TSM dosing after extinction

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 the topic of TSM dosing after extinction.

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. Please consult your medical provider before taking any prescription medication or changing doses. Naltrexone is labeled for daily use and TSM providers prescribe it at 50 mg 1-2 hours prior to the first alcoholic drink of the day. Claudia’s personal and professional experience does not contradict either of these prescribing options.


Jenny: Okay. Question number eight. After extinction, when I’m only drinking a few times a year, can I use a lower dose if I’m having side effects?

Claudia: So that’s a really good question, and I’ve run into this a lot lately with people who are drinking very, very seldomly. So, I find that the safest way to do this, if you have the ability to plan – so let’s say you know you’re going to a wedding on such and such date and you really want to enjoy some toasts and drinks. I think the safest way is to titrate up before the event. That seems to have been the overwhelming response to people who have done it this way. So they will take a half a tablet, on let’s say Wednesday, have tablet Thursday, have tablet Friday maybe, or maybe just two times so that they can take the full 50 mg on the day that they drink. That said, there are a lot of people who have found that they’ve drunk maybe once or twice a year and 25 mg helped them get through that event. I’m not a doctor. I do know from Drs Eskapa and Sinclair, that 25 mg does not block alcohol, but there’s a placebo effect in the beginning when people start taking it, and they think it’s blocking it, and they actually drink less. So that’s a really complex and very good question. I always say safety first, and that would mean taking 50 mg. So I kind of like the way people plan for that event, and they titrate up to it, and by the way this is without drinking. So they would take 25 mg with no alcohol, but I mean that’s a kind of controversial thing. According to your face you’re thinking I’m saying something wrong.

Jenny: No, not at all. No, I’m spinning questions.

Claudia: Oh okay. I have found with individuals that this really works. They titrate up to so that they don’t ruin their evening out or their trip to Mexico, by having side effects. So they just plan a couple days before they take a half a milligram, a half a tablet for a couple days. That seems to work really well for them, and they do not drink with that half tablet, so understand, 25 mg with abstinence, 25 mg with abstinence, and then Friday night you go out and you have your 50 milligram pill and you drink, and hopefully you’re used to the side effects by then.

“I cannot safely or comfortably recommend that anybody tries a lower dose, and then drinks alcohol, regardless of whether it’s one drink or a half a drink. I just I can’t.”

Jenny: Well, one of one of the things I was thinking about while you were talking about that was going back to our very first question. Look you now have a very legitimate reason that you just said, that explains taking naltrexone without following by drinking. And so, you know, this is something that that you’ve mentioned before, and do I recall right, before you stopped drinking entirely, when you were only drinking really sporadically, didn’t you mention that you would occasionally have some side effects from the medication because of not using it so often, so you’re speaking from experience.

Claudia: Oh yeah, no it was like starting over, and I stupidly didn’t know about, well I did not know about this titrating up idea because I didn’t think about it. So I would just pop 50 mg and hope for the best, and every single time I felt woozy and out of it, and it affected my night out, because my night out was going to be that one time I was drinking. 25 mg which I tried absolutely was a lot easier, but you know, is it necessarily safe? Could it lead to me wanting to drink the next night? You know I don’t have to worry about that anymore because I’m currently not drinking, but nor have any plans to right now. But if I was going to drink, let’s say I was going to go to Italy in December for Christmas, and I thought you know what, I know it’s been three years of no drinking, but I kind of feel like I want to, I would definitely do the titrating up. I would probably start four or five days before the trip and get used to the medication, absolutely.

Jenny: And I see a comment in, you know, in the stream here, for those not familiar with the word titrate. Titrate is, I learned it in chemistry in college. Basically it’s taking very small steps to get to the desired amount. So what Claudia is talking about is taking lower doses and moving up slowly to the full dose, is the simplest explanation of that.

Claudia: If you’re hyper sensitive to naltrexone, and you haven’t had a drink, let’s say it was really tough for you to get used to it the first time around, one or two weeks of side effects, then you can start with a quarter of a tablet before your trip, and just you know, increase it as you get more comfortable, and by the time you go on your trip, you’re ready to take the full 50 mg, and it won’t adversely affect your good time. So you know, that I think, is a very reasonable safe option for people to get back used to it, and once again, you know, if you only drink a couple times a year, that’s a very real possibility. I mean there are some lucky people out there that pop a pill and it just sits in the back of their brain regardless of whether it’s six months or 12 months or 18 months after the last one.

Jenny: Well and, so here’s a different scenario. So, I’d love to hear what your thought is on this one. Say I’m on The Sinclair Method. I haven’t, I’m literally drinking once a year. It is on

New Year’s Eve, and I know without a doubt, that I am only having one glass of champagne and quitting. Does it make a difference now? Should it still be a titrate up? or do you think that’s lower dose, because I’m not drinking that much, and I know I’m not drinking that much, because this is also one of those questions we hear. Does your answer stay the same?

Claudia: I cannot in good measure, even though I’ve seen 25 mg work for some individuals, I cannot safely or comfortably recommend that anybody tries a lower dose, and then drinks alcohol, regardless of whether it’s one drink or a half a drink. I just I can’t. I can’t. I don’t feel comfortable saying that. I mean I was told by the masters you know, that 50 mg blocks alcohol, 25 mg does not block alcohol, that is what I’ve been told. You know we talked earlier. You clarified in a really great way you know, how the body can absorb and help different bodies absorb different amounts of medication, and on a biological level, but we don’t know, I can’t tell you that you’re not gonna relapse. I can’t tell you that you take 25 mg and wait an hour and have a glass of champagne.  You’re not, your brain, your lizard, that’s been asleep for a year might just wake up and go, oh wait a minute now, let’s get another drink and you know, I don’t know, so I’d rather be safe than sorry. I have relapsed myself on TSM. I’m never going to suggest anything that would put you at risk, so I say titrate up, be safe, take the 50 mg, have your glass of champagne. That’s what I say. Sorry.

“The red flag is there, because I’ve been there, I’ve seen that movie, and I’ve worn that t-shirt, is that the lizard is trying to get you to take a half a tablet, knowing that this will be his opening to wake up, and become the dragon again.”

Jenny: I think that, well I think that needed to be said, because the common comeback on the well okay, well a wedding you know, I’m expecting that it’s a celebration. I’m not gonna be thinking about it. Yeah I’m going to have a lot, but so, it’s common for someone to say well what if I’m only having one.

Claudia: No. Taking one more time out and then we can move on. But to me, you know where the red flag is right there. The red flag is there, because I’ve been there, I’ve seen that movie, and I’ve worn that t-shirt, is that the lizard is trying to get you to take a half a tablet, knowing that this will be his opening to wake up, and become the dragon again. The kraken is ready to wake up, because it’s sick of being sober for the past year.  So I don’t know. Your lizard could be just saying a wedding? Things are sparking, endorphins are sparking already. Alcohol? Ah. You could even be sparking endorphins just thinking about that one glass of champagne. You could be preparing yourself and waking up that lizard by thinking about the glass of champagne, the cork, the thing, the excitement, I get to drink. Maybe he’s already awake. Now he’s telling you, that insidious little bastard, is saying to you, just take a half a tablet, you’ll be fine. It’s the same lizard that told you years ago, when you were six months sober, just have one glass. You’re not an alcoholic. You were just six months sober. I don’t trust him. I don’t trust the lizard. So I’m going to say a big no to your 25 mg and one glass of champagne.

“You are in remission as long as you stay compliant and vigilant. You’re not cured. You cannot go drink without naltrexone, period.”

Jenny: Excellent. I love it, and I think, and I love the way you have very passionately, and yet very clearly put that, and why, because it’s so important. It’s so important, it’s so important that you stop and realize that again, you’ve made a commitment to yourself that you’re going to beat this thing and keep it beat. Why on earth would you want to take any chance to allow it to come back?

Claudia: Let’s just reiterate this. You are not cured. You are in remission. You are in remission as long as you stay compliant and vigilant. You’re not cured. You cannot go drink without naltrexone, period.

Jenny: And I think starting with oh I’m just gonna do the half is opening the door to the oh well, if half then then maybe I don’t need it at all, and that’s a scary, scary escalation to put yourself through.

Claudia: I lost 20 pounds, but I’m just gonna pick up a gallon of ice cream. I won’t eat much of it. You know okay, if you have that much willpower to have one spoonful but you got a gallon there, and you’re gonna have a spoonful every night, spoonful the next day. We know ourselves folks. Be vigilant.

Jenny: All right, I don’t see any questions, so we are going to go ahead and transition to our final question, and this is one that a lot of people ask as well. So we’ll go ahead and pause for a moment.