Tips for cutting down... drinking too heavily to stop

[CheersAndWhine]

My friend is alcohol dependent and drinking a lot, starting in the morning to calm down the shakes.

They have been told they mustn't go cold turkey or they will end up in an ambulance, but they need to cut consumption drastically before they can access any help with detox. Friend is so disheartened. They want to stop but willpower alone is just not enough.

Any ideas?

They were told that they cannot access any help with detox?

Perhaps have a word with these people who may be able to point your friend in the right direction:-
https://www.dearalbert.co.uk/nhs-alcohol-detox/

As to cutting consumption, what are they drinking? An easy way to cut down may be to use a mixer. For example, if it's wine or clear spirits then soda and lime can be a good mixer - similar to a white wine spritzer.

Start off with whatever split works, whether that be 50/50 or even if it's something like 80/20 then you are still diluting the alcohol to some extent. So you would have 80% whatever they drink, topped up with 20% soda and a dash of lime.

If they still drink the same volume of liquid, even if it's 80/20 then they have reduced the amount of alcohol by 20% over the course of a day.

From there, gradually decrease the amount of alcohol from 80/20 down until it becomes more like 20/80. This may take weeks or months to get to that point.

If its whisky, brandy, rum etc then maybe choose a different mixer if they prefer a different taste and gradually increase the proportion of the mixer.

Thank you... I hadn't come across Dear Albert.

Mostly whiskey. Wine, mostly in the evening. Occasional pint of Guinness.

Cold turkey can be dangerous for chronic heavy drinkers. Even for binge drinkers (like myself), the withdrawal symptoms can be enough to keep the person drinking.

it sounds like your friend has been advised to taper off. Beer is often suggested as it is lower in alcohol than spirits/wine. So your friend would drink just enough beer to stop major withdrawal symptoms - how much that is will depend on the person.

I’ve done this when coming off a 4/5 day bender - I start with a quarter of a pint every half hour moving to only a mouthful on the hour until I can stop safely. I’m not a constant drinker so this only takes about a day for me. For others who drink constantly, they may need to taper off over a number of days.

This only works if the person is totally committed to stopping drinking - they must only drink just enough to stave off serious withdrawals and not to get drunk again.

I hope your friend can get the help they need and that you also have some support.

Thanks @2023forme - thats very helpful and thank you for sharing your experience.

Yes they have been advised they need to cut down before they can access detox. But cutting down isn't working at the moment - they can't sustain it.

@CheersAndWhine - are you in the U.K.? It seems illogical that your friend is being asked to cut down before detox.

I can understand someone being told they need to be abstinent to enter some rehab/recovery programmes but by definition, someone needing detox needs help now. Indeed part of detox might be administering meds to prevent withdrawal.

can your friend get a second opinion? Are you 100% certain they are telling you the truth? I’m sorry if that sounds harsh but I am painfully aware of the stunts an addict will do to avoid getting clean if they don’t truly want to.

I've encouraged them to try some different sources of support, including organisatuons led/staffed by people with lived experience.

Any more tips are welcome... I struggle as I've not been through this myself and I don't want to upset them with stupid or patronising ideas.

@2023forme yes we are in the UK.

Add ice to the drinks it will dilute the drinks and alcohol

Doesn’t seem right though that they have been told to taper off before detox if they are that alcohol dependent… did a doctor tell them this?

Two things: I think they need to go back to the GP and explain that they're struggling to do this. If possible, see a different GP. The reality is that if it was easy for us alcoholics to just cut down on drinking, most of us probably would before it got to the level of physical dependence. I think they need a different plan and more support to get to where they need to be.

And are they involved in any peer support - like AA - even if online (you can log in and keep your mic and video off and just listen). But I think that going to a meeting - try several, because they aren't all the right fit for everyone - means meeting people who have done it already. They may be able to offer some advice and guidance, even just what to say to get the support they need from the NHS. It's just about connecting themselves with others who have walked that path before.

We Are With You have some resources online, and a chat function online for advice and guidance

So... does anyone know what happens if someone who is alcohol dependent is admitted to hospital? What happens when the withdrawal starts?

Are they helped to detox safely or just kicked out?

Friend is scared about what would happen if they were ever admitted to hospital...

Hey @CheersAndWhine sorry to hear your friend isn't getting much support, I'm surprised they haven't been offered help from alcohol services if they really want to give up. They must feel pretty lonely and stuck which can't be helping!

As far as I know if they were to be admitted to hospital and made the staff aware they were alcohol dependent then yes they would be given medication to detox. It must happen quite a lot

How are they right now? Is any sort of tapering working? X

This has been our experience too with SIL - no support unless she gives up - they want her to slowly cut down over 3 weeks and it's too hard she can't do it - worse than that she is depressed and they won't give her meds until she is alcohol-free - you couldn't make it up. The NHS outsourced alcohol support to a fairly useless charity that messed her around, told her off, and shamed her, so much she lied and told them she didn't feel like drinking anymore. They decided she was cured from alcohol addiction (they actually used the word cured!) and discharged her - NHS support is so lacking, it's criminal.

to answer your question about hospital, my Dad had a fall, treated for it and quickly went into withdrawal, hospital gave infusion and detoxed him on the ward, the rapid withdrawal nearly killed him, caused heart issues, psychosis, delirium resulting in hospital/care home for 3 months.

on the ward the Sister explained that they get many people, mostly older men come in with a fracture/appendix, gall bladder issues and then go into withdrawal, often their family unaware that they were drinking heavily.

Easy way to cut down is to keep a record of what you are drinking, be honest, try less than day before, then maybe try 2/3 drinks a day.

I know someone who drinks a single glass of champagne a day.

Easy way to cut down?

That's the problem. People think its just a matter of will power. But the stuff that gets in the way is just so overwhelming... drinking is a habit, a physical addiction, a coping mechanism for chronic anxiety, low self esteem, intrusive and suicidal thoughts. Pressure to stop is just as likely to result in drinking more. The effect of withdrawal on the body is horrendous.

@BroughttoyoubyBerocca sorry to hear of your experience. I can well imagine that many people have no idea their friend/family member is dependent... drinking can be well hidden.

@UmbrellaBees we have also found the local drug and alcohol charities to be pretty useless. They try, but it feels like they don't have time, so they suggest things but a new client is too scared and emotional and overwhelmed to just go away and start filling a drink diary or whatever the advice is. I think people need peer support. Lots of people don't want to go to AA straight off.. they need 1:1.

@VoldemortsKitten my friend is not doing well. It's really hard. I do what I can but all I can do is to try to create the best possible conditions for them to have the strength to help themselves.

I’m not dependent so take what I say here as heresay, but I think based on sound advice. Aim to cut down by 10% a week - by logging drinks. Your friend will need strategies, eg only having that much available, going to bed when it’s finished, etc.
Reading quit lit can be a good motivator as can peer support. There are online support groups, eg AA, Recovery Dharma, Reframe, so they may find by trying a few they find something that’s comfortable for them.

I wasn’t being flippant, as per my previous post I gave witnessed the devastation of alcohol withdrawal. There is a reason all the counselling/support services get people to start logging what they are drinking.

@BroughttoyoubyBerocca sorry I realise my response was a bit harsh.

It is hard being so close to this. I see the benefit of the drink diary - I have used the Try Dry app in the past myself and it was really helpful. But there is quite a bit that needs to happen before that, which is the desire to stop drinking + hope that its achievable + support to cope with the stuff that alcohol was 'helping' with before.

First thing I think is for her to stabilise her drinking in the sense that she is drinking the same amount of units every day. Do you have an idea of how many units she is drinking a day?

It is safe to self reduce but by no more than a max of 10% per day, and if she has a history of withdrawal related seizures or hallucinations she needs to be particularly cautious.

Generally, drug and alcohol services are more interested in showing good engagement and commitment to recovery to offer in patient detox rather than needing to reduce first in the community. Does the service offer groups etc that she can attend to demonstrate her commitment to recovery? In patient detoxes are expensive so they won't be offered unless someone can demonstrate they are ready.

Drug and alcohol services also usually offer ambulatory detoxes where appropriate (so home detoxes where you are given the medication to take at home and monitored by home visits and/or appts at the service). Community detoxes are generally only appropriate if there aren't other complexities, for instance liver disease, serious mental health problems, or history of seizures. Could this be something she could explore as it's cheaper for services so generally easier to access. If she lives on her own or can't sort childcare etc this wouldn't be an option.

Having said all this, getting a medically assisted detox is only a small part of recovery, but one that people often focus on. There is no point in having a detox unless she works on how she will remain alcohol free after. Things that seem to support this are meaningful use of time/structure to days whether it be work, volunteering, exercise, hobbies etc, supportive family/friends, attending groups whether it be AA or another style of peer led support, accessing mental health support if this is an underlying issue, some people find disulfiram helps if this is appropriate and alcohol services are willing to prescribe.

I hope that your friend is able to move forward with her problems, I wish her the all the best.

I don't know if this is the norm but when my late fil went into hospital in the UK after breaking his hip they gave him some medication to help with the alcohol withdrawal. He lived in France for many years and hospitals there gave patients wine with their meals!
I hope your friend finds the help they need in order to detox to a
feel they can get the help they need💐

If someone is admitted to hospital with an unrelated physical health problem and is alcohol dependent they should be given detox meds (basically a benzo of some description, usually chlordiazepoxide). However, they obviously won't get any psycho-social intervention and in my experience people are often given a partial detox of only a few days