Chronic Alcoholism, mental decline, unmedicated hypothyroidism but seemingly no help to be had?

[ScottOfTheArseAntics]

Alcoholism runs deep in our family and I know that ultimately only the alcoholic can turn it around, but one of my relatives has gone so low that I think she is beyond making a coherent decision to seek help and take the steps she needs to change her life. We are all at a loss and I just wanted to would put this out there on Mumsnet to see if anybody has any insights or thoughts, particularly around options for treatment or help that might still be available.

I live a long way from this particular relative but she has two adult children nearby who have done everything they can but now feel helpless. She has been in and out of rehab with no success. The last rehab place said she had dementia and that until this was assessed they couldn't do anything for her. Her GP has said to her daughters that until she is off the alcohol he cannot fully assess her for dementia!?

She has been in and out of different AA groups all of which she hates. She has isolated herself from all of her friends, she has lost all her money and she is at risk of being evicted from her rental flat because she has let it get into a terrible state (bowls of vomit under the bed, faeces on the floor, vile stench from chain smoking etc).

I haven't seen her for a while but she went to stay with my sister recently who said that she was in a terrible state. The level of physical and mental decline was beyond anything we'd seen in other alcoholic relatives. She kept getting up in the night and freaking out because she didn't know where she was and she had very limited control over her bowels. At this point she hadn't had a drink for 5 days so this behaviour wasn't because she was drunk. She seemed to be in a bad way with withdrawal if anything.

So, today I get a call to say that she went to visit a relative in another country - short hop flight. She somehow managed to get there with no problems but on the way back she never got on the flight. Her daughter called her and fortunately got through to her, she said she was at Heathrow Airport and was getting a flight to Gatwick (she was meant to be heading to her home airport at the other end of the country). After hours of worry and checks at Heathrow and Gatwick, she was eventually found in the original airport overseas, in an entirely different terminal, just shuffling around.

Her daughters are convinced she has dementia but they seem to be in a Catch 22 with the GP who won't assess her until she gives up the drink and she can't give up the drink because she doesn't appear to have the mental capacity to make any rational choices. She is also hypothyroid but not taking her meds which I believe can create dementia like symptoms in some people so that adds another level of complexity.

It's just a mess, the message the daughters seem to be getting is that there is no help to be had from the NHS at all. The family could club together and pay for more rehab but after the last failure and the suggestion of dementia what's the point. I don't like to undermine daughters but I do wonder if they shouldn't be pressing her GP much harder. Surely the state she is in warrants some treatment in spite of her alcoholism. I don't know. Any thoughts on that matter gratefully received.

Anyway,that's it. Sorry for the long post but I really needed to get it off my chest. If you've ploughed through it all then thank you, thank you, thank you for your time and patience.

Such a sad situation for everyone. I wonder about korsakoff's syndrome. If your family has had a number of people dependent on alcohol, you may have heard of it. l have had contact with a couple of sufferers and think presents like dementia, and is the result of heavy drinking over a long period. Memory and behaviour are affected and it's difficult to support people with this as they usually continue to drink, and even if they aren't drinking, the brain damage has been done. I think there is also a vitamin deficiency element. The support services are so stretched, which alongside the difficulty you describe in encouraging people to stay in treatment, tends to leave families feeling isolated and hopeless.

You say that because of the state she is in, she warrants some treatment in spite of her alcoholism. I fear the only way to force treatment would be through a mental health assessment. It would take a GP to refer her for psychiatric assessment, which could take place at her home, and she may then be admitted, by agreement, or under a section. You may find it helpful to phone your local drug and alcohol team to talk this through, they will know what local services are available.

Thank you lotsofdogs. Thanks for the pointer to Korsakoff's I had heard of alcohol related dementia but am not very familiar with it. I did quick Google and she fits the description so to speak. I do think that we should talk to her GP again and ask for a psychiatric assessment. Thank you.

Hi Scott of, I'm a social worker and I see people exactly like your aunt. If I saw her it's likely i'd do the following:

1. Arrange for home care. The home carer could collect her medication from a pharmacy and prompt her to take it daily, they could help her clear up the vomit etc, make sure she was eating.
2. Make sure she had a psychiatric assessment.
3. If the home care didn't work out, there would be other options like residential enablement. If she didn't agree to have home care I would assess her mental capacity to make her own decisions (which is hard to do in a drinker), if she didn't have the capacity I would arrange the home care anyway and hope she came round to it once she got to know the carer.

4.Ask a worker from the drug and alcohol team to do an assessment.

In some areas of the country social workers work in a joint team with the psychiarist and the community mental health nurses, in other areas we work in separate teams and you have to make a separate referral to us. Hope this helps.

Monday - thank you for that insight, you have no idea how helpful it is to hear it. Much appreciated.

The symptoms of Korsakoff's syndrome are a direct result of low levels of Vitamin B12. If she could get that tested, that would be really helpful. Alternatively, you could try getting some 5,000 mcg sub lingual B12 lozenges down her. You can't overdose on B12 - what you don't need is simply peed out.

However, the bottom line is that only she can fix this if she wants to fix it - and she may not want to.

If she does want to, then you may have to deal with the fact that no-one will touch her while she is still drinking - this was always the issue with my XP and he's still drinking 15 years on.

Even then, that doesn't take away a doctor's duty to treat her if she goes to him with physical ailments.

This is a horrible situation for you but I am not sure the answer lies in your hands.

Another vote for Korsakoff's. I've seen it a few times in my clinical work. My mother was also a serious alcoholic and although no longer drinks is not the same person. I believe she has cognitive impairment from the years of alcohol.

First off she needs to see a psychiatrist and then probably have some psychological assessment. It's a horrible thing to watch, I feel for you.