ANTABUSE



IMPORTANT NOTICE REGARDING ALCOHOL TREATMENT


We have limited availability for the treatment of alcohol problems at present. Please telephone reception on 020 7823 6840 to check availability.



EFFECTIVE, LOW-COST TREATMENTS FOR ALCOHOL ABUSE

The items listed below are the most frequently asked questions.



IS ADMISSION TO HOSPITAL NECESSARY?

Not in most cases. Admission may be advisable when previous attempts to stop drinking, even for a few days, have failed because of severe alcohol withdrawal symptoms such as the shakes, sweating, vomiting, sleeplessness and, in extreme cases, visual hallucinations (DTs, 'the horrors,' 'pink elephants'). However, most people who want help for drinking problems don't have severe withdrawal symptoms. Withdrawal can often be managed at home by the family, with medical advice and a short course of sleeping tablets and anti-withdrawal medication. Sometimes a private nurse is needed, perhaps just during the day. Many patients have no difficulty in stopping drinking; it's staying off for long enough to get used to moderation or abstinence that is difficult. Some people with medical insurance naturally feel that if they're going to be a bit under the weather for a few days, they are better off in hospital than at home, but it's largely a matter of taste and finance.


IF I DO HAVE TO BE ADMITTED, HOW LONG WILL I HAVE TO STAY?

Even people with quite severe withdrawal symptoms can usually be returned home within two or three days, unless there is nobody to look after them. Hardly anyone needs to stay for more than five days, though some may prefer to for non-medical reasons.


IS WITHDRAWAL UNPLEASANT?

It shouldn't be, if you receive generous doses of sleeping tablets and anti-withdrawal drugs. We believe that a bad withdrawal is usually a bad start to treatment, so we try to make it as comfortable as possible. At night, our philosophy is that sleeping patients are happy patients.


CAN I GET ADDICTED TO ANTI-WITHDRAWAL DRUGS?

There's a slight risk, but we keep a careful watch for any signs of abuse, etc. Fortunately, several non-addictive drugs are often very effective. In any case, needing a small dose of sleeping tablets for a few weeks is a much less serious problem than excessive drinking.


IF I START TREATMENT, WILL I HAVE TO GIVE UP ALCOHOL FOR
THE REST OF MY LIFE?


It depends. If this is your first attempt at dealing with the problem, and if drink hasn't wrecked your life too much, attempts to return to controlled drinking may be a reasonable aim at some stage, though they won't always succeed. If you've had a lot of treatment and have tried and failed several times to drink moderately, we probably ought to help you to accept defeat gracefully. At any rate, controlled drinking is not a taboo topic with us.


CAN I START TREATMENT WITH A CONTROLLED DRINKING PROGRAMME?

Yes, in some cases, but we think it is more likely to succeed after a period of abstinence than straight after months or years of heavy drinking.


HOW LONG IS 'A PERIOD OF ABSTINENCE'?

It's a very individual matter. At least three months; often six or twelve. That may seem a long time but if drinking is so important to you, it's worth taking the time to get it right (and perhaps to talk about why it's so important.) If you do get it right, you may have many years of moderate drinking to enjoy. If you don't, you're going to have to resign yourself to years of total abstinence or continued alcohol abuse.


SIX MONTHS? I'VE HARDLY EVER MANAGED SIX DAYS. HOW DO I DO IT?

Surprisingly, a lot of people find that once they accept that they need help, and actually get as far as seeing someone about it, they can stop drinking or cut down without much difficulty because their attitude to the problem changes. If your willpower isn't strong enough, or if it is strong but you have too many pressures and temptations to drink, we have some useful ways of reinforcing
it.


DOES THAT MEAN LOTS OF COUNSELLING OR GROUPS?

Usually neither. We think there's a place for intensive counselling - which basically means talking, listening and informing - in selected cases. The same goes for the more elaborate types of counselling called psychotherapy. But stopping drinking for long enough for the dust to settle is usually the most important part of treatment. Only then can the need for special counselling or
psychotherapy be properly assessed. A lot of problems are the result of excessive drinking, not a cause of it. If drinking stops, they often go away. As for groups, we think most people prefer to discuss their problems in privacy with one person who knows their case, but some patients find a group helpful.



WHAT IF I JUST CAN'T STOP DRINKING FOR LONG?

Then we would probably advise you to take Antabuse under supervision.


WHAT IS ANTABUSE?

Antabuse (also called disulfiram) is a drug, which has been around for over fifty years. If patients who are taking an adequate dose of it drink more than very small amounts of alcohol, it causes a very unpleasant reaction to develop within a few minutes, which gets worse if you keep drinking. Having more than a pint or two is usually impossible because you would be feeling too sick to lift a glass. So people on Antabuse usually don't drink, for the same reason that people don't exceed the speed limit if they see a police car in their driving mirror. If they do risk drinking, they usually don't do it again.


BUT IF I REALLY WANT TO DRINK, I'LL JUST STOP TAKING IT.

Of course, but there are two obstacles. First of all, the effects last for up to a week after the last dose. Secondly, we don't usually prescribe Antabuse without asking you to agree to have a third party actually see you taking it.


WHAT SORT OF THIRD PARTY?

Usually a family member - your partner, a parent or one of your children - but it could be a friend, a colleague, your secretary, a neighbour, your GP or the local vicar. Someone you can't easily avoid meeting once you've agreed. We will want to explain to them - in person or over the phone - how to do the job properly and answer any questions they may have. We'll also ask them to let us know promptly about any problems so that we can try to limit the damage. You could come to one of our clinics three times a week, but it's usually easier and much cheaper to use your family or friends.



SUPPOSE I REFUSE TO TAKE IT AFTER A WHILE?

Well, it's a free country, but if you refuse, you're virtually making a public declaration that you want to go back to your old ways and that you don't want treatment. That's a serious matter and the implications will be obvious to everybody. In any case, by the time the effect of the Antabuse has worn off, you may have lost the urge to drink.



WELL, I COULD JUST PRETEND TO SWALLOW IT, AND SPIT IT OUT LATER.

We've thought of that. That's why we ask your supervisor to dissolve it in water before giving it to you. We've also thought of all the other ways you might try to avoid facing up to your problems. They're some of the things we tell your supervisor when we brief them.



ISN'T THIS GOING TO CREATE A LOT OF ARGUMENTS?

Not half as many as if you carry on drinking too much. In any case, it was our idea and you agreed to it. If you want to argue, argue with us, not with your wife or husband.


BUT I DON'T LIKE TAKING DRUGS.

You seem to make an exception for alcohol.


WHAT ABOUT SIDE EFFECTS?

Compared with the alcohol you've been drinking, very few. All effective drugs will cause some side effects in some people, but as drugs go, Antabuse is probably rather less dangerous that aspirin. The most serious 'side effect' is the reaction with alcohol, but that's why we prescribe it. Very occasionally, the reaction can be fatal, but continued heavy drinking is much more dangerous.


WHAT'S THE EVIDENCE THAT IT WORKS?

Several controlled, scientific studies from good universities and hospitals during the past 20 years have shown that a combination of supervised Antabuse and fairly simple psychological treatments is very effective and often succeeds when purely psychological methods fail. Research also shows that intensive in-patient treatment doesn't seem to give better results than good out-patient treatment and is very much more expensive. We can give you the research references if
you want.


SHOULD I GO TO ALCOHOLICS ANONYMOUS MEETINGS AS WELL?

If you find them helpful or want to learn about their approach, AA can provide a useful alternative, especially if all your friends are heavy drinkers. Some alcoholics really take to it but a lot of people don't like the atmosphere of AA meetings. Many AA groups are hostile to Antabuse, even though the official AA publications accept it. They are even more hostile to controlled drinking programmes. We have recently helped establish a SMART Recovery group in London. They offer the group support and self-help features of AA but are much more flexible and pragmatic. SMART Recovery recognises that medication like Antabuse can be very helpful for recovery. We can give you contact numbers if you are interested or you can visit their web site through our linked-web sites page at this direct link SMART


OK, HOW LONG DO I TAKE IT FOR?

We usually suggest six months initially, and then you should stay dry for at least another six months without Antabuse. By that time a lot of people who were at one time interested in a return to controlled drinking have got so used to not drinking that they decide to stay that way. If you relapse, we'll ask you to go back on to it to get the situation under control again. A few people need to take it for years until they get the message.

WHAT ABOUT ALCOHOL IN FOOD AND ALCOHOL-FREE WINE AND BEER?

You're generally safe with cooked food - sauces etc. - because the alcohol evaporates. It's best to avoid cold alcoholic foods like real trifle. 'Alcohol-free' drinks - containing 0.05% alcohol or less - such as Calibre, Clausthaler and Eisberg are permitted.


WHAT IS TREATMENT LIKELY TO COST ME?

If all goes well, we will want to see you on about eight to ten occasions spread out over twelve months. We often like a family member to be present during some of the consultations, which will usually be half an hour in duration. Sometimes we can consult by telephone. If you stay dry, or at least sober, that shouldn't cost more than about 850. If you have a lot of relapses or underlying problems, it could be twice that amount, but don't forget that drinking the equivalent of five pints of beer or two bottles of wine a day could cost you at least 3000 a year. Even if you have to be admitted for withdrawal from alcohol, it needn't add more than 450 - 900 to the bill. (We have admitting arrangements with several private hospitals in and around London, including some very discreet ones with no psychiatric or alcoholic connotations.) Antabuse is not a very expensive drug and most GPs will give you an NHS prescription for it. Some private medical insurance policies will cover all or part of the consultation fees and in-patient charges.


IF I DON'T WANT TO TAKE ANTABUSE, ARE THERE OTHER MEDICAL TREATMENTS WHICH MIGHT BE HELPFUL?

Research indicates that no other medical treatment is quite as effective as supervised Antabuse but two other drugs, naltrexone and acamprosate, can also be helpful in reducing excessive drinking or prolonging periods of abstinence. Please see the separate information sheet for details of treatment with
these drugs.

LEGAL PROBLEMS?

If you are facing trial for an alcohol-related offence (eg violence or drunk driving) agreeing to take Antabuse and have blood tests as a condition of probation can sometimes lead to a more lenient sentence. Your solicitor can advise you if a report would be helpful