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

If this happens regularly, it can actually make cravings and drinking worse and that is why compliance is so important with this treatment. It's like hitting a snake on a snakes and ladders board - the only way is down. 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. 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. However, when someone intentionally doesn't take the pill, it will sadly set them back quite a lot. 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.

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