A week of liaisons with GP/Addiction Charity/Psychiatrist/NHS Addiction Service: Anti-cravings meds

Posted , 8 users are following.

Well, I am really not much wiser than when I started.

First-up, I'm in Northern Ireland, and it seem plain that each of the four parts of the UK - and perhaps different counties/Trusts/etc - have different rules and practices.

(I should say that my descent into alcohol dependency has root-causes and alcohol was the last resort, so, as I've said on another couple of threads, my dangerous drinking has really been in the form of very short, isolated binges since October 2013, then much more serious and dangerous continual heavy drinking of mainly hard liquor/spirits from April to mid-August this year, with a six week gap in June/July when I tried re-rab, but realised it didn't work for me anyway.)

The first discussion about these anti-cravings medications was with an alcohol liaison nurse in the major hospital close to me.  She knew about all of the medications, but not 'The Sinclair Method' (TSM), but said she thought they would all only be prescribed by NHS Addiction Services.  However, she saw the benefit in them in different ways for different people and said that, even if abstinence couldn't be maintained, moderate drinking with the helping of the meds was infinitely preferable to continued dangerous drinking and its consquences.

Then I saw my GP.  I asked him about them.  He said he had no objection to them being prescribed to me, but only really knew about Antabuse (which I told him I wouldn't touch) and Acomprosate, but that any of them would have to be prescibed by the Addiction Service Consultant/Doctor in the first instance, though he had no objection to me being prescribed them and would have no problem signing-off repeat prescriptions if I continued to work with Addiction Services.  He had never heard of 'The Sinclair Method'.  He knows that I am very open and honest with him and I told him that, if medication promoting it was not prescribed to me on the NHS, I had researched things comprehensively, including on this website - which the surgery I belong to links to - know that it not illegal to buy or use them in the UK for the good of one's own health, and that's what I would do.  He didn't admonish me for that and we parted on the usual good terms.

A few days later, it was time to see Addiction Northern Ireland (AddictionNI).  They are a charity.  It was really just an introduction.  I told them that I had reduced my consumption dramatically (it was dangerously high) to a few glasses of beer or cider most days, probably above new government guidelines that I doubt hardly anyone who drinks seriously sticks to.  We touched on the anti-cravings drugs, the counsellor didn't know much about them, but said they would be a matter for the NHS Addiction Services.

Then I saw the Consultant Psychiatrist who I see reguarly and has been very sympathetic to me.  The last time she saw me, in May, I was just over 12st (I am 6ft 1in), longish-haired, unshaven and looked awful.  Now, I am back over 14st, short hair and had showered and shaved as a normal person would.  She said she was amazed how well I looked.  She DID know about all of the medications and said she had some patients and they were doing well on Naltrexone.  She realised that I had read extensively about them and how they could work, but to go to my appointment with NHS Addiction Services before returning to see her next Monday (3 October).

I saw a counsellor at the (Belfast NHS Trust) Addiction Service yesterday (29 September).

She said I had obviously "done well" since the worst of times, but wondered if I realy wanted to quit drinking completely.  I said I didn't know if I would be able to, and simply don't feel that (me) stopping completely would make me less likely to go on a binge or binges if it took my notion or if there was a trigger.  I told her (as I tell you all) that I wouldn't thank you for brandy (I was drinking a litre a day on some occasions, and not eating, hence hospital admissions) but feel OK having reverted to a few glasses of beer or cider and actually my appetite is very good (I suspect because beer and cider stimulate appetite and I also take an anti-depressant called Mirtazapine, which is an appetite stimulant and sometimes prescribed as such).

We then turned to the anti-cravings drugs and the counsellor said she would discuss them with me with their information sheets.  Here's where the contradictions start ....

Antabuse:  Rarely prescribed any more, CAN be prescribed by a GP, but I said I wouldn't take it anyway.

Acomprosate:  CAN be prescribed by any GP, designed for people, she said, who are abstinent to keep them abstinent.

Nalmefeme:  CAN be prescribed by a GP, designed for people who want to seriously cut-down and may wish to become abstinent.

Naltrexone:  Can only be prescribed by a specialist (basically the Addiction Team's Consultant) for people who are already absistent to take daily or whenever they feel a craving.

TSM:  No knowledge of same.

I am due to go back to see them once they send me an apointment, probably to be assessed by the Consultant, but the counsellor said she felt it was extremely unlikely that the consultant would prescribe Naltrexone if I was still drinking any alcohol.  She said they would also probably breathalyse me but I told her the reading would be negligible or zero was I was only drinking moderate amounts and not when I got up.   

I also told her that, if they were not prescribed, and I felt I was at risk of binging again, I would buy Nalfememe, or preferably Naltrexone, myself and follow 'The Sinclair Method', but would obviously prefer it to be done under the NHS and with a doctor's supervision.

So, now I will take this new information to my Psychiatrist three days from now, presuming that she can prescribe at least the Nalfememe and maybe the Naltexone, and, if it comes to it, have to - in a nice way - contradict my GP on what he can and cannot prescribe.

Maybe it's worse here in NI, but is it any wonder people are so confused and NHS policy on this seems to be all over the place.

I know that people who work in addiction work prefer the idea that addicts'/abusers' goal is better being abstinence, but surely it is better that either this is attained gradually, or that drinking is reduced to much safer levels in people with alcohol (or other addictive substances) problems, than misery, expensive hospital admissions, treatments and operations, accidents and deaths?


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9 Replies

  • Posted

    Well done so far Gav!  You can see how important it is that you do your own research first, but sadly a lot of people are not in a position to be able to do this.  It makes me so angry that the people who are supposed to be experts in addiction matters don't even appear to keep up to date with addiction matters.

    Just a note, the method is not actually referred to anywhere in the NHS as 'The Sinclair Method'.  It might help if you refer to it as the medical name which is 'Pharmacological Extinction'.

    And it also might be worth you contacting the Irish Health and Social Care.  This is the organisation that commission which services are availble in Ireland.  Ask them for their official guidelines for both naltrexone and nalmefene.  If they come back to you and say that naltrexone is for both maintanence of abstinence and reduction in drinking, then that is what you can be prescribed it for and you should be able to receive it, if it is medically suitable for you.

    If naltrexone is just indicated in Northern Ireland for maintenance of abstinence, then you will at least have the official NI guidance for nalmefene, so you should be able to receive that, if it is medically suitable for you.

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  • Posted

    Thank you all for replies to date.

    It's almost 3.30pm here and I'm just starting to sip a glass of cider having done my chores for the day.  Six weeks ago, I would have been in a stupor or sleeping/blacked-out by now I don't doubt.

    I think the more realistic  appraoch(as opposed to the one of abstinence or nothing) is the one much, much more likely to help me.

    The Republic of Ireland health service, of which I have very limited experience - one day and night in a hospital in Donegal - is much-maligned by the people there: they are, perhaps rightly, evious of the NHS, as most people in the Republic have to pay each time they see a GP, as well as much higher prescription charges (prescriptions are free in Northern Ireland, like Scotland and Wales).

    I am going to talk about all this, and the additional reading I have done on the C3 Europe and related sites, and see what my Psychiatrist says.  If she prescribes what I want and need, then I won't have the potentially awkward consultation with my GP who said he couldn't (wouldn't?) prescribe what he actually can.

    If she won't and he won't, then I am stuck until I see the prescriber from Addiction Services and the counsellor there was pretty adamant that I would have to have stopped drinking alcohol and stay-stopped if I wanted Naltrexone (though how they would know if they breathalysed me and the reading was negligible or zero, as I'm sure it would be these mornings and days before appointments).  Of course, I would not want to lie, but I don't think I should be denied somethng for being honest and saying I have liked the taste of beer and cider for 30 years and if I can continue to enjoy it moderately, or don't feel like it any more because of Naltrexone, which might happen and would be an even better thing, then why not prescribe it to me? 

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    • Posted

      My doc has never heard of any of the meds used to  cut down the liking, she really had not a clue and referred me to Smart recovery.  On checking it out, they will not prescribe meds if they can help it and try the counselling route.  Well that seemed a waste of time to me so I decided to counsel myself and here I am in my 6th week and still having one small glass of wine per night instead of 2 bottles.

      I don't want to stop having this small pleasure neither.

      Didn't think I could do this - but I HAVE. 

      Whatever you need to do gav is good.  At least you are trying your hardest and it is b++++y hard work. 

      Brillilant post by the way.......................G.

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  • Posted

    you have done A LOT of work.

    Good for you..

    I'm proud of you...this shows that you are ready...thank God for that.

    Readiness is the gift of sobriety.

    Good luck this week.

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  • Posted

    Thank you, Misssy2, for your kind thoughts and good wishes.

    But I don't think I am ready for complete sobriety.  I drank more on Saturday because I always did on Satursdays (chores done, sport on TV).

    Sobriety might be nice, it might even be health enhancing or death preventing, but I just don't feel that I can or sustain safe drinking without nalefeme or naltexone.  Doing abstinence on my own, or in re-hab (I tried rehab in summer and, of 32 peiople in my group, two-thirds had been there more than onece before - meditation and the Serenity prayer said like a mantra is not for me and,it seems most others).)

    As many told me that AA meeetings consisted or boring ;dry drunks', and others who turned-up at meetings having consumed alcihol, or went to the pub afterwards,  No thanks!


    We will see what Monday brings with my Psychiatrist,

    Thanks again.

    Gavin.  xo

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