Coming here not out of desperation, but because I've run 2 psychs (while residing outside of the US) and my GP out of ideas. My US psych has known me the longest, and he's certainly tried to come up with any ideas to help me.

Basically, I am not supposed to drink anymore due to prostate issues. Not to mention, my body is certainly predisposed to AUD. I have tried multiple treatments for the latter (including TSM and naltrexone) with minimal success. Being sober and having a few sober friends has helped me the most.

BUT that doesn't solve the absolute downright worst situation where I struggle to not drink: flying. It's not an anxiety thing. My therapist and US psych agree that flying (and access to airport lounges) give me some sense of total escape from my life. It's F-U-N for me. I think it also stems from being completely unable to sleep on flights unless I book business class with a lie flat seat - alcohol would knock me out, but then the free drinks in business class and the fun in the air components mixed and made a bigger problem.

That's probably why none of the options we've tried have worked. Naltrexone does little to curb short term travel drinking, disulfiram we agreed is risky in case food/drink ends up with alcohol in it. He's been on board trying harm-reducing "alternatives" that might give some form of safer buzz like benzos, which just sedate me without a buzz. Obviously barbiturates are off the table, especially given the risk of an OD in the air. Pregabalin is the closest we have found by fair. I've discovered kratom does really well too, but I can't get it everywhere, and my brain does start to crave it so I try to stay away from it.

It's at the point my psych looked into any way he could prescribe my Xyrem/Xywav. He wasn't totally familiar with how controlled that is until he looked. BUT I have been prescribed it in the past due to an arguably false narcolepsy diagnosis. I certainly fit into idiopathic hypersomnia much better. I'd have to find another sleep doctor to discuss that, but my psych has agreed it would deter me from drinking, has not been a problem substance when I was prescribed, would give me a bit of a buzz then help me sleep through the flight. Again I know this is unorthodox, but it's at the point of risking a serious problem due to drinking while traveling, and nothing has worked to resolve it. I've even bought shirts that say "SOBER" to wear on the plane in hopes that would help!

Willpower works well on the ground for me, but in the air/airport, I can't even seem to be able to get food or get through a 2 hour flight without caving.

I know long term this is best resolved through therapy, but trying to help my psych out with any other ideas that would fit into "harm reduction" and help me here. TSM is now off the table given the prostate thing; I can't commit to 6-12 months of drinking w/ naltrexone instead of successfully being sober while not traveling.

Thanks for reading, and thanks for any advice.