How do I know if TSM isn’t working for me?


In this short video excerpt from our Tackling the Tough TSM Questions live stream on Twitch, C Three Foundation CEO Claudia Christian and Executive Director Jenny Williamson discuss how someone will actually know when the Sinclair Method isn’t working.


Watch the full video Tackling the Tough TSM Questions on our YouTube channel.

DISCLAIMER: The contents of this video are not meant to serve as medical advice, but rather, to assist people in asking their doctors questions that will enhance recovery success. Please consult your medical provider before taking any prescription medication or changing doses or frequency of dosses.


Jenny: When should you consider TSM isn’t going to work for you?

Claudia: Oh Yeah. That’s a, that’s a really, and I’ve seen this. I’ve seen people work so hard at their recovery with TSM, and the medication just wasn’t right for them. There are examples of people who, they just genetically don’t respond to naltrexone. When do they notice this? There are, there’s mixed responses to that. As hard as it is, I always like to have people try it at least six months. I mean that’s because some people don’t see any difference in the first three or four months, but then I find out that they haven’t changed any of their habits, and that they did see a small reduction in the first seven days. So this means that they might truly be a responder, but they haven’t been helping the pill along. So I want to re-evaluate that. So if you, if you genuinely have been taking the tablet correctly. You’ve been complying. You’ve been keeping a drink log. You’ve been changing your habits. You’ve been staggering the times. You’ve been mixing things up. You’ve been going for walks. You have been doing TSM like nobody’s ever done TSM before in their life. I mean you’re doing everything. You’re doing coaching sessions and counseling and therapy. You’re doing everything, and your drinking literally has not changed at all, and you’re at the six or nine or 12-month period. You know, then barring taking a genetic test for that particular gene, I think we can probably say that maybe naltrexone isn’t the right medication for you.

Jenny: So, let’s talk about some of the other things that people can look for in addition to their reduction, because you and I both know that you can have responses that don’t necessarily translate immediately to your drinks reducing, but they’re still changes. So talk about some of those.

Claudia: Well, I mean if you’re thinking about alcohol less. I mean, you know, just the fact that maybe… I have some people that say to me; Well, I’m still drinking a bottle of wine every night, but I don’t really think about it all day. So that indicates to me that that’s a habit. They haven’t changed their habit. So does that necessarily mean that naltrexone is not working? No. It means that naltrexone is working, but these people are drinking – now would you say they’re drinking through the naltrexone, or they’re overwhelming the naltrexone.

Jenny: Could be either.

Claudia: Yeah, it could be either. So you know, that’s a matter of changing your habits, and adding more things into your life, so that you’re not just sitting there expecting to drink that bottle. I mean I don’t know. I’m not in their house. I don’t know how they’re drinking that bottle, or if they’ve made any changes. But the fact that they say to me: It’s funny, but you know, I didn’t really want to finish that last drink but I did. Okay, that right there says, hang on a second. What do you mean you didn’t want to finish that last drink? Well I just didn’t want to finish it. But of course they did, because they don’t quote unquote waste alcohol or they don’t leave wine in their glass. They’re not used to doing that, so that’s why they finished the glass. Well that’s an indication that the naltrexone was working, but they didn’t listen to that cue.

“You didn’t learn this this problem overnight. You didn’t take your first drink and that, and then immediately the next day have three bottles of wine. This took years and years and years of learning how to drink in the particular way that you drink right now, and it’s going to take time to unlearn that drinking pattern and those cravings.”

So this is kind of a loaded question. When do I know naltrexone’s not working for me? I would say, if I’ve done everything absolutely correctly, and I’ve seen absolutely no changes in a year. If you want to give it a year, give it a year. At the six month point I would definitely speak to a professional, and evaluate what you’ve been doing, because it really could be something as simple as – I had a recent client who said, “Yeah, you know, it was working so well in the beginning, but I don’t know.” Well it turns out she’s drinking all day, and she’s not taking a second dose. So yeah, the levels of alcohol are really not decreasing at a great, the measurements, the how many drinks per day, but the first part of the day when the naltrexone was actually working, she drank less, so the naltrexone is working. So I think every situation is sort of unique, and we have to determine whether or not the person is employing the other techniques and tricks that you have to during your TSM journey. That said, I would definitely, if you think you’re doing everything right, and you don’t see any reduction within six months, I would definitely speak to a professional and go over everything. Your drink log. That’s why it’s imperative to keep the drink log because we forget. Even if it’s a 10% decrease that’s important, that’s really important. So, you’ve got to keep that drink log up to date every single time you drink. And then you can see a professional, and they can ask you if you’ve made any changes. Go to a TSM expert, and then you can determine if you’ve really been helping the pill along. And then if they do recommend changes, you can try those changes for a few more months. I mean, we know somebody, Jenny and I know someone, who tried TSM desperately for over two years. I mean tried it, and tried literally every single thing. Making changes, breaking habits, and finally just said: You know what, I don’t think it’s the medication. And she had the doctors say, “Yeah, you know what, you’re doing everything you should be doing. Naltrexone’s not the medication for you.” And the doctor switched her to a different medication, she did great. So…

Jenny: Sorry I’m trying to take care of a few spam things so I’m continuing to listen.

Claudia: No worries. So that’s my opinion on when you should sort of think that TSM is not working for you. I would give it a good chunk of time, and if you’re only taking the medication and complying and keeping a drink log, I would then add, you know, if you’re not adding all the tricks that we’ve been discussing throughout all of these chats, definitely start doing that and see if you see a difference. And that would be staggering the times, trying to delay, going out for a walk, asking yourself, “do I really want or need another drink and why?” All of those things, mindfulness and things. Start employing that, and then give it a few more months, and if you really, really don’t see a change after nine months or 12 months, then perhaps a different medication is right for you.

Jenny: Yeah, and how much of this do you think comes down to people who fail to recognize and celebrate the small victories.

Claudia: I think a lot of it has to do with that, and also people want immediate gratification. That’s the way we’re built. That’s what this society, we have no attention span. So if you see somebody on Facebook, “well I don’t understand why she cut her drinking in half in three months.” Well that’s her, that’s not you, okay. You didn’t learn this this problem overnight. You didn’t take your first drink and that, and then immediately the next day have three bottles of wine. This took years and years and years of learning how to drink in the particular way that you drink right now, and it’s going to take time to unlearn that drinking pattern and those cravings. So I like to think of every single time that you drink mindfully and you comply with the medication, every single time you do that is a drinking session toward extinction. It’s something beneficial. But the times that you’re drinking mindlessly, the times that you leave the booze on the table, and just keep refilling your glass while you’re chatting with friends, or watching a movie, and next thing you know the bottle’s gone, that mindlessness. Okay, you took the medication but you really didn’t do TSM properly and that don’t beat yourself up, but maybe you’re not going to get as far ahead as quickly if you keep doing things like that. So it’s a matter of a cumulative effort. It’s a matter of keeping your eye on the prize, and but it’s more important. Yes, you’re absolutely right Jenny, keeping your eye on your little successes, these small changes, the “Oh I didn’t finish the glass of wine on my bed, on my night table,” that’s huge. You wake up and there’s two inches left, like the gal on One Little Pill. You know she found this little half a glass of wine. It was unheard of for her. I remember the first time that I looked in my refrigerator and there was a half a bottle of white wine with a cork in it. I mean, there was never a bottle of wine with any wine in it unless it was a closed bottle of wine in my house, and I looked at that, and went “Wow, there’s a half bottle of wine in there, and not only did I not finish that bottle of wine, I don’t want any of it right now.” So you know that was a huge success.

Jenny: Right, even if throughout that week you still ended up consuming the same amount of alcohol as you otherwise would.

Claudia: Yeah.

Jenny: A hyper fixation on only reduction and we have a several drink tracking things available which is why there’s – I mean they’re good tools but this should not be the only thing you look at. Whether you use a drink log where you journal or use an excel spreadsheet or if you use our drink tracker, those are all drink logs. Those are all ways to just keep track of your drinks, because you’re looking at just data. That data isn’t judging you. Use it as a tool but it is not the ultimate, only, singular reflection of the process. One of the things I ask people is, so when you, when you pour yourself a drink, are you drinking it slower? And people don’t stop and think that if you’re able to drink your drink slower, and make it last longer, you’re doing two things. First of all you are learning your own stop and go controls again. TSM is helping you to achieve this. But also if you take twice as long to drink every drink, eventually that’s going to result in half the amount of consumption unless you double the amount of time that you’re drinking. You know, if you’re drinking for over the course of three hours a night, and you’re drinking one drink every half hour, you know over three hours that’s six standard drinks. But if you’re drinking one drink and making it last for a full hour, you’re going to cut down. It’s about, as you said, are you thinking about alcohol all the time? Has your craving level diminished even a little? You know, what mindfulness practices are you trying to incorporate? What are some other questions that you ask people?

Claudia: All of that, and taking note of any changes, any changes, whether it’s you know, I went over to my friend’s house and we always usually play cards and have a drink, and this time we had tea. Huge win. You know, I went out to a party where I thought I was gonna drink, but I got there, and I kind of forgot to order one. I was more interested in the pizza. I mean, that’s a massive change. Now the next night you could drink six beers, and so that your weekly total is actually the exact same as it was the previous week, but you had that night where you focused on the food instead of the booze…

Jenny: and that is success.

“For some people it’s not enough on its own and so it’s working, but to reach certain goals, people have gone to their doctors and either added other medications or gone to other groups such as SMART Recovery or Moderation Management to learn different tools.”


Claudia: That is a huge success, and it doesn’t mean that the naltrexone is not working. It just means that your journey towards extinction is different. The paths are all different, and you have to note those changes, those chemical, the biological changes and especially the emotional changes. You know, guy cut me off in traffic, and I had a really crappy day at work, but I came home, and I played with my dog. I didn’t grab the alcohol. Okay, something’s working, something’s changing, because your go-to comfort mechanism in the past was alcohol, and now it was your dog. That’s huge. That’s huge, and we don’t recognize these little things. We take them for granted. We can’t do that. We have to recognize them, and say wow, okay, that’s a huge change, because my normal habitual thing would be to come home and get hammered.

Jenny: Well, and here’s another one I’ve seen, and you’ve probably seen it as well in many iterations. There are people who at the beginning of the process struggle with medication adherence. They’ll take the medication but they have a problem waiting for that hour, and then it becomes less of a struggle to wait the hour, and then finally they reach a point where they’re capable of reaching the hour without having that intense anxiety over it. And that alone is progress.

Claudia: Sure it is. All of this is progress. Look, you’re introducing something new to your system. You’re taking control of your drinking. You are making an effort, and you can never lose sight of that, and that’s why we always tell people, don’t compare yourself to other people. This is your journey, and it’s going to turn out to be the way it is, and if naltrexone helps you reduce your drinking great. If you give it every single effort that you can possibly muster up, and you know you’re doing everything right, you’ve spoken to your provider and your therapist and your coach, and everybody agrees you’ve been doing everything right, and in one year you’ve seen absolutely no reduction, then it’s time to go to your doctor and say, you know what, I really did try naltrexone and I mean it from the bottom of my heart, I tried everything I could but it’s not working for me. And then they can find you a different medication.

Jenny: Yeah, and then there are some people who, in fact a lot of people, we’ve seen do this. Because TSM strictly works on that biological process. For some people it’s not enough on its own and so it’s working, but to reach certain goals, people have gone to their doctors and either added other medications or gone to other groups such as SMART Recovery or Moderation Management to learn different tools. So talk real briefly about some of those additional things that may just boost TSM when done alongside it.

“there’s so many things you can do to add to this journey, and I don’t want people to give up when they think that naltrexone is not working for them, that’s a very real fear, but you really have to say to yourself, “have I done everything I can to help the tablet along?” You have to be really honest with yourself…”

Claudia: Absolutely. Exercise is always a great thing. We definitely want to employ mindfulness and changing of habits. We also, I always tell people you’ve got to start new hobbies, or pick up old ones, it’s so important. I mean I say this a million times, but I’m always so overjoyed when I hear somebody picked up the guitar again, or started studying French again, or got their old high school band together again, or started wood carving or singing, or doing something in the community, because it brings so much richness and joy to their life, and you are going to have more time on your hands folks when you drink less. So this is a just part of the process. If you want your life back, and you want to be free from the chains of compulsive drinking or over drinking or drinking to excess, then you’ve got to start filling all those hours that you had when you were thinking about drinking, planning drinking, drinking, and getting over the side effects of drinking. You know that’s a lot of time that we spent thinking about alcohol, drinking alcohol, and getting over alcohol, so you’re going to have a lot of time on your hands. So you’ve got to make plans now. And if you can say, “Oh I don’t have any money to travel.” Okay, but you’ve got the time to take a Tuesday night and plan a fantasy trip. Anybody can do that, and that takes up the entire evening of no drinking. You’ve got your lovely cup of tea, or your non-alcoholic beer, and you plan a trip in your mind. You envision this. You go online. You pick the hotels and everything. It’s fun. Trust me, it releases endorphins. Get to know your local parks and museums. Volunteer at your local food bank. Do something by giving back to others. It makes you feel better about your own self. Makes you feel like a really good human being, and we need that when we’re in recovery because we already feel badly enough about everything we’ve done when we were drinking to excess.

So, there’s so many things you can do to add to this journey, and I don’t want people to give up when they think that naltrexone is not working for them, that’s a very real fear, but you really have to say to yourself, “have I done everything I can to help the tablet along?” You have to be really honest with yourself, and that’s when you can reach out to a professional and say, you know this is what I’ve been doing, do you think that I could make any more changes to help the tablet along, or am I just not a responder? And at that point, that’s a very legitimate, you know, it’s very legitimate thing to do is to reach out to somebody and ask them what they feel, to get outside perspective on your journey, and if they say, you know, now you could tweak it a little bit, then start doing some of these things, and you know, it really is remarkable to me that people just expect the pill to do absolutely everything. And by the way, I’m not judging you, because that’s exactly what I thought. I mean I didn’t know anything about mindfulness or drink logs or any of that jazz. I just took the pill and waited an hour, and that was a huge accomplishment I thought. And it was. It helped a lot, but it wasn’t the end-all be-all, and had I had more preparation and added more things into my life, I would have had a smoother road to recovery. So I want you to do more not less. That’s what I tell people. Do more not less. Sign up for classes. You know, start taking an interest in hot yoga. I don’t care. Do something, not just you know, seeing the same friends you drink with, making the same plans that you did in your drinking life. You gotta change things up. A lot of people get dogs or cats during this time. That’s another thing you know, okay, you could foster an animal. That’s probably better than adopting one, because you don’t know when COVID is over if you’re gonna have the time to care for it, but yeah, anything. Just mix it up.

Jenny: So, to end this segment, just real quick, just summarize –  when is it too early to wonder if TSM isn’t working for you?

Claudia: I think it’s way too early in months one, two, three, four, five, six, I mean, because we don’t know, half a year in, we don’t even know if you’re making a dent in in your habits or anything. But also if you’ve noticed these small changes like I was focused on the pizza not the beer, or I left a half a glass of wine on the table and walked away, I’d never do that. Or, I went to a restaurant and forgot to order a second glass of wine. I mean, we don’t know if you, did you recognize those? That’s a change. That’s TSM working right there. Any change in your behavior that’s positive might mean that the pill is working, so let’s give it a really fair shot. So I would say anything under a half a year, you know, reevaluate at that point, and make some changes, but most people really give it a solid year before they absolutely think about giving up. They don’t even give up at that point. They start thinking about giving up, because think about it, it took you 20, 30 years to learn this, some people only 10 years, but most people took a long time to learn this behavior, and it’s going to take a little bit of time to rewire your brain and unlearn the behavior.

Jenny: All right. I’m going to go ahead and put out our little transition screen real quick, and then we’ll move to a real quick Q&A because Claudia is going to have to leave us very soon.

Claudia: Yes, I do. Sorry. It’s been a busy day.