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Advice on Alcohol

Chemical Roulette Is a Losing Game

January 15, 1985|DR. JOSEPH A. PURSCH

Question: I am a 32-year-old businessman. After I began treatment for alcohol abuse two years ago, my psychiatrist prescribed Tofranil, 50 milligrams to be taken at night for my depression. About a year later he changed me to Elavil, 25 milligrams at bedtime, which he later changed to "take as needed for anxiety." After two years of weekly therapy sessions, I stopped seeing the psychiatrist because I felt trapped, I was in a rut, I was not getting anywhere and I could no longer afford the expense.

About three months ago I saw an internal medicine specialist. He said I was in excellent physical health but diagnosed me as depressed and prescribed Ludiomil. When I gave him my previous history, he said that my previous treatment (Elavil and Tofranil) "was not at all right."

My problem now is that I have lots of doubt, anger and worry about my previous psychiatrist's approach to me. I haven't had a drink for two years, but my "pursuit of perfection" is making me feel anxious and stressed. What is going on? Can't doctors make up their minds about a simple thing like alcohol abuse? Why all these conflicting drugs?

Answer: Your pursuit of perfection is complicated by chemical roulette and ineffective psychotherapy in the face of a healthy body as pronounced by your internist. Probably the only valid opinion you've gotten so far is the internist's statement that you are physically normal.

Your letter paints you perfectly as a compulsive alcoholic. You've been suffering "white-knuckle sobriety" (painful abstinence) which characteristically causes anxiety, depression, insomnia, anger, self-doubt and other symptoms you have been treated for. There is no such thing as an alcoholic or drug addict who after detoxification and initial rehabilitation does not suffer some or all of the aforementioned. It is for that reason that individual psychotherapy and chemical bullets (Tofranil, Elavil, etc.) are ineffective.

I am impressed by your ability to have abstained from alcohol all this miserable time, but your pursuit of excellence is taking you on a road paved with pills, side-effects and doctor shopping. Get yourself immediately into an outpatient aftercare program designed for people who have undergone treatment for alcohol or drug abuse. Your program should consist of the following: no mind-altering drugs whatever (since you have been diagnosed as not being manic-depressive or otherwise psychotic) and some kind of self-help affiliation like Alcoholics Anonymous, as well as group therapy, individual sessions and education to address your compulsive life style.

Q: Your column about the woman who drank a six-pack of beer and lots of vodka daily while breast-feeding her baby made me very angry and then sadly depressed for several days. All I could feel between sobs was a deep desire to help that little baby. The letter also reminded me of my husband, who has a serious drinking problem but won't do anything about it. Too bad that an alcoholic can never go down alone--they always have to ruin someone else's life along with their own. I just never thought it could affect an innocent baby. I just wish there was something I could do.

A: Your emotional letter is typical of a number of responses to that column. It exemplifies the family and community nature of alcoholism.

The good news is that positive things are happening and there is something you can do. The most positive thing is that the media are daily carrying information about alcoholism and, as a result, many more people are getting treatment and education. What you can do personally is to start doing your part about taking care of the alcoholism in your life, just as that baby's grandmother is hopefully doing, now that her alcoholic breast-feeding daughter's problem has been explained. What I mean is to start taking care of your part in your husband's alcoholism. Thank your for sharing your letter with us.

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