Tuesday, 28 October 2008

Democracy is Coming

A particularly relevant favourite from LC (who I will be seeing in concert soon)

Tuesday, 21 October 2008

Alcohol misuse treatment & support

Alcohol Concern is the national agency on alcohol abuse. Their website publishes a number of leaflets and fact sheets and there is a directory of all local drug & alcohol services in the UK searchable by area. The directory also lists residential support providers. Some of the providers in the list are private organisations as opposed to those supported by public funding.

ARP is a London based charity & registered housing association. They run a number of treatment programmes including one aimed at the black community and one for women.

Of particular interest to people with alcohol involved in care proceedings are the rare residential units who will accept parents and children. Phoenix Futures runs two such units in Brighton & Sheffield - you do not have to be drug / alcohol free on admission as they also provide detox. They will accept children up to 10 years' old. You can refer yourself to their service as well as getting referred through your GP, social services or other drug / alcohol support services. You are likely to need help from your local heath service to get funding organised for this type of placement which can take a long time to organise.

A similar facility available in Wales is Ashcroft House . Their website does not seem to say whether they will only take mothers and children from within Wales but they only take children up to 8.

The Maya Project is another good centre for residential rehabilitation. It is a women only project (taking women from all over the UK) and although they will work with pregnant women, they don't take children.

St Michael's Fellowship also offers a residential service to support those who wish to become or remain drug or alcohol free and will accept children. Their website does not contain much information about this aspect of their service but there is contact information to find out more. Generally referrals have to be made or supported by social services.

You should be aware that there are often some restrictions on who these sorts of project will accept - for example, they may not accept mother with a mental health problem other than / as well as alcohol or drug issues, or people with convictions for offences against children or with convictions for arson etc. Residential facilities are not generally available for couples and children. As far as I can see all the facilities require that abstinence from alcohol is a goal and, of course, you are not allowed to drink or use drugs whilst in the unit although there are usually detox services offered for those who cannot stop using straight away. Generally, parents will not be able to have their children with them for any detox part of the programme.

Addaction is the largest UK drug / alcohol charity and also has a good website and a directory of UK service providers.

Sunday, 19 October 2008

Alcoholics Anonymous

Many of my clients who have drink problems refuse to go to the obvious place for help: Alcoholics Anonymous . Over the years I have been given numerous different reasons and I thought I would do my best to debunk a few of the myths about AA.

A common objection to AA is to say - I am not an alcoholic. AA itself acknowledges that there is no definition of 'alcoholic' but they suggest it may mean something like 'a physical compulsion coupled with a mental obsession'. But no one in AA will tell you that you are an alcoholic - only you can decide that for yourselves.

Net doctor equates alcohol dependence with alcoholism and says

"In alcohol dependence a number of features come together in the behaviour of the person affected.
* Drinking begins to take priority over other activities. It becomes a compulsion.
* Tolerance develops, so it takes more alcohol to produce drunkenness.
* Withdrawal symptoms such as anxiety and tremor develop after a short period without a drink, and are reduced by taking more alcohol.

Many addiction specialists, however, draw a distinction between alcoholism and alcohol dependence.

"Alcohol dependence, as described in the DSM-IV, is a psychiatric diagnosis describing a physical dependence on alcohol. For a person to meet criteria for Alcohol Dependence (303.90) within the criteria listed in the DSM-IV, they must meet 3 of a total 7 possible criteria within a 12 month period. The first 2 criteria are related to physiological dependence: tolerance and withdrawal. The 3rd and 4th criteria establish a pattern of losing control of drinking by breaking drinking rules or failing at attempts to quit or cut back. The 5th and 6th criteria are indicative of a progression of addiction as more and more time is spent on drinking and lifestyle changes result. The seventh criteria for Alcohol Dependence is met when a person continues to drink despite being aware that their drinking is causing or excacerbating some psychological or physiological problem(s). It is important to note that because only 3 criteria of 7 are required in order to be diagnosed with Alcohol Dependence, not all meet the same criteria and therefore not all have the same symptoms and problems related to drinking. Not everyone with Alcohol Dependence, therefore, experiences physiological dependence. Alcohol Dependence is differentiated from alcohol abuse by the presence of symptoms such as tolerance and withdrawal. Both alcohol dependence and alcohol abuse are sometimes referred to by the less specific term alcoholism. However, many definitions of alcoholism exist, and only some are compatible with alcohol abuse." (from Wikipedia).

This explains why an addiction specialist may say that it is not necessary or essential for a person with an alcohol problem which does not meet the criteria for alcohol dependence to have a goal of abstinence.

Only you can decide whether your lack of control over drinking is one which means that you could be described as an aloholic and ought to have abstinence as a goal short-term or long-term. The only thing AA requires is that have a desire to stop drinking one day at a time.

To help you decide on the level of your own problem there are two particularly good leaflets on the AA website.

* the AA newcomer pack

* Who Me?

I have already posted about some of the reasons why people resist accepting the description alcoholic - I don't drink on my own, I don't drink spirits, I don't drink every day, I don't drink as much as X, I hold down a job, I don't suffer from the DTs, I don't live on a park bench. All these can be true and you might still be an alcoholic. People often think of AA as full of people for whom all those things are true and as an unglamorous place to hang out. Actually many meetings are full of people who have spent years telling themselves all those things but have finally come to realise that they cannot win the battle with alcohol. I recommend that anyone interested in AA calls the helpline, gets some individual support from a current attender, goes to several different meetings (each meeting group runs its own show and has a different feel and type of membership - lunchtime and weekend meetings are likely to be full of high functioning job-holding people) until you find one you are comfortable with. Clients often also say that they are put off by the idea of a group meeting. Well, I say, suck it and see. You don't have to say a word until you are ready. Just listen if you want. Stay for tea and an informal chat afterwards and see if you find people you click with.

I don't say just do it for this reason but if you are in care proceedings and you want to show people you are serious, AA is the quickest way to do it. Although there is a limit to their willingness to be involved in court cases (it is an anonymous organisation after all) they will often write letters confirming that someone has been attending regularly and offer to come to court with you to offer support. AA attenders will also be there to offer support long after the local Drug & Alcohol service has shut for the night and over the weekends when social workers are not available.

The leaflets that I have linked to and other materials on the website also deal with a number of the other issues people say they have with AA eg the God thing (it's not allied to any religion and you can interpret your higher power as whatever works for you), the lack of time to attend meetings (funny how there was always time to drink) etc. Examine each of your objections critically and make sure they are not just excuses.

That said, AA is not the only way and I will be posting about other ideas in later posts.

When You Are Old & Gray

Tom Lehrer does not look forward to growing old together

If you think s(he) is the only one for you ...

Tim Minchin's thoughts on whether he's found the one ...

Monday, 13 October 2008

Drink problems

There is a facetious answer to the question - what is a drink problem. Empty glass is the problem - another drink the solution. Or drink is the solution - now what was the problem again? In care cases, however, the usual joking between mates will not do.

I am talking about this because I seem to have had a run of cases involving alcohol misuse in which several essential questions have been debated.

* at what point does one person's drinking become such a problem that the state is justified in interfering?

* what is the definition of an alcoholic?

* what is the definition of alcohol dependence?

* is the only solution to an alcohol issue abstinence?

* can controlled drinking ever work?

* how many chances / how long a timescale is it reasonable to allow someone with an alcohol issue to have before the court should make arrangements for a child to be placed outside the family?

I have found myself over the years giving clients the same advice - first on a general level:

* an alcoholic is not just defined by - someone who starts drinking first thing in the morning and cannot function during a normal day without a drink, that person who drinks more than you and at all hours of the day or who drinks spirits whereas you only drink wine or beer, or the person who drinks alone whereas you only drink in company, or someone who drinks out of a paper bag on a park bench or has lost their driving licence (you just don't drive so you don't drive over the limit) or lost their job.

* you could only drink a bit too much once a year but if every time you do so you kill someone you have a serious alcohol misuse issue. We rarely know what we are like for other people when we have been drinking. Binge drinking is not necessarily a separate issue from alcoholism. Very few of your friends are going to tell you just how awful you are when you have been drinking, particularly if your are that friend that they use as an excuse to hide behind ie I am not an alcoholic because X drinks more than me. Many people who are alcohlics or have drink problesm are highly successful in certain areas of their lives.

* if you don't have a problem and could give up any time then when care proceedings are issued that is a good time to give up - you may not be someone who can never drink again but abstinence is the best way of avoiding all doubt on the issue - if you can take it or leave it then leave it

* don't kid yourself that the kids don't know you drink just because you think you only get drunk once they have gone to bed

* don't kid yourself that just because you aren't falling down drunk when you meet people or pick the children up from school no-one will notice. Alcohol smells. People can tell from you slurring your words or your level of excitability or the way that you cannot be contacted whenever you are off having a little drink.

* Just because the alcohol advisory service / Psychiatrist you are seeing does not think your physical dependence on alcohol means that the only solution is lifelong abstinence does not mean that you should not just stop. The job of the alcohol support service is to support you no matter what and they will not want to put you off by insisting on abstinence. But your children may need you to stop, your partner may need you to, the professionals may need you to, in order to rebuild confidence. And if it has taken you to a certain low level in life maybe abstinence is something which will be good for you too.

* once drink is raised as an issue you should know that if you say you drink 2 bottles of wine a week or a day everyone will assume that means at least 4 & add one for good measure

* Denial is not a river in Egypt

Here is one test that is applied by Psychiatrists and other substance misuse specialists to decide if you have a problem at the alcoholic level:

Have you ever felt you should cut down on your drinking?
Have people ever annoyed you by criticising your level of drinking?
Have you ever felt bad or guilty about your drinking?
Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover?

If you answer yes to any two of these questions it is considered to be clinically significant & you have a drink problem. I am sure many people who have ever had a drink will be tempted to answer yes to some of the above questions but if you know that these are regular issues for you and you have lost your driving licence or been convicted of failing to provide a specimen or lost a job or a relationshp or friends or care proceedings have started my main advice is don'r bury your head in the sand. There are a huge range of sources of support and I will be posting more about this later.