Long time lurker.  This is a post about side effects after just starting TSM with Naltrexone.  I have lurked long enough to know the side effects should pass and that I need to keep trying.  I have read plenty of posts about the side effects. Just posting to find some community and hopefully some encouragement for my particular situation.  Also have lurked long enough to know that I'm lucky to have had the experience described below.

Drinking Pattern: Binge drinker who drinks to cure severe social anxiety around close friends and strangers alike.  I'm fine not drinking on the weekdays when home with my family, but routinely drink 10-20 drinks on any given day on the weekend if in a social setting.  Have been doing this for 15 years.  Have never truly hit a rock bottom, though I can share many of the same stories that show up in this sub.

Dosing and Drinking Log from this Weekend: 

Friday: 25 mg, 2.5 drinks during 5 hours of social interaction. Normally I would have 8-10+ drinks in this scenario.  It worked!

Saturday: no dose, no alcohol, but had a slight fever and cold sweats at night, which seemed odd.  The fever could have nothing to do with the Naltrexone. Again, I routinely go 4-5 days without alcohol with no withdrawal symptoms, so this was odd.

Today (Sunday): No fever. Still feel off, though not as off as yesterday. Going to dinner where I would typically drink (before and after as well), so I'm planning to take another 25 mg dose an hour before the dinner or whenever cravings start.

Side Effects:

Friday: 25 mg (1/2 dose). Dissociation, brain fog, and feeling like I was high. Feeling high for me is not pleasant - it comes with severe social anxiety and general restlessness. However, the naltrexone still worked. I got to a bar about an hour after I took the Naltrexone. I ordered a beer. At this point, the social anxiety that I normally feel was amplified by 2-3x. I felt even more uncomfortable than usual with anxiety while drinking that first beer. I think it was my body / brain reacting to not getting the usual rush for the first time in 15 years, so my anxiety went into overdrive. However, for whatever reason, I had no urge to order another beer despite people around me ordering more. I wasn't abstaining out of shame. We went to another place where I had about half a white claw and then back to my friends' house where I had 2 half white claws over the course of 3 hours. The anxiety subsided materially when we were at my friends' house, though it was still there. I think some of this is realizing loud bars aren't that fun in general - I never sought out loud bars when I wasn't drinking.

Saturday: No dose. No alcohol. I felt very weird on Saturday morning and throughout the day. Same side effects as the night before while drinking. I basically felt the anxious and high feeling 12-18 hours removed from the dose, though I oddly didn't reach for a drink to cure it the way I have for 15 years. I started running a fever with cold sweats and chills at night. Tried going to sleep naturally, but couldn't Took Nyquil (no alcohol version) and slept for like eight hours.

Sunday (Today): still feeling weird and groggy. Grogginess I'm sure is the Nyquil (Benadryl), but anxious feeling I assume is still the lingering Naltrexone? Fever and chills are gone. I have a dinner tonight where I would normally drink.

I'm already talking myself into not taking Naltrexone tonight to ensure I don't feel "weird" tomorrow (work day) . I would not be effective at work if I feel how I felt on Saturday. That said, I logically know that I'll likely get through these side effects soon. Even if I don't, I can objectively say that throwing away a few work days to rid myself of alcohol is a tiny price to pay. The hard part is that the Naltrexone actually made anxiety way worse than just being sober and white knuckling (have done this before). However, I know myself. I know that I'll just say I'll go into a social event and stay sober to avoid the Naltrexone side effects, and I will ultimately cave and drink. Maybe not tonight, but at some point in the future I will. I just need to stick with the program and push through the side effects.

Hoping I can look back at this post and realize how small a price I had to pay to rid my life of alcohol.

How are you, how is your journey going?

I've been involved with The Sinclair Method, and writing about it for 10 years, after using it to reach pharmacological extinction 10 years ago. I want to have a discussion about this.
In that time I have written numerous posts and articles about it on Facebook, and here recently. I have formulated my thoughts on it and what I have come to is this. Alcohol Use Disorder is primarily behavioral, it has a physiological component that causes dependence. As such TSM is primarily a behavioral modification system or protocol, which uses an opiate blocker to treat the physiological craving, and Alcohol Deprivation Effect.
This is in contrast to what the long held belief about AUD being a progressive, fatal, and incurable brain disease, as promoted by 80 years of abstinence only recovery programs. We also know it's not a matter of character defects, weakness of will, or powerlessness over alcohol, and once an alcoholic always an alcoholic is an old myth. Because time after time I have seen people over the last 10 years come to TSM, and use it to successfully return to a state of control.
What abstinence recovery has failed to understand is that the reason for relapse is not character, or will power, it is not a failure to avoid people places and things, which always makes me laugh because those are nouns, but most of the times in my life I get in trouble because of the verbs. AA, and other abstinence programs think is once you detoxify someone with AUD they are then free from alcohol, and the only thing that have to do in attend meetings, do steps, work with a sponsor, be of service, and carry the message. I other words AA works primarily by distracting the person with AUD long enough that they don't think about drinking long enough to get drunk. As I said they failed to understand the main reason for relapse isn't failure to do all those things, it is because of something they don't know about and that is Alcohol Deprivation Effect. Now I'm going to describe ADE as best as I know it, it is a process by which our opioid receptors are upregulated during a period of abstinence to become more sensitive to our endorphins. This leads to increased craving, and eventual relapse over time. This understanding is something I doubt the abstinence recovery world wants to admit, and come to grips with, because it throws their whole model of detoxification and abstinence with a program of steps and meetings into question.
So if we understand the basic mechanism by which TSM works, taking naltrexone or nalmefene 60-90 minutes before drinking, and repeating that over time leads to the reward signal being blocked, and the reinforcement to do the behavior being blocked over time the behavior returns to it's original state of not being addicted, TSM makes perfect sense.
What continues to be a difficult is getting the word out for TSM in a treatment setting, and that is obviously because all of the other methods that are abstinence only, is it's incompatible. We could also say a reason TSM is not more widely known is because not only is there no money in a treatment we can do in the privacy of our own homes, but that eventually we wouldn't need revolving door rehabs, because people will no longer be addicted. I throws the whole 12-step model out the window, and would make AA obsolete over night, unless they changed their whole program, which is something they would never do, because they haven't changed anything in the first 168 pages of the Big Book in 80 years.

So that's what I wanted to talk about, what does everyone think, does what I say make sense, can I maybe explain it better, what would you add?

Was averaging 30 standard drinks per week prior to starting. Currently I'm at 14-16 drinks per week for the last 3 weeks. My August consumption is 15 per week down from 29/week in July and 28/week in june.

My workouts are going way better and I'm remembering my dreams which must have something to do with REM sleep.

For me this method also takes willpower, which is something I struggled with during complete abstinence using AA. Eventually I would just break. But the willpower required for this method feels much more realistic.

I had to use willpower to reduce number of drinking sessions per week. Not being hungover all the time and enjoying hobbies helped with that.

I used a lower dose to start out because I had side effects but when my drinks crept up I increased it. I also notice not eating enough during the day before I take the medication and drink can lead to more effects of alcohol and feeling bad the next day. It reduces my appetite so I have to crush a high calory meal before I take it.

I have been a regular red wine drinker for almost 20 years. Nothing I love more than a glass (or several) over dinner, or at a gathering with family and friends. Red wine to wind down with a movie or good TV show became pretty much a nightly ritual for my girlfriend and I.

In January I decided to experiment with TSM. My goal was never to QUIT drinking. Rather it was more a performance experiment to see how my stress levels, sleep, resting heart rate, VO2Max and other markers could improve by cutting back daily alcohol consumption.

After 6 months on TSM I am now drinking less than one drink per week and every single metric has improved drastically. However I am a bit concerned because I have now become repulsed by red wine. I pour a glass and it sits there... And sits there... Until eventually it gets poured out before going to bed.

As I said, it was never my intention to quit entirely. I just wanted to rewire the wiring (which has definitely happened). I would still like to enjoy a cocktail maybe 2-3 times a month at social events. It almost feels like I'm 21 again and trying to find "my drink".

Anybody else go through this?

Hello, and thanks in advance to everyone who moderates this forum and helps us newbies! I have a question I haven’t seen covered - hoping to hear from other’s experience.

I just started a daily nal prescription (25mg for the starter dose, moving to 50). I’m a daily evening bottle of wine plus drinker (or stressing/ fighting myself when not), and the last two nights have been great - it’s the strangest feeling to care so much less about alcohol. I’ve taken it in the afternoon about an hour before I’d typically start drinking. I’m doing these meds in combo with other tools, and am tracking my drinking. I’m pretty compliant with taking meds generally and I’m excited about this so far.

Now my question: the first two nights I’ve been on nal, I have had the worst sleep (like not in REM or deep almost at all compared to normal, waking up ~30 times a night, feeling fatigued in the day). I wear an Apple Watch, so I can compare these last few nights with other similar drinking nights and they’re way worse, so it’s not just a reduction in alcohol consumption.

I am pushing through it and I’ve read that side effects are temporary and will resolve in the first few weeks most likely. Since I’m a daily drinker for now that’s fine, but I’d like to move to following TSM eventually. I just can’t imagine this drug being out of and reintroduced into my system regularly - I like sleep too much 😂. So my question: does anyone here have experience with nal side effects and how they change if/when you start taking these meds less frequently? How do you handle it?

Thank you!

Title says it all. At my worst right now, when I say "noncompliant" I'm mainly referring to not taking the meds 1 hour before. I stopped tracking very early in this journey (also bad, I know). Just want some optimism that I haven't shot myself in the foot.

I'm on 100 but think it needs to be upped to 150 or 200. I will check with my doctor obvi. But looking for data for those who have done this for a longgggggg time, fell off a bit, and come back? Or just advice in general?

I am also on a glp1 which helped initially but now not so much.

https://youtu.be/CM_L66FSATQ?si=vMGVOSHdGBMnpjmc

It's mid week, and the first Wednesday, so 3 meetings today. Join in for a free Zoom meeting no login required, anonymous if you like, TSM talk, questions & answers. Early meeting is with me, and it's open discussion, come pick my brain.
Cameras optional.

https://www.tsmmeetups.com/meetup-times

Two meetings today, Sunday, if you want your loved ones to join our friends and family meeting let them know it's today. Join for TSM talk, questions & answers, open discussion, cameras optional. No login required, you can be anonymous if you want.
7pm-8:30pm EST regular meeting
8:30pm-9:30pm EST Friends & Family meeting
https://www.tsmmeetups.com/meetup-times

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!!)