Plain Vanilla, there is no contradiction. We are arguing the same facts, which are not contradictory.

By AJ
I am concerned that there may be a perception that the more frequently one drinks, the more rapid the extinction, or perhaps I should say 'the cure'. That is, a view that one ought try to drink as often as possible.

I HOPE THERE IS THAT PERCEPTION BECAUSE THAT'S WHAT SINCLAIR'S STUDIES SHOW

By Eskapa and Sinclair
"[We need to think of drinking] as 'good for me', or at least 'necessary for me to get better.'" (p. 103)

"De-addiction happens slowly but surely with the research showing that the more often you drink on naltrexone, the more you weaken your addiction." (p. 107;italics his, bold mine). "Sinclair insists: 'We want to be clear that we are not encouraging patients to drink very large quantities at one time. Large volumes of alcohol do not help (do not hasten the de-addiction process) and can be dangerous. But drinking frequently while on naltrexone is beneficial since each time drinking is an extinction session.'" (p. 107 fn* [Eskapa's parentheses]) (bold mine).

On another topic, I'm all for lively discussion but I don't want anyone worrying that an extended, uninterrupted period with the opiate receptors blocked by naltrexone is harmful. It is not.

Nowhere does Eskapa suggest that the point is to substitute healthy sources of endorphins through non-nal selective reinforcement. The point is to dismantle the superhighways our endorphin-seeking neural pathways have become to the non-addicted country roads they are when healthy. Eskapa repeats several times that endorphins are non-essential hormones that provide a shortcut in learning, especially survival skills (e.g. p. 9).

Few if any here report diminished interest in parenting, sustenance (although some report decreased appetite), working out or sex. To the extent these opioidergic behaviors are unconsciously extinguished along with drinking while on nal, there is plenty of time to re-learn them through reinforcement when we are ready for AF days.

AJ, your quote from p. 208 is best viewed in context. In that chapter, Eskapa is trying to pitch TSM to m.d.'s, who must be helped to overcome the mind-boggling cognitive dissonance when presented with an alcohol addiction treatment that requires continued drinking. Earlier in the book, Eskapa discussed at length the attitudes of the rehab industry and the medical profession, including the tricky ethical challenge of how an m.d. can recommend a non-abstinence method.

It's this simple: Take nal one hour before you drink. That's the Golden Rule. As SpringerRider used to say, it works whether you want it to or not. And as Potato used to say, don't overthink it. As Dr. Eskapa recently said, "It undulates. The only constant is the Golden Rule."

It's so simple we wouldn't need this board if not for the fact that the cure happens slowly without our consciously feeling it, with sometimes wild ups and downs and at varying rates among us. As N101CS once said, "'Naltrexone + Drinking = Cure.' To that I would add a dose of patience." This board helps to supply the dose of patience.

About Vivitrol: Just as with oral naltrexone, its prescribing information describes it as an anti-craving drug. How sad. What a scam. In fact, http://www.enterhealth.com/, a rehab clinic that is pricey even by rehab clinic standards, boasts of using Vivitrol as part of its cutting-edge anti-craving regimen. The owner has written a book that was touted by someone on this site , "Healing the Addicted Brain," that looks to me like an infomercial for the pricey clinic. (I only read the excerpts available online).

Even if Vivitrol were used as part of TSM, it would be of limited use in a pricey rehab clinic because TSM is not conducive to a clinical setting. We must drink through our triggers. Sinclair has an interesting story about this on the shrink rap podcast http://www.podcastdirectory.com/podshows/1571068

Eskapa has said on this board that Vivitrol wouldn't hurt in the first month or two, but after that you would be missing opportunities for AL-free days without nal in the system.

For a discussion of why nal still has a patient insert describing it as an anti-craving med, read the section in Eskapa's book on Sinclair's patent. I also posted about it somewhere. It's called something like "pharma sabotages TSM."

Damn, damn, damn... I just can't stop this evening drinking compulsion. But I have to. Soon!

Reason: I've been invited by a friend to sail from Cape Town, South Africa, via the Skeleton Coast of Namibia and the island of St. Helena to Salvador, Brazil, starting in late Oct. ending mid Dec.

There will only be two of us: the Capt.-owner of a Hallberg-Rassey 40' and myself. Eight hour watches each. Six weeks at sea with only three ports of call. He's been sailing around the world for ten years. I've done a lot of blue-water sailing myself, but not to that extent.

I've HAVE to get myself abstinent, or at least only occasionally hoisting a beer or two for social reasons (the owner-friend is German and stocks more beer onboard than fresh water). The Naltrexone so far is not kicking in. I've been following Dr. Eskaba's recipe to the letter, except for no washout days. There must be an additional mental/psychological factor beyond the physical/chemical neurotransmitter stuff that needs addressing in my case.

I started TSM on June 11. I actually drink more now in the evenings, maybe by thinking "magically" that the medication will make me drink less. I wish I could say "CURED!"

I would appreciate some feedback about how mentally to become resistant to the influence. I've stopped myself out of the blue before, ranging from eight years AF, to seven months, weeks, to a few days. But currently, I just can't find the "off" switch. When I did before, it was a piece of cake. Not now. Where the hell is the off switch?

If I don't find it, I may find myself in the deep drink, overboard somewhere between Africa and Brazil. Gotta get it soon! Yaggghh.

Mike

Hey Mike --

You are still relatively early in the TSM process. The 3-4 month cure period cited in the book is (a) the minimum time required and (b) applicable to people who "only" have 35 drinks per week. At six to ten units per night you are considerably higher than the studies' subjects and our experience here (as well as extinction theory) leads to the conclusion that extinction in your situation could easily take six months (or far longer, depending upon how long you've been drinking as well as other individualistic factors).

I'm not sure how to weigh the implications of the above-facts to your situation. You will have to do your own risk/benefit analysis. For me personally, I would assume I'll still be drinking by the time of the trip. Then I'd factor in how risky it is to consume that much in the middle of the ocean. It sounds like the risks are extreme. IMO, I would not assume that TSM will have fully kicked in by the time you take this trip and would also be aware of the fact that TSM may not work for the unlucky 12% or so for reasons still unknown.

Also, I agree with AJ about the "extinction burst" -- you are drinking more now because the naltrexone is depriving you of the endorphin rush you have learned to crave. Since you are not getting it, you instinctively reach for more wine. This spike in drinking is fairly common with TSM and should pass with time.

I wish you the best in sorting out this dilemma. I think I recall you stating that you have a loving wife. I personally would err on the side of caution in this situation but you'll have to do your own risk/benefit analysis, starting with the assumption TSM may very well not work for you by the time of your trip.

My Best,

Nick

Thanks for the responses. I e-mailed Dr. Eskapa at his gmail address with the same questions, and his reply mirrors the ones posted here: that it make take 6 months on Naltrexone to reverse-learn; that I might want to try 100 mg, which I doubt my doctor would go along with; that I may be among the 20% of poor responders. My gut reaction is to try some forced AF days, followed by nal+drink, and repeat that cycle frequently if I can without activing the alcohol deprivation effect. It's apparent to me now that after each lengthy period of not drinking in the past, then taking it up again, that's the reason it becomes increasingly more difficult to stop again after each hiatus. It's obviously too late now, but I wish I'd never started this stuff. Never had an inkling of a desire for alcohol until freshman year in college when I succumbed to peer pressure. I probably have some kind of genetic proclivity that once awakened runs rabid.

-Mike

Mike -- Please read in my post above what DR SINCLAIR says in Eskapa's book. The more drinking sessions, the better your chance at extinction. Springer was talking about what he did late in the process, which basically was creating then extinguishing Alcohol Deprivation Effect. Sinclair commented that it was fine theway he described it. I don't know whether you were a daily drinker. Daily drinkers do not have alcohol deprivation effect and do not need to extinguish this as a trigger. Remember, 10 of the 20 % failed because they were non-compliant. Your best bet is to take your nal and, as Eskapa repeats throughout his book, drink as you normally do. Maybe you will get enough control by then to be ready for some AF days.

I remember N101CS was the first to forget to re-order his nal (we were still at MWO) and thought he was going to have to gut out some AF days for the first time after about 4 months of TSM. He was quite surprised at how easy it was.

Good luck with whatever course you choose.

BTW I don't want to leave the impression I believe AJ's theory is totally off the wall (to the extent he does not conradict Dr. Sinclair). Selective reinforcement -- actively using our AF days for positive behaviors -- is an important aspect of TSM. Several people have mentioned to me that once they were ready for AF days, they were a motivator to cut down the drinking. But you have to be READY for them. Forcing them early on just for the sake of having them means missing valuable extinction opportunities.

No, it isn't too late. The beauty of TSM is it will roll back your craving to the point where you quite literally have little to no desire for alcohol.

You may be genetically predisposed to alcohol addiction, but you built the wiring in your brain that drives your addiction by repeatedly drinking in an unhealthy way over time. You weren't born addicted to alcohol. TSM is going to get rid of this bad wiring, leaving you in a state similar to what you were before you became addicted.

You are going to get a "do over" on this part of your life.

Q

Just jumping in, I am going to try the weekend AF scheme as proposed by Dr. E. Yesterday was no prob as I was hungover. Today presents more of a dilemna. What in fact do I crave? Is it al alone or is it the treatment of loneliness which I receive in the company of my hard drinking "friends" at the bar. I'm not gonna go nuts here-if push comes to shove I'll take my nal and have a couple pops, but I do feel it might be important to put together a few days AF.