oa Central African Journal of Medicine - The present trend of medical practice in the treatment of alcoholism

Volume 9, Issue 10
  • ISSN : 0008-9176



Address to the National Study Conference on Alcoholism, Salisbury, in May, 1962. Alcoholism is the commonest form of poisoning, and logically medical men should advise their patients to abstain from all forms of alcoholic beverages. This, however, would be unrealistic in the light of practical considerations. The doctor sooner or later comes into contact with alcoholism and the alcoholic either on the domestic or occupational level. Initially alcoholics are sympathetically received, but due to the repeated recurrence of alcoholism, together with the associated subterfuges, the medical man in attendance becomes eventually disinterested. Broadly, there are two categories of heavy drinkers. The one consists of the heavy drinker with a host of synonyms, while the other category consists of those who have a need for alcohol, manifesting as heightened drive, and who meet this drive by strong alcoholic beverages. The term dipsomaniac has been applied to the latter category of heavy drinkers by various clinical authors, with a descriptionption which has not changed for the last 26 years. In the main the observations made by these authors are applicable to the chronic alcoholic today. However, they relegated to psychiatry those unexplained aspects of which they themselves were apparently unsure of. This involvement of psychiatry into the field of alcoholism and the alcoholic has become a commonplace practice. The various pronouncements seemed to indicate a multifactorial approach in which there was apparently very little place for those concerned with the general practice of medicine. The general practitioner became disinterested in alcoholics and alcoholism and patients found themselves"" eventually subjected to a psychiatric regime. The disinterest of the medical profession cannot entirely be separated from the various concepts of alcoholism and the alcoholic, which it finds difficult to accept. A starting point in the approach to the alcoholic, which to us appears as a keystone to the whole problem, is concerned with the heightened drive. Diethelm and Fleetwood have shown that anxiety, tension and resentment in the alcoholic have biochemical equivalents which are significantly reduced by alcohol. This resentment finds expression as a ""resentment substance"" in the blood and which is not unlike 5-hydroxytryptamine (serotonin) . This serotonin has metabolic linkages with a bearing on the alcoholic individual. Olson, Cursey and Vester found that the breakdown of serotonin could be expressed by the increased secretion of 5-hydroxyindolc acetic acid (5.HIAA). This was significantly lower in alcoholics than in normal controls and indicates a biochemical difference between alcoholics and non-alcoholics. Peter ,and Neuman found that the excretion of xanthurenic acid after tryptophan ingestion was higher than normal. This again indicates a biochemical difference between alcoholics and non-alcoholics. In France, Faye found that a depletion of vitamin HI (thiamine) produces central nervous system disturbances. This vitamin acts as a cholinesterase inhibitor and intensifies the action of acetylcholine. Osmond and Hefer, in a recent publication. found that nicotinic acid \ niacin). Which is part of the pathway of the metabolism of tryptophan, was significantly useful in the therapy of schizophrenia. Alcohol, besides its local effect in slowing down bowel motility, may be responsible for the destruction of the vitamins of the B complex. The use of alcohol in the tapering-off technique, we feel, is pharmacologically invalid. Alcohol results in a dilatation of the blood vessels in the already damaged brain, produces a passive congestion and reduces the ability of the brain tissues to utilise oxygen. Insomnia is common among alcoholics and tends to produce fatigue and a lowering of efficiency. This must be alleviated by suitable hypnotics. Paraldehyde pinpoints the alcoholic and enhances existing inadequacies, so that it is contra-indicated. Barbiturates alone are seldom used, as they produce a dopey feeling which cannot be used for various occupational reasons. Impaired sexual potency has often been attributed, by alcoholics, to disulfiram or citrated calcium carbimide. An examination of this complained-of side effect has indicated that there is, in the main, no substance in this complaint. This particular complaint is also usually part of an avoidance behaviour to anti-alcohol medication.

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