In article <[log in to unmask]>, Jel Coward
<[log in to unmask]> writes
>But - to come back to the question in hand - can I ask whether you
>advise those to turn up with early withdrawal just to source more
>alcohol and halve their intake (I am not criticising such an approach,
>but rather I am interested. I guess I am wondering about the ethics and
>physical effects of not knocking down withdrawal symptoms in someone who
>has run out of money for this week)
I must admit to seeing very few such patients, but my inclination would
be to:
1) "halve" the intake of someone who can afford to present still
intoxicated but asking for help, with advice to carry on halving every
few days until dry, then seek support to stay dry if needed. Avoids
risking prescribed benzos plus own alcohol.
2) prescribe the 1st few days of a 10-14 day diazepam withdrawal regime
(what our shrinks advise) for the ones that come in having already dried
themselves out yesterday but getting twitchy today, with advice (and
letter) to consult GP before the 2-3 days supply of benzo runs out for
further prescription and support as needed. If they're not serious about
complying, they won't stay sober enough to follow advice, but they won't
have a dangerous number of benzos to wash down with vodka. If they are
serious, they will safely get as far as the GP who is the next best
thing we have round here to an alcohol support service.
Loose rationale: both patients should benefit (one from reducing intake,
the other from not restarting) and both from not fitting.
Would be nice to hear from someone more expert than I - anyone from
Paddington out there?
ps: thiamine
Dr G Ray
A&E
Sussex
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