Medical Case: Alcohol de-addiction
#MedicalCase

Alcohol de-addiction (Psychotherapy)

Dr. K. V. Anand., PHD COUNSELING PSYCHOLOGY

 

Medical Case Details:

The patient is a 47 year old male, and he is not inclined to take any medicines to quit alcohol. He is a gentleman unless he is under the influence of liquor. He consumes alcohol almost every day, especially in the evenings. He never drinks in the bar or other areas, and he prefers to drink at home. He has a wife and two children aged 11 and 7. Once he is under the influence of alcohol, his behavior changes totally. He takes 3 to 4 peg per day.

Once under the influence of alcohol, he starts cursing, yelling, and brutally assaults his wife. If the children try to stop him, he punishes them physically. After coming back to his senses, he regrets about whatever he has done and cries.

His wife and children are very happy with his normal behavior, love, and affection. But they are worried about his behavior when he is under the influence of alcohol. Please provide suggestions.

 


    Discussions


    Dr. Alok Vinod Kulkarni
    Psychiatrist

    Harm reduction should be attempted in this individual as he is refusing to take anti-craving medicines. He would also benefit from Motivational Enhancement Therapy (MET), CBT and Twelve Steps Facilitation (TSF). Project MATCH (Matching Alcoholism Treatment with Client Heterogeneity) has shown that MET, CBT and TSF are equi-efficacious in terms of helping the client remain abstinent from alcohol use and that the treatment gains are maintained at the end of the first year.

    ▲ 1
    05.Jun, 11:36am

    Dr. K. V. Anand
    Psychiatrist

    Do you suspect alcohol induced psychosis or histeria?

    05.Jun, 11:49am

    Dr. Anil Kumar
    Psychiatrist

    Alcohol induced Psychosis will not get corrected in a night. Alcohol induced hysteria is a term which i have not found in literature. His drinking may be result of impulse control disorder. MET, Alcohol Anonymous, and even yoga will be helpful if he is not willing to take medicine. on the other hand, if he is not ready to take medicine then probably he doesnt want to quit alcohol seriously

    ▲ 2
    05.Jun, 12:11pm

    Dr. K. V. Anand
    Psychiatrist

    Thanks Dr. Anil Kumar.

    05.Jun, 12:14pm

    Dr. Rima Shah
    Psychologist Counselor

    I agree with Dr Kumar. It's not so much what will help him as much as does he want help. If he is so regretful about his behaviour later, why is he not seeking help. There are obviously other dynamics at play here which need to be worked on with the patient. If he does not want help, no psychotherapy will help him. The patient needs to be an active variable in the process.

    ▲ 1
    05.Jun, 12:19pm

    Dr. K. V. Anand
    Psychiatrist

    Dr. Rima and Dr. Anil Kumar. That is the point where I am also totally confused. He is whole heartedly willing. He even went to AA group several days. His family also are fully supportive and motivating. He says there is something which pulls him towards the liquor shop at the evening. Even when he is in his office,in the evening, this happens. Throughout the day, he is reiterating to himself that he will not drink that day. Even for this purpose he took vacation, went to other locations for keeping himself away from this situation. But even when he is away, he becomes so restless etc, he somehow finds himself in front of a liquor shop. I can't find any explanation to such a behavior.

    05.Jun, 12:34pm

    Dr. Rima Shah
    Psychologist Counselor

    These are stop gap and deflection techniques. If he's keen to help himself the first step would be serious de addiction centres. Why is he refusing all that?

    ▲ 1
    05.Jun, 01:06pm

    Dr. Prashant Gohil
    General Practitioner

    It looks like he is motivated to stop alcohol but either because of craving or withdrawal symptoms he is not able to stop it. So first step for him will be to reduce the craving for alcohol but on the other hand he is not willing to take any medicines. I can see two options here. If he is motivated to stop alcohol, either you have to convince him to take anti craving agents. Second if still he refuse to take then the only option left for him would be placement to some rehabilitation center where he doesn't get access to alcohol. Once he is out of this craving or withdrawal state, then MET and other psychotherapy can be started for him.

    ▲ 2
    06.Jun, 05:00pm

    Dr. Sheetal Kamble
    Homeopathic Physician

    I agree it is very difficult, almost impossible to convince addicts to take the medicines. In such cases usually homeopathy works well. You can prescribe a homeopathy remedy , his family members can add the remedy either in his drink without him knowing or just apply the solution at the side of wrist. remedy will get absorbed through the skin. The remedy will motivate him either to stop the alcohol or motivate him to seek further help from you.
    I have seen personally helping many drug and alcohol addicts.

    ▲ 1
    14.Jun, 01:45am

    Mehwish Mursaleen
    Psychologist Counselor

    I completely agree with Dr. Prashant R Gohil.
    Addiction is a brain disease which affects the brain areas involved in decision-making. An addict is likely to refuse medicine because of his state of denial and lack of knowledge regarding the treatment procedure he must undergo if he really wants to quit the substance. He should be guided/counseled about the addiction treatment. The first step of addiction treatment requires complete detoxification of the drug from his body (and definitely it will include some kind of medication to get his body recover from the damage what the drug has done to his brain-body-soul) and then any form of psychological treatment would be effective on the patient for complete recovery or abstinence.
    He must be referred/admitted to a Drug Rehabilitation Center and his family should also be guided about the treatment procedure so they can admit him to the center. The rest will be taken care by the rehabilitation center because they don't allow patients to go away until completion of the required steps of addiction treatment.

    ▲ 1
    15.Jun, 01:06am

    Dr. Bharat Udey
    Geriatrician

    Hello,
    As per the above discussions and the presentation of this person, few things I would suggest:
    1. Drinking pattern should be assessed in detail- amount specially, is it progressively increasing over last few years.
    2. Explore for any withdrawal symptoms: as in the begging person drinks for pleasure later on he drinks to avoid withdrawal symptoms.
    3. Have he tried to quit alcohol in past? If yes was it without medications or with medications? For how long he was sober? Why did he resorted back to his drinking behaviour?
    4. At present is he motivated enough to quit alcohol? How does he see his drinking behaviour - fir himself and his family? What steps will he take from his side to quit his drinking behaviour?
    5. Discuss in detail the treatment modalities with patient and his family member- active involvement of patient should be encouraged. Along with this MET steps should be incorporated, he should be motivated to start with treatment by giving objective evidence of Benicia of quitting.
    6. Pharmacotherapy - a. Detoxification should be done depending upon the severity of withdrawal symptoms if any. B. Maintainance therapy should be started once withdrawal symptoms are managed. MET should be done side by side.
    7. One should be ready of lapse in between but don't lose faith on patient and always keep encouraging them. Keep a track of number of sober days for motivating them in every visit.
    8. Besides, assess for other psychological disturbances : depression, anxiety, co-morbid substance abuse, medical co-morbidities and manage them actively.


    ▲ 1
    19.Jul, 06:23pm

    Dr. Bharat Udey
    Geriatrician

    Hello,
    As per the above discussions and the presentation of this person, few things I would suggest:
    1. Drinking pattern should be assessed in detail- amount specially, is it progressively increasing over last few years.
    2. Explore for any withdrawal symptoms: as in the begging person drinks for pleasure later on he drinks to avoid withdrawal symptoms.
    3. Have he tried to quit alcohol in past? If yes was it without medications or with medications? For how long he was sober? Why did he resorted back to his drinking behaviour?
    4. At present is he motivated enough to quit alcohol? How does he see his drinking behaviour - fir himself and his family? What steps will he take from his side to quit his drinking behaviour?
    5. Discuss in detail the treatment modalities with patient and his family member- active involvement of patient should be encouraged. Along with this MET steps should be incorporated, he should be motivated to start with treatment by giving objective evidence of Benicia of quitting.
    6. Pharmacotherapy - a. Detoxification should be done depending upon the severity of withdrawal symptoms if any. B. Maintainance therapy should be started once withdrawal symptoms are managed. MET should be done side by side.
    7. One should be ready of lapse in between but don't lose faith on patient and always keep encouraging them. Keep a track of number of sober days for motivating them in every visit.
    8. Besides, assess for other psychological disturbances : depression, anxiety, co-morbid substance abuse, medical co-morbidities and manage them actively.


    ▲ 1
    19.Jul, 06:23pm

    Dr. Janrao Smit Uttam
    Internal Medicine Physician

    Hello everyone, I think this person is caught in vicious cycle of alcohol addiction most probably due to underlying depression and stress . he should be taken to a good psychiatrist. i think his problem of drinking will dramatically get treated.
    Depression...let's talk!!!!

    ▲ 1
    26.Aug, 12:58pm



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