Unusual reaction to naltrexone?

General health and lifestyle
1

Hello there.

​50 year old male, Drinking for over thirty years but last September-December was hitting 200 units a week.

​Started naltrexone 9 days ago. No side effects except getting a slight buzz from the pill itself. Have taken a tablet every day for the last 9 and been going to the pub. Down to 80 units in week one.

​But the last few days have been a bit odd because I get a moderate buzz off the first couple of pints and it stays that way no matter how much more I drink. I could easily go back to 200 units a week at this rate, albeit only being mildly drunk!

​Too early to say what is going on here?

2

I’d say it doesn’t really work for you 😊

3

Hi Alex

I would say that you have only just started your journey, and it is far too early to tell.

I think you need to go to c3europes website and read through hints and tips. I would also say that starting your journey in a pub, surrounded by alcohol is not helpful.

I am sure others will be able to give you more advice on TSM.

My husband was in a similar situation, drinking a long time but is fully compliant with TSM and is getting good results

Hope this helps

JulieAnnex

4

When alcohol is consumed it affects many parts of the brain.

Endorphins are released which attach to the opioid receptors in the brain and cause a chemical cascade that creates the compulsion to continue that we are unable to regulate - that is the part that the naltrexone blocks.

The pre-frontal part of the brain is also affected, which means that you will get relaxed and buzzed when alcohol hits it (that is what you are likely experiencing, just like normal drinkers after a couple of pints), and indeed gets intoxicated if it is overrun by alcohol i.e. you get drunk.  The prefrontal cortex of the brain is also where the stop and go signals are produced.

So, with the chemical compulsion being blocked by the naltrexone, it gives you the ability back to make better decisions about your drinking.  This is something quite new to many of us who begin naltrexone because we've generally never had any decision-making ability ever - when we drank, we mostly drank more than we intended and didn't know why!

The naltrexone is a partnership between you and it.  Taken as intended, an hour before drinking, every time you drink and you will no longer receive that compulsive signal in your brain and you will have a choice.  It will help you to make better decisions, so your part is to begin to learn how to make those better decisions as far as alcohol is concerned.  And this is a key point - if you overload the prefrontal part of the brain with too much alcohol, or too quickly, you lose the ability to make the decision even if you want to.

A suggest might be to look around you in the pub.  Many are drinking slowly, enjoying the social event and in good conversation or good food.  That is usually what 'normal' drinker too, and you goal will be to slowly move yourself towards drinking how they drink.  i.e. a normal drinker will (for the most part) decide to stop at a certain point of the buzzed feeling.  They might switch to a coke, or maybe even a coffee.  They generally don't keep drinking beyond that point.

Slow but sure, start to decide what type of drinker you want to be and then move towards it.  If you are looking to be a moderate drinker, for example, then start learning to interrupt your drinking when your brain gives you the signal to do so..... and keep an ear out for that signal by not over loaded your brain with alcohol.  The body processes alcohol at a rate of about 1 unit an hour, so if you drink more than that then you will end up overloading your brain with alcohol pretty quickly, and in turn rendering yourself incapable of acting on a decision.

5

Thanks for the advice, everybody.

​So it isn't as simple as take the pill, wait an hour and then drink.....because you can still overload your brain?

​I mistakenly thought that the naltrexone would create a barrier after one hour which would, over time, remove the desire to drink.

​I'm looking to be a 20 units or less/week drinker. I'll take on the advice that you've given me and go slower.

Cheers! 

6

What you say is scientifically correct but compliance is everything with this treatment.  What experience has shown us is that those who don't actively take any part in trying to make small changes to their habitual drinking will (at some point during the months it can take to reach the end point) perceive that it isn't working for them because their situation isn't changing much.

This, in turn, dramatically increases the chances of someone deciding not to take the tablet i.e. non-compliance. 

So, those who actively start to make small changes to their drinking style see it working and that success element, no matter how small it might be, keeps someone compliant.

A great way to explain this is that there are a number of tablets available to help someone lose weight.  If a person takes that tablet and starts to learn to cook properly, then results will be more obvious and that person will stay the course.  A person who takes the tablet but keeps eating junk food every day will see little progress and at some point will decide the tablet doesn't work for them.

7

Excellent advice from Joanna there!

I'll add that TSM is very up and down on a daily/weekly basis. If you go to the Options Save Lives forum and search on "Honeymoon" you'll see more info on that. This is another reason that logging your drinks can come in very handy, as month by month you will likely see the drinks count declining overall. In the shorter term, there can be a lot of variation as the addicted part of the brain gives up, fights back, gives up more, fights back, etc. This just seems to be the normal rhythm of TSM and it's how it went for me too. There are a few areas that you can focus on in an effort to consciously make a difference in your drinking, the start time, the rate of drinking and the stop time. Hit each one in rotation and see what you can manage, as efforts at habit-breaking can make a huge difference in your progress. 

8

Yes, I can see the rookie mistake I was making.

​It's not "Take this pill and over time you'll become a moderate drinker" it's "Become a moderate drinker NOW and this pill will, over time, help you stay that way"

​The Canadian clinical psychologist Dr Jordan Peterson (whose PhD was about alcoholism) has a very interesting short video on YouTube where he is asked 'How do I stop drinking?' His answer is in two parts.

​a) Take naltrexone

​b) Figure out what you are going to do with the rest of your life now that you have so much free time on your hands.

​I have to admit to myself that it isn't just ethanol that has gotten me here, it's a love of the entire British beer culture and everything that goes with it. Those quirky little historical buildings made of old timbers and roaring fireplaces. The whole CAMRA lifestyle full of eccentric people, oddly named beers and the funny little cartoons on the pump clips. I love it.  There's a tendency nowadays to call young people 'snowflakes' but the pub has been a 'safe space' for many a middle aged man for generations.

​So there's a lot to learn but I think, over time, the pills and forums like this will get me where I want to be.

9

That's a really good positive reply Alex. I can only speak from my Husbands point of view as he is the AUD sufferer. Like yourself he is a great lover of real ale. He did say when he first started TSM that he would not be able to cope with drinking in a pub surrounded by alcohol. He used to get dependent very quickly and had become sensitive to large amounts. DTs would kick in after only 24 hours followed by seizures.

He finds he is able to have 1 or 2 pints now when we go out. TSM is definitely working for him. He began in April last year. He is so well.

Everyone is different though but it does help to keep a chart of your progress

JulieAnnex

10

Thought I'd give an update to encourage everybody (if anybody needs encouragement!) and ask a vague question.

​This is week five and I've gone from 200 units to 20.

​I know, I know, early days, honeymoon period, etc but I'm more than happy with a 90% reduction in my alcohol consumption and am pressing onwards to reach zero units/week.

​One thing has surprised me, and I was wondering if this was common on TSM, is that I seem to have quickly trained myself not to drink if I haven't taken my pill. As I usually take the pill at 5pm, this means I can wander around the streets in the daytime without any fear of wandering into pubs. ​Some people are put off by the idea of taking a pill forever but I find it gives an added discipline to my recovery.

​Coming off alcohol can feel like learning how to swim by being thrown in the ocean. You might be able to do it, but sheer panic is more likely to drag you under. The pills are like water-wings. They won't teach you how to swim, but you know you won't drown with them on and can relax and get things done.

Typical week five feelings?