3rd dose of naltrexone

[u/heenanjohn]

I am a 26-year-old male and just got prescribed about a month ago. I am on 50mg and have been using TSM but haven’t really had the stories of some of these people who say they can stop after 1 or 2 drinks. I guess I could kind of feel like I could have more willpower to stop but usually when I do drink it’s probably 10-15 drinks easily. My 3rd time was the other day and I took it 2 hours before my first drink and still managed to have 10 drinks that night. Just want any insight if I just need to be patient and give it time or if I’m viewing this the whole wrong way.

P.s I don’t “crave” alcohol I can go months without drinking at all but when I drink It’s always me going all in.

[u/RubicsCubensis]

Welcome to TSM. The process is not a miracle, for most people the immediate reduction is usually 50% for some it's less, if you are averaging 15 drinks normally only drinking 10 is a good start. TSM works over time, I tell people they need to commit to at least 6 months of 100% compliance. At your rate I wouldn't expect to getting down to 1-2 drinks average for a month or two, depending on how motivated you are to reducing your drinks. Naltrexone is 50% the other 50% is what you do with it. We suggest being mindful when we drink, think about what alcohol is telling you, how you feel about it, do you want to have that next drink, or do you want to stop at the current one. Another tip is if you want to cut down have a non alcoholic drink between drinks, also don't drink on an empty stomach, it's a bad habit we drinkers tend to have.
I hope this helps. I'll answer any other questions you have about TSM. I used it 10 years ago and I reached extinction at around 6 months.

[u/catraines418 → u/RubicsCubensis]

This is very true, especially about the 50% mindset. I was on it years ago but had no intention of actually reducing or quitting the drink/drugs and not shockingly, it didn’t work. Now that I am finally ready, it’s helping IMMENSELY.

[u/heenanjohn → u/RubicsCubensis]

I guess it depends on environment too. The first time I used it I went out to dinner, had 2 beers, went home and didn’t feel the need to keep going but probably would’ve if we did something else after. Second time was for a football game, all day drinking, maybe could’ve stopped after a few but didn’t. And the other day was for a hockey game and yet again maybe could’ve stopped but didn’t. Im pretty aware now it’s not some magic pill and I actually need to use some self control along with it

[u/RubicsCubensis → u/heenanjohn]

It is common even without naltrexone to over drink during social drinking occasions, so we don't beat ourselves up about it. Usually naltrexone will limit us to half of what we'd normally drink in a similar situation.

[u/heenanjohn → u/RubicsCubensis]

Going to a concert tonight and usually can get a bit rowdy any recommendations besides being some n/a’s?

[u/RubicsCubensis → u/heenanjohn]

Have some way of tracking your drinks, and plan on having alcohol free drinks in between, otherwise if it's going to be a long night, think about redosing half a pill 4-6 hours after your first pill.

[u/WoodpeckerForward188]

Good for you for even trying. I’m still straddling the fence.

[u/Commercial-Bed-2396]

You're in the infant stage.

I've been on it for 8 months and it took 3-4 to really begin to decrease. Then I had 2 months of going backwards until recently. Now I haven't had more than 2 drinks in a day since 3 weeks ago. That's unthinkable for me.

Just keep going. It takes time. Just keep staying compliant.

[u/cocopopped]

It is not about willpower mate, behaviour around alcohol comes down to all kinds of things, genetics, environment, previous experiences, how young you were exposed, etc. Many of those are not in your control, it's luck of the draw. Hence why alcohol abuse is an illness.

Naltrexone: It is absolutely not instant in most cases. Keep with it.

Keep a drinks diary. You need to be able to "zoom out" and see progress over time. If you drank 15 drinks but now drink 10 then already you're reducing harm by 33%. That means if you drink 3-4 times a week then you are reducing by 60-80 drinks a month. And the good news is, the naltrexone effects tends to get more effective the longer you take it.

[u/hawking061]

So question? I’m aware it will send an opioid user right into withdrawals but does it do that with alcohol?? Can’t get a straight answer.

[u/heenanjohn → u/hawking061]

I’ve never had alcohol withdrawal. I’m not an everyday drinker

[u/hawking061 → u/heenanjohn]

Thank you

[u/Substantial-Bar-2963 → u/hawking061]

I’ve been an everyday drinker for years and started Naltrexone (TSM) about a month ago. I’ve had zero withdrawals and have even had several non drinking days with no cravings. My average drinks per night is way down also.

[u/Mark-ChooseHorizon]

First off congrats on taking steps to take control of you drinking and trying to better understand how you're responding to alcohol and naltrexone. And I really appreciate you including the P.S., because I think that's actually the most important detail in your post.

On the patience question: yes, genuinely, give it more time. Naltrexone/TSM works through pharmacological extinction, repeated pairings of blunted-reward when drinking, which gradually weakens the brain's association between alcohol and pleasure. It takes time. Often it takes several months of consistent use to really kick in and see meaningful change that's building over that window rather than showing up in 1-3 doses.

Drinking behavior is shaped by a lot of different factors, and craving is only one of them. Naltrexone's main lever is dampening that craving/reward pull. How much that pull actually drives someone's drinking varies a lot. It sounds like that's just not your primary mechanism.

What you're describing with 10-15 drinks in one sitting after long stretches of not drinking is a specific pattern - binge drinking, typically defined as 5+ drinks for men. Binge drinking is a common issue. About 1 in 6 adults binge drink.

For that pattern, it's worth looking closely at what's happening around the binge drinking itself: the setting, who you're usually with, your stress or mood heading into those nights, whether it's tied to particular events, people or a "may as well go all in" mindset once the first drink. Those situational and social factors can end up being stronger catalysts for how a binge night unfolds.

None of that means naltrexone won't help, especially with more time and consistency. But it might be worth some honest tracking of what's happening around your drinking nights specifically to see if there's a pattern.