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What has anyone seen as far as problems with patients who have a medical problem that drinking has caused and what do we do to get them to stop drinking?
Alcohol dependence
- Thread starter John Korkow
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I've had some patient experience, but also some family experience with alcohol abuse and/or dependence. My (take it or leave it) advice would be to (1) please treat them like human beings. We all have problems and they're dealing with things the best they can right now. I don't agree with their choices, but there are a lot of factors that go into it that I am unable to understand. (2) Know that you won't be able to get them to stop drinking or understand why they don't stop. They will stop when they want to stop. Be honest and tell them how their drinking is affecting their health using specific examples. Educate them. But, in the end, they are adults and the decision is theirs (much like a person who is obese or smokes and does not change his/her habits even though their lifestyle is making them sick, which is VERY common). Lastly, (3) Don't forget to treat them for EtOH withdrawal when they're in the hospital.
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Examples:
1) Patient comes in with a broken hip from a fall. He has a history of heavy drinking and his mind is now like a 10 year old's. We are presently investigating his pancytopenia.
2)Patient arrived in our ER from a detox center with uncontrolled N/V. Because she came from a detox center, we'll probably send her back once her GI system is under control.
3) Finally, we have another patient who is essentially brain-dead with a history of chronic alcohol use, although I believe his present condition was the direct result of a massive stroke. He has already had his last drink...
1) Patient comes in with a broken hip from a fall. He has a history of heavy drinking and his mind is now like a 10 year old's. We are presently investigating his pancytopenia.
2)Patient arrived in our ER from a detox center with uncontrolled N/V. Because she came from a detox center, we'll probably send her back once her GI system is under control.
3) Finally, we have another patient who is essentially brain-dead with a history of chronic alcohol use, although I believe his present condition was the direct result of a massive stroke. He has already had his last drink...
John Korkow said:
The only "success" stories ive seen are those ppl who have remained abstinent only because the effects on their health have been so severe that they are on the liver transplant waiting list....
Then again, one of our patients recently came in with alcohol and cocaine on board, even after a 2nd liver transplant.... 😡
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If you would like to learn more about the success stories in addiction - go to an AA or NA meeting. Some meetings are "closed" which means recovering persons only, but other meetings are "open" and welcome other people.
Working in medicine we often see those who haven't stopped drinking or using. The people who have gotten sober tend to be in better health, need less medical services, and often we don't know that they were substance abusers if they don't volunteer the info.
Substance abuse can be so frustrating to deal with in patients. It can be hard not to take their denial personally or to maintain any hope that one day they will stop. ATC2MD makes some great points and I second them.
The only thing I can add is something I was told which has helped me:
I've never had an alcoholic or a drug abuser lie to me. They are lying to themselves, not to me.
Working in medicine we often see those who haven't stopped drinking or using. The people who have gotten sober tend to be in better health, need less medical services, and often we don't know that they were substance abusers if they don't volunteer the info.
Substance abuse can be so frustrating to deal with in patients. It can be hard not to take their denial personally or to maintain any hope that one day they will stop. ATC2MD makes some great points and I second them.
The only thing I can add is something I was told which has helped me:
I've never had an alcoholic or a drug abuser lie to me. They are lying to themselves, not to me.
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ATC2MD said:
Great post. Addiction is a symptom of deeper problems. Don't expect too quick a response.
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ATC2MD said:
Don't forget that students don't treat anything. Now, lets go drink a beer...
beanbean said:
I'm getting warm and fuzzy already. Wait, that's just the booze in my gullet.
Look, maybe we shouldn't think so hard about this issue. Alcoholics like to drink almost as much as I do. So what? We treat them symptomatically when they show up, maybe throw in a few threats about death if they keep drinking, and wash our hands of it. At least I do. I don't let it ruin my day. Hell, I've treated guys in the ER who come in for their weekly pericentesis and know they are dying. One of the guys had quit drinking. We both knew he would die soon, we both knew it was his own fault, and we just went about our business, had a friendly exchange, and it was over.
Being a doctor isn't about treating people's demon's. I don't get too worked up about treating self-inflicted diseases/wounds as a professional. I treat them nicely and go one with my day. I do grief for the state of humanity, but I don't think I can excise demons with medicine.
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TX OMFS said:
That's a very honest and interesting answer. I agree with you about treating people with self inflicted diseases/wounds with warmth and respect regardless of whether they are recovering or going further down hill. That this is often not the case is something that bothers me a lot about hospitals.
But I can't accept that the demon doesn't need treating. Or that it isn't appropriate for a doctor. My job is to help people achieve health in exchange for a fee. And those "demons" are generally the greatest obstacle between them and greater health. But "excising" demons is not a simple matter. It can't be done with a furrowed brow and a few stern words. But if the right moment arises and in a reflective state a patient opens up and asks for advice I do my best to gently help them in whatever small way I can. Sometimes that just means listening. Nothing else. So, it's hard, and low yeild but I do think it's important to try. I'm sure you'd probably agree with this.
Most important, like you say is never to push or be unkind. Counseling or psych help can be extremely helpfull to a tortured soul. If you can help someone to feel that they can talk about their demons without feeling humiliated, that in itself is a great thing. And if they don't want to change then don't try to force them, that may be how they got there in the first place.
