Naltrexone implants

[Greg]

Hi everyone, I just wish to ask if anyone has had a naltrexone implant for the treatment of alcohol addiction? If so, does it actually have any therapeutic effect, and does it cause dysphoria or depression due to the endorphin blockade? I am a person who gives up on treatment methods far too quickly and I have been considering an implant of naltrexone. I know it doesn't stop alcohol cravings by itself but maybe it could finally get me onto the Sinclair Method since I would have no choice. Extinction would have to occur if I drank with the implant, since that would be the Sinclair Method. The clinic offering the implant also recommends oral Antabuse as part of the treatment but maybe I can get out of that part.

[lenaleed]

Naltrexone implants

Hey there Greg -- Nice to see you post here.

I I've not heard of a nal implant and don't know how long the implant lasts; I do know that the injection (Vivitrol) is supposed to provide coverage for thirty days.

Dr. Eskapa does not recommend the Vivitrol beyond the first month or two, because under TSM you do not take nal on days you do not drink. This is an important part of TSM, because on AF days we engage in opioidergic activities to reinforce them (fine dining, sex, exercise, etc.).

Most of us on TSM are ready to have AF days after a month or two, so continued use of a long-acting form of nal would mean nal in the system on non-drinking days. But if you feel a long-acting form of nal would jump-start you on TSM, by all means go for it.

I'm glad you recognize that naltrexone is virtually worthless as an anti-craving med.

Good luck in whatever you decide and drop in to say hi to the folks at thesinclairmethod.com. You'll be surprised and delighted by the successes folks are experiencing. Take care -- Lena

[Changed1]

Naltrexone implants

Hi there!

I just went through rehab and both of the guys in there had the implant - one for alcohol, the other for opiates. Both were doing very well with no relapses. Both will be on them for two or three months.

While not for me, it does seem like a good and reasonable way to get some AF time under your belt. Here in the US it is very expensive and, due to our lousy healthcare system, I don't even know if it's covered under insurance. One of the guys told me it cost him $2500. Too rich for my blood. Maybe where you live it would be different for you. Certainly worth exploring.

[nancy]

Naltrexone implants

I heard that the implant is good for preventing relapses, so if you drink, you don't enjoy it and don't keep doing it. But as someone else wrote, it takes away other kinds of pleasure which is why it's not part of the sinclair method. Maybe you should ask your doctor about this.

Is The Sinclair Method an option for you? With the goal of working into abstinence? I wonder what Eskapa says about that. Can anyone answer that out there? Someone like Bill? How does TSM work for those who really want abstinence as the end goal, not moderation.

[lenaleed]

Naltrexone implants

Nancy -- I'm glad you asked. I keep posting this, as there is some misinformation on the board, but it is a big board and I'll catch it when I can. You are so wonderfully supportive of all on this board who have worked to find their way out.

Dr. Eskapa writes that many who started TSM with the goal of moderation simply lost interest in AL and quit. That is why we are advised to defer the decision whether to be abstinent until we are well into the program. For example, SpringerRider started with the idea he would like to moderate, then decided to just go where the journey took him. One of his latest reports is that he can see himself giving up AL because he has lost interest in it.

The implant would NOT be good for preventing relapses according to the studies. First of all, please understand that naltrexone is NOT an anti-craving med; it has an abysmal failure rate used that way. We do have some anti-craving the first few days; I can see nal putting the brakes on a major bender (as Evie.Lou has said) for that reason. But it has no meaningful long-term value that way.

Those in the studies who showed benefit from NAL+ABSTINENCE consistently were the very ones who fell of the wagon and drank. Sadly, the ones on nal long enough to get the TSM brain rewiring -- at least 3 months -- were thought to have benefited from the supposed anti-craving benefit. That of course meant they were led to believe they no longer needed the nal so of course they were doomed to certain re-addiction if they started drinking again without nal.

Even non-drinkers who have done TSM are admonished to carry a dose with them -- just in case. This is not to arrest cravings but rather it is to form a blockade of the opioid receptors and prevent the commencement of the re-addiction that inevitably will occur if drinking without nal resumes.

I'm not aware of anyone on TSM who quit because of the diminished pleasure from other activities. It's not a day-to-day thing that very many of us notice. Just as with alcohol, it's a long process of which we are not conscious as it takes place. The good news is that desirable behaviors can be reinforced along the way as we extinguish alcohol addiction. And, it completely becomes a non-issue as we no longer take nal daily a few months in when we have several AF days a week.

Finally, PLEASE understand that for most of us, especially after the first few days, drinking on nal doesn't kill the buzz. We still enjoy drinking alcohol. But over several months we extinguish the brain circuitry that tells us we NEED to drink alcohol.

An implant would deprive the patient of reinforcement on non-drinking days, which is not a good thing after the first couple of months. But the real damage with these implants or long-acting injections is leaving the patient with the mistaken belief that nal is not necessary every single time one drank after the long-term med wore off. We are taught it is the Golden Rule: Nal one hour before drinking always. For some, that may be just on New Years Eve. For others, it's once or twice a week. For many, it ends up beeing a dog-eared blister pack in the purse or pocket for years.

[Greg]

Naltrexone implants

Thank you all for your replies. My goal is definitely abstinence, since I no longer want anything to do with a substance that has ruined my life so much. I don't think I could ever enjoy a social drink again even if I was able to gain complete control over the addiction, since it has caused me so much misery. However, good luck to those who can achieve moderation.

I suspect that the clinic offering the naltrexone implant may be a sham, based on their false promises and their insistence that naltrexone is an anti-craving drug, to be used together with oral Antabuse (disulfiram). They have no understanding of The Sinclair Method whatsoever. They are very money-oriented.

I must admit that naltrexone scares the hell out of me due to its total endorphin blockade. I felt depression and loneliness even before alcohol became a problem in my life, and now of course it's even worse. However, continuing to wipe myself out by drinking every night, and waking up the next afternoon feeling like a living dead person, cannot be as bad as any treatment!

I wish I could write a longer reply at the moment but I am drinking, and I would rather sign off now than keep writing and risk saying something stupid.

Thanks again to you all.

Greg

[lenaleed]

Naltrexone implants

Greg -- Naltrexone itself has no mood-altering properties. I don't see much reported in the way of increased depressed mood from the TSM folks. Sinclair reported that one group of his subjects was given the Beck Depression Inventory before treatment and again after about 12 weeks of treatment. He found a very large decrease in depression among his subjects.

Getting free of the grip of alcohol addiction seems to work wonders for us in every aspects of our lives.

Of course if you have been diagnosed with a psychiatric condition, or feel you have one, you should continue or seek treatment for that.

Best wishes for success with whatever you decide.

[Zman]

Naltrexone implants

Hi Greg,

I remember you posting a few times on the Bac thread. Did you decide not to try Baclofen?

[brightlite]

Naltrexone implants

Greg;668726 wrote: The clinic offering the implant also recommends oral Antabuse as part of the treatment but maybe I can get out of that part.

This doesn't make sense to me. If you are to use a Nal implant for the practice of TSM, why would they want you to also take Antabuse which would restrict you from drinking any alcohol. Doesn't sound right to me.

[Guest]

Naltrexone implants

Hi Greg, Just wanted to say I am thinking of you and reading your posts here and in TSM.
There is going to be something that will help you, as you are so ardently striving for a solution.

Please, dear friend, be strong, persevere, and be well.

What happened to the rehab to detox? Are you afraid to do that? (Now this is a personal question so you can pm me ok?)

Your buddy, OO

[Greg]

Naltrexone implants

Thanks again everyone and I'll try to answer your posts.

Lena, I'm glad that naltrexone doesn't seem to induce depression. That has been my greatest fear of undertaking the Sinclair Method long-term. I have taken naltrexone while still drinking and I blamed it for feeling down, but in hindsight I could have just been blaming it for my general depression that can change in intensity at any time. I also tried it during a period of abstinence, but of course abstinence brings on depression along with many other symptoms, so I can't be sure naltrexone was responsible for that either. I suppose I have over-analysed things and concluded that any drug that totally blocks the opioid receptors would have to increase depression, or at the very least block pleasure from everyday activities.

Zman, I tried baclofen, now up to the maximum daily dose in my country, which is 75 mg. To get the real benefit I would have to order from an online pharmacy or see two or more doctors, as 75 mg is not enough to block my cravings. There is just not enough evidence to convince one doctor to go way above 75 mg, and I don't think Dr. Ameisen's book would be enough to convince a doctor at this stage. As Bill P. said, only high doses can work in many cases. I have not chosen the online option because I would find myself having to constantly order huge amounts without a prescription, and risk seizure by customs. Even if that wasn't a problem, I'd be constantly reliant upon doses of baclofen that I can't legally get, and it can have some nasty withdrawal symptoms if the supply is interrupted for any reason.

Brightlite, the clinic offering the Nal implant never intended it to be used for practicing TSM. They only offer it for total abstinence as an "anti-craving" medication, which is why the Antabuse is part of their program.

Thanks OO, glad to hear from you again. Me and my addiction will continue fighting each other until the end, and there will be only one winner. I guess I have known this for a long time, since I have never denied that I am an alcoholic, and I know that there is only one possible result from untreated alcoholism. I'm sure many others here feel the same way. I always feel that I am trying to beat a part of myself, almost a second part of me, rather than just seeing it as a simple fight against "the bottle". I haven't given up and I thank you for your faith in me. As for detox, I am thinking of an unconventional way that does not involve the usual diazepam (Valium) as the detox drug, since it has a very weak effect even at huge doses (eg. 180 mg. in one night). Alternatives could be alprazolam (Xanax) or phenobarbital, since Valium just seems like a sugar pill no matter how many I take for detox.

I may not be on the forum all that much but feel welcome to PM me if any of you wish to.

Best wishes,
Greg

[Krs10]

Naltrexone implants

Hi all, I actually rec'd my naltrexone implant yesterday so I thought I would share my experience with everyone....
I found a local Dr's office through The Coleman Institute website (google it for more info about the implant). I actually had to call their hotline and wait for a Dr to call me back for an appt, which it took over a week for someone to get back to me. I don't know if that is standard or my luck....but anyways, I was told I had to be alcohol free for 5 days before getting the implant. I went in for my appointment yesterday and the whole thing only took about an hour start to finish.
I was relieved to find that this was a "regular" Dr's office, meaning that it wasn't just a clinic that only treated patients with this type of issue, which made me feel like it was legit and also like I was there to get treatment for a medical illness just like everyone else. Once it was my turn to go back I had a brief consultation with the nurse and suprisingly it wasn't some kind of probe into my whole life history by a shrink which was what I was expecting. Basically just asked me about my current drinking habits and health related issues. I would guess they already assume someone who is going to this extreme really needs/wants the help so it was quite nice that I didn't get 20 questions about personal things. (although they do recognize the need for counseling in combination with the medication and recommended some places)
As for the price... the complete first visit including the placement of implant was $935. Then I was told I have to go back to get the stitches out in 10 days which will probably be over another $100 w/ out insurance. And last to my shock I went to drop off the antibiotic script (to prevent infection of the implant) and found that even the generic version was $60! The Dr. said I can expect the implant to last 60-80 days. So the implant is pricey, but it's not outrageous to think I probably would have spent near that in alcohol and alcohol related activities during that stretch of time anyways, so whatever.
The placement of the implant only took about 10 minutes and I felt practically nothing. I was numbed with a needle which didn't hurt either. The implant looked just like a piece of chalk but it's only about 1/2 inch or so long. The cut is close to an inch long and has 3 stitches, it is located just next to my right hip bone, a place that will be hidden by a bikini.
I got the implant at 5pm and felt fine until 8pm when I started feeling hot and a little sick to my stomach. Sleeping was wierd, I was up every hour or so but then would doze off again. Overall just didn't feel like a normal good nights sleep, but I was able to get some sleep in. But anyways, I got out of bed today and felt a little sick to my stomach but for the most part feel fine.
How everyone may react to the medication is different, I wasn't having any withdrawal symptoms when I got the implant so that may or may not be why I don't have the extreme side effects some people talk about. I know many people on this site are drinking on this medication, I am going to be abstaining. To each their own.
I will try to post in a few days with updates on the reaction of the medication for those who are considering getting the implant. I hope someone finds this helpful as I couldnt find a first hand account of someone who got the implant before I got mine.

[Zman]

Naltrexone implants

Greg,

I dont know how things work in Oz, but why not try to get a prescription from 2 docs?

And wouldnt it be worth taking the risk of having shipments being siezed at customs if the higher dose could actually cure your addiction. Just order a few months before your previous stash is going to run out, in case you have to order again.

Also, while I understand your fears about the effects of withdrawal, you know that at the very least, you have a 75mg dose available to you which you can legally procure as a fall back.

It just seems like the possible benefits outweigh all risks.

[Cinders]

Naltrexone implants

Krs10,

Thank you for putting your experience out there for others to see.

Yes, it is helpful when people do this kind of thing, as you have. Otherwise, they walk into the whole thing completely blind.

I hope it helps you with your goals.

Cindi

[Krs10]

Naltrexone implants

Day 4 almost complete on the implant and wanted to share an update on the effects if anyone is following....

I have been nauseus the last few days and have had trouble sleeping. I have had some anxiety which seems to go away after about an hour or so if I rest, that could just be the lack of sleep though. It seems kind of hard to concentrate as well, which could also be accounted to many other things. Usually feel bad after I smoke, which I should probably quit as well, but strangely enough my Dr. actually told me to go ahead and smoke all I wanted b/c he wasn't going to advise me to attempt to quit 2 addictions at once....

Woke up today and felt much better, and for most of the day I have felt like I am not on any medication...except for the over all feeling of being tired. My body must be adjusting to the medication, which is good, but I'm afraid that if I feel "normal" again the I will want to drink like "normal".

I have thought about drinking, but basically only when I am driving home from work which is when I had the usual argument in my head about stopping at the store (which I always lost). Basically I only thought about it but did not have the uncontrollable impulse to have to do it, which I don't know if I can credit it to feeling somewhat sick and tired, or if it's the meds actually doing something. Still a bit early to tell.

Going on 10 days sober now, and it has been so far easier than other times I have tried to quit. I'm guessing the med must have something to do with that. I do not have the overwhelming feeling to go out and get alcohol, but I also know that I am not at all ready to be put in social drinking situations where it was just "there" because I don't know if I could resist at this point yet. Just thinking about it makes me angry that mostly all the other people in the world can drink and just have fun and not have it ruin their lives. It's Friday today, one of my usual out of control drinking days....trying to not think about it for the rest of the night.

So...over all so far so good, can't say I would recommend the implant as of just yet, still not sure if it actually works. I will update again in the near future.

Take care all.