I just finished reading minneapolisnick's note. Basically, drink without Nal and the problem returns in full bloom. There were a couple more of essentially the same observations on this board recently. True, that's what TSM shows for mice and that's what Eskapa's book talks about - we all were warned. This got me thinking though: In what regard is this a "cure" then, with individuals being "cured"?

The way I see it, it is not much different from AA. We pop pills, they use will power. Whatever works. TSM seems to be much easier to follow through, yes. But in neither case the disease/problem is cured. Instead, similar to all chronic and incurable illnesses, it is managed. Drop the regimen and you are sick again. The biggest difference is language then: AA says upfront that there is no cure and one is damned to eternity to fighting the alcoholic brain while TSMers cheerfully proclaim cure because popping pills for eternity is pretty damn easy.

And if there is no cure, shouldn't the emphasis be shifted at least a little toward the long-term abstinence goals? After all, no one is trying to goad meth or heroin addicts into long-term moderate drug use. It is universally acknowledged as a bad idea. So, what makes alcohol so different then? Does anyone really think that alcohol is not as dangerous for alcoholics?

My take on this is that "the cure" is not curing you of alcoholism, it is curing you of the cravings and constant thoughts and being consumed by drinking. Once the "extinction" has occured, you can certainly choose abstinence, but you do not have too. If you want to take a drive through the wine region and stop and have a glass, you can without it gong back and consuming you--In my mind, that is the difference.

I think of it in terms of type II diabetes, I can alter my diet and control any symptoms of the disease but if I start eating poorly again I will be sick again. TSM can return me to when I was 16 years old and not addicted to alcohol. If I stay away from alcohol or take nal and don't reward myself for drinking it I'm fine but if I choose to drink repeatedly off nal I will learn to be alcoholic more quickly just like the type II diabetic will develop signs and symptoms of diabetes more quickly with each successive lapse in diet. We lose plasticity in the case of diabetes and we relearn addiction more quickly in the case alcoholism. I have thought about this a lot with regard to my children. One of them is wired just like me. I can see him getting the endorphin "hit" when he plays video games and when he gets older he would probably do well to stay away from AL or drink only on nal and avoid developing the addiction I did. "Cure" is irrelevant and more about semantics. "Un-addicted but susceptible to future addiction" really describes the cured TSMer better but it's a mouthful. I do enjoy these philosophical discussions while I'm finding my way out of the woods.

I have to agree with Saint Vincent. It is really an issue of semantics. TSM is not really a "cure" but rather an ongoing treatment for a chronic vulnerability. It can promote remission from the condition, but the patient is always liable to become ill again if they discontinue or fail to comply with the treatment protocol.

On the issue of abstinence vs TSM. This is the huge advantage of TSM : you can work towards abstinence or near abstinence, but how realistic is it for most people that they will never, ever have, or be tempted to have, a cold beer on a hot summer`s evening, a glass of wine while on vacation in Italy, etc., even after several years of abstinence? TSM provides you with the option to try abstinence while also providing you with a safety net. Compare that to AA. The AA member is considered a failure if he or she has a single glass of wine. The AA member does not have the option of taking a pill that will help them control any slips. If the initial slip leads to a full blown relapse, the AA member does not the option of using NAL to gain control. I will go even further. A TMSer that slips up like Nick is in a much better situation. Even if after gaining control of the problem for an extended period, the TMSer slips and drinks without NAL on a few occasions, he or she has a proven method to get back on track fast by continuing to drink according to the TSM again.

I agree with the above three posts. It really is about semantics and I don't like the word "cured" either because -- as so aptly described above -- even after we no longer obsess over alcohol, we are still susceptible to re-addiction if we do not take naltrexone and continue to drink. Accordingly, IMO TSM is not really a "cure" but more about regaining control. If you read my old posts, you will see that I made this distinction even before I made the dumb decision to drink off of naltrexone.

Also, some clarification of my situation is in order. When I made the dumb decision to drink off of naltrexone, it wasn't like I immediately fell into my old habits. I didn't binge big time and wake up crippled by a 24-hour hangover like pre-TSM. Rather, my numbers gradually went up and before long, I realized I was drinking past unhealthy levels. It was gradual. After I realized my mistake, I took a week off of drinking and again it took ZERO effort during that period of complete abstinence. I didn't think about drinking the entire week, so it's not like I went back to square one. I also do not think complete abstinence has to be the goal. If you can drink with control for life so long as you take a pill, I see nothing wrong with it. Personally, I remain grateful I'm not going through a life of white-knuckling and relapse, like almost everyone else I have met who bought into AA.

Also, you have to be REAL careful using the word "cured" amongst the 12 step crowd. They get fired up. I prefer to use extinction.

Once they look up the word "extinction", they'll be just as fired up.

The analogy to diabetes type II is nearly perfect. Yes, there is no cure. In general, I agree with most of the comments above. Interestingly though, the question of why alcohol should be any different from heroin, meth or nicotine was not addressed by anyone. Something tells me that "take pill, have all the sugar you want" approach would not be very popular either.

Alcohol is not the same as heroin or meth. Heroin and meth are far more inherently dangerous than say, a beer or a glass of wine. And last I checked, a typical drinker can have a glass of wine or a beer and call it quits -- just as we can if using TSM. Whereas not too many heroin users or meth-heads have one hit and call it quits; moreover, none of them have a drug like naltrexone to set them free.

"while TSMers cheerfully proclaim cure because popping pills for eternity is pretty damn easy."

I have not read one person on this board "cheerfully proclaim cure because popping pills is pretty damn easy." In fact, I've heard EVERY person who uses the language "cured" discuss how long and painful their journey was, how sad they are for a life nearly wasted, and how grateful they are now not to be a slave to alcohol.