SMMGP - Substance Misuse Management Good Practice

Substance Misuse Management Good Practice

Supporting good practice in drug and alcohol treatment

Post-its from Practice:
Alcohol is a family dis-ease (Dec 2010)

Our practice counsellor Mel asked me to see Claudia, a 35 year old patient of hers. She had been referred to Mel because she was struggling with her father's drinking problem which had led her to develop multiple anxiety symptoms. Mel believed that these symptoms were the cause of Claudia's upper abdominal pain but she wanted my opinion to exclude any potential physical problem.

When I saw Claudia, it quickly became apparent that she was producing too much acid because of stress. The physical symptoms were easy to control with medication but the psychological ones less so. I asked how the counselling was going - a simple question - and the floodgates opened.

Claudia told me that her father was an alcoholic and was slowly dying of liver failure. He was a patient of the practice but had refused all help with his alcohol problem, both from us and the hospital. Her father was now 62 two years old. She told me that he had tried countless times and various ways to stop drinking; as an inpatient, as an outpatient and through Alcohol Anonymous. However, in total, he had been abstinent for less than one year in the past forty.

During those forty years, he had married, fathered Claudia and her younger brother and worked until around seven years ago, when he retired due to ill health. Claudia said that this period of counselling was the first opportunity she'd had to discuss her feelings and that she felt guilty about it. Through counselling, she had explored and acknowledged how damaging her father's drinking had been to the family. He had no insight into this because in his eyes, he had always been a provider for them.

Claudia had never had a long-term relationship, still lived at home and had felt powerless to leave. Since starting counselling she had begun to investigate renting her own property and had joined a singles group to widen her circle of friends. She was not self-pitying but did express regret that she hadn't broken away earlier. She recognised that as the oldest child, she somehow felt that she had had to stay to keep the family together.

Claudia had been given details of Al-Anon, which she kept untouched in her bag for weeks, feeling that no-one else could understand her experiences or have had similar feelings. Only one week before I saw her she had found the courage to go and had been bowled over with stories so in tune with her own.

Al-Anon is for anyone affected by another person's drinking, be it a relative, friend or partner, male or female. Al-Anon Family Groups hold regular meetings where members can share their experiences of living with alcoholism. Al-Anon does not offer advice or counselling, but offers a forum for members to give each other understanding, strength and hope.

Claudia had encouraged her mother and brother to access counselling but to no avail. They had both said that they didn't have a problem so didn't need it. They had, however, agreed to join her at the next Al-Anon family group.

After rather more than the allotted ten minute slot Claudia apologised for talking so much and rose to leave simply saying thank-you and adding, "Yes, I now definitely see that Alcohol is a family dis-ease."

- Dr Chris Ford
GP Lonsdale and Clinical Lead for SMMGP

Al-Anon helpline 02074903 0888, and website