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May 9, 2003

Behavior

Question from Metairie, Louisiana, USA:

My 56 years old friend is in denial of his diabetes, and his sugar levels fluctuate wildly, ranging 250-450 mg/dl [mmol/L] or higher. He eats beans, pasta. rice, breads and also drinks alcohol above what could be considered moderate. The doctor said if he did not go on insulin he would die in five years, but he is terrified of needles and absolutelyrefuses to use the medicine unless it can be swallowed. He is miserable and his life is totally unmanaged. His mental concentration is always confused and defiant. His serious compulsive obsessive tendencies are amplified and the confusion of anxiety has debilitated his abilities tocope on reasonable levels. Any concerns about his refusal to control his diet of heavy starch carbohydrates and liquor is met with an angry tirade of "old wives tales" and "you don't understand" and "Leave me alone!" & "I cant's" in his responses. Diabetes has cost him his law practice and is now costing him his family and his friends. He is overwhelmed and so is everyone else. We are frustrated beyond belief with his attitudes of disregard. The family is talking about having him declared incompetent and having him committed institutionally. I consider this an extreme and drastic measure, and I am asking for help here. Could an intervention be the answer? It has been suggested that the family escort him to the doctor to prevent the games he uses to dodge the advised pharmaceutical approach and document his self-destructive behavior.

Answer:

If someone’s use of alcohol repeatedly causes problems with health, employment, the law, marriage, or other relationships, then there’s alcohol abuse. Period. Sounds like he needs help, big-time.

Interventions need to be coordinated, and the physician must be fully informed and willing to participate. The best bet would be to have a counselor or psychiatrist who has seen him, and who is skilled in interventions, do the coordinating. See, for example, Intervention: Getting The Alcoholic Into Treatment.

Yes, the recommendations are “extreme and drastic”. But from what you say, they may be life-saving.

WWQ