To drink or not to drink

[ArmyMomJo]

At clinicals this last week, an alcoholic was admitted and made to go cold turkey. It seemed to me that giving him a drink would have taken the edge off instead of putting him into DT's and making his life completely miserable. This is his 6th time in the hospital for over drinking and his liver is pretty much gone. Probably won't make it in again. What do you think of a physician writing for an alcoholic beverage?

[CareteamRN70]

My Father was in a VA hospital in Kentucky during the late 1960's where it was (or so he swears) not uncommon for wounded soldiers to become addicted to morphine. He said a lot of the time they would cut back on the morphine and give the patients a shot (glass) of 80 proof alcohol for moderate pain relief. The rationale he was told is that it is easier to ween someone off alcohol then morphine. My father who later in life became an alcoholic greatly disputes this assumption.

[himilayaneyes]

I've heard of situations where a physician may order 1 beer tid, but more than likely the doc is going to put the pt on librium while they're in the hospital and give an order for ativan prn.

[NYnurseatheart]

I have worked in a hospital where they actually hung alcohol drips (I think it was 5% alcohol or 10%, not exactly sure) on patients who had surgery who were alcoholics. If their liver function was okay (perhaps not the best, but not in failure either) we essentially weaned it - it started out at 100 ml/hr, then every 4 hours we weaned it down by 10 ml. Usually by the time they were weaned off the alcohol, they were transfered from the ICU to a floor where a doc would order oral alcohol, rather than IV. The doctor's rationale was usually that this is what the patient is used to, and why take them off the alcohol and put them on Ativan or some other Benzo?

[sunnycalifRN]

holy cow... Ive never heard of this or seen this. When you get an order for this where do you get the alcohol from? It's not like pharmacy has a fully stocked bar full of brandy, wiskey, vodka? or do they? hehe

Oh yes, our pharmacy has beer and whiskey. Not prescribed too often, but I've given it.

[GooeyRN, ADN, BSN, CNA, LPN, RN]

I have seen orders written that a pt may have a beer or drink. Some patients do not want to detox.

[LouisVRN, RN]

I can see that if a patient is there for a reason other than alcoholism this would be okay. However if the pt has substantial liver disease caused by alcoholism I do not see how the doctor could not be charged with maleficence should the pt/family later try to sue.

[linearthinker, DNP, RN]

depends. Medically managed w/drawal is fine if it is the patients intention to enter outpatient rehab, etc and make a go at sobriety. when alcohol abusers are admitted for sundry other c/o, it makes little sense to put them through ETOH w/drawal.

[mustlovepoodles, RN]

I am horrified that in this day and age ANY doctor would make a confirmed long-term alcoholic go cold turkey. People can die in DTs. Alcoholism is a disease, not a personality flaw. To force any patient to undergo such a terrible, dangerous experience just to "teach them a lesson" is, IMO, negligent and abusive. The only thing it taught this person is to NOT go to the doctor again and to definitely NOT stop drinking.

As far as a doctor ordering an alcoholic drink, I think that's perfectly acceptable. My MIL is a long time alcoholic, 90 years old and living in a nursing home. She has no intention of giving up her nightly toddy and her doctor understands that. At 7pm she gets her gin & tonic, then turns in for the night. I figure if the cirrhosis hasn't killed her by now, a few more drinks aren't going to make that much difference.