Updated: Jan 12
Hello people, I feel ecstatic to come your way after a long period of absence. It’s time for another refining lecture on a mental disorder troubling a lot of energetic young men out there. Alcohol Dependence Syndrome. As usual, this shall be narrated in the form of a story.
Who loves Mondays? I sure don’t! What’s worse than hauling yourself out of bed and mourning the death of a fun- filled weekend? Mondays can however be very busy days at the Department of Psychiatry. A bustling day we have an influx of novel patients with varying complaints which are predominantly mental.
As I took my seat, a referral form was handed to me. “This man has taken alcohol for the past 15 years and has the desire to quit”. “Oh this is going to be easy” I say to myself, as I reposition myself by adjusting my seat, furthering myself from the patient. Social Distancing
“What brings you here Sir?” literally throwing away the content of the referral form. I ask. “I have been experiencing generalized body pains and weakness for the past six months. And Doc I can’t eat. My stomach is full even after taking a just a spoonful of rice” This middle aged man mutters under his breath. A fleeting look at him revealed he was in an oversized shirt. Or was it an undersized torso? I definitely do not know. But there was a clear mismatch of his shirt to his body. This was most likely due to a recent weight loss.
As he pulled his mask down to speak, there was a stain of nicotine on the prominent aspect of his teeth. His fingers were burned with stains of soot. A blacksmith or coalmine worker? A question for his future self.
Seated a few meters from him was a young man in his twenties I assumed was his son. He listened intently as his eardrums were filled with melodies of symptoms of physical illness. He sharply interjected when the threshold of the barrel to his patience was lowered and words flowed freely with a loose tongue. “He takes alcohol!! That’s why he’s here!!”
I acted surprised and motioned to the middle aged man why he hadn’t revealed this to me yet, for which he suddenly went mute; most likely out of shame.
What I had to do next was to redirect the conversation by enjoining him to tell me about his drinking habits with the hope of establishing the exact duration of this complaint of drinking excessively. This was to ascertain the best measures we could employ to help him. However, the silence that accompanied my questioning was so deafening I had to scurry for a secluded place to interact with my patient, as gestures he demonstrated clearly indicated he was not comfortable with the setting; being positioned so close to another young man who was simultaneously being interviewed by a colleague. He might as well have asked for a hospital bed to share with this ‘friend’ just because he literally knew everything about him.
“I started drinking 15 years ago” He let out, after the ambience was changed to incorporate just three people. I distinctly could not see why this could be a stand- alone problem because he was not the only person who gulped down alcohol, and neither had he been boozing for long. Because 15 years was a relatively short duration.
Some people drink leisurely, others drink only on occasions. Others drink to retract themselves from a stressful experience. And a minority do consume alcohol just because it’s readily available; the commercial that hit their TV sets resurfaced their appetite by intoxicating their hippocampus with cravings for a jolly filled bottle with sweat and tears on the outside. But how does this become problematic?
In the words of Paracelsus, “All substances are poisons; there is none which is not a poison. The right dose differentiates a poison and a remedy."
Drinking serves as a means to be enhance sociability and provide a route for escape to diverse forms of problems. Some people are able to achieve an expected outcome of alleviating misgivings with ease.
But what is more problematic than the serious psychological symptoms encountered by savoring bottles of alcohol, which includes depression and anxiety.
What is more precarious than being tipped into a neurological condition called Wernicke encephalopathy due to the thiamine deficiency caused by your intestine’s incapability to absorb Vitamin B1 adequately.
Or the perilous effects rendered to your liver by infiltration of fatty soldiers? Typically manifesting as abdominal pain and jaundice?
And lastly, your increased predisposition to cancers of the head, neck, oesophagus, lungs, liver, stomach and colon because of your drinking habits? A risk factor you could totally avoid?
I am not being an agent to spell doom here because I know someone who knows someone who knows someone who consumes alcohol and I know deep in our cabinets and closets we bury decorated bottles of varying degrees of alcohol.
The role of the psychiatrist comes in when there is significant impairment or distress to a person’s life, as characterized by
His failure to fulfill major obligations at work or school. Evidenced by the inability of my middle aged friend to attend work every day, culminating in his sub optimal performance as a car mechanic in apprenticeship.
His oblivion to realize in the setting of full knowledge, it could be required of him to take a healing car for a test drive and still showed up at work every day heavily intoxicated with alcohol; risking his precious life and the lives of others by the decision to push the car into the seventh gear when on a highway.
His affection for a bottle which has become his happily wedded spouse after his drinking habits push away his wife of 18 years to her matrimonial home. His children follow the trail blaze of their mother’s hurried steps to their grandparents’ home with an attitude of scorn for their father.
His tolerance for alcohol as he jumped from a bottle of beer a day, to five bottles of whiskey a session, to achieve the imagined desired response of curbing his apprehension.
His symptoms of headaches, nausea, tremors, anxiety and seizures which typically occurred following cessation of his drinking habits after listening to a sermon on a TV set.
His strong cravings to devour a beer bottle manifesting as his intense desire to say “Good morning” to a cruet of alcohol under his pillow; on opening his eyes.
His irrationality to recognize it was illogical to fund his drinking habits by using a structured lie of admission of his second daughter.
And lastly, his persistent desire and unsuccessful attempts to cut down his consumption of alcohol; just like a hooked parasite to his brain, draining him psychologically, physically, financially and mentally!
Based on a constellation of all these symptoms, a diagnosis of Alcohol Dependence Syndrome was made for which therapy strongly indicated he had sessions with the psychologist to assess his readiness to quit his drinking habits and pharmacotherapy - which employed the use of medications to either control abrupt symptoms experienced, by willingly discontinuing the use of alcohol or psychotic symptoms experienced by prolonged use of alcohol.
Irrespective of the duration of treatment, patients together with their relatives have to be optimistic there is hope for even the person who will like to put on a bottle instead of a shirt when going to work, and with patience, persistence and time, this patient would be brought back to his toes.
This patient would be seen in a subsequent review in the company of a relative to ascertain the efficacy of our treatment modalities instituted and the need for any adjustment if expectations were not met.
It’s high time we stopped the stigma against people who are seen dazed in gutters on a bright Monday morning, and realize this is a desperate call for help, because he/she could be a relative to a very prominent person you see clad in kente frequently.
Supporting those with alcohol use problems, especially those with alcohol dependence, risky alcohol behaviour, injury from alcohol or alcohol poisoning, has indisputable benefits. These benefits extend beyond the individual to their families, work places and society.
If a friend or a member of your family is using alcohol in a risky fashion, then their alcohol problem needs to be addressed by a doctor.
It is important that members of the general public know how to recognize when a person is either intoxicated or heavily dependent on alcohol and how to help them if the situation arises.
Helping an intoxicated individual can be challenging. Often, the person may be confrontational, argumentative and uncooperative. The individual may also be emotionally unstable and require some emotional support. While it is important to help an intoxicated person stay safe, the first priority must always be your personal safety. If an intoxicated individual becomes violent, then you should leave the scene and call the police.
If you suspect that you or someone you know has developed an alcohol dependency, it is very important that medical advice is sought. People who see a doctor for help to cut down on their alcohol consumption may benefit from the following:
Your doctor will help you work out a drinking goal. It may take time to completely cut down, so it may be helpful to gradually cut down by setting weekly goals;
Some people may benefit from seeing an addiction specialist;
Some people may benefit from seeing a mutual help group; and
For people highly dependent on alcohol, detoxification and medically-managed withdrawal may be necessary.
Let’s make the world a better place and fight against Alcohol Dependence.
Even if you would want to drink, try to drink moderately and do not drink and drive because we need us all alive.
Thanks for reading and have a lovely day!