We had an interesting debate at Butabika today, about the use of disulfiram for alcoholics. To put it simply, this drug causes any intake of alcohol to give a quick and massive hangover, and thus functions as a deterrent for drinking. This seems to be a drug that is more widely used in Norway than here in Uganda.
For once, this is not because of a lack of resources. Rather, it's the principle behind the use of such drugs that appears to be the issue here. Their point is that getting alcoholics to stay away from alcohol by making them fear its consequences is a step in the wrong direction. That is, that it is better to actually motivate them to manage it on their own.
But I ask, isn't all motivation based on either a fear of consequences or the want of a reward? Even telling the patients something as basic as "abusing alcohol will make it harder to recover from your other psychiatric conditions" is still a telling them about a consequence per se. Ignoring side-effects for the sake of argument, why should disulfiram be considered so different from telling them that?
Subscribe to:
Post Comments (Atom)
Well I'd say there is a definite difference in the mindset of it. I mean, I see your point, but I'm not sure I agree.
ReplyDeleteThe basic difference is seeing long-term vs. short-term consequences of drinking. If you ask me the hangover thing in itself isn't necessarily enough motivation to stop altogether, whereas the more drastic "ruins your whole life" is a bit more scary.
Also - wanting to get better isn't necessarily the same as the fear of getting worse is it? I mean they can be interlinked but they don't really have to be...
Finally, and I think the most important reason, is the fact that the mere process of overcoming an addiction by yourself can be something that helps instill a feeling of self-confidence, more so than taking pills would.
Of course, this is only given to those who are motivated to quit but feel that they are bound to get into situations where they won't be able to say no - and thus need extra help.
ReplyDeleteThe ideal situation is managing on their own, but I see this more as a "stepping stone" to that point, rather than a step backwards. I guess that's the core of the difference in opinion here.
I don't see it as a step backwards, any attempt at getting better is a step forward. Hmmm... not sure. Need to think about my opinion some more. :P
ReplyDeleteThis reminds me of a slightly related issue, see some comments in Norwegian media on a recent article in Neuropediatrics:
ReplyDeletehttp://www.dagensmedisin.no/nyheter/2010/02/09/alkohol-reduserer-barnas-e/index.xml
http://www.aftenposten.no/helse/article3512325.ece
http://www.forskning.no/artikler/2010/februar/242459
The cooperation between Bergen and Western Cape is particularly interesting, I think. Surely, the harmful effects of alcohol intake during pregnancy have been known for some time, but there are still more to be done to bring out this message unambiguously. How is this issue treated in Uganda? (I guess disulfiram is not a good solution in these cases).
Definitely an interesting point. Getting over alcoholism is all the more important during pregnancy like you point out, but disulfiram is contraindicated during pregnancy. It would certainly be interesting to find out how the issue is handled here.
ReplyDeleteI'll try to ask someone and get back to you on that.
I finally got around to asking about this.
ReplyDeleteLargely, it depends on whether they are in withdrawal or not. If not, they are treated using psychotherapeutic techniques, for example group therapy. If they are, benzodiazepines are added.
Much the same as in Norway, I guess, although I think we're more restrictive with our use of benzodiazepines if I remember correctly.