In response to Question 3 on page 33: He is taking between 200-300
ml. of alcohol a day. the equvalent of a 70cl bottle of spirits. Cider is
the best buy, the most alcohol for the least money, a sign of a serious
drinker. On this dose of alcohol his depression would have been due to
alcohol and an anti-depressant would not be useful and even hazardous in
overdose. The popular view is that the depression leads to drinking rather
than in fact the other way round. The principal of treatment is to reduce
alcohol intake to a safe level that may be zero.It is very likely that his
intake should be zero on clinical not moral grounds.
In response to
questions 2 & 3 on page 98: About five years ago Mr. Bond has left his
wife and children and gave up his job.This suggests an alcohol 'career
move'to minimise restraints upon his drinking. He has continued in this
career in spite of very serious consequences. We should look at the career
trajectories of those dependent on alcohol ( and other drugs).
One patient
said to me that alcohol was his lover. We could think alcohol getting into
the brain through the back door,the blood stream. It gets into the
machinery of the brain including the 'reward system' and the brain
mechanisms for attachment to others. Is an addiction to alcohol the
equivalent of falling in love? You are'locked on' to alcohol as if it were
your lover. Love affairs have careers of their own including staying
attached to ones lover in spite of any hardship. We can think of the
continuing attachment of abused spouses. If Mr. Bond can see his
relationship with alcohol as a literal (or even metaphorical) love affair
with an abusive partner and realise just how difficult it is to break such
a relationship. He may come to see and feel in his head and heart that
this relationship is so destructive that he must part company with
alcohol.
As our attachments to others will last unto death so may
Mr.Bond's attachment to alcohol. He should come to understand this
situation and his dilemma. Then he may be in a position to make a choice
about drinking or not drinking. But like anyone strongly attached to an
abusive 'partner' there are always an infinite number of reasons not to
part! Any attempt to help is a threat to this realtionship and it will be
difficult to engage Mr. Bond is support for a change that would separate
him from alcohol. Alcoholics Anonymous is always on hand and other methods
of care may be available. Mr. Bond has choices, the fatal option to keep
drinking or the much more difficult one of changing the fundemental
direction of his life.
Rapid Response:
Comment on the case study
In response to Question 3 on page 33: He is taking between 200-300
ml. of alcohol a day. the equvalent of a 70cl bottle of spirits. Cider is
the best buy, the most alcohol for the least money, a sign of a serious
drinker. On this dose of alcohol his depression would have been due to
alcohol and an anti-depressant would not be useful and even hazardous in
overdose. The popular view is that the depression leads to drinking rather
than in fact the other way round. The principal of treatment is to reduce
alcohol intake to a safe level that may be zero.It is very likely that his
intake should be zero on clinical not moral grounds.
In response to
questions 2 & 3 on page 98: About five years ago Mr. Bond has left his
wife and children and gave up his job.This suggests an alcohol 'career
move'to minimise restraints upon his drinking. He has continued in this
career in spite of very serious consequences. We should look at the career
trajectories of those dependent on alcohol ( and other drugs).
One patient
said to me that alcohol was his lover. We could think alcohol getting into
the brain through the back door,the blood stream. It gets into the
machinery of the brain including the 'reward system' and the brain
mechanisms for attachment to others. Is an addiction to alcohol the
equivalent of falling in love? You are'locked on' to alcohol as if it were
your lover. Love affairs have careers of their own including staying
attached to ones lover in spite of any hardship. We can think of the
continuing attachment of abused spouses. If Mr. Bond can see his
relationship with alcohol as a literal (or even metaphorical) love affair
with an abusive partner and realise just how difficult it is to break such
a relationship. He may come to see and feel in his head and heart that
this relationship is so destructive that he must part company with
alcohol.
As our attachments to others will last unto death so may
Mr.Bond's attachment to alcohol. He should come to understand this
situation and his dilemma. Then he may be in a position to make a choice
about drinking or not drinking. But like anyone strongly attached to an
abusive 'partner' there are always an infinite number of reasons not to
part! Any attempt to help is a threat to this realtionship and it will be
difficult to engage Mr. Bond is support for a change that would separate
him from alcohol. Alcoholics Anonymous is always on hand and other methods
of care may be available. Mr. Bond has choices, the fatal option to keep
drinking or the much more difficult one of changing the fundemental
direction of his life.
Competing interests:
None declared
Competing interests: No competing interests