Frequently Asked Questions

Beginning any treatment requires that you have full understanding of the risks, benefits, and costs.  Below are common questions, but you may have specific ones that aren’t answered.  Please fill out the form below, send it to me, and I will get back to you.

General Questions.

What is the goal of TSM? How is success measured?

The goal of treatment of AUD, no matter the treatment, is resolution of AUD symptoms.  Ultimate success is complete cessation of alcohol use, without the “white-knuckle” feeling.  

Success is measured from lowering, and ultimately eleminating the factors which define your AUD.  

Many people can, and do, return to use of alcohol in normal patterns, but it should be noted that this is not a primary goal.  The goal is removal of problematic alcohol use patterns.

Are there reasons why a person could not do TSM?

Naltrexone should not be used in anyone who is physically dependent on opiate medication, or who needs to take opiates frequently for pain management.  Also people who have serious liver or kidney disease should not use naltrexone.  TSM should also not be used for anybody who is pregnant, or trying to become pregnant.

What are the side effects of TSM treatment

Any medication has side effects.  Naltrexone can cause nausea, dizziness, insomnia, constipation, loss of appetite, nervousness or anxiety.  These side effects are generally well tolerated, and disappear with time.  Many people have no side effects at all.  We will start the medication in a way to minimize the side effects.

Naltrexone has also been shown to be helpful in some cases of pain that has been diagnosed as fibromyalgia, autoimmune diseases, and is approved to support weight management.  You may find these added benefits with use as well.

How long will I have to do TSM?

Your brain has discovered that alcohol opens a lock in your brain.  TSM makes the lock difficult to open.  Your brain then forgets about the lock, but the lock will always be there.  This means that you will always (with or without any treatment) have that lock in your brain.  There are two ways to never have to deal with this lock again.  One is to never, ever have another drink (which is a hard thing to do).  The other is to take naltrexone 1 hour prior to having a drink, every time you drink.

Naltrexone blocks pain medication, what if I need it?

Naltrexone does prevent pain medication from working, and in fact reverse its effects if you are taking the two at the same time.  For 6-8 hours after you take naltrexone, opiates would be less effective than if you did not take naltrexone.  For most people, opiate use is very rarely needed.  If pain medication was needed there are options that could be needed until the naltrexone wears off.  If you needed to have a surgery or treatment..such as having dental work…and suspected that you would need some pain medication, you would not drink anything (and therfore not use any naltrexone) for a day before and after medication use.

Will TSM change how I respond to alcohol?

Naltrexone does not change the effects of alcohol on your body.  All of the same limitations  and imparements that you have when you are intoxicated are still present.

Many times people will develop increased sensitivity to alcohol, not due to naltrexone but due to drinking less often or fewer drinks.  For this reason you should not expect to have the same tolerance for alcohol than you did before treatment.  This is actually a good thing and signals that the treatment is being effective.

How long do I need to be seeing you as a provider

TSM is a medical treatment.  It requires oversight, prescription medication, monitoring and support.  As long as you are recieving active treatment, we will have a provider/patient relationship.  We will need to talk in person or via telemedicine at least monthly, and blood work will need to be reviewed every 6-12 months.  If you have completely quit using any alcohol (and have not needed natrexone) for 6 months you will have the option of successful cessation of service.  You may also decide that TSM is not working for you, or you don’t like the outcome and stop service at any time.  If you later decide that you would like to retry TSM, you are always welcome as long as there is an opening in the program.

What does treatment cost?

I have kept treatment costs low to make the service available to as many people as possible.  I have experienced people who have had to cash-out retirement, take time off of work, mortgage thier house or borrow from their child’s school fund to seek treatment.  One of the sad parts about treatment for substance abuse is that the treatment, which often is a failure, can cause massive financial stressors.  Ironically these stressors are often a trigger for relapse.

The in-office initial evaluation and program introduction takes about 1 hour and costs $250.  $100 of this is paid prior to the visit and scheduling.

This includes:

  • Review of your lab work
  • Review of your medication
  • Review of the Prescription Drug Monitoring Program (PDMP) Database
  • Answering questions about TSM, the medication, how to use it.
  • Writing the prescription to begin naltrexone

After this visit we will arrange a telemedicine contact for approximately 2 weeks to evaluate the success of the initial treatment period.  There is no charge for this visit.

Monthly visits will be made either in-office or via telemedicine.  This visit is up to 30 minutes and costs $100

This includes

  • Addressing any questions about treatment
  • Evaluation of drinking log and treatment efficacy
  • Discussing any changes in overall health
  • Review of PDMP database

Other costs include the cost of blood work which is needed to screen for liver and kidney function, and the cost of medication.  These should be covered by insurance.  If the medication is not covered, or you do not wish to have it billed to insurance, I will connect you with a service which will allow you to purchase the medication for $.90 to $1.50 per dose (dependent upon your pharmacy).

I will also provide you with a keychain pill holder so that you always have doses of naltrexone with you.

All visits are paid for prior to the visit.  You will be invoiced via email and can pay via credit/debit card.

What does treatment cost?

I have kept treatment costs low to make the service available to as many people as possible.  I have experienced people who have had to cash-out retirement, take time off of work, mortgage thier house or borrow from their child’s school fund to seek treatment.  One of the sad parts about treatment for substance abuse is that the treatment, which often is a failure, can cause massive financial stressors.  Ironically these stressors are often a trigger for relapse.

The in-office initial evaluation and program introduction takes about 1 hour and costs $250.

This includes:

  • Physical examination
  • Review of your lab work
  • Review of your medication
  • Review of the Prescription Drug Monitoring Program (PDMP) Database
  • Answering questions about TSM, the medication, how to use it.
  • Writing the prescription to begin naltrexone

After this visit we will arrange a telemedicine contact for approximately 2 weeks to evaluate the success of the initial treatment period.  There is no charge for this visit.

Monthly visits will be made either in-office or via telemedicine.  This visit is up to 30 minutes and costs $100

This includes

  • Addressing any questions about treatment
  • Evaluation of drinking log and treatment efficacy
  • Discussing any changes in overall health
  • Review of PDMP database

Other costs include the cost of blood work which is needed to screen for liver and kidney function, and the cost of medication.  These should be covered by insurance.  If the medication is not covered, or you do not wish to have it billed to insurance, I will connect you with a service which will allow you to purchase the medication for $.90 to $1.50 per dose (dependent upon your pharmacy).

I will also provide you with a keychain pill holder so that you always have doses of naltrexone with you.

All visits are paid for prior to the visit.  You will be invoiced via email and can pay via credit/debit card.  

Do you bill insurance?

There are two reasons why I do not bill insurance.

The first is that any substance abuse treatment is a matter between the patient, family/loved ones, provider and anyone else the patient chooses to involve.  Billing insurance involves entering into the record labels that will always follow you, long past the point at which AUD has been successfully resolved.

The second is that I very much want the service to be private, simple and cost-effective.  The costs associated with billing insurance easily adds up to 50% to the costs of providing services, and these costs get passed along to the patient.

Does my family need to be involved in treatment?

This is absolutely up to you, but it is highly recommended.  Successful treatment may need to include all of those who have been with you in your struggle with AUD.  They will likely have questions, and may be scared that you are being assigned to use naltrexone with alcohol to get better.  If they have seen your drinking take you down a dark road, this will be very scary for them.  Also, this treatment should be absolutely out in the open.  Hiding, shame, lying and guilt are some of the earmarks of the addict, and we are leaving that behind.

Do I have to live close to Salem to receive TSM treatment

I am licensed to be able to provide TSM treatment anywhere in Oregon.  The initial appointment will need to be in person.  Follow up appointments can be via telemedicine (video conference,  Skype, Facetime).  I will need to see you every six months in person for physical evaluation.

About Functional Wellness Salem

I established Functional Wellness Salem in Spring, 2018, with the idea that treatment of any medical problem should be respectful, professional, peaceful and most of all give patients the right and responsibility for thier own treatment and outcomes.

In my 23 years of practice I have seen friends and patients go through treatment that was not always effective, and in some cases embedded in them an idea that they were permanently broken and had little choice or power in the outcome.

This program is developing, and is based in Western medicine, with tremendous respect for Eastern philosophies and absolute belief that health can only be optimal through attention to all parts of ourselves, including brain, body and spirit.

Have a Different Question?

Email anytime

Or call — (503) 991-8549

Innovation in the treatment of Alcohol Use Disorder

(503) 991-8549

rmeyers@functionwellsalem.com

1130 Liberty St SE, Salem OR 97302