Category Archives: Additional support

Starting Addiction Treatment

starting addiction treatmentThis was an excellent blog by Castle Craig looking at starting addiction treatment.  Therapist Christopher Burn speaks about the feelings of anxiety patients experience at the start of treatment and the challenges of committing to the treatment process.

‘It was the best of times, it was the worst of times’ (Charles Dickens – A Tale of Two Cities)

When starting treatment, you may feel trapped and anxious. But this is an opportunity to deal with your addiction problem and turn your life around. Make the most of it! If you can take a positive view of entering treatment, then you’re off to a flying start.

Please do not think that treatment means that you sit and wait for others to fix you. That may work for a broken leg but it does not work for addiction. You must be proactive. Others can give guidance. They can even give you inspiration. They cannot change you. Only you can do that.

Some choices will be taken away – no drink or drugs, probably not much entertainment or lying in bed. But gradually these choices will be given back. You have to learn to make the right choices – between what you want and what is good for you. You will be encouraged to take responsibility for your recovery.

The treatment process is one of change – you are here to change yourself. Change happens through constant challenge, support and education and this process happens all day, through your interaction with your peers. This is what being in a therapeutic community means.

Your therapist will meet you and will help devise a treatment plan to take you through the process of change. It will be tailored to your needs but it will be flexible.

A vital part of treatment is group therapy. For newcomers this can be frightening. Very few people have had any prior experience of this. Participation is vitally important; the peer group is the most effective medium for change and the most important recovery tool that you have. Learn to put yourself in the spotlight – by doing so, others will be able to help you.

For most people, the stages of treatment happen like this:

  • Face reality, learn about addiction and deal with denial;
  • Become willing to change and ask for help;
  • Discover and explore spirituality as a source of help and a means of ‘filling the void’;
  • Engage in self discovery;
  • Identify, with the help of your group and therapist, obstacles to change;
  • Commit to make changes;
  • Take action to change.

Treatment is a mirror of the world outside and a place to practice life skills. Everything that happens is a chance to practice – if someone annoys us, ask why, and devise ways of coping; if bored, challenge that feeling and learn to deal with it; see everything as an opportunity.

As you progress through treatment you will learn to make better use of the tools at your disposal, especially your peer group. You may be challenged but you will also be supported. This may be painful but it will also be hugely rewarding. By the time you leave treatment you will have a different attitude to life – a change for the better. You may not want to repeat the experience but you will never forget it.

Treatment is the start of change but that process goes on for the rest of our lives. You are on a journey but you will never arrive at your destination. Enjoy the ride.

I volunteer at a local drug and alcohol treatment centre and the change I see in clients between admission and graduation is astonishing and so profound it’s amazing.  If you need professional help to stop there is no shame in that and could be the extra step you need to take.  Do reach out and seek help either through your local Drug and Alcohol Treatment Service or GP.

PHE One You

PHE One YouIn March Public Health England (PHE) launched their brand new health campaign One You. They reported that the response so far was fantastic and they were delighted to see such a positive reaction in the media, from our partners and from the public online.

The image is a screen grab of what it looks like and here are some of the categories and areas for information around drinking.

Drink and you

It may seem like you don’t drink much, but a drink or two most evenings can do harm to your body. From making you gain weight to increasing your risk of cancer, alcohol can have serious effects on your body.

The more you drink, and the more often, the greater the risk to your health.

It has further information headings covering being drunk, booze and your body and other health worries.

Why cut down?

If you regularly drink above the lower risk guidelines, cutting back on alcohol can help your general wellbeing. Once you start cutting back, you’ll probably notice the benefits. The biggest benefit is the reduced risk to your health, but there are lots of others, too.

Medical warning: If you have physical withdrawal symptoms (shaking, sweating or feelings of anxiety until you have your first drink of the day) you should take medical advice before stopping completely – it can be dangerous to do this too quickly and without proper advice and support. Call Drinkline free on 0300 123 1110 for more advice.

Further subheadings look at: Be healthier, save some cash and feel full of beans.

Drink less

It’s important to know how much you are drinking and that there are easy ways you can cut back, without cutting alcohol out completely.

You could try making some simple swaps when you’re out, or, if you drink every day, having at least a couple of booze-free nights each week.

And further advice entitled: Tools to cut down, top tips to drink less and need more support.


It looks really good and is an improvement on the Change for Life campaign in my opinion.  Thanks Public Health England! 🙂

PS New header image time – the Great Barrier Reef in preparation for our summer 1000 day reward 😉

Friday Sober Jukebox – We are family

SUMA researchThis song feels appropriate today seeing as it is my son’s birthday!  We are off as a family to the seaside for the week-end to celebrate 🙂

It also feels appropriate because it resonates with some excellent research that the University of Southampton have completed exploring the success of mutual aid in recovery as represented by the Soberistas website.  The image to the left represents the different stages relating to online identity and alcohol use that the researchers found during their grounded research qualitative study.  You can watch the full 13 minute presentation here:

SUMA sampleThis was a robust qualitative study that covered a wide representative demographic.  It was such a positive and optimistic research study of the phenomena that we know only too well out here in the soberverse to do with identity transformation.  How people can change their drinking with no professional intervention through the support of others role-modelling the behaviour around them whether as part of a fee paying community such as Soberistas, or all the other free groups that I am aware of: the BFB on FB & Yahoo, SWANS, Living Sober, Club Soda – the list is ever growing!  Plus I think that’s what us sober bloggers do too – people can come and read our stories and identify and that helps them to feel less alone and to think that change is possible.  It it both empowering and affirming to read research findings to support what we instinctively know and feel.

So over to that tune!  I feel we are a family out here too so this tune is for both my son and you my sober online family 🙂

PS I’ve been approached by the University of Southern California asking for your help in some research they are doing.

We’re interested in hearing about people’s experiences in addiction and recovery. If you are aged 18 or older, believe you have ever been addicted to drugs, alcohol, or another substance, and you have substantially reduced or entirely stopped use at any point, you are eligible to participate in our study. The study consists of an online and completely anonymous survey. We estimate that the study will take between ten and twenty minutes. Participation is voluntary.

Here is the link to the survey: 

Thank you!

Dutch trial of web-based treatment programme for problem drinking

This was featured on Findings in December and looked at the use of a web-based treatment programme for problem drinking as part of a randomised trial within the Netherlands.

Web-based-addiction-treatment-services-2The trial had included 156 adult problem drinkers who on the project’s web site (now also available in an English-language version) had identified themselves as drinking at least 150g alcohol a week for women and 220g for men (about 19 and 28 UK units respectively), but no more than 670g for women and 990g for men. They were among over 500 who had responded to adverts and other invitations to join the study who said they had not recently been in alcohol treatment and were not suffering a psychiatric disorder. Just over half were women, 82% were employed, and they averaged 45 years of age. About 8 in 10 self-assessed as dependent on alcohol, though 86% had never received professional help. The women averaged 352g alcohol (44 UK units) a week and the men 419g (about 52 UK units).

Half were allocated at random to immediately gain access to a 12-session web-based treatment programme. The other half formed a control group who had to wait three months for access, during which they were kept in touch with through fortnightly email messages from the research project.

The web-based programme involved patients being allocated their own personal therapist with whom they communicated in writing via the project’s web site. Rather than online ‘chatting’ in real time, communication was analogous to email messages, responses following some time after the initial contact. The programme was based on cognitive-behavioural therapy and motivational interviewing. The first part involved assessment, assessment feedback, a drinking diary, and identifying situations which for that individual risked heavy drinking. This part culminated in advice from the therapist on how the patient might change their drinking habits. Part two was the change phase, involving setting a drinking goal and formulating a plan for maintaining the new drinking behaviour.

The authors’ conclusions

Post-therapy improvements in drinking and health and in quality of life were sustained over the next six months. The decrease in alcohol consumption was substantial and clinically meaningful. These results suggest web-based alcohol interventions with intensive personal support from a therapist can help reduce problem drinking. However, support of the kind offered in this trial requires more resources than less intensive web-based interventions such as brief interventions or self-help programmes. Professional therapists available at least twice a week are needed to maintain communication with participants, and technology and security requirements are greater because personal information is sent between clients and therapists. Despite these costs, web-based alcohol interventions of this kind are legitimate additions to the range of treatment modalities as they attract new groups of problem drinkers and extend the accessibility of interventions.

Web-based treatment particularly attracts women and better educated and employed drinkers, groups under-represented in face-to-face therapy. Anonymity means participants no longer need stay away from treatment because of shame, fear of stigmatisation, or other barriers to professional help. Participants are helped in their own environments at times of their choosing, making therapy more accessible and convenient. These are also why email type communications have an advantage over ‘chat’ sessions which require client and therapist to be available at the same, set times. An advantage over self-help is the added value of personal contact with a professional therapist. The main challenge seems to be keeping participants involved until the end of the programme.

As part of my online course 1:1 support is available via email – and as this study shows it can be very successful 🙂

Friday Sober Jukebox – Gratitude and thank you

circle of gratitudeIn a circle of gratitude I want to thank this person for sharing this with me 🙂

Hello I’m ….. and I am an alcoholic … or am I ?

I really don’t know the answer to that question, but I do know that my drinking was way out of control and needed to be addressed.

I had been drinking heavily, VERY heavily for many years I was physically, and emotionally worn out with it . I wrestled with the concept of sobriety for two years before I finally fully accepted that this was the only way forward for me. Over the two years I spent thousands on therapy with various different therapists all with different views and treatment plans finding out why I drank and ways to help me moderate my drinking in the hope that I could put an end to all this misery. I knew all along that in my heart that I was killing my self with drink but knowing that and accepting that are two very different things. Alcohol was my best friend and worst enemy, I really didn’t have any clue on how / where to start to live without it.

It is such a scary place to find yourself and I was genuinely shocked to have found myself in this place. I considered myself to be a strong person surely I could take this on ?

Once I accepted that sobriety was the only way, I felt relieved, I stopped arguing with myself and decided to start taking action rather than just thinking about it. In December 2014 I set my sober date for January. I completed the Udemy course hangover free life by Louise Rowlinson which was great and gave me lots of tools and information . I subsequently had the follow up telephone call with Louise . Louise was fantastic, she was so understanding and most importantly believed in me and my ability to get sober . She helped me formulate a plan and emailed me every day to see how I was coping . I have to say although it hasn’t been easy it really has been life changing . I have now been sober for one year, although initially I found stopping drinking hard it is something that has become second nature. In the last year I can honestly say I have got my life back. It’s a very different life but a far far better one. I’m still in the process of finding out what I like to do hobbies etc but I’m being kind to myself. Reconstruction of my life has been an exciting time and so many thing have improved, my relationship with my children and partner, my anxiety, appearance. I am truly grateful for not only Louise’s help but also her belief in me at at time when I didn’t believe in myself. Although a stranger to me at the time she turned out to be a person who I will never forget!

So to riff on the theme of gratitude I’m going to continue to offer my Udemy course at it’s discounted price of £60/$89 until the end of January when the price will increase to £99/$149.  You can access it via the image to the right of this or via this link Udemy online course.  I am so grateful that 500 of you have signed up for this course so far and want to continue to help as many others as possible 🙂

Plus you can still sign up for my How to Quit Drinking workshop in London on Saturday 30th January here.

And now a tune 😉


Addiction Recovery Apps

This excellent blog post about addiction recovery apps comes from the Castle Craig blog and I’m sharing it completely as the information is useful in our now app centric world 🙂


Facebook, Twitter, YouTube, texting, checking the weather — everyone seems to be on their smartphone these days. But are there any mobile apps for those in drug or alcohol recovery?

Whether it’s for alcohol or drug addiction, or behavioural addictions like shopping, a host of mobile apps have been specially designed to support people in recovery.

Here is an up-to-date list of the most popular apps used for addiction recovery – in no particular order. We recommend you try them out and find the one that best suits your needs. Download links are included in brackets:

  1. Twelve Steps – The Companion was one of the first recovery apps available. It consists of the Big Book of Alcoholics Anonymous; daily meditations; a sobriety calculator, reminding the user how much time they have been abstinent; as well as an AA Meeting Finder with quick access to Maps. (Android & iPhone)
  2. An alternative to The AA Companion is the One Day at a Time app, which also provides The Big Book along with daily meditations, an abstinence tracking system and access to helpful phone numbers. (Android & iPhone)
  3. Hazelden, a world-renowned American rehab clinic, recently won the White House Behavioral Health Patient Empowerment Challenge award for its Mobile app: MORE “Field Guide to Life”. This new app is part of MORE (My Ongoing Recovery Experience), a web-based program of personalized continuing care provided by Hazelden to its former patients. The app guides users through the stages of early recovery for a year. (Android & iPhone)
  4. While alcoholics in recovery can get the A.A. Speakers app – a collection of over 300 audio recordings of people speaking at AA meetings – with a note of where the recording was made (Android & iPhone); people in drug addiction recovery who prefer audio material can get a separate app to listen to over 300 speakers at NA conventions. (Android & iPhone)
  5. Afternoon Affirmations sends users inspirational quotes, photos or videos every day at 1 pm. It is aimed at people suffering from alcoholism, drug addiction, prescription drug addiction, gambling addiction or eating disorders. (iPhone only)
  6. The Mindfulness Meditation app encourages users to take a break, set a meditation time and start relaxing. Mindfulness is known to be helpful in recovery by helping people de-stress. (Android & iPhone)
  7. iPromises is a free app that incorporates “trigger alerts” (warnings about the risks of relapse), a directory of AA sponsors (mentors in the AA methodology), a progress-tracking calendar and a directory of phone numbers for AA meetings anywhere in the USA or Canada. (Android & iPhone)
  8. CleanTime Counter keeps track of the user’s sobriety by calculating the time that has elapsed since a starting date. It has different customisable settings. (Android only)
  9. There’s even an app to help dependent people who are travelling to find the closest NA Meeting. This also includes daily meditations, websites and helplines for the traveler’s selected area. (Android & iPhone)
  10. Another popular app from Hazelden is My Sober Life. Specifically aimed at young people (ages 12 to 25) it provides such features as: a sober counter; daily guidance with inspiring thoughts; a photo uploader to be reminded of the person’s motivations in recovery; tracker of obstacles (triggers, stress, anger, etc); relapse prevention tool; AA, NA, Al-Anon meeting finder; addiction news and more. (Android & iPhone)
  11. The recoveryBox app uses a light system to keep track of the user’s daily activities. These are put into categories to mark their helpfulness: green light for beneficial activities, yellow light for potentially harmful behavior and red light for “acting out” or dangerous activities. It also has an email/text service to keep the person connected with their sponsor or counselor. An interesting thing is that this particular app supports from conventional to less-mainstream dependencies, like addiction to caffeine, exercise, social media, shopping, perfectionism, etc. (iPhone only)
  12. Sober Grid is a social networking app that gives access to a global recovery community. Its geosocial searching features allows users to find other sober people locally and around the world. Users can choose to remain anonymous, while being able to message other users, share content, answer questions and provide help. If a user is in need, they can select the “Burning Desire” button  which highlights their profile in red, showing others they are going through a hard time and need support. (Android & iPhone)

Plus another apps that I have is the I’m done drinking counter, which is like the clean app listed at no 8 above but for i-Gadgets 🙂

Any apps you would add to the list?
Edited to add: 20/01/2016

Apps and Alcohol

As the proportion of the UK population owning a smartphone steadily rises, the use of apps is becoming increasingly widespread | DrinkAware, UK

Safeguarding in Treatment Services: Everyone’s Business

Following on from yesterday’s post about children and young people living with family members with alcohol and drug addiction, I tentatively present the conference at which that resource was launched.

help me understandMy approach is tentative because I know what an emotive subject this is and how conflicted I myself become when I start to even think about writing a post about it.  Why?  Because I am a healthcare professional that has a children’s safeguarding role and therefore a duty of care AND I’m a parent who used to drink abusively around her children.  One of the reasons I stopped was because when I started working solely with children and adolescents and their families my own hypocrisy around alcohol became very clear.  Do as I say not as I do does not sit well with me …….

So here are the resources from that conference for your information should you be interested:

Safeguarding in Treatment Services; Everybody’s Business

Adfam and DDN Conference – Birmingham, 10 November 2015. The day told on Storify | Adfam, DDN, UK

And access to the presentations from that day are here:

Safeguarding conference

It’s important to speak about this otherwise children and young people don’t have a voice – like this one:

How my famous jockey dad died from alcoholism

Natasha Eddery-Dunsdon says she knew deep down all her life that her dad liked to drink | BBC Newsbeat. [See also‘My father suffered from a horrendous disease’ BBC radio iPlayer]

None of this is written in judgement of those who are reading this and have children and are continuing to drink abusively as I know how hard it is to break an addiction.  But I would ask, please seek help whether via your GP, local drug and alcohol service, private counsellor (specialising in alcohol addiction), AA, Smart Recovery,  or contact me and I will do my very best to signpost and support you.  Whatever works for you and your children.

Help me understand

This is a new resource for children and young people to help them understand a parents drug and alcohol addiction that was launched in November by The Children’s Society.

help me understandThis was their press release:

Our new resource booklet to support children and young people affected by a parent or carer’s alcohol or drug treatment is now available.

Help me understand, aims to help those affected talk to support workers about what the treatment undertaken by a parent or carer means, and how they might be feeling and experiencing it.

The booklet includes exercises and simple information for children and young people and an information section for workers to help guide children and young people through the topic and signpost to other resources where needed.

Joanna Manning, national lead on substance misuse at The Children’s Society, said: “While having a parent or carer in treatment can be a positive thing, it can also be very confusing and distressing.

“This new booklet is designed to talk simply and directly to children and young people and includes messages from others in the same situation, as well as a variety of exercises to work through.

“It will be a valuable tool for workers to use in helping children and young people to stay safe and to understand the importance of accepting and sharing their feelings.”

The booklet was officially launched on November 10 at the Drink and Drugs News/Adfam conference Safeguarding In Treatment Services: Everybody’s Business. 

Help me understand is available to download as a free online resource

If you are interested in purchasing hard copies then please contact us

A brilliant resource to add to what we have already 🙂

Are You an Invisible Alcoholic?

Thank you to the kind member of SWANS on FB who kindly shared the link to this The Fix article about high functioning alcoholics.

eckhart tolleHigh-functioning alcoholics are often hiding in plain sight—and they’re often more dangerous than drop-dead drunks.

“He was never drunk when I interviewed him,” the late writer Truman Capote’s biographer told me.

“It was just a mistake. He didn’t hurt anyone,” a friend said of an acquaintance who got a DUI last year.

“She doesn’t drink much,” my husband said of me when a therapist asked about our drinking habits. “Just a little white wine.”

Alcohol is confusing. For one thing, it is selectively addictive. Some people can drink safely; others can’t. For another thing, although alcohol is a depressant, especially in large doses, new research shows that in moderate doses it can also act as a happy stimulant. The first few drinks make the world a better place. The next few have the opposite effect: The drinker “may not be able to grasp the thread of a conversation; his reflexes will be somewhat delayed, his speech slurred, and his gait unsteady,” writes Dr. James Milam in his classic study Under the Influence.

Because ethanol, the active ingredient in alcohol, is a very simple and very tiny molecule, it is the Speedy Gonzales of addictive substances, zooming right through the protective blood/brain barrier and delivering
an immediate punch. Once alcohol enters the bloodstream, it triggers a series 
of responses that can last 24 hours. Many heavy drinkers are always in some 
stage of inebriation or withdrawal, and this changes the way they engage with
the world. There may be hours—entire mornings!—when they appear to be “normal,” but there is no “normal” in the body or brain of a heavy drinker.

Alcohol is metabolized at the approximate rate of one drink per hour. Someone who has two drinks before dinner, three beers with dinner and two nightcaps may pass out and wake up six hours late still drunk. If
 they sleep longer, they wake up with more alcohol out of their system but often in a painful state of withdrawal (along with dehydration and other nasty symptoms caused by the toxins that your body churns out as it processes the ethanol). Hangovers, which arguably have a greater effect on mood than alcohol itself, are the body’s scream for more. Soon enough, driven by a cellular level craving, the heavy drinker with a hangover will have that beer or that brandy in the coffee that quiets the disturbance, at least for a while.

Someone in withdrawal is even less likely to seem drunk than someone who has had a few drinks. But the effects can be deadly. “The strange truth that alcoholics are often in worse shape when their blood alcohol content is descending than when it is at its highest level is an extremely difficult point to grasp,” write Catherine Ketchum in her book Beyond the Influence. “The withdrawal syndrome represents a state of hyperexcitability, or extreme agitation in the nervous system. “ Ketcham uses the tragic example of Henri Paul, the driver of the car in which Princess Diana and Dodi Fayed were killed in 1997. Paul, who had a blood alcohol level three times the legal limit when his body was tested after the accident, had been waiting around the Ritz for two hours to drive during which he had little to drink. “Paul was drunk and he was in withdrawal,” Ketchum writes. “Both facts sealed his doom and the fate of his passengers.”

In Understanding the High-Functioning Alcoholic, Sarah Allen Benton makes the case that the image of the archetypal alcoholic—the stumbling Bowery bum—has obscured a much more common and infrequently treated type of alcoholic—the alcoholic who can function in the world and appear to be fine. Perhaps because high-functioning alcoholics do not tax government systems and cause social problems, they get far less attention than more dramatic drinkers. Although these high-functioning boozers sometimes do not 
meet the diagnostic criteria for alcoholism, they are desperately in need of help. Examples abound: from former First Lady Betty Ford to actor Robin Williams and musician Eric Clapton. Dr. Mark Willenbring, an addiction specialist, told Benton, “[High-functioning alcoholics] are successful students. They’re good parents, good workers. They watch their weight. They go to the gym. Then they go home and have four martinis and two bottle of wine. Are they alcoholics? You bet.”

I was one of those confusing invisible alcoholics. I didn’t stumble or slur. I didn’t break out in handcuffs. No one ever told me to stop drinking. There were
 no emergency rooms or rehabs. Most of the day, I considered myself sober. From the outside all was well: I had a loving husband, two terrific kids and an enviable career. From the inside I was hollowed out by despair. I got through the mornings on coffee and sugar, promising myself that I wouldn’t drink again. In this twilight state I lived my life—driving cars, arguing with the IRS, complaining about my marriage. By evening there only seemed one solution to the unbearable hammering of the hours—a glass of white wine, and then another. I felt entirely alone. Now, 20 years later, I realize that I had a great deal of company.

Susan Cheever, a regular columnist for The Fix, is the author of many books, including the memoirs Home Before Dark and Note Found in a Bottle, and the biography My Name Is Bill: Bill Wilson—His Life and the Creation of Alcoholics Anonymous.

The bolded section and last paragraph of this article could have been written by me about me before I stopped.  If you’re worried about your drinking maybe you should watch this documentary programme that is out on the 13th of Jan at 10pm on C5.

Here’s the trailer (which features Lucy Rocca from Soberistas) and she wrote this  comment is free article in The Guardian to support it:

Other people were alcoholics. I just liked a drink – or so I thought

Thanks to Paul over at Alcoholics Guide to Alcoholism for bringing it to my attention and he’s written more about it here.


A Cry for Help

This was an excellent blog by Castle Craig looking at alcohol withdrawal and delirium tremens called ‘A Cry for Help’.

Last winter in the UK, a young man was found dead in a bloodsoaked hotel bathroom. The inquest determined that he had died by his own hand. It emerged that, in a confused state, he had tried to alert staff where he was accommodated to his fears that he was unwell, but seems to have been disregarded as a drunk causing a nuisance.

The inquest did not link the death to alcohol because there was no alcohol found in the body at post mortem. He was known by friends and family to drink alcohol but had never been diagnosed or treated for that.

His lap-top computer showing messages and websites browsed in the last hours of his life, depicted a frightening sequence. He had sent this message:

“I had stupidly started on a drinking binge and never stopped until 3 days ago. I thought I was getting better today but now I have the shakes and am hallucinating whenever I close my eyes and can’t sleep. I’m sorry if this appears scary because it is . . . I’m not here to harm anyone. I have looked this up and I have all the symptoms for alcohol withdrawal. This is a treatable condition. I mean no harm, I just need a doctor. The moment they see they will prescribe medication. If you feel threatened by me, which it looks like you do, get the police to escort me. I need to get to a doctor or to try sleeping this off.”

In the hours prior to this, he had accessed websites giving information related to alcoholism, and in particular delirium tremens. He had looked at Wikipedia and other websites about alcoholism and the withdrawal syndrome. One site said withdrawing from alcohol was no worse than quitting smoking.

But elsewhere he could have found a link to this account published in 1844: The Horrors of Delirium Tremens by James Root 1844 . . . he recounts how after one particular drinking spree, he experiences the effects of Delirium Tremens. As he wanders from Manilus to Syracuse to Geddesburgh, he begins to hear strange, shrill noises and whispers. He strikes up conversation with the source of the noises, finding little to be unusual about his experience until he follows the voice to a group of ‘fiends’ and devils who threaten him with damnation. He climbs up a tree to try to escape them and even enlists the help of a local landlord, but to no avail.

Some people are able to sustain high alcohol consumption for long periods, and still function in their jobs and relationships. However, cessation of alcohol consumption after periods of very heavy drinking may precipitate the alcohol withdrawal syndrome.

The severity and pattern of bodily and mental disturbance varies according to the individual’s constitution, physical health, nutritional status and the duration and quantities of alcohol consumed especially if consumed continuously.

Brain chemistry adapts in numerous ways to compensate for the effects of heavy consumption of alcohol. When alcohol is removed, certain systems that have been ‘suppressed’, such as the alerting transmitter glutamate and the flight/flight mechanism (noradrenergic and corticosteroid system) overshoot as they spring back into action. The individual is agitated, tremulous, unable to sleep, and may become confused. Hallucinations and accompanying deluded thoughts do not always ensue, but if they occur typically commence 2–3 days after the last consumption of alcohol.

This may be frightening. Beliefs and hallucinatory voices may be convincing, even commanding the person to behave in a way that would be out of character, including self-harm. Such commands may be acted upon. There are reports of individuals who, under such influence, mutilated themselves. Patra et al. (2014) describe an individual inflicting multiple stab wounds on his abdomen during alcohol withdrawal, as did Roig et al. (2014), and Charan and Reddy (2011) report an individual mutilating his genitals.

Severe withdrawal symptoms are sometimes seen during detention on remand in prison or in police custody when there is forced immediate cessation of alcohol consumption. If there is no medical treatment delirium may ensue. The first few days in custody comprise a frequently reported risk-moment for suicide.

Hospitalization after trauma or for a medical condition resulting in sudden alcohol withdrawal can result in impulsive or even deluded behaviour leading to self-inflicted death (e.g. Edinburgh Evening News, ‘Patient Plunges from Hospital Window’, 1997). Brådvik and Berglund (2003) documented that from 1949 through 1969, 1312 patients with alcohol dependence were admitted to the Department of Psychiatry in Lund, Sweden. By 1997, 102 of those patients (of whom 99 were men) had committed suicide.

Their deaths were compared with those of other suicide victims who had been previously diagnosed with severe depression or other illnesses. For the patients with alcohol dependence there was a suicide peak on the first 2 days after weekends and holidays. Alcohol withdrawal was suspected to be a contributor to that suicide peak—suggesting that trying to get sober for work on Monday after holiday or weekend heavy consumption of alcohol carries a risk for some drinkers.

The inquest mentioned above made no mention of factors that might have led to that violent death.

This article was first published in the scientific journal “Alcohol and Alcoholism”. The original version includes all references to the quoted research:

If when you stop drinking you get any of these symptoms please seek medical help.

PS I’m taking a wee cyber break over the week-end and will be back responding to comments again on Monday afternoon 🙂