Are you an alcoholic?
If you drink any alcohol at all, then some would argue that you are.
"Turning to drink" may not be your style, or so you think. But maybe you don't yet know. Life may have a surprise or two in store for you yet. How, for instance, would you cope with the loss of a child?
I don't seek to be morbid, but to point out that - when we see a drunk - we might quite reasonably say "But for the grace of God, there go I". Or it could be your brother. Or your daughter.
So with that in mind, let me introduce you to John. He's in his forties. He holds down a job as a fabricator - a semi-skilled job - with which he supports himself, his mother and his substantial drinking habit. He started drinking seriously after he lost his daughter to cancer. That was several years ago, and he knows it's no longer a reason - or an excuse. He had it under control, that with the help of a charitable detox centre he wasn't drinking at all, Then, about a year ago, his father died and since then he's been back at the bottle with a vengeance.
On a good day, when he's with his mother, for instance, he keeps a lid on it. Which means half-a-bottle of Vodka rather than a whole one. On the weekends he loses control. This puts him at several hundred units a week. Maybe ten times the "safe limit".
When I saw him in A&E he told me he felt weak willed. Yet he knows he drinks because he must. Without the alcohol he starts to shake uncontrollably. Hallucinations start. Then he fits. Without medication or alcohol, he'd probably die if he stopped. He's in a rotten category prognostically. Can't drink, can't stop drinking.
So - like so many alcoholics we see in A/E - he came to us in a desperate state. Desperate for help for what is now a life-threatening physical disease, a complete and nearly irreversible dependence on alcohol.
What is the response of our hospital system? Is it to recognise that this middle-aged, tax-paying man is dying early and unnecessarily? No, our hospital - as the place of last resort for people with dangerous, and life-threatening physical diseases - merely has some advice:
"Keep drinking".
Odd, I always think. Had he come to us with some other form of self-harm, daily cutting himself repeatedly with a knife, say, enough to cause anaemia, we would be offered psychiatric services.
Later, of course, when he inevitably develops liver failure then we will admit him and spend many tens of thousands of pounds on inpatient care.
But now, when we could perhaps do something for him, probably for a few hundred pounds, we simply turf him back onto the street saying "Don't stop suddenly, because it's dangerous". "Try to cut down". His GP won't prescribe him any medication because - he tells me - his withdrawal needs to be "managed" by a specialist.
So John - many other thousands of middle-aged men and women - are left on the streets, in their bedsits slowly dying, most claiming benefits and waiting for the moment their deterioriating liver function allows them access to the NHS.
There is, of course, an alternative - but it's one that politically we can't stomach. John needs services which the NHS doesn't provide in the quantities that out population need: the funding of inpatient detoxification with adjuvant CBT is in the hands of faceless commissioners who don't see a need. It would take a lifetime of committee meetings to decide that, in his area, John could access what the charitable sector struggle to provide.
The alternative is giving all our NHS patients the majority of the money that commissioners now control. 80% of the £1,500 that the NHS costs, per person, could be individually controlled by the people who know what their needs are. John can easily tell you what he needs, but the monstrous bureaucracy of the NHS is making him sick and will eventually kill him.
And let's not forget, John is not the only alcoholic that needs this inexpensive help. The NHS's obsession with centralisation and a total lack of personalisation affects hundreds of thousands of alcohol dependent men and women in this country.
One of them, one day, might be you.
If you drink any alcohol at all, then some would argue that you are.
"Turning to drink" may not be your style, or so you think. But maybe you don't yet know. Life may have a surprise or two in store for you yet. How, for instance, would you cope with the loss of a child?
I don't seek to be morbid, but to point out that - when we see a drunk - we might quite reasonably say "But for the grace of God, there go I". Or it could be your brother. Or your daughter.
So with that in mind, let me introduce you to John. He's in his forties. He holds down a job as a fabricator - a semi-skilled job - with which he supports himself, his mother and his substantial drinking habit. He started drinking seriously after he lost his daughter to cancer. That was several years ago, and he knows it's no longer a reason - or an excuse. He had it under control, that with the help of a charitable detox centre he wasn't drinking at all, Then, about a year ago, his father died and since then he's been back at the bottle with a vengeance.
On a good day, when he's with his mother, for instance, he keeps a lid on it. Which means half-a-bottle of Vodka rather than a whole one. On the weekends he loses control. This puts him at several hundred units a week. Maybe ten times the "safe limit".
When I saw him in A&E he told me he felt weak willed. Yet he knows he drinks because he must. Without the alcohol he starts to shake uncontrollably. Hallucinations start. Then he fits. Without medication or alcohol, he'd probably die if he stopped. He's in a rotten category prognostically. Can't drink, can't stop drinking.
So - like so many alcoholics we see in A/E - he came to us in a desperate state. Desperate for help for what is now a life-threatening physical disease, a complete and nearly irreversible dependence on alcohol.
What is the response of our hospital system? Is it to recognise that this middle-aged, tax-paying man is dying early and unnecessarily? No, our hospital - as the place of last resort for people with dangerous, and life-threatening physical diseases - merely has some advice:
"Keep drinking".
Odd, I always think. Had he come to us with some other form of self-harm, daily cutting himself repeatedly with a knife, say, enough to cause anaemia, we would be offered psychiatric services.
Later, of course, when he inevitably develops liver failure then we will admit him and spend many tens of thousands of pounds on inpatient care.
But now, when we could perhaps do something for him, probably for a few hundred pounds, we simply turf him back onto the street saying "Don't stop suddenly, because it's dangerous". "Try to cut down". His GP won't prescribe him any medication because - he tells me - his withdrawal needs to be "managed" by a specialist.
So John - many other thousands of middle-aged men and women - are left on the streets, in their bedsits slowly dying, most claiming benefits and waiting for the moment their deterioriating liver function allows them access to the NHS.
There is, of course, an alternative - but it's one that politically we can't stomach. John needs services which the NHS doesn't provide in the quantities that out population need: the funding of inpatient detoxification with adjuvant CBT is in the hands of faceless commissioners who don't see a need. It would take a lifetime of committee meetings to decide that, in his area, John could access what the charitable sector struggle to provide.
The alternative is giving all our NHS patients the majority of the money that commissioners now control. 80% of the £1,500 that the NHS costs, per person, could be individually controlled by the people who know what their needs are. John can easily tell you what he needs, but the monstrous bureaucracy of the NHS is making him sick and will eventually kill him.
And let's not forget, John is not the only alcoholic that needs this inexpensive help. The NHS's obsession with centralisation and a total lack of personalisation affects hundreds of thousands of alcohol dependent men and women in this country.
One of them, one day, might be you.
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