I started last Thursday but the second Thursday tomorrow will be hella busy for me so thought I'd kick this off with a short summary of week one.

So far, it's all about the nausea.

I started with 25mg for two days, went to 50 mg for a few days, and went back to 25 mg last night. I have to be 'on' for the next couple days with some public speaking and whatnot and really did not want to have to deal with nausea on top of that, but it looks like I'll just have to muddle through. The choice was to wait until after this weekend was over to start with NAL but I've waited too long, there's always an excuse, etc. So onward ever upward.

I take my NAL at 4:00 pm. My nausea does not seem to come while drinking; it is mostly during the day (in waves). Strangely, I probably feel best in the hour or so after taking the NAL. Weird. Eating also makes me feel better while I'm actually eating, but then the nausea returns an hour later or so.

I surely hope that I eventually become acclimated to NAL and that this queasiness becomes a thing of the past.

Since this is my first week and I'm willing to take the long view and not get excited about numbers until late in the fall, the numbers are probably meaningless at this early juncture. I love graphs, so maybe once I hit the first month I can start charting daily/weekly numbers for trendline purposes.

My total units even before TSM are not astronomically high (35-45 or so, US ), but higher than I want them, and it's an everyday thing. I start at 5:00 or so and then proceed until I've at least finished a bottle of wine or had three beers. (The beers seem to fill me up in a way wine does not. Although I tend to prefer wine.) My goal like many folks is to simply get to safe levels for long term health.

Since my drinking is pretty much constrained to between 5-10 pm, I'm hoping that staying at 25mg for a few days or so will be both effective and allow my body to acclimate to the NAL.

I haven't even tried to cut back on drinking yet, although maybe I should try at least a bit. My thought was to simply proceed as I always do. A couple of glasses before dinner, then refills while I work on the computer until I go to bed. I almost can't think at my desk without a glass at hand, and I think this long-standing habit could easily have led to the kind of conditioning that I'm now trying to undo. Since this situation is my most common trigger, it seemed best to try to just behave as usual, at least at first.

The 10% estimate for nausea as a side effect of naltrexone I keep reading about appears to be a drastic underestimate. It seems that the vast majority here, including me, had significant nausea when they first started naltrexone. You are the third or fourth person I have told, "Don't worry, the nausea is fleeting and will go away after the first week -- week two at the longest." And I've been correct each time. By coincidence, I did a little additional online reading about naltrexone today away from this site and the capsule summaries universally report that nausea goes away very quickly. Soon this will be a non-issue for you once your body gets acclimated to the nal.

You should be making zero effort in the beginning to cut down on your drinking. You are eliminating triggers, which initially, could be as commonplace as the sun and air. Just drink as you always drink when starting naltrexone -- the more regularly you drink, the more you reduce your triggers. Especially in your case -- your numbers, although medically risky over the long-term, are not dangerous on the short-term. Seven weeks in and I still only take 25 mg of naltrexone when I know that my window of drinking will be between say, 7 PM and 10 PM. If you take 25 mg of naltrexone, wait an hour, drink and then finish the drinking within a few hours after that, you are fully covered. 50 mg covers you for 24 hours; 12 mg certainly will cover you for a few hours -- probably as many as 12. I personally don't see any risk of taking 25 mg if you know for certain you'll be done drinking within a few hours after taking the nal. Dr. Eskapa verified as much on this site with others who really wanted to stick at 25 mg in order to mitigate side effects.

Week 2: As predicted, the nausea has subsided and I'm now able to take 50mg without any notable problems. I did cut back to 25mg for a couple of days to get through my event weekend, but switched back to 50 on Saturday with no ill effects. Yay.

Congrats on Week 2, PV, and the reduced Nausea...

Keep going!

Tonight will complete four weeks. I feel it's still too early to worry (or get excited) about numbers. I also feel my slight trend down is due to switching over to beer due to hangover avoidance and unusually hot weather here in Puddletown. I never drink as many beer units as wine units, usually stopping at 2-3 beers versus the whole bottle of wine.

Last night, due to late arrival home after a meeting, I actually had a single beer before going to bed. Normally I'd have powered down two in rapid succession just to enjoy the taste, decompress from the meeting, and because one is never enough. I fully enjoyed the first one, then decided why have a second if I'd made it this late was just going to go to bed anyhow? Small victories.

Question about "Drink as you normally do."

I think my numbers are artificially down here in the early weeks due primarily to this wine-->beer switch. Normally I'd have wine 5-6 days a week and beer only one. Situation is about reversed at the moment. If I am to "drink as I normally do" should I make a conscious effort to switch back to wine to exactly match my typical scenarios? (Hangovers be damned.) Or is AL = AL = AL for the intents and purposes of TSM?

I am guessing that sticking with beer is fine. To quote Lena, "Don't over think it." If you weren't on TSM, you would have switched over to avoid the hangovers anyway, right? So by continuing to drink beer you are arguably "drinking as you normally would" absent TSM. Having repeated hangovers from wine out of concern that you are not "drinking as you normally drink" sounds like to stiff a price to pay when the process is going to work with beer anyway, IMO.

I am appreciating this forum very much. Seeing folks in various places along the continuum of the cure is exceedingly helpful, encouraging, reassuring. Plus, some very nice folks here.

I'm fairly active online in other contexts and I worried a bit that checking this forum too much would lead to becoming too impatient, when I know that patience (and consistency) is key to the whole thing working.

I finally found a way to internalize TSM that I hope will allow me to make steady, patient progress: TSM is clearly a journey. I like to walk. If my TSM journey were to be a hike from New York City to my home in Portland, Oregon -- at this point I'm barely past Cleveland, Ohio.

I'll try to enjoy the sights and the hills and the valleys along the way, keep my eye on the horizon, and just keep walking ... toward home.

I know it's *way* too early to be reading tea leaves, but wanted to note a personal milestone. Last night I put a stopper into a wine bottle for the first time in years. I figure it had about two glasses left in it.

I was ravenous for a drink when I got home from work today. I took my Nal and set a timer. I was afraid to think about trying to just finish those two glasses from last night's bottle tonight because I was sure I'd end up opening another bottle, and then I'd feel bad. So I simply opened a fresh bottle, wondering if I could stop before it was gone.

Stoppered it up while watching tv, with about two glasses left.

Both nights I sat watching tv with a glass in my hand for probably half an hour or more at times, just holding the glass and not caring to drink from it.
As Vizzini from the Princess Bride loved to say, "Inconceivable!"

Hi PV,

Happy to hear you've reached such an important milestone. I'm sure there will be more to come. Nice to finally put those neglected stoppers to use, isn't it?

Week 7: Patiently (OK, impatiently) counting off the days. Seven weeks seems too early to be bothering with graphs, but what the heck - I just had a downward tick and I'm going to celebrate it. General mood is optimistic. I've stopped taking my Nal before leaving work, instead taking it when I get home. I'm finding it a bit easier to wait that hour. I feel I'm drinking more slowly. Beer and wine both still taste delicious. The craving is beginning to seem more mental than physical. I'm prepared for backsliding, but still taking the long view and setting my sights on Thanksgiving.


I read the board every day and I am so grateful and inspired by those who have been cured; I'm impressed and rooting for those sticking it out despite frustratingly slow progress; I'm thankful for this community that is so welcoming and active and encouraging to one and all; and I feel a flood of warmth and optimism for those who have recently found their way here, and are beginning their journey.