I'm not sure what can be done here. Having had a very close relative (as close as it gets, but I don't wanna associate anything precise publicly) being an alcoholic for decades, watching them succumb, degenerate and eventually die over a long and horrifying period, I don't see how the medical system can be the solution to this problem.

The motivation to stop drinking and continue to stop drinking has to be mostly intrinsic. There can be additional extrinsic factors (like doing it for your family) strengthening the intrinsic motivation, but without a strong and constant inner will to stop nothing will.

My relative took the final bottle of Whiskey on a lonely Christmas day. It took 2 months of suffering before it finally ended for good. No medical system can prevent the loneliness and dark times. And relatives also have their own lifes.

Addiction is a terrible problem and it's great that there is help for the persons motivated to seek help, and AA is a good initiative for that. But not everyone can be helped.

I have a friend in the UK, similar situation. After years of receiving no help I took it upon myself to figure out what was causing his self-sabotaging behaviour. I can't say I made any great discoveries other than figuring out his trigger points and devising strategies to avoid them.

Obviously everyone is going to be different but my friend's issues stem from being lonely and isolated a lot of the time. Simply me being around for a couple of days a week has helped. He still drinks but in a much more controlled manner and, ironically, I found that ensuring he always has a supply at home has helped with this too. It's taken away the constant panic in his mind - for want of a better explanation.

Could you expand on "I found that ensuring he always has a supply at home has helped with this too"?

I guess you mean that when they'd go out to a pub or bar they'd spend too much, which means that social pressure of embarrassment and bar-staff weren't effective controls. Did the extra money spent add to the pressure?

What I'm curious at is that makes it sound like they're somewhat controlled within their home, or just haven't got an easy source. If that's the case I wonder how small nudges around the home (putting alcohol in a tricky to reach cupboard or out-of-sight) would help.

He would buy his drink daily, not always from the same place and not at the same time. So some days he'd buy a bottle of cider, other days a bottle or two of wine, a bottle of spirit, etc. In other words, his alcohol consumption was erratic and the fact he had to go out and buy it everyday sometimes led to unintended outcomes such as mixing with the kinds of people with similar issues, having small accidents, being robbed a couple of times, and so on..

I don't know what went through his mind every morning but I'm sure that buying his daily alcohol fix was a top priority and everything else was secondary.

I figured that if he got up everyday without this nagging thought in his head then it may help him regain some semblance of control? Because I bought the same brand of drink and in enough quantity to ensure he wouldn't need to go out any buy anymore each day, it also helped him establish a steady routine. In a way, it made it boring for him but not to the point where he'll resort to his previous behaviour. The fact he isn't paying for it is also a motivating factor, obviously.

A year on and he's now in a routine where he doesn't drink before 3pm and then only one 1 ltr bottle of 5% strength cider. His health and general mood have both improved and, most importantly, there have been no hospital visits.

I describe him as alcohol dependent rather than a full-blown alcoholic because his drinking is more a learned habit rather than pure addiction. I'm not sure my strategy would work so well otherwise and I would certainly caution against it.

Hmm. How much experience do you have with alcoholics? To me this sounds very naive. I have seen various forms of well meaning enablement that follow this exact pattern. The drinker still buys drink for themselves on top of their "ration" while maintaining a facade of moderation for the one buying them drink. If someone is meeting them a couple of times a week, then they plan bigger binges around those visits.

I have had the pleasure of clearing out the private stashes behind the washing machine or garages full of hidden empties despite the claims of a gullible enabler about the progress being made. 1l of 5% is barely going to wet the whistle of a dependent drinker making me less inclined to believe this is a unicorn case of magical moderation. If there is one thing that happens very early in problem drinking, it's all the fucking lies about drinking.

Well, I did point out that he isn't a full-blown alcoholic which is a big difference to the kind of issue you're alluding to.

I did have the dis-pleasure of living with a proper alcoholic many years ago and she was exactly the type of person to have hidden stashes around the house. Alas, she was also the kind of drinker who needed to hit rock-bottom before she would even accept she had a problem and nothing I could do would be of any help to her.

She was a 'functioning alcoholic' able to hold down a job, be presentable and sociable. Also clever and devious enough to hide her problems from others to the extent that I left the relationship being perceived by others as the bad guy.

So yes, your points accepted but for the naivety on my part.

Something people don’t expect from alcoholics is that they become extremely effective at masking their issues. If they’re intelligent, they might even trick a lot of people around them into thinking they have a chronic illness or something - no one suspects a thing. In the way they speak and behave to hide their problem they show a sort of cunningness you don’t often see.

That’s not to say alcoholics are bad people. The need to drink is just an insane motivator for some. It makes it extremely hard to help them because it becomes nearly impossible to trust them, and that alone can be a massive strain on a relationship.

But I have no trouble believing a relationship would end with you looking “bad”; this sort of thing is part of hiding their problem and protecting their habit. You getting thrown under the bus is a strategy to draw attention away from evidence that her being an alcoholic was destructive to your relationship.

This is obvious to some people but has been a real revelation to me as I’ve gotten older and seen alcoholism around me more. It’s extremely insidious and difficult to navigate.

Wow, that's impressive. You made it made it boring for him. I appreciate the caveats but from my arm-chair perspective it looks like you're doing the right steps here.

I think this is an extremely fascinating reply, and potentially very effective. Speaking from personal experience on the other end. It’s difficult to describe the energy that takes you to the store, but prevents you from doing everything else in life. Something like anxiety-constrained motivating, but taken to the extreme.

Not GP, and not battling any major addiction (luckily), but this reminded me when I got fit/lost some weight (~20 pounds or so) a decade ago.

I simply (not easily) cut out snacks (candy/chips/sugary drinks/etc) but my main vice was ice cream. So I kept a pint of my favorite kind (mint chip) in the freezer. I don't know how I got the idea, but my reasoning was that it gave me a singular focus on what to avoid, instead of navigating 50 traps, there was just 1. If I was at the store I didn't have to be tempted by anything as I already had my favorite at home.

No idea if it is the same idea as GP describes, but it reminded me.

I've dealt with an alcoholic for almost my entire life. Unless that person decides to stop, there is nothing a hospital (or anyone else) can do. It's sad and it's hard, but it's the reality.

>>then push you out the door and tell you to find an AA group.

What is it exactly you want the hospital to do if your friend won't stop drinking?

Your comment illustrates a large part of the problem. If society believes addiction is mostly a willpower problem, then effective services to help address it won't exist.

I am an alcoholic sober for several years. It is fundamentally a willpower problem. Even if insurance or the government paid for inpatient rehab, as soon as you walk out the door it’s only willpower that stops you from continuing to drink. The same goes for being given medication that reduces cravings for alcohol or makes you sick if you drink. You can always just not take it.

That said, most people don’t become addicts in a vacuum. Many people become addicts only because a life under the influence beats their life otherwise. Unfortunately it’s a lot harder to fix someone’s life than it is to get them sober. But the poor sober life is, in my opinion, the actual underlying condition which leads to addiction. We don’t really have a framework for treating that as a society nor through the medical system.

Isn't the first step admitting you have a problem and wanting to fix it? There's not much one can do without patient consent (which I don't think is mentioned here).

Even then, the most the hospital can really do is counsel and recommend inpatient treatment at a specialized facility. I really hope the 'pushed out the doors comment was a slight exaggeration. They should have at least talked about the treatment options, given them a brochure/info for a treatment center. It's not much, but that's basically all they can do.

I do wonder if people would be more inclined to address and solve their problem if they felt people around them and society at large cared for them. Most alcoholics I’ve known have struggled with a sense of not mattering, not being cared for, of their problem being inconsequential because they don’t matter, etc. Telling people like that to recognize their problem and want to get better is almost pointless.

It is. But that's making the assumption that step 1 is where most people fail. I suspect that's not the case.

Well, anyone with a problem fails that step for some period of time until they realize it. But sure, once in or trying to be in recovery, that occupies the rest of their life.

This whole thread is making assumptions as it wasn't mentioned if the person would consent to treatment.

That service exists, though. The hospital specifically referred them to AA.

AA is a religious organization. Not everyone wants to be “saved”. Nor should they have to be in order to get treatment for alcoholism.

Not only is it religious, its not founded in any empiricism or medical study. Here's a decent article laying out the critiques, the opening paragraph is what everyone should keep in mind: https://www.theatlantic.com/health/archive/2014/03/the-surpr...

> Say you’ve been diagnosed with a serious, life-altering illness or psychological condition. In lieu of medication, psychotherapy, or a combination thereof, your doctor prescribes nightly meetings with a group of similarly afflicted individuals, and a set of 12 non-medical guidelines for recovery, half of which require direct appeals to God. What would you do?

AFAIK, AA doesn't make you swear on the Bible or profess one's faith in Christ before you're allowed to join a meeting.

You can ignore the religious stuff and still make use of AA's highest-impact features:

- regular meetings, no appointment required

- being open and vulnerable in front of other people who understand the hell of addiction in ways your partner or family won't.

- having an accountability partners to call during moments of temptation, and having that reciprocal commitment is a far stronger deterrent to relapse than calling a crisis hotline offering scripted responses.

You can't ignore the religious stuff. It's baked into the program. Daily prayer is considered a non-optional part of the 12 steps and atheists and constantly derided as being arrogant and unlikely to stay sober. They're a reason why atheists have found it necessary to create separate meetings and why regional intergroups often exclude those meetings from public meeting lists since they consider it to not be "real" AA.

The alternative to AA isn't a crisis hotline, but medical treatment with empirical support for its effectiveness

What medical treatment? 12 step is fundamentally about community and connection (opposite of addiction), there is no pill that can give one that.

IMO it's a cult.

I spent a lot of my childhood at AA meetings with my alcoholic mother. I am also an alcoholic and struggled for years because the only answer I was ever offered was AA/NA. I tried it for myself a few times (usually to please others) but was always instantly turned off by it's cult like attributes. I eventually found help through a few different paths.

disclaimer: my half-sister's mother was in a cult (Alive Polarity Fellowship) for 20 years.

Share what helped, please.

This might sound rough, but don't you think some brainwashing could help your situation?

Well, there was this in my post > "I eventually found help through a few different paths."

So thanks anyway but I don't need any help, especially brainwashing. My mind is too analytical to respond to it anyway ;)

With respect, I believe you have a common misunderstanding of 12-step programs... AA is not an inherently religious organization, nor does it require any religious/supernatural beliefs.

I'm an atheist, and I've been to years of AA meetings. There is no requirement of religious belief for participating. The concept of a "higher power" is an important part of dealing with our narcissistic ego defenses, but it's not necessarily a religious concept. God just happens to be a convenient implementation of a "higher power" that works for a lot of folks.

Now, there are plenty of people in AA, attending and running meetings, who DO have religious beliefs. A lot of AA literature is written by people who have religious beliefs... The people who founded AA had religious beliefs. So I think it's understandable that religion appears a lot in the mix.

Plenty of modern AA groups explicitly address the "God not required" issue... Maybe it helps that I live in a big city, but I've never had a problem with being an atheist and participating in AA.

AA barely works, though.

I know lots of ppl with years of sobriety through AA so I would say it does work for some. It existing as a choice free of charge around the world for ppl suffering is a good thing.

I know lots of people who haven't been attacked by bears since they bought a bear protection talisman so I would say that they work for some.

Yeah except those people don't intrinsically enjoy being attacked by bears despite that it will kill them, and the attacking bears aren't featured as a prominent aspect of the social fabric visible in everyday life, on nearly every corner, tv ad, social event, and otherwise.

Maybe there is something more going on than some person making a conscious decision to keep drinking? I'm not sure what the hospital should do in this exact situation but simply 'pushing someone out of the door' is very likely to have one result and this is the same person coming back through the same door time and time again.

so you don't have any idea what 'they' should do, but clearly it's the hospitals fault.

Maybe the 'they' that should do something is you?, but I guess it's actually easier to blame 'them', because 'they' should do something.

Even AA doesn't want people that won't admit they have a problem. because 'they' can't do anything for them either. The problem lies with the drinker, if they don't want to stop, they have nobody to blame but themselves.

How do you fix a problem that the patient won't admit they have?

What I was trying to say that it would be in the hospital's interest to offer a better solution since it will be that very same hospital that this guy will inevitably return to.

I guess you are in the camp that thinks everyone can help themselves? All I would say to this is that there's lots of evidence around you that proves this idea is wrong.

OK, tell me specifically what a hospital - or anyone else - can do, to 'help' a patient that won't help themselves? Lock them up and dry them out against their will? Should we lock up drug addicts to keep them away from drugs? how about forcing blood pressure meds down the throats of people who are on the verge of a stroke, but won't stay compliant?

My guess is you have never worked in primary care, if you did, you would have a very different opinion about the limits of how much you can help someone that won't help themselves, or even admit they have an issue.

Easiest thing in the world to say is 'someone should do something', and what you usually mean is 'someone else should do something'.

This person is right that hospitals, or health care systems in general should be working on this. It's more complicated than simply not helping people who won't help themselves. The difficulty is that no one knows the best, most effective systems or approaches for doing this, and emergency medicine resources are stretched very thin here in the United States. Emergency departments were designed for the stabilization of life threats, but in our modern collapsing medical system, limiting their scope to this falls short of community needs. There are many people whose only contact with the medical system will be the ED, and finding ways to treat and integrate them into more sustainable programs should be a goal. There are promising advancements being made, however, in initiating standard of care treatments in emergency department settings. On the opioid front, we can start suboxone in the ED, which has proven a pretty effective method of stabilizing people and increasing their participation in treatment down the road. (1)

As someone who is working on this, I don't think it's unfair for people who aren't experts in the field to recognize and call out the fact that something should be done differently. The experts agree, and many of us are trying to figure out a better path forward.

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4527523/

Referral to psychiatric consultation would be a start. There is a reason why people resort to harmful behaviours and without addressing this you are never going to cure the underlying problem.

I guess the alternative is to do nothing and expect people to cure themselves purely through sheer will, as, more or less, what happens now?

Please explain how this is working?

The sad reality is that they roll them out the door like that with suggestions to find an AA group is that there really is no other solution. ER staff are busy and can use their time more wisely by helping the ones they can help. We like to throw a lot of money at rehab facilities, but even those have very poor track records. The most cost effective treatment is to prevent people from getting into that situation in the first place.

I think the issue is mismatched expectations. General, ie university hospitals are normally not a place to treat addictions of any kind. You have rehab clinics, psychologists, AAs, church for those who need such authority and so on. These tend to be on their own, separate, not in hospital.

Emergency services is set to treat physical damage to the body, not psychological issues of any kind.

Church is only good if someone is already a believer: We shouldn't be pushing religion as a solution to addiction, though. That is one of many issues with AA (Yes, I know it works for some people, but it fails so many)

It's not about faith. It's about community and being part of one that at least gives a tiny crap about you (as opposed to the general population).

Lies. They don't exactly accept folks that are openly atheist and tell them their rules for life are crap. You have to act like the religion is correct, even if you don't believe it.

A lot of them won't accept you if you are queer in any form. I'm bisexual, and refuse to act like half of me doesn't exist.

Some of them won't accept you if you do not dress well enough, though I realize some are more lax.

Some consider me a sinner simply for being divorced: Others, because refuse to birth children.

I'm not in that group they care about, in other words.

I'm an atheist, and I've attended years of AA meetings. I've never even remotely experienced anything like what you described. But I live in a big city on the West Coast.

AA reflects the character of the people and culture who are implementing it... If those people are judgy religious assholes, then I can't expect their AA meetings would be much different. But it would be a mistake to assume that your local sample defines the entire movement.

"A lot of them won't accept you..."

There are tons of religions out there. You have to find one that works for you. Atheist? Join an atheist group. There are options.

Again, though, you are pressing religions. I've looked, and I'm not willing to change myself for a religion. Kinda by definition, atheist groups aren't religious groups.

I'm from Indiana: How many atheist groups do you think are in a town of 3,000? or 50,000? You know, in person spaces.

I'm no longer in Indiana, but I no longer share a native tongue with locals and religion isn't a big thing here. I'd just go and get actual medical care here and do hobbies I like. These aren't atheist groups, just non-religious.

"Kinda by definition, atheist groups aren't religious groups."

Kind of by definition they could be. There is still debate by scholars as to what defines a religion. But something as simple as shared beliefs and world view can meet that definition, especially if it deals with the presence or absence of rituals or objects related to supernatural beliefs.

"you are pressing religions."

Nope. Follow the comments back. I'm not pressing people to get into a religion. I'm merely clarifying why AA includes religion - for the sense of community.

A potassium IV should not be painful in the sligtest, it should just be a tiny pin prick when it's going in. Something went wrong if that was hurting.

Strange, where is the sources backing up that it should always be painless? Found lots of resources pointing towards that many do in fact feel a burning sensation from potassium IV:

- https://cms.galenos.com.tr/Uploads/Article_21792/EAJEM-16-14...

- https://www.webmd.com/drugs/drugreview-6224-potassium-chlori...

- https://www.nyspana.net/wp-content/uploads/2017/10/NYSPANA-P...

- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2730072/

- https://pubmed.ncbi.nlm.nih.gov/3063479/

- https://musculardystrophynews.com/forums/forums/topic/17193/

- https://www.nursingcenter.com/journalarticle?Article_ID=3535...

Yep, pain at the infusion site is an incredibly common complaint with potassium IV. The person you replied to is talking confidently outside of their expertise.