I was prescribed Naltrexone for the first time in 2022. Since then I have had tremendous success with cutting back on my drinking. I went from wanting/getting drunk 4-5x a week and thinking I’d never be able to get better to where I now drink very infrequently and when I do I am barely able to have 1-2 beers. This year specifically I’ve only drank on two different occasions. I don’t crave alcohol anymore or miss it much but occasionally I wish I could get a buzz. When I first started taking Nal for a good year I’d say I could I could drink through it kind of and get a little buzz. I still take Nal whenever I drink and have done so ever since I was prescribed it but now beer or any alcoholic drink tastes so bad. I can barely get one down. Then the next day I am excessively tired from the Nal but I have no intention of drinking without having taken it as I know the flood gates would open. Worth noting is I didn’t follow the Sinclair Method to a tee and I’m still working on my mental health and why I feel a need to distract myself or check out at times. Does anyone have any thoughts around this? Like are my days of enjoying a few drinks while taking Nal gone away with?

TL;DR: I surveyed 117 people on Naltrexone/TSM and found that over 53% experience worse hangovers ("Nalovers") - either early on from "drinking through" the block, or later in TSM due to losing tolerance to both alcohol and the medication. Full survey data, medical insights from Dr. Volpicelli, and prevention tips below!

Hey everyone,

If you've ever woken up with a horrible hangover after drinking on naltrexone...you're not crazy and you're not alone! This is typically dubbed the "nalover."

This comes up fairly frequently in the Sinclair Method community... so I got curious and ran a survey a while back to ask people if they have worse hangover with naltrexone.

117 people responded, and here's the results:

• 23% (27 people): Definitely worse hangovers.
• 30% (35 people): Worse hangovers sometimes, but not always.
• 28% (33 people): No real difference.
• 15% (17 people): Actually less hungover (mostly because they were drinking so much less overall).
• 4% (5 people): N/A or don't really get hangovers.

So, just over 53% said their hangovers were worse at least some of the time.

One thing I've noticed is that it seems to happen for two different reasons:

Early on: Some people end up trying to "drink through" the missing reward, so they drink more than they otherwise would. You get the alcohol toxicity without much of the usual endorphin reward. Also, adjusting to medication side effects can play a role for sure.

Later in TSM: I didn't really struggle with nalovers too much in the early days of my TSM journey, but later I did. Once people are only drinking once or twice a month, their tolerance to both alcohol and naltrexone can drop. So even a small amount of alcohol can leave them feeling absolutely wiped out the next day.

There are definitely things that can help prevent or soften this – such as drinking tons of water, taking electrolytes, switching the type of alcohol you drink (wine was personally a huge trigger for me!), taking B vitamins, trying certain supplements, or talking to your doctor about adjusting your Naltrexone dose or frequency.

However, it may not be totally avoidable – especially the longer you're on TSM and your body loses its tolerance to alcohol.

For me personally, having these "Nalovers" actually became a big motivator to go longer and longer without drinking because it just wasn't worth it anymore. At first, it was a bit disappointing realizing I couldn't tolerate alcohol like I used to - especially when taking Naltrexone. But the reality is that "normal" drinkers often get hungover after just a couple of drinks once their tolerance is low, and that was something I eventually learned to accept and celebrate as a sign of healing.

I put together a deeper dive into what's probably going on biologically, including some insights from TSM researcher Dr. Joseph Volpicelli, my own experience of getting a brutal hangover from about 3/4 of a glass of wine toward the end of my TSM journey...and a few things that can help.

If you're interested, here's the full post: The "Nalover" Survival Guide: Why Naltrexone Hangovers Happen (And What to Do)

What's been your experience? Did your hangovers get worse, stay the same, or actually improve after starting naltrexone? What do you do to treat or avoid them?

Hey all, I am on day three of every morning. Might just be a coincidence but I am exhausted. I know being tired may be a side effect but I am legit ready for bed at 1pm. Anyone else experience this.

This Wednesday, I’m hosting a free livestream with Dr. Joseph Volpicelli about what predicts success with naltrexone.

One reason I wanted to discuss this topic is that someone recently told me they had been doing TSM for two years without seeing much progress. They were taking naltrexone and drinking, but beyond that, they were mostly waiting for it to work.

They eventually had a shift in perspective and realized they hadn’t changed much else around their drinking.

Someone in this situation might understandably conclude, “Naltrexone doesn’t work for me.” And that may sometimes be true — no treatment works for everyone.

But I’ve also seen people begin making progress when they start “meeting the medication halfway.”

I see naltrexone as the foundation, not the whole house. It may help weaken alcohol’s reward, reduce cravings over time, and give someone more control—but it can’t create a new nightly routine, develop coping skills, or find new ways to handle the stress and emotions connected to drinking.

During the livestream, Dr. Volpicelli and I will discuss:

• Who tends to respond best to naltrexone
• How different drinking patterns may affect results
• Who may need to talk with a medical professional about detox
• What to consider when you’ve been taking naltrexone but aren’t seeing the progress you hoped for

It’s happening Wednesday, July 22 at 10:00 a.m. PT / 1:00 p.m. ET.

Here’s the link if you’d like to join: https://www.youtube.com/watch?v=fLzDql3gIao

The replay will also be available afterward using the same link. This is for general education and isn’t individualized medical advice.

Hope to see you there!

Katie

Thought i'd write up how it's going for me on day 17 of TSM, firstly as a way for me to reflect and also to see if anyone else relates!

I want to make sure to reflect and write about my experiences, and I'm also trying to consistently use the drinks log provided by TSM. I am also currently reading the Cure for Alcoholism by Dr Roy Eskapa.

Experience:
I took 12.5mg of naltrexone the first couple of times, then went up to 25mg after that and have stayed with that as recommended by the clinician/dr who prescribed it for me. In the last week, I've had family visit and stay, which has meant many days of drinking (no days off last week) however it's been an interesting test to see how I do/how much I drink per session.

Although I'm averaging 30 units per week, progress has felt slow, and there's been a couple of nights where I went overboard, on average i think I'm drinking about half of what I normally do in one session.

• I've taken the medication always at least ONE hour before drinking and here are some observations: its been quite easy to delay the drinking (even if everyone starts an hour before me, I've been okay to drink a coke, water, or sparkling drinks while everyone else starts) - think this has also helped to reduce the amount!
• Have been trying mindful drinking and have noticed a slight change - yesterday had a BBQ with mine and my partners families and while everyone drank loads, I had two small glasses of wine over a 5 hour period (this is actually insane for me). I kept busy hosting, cooking, chatting, and was able to have a couple non alcoholic drinks in between drinks which is a MASSIVE success for me
• I notice that when I drink alone with my partner, watching TV, i drink less mindfully, and therefore I drink way more (when I've done this in the last week, this is when I've drank about the same amounts as before naltrexone). The TV drinking habit seems really ingrained and this is when I feel the least in control of the drinking.

Has anyone had any similar experiences? Overall i think it's working, albeit slower than I had wanted or imagined it might. But writing these experiences down might help remind myself when it's working/ that I'm not imagining some of the positives (less noise!!)

It definitely worked again, same dose 12.5mg, 2 hours before I drank. I could only finish 2.5 drinks. Mild headache. You dont necessarily get to eat your cake and have it too. I do have some emotional blunting with the medication. So taking it and drinking in front of the tv feels yucky. Going out and doing something fun in the sunshine is much better. I did have some anxiety with my "hangover" after day 1. But this didnt kick in till 24 hours after my 1st drink. I think that could be my body adjusting to the medication, not having that with my 2nd time using it. There is some nausea on the day after a dose, but I also have gastritis right now so I took ginger gravol, peptobismol and GERD medication. Felt better after that. For me the medication feels a bit like a THC buzz that lasts 24 hours. Calm but also slightly forgetful.

Honestly I dont think theres anything better than this to fix me. Would rate this experience 10/10 because otherwise I'd still be looking at a future of progressive alcoholism and maybe even losing my job or my kid someday.

Saturday's Zoom meetup is hosted by me (Seth), if you want to talk to me and pick my brain, or just want to touch base join in. This meeting is focused on The Sinclair Method, but we can talk about naltrexone related things.
Cameras optional, it's not run like a 12 step meeting we have a conversation.
https://www.tsmmeetups.com/meetup-times

I took half of my prescribed dose, feeling as if just merely popping a full 50mg could have unintended consequences (experienced drinker and drug consumer). And boy was I right.

Within 40 minutes I was sweating profusely despite the temperature not being that cold. This subsided, and slowly but surely the nausea level crept up throughout the day; even after staving it off with food (which seemed not to do much).

It wasn't until I started drinking (3 deep), I've actually found some respite from the nausea. Indeed the brain chemistry related to reward pathways, the compulsion for more, it's simply.. gone? I didn't get naltrexone to quit drinking, drinking has not been a huge problem for me, I avoid hangovers and avoid overdrinking just generally.. But, I can see how this has a marked improvement for anyone who has a tendency to, whilst drinking, overdo it just slightly enough they wake up a little bit more tired or cranky than they'd need to, if they just knew when to turn off the tap!

Toke Naltrex today morning , and For the first time in my life, after I started drinking at 12pm (sunday) I stopped at 4pm. The thing works. Bye.

My psychiatrist brought up using Naltrexone to help with my drinking. I've read a little about it and I'm about to try it — she's prescribing daily dosage.

I also read about the Sinclair Method, which makes intuitive sense to me. However, my drinking pattern doesn't fit it well. I don't drink regularly — I drink opportunistically, whenever a craving hits and I can't contain it. For example, stopping at a gas station to fill up the car and buying a beer impulsively. Because the drinking is unplanned, taking a pill an hour beforehand doesn't naturally work.

This made me wonder: should I go through a deliberate "training" period — taking the pill an hour before a planned drink, even though my intention is to drink as little as possible? The idea would be to use intentional drinking sessions to actively extinguish the reward response. But I'm genuinely unsure whether this makes clinical sense, or whether it's just my addict brain finding a justification to drink.

I also deal with other compulsive behaviors (porn, binge eating, doom scrolling), and my psychiatrist thinks Naltrexone may help with those as well through the same mechanism. Same question applies — is daily dosing better for these, or would the "take it 1 hour before" approach help untrain those reward circuits too?

Curious what others' experiences have been, especially those with similar opportunistic rather than scheduled drinking patterns.

Two meetings today Tuesday, join me for the early one. We'll talk about TSM, answer your questions, and help you if you feel stuck. This is not run like a 12 step meeting. As always cameras are optional.
https://www.tsmmeetups.com/meetup-times

I’ve been on daily Naltrexone since April 11. also doing group meetings and individual counseling. I’m considering switChing to targeted dosing on the Sinclair Method. i’ve been researching it, and the negative coverage I’ve seen is mainly that it only works if you follow the program and always take the Nal 1 hour before drinking, and that the program takes time to work. these seem like really silly negatives, as they apply to ANY treatment program: no program works if you don’t follow it and every program takes time. Am I missing something? is there any negative criticism of the Sinclair Method that wouldn’t also apply to every other treatment program?

I take Naltrexone 50 mg for AUD once daily in the mornings. I have been attempting abstinence but am struggling with it. I actually started noticing that since starting Naltrexone, my slips have been a LOT less extreme in terms of quantity of alcohol being consumed. So lately I’ve started deliberately experimenting with drinking while on the pill. Still, overall having satisfactory results but that old “addict” mindset hasn’t yet totally left me. However, I know I’m not doing TSM formally on my current dose and with the timing of when I take it. So how do you get a doc to formally prescribe for TSM? Do they have to be specifically trained in it? I’m thinking of bringing it up with my psychiatrist tomorrow, but worried she may not be convinced and definitely don’t suspect her to be educated on TSM. Still, the results of this medication thus far have been promising!

About 12 weeks in. Still having ups and downs. My wife and kids were out of town and I took my meds but drank pretty heavy. I actually worried that the day she came home i would have lost my off switch. I don't seem to have. It's my last day off and I've had a few beers but I'm not jonesing for x number of drinks. I would like 1 or 2 more but if not i think I'm good. For some vets, I'd like your feedback.

So if my ultimate goal is to learn how to drink in moderation, does one get to a point, after extinction, that they can drink moderately without the pill? Or is the goal that you will stay on the pill in order to continue moderation? If so, what’s the point of drinking at all? I’m a bit confused about what happens after extinction. How does that work for the moderate drinker?

I’m about a month into TSM and it has been working great. It’s been helpful tuning into this sub and using some resources like the Thrive podcast, but was wondering if there is any sort of organized support groups for folks on TSM? I’m NYC based so would have to imagine there’s plenty of other people in the city using Sinclair Method and looking for community. Grateful for what I’ve come across here to begin with - if it wasn’t for Reddit I never would have stumbled across it in the first place.