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**Road to Recovery** · October 5, 2011, 04:06 PM

Naltrexone confusion>? Need some insight!

DB,
I only know a little about Nal, UK Blonde and Katie Smiles are the SMEs here. I do know that Nal is not typically used for abstaining but Baclofen is very successful in helping people abstain.
Welcome!

**Greg** · October 5, 2011, 06:56 PM

Naltrexone confusion>? Need some insight!

I have heard of a few cases where naltrexone by itself (i.e. without drinking) has reduced cravings, but those who follow the Sinclair Method say it generally works best if done via that method.

I tried it but didn't stick with it long enough to give a personal verdict. I found myself depressed at the time of taking it, but I suffer depression generally, which comes and goes. I can't say for sure whether I had a depressive reaction to naltrexone, as it could have been a coincidence, or possibly my own fears of worsened depression due to the drug blocking opioid receptors (and hence natural endorphins). Ukblonde seems to have found few/no bad effects like this, in fact she sounds very enthusiastic about her results with it. Maybe PM her to ask more.

**KatieSmiles** · October 5, 2011, 08:08 PM

Naltrexone confusion>? Need some insight!

Hi Db
Noelle is a long standing member here and started taking Nal late Dec 2010 for cravings. It worked for her right away and as far as I know, she hasn't had a drink since. Her last post was mid July, if you send her a PM she might respond.
I have been taking Nal almost daily for 5 months following The Sinclair Method with no signs of depression so far. I did have some SE's (dizziness, tiredness, stomach cramps etc) in the beginning, but they went away within a few weeks.

Hopefully Noelle is still around to help you with any questions you might have.

best,
K

**Heavy Fuel** · October 5, 2011, 11:08 PM

Naltrexone confusion>? Need some insight!

Hi. I take naltrexone and follow the Sinlcair Method. Naltrexone is an opiod antagonist, meaning it blocks endorphins. In terms of side effects, I had a few in the beginning: bouts of short term nausea the day afterwards and some jittery feelings. Those passed within a few days. In so far as side effects, they seem to be minimal compared to some other drugs. Naltrexone seems to leave my body in about 16 hours. If I drink too much, I have a vicious hangover. Otherwise, I am actually MUCH happier now than I have been in the last ten years. But, I also have down times. But that has more to do with getting variability in my moods and my mind is clearing. I am starting to be able to walk away from alcohol.

What makes it work in conjunction with drinking is there is no endorphin rush to reinforce the behavior of drinking. I still can get drunk, but I don't get the warm feeling of the rush. The hangovers are hard too. Over time, without the endorphin reinforcement, one becomes indifferent to alcohol. Without the endorphins, I think the body recognizes alcohol as harmful.

TSM requires some different thinking about the cure. First, the pill doesn't cure: you must take the pill and drink. Second, it takes a while. Some people have gone for a year. Most are six to nine months, and it seems to be based on how long someone drank. Most doctors are will prescribe naltrexone and say "don't drink," but when one drinks, the success rate is 78% according to the Combine study (published in JAMA.) You can find the study at the NIH website and the Journal of the American Medical Association's page. Also, a person following TSM will not take naltrexone unless they plan on drinking.

If you want to know more, I would suggest the book by Dr Roy Eskapa and Dr David Sinclair, "The Cure for Alcoholism," there is a webpage with the same name, The Cure for Alcoholism Be sure it's Dr Eskapa's book. Also, there is a forum dedicated to TSM, thesinclairmethod.com • Index page

I hope this helps!

**dirty birdy** · October 8, 2011, 03:24 PM

Naltrexone confusion>? Need some insight!

so basically what it boils down to is some people were helped by naltrexone by craving reduction and others were helped by following the sinclair method. All i know is though that when i took it the next day i was extremly depressed(more so than usual anyway) and just felt completely out of it. Again not sure if this was from the drinking on naltrexone or the naltrexone itself. Gonna go with the campral for now i think.

**eight days a week** · October 8, 2011, 03:50 PM

Naltrexone confusion>? Need some insight!

I've tried all three for extended periods: Naltrexone, Baclofen and Campral.

For me:

Campral - no craving reduction whatsoever, but seemed to imperceptibly help, somehow. Very subtle. So subtle in fact I think a placebo may have been just as good.

Naltrexone - no effect on craving whatsoever. In fact, all the talk (at the time The Sinclair Method had just hit the news and looked very promising) pointed to you actually being better off drinking on it. Not much encouragement to stay sober!

Baclofen - a powerful anti-craving drug imho, really hits the spot.

**Heavy Fuel** · October 8, 2011, 04:55 PM

Naltrexone confusion>? Need some insight!

eight days a week;1189921 wrote: I've tried all three for extended periods: Naltrexone, Baclofen and Campral.

For me:

Campral - no craving reduction whatsoever, but seemed to imperceptibly help, somehow. Very subtle. So subtle in fact I think a placebo may have been just as good.

Naltrexone - no effect on craving whatsoever. In fact, all the talk (at the time The Sinclair Method had just hit the news and looked very promising) pointed to you actually being better off drinking on it. Not much encouragement to stay sober!

Baclofen - a powerful anti-craving drug imho, really hits the spot.

The idea naltrexone in and of itself relieves “cravings” is a common misconception about TSM and naltrexone. First, every study that I have found concerning naltrexone and “craving,” shows the drug does not reduce “craving.” Drs Eskapa and Sinclair say as much in their book. Secondly, TSM is not for abstinent people. Let me say this again: THE SINCLAIR METHOD IS NOT FOR ABSTINENT PEOPLE. Further, the goal of TSM is NOT abstinence. The goal is safe drinking levels. Again, the studies and book clearly say as much.

To use TSM, you must drink. Therefore, this isn’t for abstinent people. TSM is for those who currently drink at problem levels, i.e. active alcoholics. This seems to cause many people a kind of disconnect: most people think you take the pill and not drink. TSM requires you take the pill and then drink. As much as the person wants, there is no concept of “sobriety,” as defined by AA or popular usage. There is no concept of "relapse," soul searching, personality inventories, sponsors, higher powers nor demeaning "treatments." The pills do not make you sick. The only requirement is 50mg of naltrexone one hour before one expects to drink. There is no long commitment to taking drugs daily, as one only takes the naltrexone when they drink. And if one keeps at it, at some point there will be alcohol free days.

My end goal is safe drinking, as in no more than the Upper Limit of Moderate Drinking. I have a 78% chance of this occurring. However, there is a 16% probability that I will be completely abstinent. Which is fine, all I want is control over my life again. I will never define myself in terms of AA’s concept of “sobriety,” which as I understand it, involves more than just abstinence from alcohol.

**eight days a week** · October 8, 2011, 05:28 PM

Naltrexone confusion>? Need some insight!

Heavy Fuel:

I tried to avoid commenting on your first post directly, because TSM is NOT the point of this thread. The OP is asking for info about craving-suppressing meds.

Naltrexone is licensed for craving-suppression, is it not? It may not work very well (but then nor does Campral, nor does AA - and yet both are still two of the fundamental blocks of the 'recovery' industry), but that's what it's long been prescribed for.

Now Sinclair (brought to the world's attention by Eskapa - please note neither of them are medical doctors, and both have seemingly completely abandoned the cause since the book was published) found a different use. There has been one major study that seems to back-up his findings. Supposedly tens of thousands of successfully treated patients in Finland (of whom only one or two apparently speak enough English and have internet access to attest to that!!) Oh, and hundreds if not thousands of people have tried it on the sinclair method forum, with only a few handfuls coming back to declare themselves 'cured'. If you don't know all this and are following TSM then you need to get better informed - it's all actually there on that forum if you go back, read, and see between the lines.

Heavy Fuel;1189954 wrote: The idea naltrexone in and of itself relieves “cravings” is a common misconception about TSM and naltrexone. First, every study that I have found concerning naltrexone and “craving,” shows the drug does not reduce “craving.” Drs Eskapa and Sinclair say as much in their book. Secondly, TSM is not for abstinent people. Let me say this again: THE SINCLAIR METHOD IS NOT FOR ABSTINENT PEOPLE. Further, the goal of TSM is NOT abstinence. The goal is safe drinking levels. Again, the studies and book clearly say as much.
1) You are replying to me (in fact you quoted me) but I assure you I have no misconception about Naltrexone and TSM - I know both very well. Naltrexone is 'properly' prescribed for cravings - and largely doesn't work. In 'real life' people alternatively try TSM, which also largely appears not to work (it does for some though). On this forum I think you'll find more people who it's worked for in the 'original' way rather than TSM (i.e. not the long-term continue-to-drink-yourself-to-death-and-wait-for-it-to-lose-its-allure method).

2) Why is TSM not for the goal of abstinence? For the people that TSM has worked for, afaik a very large proportion end up close to abstinence, or actually abstinent.

I could go on about the other ridiculous things you've said on this thread, and pick them apart, but would rather prefer to think that you're just repeating the mantras from the sinclair method forum, despite not knowing enough people personally who have been on TSM for over a year to know that much of what is written there is nonsense. So I'll just say one final thing:

Heavy Fuel;1189954 wrote:

My end goal is safe drinking, as in no more than the Upper Limit of Moderate Drinking. I have a 78% chance of this occurring.

In terms of real life, I am very sorry to say this figure is complete nonsense. I myself chased this supposed figure for over a year, and so did my friends. Out of 20 or so of us in close contact NOT ONE was 'cured' this way. Go figure. And now, where is Eskapa? Where is Sinclair now his 'cure' for alcoholism has been out in the wide world for a few years? Nowhere. They're not that interested.

In contrast Baclofen works as an anti-craving for many, immediately. It seems to work for a good many as a 'cure' if they can titrate high enough.

I have no doubt that Nal has a place, works wonders for the small minority, may work well as a 'boost' to Baclofen etc. But what Sinclair and Eskapa say it is, I have no doubt that it is not.

Sorry.

**Heavy Fuel** · October 8, 2011, 06:36 PM

Naltrexone confusion>? Need some insight!

eight days a week;1189962 wrote: Heavy Fuel:

I tried to avoid commenting on your first post directly, because TSM is NOT the point of this thread. The OP is asking for info about craving-suppressing meds.
I am no shrinking violet. I welcome discussion. In fact, I learn the most from those I disagree with. If I agree with you, there is nothing for me to learn.

That said, our initial disagreement begins with what YOU said. I can read and write English, so I am sure what the original poster asked.

First, let us look to what he title his thread: "Naltrexone Confusion>? Need some Insight!" S/He then asks those who have taken the drug what they feel. I explained my experience. S/He also goes on to say s/he is looking to reduce cravings, but was drinking on naltrexone. I explained why naltrexone/abstinence doesn't work and why TSM does.

Where did I misunderstand the original poster?

eight days a week;1189962 wrote: Naltrexone is licensed for craving-suppression, is it not? It may not work very well (but then nor does Campral, nor does AA - and yet both are still two of the fundamental blocks of the 'recovery' industry), but that's what it's long been prescribed for.

Off label uses of medicines are quite common. In fact, let us consider another off label use of a drug: originally wellbutrin wasn't "authorized" for smoking cessation, only as an antidepressant, but it had both uses. There are many drugs like that. I suggest you research it.

eight days a week;1189962 wrote: Now Sinclair (brought to the world's attention by Eskapa - please note neither of them are medical doctors, and both have seemingly completely abandoned the cause since the book was published) found a different use. There has been one major study that seems to back-up his findings. Supposedly tens of thousands of successfully treated patients in Finland (of whom only one or two apparently speak enough English and have internet access to attest to that!!) Oh, and hundreds if not thousands of people have tried it on the sinclair method forum, with only a few handfuls coming back to declare themselves 'cured'. If you don't know all this and are following TSM then you need to get better informed - it's all actually there on that forum if you go back, read, and see between the lines.

Bull. The Combine study was published in 2003 in the JAMA. Their book wasn't published until 2008. You are playing fast and loose with the dates with your post. As far the studies (and do note the dates: )

1. Renault, P. F. (1978) Treatment of heroin-dependent persons with antagonists: Current status. Bulletin on Narcotics 30: 21-29 ? Renault, P. F. (1980) Treatment of heroin dependent persons with antagonists: Current status. In: Naltrexone: Research Monograph 28, Willett, R. E., and Barnett, G., (eds.), Washington, DC: National Institute of Drug Abuse, 11 22. First clinical trial of naltrexone and only controlled trial for opiate addiction. Large double-blind placebo-controlled (DBPC) trial (n=197) plus 1005 open-label patients. Naltrexone was effective but only in patients who disobeyed instructions not to use opiates while on medication. Not effective with abstinence. It was concluded that Naltrexone works by extinction. Basis for FDA acceptance of Naltrexone for opiate addiction.
2. Volpicelli, J. R., O'Brien, C. P., Alterman, A. I., and Hayashida, M. (1990) Naltrexone and the treatment of alcohol dependence: Initial observations. In: Reid, L. D., (ed.) Opioids, bulimia, and alcohol abuse & alcoholism. New York: Springer Verlag, 1990; 195 214. ? Volpicelli, J. R., Alterman, A. I., Hayashida, M, and O'Brien, C. P. (1992). Naltrexone in the treatment of alcohol dependence. Archives of General Psychiatry 49: 876 880. First DBPC clinical trial for alcoholism. Naltrexone was safe and effective, with the primary effects being found in patients drinking while on medication, as required by extinction. No significant benefits before first drink on Naltrexone.
3. O'Malley, S., Jaffe, A., Chang, G., Witte, G., Schottenfeld, R.S., and Rounsaville, B.J. Naltrexone in the treatment of alcohol dependence. (1990) In: Reid, L.D., (ed.) Opioids, bulimia, and alcohol abuse & alcoholism. New York: Springer Verlag; pp 149 157 ? O’Malley, S.S., Jaffe, A.J., Chang, G., Schottenfeld, R.S., Meyer, R.E., and Rounsaville, B. (1992). Naltrexone and coping skills therapy for alcohol dependence. Archives of General Psychiatry 49: 881 887. The other DBPC trial in addition to Volpicelli used for FDA approval of Naltrexone for alcoholism. Naltrexone was safe and effective in “Coping” groups inadvertently encouraged to break abstinence, but there were no significant benefits in “Supportive” groups with instructions to abstain. No significant benefits before first drink on naltrexone. Significant interactions indicating naltrexone is better with Coping than Supportive therapy.
4. Mason, B.J., Ritvo, E.C., Salvato, F., Zimmer, E. Goldberg, G., and Welch, B. (1993). Nalmefene modification of alcohol dependence: A pilot study. Proceedings of American Psychiatric Association Annual Meeting, San Francisco, CA, May 1993, p. 170, abstract NR442 ? Mason, B.J., Ritvo, E.C., Salvato, F.R., Goldberg, G. (1994) Preliminary dose finding for nalmefene treatment of alcoholism. Alcohol Clin Exp Res 18: p. 464 (abstract 270) ? Mason, B.J., Ritvo, E.C., Morgan, R.O., Salvato, F.R., Goldberg, G., Welch, B., and Mantero Atienza, E. (1994) A double blind, placebo controlled pilot study to evaluate the efficacy and safety of oral nalmefene HCL for alcohol dependence. Alcoholism: Clinical and Experimental Research 18: 1162 1167. Small DBPC trial showing nalmefene (similar to naltrexone) is safe and effective in treating alcoholism. No significant benefits before first drink on nalmefene; the article says this finding confirms Sinclair’s hypothesis that the medication is working through extinction.
5. Bohn, M.J. and Kranzler, H.R. (1993) Randomized trial of safety and efficacy of 25 vs 50 mg naltrexone and brief counseling to reduce heavy drinking. Proceedings of the Research Society on Alcoholism (RSA) meeting, June 19-24, Miami, FL. ? Bohn, M.J., Kranzler, H.R., Beazoglou, D., and Staehler, B.A. (1994) Naltrexone and brief counseling to reduce heavy drinking. The American Journal on Addictions 3: 91 99. Naltrexone was safe and effective in open label study for reducing drinking and craving when used without detoxification and with instructions not to abstain but to try to cut down drinking. Protocol similar to that used by Sinclair in preclinical studies and in the Sinclair Method. “Several subjects reported subjective alterations in desire for carbohydrated-rich foodstuffs and sex.”

The rest of that paragraph is your supposition.

eight days a week;1189962 wrote: 1) You are replying to me (in fact you quoted me) but I assure you I have no misconception about Naltrexone and TSM - I know both very well. Naltrexone is 'properly' prescribed for cravings - and largely doesn't work. In 'real life' people alternatively try TSM, which also largely appears not to work (it does for some though). On this forum I think you'll find more people who it's worked for in the 'original' way rather than TSM (i.e. not the long-term continue-to-drink-yourself-to-death-and-wait-for-it-to-lose-its-allure method).

Again, your supposition. Being someone who is following TSM and watching the data pile up, I am pretty sure TSM works. I have just posted multiple studies backing naltrexone + drinking and have more I could post.

I love your end statement I have put in bold, I think that shows where you were approaching this from. You have a preset view TSM is an "excuse to keep drinking."

eight days a week;1189962 wrote: 2) Why is TSM not for the goal of abstinence? For the people that TSM has worked for, afaik a very large proportion end up close to abstinence, or actually abstinent.
Why do you believe abstinence is the only way? Oh, and if you read what I wrote, you would clearly see that I stated 16% of percent end up at abstinence. But that isn't what defines success under TSM. So I fail to see why you wrote that.

eight days a week;1189962 wrote: I could go on about the other ridiculous things you've said on this thread, and pick them apart, but would rather prefer to think that you're just repeating the mantras from the sinclair method forum, despite not knowing enough people personally who have been on TSM for over a year to know that much of what is written there is nonsense. So I'll just say one final thing:

In terms of real life, I am very sorry to say this figure is complete nonsense. I myself chased this supposed figure for over a year, and so did my friends. Out of 20 or so of us in close contact NOT ONE was 'cured' this way. Go figure. And now, where is Eskapa? Where is Sinclair now his 'cure' for alcoholism has been out in the wide world for a few years? Nowhere. They're not that interested.
Really? Do go on and on. You aren't addressing studies or facts, you are simply posting anecdotal stories about your "friends." If your point of view is correct, there should be studies and data to back up that position. Just because you or I post some crap on the internet doesn't make it so. And only a fool would believe either of us without doing their own research in such a critical subject.

Want to publish your numbers? If you really did follow TSM, you would have tracked your units. I can show my numbers right now. In my time period, I am at about 50% prestart numbers and falling.

Show some studies that refute the successful outcome number. How about let's starting with that. Let's keep it factual, scientific study to scientific study. Not whatever you decide your friends out comes were.

eight days a week;1189962 wrote: In contrast Baclofen works as an anti-craving for many, immediately. It seems to work for a good many as a 'cure' if they can titrate high enough.

I have no doubt that Nal has a place, works wonders for the small minority, may work well as a 'boost' to Baclofen etc. But what Sinclair and Eskapa say it is, I have no doubt that it is not.

I hope it works for you and everyone else who tries it. The problems is you have to "titrate high enough." And the side effects.

eight days a week;1189962 wrote: Sorry.

For what? You aren't right. So far, my approach is working for me. I hope yours does for you. In another 8-12 weeks, I won't be questioning my dosage. I won't be looking for the next thing. I won't be taking pills to fix the side effects. I will be living my life.

**Lo0p** · October 9, 2011, 01:15 AM

Naltrexone confusion>? Need some insight!

Search the posts of the member name "eight days a week" on The Sinclair Method forums.

Then search the posts of the member name "Lo0p". You'll find over 700 of them. You'll see that I once spoke as fervently (or moreso) about TSM as you do now. Shit, I could've written the post you just wrote, 2 years ago. But then I actually did the research, instead of trusting that all of these references were pointing to what Eskapa said they were pointing to

I have read the full text of every single study ever done on Naltrexone (that is available). I've spent more than 2 years researching it.

If you actually read the full text of the studies you are citing (and Eskapa citied in his book) you'll find that they contain NO direct support for TSM extinction hypothesis. If they did at all it was so slight it would have been laughable if it were a funny subject. I was incredibly dismayed when I discovered this.

Eskapa, whom I entrusted my life with once, is a liar. That book is a shoddy piece of work at best (and not even remotely scientific) or a nearly criminal act of willful and cruel deception at worst.

My time is limited, but if you'd like to read some of those studies I can give them to you.

I have been witness to some friends of mine that were cured or their lives greatly improved by TSM, so I consider it a viable (and therefore invaluable) tool in the battle against alcoholism. I'd never decry it or consider it and invalid treatment but, I am afraid, Eight paints a much more accurate picture of the likelihood of outcomes of anyone undergoing TSM than Eskapa. Eskapa's so called "numbers" and "statistics" are based on nothing

edit: I don't have enough breath (time) to expound upon this right here, but if you read my 700 posts over at the TSM forums you'll see that I walk the talk.

I'm glad you are noticing improvement (that's great

). According to the Finnish study (which is the only study that has ever been done which directly tested targeted Naltrexone, and has never been duplicated), you are already included in the 78% success rate if you've reduced your drinking by about half...even if you're still drinking 50+ (or whatever) units a week.

**Lo0p** · October 9, 2011, 01:33 AM

Naltrexone confusion>? Need some insight!

The theory is beautiful and it certainly holds true and works in practice for some alcoholics. But the book, the numbers and the time frame are complete and utter bullshit.

**KatieSmiles** · October 9, 2011, 12:27 PM

Naltrexone confusion>? Need some insight!

I haven't read the book Lo0p, but over on the TSM site, pretty much everyone agrees that the time frame stated in the book is wrong.

I would like to add, my GP agreed to prescribe Naltrexone because of the findings at a medical conference in the USA that Naltrexone over time, MAY help one DRINK LESS.

I asked her if I could follow TSM by taking my medication closer to my drinking time and to skip a dose on my days AF and although she had never heard of TSM nor seemed interested in learning more about it, she didn't think it would be a problem because in theory it made sense.

TSM or no TSM.......
I take a 50 mg pill per day and drink as usual. Last week (week 23) I drank 17 drinks for the whole week!

Yes, my GP was right, Naltrexone over time, IS helping me DRINK LESS.

**dirty birdy** · October 9, 2011, 04:03 PM

Naltrexone confusion>? Need some insight!

Thanks for the responses and arguments and everything else but i don't really think naltrexone is a very good option for me considering the aftereffects of drinking on naltrexone make me too sick to function. So TSM is out(wasn't crazy about the idea of it anyway)

And since the carving reduction aspects of the drug are marginal at best it would be pointless for me to take it in that regard so campral it is!

**KatieSmiles** · October 9, 2011, 04:49 PM

Naltrexone confusion>? Need some insight!

Good Luck with the campral DB, I hope it works for you

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