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 Post subject: TSM 'cure' timelines -- 3 or 4 months is just the beginning
PostPosted: Wed Nov 17, 2010 8:59 pm 
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Eskapa book often metions that ‘the cure’ should take 3 or 4 months; however, the actual data from one of the studies he presents shows that a) the patients started at the relatively low unit count of 37 units per week on average (compared to the higher weekly unit numbers many, not all, of us had pre-TSM here) and b) they only achieved about a 50% reduction in drinking at 3 or 4 months. In fact, it took these 37 unit per week on average drinkers a full 9 months before they had reached a plateau of about a 75% reduction of their drinking.

I've looked at the data in Eskapa's book -- especially the graph of one study on p.29 -- and here is the approximate data as presented:

Participants: 148
Successful patients: 115 (78%)
Average pre-TSM units: 37
Average units after 9 months: 9 (just under 25% of initial 37 units)

The approximate data month-by-month:
Pre-TSM: 37 units (100%)
1m (30d) 27.75 units (75% of pre-TSM units)
2m (60d) 25 units
3m (91d) 20 units (> 50% of pre-TSM units)
4m (121d) 17.50 units (< 50% of pre-TSM units)
5m (152d) 15 units
6m (182d) 14 units
7m (213d) 13 units
8m (243d) 12 units
9m (274d) 9.25 units (25% of pre-TSM units)
10m (304d) 9.25 units
11m (335d) 9.25 units
12m (365d) 9 units

I graph the approximate data below showing the percentage reduction of drinking month-by month:

Image

As you can see, an average 25% reduction in units took place by the end of the first month (30 days), a 50% reduction in units occurred by about 4th month mark (actually a bit before that; around 105 days) and an average 75% reduction in units occurred after about 9 months (274 days).

The "cure" in fact appears to be just that: a 75% reduction in units (from 37 to 9 per week in this study) and took 9 months on average, with even further reduction in units and craving in the 3 year follow up (as reported in Eskapa's book).

Here’s a different graph of the approximate units per week vs. days on TSM:

Image

I present the above to provide a realistic context and to show that the 3 or 4 month time frame was for patients that averaged just 37 units and, even then, they only cut their consumption in half at around 3 1/2 months. As a lot of people have mentioned on this site, they've seen continued improvements at 6-9 months or even after a year.


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 Post subject: Re: TSM 'cure' timelines -- 3 or 4 months is just the beginning
PostPosted: Wed Nov 17, 2010 9:04 pm 
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Posts: 621
Location: USA
Thanks for reposting this Merlot. This is such an important subtlety from the book that many will not realize. I wish we had a way to "sticky" this on the Board Index page. We all appreciate the work you put into this analysis.

_________________
Began TSM 7/19/10 Pre-TSM 50-70 US (106UK/84AU)
Ave. units/4 weeks for 1 year (#AF/4 wks) 22.8(1AF),29(0),30(1),27(2),23(2),20(6),16(8),17(9),13(12),15.5(9),15.8(11),15.1(10),14.6(11)
regained control wk 33


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 Post subject: Re: TSM 'cure' timelines -- 3 or 4 months is just the beginning
PostPosted: Wed Nov 17, 2010 10:45 pm 
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Posts: 116
Is there a reference for this data? I combed through all available TMS-like studies but don't remember a paper that presents such numbers.

One thing is for sure - the Finnish TSM studies seem to involve mainly very light drinkers. This may mean one of the two: 1) they are not "true" alcoholics to begin with, 2) Finns, due to some genetic peculiarity, become addicted to alcohol at much smaller doses. Either way, caution should be exercised in translating these results onto much heavier drinkers of different ethnic background.


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 Post subject: Re: TSM 'cure' timelines -- 3 or 4 months is just the beginning
PostPosted: Wed Nov 17, 2010 11:09 pm 
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Nutella, the reference to the data is the graph on p. 29 of The Cure for Alcoholism by Eskapa. I simply took the approximate numbers by examining the graph in Figure 3.


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 Post subject: Re: TSM 'cure' timelines -- 3 or 4 months is just the beginning
PostPosted: Wed Nov 17, 2010 11:48 pm 
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Merlot, I meant the reference to a study report. A place where one could get details on the numbers and the ways they were obtained.


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 Post subject: Re: TSM 'cure' timelines -- 3 or 4 months is just the beginning
PostPosted: Thu Nov 18, 2010 12:01 am 
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Here's what it says under Figure 3 on Page 29 in Eskapa's book in reference to the chart:

Quote:
(Sinclair, JD. PowerPoint Presentations, Finnish National Public Health Institute, Department of Alcohol Research, 1997-2008). Not previously published. Similar data from the first forty patients were published in 1997. fn 16.[emphasis added]


BTW, fn. 16 references an article on a study by Sinclair in a Finnish journal, Psychiatrica Fennica, which I have not been able to access, even via online journal search at a major university.


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 Post subject: Re: TSM 'cure' timelines -- 3 or 4 months is just the beginning
PostPosted: Thu Nov 18, 2010 12:32 am 
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Thanks! That's pretty much what I thought. Either not published or published in Finnish. Almost certainly not controlled for anything. Sigh.


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 Post subject: Re: TSM 'cure' timelines -- 3 or 4 months is just the beginning
PostPosted: Thu Nov 18, 2010 3:23 am 
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Saint Vincent wrote:
Thanks for reposting this Merlot. This is such an important subtlety from the book that many will not realize. I wish we had a way to "sticky" this on the Board Index page. We all appreciate the work you put into this analysis.


Thanks Saint Vincent. I hope you don't mind that I've quoted below your post in my progress thread in reference to the data/charts. It makes some points that may be of interest to readers of this thread.

Saint Vincent wrote:
Merlot, this graph makes an excellent point which we all need to be aware of. Eskapa wrote, "You can also expect your actual drinking to go down to about fifteen drinks per week within three to four months and eventually down to nine drinks per week, as shown in figure 9 (page 120)" The 3-4 month cure that Eskapa talks about in the book is from a starting point of 37 drinks/week average down to the moderate drinking level of 15 drinks per week. From a starting point of 37 drinks per week (5.3/day) this seems a very reasonable definition of cured. It represents a 59% reduction in drinking from pre-TSM within 3-4 months. When you are drinking 60, 80, 100 or 120 like some of the people on this board that is a whole different ballgame. When you're at 120 drinks/week and you go to 50 drinks/week in 3-4 months you feel better but still not cured because you are way over moderate limits. When I look at my numbers at the 3-4 month period I was down 58%, same for mlb and I'm sure others if we look at their charts. This is exactly what the data from Eskapa showed. So I will go out on a limb here and say this for anyone reading. A 3-4 month cure with TSM will only likely happen if you are starting from a 37 drink per week basis. If your numbers are higher there is no data to say how long it may take. Presumably, we who are drinking above 37 drinks per week are more alcoholic, the disease has progressed farther. It seems logical that it will take longer for us to get down to moderate levels. Anyone who starts TSM at 80 drinks/week and thinks they will be cured in 3-4 months is setting themselves up for disappointment. The data don't support a cure that quickly for people at such high levels. Thanks for posting the graph Merlot. This is something I tried to point out to JamesCT when he was on the board but he couldn't/wouldn't see for the forest for the pessimistic trees he was surrounded by. He is over at MWO now making trouble on the Naltrexone thread as "37 degrees" (98.6 degrees F).


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