The real issue is the lack of real world results that "we," as regular people, can take confidence in. There are results from clinical trials and research, but to date our "real world" example here with this community is not showing results that match the clinical trials and research. Unfortunately, none of the people from the trials seem to be into posting on message boards as none of them have come here to post results.

I'm not challenging the protocol, but I do feel there needs to be some clarification on the process and results.

I've often wondered about Naltrexone dosage. Does 50MG REALLY block 100% of MY opiate system given MY body chemistry? Is 50MG the dose that works for "most" people or is the dose that works for nearly everyone?

Q

I followed the link suggested and found the article very interesting. At the risk of getting attacked i would link to make a few points.
1. I am concerned lena when you chastise Mclws for his/her posting- it smacks of censorship. I've seen in other posts you and others talk about 'trusting the science' - yet when presented with other science you reject this. We are all adults on this board capable of making our own intelligent judgements of others postings and the information they contain. Frankly the tone of some of the posts which appear to reject any reflective questioning reminds me of the worst kind of AA people i've come across who tell you to follow the 12 steps, that the Blue Book is 'The bible' etc.

2. As someone else -Bob i think has pointed out elsewhere- all of us on this board are in fact participating in a 'living experiment'. Many of us do not fit the profile of the participants in the trials cited by Sinclair/Eskapa. It is well known that other pharmacological treatments have different effects on women than men so why not Nal? Women produce less serotonin than men; women have hormonal cycles that have profound effects on their mood and biochemistry. I have read that traditional alcohol/drug treatment programmes recognise that women are more prone to relapse immedietely prior to the arrival of their period. (and no lena i dont have the exact citation). Any woman on this site who has had the experience of intensley craving chocolate or wanting to do do violence to their spouse when pre menstrual will recognise our 'difference'! So if houtx who is feeling despairing about the lack of progress finds the info cited by our poster on differing effectiveness of Nal on men and women- wouldn't that be great! As to why Eskapa/Sinclair didn't mention this phenomenon in my experience lots of male academics don't think about gender as an issue for enquiry- the masculine is the norm and its only when women pop up and question relevence that 'gender' is brought in to the debate!

3. The article cited went on to make some interesting points:
"The purpose of Naltrexone is to suppress the intense craving to consume alcohol, generated by alcohol compromised brain chemistry. It is not meant to solve, for example, the legal or relationship issues which are often the result of alcohol induced behavior.
The fact of the matter is that Naltrexone will dramatically affect alcohol consumption. In effect, it forces individuals to face life, on life’s terms. It forces them to deal with the consequences of their actions. Indeed, the most difficult aspect of recovery is learning how to be happy without alcohol. Most alcohol dependent individuals are not well equipped to make the successful transition to sobriety. Even though the actual physical craving to consume alcohol has been suppressed by the Naltrexone, the need to return to drinking often overwhelms them. They have become dependent upon the alcohol to deal with all their problems. Unless they start to successfully address these problems, they will almost certainly begin drinking again. When this occurs, it is simple to blame the Naltrexone for “not working”. Naltrexone does not replace treatment or counseling. Its primary purpose is to create an environment in which an alcohol dependent individual is able to begin to make progress in his or her recovery.'
So as i read it we have a challenge facing us while reducing our alcohol consumption to also learn different ways of coping with our emotions and living our lifves, relationships etc.

finally i would like to make a heartfelt plea for people to be open

[quote="lena"]I've never read any such thing, and I've read a lot. Unless you have a credible source, I don't think it's useful to discuss. The primary goal of this board is to give positive support to one another. Unfounded suggestions that we may be on the wrong dose do not advance that goal.

I wasn't aware that the primary goal of this board was to simply act as cheerleaders! some of us may find reflective, intellectual exploration equally supportive!
I await the backlash!
SBTS

SbtS - I don't think there is going to be any backlash, just lively discussion and differing viewpoints.

After reading your post above, I was forced to admit to myself that as a male, I have not considered gender when considering drug efficacy. It had not occurred to me. After you made those statements, I even wondered about the gender of Sinclair's rats. Where they a mix of male and female; just male; just female; where they reproductively active? Since they were "used" rats, they may have no longer been fertile any longer. I don't know.

I don't think any of us here are in an ideal test group as you said. We each have one or more traits that make us less than ideal. I for one am in the benzo group and I think I am the only one here who has undergone aversion therapy, which has left me with only one beverage that I can drink without initiating a vomit response. Certainly, I'm part of the "living experiment".

On the other hand, cheer leading is important. It's something I wish I did more often here. I am more prone to worry and post that it's never gonna work with someone like me, than I am say to "well done" to H4O. I also, bring up non-TSM subjects such as baclofen and my half-successful aversion therapy. The point of this discussion group though, is to report on TSM and I believe it is the moderator's right to keep us on track with the main purpose of discussing TSM, although I think it should be pros and cons. And I think it should be anyone's right to question the source of a citation to determine it's validity. What abstract/paper/book/news article stated that women may need a higher dosage of Nal than men? Simple question; and there was an answer and a link. People can read it and decide for themselves.

Regarding Item 3, addressing the problems we have in out life without alcohol, or else we'll be driven back to drinking again, personally I find that concept self-evident. Face and deal with the hand you were dealt. If you don't or can't, you either will have to ignore the problem(s) and live with them or try to escape again back into drugs or alcohol. It is not Naltrexone's fault if we electively go back to escaping the world; that would be our conscious decision.

One last note. lena is not only a moderator, she is also a patient here as well and I think she should be allowed to voice her opinions here too. Maybe when she posts an opinion it would be good to state that it is opinion, so we would know that it is the patient and not the moderator speaking.

Bob

PS The above post was my opinion.

When I post, unless I say otherwise, I am posting as a member, not the moderator. I am mindful some readers are aware that I am a moderator and read my posts in that light. And on rare occasions, the line is blurred, such as my reply to mciws. If I feel like censoring, I have that authority, but I detest censorship. On the other hand, if I have a strong opinion I will not self-censor so long I am prepared to withstand criticism

We have just been through a reminder of some conflict we've had on the board, and in fact the post in question was "reported" by a member and I got expressions of concern from others. So when someone says, "I lied," it makes the hair on the back of my neck stand up, even if it clearly is sarcasm, which is how I read it. And I thought it a bit weird that the citation was dated the very day of his post.

Importantly, I also read this post in light of earlier posts by mciws, on the notorious "Magic Pill" thread, that I personally found, umm, well, judge for yourself:
viewtopic.php?f=9&t=413&p=4222&sid=06059e3e48a7e42ebedc67a5b616e11f#p4222

Mutual support ("cheerleading") is vital. Alarming one another with unfounded suggestions that we may be wasting months of time and hundreds of dollars when we are fighting for our lives is not. We've had enough of that here.

Dr. Eskapa has suggested variations to individual members based on specific circumstances. I'm sure readers identify with these circumstances and follow what Dr. Eskapa suggests. That is part of the value of this board. I for one am not going to vary from the TSM protocol based on a single, seven-year-old study unless I hear otherwise from Dr.s Sinclair or Eskapa. They one day may refine the dosing. The real-time brain scans Dr. Eskapa describes in the Wellness TalkRadio interview would be an invaluable tool for fine-tuning dose to ensure coverage of opioid receptors.

I don't agree that we are taking significantly longer than the test subjects. An average of three or four months will include outliers -- those who went much faster and those who took much longer. It's rather like our daily drinking patterns, with the spikes and surprise AF days. Check the google graph on mabelee's weekly progress. Those who start TSM and get fast results are unlikely to be hanging out on this board, even if they learned about it here, although I wish they would. So it's quite expected that we on the board would be weighted to the longer-term TSMers.

BTW, the rats did include females, and Sinclair noted they were unusually nurturing mothers -- apparently prone to that "Aw, the baby" endorphin rush Eskapa describes!

I notice WTE has posted the question on "Ask Dr. Eskapa", following the format in "Please Read Before Posting" format in the first post on that thread. We devised that format for the convenience of Dr. Eskapa and courtesy to the posting member. I'm anxious for his reply.

I am quiet "put off" by the critical and judgemental nature this forum has taken recently. If something I said is confusing or offensive, you could have asked me directly. I would gladly engage in a respectful dialogue. Please remember this is an online forum for sharing, these are simple "posts" and not dissertations. The tone of some of these posts, such as Nick from Minn. calling people "jerks" is an extra layer of drama that is not helpful to me. As such, I will step back for awhile. However, before I do I thought I should lay out facts of my case as there are probably many lurkers who may appreciate the results.

Background: I am a 20 year alcoholic (mid 30's now), four rehab stints, 2 DWIs and multiple other problems that are typical of alcoholics. I have had periods of daily drinking, some weeks of 24/7 drinking, but the last five years has been largely binge drinking 2-3 days per week (often consecutive). In the last few years, I experience physical withdrawal after only 1-2 days of drinking days and my body simply cannot keep up with my drinking. (I have actually considered this a blessing because it has forced me to have many AF days). My patter over the last 2-3 years is drinking 18-24 drinks per drinking day (sometimes more, rarely less). Also, over the last 3 years, a single drink lead to excessive drinking 100% of the time (absolutely no control).

Other relevant facts: I am a high functioning alcoholic. I have a graduate degree, professionally trained as a philosopher, and I am in biomedical research by trade. Also, I am a male in my 30's and I fit the profile of those who respond well to naltrexone (family history of alcoholism, attracted to sweets, exhibit anti-social characteristics, and although I do not know the type of opiod receptor I have, given my positive response to naltrexone, I believe it probably is the correct type).

History with TSM: Pre-TSM weekly consumption ranged from 45-60 units (U.S.) per week, 2-3 drinking days per week, average consumption per drinking day 18-24.

During my first few weeks on TSM I saw an immediate response. Although my total weekly consumption was about the same, my drinking days increase to 4-5 and my average daily consumption was down to 10-15 per drinking day. My pattern during the next few weeks was 3-4 moderate drinking days with one heavy drinking day. This is significant because in the past I never had moderate drinking days. I am currently on week 8 and my consumption over the last 2 weeks is as follows: weekly total 15-16 units, drinking days per week 3-4, average daily consumption 4.4 units. This puts me in the upper limits of moderate drinking. While I do not yet consider myself cured, I see a pattern and I am POSITIVE TSM IS WORKING for me. My approach to TSM has been: first, trying not to obsess about it (which alcoholics do well), pursue AF days in combination with endorphine producing activities (e.g. exercise), third, stay positive when I do slip up and have a heavy drinking day.

NOW---you "judge for yourself."

Don't try to control everything because this is when you lose control of youself.

Good Luck and Kind Regards,
MCIWS

Sounds good . Keep posting .

Thanks for the personal history. It's amazing that any of us are still as functional after all we've been through. I read somewhere in these threads of wisdom that those who have an initial honeymoon phase as you have had, are most likely to experience the full TSM response in time. So, great news! Your positive spirit helps too, from a practical viewpoint that it keeps us from giving up and letting the medication silently work in our brains.

And please, keep posting. I consider you as part of our family here and value your posts.

Bob

"Please remember this is an online forum for sharing, these are simple "posts" and not dissertations. The tone of some of these posts, such as Nick from Minn. calling people "jerks" is an extra layer of drama that is not helpful to me. As such, I will step back for awhile."

I sincerely apologize if I offended you. I have NO interest in stifling conversation on this board in any way, shape, or form. Please note, I have posted 87 times on this board in the past few weeks and it took me quite some time to find your lone "jerk" reference. But I did find one example of me calling someone a "jerk" in my prior 87 posts, referring to the guy who rejected Naltrexone as a "magic bullet." I should not have called him a "jerk" and I apologize if that one comment is turning you off of this board. I should have described the guy as someone clearly motivated by a spiritual agenda that I do not share and as someone who is arriving at conclusions that completely fly in the face of the evidence presented on this board. To me, that qualifies him as a "jerk", but you are correct: name-calling is entirely wrong in this setting and again I apologize for it. I won't do it again.

On that front, Q's post -- IMO -- falls into a similar category of being drastically off the mark when he summarizes the general success of the people on this board, claiming that most people are drinking at the same levels after 3 months on naltrexone. This is ENTIRELY FALSE. As I have mentioned previously, the people who tend to post the most on this board are frequently the people who are having LESS success using TSM. You have a very small minority who are not having much success with TSM posting multiple comments. Conversely -- and I went back and looked at MWO and this board when I started to add up the numbers -- you have several people who have huge success with naltrexone, post once or twice and are not heard from again. I AM ALARMED BY THE NUMBER OF NEGATIVE POSTS ON THIS BOARD, because many people, like me, first check out this site before trying TSM in order to determine if naltrexone is a hoax. And if they read posts like Q's on this thread, and don't look much further, they are very likely to discard the one treatment that could very well save their life! In fact, the success rate of TSM users on this board in drastically reducing their consumption is very high and tracks consistently with the 80% success rate of the studies. My offer to back up this assertion with concrete numbers was rejected by several people on this board so I didn't do it. But I did start an informal tally on my own and the number of people meeting with RESOUNDING success on TSM dwarfed the number of people seeing little or no progress by a margin of at LEAST 3 or 4 to 1 and probably more like 10 to 1.

Lastly, Lena has "censored" one person on this board -- a guy who was masquerading as an expert and was essentially giving out medical advice with no authority whatsoever -- never once qualifying any of his comments with "in my opinion" and worse yet, falsely claiming to be a "clinician." In other words, he was properly censored from the board. Lena, as moderator, is dealing with the very potentially troublesome issue of people essentially offering up medical advice that is at odds with the conclusions reached by Dr. Sinclair or Dr. Eskapa. She can be a bit harsh in her language at times, (IMO) but she always makes valid points and is clearly always motivated by her desire to make sure that TSM is practiced as prescribed by Dr. Sinclair. I, personally, see nothing wrong with any of her comments (outside of few rough edges -- no one is perfect). In fact, I find them to be consistently thoughtful, ALWAYS deadly accurate when summarizing TSM as written by Sinclair/Eskapa, and often resulting in valuable debate/discussion.

PS

I just re-read Q's post and I must admit I over-reacted to it. As I read on Q does say that TSM is working for most people so I apologize Q and should temper my response a little bit. Although I do think the conclusion that "most people are still drinking at the same pre-Sinclair numbers after three months" is considerably off the mark, as I outlined above.

Ya know what - it'll all be ok.

I must agree.

To quote Rodney King, "Can't we all..."

I can't remember the rest, but it was a great quote!

Bob