He came into the office shaky and nervous with what he was about to do. His life was spiraling out of control: he was losing friends, had difficulty holding down a job, now his wife had even divorced him. He knew it was time to turn things around. He knew it was time to quit drinking.
For the last few days he was drinking about 10 beers a day. He would drink himself to sleep. When he would wake up in the middle of the night, he would again start drinking. His day would begin with a drink.
But he was tired of it now and wanted to quit. However he had heard about someone who had tried to quit on their own. As a result that alcoholic had a seizure and ultimately died.
Alcoholism has a high recidivism rate: patients easily fall back again into the addiction. Using the Stages of Change Model, I see that he is in the Preparation or Determination Stage. In order to help resolve in any remaining ambivalence, I put his commitment to the test.
Are you sure you want to quit?
He answers yes confidently.
You know quitting alcohol is very difficult. Most people go back to it after quitting. This will be the hardest thing you will do in your life. Are you sure you want to quit?
He answers in the affirmative even more determined.
Now I will put you on a tapering dose of medications to prevent you from having a seizure and mitigate the effects of alcohol withdrawal. However, nothing we do is without risk. You still could have a seizure and die despite all these precautions.
He remained unfazed determined to quit.
If you truly are serious about quitting and if you want me to work with you, then I need you to do the following: You must see me every day in the office. You must go to AA meetings every day. You will not be working during this time. You will need someone to drive for you.
Again he told me how willing he was to do anything and everything to quit drinking. Alcohol had destroyed his marriage, it had destroyed his life. He was ready to turn around.
The next day I see him in the office. He says he’s feeling better but he can barely keep his eyes open. His heart is still fast and he feels agitated.
We have a long talk about the effects of alcohol.
Alcohol affects the frontal lobe. This is the part of the brain responsible for critical thinking, moral decision making, empathy, and spirituality. So it’s the part of the brain that helps you make smart decisions. It helps you discern right from wrong. It allows you to have empathy and compassion for your partner. And perhaps it’s even the place where we hear the voice of God himself. Just one drop of alcohol and your frontal lobe checks out. At what point do you not need to hear the voice of God? At what point do you not need to have empathy and compassion for your spouse? At what point do you not need to have the capacity for moral decision-making?
Phineas Gage was a fascinating case study of someone who lived during the 19th century. He was someone who was a good citizen, married with children and went to work everyday on the railroad. While he was working with dynamite, a malfunction occurred and one of the metal rods went through his skull. Somehow the metal rod went through his skull and penetrated only the frontal lobe of the brain. Miraculously he survived. He was essentially given a frontal lobotomy. Phineas Gauge went from an upstanding citizen to a totally different person. He no longer could hold down a job. He left his wife and children and was later noted to be frequenting the bars.
Phineas Gauge’s frontal lobe was checked out. Yet we do the same thing to our own frontal lobes whenever we drink alcohol.
Jeff seemed to soak it in.
The following week I saw Jeff in my office. He seemed to be a changed man. His heart rate was now normal. He had a smile on his face. Everyone tells me I’m my old self again. I’m actually nice again.
Here’s the Best Part…
The best part was the woman he brought with him. She introduced herself to me, I’m Jennifer, Jeff’s wife.
Turns out Jennifer had divorced Jeff due to alcohol just a few months ago. Jennifer’s mother actually coerced the divorce. Jennifer needed to move out and a place to stay. As a condition of moving in with her Mom, she required her to divorce Jeff. But deep down inside Jennifer still loved Jeff.
Jennifer, too, had a drinking problem. They both got into drinking around the same time and it destroyed their relationship. Facing enormous stress, they turned to alcohol. Both sides of the couple had parents telling them how to live their lives. Jennifer had two miscarriages from the enormous amount of stress. She turned to alcohol. They both turned to alcohol.
But the day I saw them both they were happy. They were reconciling their relationship since they both put alcohol behind them. That afternoon, they were getting married.
What to Tell Your Alcoholic Patient…
What do I tell my patients whose lives have been ravished by alcohol? Here’s the summary.
- It’s the hardest thing you’ll ever do. The statistics suggest that you won’t succeed. The only chance you have is give total commitment.
- You have to go AA meetings everyday. You need to know you’re not alone. Others have traveled this road. Knowing they got through this will help you. You will also need accountability. Don’t think you can take this on your own.
- You have to see me everyday. We’re doing something dangerous here and you could be at risk for seizures and death. Even with all the medicines this could happen to you.
- Realize that you life has come to point where you need to lean on a higher power. Lean on God, on the Divine, on the guiding principle in your life that is compelling you to be a better person.
- Alcohol affects your frontal lobe – the area responsible for self-control, moral decision making, empathy and spirituality. At what point in life do you not need those facilities intact? Even a drop can be dangerous. As my mentor puts it, At what point do you not need to hear the voice of God?
- You have to see how alcohol has largely affected you by worsening your specific condition. Look how it has worsened your depression, anxiety, diabetes, blood pressure, relationships, stress, etc.
What are some ways you have talked with a patient to help release them from the addiction of alcohol?