TSM non compliance

Posted , 6 users are following.

Hi all, my husband has been on Naltrexone for 8 months. He has been non compliant at least two times that i am aware but am fairly confident there have been more. His drink of choice is vodka straight from the bottle. I have seen much improvement when he is compliant and have encouraged him to mix his drinks or drink beer, both of which he does but ultimately goes back to the bottle. He also still hides his bottles, which to me seems to be a habit that would be helpful to try to break.

My question is -- will TSM continue to be effective if he stops/starts taking the pill as he has been doing?

TSM has been the most successful treatment for his AUD that we have experienced so I am confident in the science and hopeful that it will continue to work for him.

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9 Replies

  • Posted

    Hi Noodles,

    The science of this treatment tells us that an occasional accident in forgetting to the pill will only cause a small setback, and when someone realises they have not taken the pill (they usually know they haven't because of the rush they feel from that first drink) if they stop drinking immediately, take the pill and wait the hour, and then resume drinking, it won't cause too much of an issue long-term.

    However, when someone intentionally doesn't take the pill, it will sadly set them back quite a lot. Due to what is called up-regulation, the brain produces more receptors in the brain to try and overcome the blockage from the previous naltrexone. This isn't a problem if someone remains compliant but if someone then drinks without the pill, there is more receptors in the brain and so the 'rush' of the alcohol is felt more accutely. It's like hitting a snake on a snakes and ladders board - the only way is down.

    If this happens regularly, it can actually make cravings and drinking worse and that is why compliance is so important with this treatment. Based on what you write here, I would imagine that your instinct is correct and there will not only be more non-compliance than what you know of, but also the numbers of times of non-compliance is probably in danger of increasing.

    Is your husband working with a TSM-friendly doctor or support worker in order to help him overcome the hurdle?

    If not, do you think he would be willing to communicate with me? As a counsellor who understands TSM and has been through it myself, there is probably much in me that he can identify with.

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    • Posted

      Thank you, Joanna. My husband has been working with a doctor who is supportive of TSM but not educated on it. I will let him know that he can contact you regarding support and/or questions he may have. I myself have read as much as I can find but not having AUD and being a S.O. seems to put me at a disadvantage to having discussions about it.

      Thanks again for your support and quick response.

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    • Posted

      Hi as someone taking Nal only for a short while I have found that it works very well, astonishing well BUT I was non compliant and binged that night like before. Since then not nearly as well. I'm only talking a week though and honestly I'm no expert. I liken it to quitting smoking. I think you have to really commit to it as in you either take it for the rest of your life (if drinking). Or use it to stop completely. I'm sure (and I hope) a couple of non compliances won't matter long term but I don't think it's one where you could regularly pick and choose on a regular basis. Good luck to you both

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  • Posted

    Hey noodles75. How is your husband doing? Hopefully he is being more compliant now. I have been taking Naltrexone for over a year now and I have had my up's and down's and I've been non complaint before but it does work and it will get better if he follows it. Keep your hope up and keep making sure he takes his medication.

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    • Posted

      HI all, my husband has just disclosed that he has been non compliant several times so he can relax. This makes me believe that he isn't committed to TSM and shouldn't continue on it as it can be more detrimental than helpful if he isn't following the protocol. Can anyone speak to this?

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    • Posted

      I'm sorry to hear this Noodles, but sadly, in all my experience, this is what I was suspecting. I've taken so many people through this now that I can spot many of the signs of difficultly earlier than most.

      The fact that he has finally been honest with you about his compliance should be applauded. But yes, regular non-compliance renders TSM ineffective in the long term and can actually cause him increased cravings and therefore increased alcohol consumption.

      There isn't a single recovery treatment out there that doesn't require 100% commitment. If he isn't committed to this particular one, then he should be looking for one that suits him better.

      If he insists on staying with TSM, then he needs to look towards learning new behaviours that can help him 'relax' without going non-compliant on TSM. The term relax is not quite right - he is not looking to relax so much as to lose himself and get out of his brain for a little while. The reasons why he is wanting to do this really ought to be explored. For example, if it is a work issue, then it can be tackled by discussing his workload with his employer, or finding a strategy that helps him prioritise more. If it is a personal issue, then working with a counsellor can help him explore what the issue is and how to resolve it.

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    • Posted

      I'm always willing to chat with him if it might help.

      At least, it's possibly worth a suggestion anyway. You could suggest that we just have a chat over the phone because you know that I have helped a lot of people with TSM. No commitment or anything - just a chat with someone who has done TSM herself might give him a new resolve as far as compliance goes.

      x

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