Nottingham Alcohol and Drug Team, The Wells Road Centre, The Wells Road, Nottingham NG3 3AA and
1 Sneinton Hermitage, 3537 Sneinton Hermitage, Sneinton, Nottingham NG2 4BT, UK
Received 5 November 2001; in revised form 13 December 2001; accepted 16 January 2002
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ABSTRACT |
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INTRODUCTION |
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The 20th century construct of alcoholism, characterized by impaired control over drinking, has been challenged (Heather and Robertson, 1981), but still pervades the alcohol treatment field. It predicts that using alcohol for alcohol withdrawal is irresponsible and doomed to failure. In the present report, we demonstrate the successful withdrawal from alcohol of a subject by using monitored alcohol consumption.
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CASE HISTORY |
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At the time he presented, he was consuming up to 6 l of strong cider daily and experiencing withdrawal symptoms on waking-up. The hostel employs trained nursing staff, with close links to local specialist alcohol services. It supports sobriety, but is not a dry house, and encourages residents to restrict their levels of intoxication. The staff became aware that the resident had a large store of cider in his bedroom and suspected that he intended to drink heavily before medication could be arranged. Consistent with their restriction of levels of drunkenness, they suggested he drink his cider more slowly that day. He was receptive to this advice.
Procedures and results
He gave his supply of cider to the staff on the morning of the first day and without objective signs of alcohol withdrawal, at a breath alcohol concentration (BrAC) of 110 µg/100 ml, and was given 275 ml of 7.5% ABV cider. The staff judged that, to wait for the emergence of withdrawal symptoms, or even delay the first dose of cider at all, would probably result in demands for all the cider to be returned. Thereafter he repeatedly requested cider and 275 ml was given on occasions when his BrAC (Table 1) had declined by any measurable amount since his last drink (the breathalyser measured in 1 µg/100 ml increments). The interval between glasses of cider varied but averaged
2 h, and the staff's efforts to build in some delays to rebreathalysing resulted in variable incremental falls in BrAC between drinks. To avoid onset of withdrawal symptoms during the night, the patient was given 1 l of cider before going to bed. He enjoyed being breathalysed and was interested to see if his BrAC had fallen. He breathalysed negative at the start of the third day, and was not exhibiting alcohol withdrawal symptoms. He was therefore given no further cider and congratulated on completing his detoxification. The staff noted his disappointment that the detoxification had finished and feared that he would immediately restart drinking cider. However, with support he remained abstinent from alcohol for 5 months.
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DISCUSSION |
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Alcohol withdrawal with alcohol empowers the client, because it achieves a desired goal through a process that makes obvious the importance of the client's own choice to stop drinking. It demystifies and demedicalizes the process of stopping drinking. The experience of the present case study is that the structure and monitoring were essential to the client's motivation and compliance. We doubt that similar levels of nursing supervision could be achieved in most hostels, so this probably does not represent a widely applicable therapeutic approach for this difficult-to-treat population. An alcohol detoxification ward could provide the environment and resources to best evaluate the use of alcohol as a detoxification agent, but this too presents problems, perhaps in particular the acceptability to other patients. Additionally, the dangers specific to the detoxification process remain scarcely evaluated, and drinkers with a variety of physical complications and behavioural disturbances may be unsuitable for an alcohol detoxification using alcohol.
Dolinsky and Babor (1997) concluded that there is no evidence of long-term harm from ethanol administration research involving alcoholics as human subjects', and suggested an ethical framework for future clinical work. Their conclusions are based on a review of the administration of alcohol in a wide variety of research designs and treatments; but they make reference to only one study of alcohol withdrawal using alcohol. Nevertheless, their conclusions and our experience in the present study should help allay fears that administration of alcohol to such individuals might lead to more drinking in the future. This removes the major barrier to research into the use of monitored alcohol consumption to achieve withdrawal from alcohol.
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FOOTNOTES |
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REFERENCES |
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