4 meds - which one?

[37degrees]

A few weeks ago, I got a big, big wake-up call that I had to do something about my drinking, and fast. As an atheist of long standing, 12-step programs are non-starters. ("If there is a God, how can I not be Him? Therefore there is no God.")

I looked at the various meds for AL treatment. The preponderance of the evidence is that all 4 have some mild efficacy. As expected, the treatment protocols with the least medical support have the most fervent supporters, some bordering on irrationality. (For example, some nalexone users on the "Sinclair Method" think that there is a vast conspiracy to suppress their therapy and that most alcoholics will be cured if only they will stick with the program for a year and more despite no progress.)

Given that I think that all 4 meds work, but not all that well, which one do I choose?

Topamax: I had been on Lamictal for years for bipolar, and it didn't make any difference to my drinking. Since both have similar theoretical actions, I didn't think Topamax would work for me.

Baclofen: To get to the "Swtich" dose, I would have to go thru stages of Zombieland not compatible with my work. I prob. would have to take 2-3 months off to try this modality, and I may do so in the future if needed.

Campral: Big attraction is that there is no cult-like following (yet). Big negative is that there is no promise of hitting for the fences to "cure" me.

NAL: Easy, few (minor) side-effects. I read the Sinclair Method book and references. Theory is ridiculous. "78% cure rate" is not supportable at any level. The Sinclair forum has several desperate folks who are drunk 6 months or so into the program and insisting that they just need to keep at it for another month, or year, all the while invoking "extinction bursts", "pharmacological extinctions", and other pretty catchphrases which they don't understand and which have never been demonstrated for humans. Sad.

I went with naltrexone. It is easy, pretty well harmless, and requires little effort on my part. I expect efficacy slightly above placebo, and if it doesn't work for me I will move on.

If NAL doesn't work my next step will be taking 3 months off work and trying high-dose BAC.

[Isolde]

4 meds - which one?

37degrees;988170 wrote: Topamax: I had been on Lamictal for years for bipolar, and it didn't make any difference to my drinking. Since both have similar theoretical actions, I didn't think Topamax would work for me.Didn't work for me. You can read my post in the recent thread about Topamax vs. Baclofen if you want to know the details.

37degrees;988170 wrote: Baclofen: To get to the "Swtich" dose, I would have to go thru stages of Zombieland not compatible with my work. I prob. would have to take 2-3 months off to try this modality, and I may do so in the future if needed.Wondering where you got the idea that Baclofen turns you into a zombie? I experienced that to some extent with Topamax, but have really had no issues with Baclofen affecting my work. On occasion when I increase my dose, I might feel a little sleepy for a day or two (not all day either, just for a short amount of time). Nothing a cup of coffee doesn't completely fix. You could always look into nootropics (aka "smart drugs") if you're concerned about it affecting your mental capacity. I've had good results with Piracetam for mental clarity, and it's good for overall energy too. Take it with some lecithin or choline for best results. I don't think that 3 months off would really be necessary. If you're really concerned about it, I'd say see how it goes first before taking the time off. See how the low doses affect you - you can always titrate back down and wait until you can get the time off if you really feel that the Bac is affecting you mentally. If you read more around this forum, you will find MANY people who have had (and are having) success with Bac.

37degrees;988170 wrote: Campral: Big attraction is that there is no cult-like following (yet). Big negative is that there is no promise of hitting for the fences to "cure" me.

The reason it doesn't have a "cult-like following" is because it doesn't work terribly well. I haven't taken it personally, but I've never read about anyone who has had success with Campral.

37degrees;988170 wrote: NAL: Easy, few (minor) side-effects. I read the Sinclair Method book and references. Theory is ridiculous. "78% cure rate" is not supportable at any level. The Sinclair forum has several desperate folks who are drunk 6 months or so into the program and insisting that they just need to keep at it for another month, or year, all the while invoking "extinction bursts", "pharmacological extinctions", and other pretty catchphrases which they don't understand and which have never been demonstrated for humans. Sad.

Haven't tried it, but have read about people having success with it. From what I've heard, it can take awhile to work, but I'm sure you've read about that as well. Lo0p here has had success with combining Nal and TSM with Bac. You can read his posts on that for more info.

Best of luck with the Nal, keep us posted on how it works for you.

[guardian]

4 meds - which one?

Naltrexone worked well enough to get me to the point where I could abstain 3 or 4 nights a week with little difficulty. The problem came when I did drink, I drank as hard as ever. It never had any effect on the total quantity per day. Which is why I looked to baclofen.

https://www.mywayout.org/community/f2...udy-45734.html

That's a thread I started that got a little off track and became my "success thus far" story. I pushed my dose up pretty quickly and hit my switch in under a week. That's definitely not typical. I had to wear an eye patch to keep from falling down or throwing up the first 4 or 5 days. Not too appealing right? Well, the days since the switch have been the best days of my life. No exaggeration.

I'm sure there are similar success stories with any one of these meds. I can only speak for the two, but they got me to a place I never thought possible in a shorter time than I could have imagined.

There are others that have titrated with baclofen much more slowly and minimized side-effects to a manageable level but still arrived at the same place in the end. I hope you hear from some of them. They'll probably have better advice. I kind of dove in head first before having a chance to really absorb much.

-Ian

[Publius]

4 meds - which one?

okay so here's my personal rundown of all the majors...

campral - utter nonsense. at best a placebo, at worst garbage

topiramate - seems to have some good results. no personal experience, but there's a lot of success stories with it

antabuse - it definitely works, was on it for 9 mos, but it is certainly all or nothing. The biggest problem is you create a situation where you have no choice but to be a dry drunk, as it does nothing to treat any brain function, underlying or directly related to the alcohol dependency, if you're okay with that, knock yourself out.

naltrexone/sinclair method - I took naltrexone for a while, seemed to be hit or miss. While I've never done sinclair, I believe that the science is sound, and there are many that can attest to its efficacy. The largest problem I have with the treatment, is that it only treats the alcohol dependency. The basic idea is that by removing the positive effects of alcohol, and your brains obsession with it, you will eventually rewire your neurons to the point where you will no longer be addicted. I believe this method works, but with one great downfall, and that is it doesn't treat the reason you initially started abusing alcohol. Even if you remove the alcoholism from the equation, the reasons you are predisposed to the disease remain. It is my belief that once you remove that temporary fix that is alcohol, your brain will search until it finds something to substitute for that dependency....which brings us tooooooo

baclofen - Baclofen in my estimation is the ultimate alcohol dependency treatment. Not only is the efficacy rate high, but when it works, it seems to be absolute. Baclofen by many accounts, not only treats the alcoholism, but also treats the underlying causes of the disease, namely, debilitating anxiety. It is my belief that this is the very reason why baclofen has shown such success. There is a large subset of alcoholics, myself included, whose problem stems directly from lifelong struggles with anxiety, and the only cure that we have found, however fleeting, is self-medication with alcohol. Baclofen is the first thing that truly comprehensively treats that underlying condition (something that SSRI's and other meds failed to do) making the need for alcohol obsolete. If you don't feel like this underlying condition includes you, baclofen may not (or may, this is obviously conjecture of mine constructed from the stories of others) work for you. As for the side effects of baclofen, for me they have been very mild. I've been as sharp as ever at work, and I wouldn't let the SE's dissuade you from this as an option. I realize that they vary from person to person, but I also think that a slow titration schedule (start at 10mg/day for a week 2x/day and increase by 20mg every week, after the first week admin 3x/day) has many benefits, not the least of which are diminished side effects.

In conclusion, if it's just alcoholism, nothing else, do naltrexone/sinclair. If it's anxiety and other factors that lead you to abuse, I'm a very firm believer in baclofen.

I hope this helps...but good luck in whatever you decide...:getwell: soon!

[guardian]

4 meds - which one?

Publius,

thank you for that. That's it in a nutshell for me. I've never heard it put so concisely. Gives me great ammo when I break the whole thing to my folks about why I don't have an alternate, calm and friendly personality. Again, thank you.

-Ian

[37degrees]

4 meds - which one?

Thanks for the feedback. Much appreciated.

From lurking here, I had thought that high-dose BAC hits hard for many people. In my job, I don't want to risk injuring people because I am zonked for any reason. I do have the luxury of not working for a few weeks/months at a time (until the beer money runs out - ha) if I plan ahead. So I still think that if go the BAC route, I will stay home and titrate up rapidly.

I am giving NAL/Sinclair a 3 months trial. As I posted in another thread, my AL use is down. However, in what really matters to me, I haven't change. I am still unable to restrict or stop drinking when I should - prior to driving, at social/professional engagements, etc. It would be great if I can still enjoy the occasional beer or wine, but I will accept abstinence if necessary.

I looked extensively into the Sinclair references, and unfortunately there is little scientific or clinical support. Most of the 100+ quoted papers are irrelevant or even contradict the claims. TSM's populizer, Dr. Roy Eskapa, got his doctorate from a therapist diploma-mill and has never written a peer-reviewed publication. His only other publication was a book about having better sex (or whatever).

There is evidence that naltrexone works, which is why I am using it now. However, TSM is much like AA in that both insist on faith in their methods and blaming the victim in case of failure. Cults, in both cases.

[Sunnyvalenting]

4 meds - which one?

37,
not all baclofen users need the highest of doses. The range of effacacy seems to be quite individual and ranges from 15 to Over 300 in a recent study. The average effective dose was 145mg/day. I myself noted significant success from even the lowest dose. But i had also already been on the wagon for a few days when I started it and was VERY determined not to fall off the wagon again.
I don't think there is any drug that will make a person want to stop drinking. That must come from the person themselves. I started trying to sincerely stop drinking over 10 years ago and tried everything on the above lists and then some (except campral as it had a very low success rate). NOTHING made me feel as securely abstinent as baclofen from the very first dose I knew I could do it with this helpful drug. I never knew to expect a switch which is a good thing for me as I would have been wondering if I had reached it. All I know is that I found it possible and easy and comfortable to do what I knew I wanted to do and not do what I knew I didn't want. I titrated up slowly to about 90-100 mg over several weeks. I allowed any side effects to dictate how quickly to move up. I took 2 weeks off work as the program I went to was a 2 week program. I don't know if anything else they did there (lots of talk, special diet, etc) made a wit of difference but I did whatever they told me to do while there. I believe that I wouldn't have had to take a job leave during the first weeks. I would just have had to work my doses around my peak times. After all I was about to lose my job for absenteeism and poor performance due to this addiction at any rate. Titrating up on bac is small potatoes compared to active drinking or a hangover IMO.
I am glad you are looking at all your options. I tend not to be a "true believer". I too am an athiest. I am also a scientist and have read extensively on this drug AFTER having experienced its effect on me. Good luck in your pursuit of your solution. I wish you and all concerned the very best.
Sunny

[37degrees]

4 meds - which one?

Thanks Sunny for your reasoned approach.

I am near Month 3 on NAL. Since I drink daily and haven't consciously limit my drinking, I suppose I am also following TSM. I am more aware of my drinking, as I likely would be on any regiment, but I really don't find any big difference in craving or liking alcohol.

About abstinence, my understanding is that with "traditional" approaches to alcoholism, social or limited drinking is unstable long-term and settles into either abstinence or return to alcoholism. Proponents of some of these newer treatments believe that one can get cured and drink alcohol non-problematically because the brain gets re-wired. I am skeptical.

Another month on NAL/TSM and I will see how it goes.

[Sunnyvalenting]

4 meds - which one?

for me moderation is a very high risk situation. I am choosing abstinence as the most common reason for relapse is exposure to the substance. this is true for rats as well as people. I think I can rewire for an alternative to the cues but I also believe the original wiring remains and will be strongly activated if I drink again. It isn't worth the risk. IMO there is NO upside potential even for moderate drinking anyway. The lies our culture tells us about social drinking are phenomenal. I lose nothing and gain everything with a choice of permanent lifelong abstinence. Good luck and keep us posted.
Sunny

[help4me]

4 meds - which one?

I've tried both Topamax & Campral in the past with no avail.

BACLOFEN is working for me!! It's a magic pill it is. I'm still in awe.

[AllyB]

4 meds - which one?

Publius;988195 wrote: baclofen - Baclofen in my estimation is the ultimate alcohol dependency treatment. Not only is the efficacy rate high, but when it works, it seems to be absolute. Baclofen by many accounts, not only treats the alcoholism, but also treats the underlying causes of the disease, namely, debilitating anxiety.

Just on this, my husband has been taking it for 3 weeks now and from the first morning after taking 10mg the night before his whole personality changed. He used to be so wound up it was literally visible to anyone who knew him. That morning (Saturday 9th) he was calmer and more relaxed. There were still a few crazy moments in the following few days as he was trying to fast forward to "cured" but after about 5 days that fizzled out.

Unfortunately the timing with his work has been foul, in the last 3 weeks he's been working 100+ hours a week and had been for the month before as well. It's not an ideal scenario for taking this drug but once they arrived he felt it was better to start the baclofen while working like this rather than be drinking heavily.

He's on high doses but the only zombies we've experienced has been the pre-air of The Walking Dead that I got a hold of last week.:sofa: His job is incredibly intense and highly skilled (a small mistake could cost 6/7 figures) and he has had a lot of praise from his boss about how he's handled the last few weeks. He's also able to drive to and from work. The biggest baclofen SE he's experienced has been insomnia. This was terrifying to him around the start of week 2 but he relaxed once he realised he's actually coping quite well on 4-5 hours sleep.

The other big problem he's having is that he often forgets to take his pills or sometimes he'd take them, forget he'd taken them and take more so the amount he was taking everyday was fluctuating wildly. To solve that I bought a pill box with different day of the week compartments and 1 days pills goes into the entire box in 6 doses with the 7th for spares. (He's also on a vitamin programme, so there are a lot of pills). This way he doesn't have to concentrate so much on what he has and hasn't taken.

And even with all of the craziness of the work hours, the sleeplessness and the stage of utterly random doses it's clear that the pills are working. He's a very, very different person. I've lived with him a number of times while he was working through similar intense periods (though never as bad as this one) and he's cracked badly. Drinking small amounts around the clock, coming home in a stupor, irrational, crazy, fucking up tasks at work, fighting and arguing with colleagues, friends and me about the stupidest crap. He lost a job in the past and alienated people in other positions. By the time it was over he'd completely come apart and would go on an extended binge. But this time around he's had more required of him and gotten through it better than was expected of him.

[Isolde]

4 meds - which one?

Ally, that is awesome!! I'm so glad to hear that baclofen really seems to be working for your husband.

[Sunnyvalenting]

4 meds - which one?

This is wonderful news. I know he will do well. I have been on it for almost 10 months now and totally AF.
All the best and thank you for posting your husband's success.
Sunny

[Anna B]

4 meds - which one?

Yes, I'm so happy for you about your husband's success!!

As far as the four treatments go, baclofen has been like a miracle for me. Never made me into a zombie--just tired but all I needed to do was drink more coffee. Not a big deal at all. It never made me mentally less sharp or in any way not myself.

If you're worried about turning into a zombie, then just titrate up really slowly

[Sunnyvalenting]

4 meds - which one?

I found I was sleepy mostly if I wasn't moving about. So kept busy. Reading or the tube were out unless I wanted to be. Again best of luck
Sunny