What happens if you miss a dose of naltrexone?

It happens to most people at some point. You go out, have a few drinks, and only afterwards remember you did not take the tablet. Or you took it twenty minutes before drinking, not the full hour. Or you forgot for a whole evening. What does that actually do?

Drinking without naltrexone on board lets that session reinforce the old reward, alcohol gives endorphins, which give dopamine, which strengthens the drink-equals-pleasure link. It is the opposite of extinction, a reinforcement rather than an unlearning.

But one missed session does not undo your progress. The brain's learning is gradual, and one reinforcement in the middle of dozens of extinction sessions slows things a little, it does not reset you. The pattern matters far more than any single occasion.

If you take it only twenty or thirty minutes before drinking instead of the full hour, it is not yet at peak, so you get some reward-blocking but not the full effect. Just get the timing right next time. Do not double up on tablets to compensate; it does not help and may add side effects.

If you remember while you are still drinking, take a tablet, and the rest of the session is at least partly blocked. If you only realise hours later or the next morning, do nothing; the tablet only works taken before drinking. Then make your next planned drink the one to get right.

This is the one that matters. The single biggest predictor of success is taking the tablet reliably, an hour before every drink. Miss it often, say more than one time in five, and the fade slows or may not really happen.

If you are struggling with it:

• Set a phone alarm an hour before your usual drinking time

• Keep packs in two places, one at home, one in your bag

• Pair the tablet with something you already do, after work, when you sit down for the evening

• Tell your partner or housemate and ask them to nudge you

• Talk to us; there are specific tricks that help the habit stick

Plan ahead. Going away for two weeks? Take enough tablets and keep them in your hand luggage. A wedding where you will be drinking? Set an alarm an hour before the reception. Most people build their own systems within a few weeks. And if you do miss some across a holiday, it is not a disaster, take one before your next planned drink when you are back, and carry on. We can help you reset the plan if you need.

The online assessment is quick. A doctor reviews it and, if naltrexone is right for you, prescribes it, dispensed and delivered to your door.

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