DOSE:		oral	Alcohol	(daily)
	50 mg	oral	Naltrexone
	200 mg	oral	Disulfiram

BODY WEIGHT:

70 kg

Can Work for Alcohol Abuse, but Not for Everyone

For background, I have been struggling with alcoholism over the past 10 years. Alcoholism runs in the family, and while various family members have had more serious problems than I (getting too trashed all the time to care for kids properly or go to work, getting DUIs, destroying their relationships), no one knew I was an alcoholic .

I was mostly using alcohol as an anti-anxiety and sleep medication. I have had serious insomnia problems since I was a teenager, and once I figured out that some drinks at bedtime would help me sleep, it was all over and I quickly ended up with a heavy drinking habit. Bedtime use became night time use, and that led to evening use. I would start drinking like clockwork while preparing dinner, and continue at reasonable doses until bedtime to keep a buzz going. The buzz was nice, but it wasn’t what I was really after. No, the main thing was the relaxation, and at bedtime I would drink a much larger amount to lay in bed drunk and read for awhile, until drinking even more to knock myself out. Obviously this is all very unhealthy, especially in the long term.

My average consumption was about 25-30 units per night, sometimes more, in various forms. I’m a skinny guy, and easily affected by substances generally. My wife, who does not drink at all, knew I drank each evening, and was not happy about it, but it didn’t affect my family in any obvious bad way, so she mostly looked the other way, and in any case much of my drinking was still hidden from her as I did it late at night. No drunken rages, no alcohol-fuelled bad decisions, no passing out in front of the kids, nothing like that. But this is still a lot of booze every day. It made me lazy and unable to do some kinds of things in the evenings/nights, but also, during the day (every day!) I would be in alcohol withdrawal and that affected my mood a lot and sometimes made things difficult for me at work.

I tried to quit a number of times, but the withdrawals were too horrible (guaranteed to have many sleepless nights in a row, and the first few nights were always absolute hell, with sweating, massive anxiety, hallucinations, etc). This is just impossible for an insomniac to face, so my many attempts at quitting went pretty badly.

As I approached my 40s I began to worry a bit about my health. Remember, this heavy drinking pattern had been going on for 10-15 years. I had heard about an amazing drug called naltrexone that would reduce consumption and cravings, and best of all did not require me to immediately try to kick alcohol. Interesting, no? So I got a prescription from my physician (who didn’t know I was an alcoholic either, until then, heh) and was eager to try it.

Sadly, it did not work for me, and here’s why: naltrexone does not seem to block the relaxing effects of alcohol. When I took my first tablet, then started my drinking protocol an hour later (gulp down one 8% 500mL beer on an empty stomach, while getting the ingredients ready for cooking, then get out another one), indeed there was a very different feeling going on. I did not get any buzz from the alcohol, but instead, the effect was similar to the times I had taken diazepam (Valium). It made me listless and wanting to lay on the couch, instead of “partly relaxed and partly charged up” as alcohol tends to do. The stimulating, “buzz” effect of alcohol is what it blocks, the euphoria if you can call it that. I continued to drink that evening, though in a somewhat smaller amount than usual, but at bedtime I had even more in order to increase the relaxation effect prior to sleep. So, I was still drinking pretty high amounts of alcohol, and was getting more or less the effect I was after, with some changes, despite the naltrexone.

I continued taking the tablets, and still drinking, but I found that there were a number of serious side effects. For one, insomnia was a huge problem. Some nights I could not sleep at all, tossing and turning until the sun came up, and drinking more alcohol (within reason) did not help. Second, I basically lost my ability to enjoy food. I would pick at all my meals. Eating became a chore. Sexuality was also affected. I normally have a strong drive, which my wife really appreciates, but all the physical aspects became quite muted. I could still get erections anytime, and had sexual thoughts as usual, but the actual process of sex was muted at all stages. Totally unacceptable side effect for me.

After 10 days or so of taking the naltrexone daily in the evenings, I gave up, and the side effects were gone by the next day. I then continued to drink heavily for several more years.

What did eventually work for me was to get a prescription for lorazepam (Ativan) to be used at night (only when needed, not every night), which helped mitigate the withdrawals considerably, and then getting onto disulfiram (“Antabuse”), which basically makes you allergic to alcohol entirely - if there’s disulfiram in your system (and one 200mg tablet has effect for at least 3 days, in my experience) I will get an immediate hangover from drinking even half a normal beer, with skyrocketing heart rate, flushing, nausea, and all sorts of other awful symptoms.

After having tapered off the alcohol with the help of the lorazepam, I now take an antabuse tablet first thing in the morning (or even every 3rd morning; I seem to be especially sensitive to this drug) when my mind is fresh and clear and I am not thinking about drinking, and then I cannot, like literally cannot, drink in the evening. Drinking on antabuse results in absolutely horrible, crippling sickness within minutes , and no good effects at all. What’s more, antabuse builds up in one’s system, and there is no tolerance to it. In order to enjoy a drink (more like 20 drinks, let’s be honest) I have to stop taking the tablets and wait at least 14 days (!). And even then, some antabuse effects may surface. I have my wife administer the dose to me each morning or two so I can avoid any temptation to not take it.

The disulfiram has no major side effects that I can think of. I had some erectile dysfunction with the normal dosing regimen (500 mg at first, then 200mg per day), but that was easily solved by taking the 200mg every 2-3 days instead of every day. The harsh alcohol allergy stays in full force for nearly 2 weeks, as noted, so daily dosing is not necessary in my case.

I never went to AA or a therapist or anything like that, and almost no one knows that I ever had an alcohol problem, other than my wife and my physician.

To sum up:

- The Sinclair Method is certainly valid, but will not work for some alcoholics

- When taking naltrexone, alcohol seems to function like diazepam (Valium) instead. No buzz, just a deadening, listless feeling, and of course some relief of anxiety.

- Naltrexone had significant side effects related to its general pleasure-blocking mechanism. Anhedonia, anorexia/no appetite, pushes away sexual enjoyment, possible insomnia). These surely vary per individual, and may cause no problems for some.

- Disulfiram (Antabuse) is an old medication apparently considered somewhat obsolete by physicians, but it can work very well under the right circumstances. So if you are an alcoholic, or want to stay off alcohol for some reason, think about it! Most physicians will give you an rx for it no problem.

I have heard many stories of naltrexone being a magic cure for many alcoholics, but unfortunately that was not me.

Exp Year: 2024	ExpID: 118303
Gender: Male
Age at time of experience: 39
Published: Sep 4, 2024	Views: 16
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Naltrexone (338), Disulfiram (972), Alcohol (61) : Combinations (3), Retrospective / Summary (11), Medical Use (47), Hangover / Days After (46), Addiction & Habituation (10), Alone (16)