quitting (abstinence,) but to just get it under control and to be able to drink in moderation rather than excessively every night.
He's in the middle of his 4th week. Patience, patience, patience.

Lovemyman,

If he has a smart phone there is an app for that. I have an old phone so I don't have it; however, I think if you go up to the search area in this forum put in "app or drinking app" you can find where someone posted it, or just google it (for google is my friend).

I am proud to hear that he kicked that cocaine habit, for that was not an easy task. It is good that he is aware of addiction and the process of how hard it is to break which is a good thing and this may be a lot easier. One thing you might remind him is that the nal. is a TOOL, and he will have to put some work into it. I think it took me 3 nal overs and about 16 weeks to realize I needed to slow down my drinking; however, I think slowing down the drinking is key. Some people disagree, but I have read and seen that once the drinking is slowed down it does help you feel the nal.

Do not be alarmed if he does "drink through the medicine", for it does happen to some. He can still get drunk, and when he does the next day he might feel awful. And I think a lot of people get grumpy on this medicine, and it is a side effect (I know I can, but it could be combined with my hormones).
I think having him use H.A.L.T. (hungry, angry, lonely, tired) in this process might be helpful. He might have used it trying to kick cocaine. Hungry sounds like a trigger for his drinking, so ask him to eat something even if it is just a protein bar. He still needs to drink to help extinct that trigger from his brain, but he may be able to drink less. The book will also ask to track your desire or craving, and that can be helpful to see if his still thinking about drinking all the time.
If you haven't read the book please do. There is a link in the forum that is free, I have it PDF file on my computer and go back to it for reference. There is a chart in the book you can print out.

I think we all want to keep on drinking, for that is how the world is, and that is why we have turned to this process! If you need more support from others, you can start a log on the spouse page for it can be very helpful. I just noticed a new name on the side and saw your question.

Hopefully someone can chime in with more advice,


Jaba

I will see if I can find that link to the book and post it; however, I am not that computer savvy.

I hope this link works for the book


https://www.dropbox.com/s/60fs7gmvbyzs1 ... m.pdf?dl=0

Jaba,

thank you SO much! everything you have mentioned is SO helpful.

I have read the book, and have it- but your link worked so I can print that page easily!

I will definitely go on, and have read, on the spousal support pages. I want to have a clear understanding of experiences and what it FEELS like so that I can be more empathetic to what he is going through, so I find yours and others that have been doing TSM experiences to be a true education. I can't know exactly, and no two people are alike, but this is so informative.

Going to google now!

lovemyman - just wanted to say welcome and sorry that you are going through what you are going through - great that you are standing by your man though! Jaba is wonderful here and is so helpful to many ! She is great with research and also just answering posts - I will try and answer some of your questions ..... I think the drinking link is called Alcodroid - something like that anyway if he has an android phone.

I also totally get the drinking the first drink down quickly - I STILL do that and have been on Nal for nearly 9 months - so please do not expect miracles from it. It is a long slow process ! Nal is not a magic pill - it takes time and motivation! For the first few months, just drink as usual - then one has to start working on it too - I am still a Work In Progress !

Hugs, Maggie x

Maggie- thank you so much for your note, and for sharing your experience. As I keep reading I have found more information about benzos and nal. My man takes klonopin for anxiety and I wonder if this might be interfering and enabling him to "drink through" the effects of the opiod receptors the nal would be covering. (Not sure I phrased that right.) After reading a few posts I have asked him to make sure that he doesn't take the two close together, I'm not sure we're going to get them a full 4 hours apart just yet-but maybe. His compliance with the one hour before is awesome.

It's still so early, I don't want to expect too much, but since I am "the coach," I want to be giving him correct information.

I found the app-he does have a droid-THANK YOU. I'm going to play with it and make it as simple as possible so he can start tracking.

There is SO much on here, and I really appreciate any and all info.

Do you still have the graph/spreadsheet that that Badger sent you? would you mind sending that to me?

Thank you again.

Lovemyman,

Please talk to the pharmacists about the benzos and the nal. I just sent retread a link to alternative drugs that may help, and I will try to post the link. Retread thought his lack of progress may be the cause of the benzos, and I would hate for your husband to slow his progress because of those. Since the link didn't work here is the info. I think the pharmacists would be able to tell you if the klonopin would affect the receptors that the nal. is supposed to block, or cause a problem with his progress. The pharmacists may need a lesson in TSM, but should be able to get the concept enough to help you. I admire how much you are trying to help your husband, for not every women stands by her man...most would get tired of it and kick them to the curb. Kudos to you...and I hope he appreciates all that you do and put up with (for I know it's not easy).

Question:

As a primary care provider, I frequently need to treat anxiety and do not have the "luxury" of referring patients to psychiatric specialists. However, I am somewhat uncomfortable with prescribing benzodiazepines because of their potential for addiction and abuse. Can you provide some insight and guidance for nonbenzodiazepine anxiety management?


Response from Richard S. Ferri, PhD, ANP, ACRN
Lead HIV/AIDS Adult Nurse Practitioner, Greater New Bedford Community Health Center, New Bedford, Massachusetts
Anxiety is a common condition and often requires pharmacologic treatment in the primary care setting. In addition, waiting for a specialist referral is not always a realistic option. Your concerns about the abuse potential with benzodiazepines are valid and well documented.

This column will focus on medications for anxiety management. However, behavioral interventions are key to anxiety management and should always be incorporated into the care plan, even when medications are being prescribed. Very few medical conditions are cured or controlled by pills alone. Mental healthcare, just like physical healthcare, has no one-size-fits-all treatment.

In the primary care setting, clinicians see anxiety associated with depression, acute anxiety owing to sudden life events (death, job loss), and other anxiety disorders. The use of benzodiazepines, such as alprazolam (Xanax®, Pfizer, New York, New York) or clonazepam, is worrisome, because they are notoriously habit- forming and the dose must be increased to achieve the same effect. Benzodiazepines can also relax social inhibitions that may increase a patient’s risk-taking behaviors.

Anxiety can be managed pharmacologically, without automatic benzodiazepine use. Selecting an agent that can produce a fairly quick reduction in anxiety symptoms is crucial. Antidepressants, antipsychotics, antihistamines, beta-blockers, and anticonvulsants all have demonstrated efficacy in controlling anxiety.

Virtually all classes of antidepressants can be prescribed to treat anxiety, but these agents generally require 2-4 weeks to become effective, so you may want to use faster-acting agents during this period to stabilize the patient or prescribe a short-term benzodiazepine for acute anxiety episodes in the interim.

Antidepressants are divided into several classes depending on the mechanism of action. Fluoxetine (Prozac®, Eli Lilly & Co., Indianapolis, Indiana) is a selective serotonin reuptake inhibitor that increases serotonin levels in the brain by reducing serotonin loss. Another class is the serotonin norepinephrine reuptake inhibitors, such as venlafaxine (Effexor®, Pfizer), that promote increased levels of both serotonin and norepinephrine. One of the oldest classes of antidepressants is the tricyclic antidepressants, which primarily increase norepinephrine levels in brain tissue. Examples of these antidepressants include amitriptyline, doxepin, and imipramine. The monoamine oxidase inhibitors are the oldest class of antidepressants; these drugs elevate serotonin, norepinephrine, and dopamine by inhibiting their degradation. They have numerous food interactions that can lead to critical a hypertensive crisis and thus should be prescribed with extreme caution.

Atypical antipsychotics, such as aripiprazole (Abilify®, Bristol-Myers Squibb, New York, New York) do not usually produce the worrisome extrapyramidal side effects seen with typical antipsychotics, such as haloperidol (Haldol, Ortho-McNeil, Raritan, New Jersey). Atypical antipsychotics may have additional benefits if fear and agitation are present secondary to psychotic experiences, such as delirium.

Antihistamines can also be used to control anxiety. Their effectiveness is believed to be a consequence of their sedating properties. For example, hydroxyzine (Vistaril®, Pfizer) provides quick relief of anxiety, especially if the patient has symptoms associated with obsessive-compulsive disorder.

Low-dose beta-blockers, such as propranolol (Inderal®, AstraZeneca, Wilmington, Delaware), can help with sympathetic somatic symptoms, such as sweating, tremors, and tachycardia. Potential adverse effects of beta-blockers include light-headedness and orthostatic hypotension. These drugs should generally not be used in patients with chronic obstructive pulmonary disease, cardiac conduction defects, or heart failure.

Anticonvulsants, such as gabapentin (Neurontin®, Pfizer), are believed to work by reducing neuronal activation in the brain. Reducing the potentiation of certain neurotransmitters, such as gamma-aminobutyric acid, can mitigate anxiety. However, the mechanism of action of anticonvulsants is not fully understood and it is believed that they may affect several different chemicals simultaneously. Evidence is also emerging that "gabapentin abuse" by people with the disease of addiction is growing. The feeling produced by inhaling or "snorting" gabapentin has been described as a "laid-back" feeling, and it has become a popular drug of diversion in correctional settings where access to illicit drugs is limited.

Numerous options other than benzodiazepines for anxiety management are available. Clinicians should familiarize themselves with these medications and ensure that benzodiazepines are used appropriately.