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.

@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.

Thank you, I'm going to call New Direction and see if I can set up another appointment for her.

It looks like I'll have to chaperone to make sure I'm clear on the situation as she's not great at relaying back to me.

I wasn't aware that in many cases the medication has to go through these services, as she was told to speak to the GP by one of these services.

As it stands today she has tried again to access a prescription through the GP and doesn't understand why they won't help her.

It makes sense, reading these comments.

Thank you

@EllenMonte

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.

That's correct yes, they were thiamine.

It's good to know that they had a specific purpose related to the issue.

When helping with mum's alcoholism, one GP and two consultants all said that the antabuse type drugs are hell on the liver and given the state she was already in they would seriously risk organ failure. I didn't dig into it any further, to see if there were non-NHS drugs that might be less dangerous.

I've just called New Direction (our areas support service for addicts) and left a message asking for somebody to give me a call back to hopefully arrange an appointment for her.

The website said that they've shifted to telephone appointments at the minute so I don't know how much of a barrier that will be.

I'm trying to support her from a distance at the moment as I'm wanting to shield my DC from it as best as I can, but if I'm able to get her an appointment I will definitely go with her and ask all of the appropriate questions.

@HerNameIsIncontinentiaButtocks

When helping with mum's alcoholism, one GP and two consultants all said that the antabuse type drugs are hell on the liver and given the state she was already in they would seriously risk organ failure. I didn't dig into it any further, to see if there were non-NHS drugs that might be less dangerous.

That sounds worrying, I'm really sorry to hear you and your family are in a similar position and weren't able to access the medication, though with good reason it seems.

As it stands mum's liver is ok at the moment (at least it was last time she had a liver function test - god knows how)

Change grow live are the specialist service if they are operating in your area. The medication isn't suitable for long term use and doesn't stop a person being an alcoholic. It has side effects and also can be bypassed by stopping taking it for a short period before a planned binge.

I don't want to scare you, but the thing with liver function tests is that they can come back OK over and over again until one day they don't, and by then it's really bad. The liver is an incredibly tough organ that can take an awful lot, but when it stops, it really stops. So it's better not to take drugs that are hard on the liver for someone who is an alcoholic, because the chances are that OK liver function tests or not, the damage is already there.

I appreciate what you're all saying about medication not being the cure or the be all and end all.

Inevitably she will need to undergo some therapy to get to the bottom of the issue, it just feels like such an impossible task for her as she doesn't have the insight that would make it possible to benefit from it.

I'm worried that she's a lost cause in the sense that she can't get better the way that people of average intelligence can, because she can't grasp the issue.

She knows she has a problem with alcohol but can't tell you why or articulate her feelings very well. She finds counselling distressing for that reason.

When she was prescribed the thiamine vitamins she did well not to drink for just over a week, she didn't actually realise they were vitamins (such is the degree of understanding she lacks) and I, admittedly, didn't tell her they were vitamins as they seemed to have a placebo effect IE she thought they were to stop the cravings and believed for a period of time that they did.

Obviously that didn't last, but it did lead me to believe that if she was prescribed something that does help to curb the cravings then she just might do well on it for long enough to be able to work on the other stuff.

@pointythings

I don't want to scare you, but the thing with liver function tests is that they can come back OK over and over again until one day they don't, and by then it's really bad. The liver is an incredibly tough organ that can take an awful lot, but when it stops, it really stops. So it's better not to take drugs that are hard on the liver for someone who is an alcoholic, because the chances are that OK liver function tests or not, the damage is already there.

That does make sense, I appreciate your honesty. Thank you.

if she lacks insight, do you think that something like antabuse would work? The user has to make the link between the effects of mixing antabuse with alcohol and abstinence. Even neurotypicals can find that hard, eg George Best.

@godmum56

if she lacks insight, do you think that something like antabuse would work? The user has to make the link between the effects of mixing antabuse with alcohol and abstinence. Even neurotypicals can find that hard, eg George Best.

Honestly, I'm not sure but I think possibly.

Obviously she would be told that drinking on those tablets would make her react in a certain way, and if she attempted it then she'd see for herself how unpleasant it is.

She'd grasp that much.

I suppose that's when will power would need to come in and she'd need to actively want to stop, and continue the medication.

Overall I think it's worth a try and it's something she wants to give a go so I hope she can access it. She'll be 70 soon and I don't think she will live much longer the way she is, she has falls all of the time.

It's sad because I know she does want to stop, I believe it for the first time in years.

She could have woken up and got pissed this morning but instead she's stayed sober and been phoning the GP surgery, she then went down there with a list of medications prescribed for alcoholism to give to the doctor to look at and consider prescribing one - even though she knows it's unlikely and she isn't going to be seen in person today. She's making effort in her own way.

If she wasn't desperate I don't think she'd bother, it would be easy to make excuses not to do those things like she was a few months ago.

Hopefully I hear back from the support service soon so I can get her an appointment to be seen there.

I didn't realise that you could obtain any kind of medication /drugs, for alcohol abuse. I think that a lot of GP'S, would be reluctant to prescribe them , as there are many side affects to these medications, to add to the already many side affects of the alcohol itself.

I had an alcoholic partner many years ago, quite extreme problems. His body and mind were already falling apart with the drinking. I think that any added mind altering medication would have made him much worse. with any of the known side affects. to add to his already fuddled brain..

I don't know if any medical treatment would have tempered down his drinking problems ,years before I knew him, but no GP treatment would have helped eventually. He eventually died in an awful state,mind and body.

This sounds so difficult, OP, I'm sure it is an absolute constant worry for you

I know navigating the NHS is like smashing your head against a brick wall at the best of times and it's twenty times worse at the moment, but please don't try to source these via an online pharmacy. They're specialist drugs because medicated alcohol withdrawal is a clinically risky transition, and anywhere that will give them to you unprescribed is disreputable and God knows what you'd actually even get.

I hope you get a quick response from the service you've contacted. Worth revisiting the thiamine with the GP in the meantime, it is very important to make sure she has enough, long-term thiamine deficiency can do damage that you can't walk back afterwards.

I'm 66. I stopped drinking when I was in my early-mid 30s, helped by a psychotherapist. Went back to drinking 4-5 years later. Stopped again, went back. Etc. Went through another course of one-on-one therapy with no real results. Entered rehab (outpatient). Stopped again for a while. (Hated rehab.) Started drinking again after a few years. Entered group therapy with an emphasis on AA. Didn't work. (Hated AA.) Two months ago, I went on Antabuse, and the results have been GREAT. I take one dose in the mornings. Over time the urges have diminished; now they only pop up ever so often. I feel like I have a new life - https://euhealth24.com/drug/antabuse