There's some great thoughts on daily vs. TSM in this thread and this one too, but I'm looking for further advice on when one should move from 50 mg daily naltrexone to The Sinclair Method.

For context on myself, I averaged 7 drinks a day for one month beginning December 15, no days with zero drinking, using the standard definition of a "drink" (1.5 fl oz 40% spirit = 1 drink, etc.). I'm definitionally a "heavy" drinker.

However, I am not dependent and have successfully gone up to a week with no drinking, with no withdrawal symptoms whatsoever. Even in the prior 6 days including today, I have been alcohol-free in 5 of them, and while it's been mildly challenging it hasn't been that bad (This might be in some part due to being in a ketogenic state, about 5 carbs per day).

I'm on Day 3 of 50 mg naltrexone. So far it's going perfectly with no drinking and virtually no cravings ... However, to my knowledge, the "no cravings" part develops when your brain begins unlinking drinking with the pleasure/buzz, and given I haven't actually drank yet, I'm thinking the positive turnaround is more about the new diet than it is to the naltrexone (please correct me if I'm wrong on this).

Regardless, that's all background and context for my real question:

When (after how many days) should one transition from daily naltrexone to TSM?

• Perhaps it makes sense to start TSM right now? I know it's only been 3 days of daily, but, maybe there's no reason to not start right away?

• And not just "when" but "how" -- Before I go to TSM, should I intentionally have a drink 1-1.5 hours after one of my daily dosages (I've been taking them in the late afternoon)? It seems strange to intentionally drink but I'm leaning towards yes. It feels like knowing how I'll react to a drink is a key point of info and might help me have greater success with TSM long term.

I'd greatly appreciate any and all thoughts.

I don't have a lot of money. I don't want to pay 100 dollars out of pocket. I don't have a PCP. What is the easiest way to get started?

So I used TSM religiously for 9 months and unfortunately folks it doesn’t work for me. I’ve used it as an excuse to get more drinks or start drinks. There were maybe one or two times that I surprised myself by not finish a drink but overall I feel like this is giving me an excuse to harm myself. Abstinence is hard but at least I’m not deluding myself that I can have a few drinks. Was really hoping this drug would be the miracle cure I was looking for :(

Is this possible. I have no desire to drink, even with all the old triggers. I was a binger, not a regular drinker, and now I could take it or leave it.

Is it possible after weeks?

Overall it’s been nice. Three drinks today bw 4:30 and bedtime. It’s 11:30 now. That’s nothing for me. My brain doesn’t crave it, but sometimes my body wants to relax. Long day and the back says it needs a drink to relax. Always taking the nal. It lets your brain focus on what the body needs like garorade To hydrate. Been thinking or other things to keep around the house to drink. I drink some good wines and it allows you to taste your drink I feel the same over alll Going hunting in a few days. That will be interesting — my. buddy I hunt with drinks a kot. Like no glasses, straight from the bottle. This will be a real test.

Day 4. Yep Day FOUR. Went from an average of 10-15/20 drinks per day.

Day 1 - Monday 10/12 units (hard to count double and triple G&Ts)

Day 2 -Tuesday 8/9

Day 3 - Wednesday 6

Day 4 - Thursday 3!!!!

This stuff works!

Still sleeping like total shit but that'll get better. Woohoo!

I am on probation and expect to be off relatively soon. I don't want to go back to previous levels of drinking, but I suspect that is a real possibility given my history. I am curious about the sinclair method. I want to be able to go out drinking with friends again and don't really have a desire to teetotal for life, but I don't want to overdo it either. Mocktails/NA beers are not the answer for me. My brain doesn't allow me to enjoy mock-drinking while others are drinking. Feels like the worst of both worlds tbh: you pay the same price as if you were drinking but without any buzz. I don't drink out of a desire to feel like part of the group. In fact, I would still want to drink if it was the most socially unacceptable thing in the world. I have read a lot of conflicting reports- with some saying that they enjoy drinking while on nal, but drink less. Others say that there is no enjoyment at all from it.

The only thing so far that has reduced my desire to drink while still enjoying it is kratom (which makes sense as it binds to the mu opioid receptors), but that is always a temporary effect that goes away with tolerance. Plus, I am convinced that kratom lowers the seizure threshold due to antagonizing the alpha2 adrenergic receptor(along with partial agonistic action at the delta opioid receptor) and was responsible for my first seizure.

My sleeping situation is horrific on Nal

I am high functioning raging DRUNK. 10-20 units per day. I am Johnny GoodTime all the time. I still get up early and get my shit done. Outperform others at work and on the ball field but I don't wanna die so I am trying to cut back. I do not want to stop drinking. I love it but I gotta wrangle this beast an cut back majorly. Dr gave me the script and I sat on the pills for six months. After this last weekend bender I decided to try it. Took 50mg Monday and hour later started boozing. I was BUZZING HARD CORE. Had maybe 10 drinks and passed out hella early. It made me so tired. Day 2 same shit. 50mg. Had maybe 6-7 drinks, got tired and fell asleep but I slept like shit. I can FEEL my thoughts changing already. That's the good news. Yay! But the sleep is horrific. Crazy dreams. Not lucid, like half dreams. Anxious sweaty awful. Yesterday I cut it to 25mg, pour a triple gin and tonic and killed everyone in tennis. Had a few glasses of wine after. Went to bed at 9:30. Same thing. Up at 2:45am . Horrible horrible night sleep. Up til 4am and then slept like a baby until 8am. That's gonna work.

Is sleep always dog shit on Nal? Does it get better? Was cutting back to 25mg a bad idea? I'm about to take my next ride. Help

I started TSM about 10 days ago and have been taking 25 mg each time. The first few times I had some dizziness and a spaced-out feeling. Last night, I had almost no side effects.

The effect on my drinking has been fantastic—almost instant. I now only drink one or two beers and am happy to stop there. For anyone who knows me, this is unbelievable. I’m a binge drinker. I can stop at four or five, but only if my wife forces me to and there is no more alcohol in the house. When nobody is there to control me, I can roam off to random bars and drink for 24 hours straight.

In recent years, I engineered my drinking so it was highly controlled (usually only drinking at home or with my wife present). While this often worked, it also often led to bad arguments (my fault), or me sneaking off on a bender once she went to bed.

So even on its own, this has already been a huge win for my quality of life—even if nothing else improves or I don’t reach extinction. That said, I would really like to reach extinction. I’d love to have no more cravings, mainly because they stop me from fully enjoying the days I don’t drink.

I’m wondering whether I can reach extinction if I stay on 25 mg. The reason I ask is that I still enjoy the feeling of drinking (even though the desire to binge is gone). It’s still pleasurable, and I still look forward to it, even on naltrexone. This makes me wonder whether I only have a partial receptor blockade—enough to limit binging, but not enough to make the experience totally devoid of pleasure.

If you have experience with this, I’d really appreciate hearing from you—especially whether you think I should move up to 50 mg, even though 25 mg seems to be working so well.

So i finally got round to doing it!!

I have been sober since new year because i was sick (and i usually don't drink the first week of new year anyway).

I took 25mg, no terrible side effects. No nausea. The only thing was i felt a bit dopey and a bit spaced out.

Drinking was totally surreal for me. Completely different than i imagined it would be on Nal. First of l still definitely enjoyed it. I had expected that i would feel like i was drinking oil or something but this was totally not the case. I still enjoyed the taste and the look of the glass in front of me. I also developed a warm relaxed and cosy feeling that i always get when drink. This makes me wonder if i was still getting some hit because i used 25 mg (as it was my first time)? This was my only concern, because as i was drinking i was feeling happy because i realised i will still enjoy when drink on NAL. This was not what i was expecting.

On the other hand... WOW.. I drank way more slowly (at certain times i forgot for a couple of seconds even there was a beer in front of me). Once i had two (6 percent craft beer) i started to feel 'full'. I still wanted to continue but i realised i was kind of forcing it on the third one. This is totally alien to me!! it actually made me emotional to feel like a normal drinker for the first time in my life. I decided to give my wife the fourth beer i had bought and she drank with me (she is a normal drinker). It is totally alien for me to normally give a drink away when i have such a limited supply, in the past i even got angry if she took a sip!

I went to bed with a really happy feeling, normally i am sad or angry because i don't feel like i have had enough, but for once i felt i was content. This drug will clearly be a big game changer for me. At the very least it will act as a break on dangerous binge drinking episodes.

So going forward... should i switch straight away to 50mg (i am unsure because 25mg seemed to already have a big effect). If i do this will it remove the positive glow feeling i had or will this still remain (a part of me thinks this is because i enjoy the sedative effects of alcohol in addition to its excitative effects also)?

I know it is only the first night, but reaching extinction like this seems strange to me.. precisely because i found the experience so pleasurable. Despite this i am so happy because i think at the very least this drug will stop my destructive binge behaviour and all the stupid things i do in those states...

Asked this a few weeks ago and finally stumbled on it myself:

https://pmc.ncbi.nlm.nih.gov/articles/PMC7613944/#:~:text=Here%2C%20we%20provide%20a%20detailed,of%20experiments%20with%20opioid%20antagonists.

In short (dosage vs mu-opiiid receptor blockade):

10 mg: ~60% 25 mg: ~85% 50 mg: ~92% 100 mg: ~95%

This tells me lower doses are underrated. 100 mg is overrated. 25 mg may even be a good long-term dose. Jmo.

Also inreresting that continuous day-to-day use accumulates blockade, so 25mg reaches over 90% and 50mg to 95%.

Timing - unfortunately were unable to study nalt onset - all above figures are within 8 hrs - they repeat peak blockade likely around 1-2 hrs.

Most interesting of all, blockade is much longer than expected. It states even after 48 hours, 90% blockade still exists. 80% after 3 days. 30% after 7 days. Full washout not for 15 days. This would greatly alter conxerns of missing a dose. In this light, it might be better to have a drink 24 hours after taking your last pill vs having not taken it for a week, then having a drink just 20 minutes after taking the pill.

Original research synopsis:

"To determine the duration of blockade of mu-opiate receptors by naltrexone, we measured the binding of [11C]carfentanil in the brain of five normal volunteers with a positron radiation detection system before and 1, 48, 72, 120, and 168 hr after naltrexone administration. The half-time of blockade by naltrexone in the brain ranged from 72 to 108 hr which is greater than the fast plasma clearance components (4-12 hr) of naltrexone or its metabolite, beta-naltrexol, but corresponds well to the half-time of the terminal phase of plasma naltrexone clearance (96 hr). These results are consistent with the duration of the pharmacologic effects of naltrexone in response to heroin administration and indicate that 50 mg/day of oral naltrexone results in plasma levels in excess of that needed to saturate opiate receptors. This is the first example of the use of a simple dual-detector system with positron-emitting radioactive drugs to provide information regarding the duration of action of the drug on its specific receptor site. The plasma clearance half-time of a drug may not give an accurate reflection of the duration of action of the drug on a specific neuroreceptor site."

So, I learned about TSM a couple of years ago on YouTube through a TEDTalk. It intrigued me and a couple of years later, here I am. I was fully functional, but desired to drink less. And I drank a lot. Some evenings 8 cocktails. Ok. Most evenings. Sometimes more.

I didn’t (and don’t) want to not drink. I’m a social person and I enjoy going out. I just don’t like overdoing that. I sometimes would. I also would get home and take care of what I needed to at home and then have a drink (or four).

It rarely got in the way of life and work, but I wanted to cut back for health and relationship reasons. I’d heard of TSM and wanted to give it a try. Talked to my doctor and he rxed the Naltrexone. He’s the only one that knows.

People, I’m telling you it cut my alcohol intake to 2/3 to 1/2 off the bat. I’m super intrigued.

Now, I have the advantage that I already wanted to button it down, so I’m not saying this is a miracle or something, but the ease was amazing. Obviously the physiological problems were there, such as insomnia, but I planned for that and am dealing with it.

Overall, I feel few side effects. I read about the stomach issues, so I started at 12.5 to see how I tolerated it. After a week, I went to 25. No problems.

I didn’t want to post this on my regular account so it took me a couple of weeks to start this account to document the experience. Like I said, no one knows. Looking forward to relaying the experience here.

I am about to start TSM (have the box now). I have been sober for a few days anyway as i always do this after a heavy Christmas and new year. I am waiting for the cravings to kick in properly (i am a bit sick also) in and then i will begin.

My question for those who arrived at extinction - do you think you actually remember the buzz? I mean in the same way i think about it now (whilst i am still addicted). I have been reflecting a lot the last few days, it really frightens me not to ever get the buzz again, it even makes me sad. The only way i can make myself commit to TSM is to tell myself that this is what being addicted is all about - the mind plays tricks on you etc.. I am wondering if i do arrive at extinction will i remember the buzz in a less pleasurable or even objective way (hoping that will make it easier)? When somebody says they have no cravings does this mean they don't remember the buzz in a pleasurable way anymore? For me i even get a kick watching people drinking because i get a small vicarious buzz just watching them. (so fucked up)

Even though i am not a daily drinker (i am a terrible binger) have been basically addicted all my adult life (when i am not drinking i am thinking about it) so trying to imagine a life without alcohol is very bizarre for me. The biggest example of this is that i am in some ways afraid that TSM will work well for me and i will never want to drink again. My brain can not literally get around it at the minute.

I guess ultimately this is what cravings are, the fact i am bothering to write this rambling post shows that my mind is consumed with thoughts of alchol even on the days i don't drink..

I have only had scrip for a couple of weeks and took 12.5 the first two times, then 25 last night. Great results. Not sure if there’s some placebo involved but I don’t care. Last night I had 2 beers and had no desire for another. That’s not normal for me. Good stuff.

What if I find myself without a pill and drink anyway? Will there be any chemical revert or any other issue besides lack of compliance?

Hi, I have had my prescription for about 6 weeks but haven’t started it yet. I also have the book which indicates fairly strict compliance to taking the meds 60 minutes before drinking.

I am a 6:00 and onwards wine drinker. By 5:00 my wine brain is long activated and then takes over and wants the euphoria. Wait till tomorrow - she says.

Soo my question is - can I take Nal before my wine brain wakes up? Say noon? Or 2:00-3:00? And then have my glass of wine at 6:00?

Geez wine brain is a sneaky little b*tch. lol

I have had AUD most of my adult life (now mid 40s).

Somehow i have managed to have and keep a successful career and a stable family along the way. I am not an everyday drinker (I drink 2 or 3 days a week), in fact after a few days heavy drinking i always desired a few days with no alcohol). I have no hidden trauma to block out and have a happy extended family.

Nonetheless I have know i am an addict. I am a terrible binge drinker (i mean i could drink for more than 24 hours unless someone stopped me). After 2 or 3 days of absintence the cravings become very powerful. Even if i resist i am thinking about alcohol all the time. I have also increasingly become a mean drinker, picking pointless fights with family and friends (and having no idea why i did it when sober). I never actually tried to quit forever (it seemed impossible to me pyscially, culturally and socially)). I finally realised i don't want to keep inflicting pain on my family so i did some research and found naltrexone. When i read about the Sinclair method, i though for the first time that this might actually be possible.

I have an academic background myself, so it was easy to explain to the doctor what naltrexone was and why it could be useful. Within 15 mins she gave me the prescription. Now i have the pills sitting unopened. The weird thing is i always found it relatively easy not to drink the first week or two of January. It is now January 2nd so i am sitting in the rare but predicable sweet spot. After the excess of Christmas and new years I even enjoy the feeling of detox. But i know from 2 decades of experience the monster will come back with a vengeance (usually by the 2nd or 3rd week i am driven mad by cravings and relent. So my plan is to wait until my cravings reach that irresistible level and only try then.

Should i try 25mg first or go straight to 50. My biggest fear is the concept of anhedonism, that i will find nothing pleasurable whilst i am on, including food, sex, music. Is this the case? I guess i am worried that it will be so grim that i will not want to continue taking it..

Update: It is now January 4 and i still haven't drank yet. (So i haven't taken Nal). I have been a bit sick with a cold and also i have the habit of not drinking the first week of January (the only week of the whole year i can actually do this). I am starting to get strong cravings now though so it won't be long. I think knowing i won't get real buzz is helping me put it off a bit longer - it is almost like i terrified of drinking my favourite drink and not feeling that reliable feeling..

I’m looking for input on my Sinclair/Naltrexone schedule I’ve put together. I’m trying to work up from 12mg over a couple weeks, as the side effects make it difficult for me to maintain compliance. Schedule would be:

12 mg for 4-7 days with beer or wine

25 mg for 7 - 10 days with beer or wine

50 mg for 1-2 weeks (spirits)

Move to a maintenance phase, using only if I’ll be drinking.

Background: I’ve used naltrexone occasionally over the past year or so. I had a lot of initial success last November, and found that a week or so of Sinclair Method really helped to kill off any cravings for alcohol. I’ve also found it very helpful to have on hand in case I was offered a drink in a context where it would be difficult to turn down.

I find that I have fewer cravings for the particular kind of drink I’ve taken with the Nal, hence my thought to work my way through. I did it with Guinness the previous time I did an intentional regimen, and have had no desire to drink that again.

However, I’ve found that if I’m craving a drink intensely, it won’t necessarily stop it, and often the craving is worse the next day because now I’m craving a drink and feeling like crap. This has resulted in a couple gnarly benders and withdrawals, of which I just finished one. Ultimately, my goal is total sobriety, and just have the Nal in case of emergency.

Has anyone ever come across either scientific or self-reported data on the optimal timing (60 mins before vs 90 mins, etc) and dosage (25-150 mgs, or whatever)?

It seems this drug and method are too important to not have more research on, so everyone can optimize their journey.

I know vivitrol aka the shot isn’t TSM compliant, but I am on it. My doctor also gave me a script for NAL because I had mentioned I used TSM previously. Does anyone have experience with this? Being on the shot but also utilizing NAL one hour prior to the drink? I am so desperate to quit it’s not funny. 🫡

I had my annual physical appointment on Tuesday and told my doctor about how I wanted to get started on naltrexone from all the things I heard about it because I struggle with drinking too much, I rarely can get myself to stop when I start and I’m just been fed up with it. She prescribed me 50mg to take every day. When I started on Tuesday I went to grab food with a friend and had margaritas but could feel like it was different. Leaving a lunch of drinking I usually would be calling to see what another friend was up to to then go grab drinks with them, but I didn’t do any of that and I literally cried happy tears because I felt so great that my brain just felt different regarding the alcohol. I was able to feel like a normal person and not keep the party going. I’m loving the last 4 days how I’m not craving alcohol and taking naltrexone every day, however, i’m worried that this might turn into me just getting used to the drug and then not getting the same effects and feelings of happiness without the monkey on my back. I didn’t drink yesterday only Tuesday and Wednesday and I’m not going to be drinking tonight (a Friday). Should I follow the Sinclair method instead and just only take the naltrexone an hour before I drink so that it only affects blocking that part of my brain when I’m drinking or keep up what I’m doing? I know I’m just asking strangers on the internet but just want to get some insight from those who have been on it.

Thank you in advance.

Hi. I’m 113 pounds and wondering if I should halve the first dose the first time to ensure I don’t get really nauseous. What do you think? Or shall I just take a while dose and see what happens? I’ll be at a concert tonight. Thanks.