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 personal and family affair (May 2012)

When I got up to call in my next patient I found Noel hovering by my door with an enormous box of chocolates and a very large grin on his face, asking if he could have a couple of minutes - I invited him in. He sat down, and with "tears of joy" (his words) he thanked me for supporting him through yet another alcohol detoxification and spoke of now accepting that he had needed something more than just the detox. This was the first time I had seen him without his wife (who came the next day holding an even larger box of chocolates and thanked us for giving her husband and family back to her).

I've known Noel for about 3 years. He is 62 years old, has always worked as a builder, has been married for forty years and has 2 daughters. He had also always had an alcohol problem, but he hadn't viewed it as a problem from his 20's to his 50's, as he had always got to work on time and all his fellow workers drank at the same level. Then problems began to develop. He started to miss odd days off work and his health deteriorated.

When I first met him, he said had never revealed his drinking habits to a doctor before and had never asked for help. At that time he was drinking 6 units of beer (Caffeys 4%) = 13.6 units/day = 95.2 units/week and 2 litres bottles of vodka (40%)/week = 80units = 175.2 units/week. He said his intake had gradually increased over the last year. He had used AA on and off over the years and had found it helpful, but was too ashamed to attend meetings at the moment. He had tried to stop himself a few times over the past months but said he always became violently sick. He always came to appointments with his wife and she confirmed his history and mentioned that she had persuaded him to come and see me.

At that time, we talked about alcohol dependency and the options Noel had for treatment. Even giving him all the evidence, he said he just needed some tablets to help him through the withdrawals and he would go back to AA. He didn't want work to know and he could only take off 10 days from work. His wife said she would support him and he completed the physical part of the detox fairly easily. However hard we reinforced it was better to continue seeing Mel, the practice counselor, and me Noel stopped coming after a few weeks.

Noel represented, again with his wife, after a few months, saying he had relapsed after 4 months having started with one drink at a family wedding. He asked for "some more of those pills" and "he would then get out of my hair" and stop bothering me. We again went through the evidence and options but he declined all additional support.

This cycle was repeated 2 more times, until he presented late last year. Noel said his family had advised him to try it my way, as his way had failed. We first analysed this latter statement by looking at what he had learnt with each detox - and it was enormous! He now accepted he had a problem and he was powerless to do it alone; he had done "the steps" many times but had never "really done" them; he felt he was a good Catholic and his problem had made him lie and cheat and when sober he knew this and when not drinking he had realized what an effect it had on his family. He looked shocked when I congratulated him on all he had learnt and said he was by no means a failure!

After going through the choices again, he decided on an in-patient detoxification and a 12 week abstinence day programme at EACH, which he started early in the new year. I saw him a few times during those weeks and each time he was bursting to share what he had done and learnt. The programme covers life skills, builds motivation, anger management, help with employment and housing, support, even a gym session and so much more. A 12-step counselor runs one of the weekly groups and local groups and support are discussed.

Four weeks after completion of the programme Noel is still having counseling, still attending AA, still coming to see me and still being alcohol-free, one day at a time! As so many people have said before: recovery is seldom a single event contained within a set period of time. Could Noel have reached this point earlier? I don't know. But I do know in my experience that each person is different and needs to find their way and this can't be dictated by health professionals or government policy; some people need more help than others; some need no help; it is usually incremental, learning occurs with each episode, often, as with Noel, over many years.

Noel says for him the most important things for him were: people, especially his wife and family, sticking with it, and finding help for him and looking for help for themselves when needed. He feels it is different this time but he knows now he is one drink away from going back to alcohol and all its problems. And from her long journey alongside her husband to his current state of sobriety, during which she never gave up on him, his wife would have her own tale to tell of how much she too had learnt from living with the problem.

Excessive alcohol is so often the condition patients don't want to mention and doctors don't want to uncover for fear of what to do, and although we have improved about asking in general practice, we still have a long way to go.

- Dr Chris Ford
GP Lonsdale Medical Centre, Clinical Director for IDHDP, and a Member of the Board of SMMGP

EACH: Ethnic Alcohol Counseling in Brent works to facilitate and sustain positive change in the lives of individuals, families and communities affected by problems arising from alcohol and drug misuse, domestic violence and related mental health concerns.