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Comment by taw2212121 | Hacker News Reader

He has my empathy. Never had a problem for most of my life, then got sick in a way that I was given hydrocodone for 8 months. I took more than the label said, a lot more, and at some point a switch clicked over in my head. After the hydrocodone was gone, I switched to alcohol only because it was easy to get. I've been sober a while now, but stopping the drinking was MUCH harder than stopping the hydrocodone. Alcohol is a beast once that circuit breaker trips in your head and you start drinking large quantities daily.

It's very hard to explain to someone that hasn't gone through it. Suffice it to say that quitting isn't really about willpower.

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Kudos on the quit. After my child passed away, i went through a similar spiral. It took my spouse, our community, and a new life to save me. I'm not great, but doing better

thank you for sharing, and also kudos to you.

I similarly needed others, nothing I did alone, or any level of negative consequences (some big ones) made a difference.

> Suffice it to say that quitting isn't really about willpower.

I found this to be my experience as well, which is why I was so interested when I heard about naltrexone therapy. More specifically, a course known as The Sinclair Method. [1]

The idea is to use the drug an hour prior to drinking (and only then, so if you abstained from drinking that day, you would abstain from naltrexone -- this is where it differs from standard naltrexone therapy that would have you take it every morning regardless of your plans to drink). Naltrexone blocks endorphins associated with drinking and helps to reprogram your brain to no longer seek that neurochemical response.

I found it to be highly successful the first week -- I didn't even want to finish 2 drinks. After the first week, it still worked but not as well. And I also realized that the anticipation of drinking was almost as powerful as drinking itself, in that I would feel a "rush" even on my way to buy alcohol.

It took about 6 months of naltrexone therapy to finally quit. The funny part is, during that time and when under emotional distress, sometimes I would drink without the medication but it still seemed effective in that I never quite got the pleasure I used to have.

I'm coming up on 3 months sober, but unlike past attempts to quit, I have no urge to fight and no desire to drink again (and I am going to keep it that way).

I am not a doctor and this is not medical advice, just my story. The other interesting part to me is how rarely naltrexone is used for problem drinking (vs something like AA, which is faith based in more ways than one), and even more rarely is it deployed the way The Sinclair Method instructs (deliberately, right before drinking).

> Over time, your brain learns not to associate alcohol with pleasure, resulting in reduced cravings and improved control over alcohol use.

[1] https://www.sinclairmethod.org/what-is-the-sinclair-method-2...

Perhaps the effect of the drug might have carried over to the next day - I’m sure this could be verified, but it’s something I’ve experienced with other drugs. You skip a day, intentionally or accidentally, but your system hasn’t flushed everything out so the drug is still taking some effect.

It was actually over a longer period than a day. I would like to think that some part of my brain is no longer associating alcohol with the buzz I used to get. It seems far fetched, but plausible? The other side of it is I definitely would feel the "buzz" of alcohol before I actually drank it, such as when I was walking home from the store carrying booze -- I would feel elated.

To be clear, the "buzz" I refer to is straight up pleasure, not intoxication. On naltrexone I felt the intoxication without the pleasure. It made me think, is this what it's like to drink alcohol when you are not an alcoholic?

Very easy to moderate in that circumstance.

It's interesting that (I believe),

- bupropion is an antidepressant and an antismoking drug.

- naltrexone is an anti-opiate and anti-alcohol drug.

- bupropion/naltrexone together is a weight loss drug.

After trying bupropion as an antidepressant, I would really like to try adding naltrexone, but my prescriber didn't take me seriously, as I have neither an alcohol nor opiate nor weight problem.

I'm fascinated with the idea that when you try to increase a substance in your brain, it "fights back", you get tolerance, the receptors get dulled, and so on, but if you suppress a receptor, then more is produced, which works better in the long run.

> I'm fascinated with the idea that when you try to increase a substance in your brain, it "fights back",

Well, it's a truism that mostly-stable systems have at least locally corrective responses to perturbations. Back in High School, I was a bit mystified as to why Le Chatelier's principle should be so nearly universally applicable, until I realized that the sample set is extremely biased... if a chemical system isn't even metastable, it doesn't get much broad attention. Stable or metastable chemical systems must have locally stabilizing responses to change. Even for things like combustion reactions, we mostly study stable flames, except for niche studies.

I realized there's a generalization of Le Chatelier's principle that's almost a truism for any system that exhibits something approaching short-term stability or short-term bounded oscillation.

If some brain state weren't locally corrective, then it would be a transient brain state, and excluded from the most intuitive notion of normal brain behavior. So, we'd expect that for normal brain behaviors, we'd see corrective responses to change.

I’ve been losing weight on the SNL diet (about 50kg, so far) — eat less/move more. Kicking the “sugar” habit is the hardest thing I’ve ever done. A few months back (just before the holidays: Thanksgiving, Christmas, all of the birthdays in my family), I got appendicitis. During recovery I was encouraged to eat & couldn’t exercise. I put on 7-8kg in a few weeks. Getting back off sugar onto a healthy diet has been awful. If that drug combo actually works ... I dunno; I’d pay a lot.

I have found the only way I can consistently lose weight is with keto. Otherwise, even when I thought I was restricting, I would end up binging at night on high calorie foods like nuts or cheese, sometimes even in my sleep!

Vyvanse also helped suppress my appetite but I lost about 10kg just on keto over a 2 month period.

Since you mentioned sugar, I had to mention keto. I do believe refined sugar is quite bad for the human body.

re: weight loss drugs, Vyvanse destroyed my appetite (among other side effects like severe sweating, easily winded, crashing on the come down), but that should be unsurprising since it is basically a proprietary (slow release) blend of amphetamine.

Hey, sorry for getting back to you late.

I have recently been put on bupropion for depression and potentially ADHD. I have never used medication before (started 6 weeks ago), originally was put on Vyvanse (at the suggestion of another HNer ! haha) but I found the stimulant aspect too strong. In a way, the bupropion feels too weak but I am giving it time (supposedly they effect the same neurotransmitters except Vyvanse is a direct stimulant/acts of synthetic dopamine and buproprion merely inhibits the natural process that removes these).

What do you think naltrexone would do to help? I'm not sure I am following your reasoning. I actually do have some leftover naltrexone, never thought about combining it.

So naltrexone + buproprion = more naturally occuring dopamine/norepinephrine?

My concern with bupropion is that it stops the process of removing dopamine from the brain, but what if I am not producing enough to begin with?

Here are two links I found helpful:

https://www.goodtherapy.org/drugs/antidepressants.html -explains the mechanism of action for lots of antidepressants including bupropion. I believe the different uses for the drug basically comes down to dosage + marketing.

https://www.leonardsax.com/stimulants.htm - a psychologist is against the use of stimulants in kids due to potential for long term damage.

Side note, just by presenting myself well and speaking clearly (and looking like a professional), I felt my psychologist was willing to let me try most things. I was very much in the driver's seat as far as what drug to take and at what dose. Next time we meet I may see if they are open to prescribing modafinil, which I have used in the past and thought it worked great (as a stimulant, even complimentary to caffeine) with no side effects.

For a time I took both Vyvanse and Buproprion. I was able to study for 10 hours a day and passed a professional certification that week.

I have heavy boozers on both sides of my bloodline, never expected it would hit me because I was so aware of it, but at some point in my early 30s I realized I was always the one dragging friends to bars, and of course despite a self-imposed rule of no hard booze at home, that only justified continuous drinking of wine and beer.

I definitely wouldn't have considered myself an alcoholic, but it had become a significant enough part of my routine that I had increasing difficulty being honest to others about when/how often I'd been drinking.

The thing that ultimately snapped me out of it was learning of the association with cancer. I'd still love a drink, much like I'd absolutely murder a cigarette, but in both cases, neither could approach my lips without the word "CANCER" being explicit in mind. Not sure how that happened. Luck? Definitely not complaining, in any case it works.

I completely agree with your assessment. Alcohol is sneaky and before you know it, an alcohol habit that starts out as a "occasional drink to unwind" after a long, stressful day of work becomes a daily routine or focus of your existence.

I never fell into the spiral of alcoholism, but there was a point after college where I realized that I was drinking more than I wanted to for my own personal standards. And I found it was surprisingly more difficult than I initially anticipated to "moderate" the habit. Moderation didn't work for me. I had to make the conscious decision to forcefully flip the switch back off and I made a commitment to never play with that fire again.

I found that alcohol thins out blood, and that's generally a good thing (unless you're bleeding). So along with quitting alcohol you need to quit the good effects of it as well.

It's hard to manage your blood thickness when you're in over your head, but not managing it leaves you confused as brain circulation is slightly impaired

Generally unless your at risk of either bleeding or thrombosis/embolism then don’t worry too much about your blood thickness (correct word is coagulability rather than viscosity). It tends to balance and stay In a narrow range in fit and well individuals. I’ve never heard of it impacting on cognition.

This is actually a thing for some people, and if that's you, then you absolutely need to see a doctor and describe what's happening. It may be that you over-absorb iron. Someone close to me had this condition and described it as "thick blood". Undiagnosed hemochromatosis

He regularly gave blood, which helped shed the iron from his body, but at some point he stopped, and it contributed to a severe cognitive decline. He drank too much, too, which didn't help.

If you or someone you know has "thick blood", go to a doctor. Suggest they check for hemochromatosis

THIS. Hemochromatosis is rare but imminently treatable. And among the few, if not the only disease for which the oldest treatment (bloodletting) remains among the most viable treatments today.

Wouldn't children's dosage of aspirin be more manageable? IIRC some older people are recommended to eat that daily (something like 1/4 adult dosage of aspirine).

Talk to a doctor first. I asked my Pharmacist wife if I should do that (as I don't drink) and she said it's a grey area, talk to the doctor first.

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