Baclofen with Naltrexone (TSM)

[Lusus Naturae]

Why this thread? For me, curiosity. For others, I'm sure there are at least a few who are also curious, those who have tried both, and those who are currently using both. I think all of these would benefit from this discussion.

This thread is intended for discussion of using Naltrexone and the Sinclair method (TSM) along with Baclofen. Please post any and all experiences with using both methods together.

My history with Naltrexone: After a lot of reading, I came to the conclusion that the only viable drug assisted means to cease craving alcohol was Naltrexone using the Sinclair method (TSM). I hadn't heard of Baclofen at the time. I lurked around TSM boards for a while, and had tried placing orders for nal at two different pharmacies. Both orders failed.

Right about that time, I came across Baclofen and Dr. Ameisen's experience, as well as the threads in this forum. I held off on the nal, read more about bac, and ended up going the bac route. There's another thread about that elsewhere if you're interested.

I had contemplated using nal and bac together (nal using TSM, of course), but good things happened with bac so quickly I didn't have time to even get started. Since I have no desire to drink at this point, TSM isn't even possible for me unless I start drinking again for the sole purpose of reaching extinction.

I am curious, and I'm sure others are as well, about people's experience working the two together. And for those in process, I'm sure hearing about other's experiences would be beneficial.

.

[lenaleed]

Baclofen with Naltrexone (TSM)

Lusus -- Thanks for the reminder on the TSM board about that old sticky re: registering/not lurking. That was very early in the life of the board, and some members had approached the admin about concerns they were being monitored by hostile spouses/ex-spouses. Our admin put it out there basically as a suggestion for member privacy but we didn't want to discourage good-faith information seekers and decided it was a bad idea. I'm going to ask our admin to remove it. It''s ancient history.

I look forward to seeing what's posted re: baclofen and TSM. A few TSMers have mentioned it as a backup plan and many of us have read Amieson's book. As I've posted here many times, I think it's an exciting time to be seeking an end to alcohol addiction. This site has provided a springboard for so many options and so many of us are finding OurWayOut.

I know oceanaocean is trying it and making progress. She has mentioned a clinical trial now in progress in North Carolina using the two drugs. I just hope they are using nal with the extinction protocol and not as an anticraving med; it has been shown virtually useless when used that way.

Drinking IS required for TSM. Sinclair's studies show that the frequency of drinking sessions is important to success, while the amount consumed is not. If baclofen could help control the amount consumed without reducing the number of drinking days early in the process, then the two have the potential to be a winning combination. And having undergone the TSM extinction process, one could then titrate off the baclofen after a few months, eliminating the need for its long-term or lifetime use. That would leave only the occasional dose of naltrexone for those who do not choose abstinence.

A while ago I had a concern about baclofen having the same effect on the GABA system as benzos, thus hampering the TSM progress of those using the two drugs. But BillP mentioned in a post that baclofen affects GABA b, and has no effect on GABA a -- the type of GABA mediated by benzos and alcohol. So it's possible baclofen would not slow TSM progress.

In fact, for those taking benzos, it might be possible for them to gradually cross over to bac as an anti-anxiety med for that very reason. Bac does not seem to pose the problem of tolerance withdrawal that the benzos do, as evidenced by the fact that users get the same benefit after years of use, while benzo users gradually need more over the years or they start to feel symptoms such as increased anxiety. For that reason alone baclofen would seem preferable for long-term treatment of anxiety. Of course, most of us report an amazing reduction in anxiety when alcohol consumption decreases or ceases. But some, such as AnnaB here and some on the TSM board had anxiety issues before alcohol issues and actually were self-medicating with alcohol.

One big concern I have about mixing the two is that most baclofen users do not seem to tolerate alcohol well, and might have very slow TSM progress due to few drinking sessions. On the flip side, many of us experience a period of a wild uptick in our consumption a few weeks into TSM. This has been called an extinction burst: Think of the bird, taught he will receive food when he pecks a button, suddenly receiving nothing when he pecks. For a time, he pecks frantically and repeatedly until he gives up and stops pecking. This is what's going on in our brain, albeit on an unconscious level (like a statin drug lowering cholesterol). I have a concern that some might "drink through" the baclofen during this period. Others here have expressed concern about mixing bac with high alcohol consumption.

I know from her posts that Cinders opted for baclofen over TSM because she felt she needed to stop drinking immediately to save her life. She now is abstinent (miracle!) and therefore not a candidate for TSM. It never makes sense for someone comfortably abstinent to start drinking just to do TSM.

My final concern is that a hybrid of the methods would be a tough sell to an m.d. It's hard enough to explain the benefit of drinking + naltrexone; add another cns depressant med to the mix and it would set their heads spinning!!

That leaves the option of a diy program. As I said I see enormous potential, but also some potential danger. Because we can get these rx meds online, we have a heightened responsibilityto ourselves to use caution in their use.

I'll be interested to hear the input of others. --lena

[Lo0p]

Baclofen with Naltrexone (TSM)

Bump. Really thinking about this. I'm 3 weeks into TSM and still putting it away so much that I can feel it ravaging my body. I feel like I'm in hell.

For current bac users: Do you just stop drinking completely or can you use it to moderate your intake too?

[Lusus Naturae]

Baclofen with Naltrexone (TSM)

I'll answer that from pov. At first I modded, but not by choice, it just happened. I titrated up rapidly, and after two weeks had passed, just decided one day to not go get more AL from the store. I didn't decide to stop drinking, just not go get some that evening. The next day, I didn't feel like getting any either, and after that, I realized I just had no desire anymore. None. That was two weeks ago.

That was odd. I had had the goal for years to reduce to the point of moderation. I never found the idea of being abstinent appealing. Now I'm abstinent, not by choice really, I just don't want it. I don't know if I could moderate, maybe at some point I'll give that a try just to see what happens. For now, I'm just happy the way I am.

Zen, what was the verdict on your experiment with moderation?

.

[Lenore]

Baclofen with Naltrexone (TSM)

Lo0p;700315 wrote: Bump. Really thinking about this. I'm 3 weeks into TSM and still putting it away so much that I can feel it ravaging my body. I feel like I'm in hell.

For current bac users: Do you just stop drinking completely or can you use it to moderate your intake too?

I did the combo bac/nal for a couple months, but I guess I was too sensitive to bac side-effects What helped me was to increase the Nal to 75 mg and add an antidepressant, but thats me. Maybe you could add the bac and see how it goes for you?

[Lusus Naturae]

Baclofen with Naltrexone (TSM)

Another point: from reading others' accounts, it seems like many have experienced a reduction in intake pretty quickly.

.

[Lenore]

Baclofen with Naltrexone (TSM)

I should add that I'm at three months on Nal and it's working for me now...just a couple of glasses of wine in the evening--not a bottle.

[Lo0p]

Baclofen with Naltrexone (TSM)

I just got shot down. My parents gave me a resounding no. With all the studies and the conclusive proof there is behind TSM they don't want to take a chance of this interfering. Which it would, because I would stop drinking (is this irony at it's best?).

I want to do both but here's how they look at it:

Baclofen: 100+? people cured (not really, just not drinking while on meds), no studies, the possible GABA interference issue (yes I read your post Lena)

TSM: 100,000+ people cured, extensive studies, 90% cure rate in compliant patients (I am compliant), and best: scientifically proven.

Baclofen + TSM: Sounds like an incredible idea, but who knows.

[brightlite]

Baclofen with Naltrexone (TSM)

I just don't see how you can effectively take both and work both programs. The Bac will halt drinking while with Nal and TSM you are supposed to continue drinking to be effective. While you are not wanting to drink on Bac would you force yourself to drink to work the TSM program?

[Zman]

Baclofen with Naltrexone (TSM)

Bright,

If you had to "force yourself" to drink, then there is no reason to start TSM because, quite obviously, you are already cured by the Bac. I think this thread is in relation to people who are still not cured, and are still drinking, such as mself.

I am seriously thinking of doing just this (i.e., doing TSM whenever I drink but continuing with the Bac.

[Cinders]

Baclofen with Naltrexone (TSM)

Zman,

I, personally, would consider it for myself if Baclofen had not worked for me.

As it is, I did hit my off switch, despite having to work a very technical job and extreme tiredness, btw, but knew I would definitely lose my job if I kept drinking.

However, if drinking was still a possibility for me, I would love to keep a bottle of Nal in my purse to take one hour prior to.

To me it is a win/win situation. Baclofen reducing the urges and Naltrexone working to extinct the behavior.

However, I always stress, I do whatever I do under a doctor's supervision. To me, it is very scary to do anything without medical advice and oversight, except drinking, of course, I did that all on my own.

Cindi

[Zman]

Baclofen with Naltrexone (TSM)

Cinders,

I hear you. I would love to have a Doc's supervision, but I am not going to fina doctor in Dubai who knows what I am talking about.

My only hesitiation in undertaking the Bac-Nal route is that I read somewhere that Bac messes up TSM. But I am going to suck it up and try to titrate up on the bac. but if i cant, I dont see any other option.

[brightlite]

Baclofen with Naltrexone (TSM)

Zman,

You may be someone that a combination treatment would be good in undertaking. At least until you reach your "off switch" on the Bac. All of us Baclofenists are pulling for you. Stay the course!

[lenaleed]

Baclofen with Naltrexone (TSM)

Brightlite and zman, I agree with you both.

For those who are not abstinent on bac, naltrexone can't hurt. TSM may be a slow process, though, because it requires frequent drinking sessions. Again, it does not require consuming large quantities, just frequent drinking days.

Best to all in whatever path you choose. Keep us posted.

[bloggy]

Baclofen with Naltrexone (TSM)

I was I think the first person to try the TSM on this board back in Sep 2008. I was doing it without a doctor's interest and got scared after a few weeks because of severe nausea, yellowish eyes, and thought it was not doing my liver any good.

A few months later some new folk joined the board who were beginning the method and I decided to start again. With their help I was able to get through the side effects and I think I became one of the fastest success stories- my drinking reduced quickly and before long I had lots of AF free days here and there.

The problems started for me when I was stringing more than 2 AF days together- for example I would do 3 AF days, then drink on the fourth day. I would take the Nal, and once again experience the same nausea, yellow eyes, and bad disorientation as I did when I first started.

Now I might have been foolish, I don't know, but my reaction to taking a pill I knew was going to make me feel ill was to try to get along without it...remember I had been doing very very well, and the alcoholic's way of reasoning is "You will be OK now".

I know some Sinclairists will be sighing and shaking their heads that I broke the golden rule- "Don't drink without the nal"- but I am not talking about a bit of nausea, I am talking full blown stuff that left me unable to function normally, and I have to work pretty hard 7 days a week.

I wonder if anyone else would have done it differently with the working lifestyle, also everyday driving that I have to do.

Well needless to say I felt the drinking going back up, all be it not to pre-sinclair levels.

At that point Bill.P came on board here and I decided to try the baclofen because although I had appeared to be a huge SM success, the fact I reacted so much to naltrexone ended up working against me eventually.

The same has so far happened with the bac- on my first day I felt a nice mellow sort of "can't really be bothered" feeling- I was so sure it would work for me very quickly, but in the same way, I am having huge difficulties in titrating up- basically because it renders me useless- I mean unable to walk or talk properly (I must appear completely drunk!) once I get to 30mgs per day.
Again this would be OK if I could take a day or two to stay at home near a bed, but at the moment this is not possible- I am in my shop trying to serve people slurring and staggering. Yes, certainly reminds me of something.

So....to cut a long story short, ATM I find a combo of nal and bac to be ideal for me. I take around 15/20mgs of bac a day (25 if I am anxious) and 15/20mgs of nal about an hour before witching hour (a third of a tab).
Some days this is enough to stop me drinking- most days I will have one or two then feel grossed out with it, and don't continue.

I don't know about a long term solution- I don't think it would work for that- but for control at the moment it works for me very well.

In three weeks (I can't wait) my current work situation will be over, and I will try to up the baclofen dose. I feel it is probably right for me because it is excreted via the kidneys- I wonder if the nal was making me so sick due to liver issues.

However this is only my personal experience of both drugs and I think both are a godsend- but I also feel there is no size fits all- what one person finds as true for them will not work for somebody else.

I have refrained from posting lately for various reasons, but I do find it hard to read posts and not react when someone reports a negative experience about bac or nal, and the people who have not experienced the same seem to jump down the poster's throat as though it were their 'fault' and they have done something wrong.

I am just so very grateful I am not where I was a year ago, and the future looks so much brighter, whether it is with bac or nal, or both, I feel the solution is very near, I just need a week to be able to chill out and let the drugs work.