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Recently (within the last two years) I had to help someone suffering with alcoholism/DTS and I was horrified by the abysmal outpatient support the medical syste

Recently (within the last two years) I had to help someone suffering with alcoholism/DTS and I was horrified by the abysmal outpatient support the medical system here provides. If he didn't have health insurance and a ride I would not have been able to convince him to go, and he could have died. It's very hard to argue with his contempt for hospitals and doctors when all they do is give you an overpriced potassium IV (very painful) then push you out the door and tell you to find an AA group. I don't even know what the solution is, but I do know the current way of doing things is inadequate and probably getting a ton of people killed. It's very sad.

ejb999 5y ago
>>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?
- dazc 5y ago
  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.
  - ejb999 5y ago
    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?
    - dazc 5y ago
      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.
      - ejb999 5y ago
        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'.
        subungual 5y ago
        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/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4527523/
- tyingq 5y ago
  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.
  - dotancohen 5y ago
    That service exists, though. The hospital specifically referred them to AA.
    - elliekelly 5y ago
      AA is a religious organization. Not everyone wants to be “saved”. Nor should they have to be in order to get treatment for alcoholism.
      - clsec 5y ago
        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.
        franknstein 5y ago
        This might sound rough, but don't you think some brainwashing could help your situation?
        clsec 5y ago
        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 ;)
        5y ago
ascar 5y ago
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.
saiya-jin 5y ago
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.
- Broken_Hippo 5y ago
  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)
  - giantg2 5y ago
    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).
    - Broken_Hippo 5y ago
      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.
      - giantg2 5y ago
        "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.
CyanDeparture 5y ago
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.
- chockchocschoir 5y ago
  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-16-148-En.pdf https://cms.galenos.com.tr/Uploads/Article_21792/EAJEM-16-14... - https://www.webmd.com/drugs/drugreview-6224-potassium-chloride-intravenous https://www.webmd.com/drugs/drugreview-6224-potassium-chlori... - https://www.nyspana.net/wp-content/uploads/2017/10/NYSPANA-PIP3.pdf https://www.nyspana.net/wp-content/uploads/2017/10/NYSPANA-P... - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2730072/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2730072/ - https://pubmed.ncbi.nlm.nih.gov/3063479/ https://pubmed.ncbi.nlm.nih.gov/3063479/ - https://musculardystrophynews.com/forums/forums/topic/17193/ https://musculardystrophynews.com/forums/forums/topic/17193/ - https://www.nursingcenter.com/journalarticle?Article_ID=3535408&Journal_ID=3425880&Issue_ID=3534792 https://www.nursingcenter.com/journalarticle?Article_ID=3535...
  - subungual 5y ago
    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.
dazc 5y ago
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.
- moritonal 5y ago
  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.
  - dazc 5y ago
    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.
matwood 5y ago
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.
starkd 5y ago
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.

ejb999 5y ago

>>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?

dazc 5y ago
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.
- ejb999 5y ago
  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?
  - dazc 5y ago
    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.
    - ejb999 5y ago
      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'.
      - subungual 5y ago
        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/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4527523/
tyingq 5y ago
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.
- dotancohen 5y ago
  That service exists, though. The hospital specifically referred them to AA.
  - elliekelly 5y ago
    AA is a religious organization. Not everyone wants to be “saved”. Nor should they have to be in order to get treatment for alcoholism.
    - clsec 5y ago
      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.
      - franknstein 5y ago
        This might sound rough, but don't you think some brainwashing could help your situation?
        clsec 5y ago
        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 ;)
      - 5y ago

ascar 5y ago

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.

saiya-jin 5y ago

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.

Broken_Hippo 5y ago
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)
- giantg2 5y ago
  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).
  - Broken_Hippo 5y ago
    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.
    - giantg2 5y ago
      "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.

CyanDeparture 5y ago

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.

chockchocschoir 5y ago
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-16-148-En.pdf https://cms.galenos.com.tr/Uploads/Article_21792/EAJEM-16-14... - https://www.webmd.com/drugs/drugreview-6224-potassium-chloride-intravenous https://www.webmd.com/drugs/drugreview-6224-potassium-chlori... - https://www.nyspana.net/wp-content/uploads/2017/10/NYSPANA-PIP3.pdf https://www.nyspana.net/wp-content/uploads/2017/10/NYSPANA-P... - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2730072/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2730072/ - https://pubmed.ncbi.nlm.nih.gov/3063479/ https://pubmed.ncbi.nlm.nih.gov/3063479/ - https://musculardystrophynews.com/forums/forums/topic/17193/ https://musculardystrophynews.com/forums/forums/topic/17193/ - https://www.nursingcenter.com/journalarticle?Article_ID=3535408&Journal_ID=3425880&Issue_ID=3534792 https://www.nursingcenter.com/journalarticle?Article_ID=3535...
- subungual 5y ago
  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.

dazc 5y ago

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.

moritonal 5y ago
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.
- dazc 5y ago
  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.

matwood 5y ago

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.

starkd 5y ago

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.