Barry,
I am not particularly certain if you need a higher dosage because the fact that it has been working tends to suggest that everything is fine in that regard. However, having said that, if you take on board what I will write below and try it, if you are finding it difficult then it certainly would be worth a discussion with your doctor, yes.
Now then, when we drink the neuropathways in our brain become reinforced again and again and again. For someone like yourself who has been a very long term drinker, your pathways will be really strong from the reinforcement - sort of like a super highway, rather than a country lane. This means that it almost certainly will take the naltrexone longer to weaken them to a point where they eventually crumble. From my experience, extinction of cravings can take anywhere from 6 months to a year, and to even longer in very long-term drinkers. So, you not only have the pathways to break down, but also a very longstanding habit, too.
The naltrexone sounds like it is doing it’s thing in the background, albeit slowly, so what I would suggest is that you decide to do something that breaks your usual habitual drinking. A good example of this which seems to work well for people is that after the first drink, then quickly pop a mint in their mouth. This means that any drink will taste horrid until the taste of the mint has gone, and that gives them the little nudge they need to start interrupting that habitual drinking. Then, do something else for the time you are eating the mint, and you will hopefully find yourself delaying the next drink until you eventually think ‘nah, maybe I will have a tea instead’.
There are really three things you can change about your drinking - the start time, the end time, the middle bit and then the end.
All you are looking for is to slowly chip away at your edge of what you normally do, and see what happens. You might surprise yourself!
I tend to liken this whole process to someone who wants to lose weight. There are some really good medications that can help a person with losing weight, but that alone is unlikely to get someone to their ideal weight, especially if they are used to eating a lot of fast food. For that person, their aim is to begin to learn to make better decisions about their drinking, start slowly replacing some of the fast food with learning how to cook a healthy and tasty meal.
Hope this helps and please do ask anything else that you might think of, or if this isn’t particularly clear to you. I try to explain things the best I can, but sometimes I am not quite sure if I put across what I want to say in a simple way 