Hi all – I’ve been lurking on this site for several weeks but have finally been motivated to write after the posts by Minneapolisnick on keeping it real and then Providence’s today on what TSM has done for her. Both were reassuring on several levels, particularly in their reflection that this isn’t a site where it’s “my way or the highway.” I’m not sure I’m a complete convert to TSM (for instance, tracking how much I drink seems to lead to me consuming more a night, since I get obsessed with thinking about how much I’m drinking). I also suspect that naltrexone might not be enough for some people to completely retake their life, but that’s something I think this site will help me discover. What I am is a fervent believer in the efficacy of naltrexone as a very powerful tool -- I’ve been taking it since October 26th, the day after my teenage son told me my drinking was hurting our relationship, and it’s already changed my life.

I guess by a lot of standards I wasn’t a heavy drinker per se, and I doubt any of my friends or family (except for my son) would even suspect that I’ve been struggling with my drinking for the past three years or so. I was probably a 35 drinks/week gal, never during the day – but it’s always felt out of my control -- once I started I couldn’t stop, and I’ve known for a long time I had to do something. AA is not for me (I’m not a joiner, and I’ve never been great about following the company line). I started reading obsessively about natural cures (I do think that taking extra magnesium, zinc, and DLPA has helped me through what have been partial withdrawal symptoms over the past two weeks as I’ve radically reduced my consumption). I ordered self-hypnosis tapes, and I even went to a hypnotist who had helped me with my fear of flying, all to no avail. I think a lot of my problem is that I love to drink – I love the taste of good wine, I love all the rituals associated with drinking wine, and eating a really good meal without having a good glass of wine to go with it would feel like sacrilege. Drinking a glass of champagne to me always feels completely festive and fun. Drinking socially is also a huge part of my social life (media-related), and I couldn’t conceive of the radical changes that stopping entirely would mean in my life.

So out of desperation, a few months ago I finally started seeing the remarkable Dr. Mark Willenbring, who until this month was Director of the Treatment and Recovery Research Division of the National Institute on Alcohol Abuse and Alcoholism at NIH. Dr. Willenbring was the consultant to the HBO series on Addiction and is extensively quoted in the New York Times article this spring about the benefits of naltrexone. He also developed the enlightened website http://www.rethinkingdrinking.niaaa.nih.gov/
which has some great practical tools to help in controlling one’s drinking (and also is a good resource to take to a doctor if you want naltrexone prescribed). Dr. Willenbring started me on naltrexone, and the change in my drinking patterns was profound and instantaneous. I “pace and space”, I don’t pour a glass the minute it turns 6 p.m., I leave bottles unfinished, and I stop before I get forgetful or I fall asleep. I still have far to go – I will feel triumphant when I can accomplish even one alcohol free day, but I also know not to push it. I know about the honeymoon period, but I also am already so grateful for the difference it already has made for every night of the past two weeks.

Unfortunately for me, Dr. Willenbring is going back to Minnesota to start a “science based treatment model” institution to train organizations and help change the old-fashioned and outdated models for alcohol rehabilitation. With his departure I guess I’m turning to this forum to help me keep on the naltrexone path. I know it works, but I also know I'm going to need the kind of positive reinforcement this site offers. I'm also slightly worried about naltrexone's long-term potential for me -- there are several conflicting studies out there that show that it possibly works better for men than women.

P.S. FYI, The last time I saw Dr. Willenbring he told me that one of the newest and most exciting tools NIH has seen recently in helping to change drinking patterns is applying the behavioral concept of “Mental Contrasting and Implementation Intention”, which might be a helpful adjunct to naltrexone. I’m still trying to figure out exactly what that means and how to make it work, but I pass it on for what it’s worth.

Hey Sabrina, glad you could make it. It sounds like you're well versed and ready for the ride. We're here for you.

I'm am intimately familiar with I think almost every single study done on naltrexone and I've yet to come across one which shows that it works better for men than women (that I can remember off the top of my head). If you've got this info handy I'd love to look at it.

Welcome aboard!!

Hey LoOp -- thanks for answering me so quickly -- it is really reinforcing! Your graphs were one of the first things that drew me to this site. I am an inveterate Pubmed cruiser, so I often only read the abstracts of research studies, but here's one link to a study on the differing effects of naltrexone on alcohol use in men versus women:
http://www.encyclopedia.com/doc/1G1-173377432.html
There also are some studies on how it differs between men and women in terms of its efficacy in quitting smoking (apparently more effective for women than men in quitting smoking, unlike drinking -- go figure):
http://www.bio-medicine.org/medicine-ne ... g-16365-1/

I actually became interested in naltrexone even before this journey through hearing about all the new studies on using low-dose naltrexone for various auto-immune diseases.

Thanks Sabrina I'll check those out! And hey, if you ever want a full study just send me the abstract or the citation. I've got access to almost every journal there is, and I pull studies all day long sometimes just for fun. Hit me up.

Welcome to the TSM forum!

I enjoyed the link you provided http://www.rethinkingdrinking.niaaa.nih.gov. I went through the interactive questions and apparently I have a drinking problem! The reason for its conclusion is that the questions are phrased "Have you...in the last year". Well, of course, it'd diagnose me with alcohol issues since I was a raging alcoholic a year ago! Though I am now in the single digit per week club for the last 3 months, but the test doesn't know that. Anyway, great link. I like the NIAAA website and the information you can get there.

Reading your post, I also was glad to see that you are a thinking person, not drawn to dogma. As you can see here, we're not dogmatic, although we often have spirited civil discussions regarding viewpoints and observations. For a group of drunks (I say this light-heartedly, of course), you'd never think we collectively would have such respectful, thoughtful posts with no flame-wars and extremely minimal moderating. Actually, I have never seen a forum as open as this one. (There was a 12 step forum I had the misfortune of joining that the moderators would edit or delete posts if they didn't like what you had to say. I didn't last long there, in fact I was banned in 2 days, I think). You won't find that here. This site seems to attract HFA's for some good reason.

Enjoy your time here and keep sharing your insights, links and experiences.

Bob

Hi Sabrina,

Im glad you could join us here. Looks like your well informed from the technical standpoint and looks like youll add alot of valuable information and insight. I myself have never read the book and I dont really count my drinks, this forum is my book. TSM is already a success in my life. A Great Success. Ive gone from being scared to being comfortable, as it relates to my drinking. I am grateful for the science of TSM and the discovery of it. Welcome aboard. Please post often.

hapful

Hi Sabrina,
Glad to have you with us on the site - it sounds like you are already having good things happen with TSM. I'm really curious about the behavioral concept you mention above. Are you learning about this from somewhere, a book or a website possibly? Or is this something you are pursuing with a therapist? I'm definitely searching for some helpful therapeutic concepts to employ alongside TSM, so any new ideas are greatly appreciated Welcome!

Okay I found the study they were talking about in that article:

Efficacy and Tolerability of Long-Acting Injectable Naltrexone for Alcohol Dependence

A Randomized Controlled Trial

James C. Garbutt, MD; Henry R. Kranzler, MD; Stephanie S. O’Malley, PhD; David R. Gastfriend, MD; Helen M. Pettinati, PhD; Bernard L. Silverman, MD; John W. Loewy, PhD; Elliot W. Ehrich, MD; for the Vivitrex Study Group

JAMA. 2005;293:1617-1625.

I can email it to you if you'd like. I pretty much dismissed this study out of hand and didn't bother to look at the differences in results that they did get between men and women. I posted about it a while ago here: http://www.thesinclairmethod.net/community/viewtopic.php?f=7&t=872&sid=789d13b6e5f1a5075fd007ac444d2431



Don't anybody freak out now, these people were receiving at most only 380mg of naltrexone a month in a non-targeted fashion. That's like 12mg a day depending on how it is realeased.

edit: why are they reporting the median and not the mean? what is the point of that?

Thank you all for the lovely reception I've received here. In other circumstances, Bob, I'd say I'd love to have a drink with you and discuss all of this (I don't know how to add the smiley face). I guess what I like about the NIH site is that it isn't polemical, but more practical -- it acknowledges that it is possible that abstinence isn't the only option to solve a drinking problem. I found their "tools" section particularly helpful.

And Serenity Seeker, I don't know much about the "Mental Contrasting and Implementation Intention" technique beyond what I posted earlier (I was kind of hoping there was a behavioral psychologist here who could help out). Dr. Willenbring mentioned it in passing, and I've googled it and it looks interesting. It seems to be a lot about thinking ahead beyond just setting goals to thinking about what you do if you encounter hurdles in the path to that goal. (My goal is X, if I encounter stimulus Y -- which is a hurdle -- I will engage in behavior Z, which will help me achieve goal X). Eg, my goal is not to drink too much tonight (X), but the nightly news (or my teenage son, or a bad day at work -- Y) is going to trigger me to reach for a drink, but I have prepared myself to recognize that Y as a trigger and I will instead first reach for a nonalcoholic beer, or do 10 pushups, or whatever, just to break the cycle and make positive steps toward achieving goal X. Apparently that cycle gets internalized pretty quickly with pretty fast and positive results.

I'm really not sure I'm interpreting this correctly, and I'd love to get a worksheet on how to use the technique specifically for trying to avoid triggers for reaching for that extra drink when I don't need it. The naltrexone is a huge help but I'd like to reinforce it in any way possible.

Hi Sabrina and welcome. I also am interested in the approach you mentioned. I will try to plan like that if I want to have an alcohol free (AF) day, when I won't have taken a naltrexone (nal). They are too expensive to waste!

Right now I'm like you, a nightly drinker, and can't imagine an evening when I don't reach for a glass of wine as I reach for the saute pan Also, like you, my actual units are low but I don't have that control I want - yet. Again, welcome.