I’d like you to welcome back my friend Ken Smith who appeared on the blog talking about mental health issues in his professional capacity Nurse!
Today we are going to discuss a subject that causes even more shame and closet-hiding than mental health problems – alcoholism. People don’t like to admit they have personality disorders for fear of being victimised or stigmatised. The case is even worse for alcoholics. Denial sets in to the point where I have known people admit to being “alcohol dependent” but not alcoholic while consuming more than three 1.5 litre bottles of wine between two in an evening.
Ken, welcome back. You work in an addiction unit don’t you? Can you share some thoughts on what I just said?
Hello Ailsa and thank you for inviting me back to talk about a subject that in the not too distant future will be causing a great strain on our health service.
It is the stigma and negative connotations of being called an alcoholic that I believe is the main reason people go into denial. people have the impression that an alcoholic is someone who lives rough on the streets and pushes his worldly belongings around in an old supermarket trolley. Sadly people like this do exist, the vast majority of people with an alcohol dependency though are your everyday person who many of you pass walking down the street to your local shop. They could be your dentist, doctor, postman, local builder or even your next door neighbour. Being alcohol dependent is the same as being an alcoholic.
That’s correct, Ailsa. The person has to admit they have a problem before anything can be done to help them. Getting to the stage where a cry for help is made can be a long time coming, it can stretch in to years before the person asks for any help. During this time many people lose everything, their job, family, friends, self respect and their dignity. There are companies that have been set up to help get the person to the point where they know they have to have help to stop their excessive drinking. They are called “Interventionists” and they can be contacted by family members to help persuade the person that they need treatment for this illness. This can take weeks, months or even years to come to fruition. The people who carry out the work of intervention are usually recovering alcoholics and they have the ability to speak from personal experience to the person about what the future holds for them.
What is the main treatment?
The main treatment regime is to use medication over seven to ten days to help reduce the effects of physical withdrawal from the cessation of alcohol consumption.
The common drug of choice for this is, Chlordiazepoxide (Librium), in my treatment centre we use a fixed dose regime. This means we give the Librium four times a day, initially in large doses and we can also give extra doses if withdrawal symptoms breakthrough. Over the next seven days the dose reduces in line with the reduction in withdrawal symptoms. We also administer Thiamine (vitamin B1) and vitamin B compound tablets. This helps restore the B vitamins the alcohol destroys and helps to prevent Wernicke Korsakoff Syndrome which is severe neurological damage caused by excessive alcohol consumption. Along with the medication regime we also have counsellors/therapists who concentrate on the psychological aspects of addiction.
Chlordiazepoxide is the drug of choice because it inhabits the GABA receptors in the brain where the alcohol attaches itself. The Chlordiazepoxide fools these receptors in to thinking it is alcohol but because it is not the exact chemical makeup the receptors become excited and this causes the classic withdrawal symptoms of shaking, nausea, sweating and vomiting. The withdrawal symptoms are not as severe as they would be if the person suddenly stopped drinking. The symptoms I have mentioned would be more severe with an added factor of possibly a fatal seizure. So if you are a heavy drinker it is not advisable to suddenly stop especially if the drinking has been over a long period of time.
Do you think it is an inherited illness, conditioning or a mixture of the two? I know that being in a country where having a good time is equated to getting legless doesn’t help.
There are examples of addiction running in families but I am not aware of any research that proves it is an inherited illness. Nobody chooses addiction of any form as a lifestyle choice and whoever comes up with the reason why it happens will become very famous and probably very rich.
I ask because, as everyone will have guessed by now, I have my own demon in this field. Just as I “came out” about being Bipolar to help others deal with it, I’m admitting to having had an alcohol problem most of my life. For us Bippies it is kindly called “self-medication” but having a mother who was a screaming alkie didn’t help.
People say they drink to excess for many reasons the example you give is probably the most common and within that there are many others, people drink to feel normal, to be accepted in to a peer group, to feel confident, to blot out some unpleasant experiences. In the alcoholic the mechanism that tells you that you have had enough is faulty and where so called normal drinkers would stop, the addict carries on drinking. Why that happens is the 64 thousand dollar question
I won’t ask for advice for those who think they have a problem, they are not the ones I worry about. It is for the friends and family who are worried about someone else’s consumption. What can they do, if anything?
There will be many local groups that have been set up in towns and cities to help family and friends deal with the effects of a problem drinker on their lives. The national one for the support of families and friends of problem drinkers is, AL-ANON (al-anonuk.org.uk). For more information on local groups your GP or local hospital will probably have the details you need. For the drinker who feels they need help there is, Alcoholics Anonymous (alcoholics-anonymous.org.uk).
Finally, Ken. Thank you for coming, I really appreciate your help in this and do you have any last encouragement to those of us who are living with the demon or know someone who is? I have been totally dry for six months so I know it’s possible.
For those who are struggling with excessive drinking or the effects of someone who is drinking to excess all I can say is “ it doesn’t have to be like this.” There is plenty of help out there through your GP or local Drug and Alcohol teams. The hardest part to accessing these services is admitting there is a problem. If you don’t want to speak to someone you know about the problem the two organisations I mentioned earlier are a great starting point.
To all those who are enjoying the fruits of sobriety I send my heartfelt congratulations.
Thank you, Ailsa for asking me once again to contribute to your excellent blog. I hope this will be of help to people.
Don’t we all? Bless you, Ken.