Homeopathy

Alcohol Abuse and its Treatment in the Homoeopathic General Practice Setting


The Case of Robert

This gentleman was a 47-year-old man known to me as local financial businessman. He admitted to drinking 2 bottles of wine regularly (84 units alcohol per week; recommended 28 units).
He had some degree of medical knowledge having been a medical technician and his ex-wife being a nurse. Issues seemed to centre on his ex-wife. He ‘rescued her ‘(his terms) when she became pregnant after an affair with his boss. She her self was unable to keep down a ‘proper job’ because of mental illness. At that point her started bringing work home and drinking seriously. This would be 15 years previously. "My drinking was like flinging buns at an elephant". The marriage broke down 5 years prior to now
He then went on a course on finance . Business currently poor and has Inland Revenue breathing down his neck. He noted that people he had trusted previously had now betrayed him by setting up a rival company and poaching customers. The current upset was because his ex-wife had re-married for the third time. The one son lives with him. (Much more irrelevant detail was given) Finally his business partner had confronted him; get cured or the partnership is over.
The evening of the consultation he had started drinking at 5pm (it was now 7pm). He was on frisiun and Inderal LA. The latter from a private doctor in a nearby city who, he stated, would give a prescription on demand. He said that he intended to give up alcohol that evening. In view of his obvious drunkenness I felt this unlikely. I agreed to refer him to a private clinic. . I contacted a local psychiatrist that I knew who gave him a quote of £3000 and offered him an appointment to see him the next day. He attended that interview (still intoxicated) and arrangements were made for admission next day which he failed to attend.
He called me a week later .he had attended the private G.P. again and obtained further supplies of frisium. I said I was unable to help him unless he gave up alcohol and to recall if he wanted to take up this offer.
He recalled 11 days later and requested a further visit. He was complaining of agoraphobia and requesting a full medical. Blood samples were taken and they confirmed severe liver damage (gamma GT 986 [normal <50].
He was seen two days later with the results and advised that if he did not stop drinking his life was in peril. To recall if he wanted a detox at home
Called on week later given a high dose of frisium to prevent fits and calm him down with an agreement he was to get rid of all alcohol and to stop drinking.
I saw him on a daily basis for the first week and then on alternate days. After 10 days his frisium was gradually decrease. At that time he had a fine tremor and his appetite had returned
2 weeks into the detox he had received more stress but had coped without alcohol. He still had poor concentration. A repeat of the Liver function tests had shown substantial improvement. He was much more loquacious. He was prescribed Lachesis 200c and seen on a weekly basis. The Liver function tests were repeated and after 6 weeks sobriety had returned to normal. He felt shaky but managed to return to the office.
After a further 2 weeks he reported he was well and he was discharged with no craving for alcohol..



Introduction

Alcohol abuse is a common condition found in general practice; A recent survey in my own practice has shown prevalence amongst the 18-55 age groups of 8.5% who have at some point have had problem drinking. The practice is situated in the West of Scotland where there is a tradition of heavy drinking. There is also wide scale deprivation (Jarmann index +2.67) and is the second most deprived in the county. It is not surprising that this problem causes many physical and psychological problems. These, in turn present in our consulting rooms
. However the conventional treatments available are limited in their scope there is also difficulty in getting the patient to recognise the problem, act on the advice given and maintaining the lifestyle necessary
Evens with these constraints have you the right temperament to treat this difficult group of patients.
This is intended to take a complete overview of the problem drinker and to attempt to integrate the various strands of care to see where they all fit in.


Diagnosis and staging

This may or may not be easy.
The diagnosis of problem drinker is one who drinks to the detriment of his physical, psychological social or spiritual well being and if he is unable to stop he is an alcoholic and if he is just unwilling then he is not. There are those that maintain that the sole qualification to be an alcoholic is the inability to stop. The is the belief of Alcoholics Anonymous.
The problem drinker can survive for some time without alcohol but may find that he goes on a bender for 3-4 days when the alcohol is out of control but then stop as easily as he began.
. The next development which is not necessary inevitable is a cover up situation where the patient functions to the outside world completely normally yet requires regular alcohol to function properly They are less likely to come to the physician’s attention
The next category of individual are those who attempt to cover up the extent of their addiction. Yet this façade is starting to crumble and problems related to alcohol are starting to appear. i.e. the patient who comes in an obviously hung over state with state alcohol on the breath or ketotic but whose behaviour maintains the social conventions. . They may reek of peppermint to attempt to cover up the smell. Yet, when they attend you the problem of alcohol is not addressed. or dismissed
Your attention may be drawn to them because of
• non Medical causes (table1)
• Incidental Medical causes (table 2) often received as a report from Accident & Emergency
• directly related psychological pathology (table 3)
• Directly related pathology
• Cardiovascular (table 4)
• Gastroenterological (table 5)
• Neurlogical (table 6
• Dermatological (Table 7)





TABLE 1
NonMedical Clues to drinking problems

o Criminal conviction
o Drunken driving
o Neglect proceeding by social services
o Poor housing conditions found on routine house visits
o Seen in the street in an incapable state
o Concerned relatives & family
o Battered spouse
o Problems related to work
o Financial difficulties
o Sexual difficulties

• Table 2
• Incidental clues to problem drinking
o Trauma
o RTA
o Brawling & consequent attendance at AED
o Repeated fractures compounded in the elderly by tendency for osteoporosis
o Multiple rib fractures seen on cxr
o Hand fractures from fighting
o Spinal or hip or wrist fractures from falls
o Beer related obesity





Table 3
psychological, manifestations
• anxiety,
• depression,
• phobias,
• delusions,
• suicidal ideation
• self harming attempts,
• hallucinations
• jealousy
• paranoid ideation,
• eating disorders;


Table 4
Physical Ailments Gastro-intestinal
o IBS
o Diarrhoea
o Hepatic
o Pancreatic
o Gastric

Table 5
Circulatory problems
o Hypertension
o Cardiomyopathy

Table 6
Neurological
• Acute intoxication (euphoria
• incoordination,
• ataxia,
• confusion,
• coma)
not amenable to homoeopathic treatment


Withdrawal syndromes
o Blackouts
o Nightmares & terrors
o Tremulousness
o Epileptiform seizures
o Hallucinations
o DT
Nutritional deficiency syndromes
o Wernike-Korsikoffs syndrome
o Cerebellar degeneration
o Cerebral atrophy
o Peripheral neuropathy
o Pellagra
o Amblyopia

Table 7
Skin
o Worsening psoriasis
o Dupytens contracture
o Spider naevae
o Acne rosacea


When any of the symptoms on the tables of physical diseases present usually the patient is fairly deep in their addiction
The drinker may come to the attention of the physician because of problems that he himself may not realise are lifestyle related.
Finally the patient may attend the physician in a drunken or incoherent state and be reeking of alcohol. Usually there are truly broken individuals who have lost all sense of self-respect. Miasmatically they are often syphilitic. These may be the easiest to diagnose but are probably in a pre contemplative state and may not have thought about addressing the problem. There is insufficient semi sober time for them to consider the state of their health before the craving for alcohol causes them to be drunk again. Most of these individuals are categorised as alcohol dependant.
It is thus important to take a full conventional history.

1.Details of recent & current consumption
• Narrowing of the- repertoire of alcohol taken
• The pattern varies and becomes less flexible
• . A person who, at one time, could vary the amount, type, and timing of drink or drug consumed, becomes increasingly rigid, if what is required is available.
• This stereotyped pattern might become more chaotic if dependence is very severe and the person takes whatever is available
Drinking history past & present
o Past 24 hours
o Past month
o Past 6 months
• However patients may not be accurate
o Only one bottle of cider may refer to a 3 litre bottle of strong (9%) white cider
• Lack of honesty & integrity should be considered as part of the syndrome. i.e. when in recovery the persons normal values will return

Those with an alcohol dependency problem will usually have a stable pattern. Useful to concentrate on what is bought rather than what is consumed. Ignore pleas that it is given to others; no one usually gives without also receiving


2. Longitudinal study of problem and its sequelae
o e.g. how habit started
o background personality & constitution
o How the patient sees his drinking: Is it problematical?
o finance
o personal
o business & occupational problems
o educational achievement
o employment
3 . Drinking career:
• (a)Age of: first ever drink
• regular weekend drinking
• regular evening drinking
• regular lunch-time drinking
• early morning drinking;
• (b)withdrawal symptoms
• : anxiety
• , tremor,
• night sweats
• morning nausea,
• convulsions;
• (c)other features of dependence:
• tolerance,
• compulsion to drink,
• salience of drink-seeking behaviour,
• rapid reinstatement after abstinence;
• (d)delirium tremens;
• (e) Periods of abstinence.

4.Other drug use:
• type of drug,
• frequency of use,
• Route of use.
There are those that maintain that some have an “Addictive Personality” but this to homoeopaths requires further investigation.
Often the patient may move between opiate, benzodiazepine and alcohol abuse. In most cases they are fleeing from mental or physical pain (Table 8)


Table 8
Aetiology Factors
Family setting
• Local factors
o Cultural
o price
• Traumas of the past
o Childhood abusive upbringing
 Domination of children
o Armed services
o Loss & bereavement
 Ailments from bereavement
• Background psychiatric illness
o Depression
o Anxiety
o Personality disorder
 Low frustration tolerance
o Psychotic illness
 Paranoid syndromes
 Hypomania
• Current Trauma & stresses
o Occupational (doctors , Businessmen)
 Ailments from mortification
o Financial difficulties
o Marital difficulties
o Jealousy & envy
• Physical illness
o consequent disability and unable to come to terms with it
o to act as an analgesic


5.Previous treatment history:
general practitioner or specialist alcohol treatment service, medication.

6.Forensic history:
Drinking and driving, or drunk and disorderly offences
.
7.Present lifestyle:
Marital,
Occupational,
Leisure activities,
Social support network
, Non-drinking social network

8. Family & cultural History
• Parents or close relatives (4 times more likely with a positive FH)
• Often dysfunctional families with physical sexual or psychological abuse
• The attitude of the person’s cultural background may determine how forthcoming they are about their history
A strict religious background where alcohol is forbidden (e.g. Muslim, Mormon) This may indicate great shame on the patient

• A lax attitude (West of Scotland and other Celtic races

“I’m only a common old working chap As any one here can see But when I’ve had a couple of drinks on a Saturday Glasgow belongs to me!” From “I Belong to Glasgow” by Will Fyfe

•
Is the time right?

Patients with harmful alcohol consumption are at different ends of a continuum with respect to their readiness to change. At one end of the continuum are patients who are not at all ready to consider change. Towards the other end are those in the process of decision-making and actual change, while those in the middle are in a state of ambivalence about their drinking. Amongst excessive drinkers in hospital, 29 per cent were found not to be ready for change, 26 per cent were ready to change, and 45 per cent were ambivalent. People can move backwards and forwards along this continuum. Helping them move forward, even if they do not reach a decision to change, let alone make a change, is an acceptable outcome of a consultation. If a doctor talks to patients as if they were further along the line than they really are, resistance will be the likely outcome. The first task of the doctor is therefore to establish the patient's degree of readiness for change and to then select a strategy appropriate to this level of motivation.

 

.

The first and crucial stage is recognition by the patient that there is indeed a problem with his drinking. Prior to this he is in the pre-
Contemplative state. Also known as craving , this describes the overwhelming subjective sense of the need to obtain alcohol. The person is constantly preoccupied with thoughts and feelings centred on the desire to take action in order to satisfy the urge to obtain alcohol.
There is alcohol-seeking behaviour over all other activities
Drinking becomes the all-important major priority in the person's life. Social and occupational obligations and responsibilities become secondary, no matter what the consequences
It is often forgotten that there must be something pleasurable about drinking or inversely something unpleasant about stopping drinking that keeps people drinking. Alcohol some way rewarding to user
When they get drunk they get have a reinforcing element (i.e. they feel better in that state.)

In order then for them to stop the gain must be considerable to overcome the pain of stopping.
In the words of the old joke ‘How many psychiatrists it takes to change a light bulb ? (one, but the light bulb has to want to change). there is a requirement for the time and the place to be correct for that individual to embark on sobriety. The evidence of sobriety can be put to the patient but until the person is ready to listen there is no point in going further
If one feels the patient is ready to contemplate the problem then the following may be among the factors considered
The positive reasons for drinking less can be pointed out. These include: lessening risk of the harm that can arise from too much drinking can be explained. These are shown in Table 10
,

. One problem with giving advice about drinking alcohol is that many patients are not ready to change and thus direct persuasion may push the patient into a position of defensiveness.
This is an individual life style decision. People will not be hectored into change; They will not change successful to please someone else. They will only change when from their perspective the benefits of sobriety are better than the way they are feeling and coping with the situation they find themselves in.
Ambivalence is a common and normal experience. For people with a drinking problem, there is a conflict between indulgence and restraint, each having pros and cons associated with it. The intensity with which people experience this conflict varies a great deal and appears to increase as the person approaches decision-making. The most effective way to help the patient is to explore this conflict and to encourage patients to express their reasons for concern and the arguments for change.

When a patient is detected with an alcohol problem it is futile to offer any curative treatment either conventionally or homoeopathically it they will not accept there is a problem. Just giving a remedy
is colluding with the denial pattern that the alcoholic is setting up and possible driving them further from the point of contemplation. This in contradiction to one of the basic laws of medicine
“At the very least do no harm”
Most alcoholics have left in their wake a chaotic social life. Whilst living in this chaos treatment is very difficult. To ensure a good cure the patient should be away from all domestic and work stresses. This is why hospital admission for detox is preferable to community detox except in specially selected cases.


Am I the right person to treat this patient?

Three models of an alcoholic are present;
• Someone of moral slackness who needs to be reproached for their behaviour
• Someone whose behaviour is criminal and should be punished by the law (drunk & incapable; Drunken Driving; Drunk & disorderly)
• Someone who has a medical problem which , by definition the medical profession has a duty to help if the patient requests it

In truth the answer lies somewhere between these three points at any one time. If you are to treat alcoholism then, as a practitioner, you should believe that you can be of help
It is important to that the practitioner has the belief that this is indeed a curable condition. The optimism of the practitioner can be infectious and give hope to the patient. This may be the first glimmer of hope that the patient has seen
One also has to have compassion for the individual in front of you.
“We need compassion for all our remedies”
J Shore in a Glasgow Seminar
Patients sense this and are more willing to follow your direction. It may be the first time for a long time that anybody has taken the time and effort to help them
The patient has to also have good access to you. Seeing the patient at monthly intervals is of little value
. In the acute withdrawal phase, daily hour-long consultations may be needed by the team helping him.
This then brings us to the value of teamwork. Ideally there is team dedicated to alcohol withdrawal and the homoeopathic doctor is a part of that team. In our health board there is a team of CPN’s who oversee a home detox programme which allows the patient to detox at home if there is suitable support from the household. There are members of who may be prepared to provide the domestic and or counselling required and this also has good success (click here for a link to their page)
. The Alternative for those without home support is inpatient detoxification. What is NOT an option is to tell the patient to stop drinking and to return to you in a week / months time. If you are not able to offer the support mentioned above or if you feel antipathy to the unwashed, smelling incoherent person in front of you then may be the best option is to just plant the seed that things could be better for them, withdraw you care for their alcohol problem and refer to another agency.



Medico-legal and social consideration

• The patient may express suicidal ideation. A determination has to be made as to whether the person is truly likely to take their life, whether they are attention seeking or whether there is an indifference to the outcome of their self harming behaviour. It also has to be remembered that self harming behaviour can go wrong . It is not without its morbidity & mortality by accident rather than design. While attempts to ensure that discovery is made it, may be to late (e.g. paracetamol overdose). This scenario is particularly relevant for health care professionals (doctors, nurses) who feel that the cry for help has to appear ‘convincing’. It requires an experienced physician to determine which cases may need compulsory detention under the relevant Mental health statutes for that country and that the physician is aware of the procedure required for this
Safety concerns for other s. There are issues here that the physician needs to be aware of.
• Driving; if the patient is driving and is unable to stop drinking he has a duty to inform the DVLC and there are severe penalties for failing to do so. There will usually be a suspension of their right to drive until the person is shown to be sober by independent tests. This is a separate process from any suspensions for motor traffic offences such as drinking under the influence of alcohol.
• Family care If the patient has violent tendencies and there are minors present the question of their safety may be an issue and the child protection teams from social services may need to be involved. Their children may also be neglected or, finally, the patient may self-harm in front of the children causing a form of severe emotional abuse. These cases may also require referral to the care agencies on an urgent basis.
• It is important that the patient is way from stresses especially work related ones till they are psychologically robust enough to tackle it. Changes in the work environment are mandatory if the patient is not to relapse. To cure a patient and then return him to the same environment is to ensure that history will repeat it’s self.

You therefore have to be in a position to grant the patient sick leave by issuing the prescribed certificate of incapacity (med 3 in the UK). It is also wise to persuade your patient to allow you to communicate his occupational health physician (if one is available ) to allow the necessary work changes to be made



Management

Therapeutic tips
Alcoholics Anonymous
A source of the social and psychological support and a major therapeutic tool arises out of the movement. They accept that alcoholism is an affliction that some people have and some do not. They would strongly maintain that the individual cannot help themselves out of the situation and that the support of other recovering alcoholics is essential to maintaining recovery. Furthermore they say that only with the help of Their Higher Power can sobriety be maintained.

This approach is helpful for many and witness of addicts 15, 20 or more years in recovery attest to this. Further details can be found in their book Alcoholics Anonymous published by the AA General Services Office. The first Chapter of AA had as a founding member Dr Bob in 1939. This doctor was reported to be an American homoeopath.

Naturopathic

After the patient is no longer dependant, the job of repair and correction is required in all spheres.
One of the main aspects of treating all addictions is to change the settings by which those addictions took place. This requires social change and treatment of the psychological background.
Next the body must be encouraged to repair itself from the gross insults it has received. This requires good nutrition. Thus, it is standard advice to advise a mixed diet of fresh foods (to maximise the vitamins and minerals.)
Added minerals and vitamins, particularly if there has been blood loss or neurological complications.
• Magnesium
• Iron
• Nickel
• Selenium
• Zinc
• Vitamin A
• Vitamins B Group
• Thiamin

A high fibre diet will aid the elimination process as will drinking plenty of water. Highly processed foods will increase the load on the elimination system unnecessarily and should be taken moderately.
With suspected liver or gastric disorders a low fat diet would also be recommended.
Those who have lived ‘to excess’ would be best avoiding stimulating spices and high caffeine drinks (cola coffee). For those of a nervous disposition this is of course doubly important. The antidoting effect of coffee should also not be forgotten on homoeopathic remedies.
I understand that there are certain acupuncture points that can be useful and the reader is referred to a qualified practitioner for further details.

For local remedy use, the following mother tinctures shown in the mini materia medica can be used 10drops in a glass of water three times a day.
Angelicus maybe more suitable for those who have had neuronal damage which shows itself as peripheral neuropathy or chronic brain symptoms (tables 3,6 & 11). This may be helpful also in producing an aversion to alcohol
Where the problems are more related to the intestinal tract (stomach liver pancreas) Quercus may be more helpful
As it antidotes the effects of alcohol
If there are nutritional, deficiencies Avena Sateiva can help the body to assimilate the nutrients required.
. Boerecke also mentions using Tincture of opium Some of my patients do this without medical supervision of their own bat. Not unsurprisingly they find that one addiction is substituted for an even more serious one. This is therefore not recommended At the time of its writing this is probably a version of benzodiazepine detox currently in use.

Conventional treatment

• Benzodiazepine/ chlormethiazole
• Antiepileptic treatments
• Antidepressants
• Blood transfusions
• Liver transplants
• Antabuse
• Acamposate
• Surgery/endoscopic treatments under anaesthetics
• Antacids/H2 antagonists/proton pump inhibitors
• Spirinolactone & other diuretics

In the acute detoxification programme the patient is tranquillised to ensure that fits do not occur and to compensate one tranquilliser namely alcohol for another one and then weaned off that. Chlormethiazole (Heminevrin) has lost favour for the difficulty of weaning off patients. This appears to be less difficult with benzodiazepine. Despite detoxification a certain of non-drinking alcoholics are susceptible to fits and have to take anti-epileptic treatment. If underlying depressions is found an antidepressants may have been prescribed. These neuro- active substances are moderately disruptive to homoeopathic treatment but should only be modified by an experienced practitioner.

Haemorrhage may require life saving blood transfusion .Similarly a failing liver may require transplantation. Both these procedures introduce foreign body tissues . Because of oesophageal varices and increased bleeding times Haemorrhage sometimes catastrophic may occur sometimes with out warning. This may require emergency blood transfusion to save the person’s life. Therefore, any doubt in this area requires urgent hospital admission.
. Liver transplantation will however require severe immunosuppression rendering homoeopathic treatment almost impossible.
Antabuse causes the production of nausea inducing chemicals in the blood stream. This will disrupt the body’s normal responses making case taking very difficult in some instances. The affect of Acamposate on homoeopathic treatment is unknown. However several people who have taken it report that they suffer low blood pressure.
Several remedies are used to help the gastric symptoms (peptic ulceration, Hiatus hernia, gastritis) providing that there has been no gastric bleeding the experienced physician could gradually wean patients off these and

The patient may have to undergo surgery or endoscopy to correct the effects of ulceration or portal hypertension.

Liver failure may bring in it’s wake oedema for which diuretics are prescribed particularly spirinolactone


Homoeopathic Treatment

The pre treatment stage
As I have indicated the intoxicated patient may provide useful indications as to the underlying mental state but the history provided is unreliable in its self and prescribing will just deflect from the central issue of the patients need to stop drinking. The dangers of collusion in denial are emphasised again


The Acute Stage

It can be seen from what I have mentioned already that treatment in the acute phase is fraught with danger
Mental symptoms


Often the patient will be haunted by past experiences and this is particularly true of members of the armed forces with alcoholism secondary to Post Traumatic Stress Disorder
They often feel they have committed an unforgivable set of crimes.

The undercurrent is one of self-destruction and suicide is a very real threat as is self-mutilation.



The position of suicide & para suicide has been discussed above

For abuse in childhood (physical sexual or emotional) again there are deep issues of guilt, being unclean and the repercussions of being betrayed by family members either directly by the perpetrator or the other parent for failing to protect. In essence the families are deeply dysfunctional. Again let me emphasis the need to consider child protection issues and that they may over-ride any duty of confidentiality if children are still at risk
The patient may develop a hard impenetrable emotional shell :
• They may submit to the greater overwhelming force
• battle to prevent the injustice and seek revenge . All are deeply scared by the past and may use alcohol (or other substances ) to blot out the past.
• is a remedy rich in symptoms suggestive of abuse.
• In all sexual abuse cases there is an ambivalence between revulsion and fascination of sexual matters. There can be shameless nakedness yet an aversion to all physical contact.
• The abused may themselves be abusers


Professions at risk

There is a certain categories of people who feel that the tasks they face in front of the are beyond there capabilities; Indeed some people feel that they have failed those to whom they are responsible. This tension proves too much and they withdraw into alcoholism. The fostering of blame culture has , of course increase the number of victims who only too readily are able to focus n their own faults without recognising the good they have done. The condition of alcoholism , may to them be proof of their own inadequacy. Others who realise their inadequacy have the opposite effect whereby they do their best to hide any faults to the outside word. The tension between their two worlds can prove so difficult that they resort to alcohol.
Physical symptoms



Often bowel disturbances can be the presenting features in alcoholism. The alcohol itself has a bad effect on the gut however the patient is often of a nervous disposition and will produces eructations and bowel gas. Often the patient describes a feeling of an animal in their abdomen The Stomach itself is also prone to ulceration.


The organ that takes the greatest damage is probably the liver and the effects at the early stages are reversible. AT the later stages however there is fibrous change to the architecture (cirrhosis ). This liver damage causes jaundice. The damage to the liver also causes bleeding difficulties and this is also is reflected in the rubrics.
The pancreas also id deeply affected and chronic pancreatitis give chronic intractable abdominal pain described by patients as burning.


The Case of Robert……. Continued


5 months later he said he was sliding again and admitted to 4 bottles of wine over the weekend. He was advised to stop forthwith and frisium again prescribed to prevent fits. One week later he reported that all was well. However one week after that he reported further drinking. H e was admitted to the local hospital with chest pain which was reported to be of non cardiac origin. He was seen 2 days after discharge having been abstinent in hospital.
Within one day of his return he was taking both tranquillisers and alcohol. He was seen on one further occasion 3 weeks later . He requested a full medical. I advised that I was not prepared to treat him unless he was prepared to stop drinking . He said drinking was not a problem and he could stop a any time. I advised that I could no longer help him unless abstinence was part of a complete package of care. and suggest he try AA for their support. I also said that his current consumption would cause his death within six months.
He died during an alcohol-induced epileptic fit some 5 months later.
This case represents the typical features and pit falls with treating alcohol addiction. Homoeopathy was able to stabilise this man after the acute phase was ended. There were in him no cravings immediately after but the danger of relapse is always there Nevertheless it illustrates the amount of time and effort required often with minimal outcome (in his case maybe an extra year of life; half of which was sober.)
Alcohol still remains a potentially fatal condition in which the patient despite the best effort of the physicians & carers may resist treatment.


Conclusions



There are many facets to the treatment of alcohol abuse and successful treatment requires expertise in many areas. So many and so time consuming that a team effort is required. Some (but not all ) of the pitfalls have been highlighted so that fools do not rush in…..