Naltrex/Topa/Zonisamide/Baclofen all failed

[GolfMonster]

Naltrex/Topa/Zonisamide/Baclofen all failed

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[BillF]

Naltrex/Topa/Zonisamide/Baclofen all failed

Ne/Neva Eva;1300718 wrote:

....
"Combined Pharmacotherapies and Behavioral Interventions for Alcohol Dependence"
JAMA: Journal of the American Medical Association; 5/3/2006, Vol. 295 Issue 17, p2003-2017, 15p, 1 Diagram, 12 Charts, 2 Graphs
Raymond Anton, lead researcher.
[/INDENT]

Huge study. Made quite a splash actually.

...

A lot of these studies are just data-fishing. There is no a priori reason why giving a particular drug with one possibly mildly-effective psychotherapy works really well while useless with another psychotherapy. I'm too lazy to read it again, but my recollection is that the COMBINE study said that naltrexone (used similar to TSM) works as well as medical management alone, but has no effect when used with other therapies. Biologically, this makes no sense and the study has had no impact on the treatment community.

Kinda off topic, but the newest NYT magazine (available online) has a long article about anti-depressants. Nothing about alcoholism, but some of the ideas about brain circuitry rings a bell

[GolfMonster]

Naltrex/Topa/Zonisamide/Baclofen all failed

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[Ne/Neva Eva]

Naltrex/Topa/Zonisamide/Baclofen all failed

I happened on this one this morning. The take-away message for me? Eat chocolate! :H (not really. But maybe.)

"Predictors for the Efficacy of Naltrexone Treatment in Alcohol Dependence: Sweet Preference."
Alcohol & Alcoholism; May/Jun2011, Vol. 46 Issue 3, p308-311, 4p
Aims: To analyse the possible associations between sweet preference and the efficacy of naltrexone treatment of alcohol dependence. Methods: The preference for different concentrations of sucrose was evaluated in 78 participants diagnosed with alcohol dependence after treatment for 32 weeks with naltrexone or placebo without prior detoxification. Results: A significant difference between naltrexone and placebo groups was found in the association between the preference for higher sucrose concentrations and relapses to heavy drinking. Higher sweet preference was significantly related to successful treatment measures in the naltrexone group but not in the placebo group. Conclusion: Sweet preference has a strong correlation to treatment outcomes with naltrexone, and sweet preference might be used as a predictor for better treatment results in alcoholics. Our study offers one possible new explanation of the clinical observation that naltrexone is not effective for every patient. [ABSTRACT FROM AUTHOR]

[Ne/Neva Eva]

Naltrex/Topa/Zonisamide/Baclofen all failed

GolfMonster;1301157 wrote:

That said, the Sinclair study is impressive.
..."coping" = continue drinking and "supportive" = maintain abstinence.

...
My major concern of the Sinclair studies is that all the positive studies have come from this group. Is anyone aware of any other group that has reproduced their impressive results for the TSM?
There is a more recent study indicating even more positive results with non-TSM naltrexone. It's posted around here somewhere. A google search would probably find it. (using MWO in the search) That way you don't have to go to a special database to get the full study.
EDIT: Re. coping=drinking, supportive=abstinence. hmmm. I am not sure that that is what I read. Coping=practical skills. Supportive=support/talk therapy etc.

Also, there have been other studies showing positive TSM results. I can't remember where. If you don't want to take my word for it (and I probably wouldn't ) and you can't find 'em, I'll look soon.

In all of these studies the results were not earth shattering. They're rather disheartening, in my opinion. Unless one is willing to be one of the ones for whom it proves to be effective. Or one of the ones who is willing to try something else until one finds something effective. You can attest to that, right? You just kept trying. And now you are with your kids, sober and (presumably) hard of hearing from all the noise at the race track. (That's about all I remember from my only visit to a car race. That and the fact that everyone else was as drunk as I was.)

GolfMonster;1301157 wrote: As for the other study, it is a classic example of my point of the earlier post:
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These effects are clinically irrelevant.

Not according to the editors at JAMA. Not according to the hundreds of citations that the study has prompted.
If it didn't work for you, if it only works for some, it is still better for those who have not tried it, to try it. Right?

GolfMonster;1301157 wrote: Lots of alcohol advertising here, and lots of partying, but I sure am enjoying my kids sober.......

And that is all that matters. :goodjob: :goodtime:

[YouKayBee]

Naltrex/Topa/Zonisamide/Baclofen all failed

My personal experience and that of observing other TSM success stories is that TSM/Nal works for those who have a combination of various, specific incidences (sorry if my english isn't great here!).

By this I mean the genetic disposition (and yes I also have a thing for sweets, but to the point where I cut out sugar and sweeteners(or at least control the latter) because it just becomes another habit!), plus high motivation, patience and determination. Not saying everyone who tries Nal isn't determined or anything - just that in my opinion TSM requires a good level of intuition taking the tablets and pouring booze down your neck might not be enough to acheive success. Several TSmers have had to actively chase abstenance, even I did in order to break the 'habit'.

Don't know which group I'm in because I don't drink at the moment for personal reasons - I can report that in the last 3 weeks I've only had 1 glass of wine on 2 occasions and have been absolutely tee total for almost 2 of those weeks WITHOUT any cravings or question. I will return to drinking in a month or so as personal circumstances change, but I have a feeling it will be a case of not really wanting to drink at all, and only on rare occasions.

Considering just over 12 months ago I suffered terrible, overriding cravings most days (even if I didn't drink) it's amazing. I don't however think TSM is suitable, or a cure for all just as Baclofen isn't - baclofen definitely wasn't suitable for myself at all. It attacked the problem from a different angle, which didn't happen to be at the route of my problem. My problem is I am addicted to endorphin highs, chocolate, sugar, binge eating etc and get urges to do extreme things - drinking to excess was one which then brought into play the actual dependent nature of the substance itself.

I'm waffling.

Just my thoughts.

[GolfMonster]

Naltrex/Topa/Zonisamide/Baclofen all failed

All the best everyone.

[Ne/Neva Eva]

Naltrex/Topa/Zonisamide/Baclofen all failed

Morning, GM!
I'm sorry you don't want to hang out on this thread anymore. I did think the whole point was to put out and sum up and discuss some of the research/evidence about these drugs. It avoids confusion, for sure, and helps us all resist the temptation to draw conclusions given how much information is out there. (An amazing amount. Some of it silly, some of it irrelevant, some of it moot. But still, alot worth taking into consideration.)

As to weighing the merits and having a discussion about it, I wrote that I wouldn't/couldn't do that when I posted the stuff. That doesn't mean I'm not up for it in general. What I won't do is enter into any kind of fracass with anyone who changes usernames like underwear (because he gets banned) and always has something profoundly negative to say. But that's not you. (My point in writing that is that I still get a little testy when I respond, because for the moment that is tainting the rest of the discussion for me. I'll meditate on it... That has helped only a bit so far, though. :H)

I guess I sort of agree with your summation. I didn't really have any intention of moderating, and in fact had heated debates with some of "my class" (that's how I think of the group of us that took baclofen and got to indifference last spring) about the whole issue. A couple of them were absolutely intent on being able to moderate. That whole thought scared the crap out of me. I just wanted a way OUT! Since then, there is still one that moderates--as in he drinks mostly normally, can still get drunk and does, but alcohol doesn't rule his life. Another notable one, Bleep (where the hell is he? oy) finally quit drinking altogether, for at least a year, and found he doesn't miss it at all.

My experience was very different. But I don't want to digress too much into the anecdotal stuff. Still, it's worth noting that although the effectiveness of Nal is "only" 20-25% in a research scenario, that would have been more than enough to prompt me into looking into that, giving it a shot, and trying my hardest to make sure I was in that category.

I guess I take exception to #2 and #4. 80% (!!!) of ~130 men found that they stopped or moderated their drinking in a study (not the kind everyone seems to think we need) done in France. (That link is around here in a couple of places. I'll post it here later.)

And as to #4, I still have not met one person, or even heard of one, that titrates up on baclofen really slowly. Or just takes it at low dose (say less than 100mg) for a long period of time... (Consistently. Not PRN. That doesn't work. It's not a benzo...) And I wonder how that would work. 'cause lordy, I agree with you that if you need to be sharp, taking it by the handful (meaning maybe even titrating up by 20mg/week) probably will not work!

The whole group on the AB/Nal thread is really the first that have taken LDB and abstained and with a goal of absolute abstinence. It will be very interesting to see how that turns out.

Presumably the newbies will get to look around for the info, and we can direct them, for sure. And make sure the info is accurate. (While I agree with the summation that this is a support group, primarily, it is also the only place in the world for people to find information about bac for alcoholism. Without an incredible amount of research.)

The bottom line, though, is you. How you are. What choices you're making. How it's working and how we, the whole of us, can help.

Anyway, gotta run. Hope that you thoroughly enjoyed your weekend with the kids and that it's a good day!

Ne

[Heavy Fuel]

Naltrex/Topa/Zonisamide/Baclofen all failed

It seems to me there are many paths to a "way out." I personally would never have been able to do abstinence. In terms of negative outcomes, mine usually followed a period where I tried complete abstinence. Whenever I gave up and picked up again, I had a bender. Being a daily drinker, if I fed the monster, I was fine. What was scary was the amount it was taking to feed the monster. Today, I am completely abstinent during the week, without a binge when I drink Friday night. In short, the harm in my life is minimized.

Alcohol was negatively impacting my life in ways that I would never want to admit. When I started TSM, I was an 80-90 unit per week drinker. Earlier last year, I was around 120 a week. That spike was due to worry and living conditions. Once I started TSM, there was a sharp drop in intake, followed by spikes trending ever downwards. Right now, I am around 14 units for the week with a massive amount of stress in my life. Tonight, I am stressed, but I am drinking tea. And that is all I want.

My goal isn't abstinence and a life of meetings, it's to live the one life I have. I have noticed in the posts about "I tried them all and they didn't work, now I am doing abstinence." There is an underlying current of "it didn't work for me, what makes you think it will work for you?" Whenever someone finds their way out, it's usually the last thing they tried. Whether that is AA, TSM, bacoflen or kudzu. It was the last thing they tried.

To any person seeking a way out: there are many ways today. For me, it was TSM. For others, it will be something else. Be sure to do your research. Each way out has its own pluses and minuses.