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.
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