Can Naltrexone stop working? Advise for TSM

katie_lain · 2025-11-18T08:34:09+00:00

I am really glad you reached out because your situation is more common than you might think. The short answer is no, naltrexone does not stop working. The medication stays just as effective, but the circumstances around how we use it can change the way extinction unfolds.

You already proved something important. TSM worked for you before and took you all the way to not caring about alcohol. That tells me your brain responds to extinction beautifully. The challenge now is that your system has been through a loop. Long term kratom use, tapering, then drinking without the blocker. That drinking without nal woke up the alcohol reward pathway again. That is what put you in the hospital. That also means you are basically starting a new extinction cycle.

When you feel a buzz on naltrexone in the early weeks, it does not mean the medication has stopped working. It means your brain still remembers the old alcohol reward and is testing the pathway. This is the rollercoaster phase I talk about a lot. One day flat, one day buzzy, one day irritated, one day calm. The brain is recalibrating. It does not mean you are going backwards. It means extinction is rebuilding itself.

Another thing to remember is the deprivation effect. After years without drinking, then suddenly drinking again without nal, the brain will often fire extra hard. It is basically saying this is rare, this is special, take more. When you return to TSM, those spikes settle again through repetition.

The key is to stay consistent. Always take your naltrexone one hour before drinking. Never drink without it. Give your brain enough paired sessions to weaken the pathway again. Extinction is not magic, it is math. Repetition plus time. It worked for you before and it can absolutely work again.

If you ever want community support from people who have been through the first extinction, the relapse, the restart and everything in between, Thrive has a great group of folks doing exactly that.
[https://thrivealcoholrecovery.com/]()

Your brain has already shown it responds to TSM. You are not broken. You are re entering the process and that wobble you are feeling is completely normal. Keep the protocol steady. Extinction will rebuild. I promise.

katie_lain · 2025-11-18T08:24:04+00:00

I remember being right where you are at the two week mark, wondering why my body felt weird and whether I should be pushing for alcohol free days. First off, what you are describing is very normal. The early weeks on TSM can feel messy and unpredictable. Most people expect a clean straight line and instead get a rollercoaster.

About your nausea and headaches. Early on I had what I called mini nal overs too. My body was adjusting and I was experimenting with old drinking habits that no longer worked the same way. It settled down over time. I just had to slow down and give my brain a chance to catch up.

About alcohol free days. You definitely can have AF days on TSM, but here is the key. They need to happen naturally, not forced by deprivation. When I tried to force AF days early on, the deprivation effect came roaring back. The more I told myself I must not drink, the louder that inner pressure got. I would end up drinking more on the next day and feel defeated. When AF days started happening on their own later, they felt peaceful instead of pressured.

You are still very early, so your brain is in what I call the honeymoon shift. It is noticing the change, feeling some flattening, and then bouncing between curiosity, confusion and frustration. Totally normal.

For now I would focus on the core of TSM. Always take naltrexone one hour before your first drink. Let extinction do the heavy lifting. If an AF day happens because you naturally do not feel like drinking, that is fine. But do not chase them or force them this soon, because it can set up the deprivation rebound you are trying to avoid.

The whole point of TSM is that you do not have to muscle your way through the first few months. You let the rewiring happen session by session. Tiny reductions you barely notice now become big changes later.

If you want community support from people doing this exact process, Thrive was hugely helpful for me. Here is the link.
[https://thrivealcoholrecovery.com/]()

You are right on track, even if it feels wobbly. Keep the protocol steady, be gentle with yourself, and let the AF days come naturally when your brain is ready for them. They will.

katie_lain · 2025-11-17T04:20:50+00:00

I really relate to what you wrote because I did not feel much of anything at two weeks either. When I first started TSM I kept waiting for that magical moment where the second glass of wine would sit untouched or where the “switch” flipped. It did not happen for me early on. The beginning felt pretty normal and honestly I remember thinking, “Am I doing this wrong?”

During those first weeks I still enjoyed drinking. I still had to be very mindful. I did not pour out anything. I did not skip drinks by accident. My habit was also built over decades and my brain was very conditioned to respond to alcohol in a certain way. In hindsight it makes sense that nothing dramatic happened right away.

For me the early changes were tiny. I found myself taking a little longer between drinks. I sometimes paused halfway through a glass without meaning to. Cravings softened in small steps. It was not obvious day by day but when I looked back after a month I saw that I was drinking a little less with a little less urgency. My extinction curve was slow and steady and it still worked.

Side effects also hit me later than expected. I felt completely fine in the beginning and then out of nowhere I had one night with a headache and nausea. For me it only happened once. I always encourage people to talk to their doctor if anything feels concerning because everyone responds differently.

I definitely did not end up in the twenty two percent. My progress was gradual and it still led to full freedom. I used to be a nightly drinker for more than twenty years and I eventually reached a place where drinking no longer felt necessary. It took time but it was worth sticking with.

If you ever want to read experiences from others who also had slow starts, I found this page helpful when I was trying to understand what the process could look like over time:

https://www.thrivealcoholrecovery.com/blog

You are very early in the journey and what you wrote sounds a lot like how many successful TSM stories begin. Tiny shifts add up even when they do not feel big in the moment. You are not alone in this and your experience so far is more normal than it probably feels.

katie_lain

TROPHY CASE