To ask why GP won't prescribe medication to help with alcoholism?

[GreatestShowman]

A relative of mine has a problem with alcohol and wants to stop. They have tried to 'white knuckle it' several times and relapsed. After doing some research we've discovered that there are multiple prescribed medications that could help and are worth a shot, but the GP isn't forthcoming to prescribe any of them:

Naltrexone
Acamprosate
Gabapentin
Baclofen
Antabuse etc.

When my relative has asked for medical support in the past they were given vitamins

Is anybody able to shed some light on why this may be? Is it the cost of the medication? They are in receipt of benefits so exempt from paying for prescriptions but I would consider paying privately for them if a doctor would prescribe.

I would expect it is because your relative is expecting to find recovery through either white knuckling it or through medication, and that won't work. It can help, but he/she also needs to commit to addressing the underlying issues causing the alcohol addiction, which means counselling and attending AA/SMART recovery or other similar support. There's no magic bullet, and the talking/behavioural part of it is the foundation of everything. Addressing that shows the kind of commitment that's needed.

Once your relatives undertakes that, they can return to their GP and if they then still receive no support, they can ask for a second opinion. Ultimately the drugs are only another crutch, and some of them are addictive in themselves or have very severe side effects.

I don’t understand it either. My cousin finds Antabuse really helpful, but it only gets prescribed for a short amount of time, after which he slides back into drinking and gets in a real mess.

Hi, I'm not 100% sure, but GPs are restricted to a formulary of what they should prescribe and why. Usually based on evidence of success and cost. Gabapentin is a controlled drug and can be addictive, I can see why they wouldn't do that. Baclofen can be quite dangerous used incorrectly. Possibly these drugs would be used by a specialist alcohol service. Cold turkey can make people who are alcohol dependent very unwell. Have they offered to refer or sign post to a service? Really they need support to control their drinking in the community along side use of meds I'd imagine, but someone who knows a bit more might be along shortly!

All of those should only be done by a specialist service for alcohol withdrawal and dependence, not a regular GP.

If they are struggling, they can ask for a referral, usually you have to refer yourself as lots of people don't turn up after a GP referral - sad but true.

If he googles the name of his county + drug and alcohol service his local one will come up.

I'm not sure how it differs across the country but in our CCG, medications for alcohol withdrawal are only prescribed in secondary care not primary care. So the GP will refer to specialist services and they would prescribe and offer support for alcohol withdrawal.

I work on a prescription team in a GP surgery. Some of the medication you have listed is not available in primary care and has to be issued by a consultant.
Also like another poster has stated the patient is expected to engage with support service and not just replace alcohol with tablets.

Thank you for the replies.

The relative is my DM, she has a learning disability so counselling and talking therapy isn't something she can engage in productively as she doesn't have a good enough understanding of the psychological link.

I've found counselling and talking therapy immensely helpful for various issues throughout the years but mum just doesn't benefit from it (has tried counselling but found it very stressful as she didn't understand why she was being asked all of the questions and didn't know how to answer them)

Her low intelligence (I don't mean for that to sound derogatory) adds another layer of complexity to an already difficult situation.

I went NC for a period of time (she was being supported by other people so not totally abandoned) as I was on my knees with it all. I have just spoken to her after a few months and feel incredibly sad because she's adamant she wants help and wants to be able to see me and the DGC, she just can't fight the addiction on her own.

I was prescribed baclofen for well over a year for TMD and had no issue obtaining it, it seems like a shame that something that could possibly help somebody isn't even considered when the ailment is alcoholism.

@AnnaMagnani

All of those should only be done by a specialist service for alcohol withdrawal and dependence, not a regular GP.

If they are struggling, they can ask for a referral, usually you have to refer yourself as lots of people don't turn up after a GP referral - sad but true.

If he googles the name of his county + drug and alcohol service his local one will come up.

Thank you, I will have a look.

I did get her seen by a drug and alcohol support service around 18 months ago, they were a drop in (and appointment) service that offered support in the way of an assigned person to talk to, but when we asked about medication was told to discuss with GP - and around it goes.

TBH she sounds just the sort of person who would benefit from the additional support of a drug and alcohol service as they are v used to seeing people with more complex needs.

I used to work in drug and alcohol services and there are people with learning disabilities accessing what is offered.

People are usually only discharged to shared care once they have been treated by specialist services. It's not likely that your mother will achieve and maintain abstinence purely with medication.

@TheSparkling

I'm not sure how it differs across the country but in our CCG, medications for alcohol withdrawal are only prescribed in secondary care not primary care. So the GP will refer to specialist services and they would prescribe and offer support for alcohol withdrawal.

I work on a prescription team in a GP surgery. Some of the medication you have listed is not available in primary care and has to be issued by a consultant.
Also like another poster has stated the patient is expected to engage with support service and not just replace alcohol with tablets.

Thank you to you too, that's helpful.

So it's a referral to another specialist service we need then.

Sadly I don't think there's much chance of mum engaging in counselling or talking therapy, but I will speak to her about a support service.

Would an online pharmacy be an option or would she need to be seen in person by a consultant regardless?

You mention your relative has a learning difficulty? Do they have support for any part of their life because of this? Do they have a social worker or support worker?

Addiction support for someone with a learning difficulty is so hard and really does need specialist input. Even then, repeated relapse is likely because the insight won't be there. Is your DM in any kind of supported accommodation? With an alcohol addiction, it will be far too easy for her to get hold of drink if she ends up living in the community without support after getting sober.

The other thing to consider is whether she will be able to manage any medication she is given safely. It's a minefield.

It would have been helpful to include the learning issue in your opening post - a lot of the usual advice to people in addiction just doesn't apply here.

@AnnaMagnani

TBH she sounds just the sort of person who would benefit from the additional support of a drug and alcohol service as they are v used to seeing people with more complex needs.

Yes, this.

I wonder could their learning difficulties be the reason why? These drugs can be horrible addictive, my brother was on librium for withdrawal, which is a benzo. He had to go to the chemist everyday to collect that days dosage and he was slowly weaned off it. Ultimately they didn't help him with his addiction, only the physical side effects of stopping alcohol. He had to go to inpatient rehab to actually manage to get sober for a long period of time. These medications are not a long term solution and the underlying reason for for addiction has to be addressed or its a waste of time and the person will relapse

I signposted her to the following drug and alcohol support service in our area before covid, I went along with her for the introductory appointment and she went alone a few times after.

She said it was just for a chat and they did a breathalyser test on her to see what her intake was like, but despite their website stating they can help with medication she was told she'd need to speak to her GP about that.

I'll link the place below, is this the sort of organisation that people are recommending?

www.changegrowlive.org/lewisham/info

@TheSparkling

You mention your relative has a learning difficulty? Do they have support for any part of their life because of this? Do they have a social worker or support worker?

No social worker no.

Several referrals were made to adult social services by myself and the warden at mum's accommodation who has taken her under her wing but it never went beyond a phone call.

She is deemed to have capacity however functions at a level much, much lower than her actual age.

I take acamprosate daily and I had a real battle getting it - my GP has prescribed it to me for a year, but they're reluctant because while they stop people drinking, they can often have adverse affects on your liver. I have to go for regular blood tests to check I can still take it.

@pointythings

Addiction support for someone with a learning difficulty is so hard and really does need specialist input. Even then, repeated relapse is likely because the insight won't be there. Is your DM in any kind of supported accommodation? With an alcohol addiction, it will be far too easy for her to get hold of drink if she ends up living in the community without support after getting sober.

The other thing to consider is whether she will be able to manage any medication she is given safely. It's a minefield.

It would have been helpful to include the learning issue in your opening post - a lot of the usual advice to people in addiction just doesn't apply here.

She lives in a self contained flat within a complex for people over 50, the residents are independent but mum does receive alot of support from the warden who knows her and her situation well.

She struggles with reading and writing so the warden handles her admin where I'm not able to.

I agree it's so difficult when they lack insight

I'm a GP. We will prescribe if the local alcohol team is involved in which case we hand over the meds to the alcohol team and they give them out daily. Anything else is dangerous.

@pianolessons1

I'm a GP. We will prescribe if the local alcohol team is involved in which case we hand over the meds to the alcohol team and they give them out daily. Anything else is dangerous.

I take mine at home, I get prescribed a full month of it at a time and take it three times daily, my alcohol team wrote the letter to the GP and I just phone up once a month for the new prescription

@dumphies

I take acamprosate daily and I had a real battle getting it - my GP has prescribed it to me for a year, but they're reluctant because while they stop people drinking, they can often have adverse affects on your liver. I have to go for regular blood tests to check I can still take it.

Did you have to meet certain requirements before GP would prescribe, such as engaging with other therapies?

Is there any advice you're able to give as to how to approach requesting it that may make it more likely to be prescribed (or a similar drug?)

I think I may need to speak to them on her behalf as whenever she's asked for this sort of help before she has come away with something completely different.

One time she was prescribed vitamins and another time she was prescribed promazethine hydrochloride as she was complaining of not being able to sleep when trying to stop the drink. Neither thing helped whatsoever.

Most of those drugs only work to supplement the social and psychological support the patient will be getting. They don’t turn off the switch in your brain that craves alcohol, they’re more like stabilisers on your bike. A bit of a helping hand but you still have to do most of the hard work yourself.

@GreatestShowman I had to engage with my local addiction team - I have a fortnightly call with my addiction counsellor and he wrote the referral to my GP for it - you should be able to speak to them on behalf of your mum, if she has known communication issues etc; she also has to show that she is willing to engage with other avenues and that she wants to stop drinking

Because in most areas it’s a specialist service, and most Gp’s won’t be trained (or commissioned!) to provide that service. What they absolutely should do is signpost to the available/commissioned service.

We’re the vitamins that were prescribed Thiamine? If so, the Thiamine is actually really important. Alcoholism can lead to thiamine deficiency, most alcoholics will be thiamine deficient. With Thiamine deficiency there is a risk of neurological issues and brain damage.