Alcohol Rehab


Life in alcohol rehab: Petty rules and $15,700 fee aside, addiction centre did what it could

When I entered Bellwood Health Services addiction centre in Toronto on Jan. 3, I was a physical wreck. Mentally, I think I was in better shape. I knew and acknowledged that I was an alcoholic and that I needed professional help if I were to live many more years. I felt little or nothing of the grief, shame and denial that so many of my fellow "clients" were to movingly express over the next four weeks during lectures for all, group therapy (six to 10 people), one- on-one meetings with their counsellor, and in informal bull sessions.

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I was able to climb the few stairs to Bellwood and walk unassisted, but with a gait like that of Tim Conway on the Carol Burnett Show. I couldn't trust myself to carry a cup of coffee 10 feet. My liver, once enlarged, was now atrophying. My heart, fortunately, was in good shape.

Part of Bellwood's "holistic" program is compulsory daily exercise class. I was an avid, though often aching, participant, and took silent satisfaction when two geezers, slightly younger than me, begged off. But I needed more than stretching exercises. Most of all, I had to get my legs back into shape. And therein lies a tale of bureaucratic bungling, incompetence, petulance and pettiness. If it were a short story, I'd call it The Bike and the Mill.

After 21/2 days in de-tox, I joined the regular program. In whatever free time there was, I made for the exercise room to work out on the treadmill and stationary bike. After three or four days, I was caught by one of the two phys-ed instructors, and told I must get clearance to work out under supervision.

This I endeavoured to obtain, only to be told that no supervisor was available. I went back to my routine anyway, doing as much as 50 minutes a day on the two machines. I set both at high, not maximum, tension. Everyday, in every way, I was getting better and better.

Then my illicit activities were discovered by a program assistant, or PA. I was handed an infraction, which meant I would receive no weekend pass. Quietly stewing at this escalation of nonsense, I vowed my petty revenge.

Each of us had been assigned one week of light duties -- sweeping up the butts in the parking lot, giving the 7 a.m. wake-up call, and the like. My job was to dust the lower lobby and water its plants. At the first meeting to explain our tasks, I loudly announced that I had come to Bellwood for treatment of my alcoholism, not to become a landscape gardener, and I refused to perform involuntary labour. I strode from the room and heard no more about my little rebellion.

A day or so later, in the hall, I bumped into Gerald Cooney, Bellwood's medical director and the man ultimately in charge of my exercise ambitions, and asked him to ban me from using the bike and the mill.

After three or four days of abstinence, I went back to the machines. Called in by Cooney, I was finally given permission to do my highly helpful thing. Wrong again. Granville, one of the PAs, said I could only work out with supervision.

Reprise Cooney. He said I had lied to him when I said I wouldn't use the machines. Whereupon I returned the compliment. When he OK'd my use use of them, he failed to mention that it was only "with supervision." Next day, the other phys-ed PA, a striking woman of Nigerian descent, asked me to demonstrate my prowess on the mill and the bike. Three minutes of each convinced her that I wouldn't fall on my head or have a heart attack while working out. Still, the bureaucrats had to have their miniscule triumph. I had to sign a promise that I would work out only after lunch and dinner. That was four weeks to the day after I entered Bellwood.

I did manage to score my own little victory one week later when, during my brief "graduation" speech, I said that "some of the staff" were preoccupied with the enforcement of picayune, petty, stupid and childish rules and regulations. It got a big hand from my now former colleagues.

Bellwood, I noted, had done for me what it could, and I was grateful for all but the crap. It was now up to me to do what I can for myself. And it's been so far, so good.

Regrets? Few. If I had been a resident of Ontario or Quebec, all or part of the $15,700 I paid Bellwood (it being a private, for- profit institution) would have been picked up by the government. Those two provinces recognize alcoholism as the disease it is and have a reciprocal arrangement to pay for the treatment of residents of the other province.

Not so in Nova Scotia. Here, medicare pays for patients in de- tox and that's it, no further treatment. Eastern Canada has no true treatment program, so for me it was Bellwood or nothing.

Of course, I wish that Nova Scotia had a taxpayer-funded Bellwood- like program. It would mean returning a small portion of the inordinate taxes that boozers pay for their position. Discreet enquiries about possible reimbursement for part of my Bellwood stay convinced me that I was out of luck.

Bellwood is just one more knock on the head to the fanciful notions of universal, taxpayer-funded, accessible, not for-profit health care. It never was so, and never will be. And the quicker we realize it, the faster we are on the road to true reform of the system.
Opiate Blocker Boosts Alcoholism Treatment

A drug that diminishes the pleasure-inducing effects of the brain's naturally occurring opiates gives added punch to psychological treatments for alcoholism, at least over short periods of time, according to two separate studies.

The drug, naltrexone, may dampen the desire to continue drinking among alcoholics who slip up and consume an alcoholic beverage shortly after entering a treatment program, both research teams assert in the November ARCHIVES OF GENERAL PSYCHIATRY.

Investigators have thus far identified no drug that consistently helps prevent a return to heavy drinking, or relapse, among alcoholics seeking treatment. Disulfiram, a drug that causes unpleasant physical reactions to alcohol, helps only a minority of alcoholics.

"Naltrexone appears to be a safe and effective adjunct to the treatment of alcohol dependence," hold psychiatrist Joseph R. Volpicelli of the University of Pennsylvania in Philadelphia and his colleagues.

The team studied 70 men, mostly black and unemployed, who entered an outpatient treatment program following supervised alcohol withdrawal. The men reported an average of 20 years of heavy alcohol use. Each man spent one month attending daily six-hour sessions that included group therapy, individual counseling, exercise, and health education. They then attended group therapy two times a week for the next 11 months.

Half the men received naltrexone pills; the rest received placebo pills for the program's first three months.

At that point, one-quarter of the naltrexone group had returned to heavy drinking or alcohol binges, compared with one-half of the placebo group, the researchers report. Moreover, 19 of 20 placebo-treated men who reported taking a drink of alcohol after entering treatment experienced a relapse, compared with eight of the 16 naltrexone-treated men.

Two men taking naltrexone complained of nausea, and another cited increased pain from arthritis, the scientists note.

A second study, directed by psychologist Stephanie S. O'Malley of Yale University School of Medicine, suggests that naltrexone enhances alcohol abstinence rates when used in combination with psychotherapy. O'Malley's team recruited 104 people receiving treatment for alcohol dependence at an outpatient clinic. Most participants were employed white men, although women made up about one-quarter of the sample.

Volunteers in the three-month study randomly received either naltrexone or placebo pills and either weekly coping skills therapy (emphasizing strategies to handle stress and avoid relapse) or supportive therapy (offering general encouragement without teaching specific coping skills).

The two groups receiving naltrexone displayed about three times the rate of abstinence as the two placebo groups, the researchers contend. Among participants who sampled alcohol during the study, less than half of those receiving a combination of naltrexone and coping skills therapy had a relapse, compared with the vast majority of those in the other three groups.

Five volunteers dropped out of O'Malley's study due to naltrexone-induced nausea or dizziness.

Volpicelli theorizes that naltrexone blocks the rush of naturally occurring opiates in the brain provoked by a first drink of alcohol, thus helping break the cycle in which one drink fuels the desire for another.

Treatment that fosters new coping skills as a front-line defense against relapse may work best in conjunction with naltrexone, O'Malley adds. The safety and effectiveness of naltrexone when used for periods longer than three months remain unknown.

"It is unlikely that any single [medication] will be effective for all alcoholic patients," Volpicelli's group adds.
Alcohol rehab programs improving in fight against alcoholism

Rosemary is heavy into discussion on the origins of her alcoholism when a hotel employee knocks on her hotel-room door and asks if he can replenish the mini-bar.

``See, you can't escape it,'' sighed the 43-year-old marketing expert as the hotel worker wheeled in a vodka bottle and accompanying orange juice.

Despite such temptations, Rosemary has gone 20 months without a drink thanks to Alcoholics Anonymous and a new drug, Revia, that helps suppress alcohol cravings.

She agreed to tell her story of hope -- she didn't want her last name used -- following a symposium Wednesday outlining a new alcohol rehab program and describing alcoholism as the top ``untreated treatable disease.''

While societal pressures and ease of availability -- as Rosemary's ironic hotel-room experience reflected -- can motivate problem drinkers to raise a glass, it's often forgotten that alcoholism is an incurable, genetic brain disease and not a ``life choice,'' addiction experts stressed.

Rosemary shares her genetic predisposition with her maternal aunt, who died in her early 40s of the chronic liver disease cirrhosis, a common ailment among alcoholics. But it was that first glass of wine at age 23, when she was a budding figure skater, that triggered her desires to drink at all costs.

The difference between having a drinking problem and alcoholism is loss of control, said Dr. Graeme Cunningham of Homewood Health Centre, which runs an alcohol rehab facility in Guelph, Ont.

``This is a nasty disease in nice people,'' said Cunningham, who dismissed commonly held beliefs that alcoholism is a disease of the poor and unambitious. ``Alcoholics drink to be normal -- to sleep, to relax, to make love . . . It's the most demoralizing and hopeless disease that as a physician I have treated.''

The good news is there's hope in the fight against the world's most common addiction problem, due to some facilities becoming better and better at treating these problems, said Cunningham.

But while problem drinking affects about 10 per cent of the population, it's still common for the problem to not be treated quickly and properly, he added.

He said many alcoholics are still treated for stomach, cardiovascular, high blood pressure and other complaints resulting from their drinking problem instead of the alcoholism itself.

``There are a host of programs out there to help alcoholics get recognized earlier and to be able to change their behaviors, but because of secrets, stigma and societal attitudes, we continue not to address alcoholism in the vast majority alcoholics.''

Early and proper alcohol rehab -- as a result of doctor referrals and family members helping alcoholics help themselves -- are key to chipping away at the human and economic cost of the problem, estimated at some $7 billion annually.

In some hospitals, about a quarter of beds are occupied by patients with alcohol-related disorders, added Dr. Ray Baker, medical director of HealthQuest Comprehensive Care Inc.

Alcohol rehab hinges on counselling and support from organizations such as Alcoholics Anonymous, where members are guided toward developing healthy attitudes by supporting each other.


- WHAT IS IT? Alcohol dependence, characterized by abnormal alcohol-seeking behavior and no control over drinking. Linked to genetic brain disorder, where certain neurotransmitter systems are involved in an alcoholic's inability to handle drinking. Social, environmental and personal factors often trigger drinking.

- PREVALENCE: One in 10 Canadians is a drinker at risk.

- SYMPTOMS AND SIGNS: Impotence, work and personal problems, drinkers' insistence they don't have a problem and can stop whenever they want. Often feel a need to drink to alleviate ``the shakes'' and stomach upset that set in after a night of drinking.

- DANGERS: Drinking and driving are blamed for half of road accidents. About 6,700 Canadians died as a result of alcohol consumption in 1992.

- COSTS: Alcoholism accounts for 40 per cent of total cost of substance-abuse treatment. Cost to the economy, considering medical and other treatment, is estimated at $7 billion annually. Alcoholics often suffer from related problems.

- TREATMENT: No cure. Focuses on alcohol abstinence aided by addiction treatment centres offering detoxification and counselling. Alcoholics are also encouraged to join the self-help group Alcoholics Anonymous, which works on a 12-steps-to-recovery program. Therapy is often combined with drug treatments, including Revia approved in Canada a year ago.
Alcohol rehab falls short

Her daughter turned to alcohol at age 12. Three years later, the 15-year-old is addicted, depressed, self-abusive, even suicidal, and there's no place in Ontario which offers the alcohol rehab she needs.

The woman, who did not want her name published fearing publicity might adversely affect her daughter, told her tale at a Wednesday meeting of a committee evaluating area substance abuse programs.

"WE DON'T KNOW what else to do," she said, with her husband at her side.

Her daughter last week finished a five-week program at a residential alcohol rehab centre in Bloomfield Hills, Mich. The family goes to weekly meetings there now. The girl also gets outpatient counselling at Windsor's Regional Children's Centre and goes to Alcoholics Anonymous meetings.

But psychiatrists and therapists on both sides of the border say the teen now needs a long-term residential program. And there are only two in Ontario. One is at Carleton Place, but it doesn't accept anyone under 16. The other is in Hawkesbury, on the Quebec border, but it doesn't offer family counselling.

Before her daughter was released from the Michigan centre, the mother asked OHIP to pay for her alcohol rehab. She learned Tuesday that request has been denied.

"I know I'm just a number and OHIP doesn't care about my daughter, but I refuse to let her fall through the cracks," she said.

The cracks begin at age 15, explained Layne Katzman, chairwoman of the Essex County District Health Council's committee on addiction services.

RESIDENTIAL PROGRAMS funded by the province begin at age 16. And in Windsor and Essex County, the Health Ministry puts no money toward long-term programs - those lasting more than 28 days.

"It's such an expensive service," said Katzman, surmising the province hasn't put any money into it because the money simply isn't there.

The House of Sophrosyne offers residential treatment for women, but the province doesn't contribute to its operating budget.

There is no local residential treatment or alcohol rehab program for children.

"Women need funding, but for kids, there's nothing," Katzman said.

Katzman's committee recently completed a report on how many local beds are reserved for substance abusers and who occupies them. Wednesday's meeting was designed to get public opinion before the report goes to the health council and then, in October, to the ministry.

Among the report's recommendations is one to establish a residential alcohol rehab facility for people aged 16 to 24. Katzman said the tale of frustration told by the mother of the alcoholic 15-year-old will be added to show treatment programs are also needed for younger people.
Consolidate addiction treatment programs

A report by the Kaiser Youth Foundation makes a good case for the B.C. government establishing an independent, arms-length commission to consolidate treatment and prevention for drug, alcohol rehab program and gambling abuse.

The foundation says because responsibility for drug and alcohol addiction services rests with the ministry for children and families, "the ministry's focus on children and families in crisis renders about 90 per cent of British Columbians invisible". Because the ministry is already stretched in its primary function, the result is a system with no real strategy, a lack of focus, and inconsistent and unreliable fundings -- not good news for a province with the highest addiction levels in the country. B.C. spends about $60 million on addiction services out of the $1.7 billion in revenues it receives through taxes on alcohol and tobacco and from gambling revenues.

There is nothing new about the foundation's conclusions. The same recommendations have been made for at least 10 years in reports and studies from the chief coroner, the provincial health officer, the RCMP and the B.C. Medical Association. The report also quotes equally well-travelled studies which support treatment (alcohol rehab among one) and prevention as the most productive and cost-effective answer to addiction.

The only question left is: Why is the government not listening?


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