The first treatment for alcoholism is to stop drinking alcohol. Going into hospital is the best thing, because generally people have no trouble giving up alcohol in the surroundings of a hospital ward. Tests, such as liver biopsy, can be done, and medical and social problems can be dealt with.
Withdrawal effects from alcohol are
sometimes troublesome, and may make a person anxious and tremulous. Taking antianxiety or tranquillising drugs in the form of tablets, like propranolol or chlormethiazole (Hemineverin), is helpful for a short time. Alcoholic patients should not be given tranquillisers to take home because they may start to drink again and the combination of drink and drugs can be lethal. This combination was responsible for the British rock group The Who becoming a trio instead of a foursome.
Sometimes withdrawal effects are very bad, and cause hallucinations and fits. This is delirium tremens (DTs) and needs to be treated quickly with drugs by injection. Most commonly used are shots of diazepam, and chlormethiazole by drip for a day or two. Some of the problems of the alcoholic are caused by poor nourishment and high dose of vitamins B and C by injection are needed.
To strengthen the resolve of the reformed drinker treatment with disulfiram tablets is often used. This means taking a tablet in the morning, when most people feel least like a drink, but it acts all day long to cover the evening when temptation is strongest. The drug blocks one of the liver enzymes and so alcohol is only partly broken down. A chemical called acetaldehyde builds up in the blood to levels which are poisonous and makes the person very unwell. This treatment can kill if alcohol is drunk, and it concentrates the alcoholic’s mind wonderfully to be told this.
The best results long term come only if the alcoholic decides to reform, but medical and social support are also needed to get good results. Voluntary contact with Alcoholics Anonymous is very useful.
When a person has cirrhosis fluid may cause the body to swell. This is treated by restricting the amount of salt in the diet and by taking diuretic tablets. If the abdomen is severely swollen a plastic tube can be inserted through the skin to drain off fluid continuously. Treatment is also started to stop this fluid returning.
Mental changes can be improved by avoiding drugs which affect brain action and by reducing the amount of protein in the diet, as it is protein breakdown products which cause part of the problem. Certain drugs may help to reduce confusion too.
One of the most difficult conditions to deal with when a person has cirrhosis is internal bleeding, which may be from ulcers or from enlarged veins at the bottom of the gullet. A temporary solution is to give a blood transfusion, together with treatment with vitamin K and fresh blood plasma, which will help blood clot better. The stomach is examined inside by fibreoptic endoscope as soon as possible to find the cause of bleeding.
If there are veins at the bottom of the gullet these can be injected at the time to block them off – alcohol itself can be used, by a nice paradox! If bleeding continues then a balloon at the end of a tube can be left blown up in the gullet for a day or so to flatten the veins, and further treatment given to reduce pressure in the veins. If this is not the answer then an operation to cut all the guilty veins or to divert the blood flow is the last resort. This is a desperate measure for a dangerous disease.
Sometimes internal bleeding comes from an ordinary peptic ulcer. This is easily healed by taking tablets, provided the patient survives the bleed.
People with cirrhosis may have health problems which do not improve with treatment or rapidly worsen. This may just be the disease getting worse, but cancer may have developed. Though the tests are limited, liver biopsy or scanning can help. Even simpler, many liver cancers (hepatomas) make large amounts of an abnormal protein called alpha-fetoprotein, which can easily be found in your blood. For someone who has alcoholic cirrhosis with hepatoma, no curative treatment is available, but help can and will be given to control symptoms.
Alcoholics with cirrhosis sometimes object that since the liver damage will not go away they might as well go on drinking. This is wrong. Continuing to drink alcohol causes even more illness and shortens life in this condition. Problems worsen each other: A man in his 60s with alcoholic cirrhosis was admitted to hospital for treatment of fluid. But did not make good progress and became more confused and lethargic. It was noticed that he was becoming increasingly anaemic for no clear reason and an endoscopy was performed. He had a bleeding duodenal ulcer and the blood from this had effectively turned his intestine into a human black pudding. The protein breakdown for this had affected his brain. When he was treated for the ulcer, and with a low protein diet and lactulose to reduce protein breakdown he became alert and grateful.