I'm 8 months into TSM and have been "cured" for months. TSM and Naltrexone have changed my life. I have been drunk only a couple of times in 8 months. I haven't vomited in 8 months. I haven't done or said things I regret because of alc in 8 months. My girlfriend, family, and friends have all said I'm like a new man. So at least consider what I have to say.

I'd like to suggest something to new and old forum members: if you're over 2 months into TSM and haven't had a couple AF days or are experiencing zero improvement, you should consider experimenting with a bit of effort.

Now before anyone's feelings get hurt, believe me that I don't say this to hurt. Only help. If I didn't care about helping you guys, I would just go about my merry way and never visit this forum. I admire and respect everyone here and wish everyone success in whatever path they take. Some people will never get any results from NAL-- studies suggest the reason is genetic. But I wonder if some people experience poor results because they wait for the pill to make all the decisions for them.

Let's say AA requires 100% effort to stay sober. There's a perception (right or wrong, I don't claim to know for sure) that TSM is the total opposite-- that you just take the pill, don't think about it, drink when you feel like it, and the pill will do the rest. In other words, 0% effort. Many statements in Eskapa's book suggest this view of TSM.

All I know is that I and many of the cured have benefited greatly by applying some effort in addition to NAL.

Try to have an AF day. Try really hard. Don't white knuckle, but try it at least once. Just see what happens. It may be easier than you think. If you fail, you fail. But if you never TRY to have an AF day or cut back, you may not even know if the NAL is working on you long-term. Are you drinking out of habit or actual craving? How would you know? Test it and find out.

Many (most?) of the "cured" say something similar. Everyone should check out http://www.thesinclairmethod.net/community/viewtopic.php?f=7&t=1570, a thread discussing effort that should be required reading for everyone on the forum.

Good luck.

Thanks for sharing Nemo-

After a long summer of daily NAL and daily drinking I'm due back in the front of the classroom on Monday. I'm going to start trying for some AF days. I'm hoping it will be a bit easier than last year when I wasn't doing the treatment.

I'm in my sixth week and I have had two AF days so far. Maybe not by choice, but I seem to have lower intake days after higher intake days. For example, I had no intention on drinking a few days back, but I forgot (briefly!) that it was my wife's birthday and she wanted to go out and play some pool, have a few pops. Of course, I blew my diet. 15 units. AF the next day. I've only had two AF days in six weeks, but that's two more than I had before TSM. And I've had several days of 2 or 3 units, which is also extremely rare. Hell, yesterday was Saturday. College football is my favorite sport and I usually drink from noon til I pass out on Saturdays. I had 4 beers all day. And that was not a result of effort. It just turned out that way.

I agree, though. Some effort may be required for some people. But that effort seems to be less difficult with Nal.
Different strokes for different folks, I guess. Good luck all.

WAX

thanks for bringing this up nemo.
i am on wk 15, and unfortunately, what i have been noticing is that it is taking much more effort for me to maintain my normal levels. these days i really want to start at noon, or 2, when i used to normally not want to start until 5. if i were to give in to this, my numbers would be higher than before. is anyone else having this experience? it's making me kind of worried. i have been noticing that a lot of folks are having consistently reduced numbers even in their first months. any thoughts? i would love to hear from those who are further along and had no reduction in units (other than the initial honeymoon, which i also had the first week).
thanks all,
path

Nemo

Totally agree with the putting effort part in. When I look back I say it was effortless, and it was to an extent, but there was some will power or whatever you want to call it on my end. Hard to explain, I wanted to quit or get down to "normal or social" levels. I could simply not imagine myself as abstinent. TSM gave me the power if you will to apply some effort or will power to exercise control. It truly was not exactly hard. I think for myself it wasn't so hard because I REALLY WANTED something to change..it HAD to. Alcohol was no fun anymore and was utterly destroying me. But once I started stringing the AF days together it got easier and easier. I also beleive the nal had a more powerful effect on me the less I drank and the less I took it. As far as the side effects, sometimes they come back like the sleepless night etc..BUT I figure they are WAY minor compared to the effects of alcohol. I guess I wanted something bad enough and LUCKILY for me TSM gave me the power to be true to myself with not too much effort - meaning nowhere near the white knuckling cold turkey deal of AA.

For myself it's a very POWERFUL feeling to know if I want to drink I can and not have any of the negative consequences prior to TSM. I guess the effort I put in was fairly simple - Follow the TSM prtocol take Nal one hour prior to ANY drinking and then the effort I started putting in after the first month or so was not to get "too" drunk..I don't think I could if wanted to but it was weird I didn't want to. Around month 3ish i started seeing how long I could go without a drink...with not being stone falling down pissing my pants drunk in months it got easier and easier and the big kicker it allowed me to start putting my life back together. From there things began to rapidly fall into place and I look back sometimes and am like "damn I was mess".

Hope this makes some kind of sense because I really beleive a lot of this happened on a subconcious level.

I Hear ya Nemo and will do just that.

I'm not drinking tonight because I'm hungover but tomorrow on my one year anniversary I will also not drink.

I'm going to make a prediction. Like my pal Jerry and as you said. I bet when I get to day three, I'll want to keep the streak up. And I bet even more, I will go even longer. But if/when I cave, I will take my Nal and not beat myself up.

Lets hope anyhow...... My best, Jim

From our dear member Lena who had an answer from Sinclair.....


Here is Sinclair's answer, which I copied from a post by Eskapa:

From David Sinclair - reply to this question. His response was quick and I appreciate it. I should state that almost everything I have learned about addiction science has been since I met Sinclair in 1990. The rest came from reading and working with people facing addiction issues. Here is an explanation for SpringerRider hot off the press from Helsinki, Finland:

What you describe is actually one of the basic processes in the nervous system. Learning is caused primarily by the synapses between nerve cells becoming stronger (reinforced), and thus making it more likely that you will make a response or think a thought or feel a craving again.

We know, however, that the opposite process - the weakening and eventually complete burning out of synapses - is at least as important. (Extintion) For example, most of the changes in the nervous system that occur in the first few months after birth are the removal of synapses. It is sort of like sculpting: removing all the other synapses (and thus breaking all the other neural pathways) until just the one correct one is left.


You may call this "deep in your psyche" but causing it is a real physical event.

The dissolving of the relationship to craving is the burning out of the synapses that previously had made you think about alcohol. It is not the relationship between craving and its satisfaction that is being removed, however. That relationship, or rather that between craving and reinforcement, is blocked as soon as you take the first naltrexone pill, and it is blocked so long as you have naltrexone in your brain, but it is completely unconscious. It just is a fact that if you happen to have endorphins released, they will not be able to cause any reinforcement (strengthening of synapses), but you cannot feel this. At most you will notice the lack of something when you do have endorphins released, after drinking alcohol, or by eating sweets, jogging, etc.

The really important factor is what happens after alcohol drinking causes endorphins to be released and then the expected activation of opioid receptors from binding their endorphins does not happen. At that part, the nervous system starts the mechanism of extinction. The synapses that had just been used, e.g., ones triggered by the sight of a drinking friend, or the smell and taste of your favorite drink, or by the mood when you drank, become weaker. These synapses are now less capable of making other neurons fire. Some of these neurons that are less likely to fire now are the once involved in thinking about drinking and in craving. Others that are less likely to fire are ones causing the drinking behavior itself.


There was a new report last week at the ESBRA meeting here in Helsinki. You may have heard of the MRI machines that can show when parts of the brain are active. The new report, from Germany, showed how alcohol-related cues (e.g., pictures of beer bottles) were able to stimulate strong firing in various parts of the brain in people who had become alcoholics because of reinforcement of synapses by endorphins. And these were the people who responded very well to naltrexone.


I found your description of how the craving grows with alcohol deprivation very interesting. This phenomenon, which I named "the alcohol-deprivation effect" is what got me started doing alcohol research over 40 years ago. It is a very powerful thing. It also is contrary to the ideas people had back then about what causes the motivation for alcohol. In particular, it was generally accepted that the motivations was logically caused by withdrawal from physiological dependence on alcohol: that people were drinking just to avoid withdrawal.

Consequently, the treatment they gave was detoxification and forced abstinence, long enough for the physiological dependence to be gone. Indeed, a misleading euphemism for alcoholism still used today is alcohol dependence. If they were right, detox would have been the cure for alcoholism. Of course, it was not. We found that the alcohol-deprivation effect does not disappear as physiological dependence is removed. Instead, the increased craving produced by the alcohol-deprivation effect grows stronger and stronger, week after week, and never went down in several months of deprivation.

Now to your question of whether you should intentionally deprive yourself of alcohol. The way you are doing it sounds good. It is a good idea to extinguish all of the various forms of drinking you had learned to do. You should drink alcohol (with naltrexone) in the same locations where you previously learned to drink, with the same people, and with the same moods.

One situation in which you previously had learned to drink was probably after a period of alcohol deprivation. Consequently, the synapses connecting the deprivation-induced feelings of craving to the act of drinking have become reinforced; and they now need to be weakened by extinction.


Naturally, there are certain cases in which you must try to limit your drinking: you must be particularly careful not to be drinking if you are going to drive, etc. The naltrexone may even make some aspects of intoxication worse.
There is another reason for have pauses in your drinking as soon as you can manage to do so: in order to strengthen healthy alternative behaviors.

It is a good idea make a list of things other than drinking that you enjoy doing and then noticing which ones are probably reinforced by endorphins. They include eating sweets, spicy, salty and other good tasting foods; jogging, sports, and other forms of strong exercise; cuddling with babies and pets; some forms of sexual activity. These behaviors will also be weakened if you do them while you are on naltrexone - but we do not generally want to have them reduced. Therefore, first, you should avoid as much as possible doing those other behaviors while you are on naltrexone and drinking. Second, when you are able, have a weekend without alcohol and without naltrexone. Saturday is a washout day in which the naltrexone is removed from the body. On Sunday afternoon you should reward yourself by doing one or more of these other opioidergic behaviors.

We have discovered a really nice thing about this. When you do the other opioidergic behavior, you will get enhanced reinforcement of it. Patients report that the first bit of chocolate, on that Sunday afternoon, is the best they have ever tasted.
The main reason for this is that while naltrexone was blocking your opioid receptors, your brain tried to compensating by making more of them. This is called "up-regulation". We have actually measured the increase; it was almost a doubling of the usual number of opioid receptors.

So long as there is a surplus of naltrexone in the brain, the increase in opioid receptors has no effect since they are all blocked. But when the naltrexone has been washed out, this huge crop of opioid receptors is standing, begging to be filled by endorphins from that chocolate, or from jogging, or from any of the other behaviors.

The increase only lasts a few days, but during this window of opportunity you have supersensitivity to endorphins and an enhanced ablility to develop other behaviors to fill the vacuum as alcohol drinking becomes less important in your life.
This also leads to the long-term solution for the drinking problem. In our three year follow study, we found that the patients drank progressively less often over the months and years. In other words, the deprivation periods became longer and longer. Some quit completely. Many others were down to drinking at most once a week - it was sauna night in Finland and they wanted to have a sauna beer, like everyone else around them. The rest of the time they were just carrying the pill with them, in case a drinking occasion arose. It costs nothing to carry it. And there is no risk of weakening any of the healthy opioidergic behaviors.

Just remember to always take the naltrexone before drinking, because this enhanced reinforcement has another part to it. If, during the time of supersensitivity you drink alcohol without taking naltrexone, there will be enhanced reinforcement of alcohol drinking. Done repeatedly, you would soon relearn all of the craving and drinking behaviors that had been extinguished.

David

Thanks for the responses, all

That's a very interesting letter from Sinclair, with plenty to discuss in the future. For this thread's purposes, Sinclair says that pauses from drinking (occasional AF days) and sometimes limiting oneself (i.e. when driving-- what Crown86 calls "trying not to get TOO drunk") are good and healthy parts of the TSM process.

Jim-- shooting for 3 AF days in a row may not be your best path to success. I don't know. If it takes TOO much effort, don't do it! But occasional AF days and "trying not to get TOO drunk" are definite areas to explore.

I've been thinking the exact same thing lately. I think I'd been expecting Naltrexone to do all the work, but I'm beginning to realize things will probably progress a bit faster if I don't immediately give in to the urge to drink. A few days ago my wife wanted some wine, so I picked up a bottle for her and a six-pack for me. She drank some of the wine and went to bed, while I finished the six-pack and then dragged a bottle of rum out of the closet and downed three pretty hefty highballs. Hadn't done that in quite a while, and regretted it the next day, when I could hardly get anything done. In addition, when I drink that much I wake up with a really rapid banging heartbeat in the middle of the night, which is scary as hell. I tend to forget about that when I drinking, but it can't be good for me in the long run. So last night we shared another bottle of wine; she had one glass and I had three, and then called it a night. Tonight I'm having nothing, although the urge to get back into the rum is there. But I don't have to act on it, and I've made the decision not to go to the cabinet, pull out the bottle and pour myself a glass or three. It wasn't that hard, surprisingly. I guess sometimes we have to talk to ourselves like Dutch uncles. And I have to say that being able to resist that urge gives me a certain sense of control I didn't think I had. So although TSM isn't going exactly the way I'd hoped, the addition of a small bit of willpower seems to be paying off.

> what i have been noticing is that it is taking much more effort for me to maintain my normal >levels. these days i really want to start at noon, or 2, when i used to normally not want to start >until 5. if i were to give in to this, my numbers would be higher than before

path,
i had a very similar experience about two months ago. i was roughly 5 months into TSM at that time. i began to have strong cravings earlier and earlier in the day, whereas prior to this i had been pretty good about waiting until 4 or 5 for my first drink. in my pre TSM days i was often an all day drinker. it occurred to me that if the craving is there, there is extinction to be done, so i decided to just roll with it-take the nal and drink if i felt like it, whenever. for maybe a week i started at noon (and as you said, units went up dramatically due to a longer time period of drinking, and i did get very worried initially) but then with just a bit of effort began to hold off longer. in a few weeks i was back to 5 o'clocktails but the really good news is that after going through this spike and change in patterns my units began dropping dramatically and have stayed low since. i'm also finally having more AF days than drinking days, including a ten day stretch AF. eskapa says one should drink in all the old familiar ways, places, moods, etc. so i think it's possible that if day drinking was part of one's routine there is benefit to repeating it with TSM. it sounds slightly insane-i remarked to jim during this period that "drink as you normally would" was not sounding like such a bright idea-but now i'm glad i did. pre TSM i could continue a pattern of all day drinking for months on end. with nal i lost interest in it pretty quickly. considering how my units dropped off after this i guess it was an extinction burst.
so don't worry, you're certainly not alone with this experience.

best,
jerry