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Saturday, October 14th, 2006

Finding a doctor who’ll help

Posted by Roberta Jewell
Categories: This 'n that

A new member to our message board posted a question about how to approach the doctor now that s/he’s ready to seek help. “Am unsure what to expect,” says C, “are they generally sympathetic?”

It’s a valid question and significant concern for those who finally decide to take that first step. No matter what we say about treating alcohol dependence without stigma or shame, the thought of sharing this most painful secret is often terrifying. It’s why so many drinkers work around their doctor, buy anti-craving meds online and undergo a self-help program with only themselves available for help. They’ve heard about patients shunned by providers, unwilling to assist. “Go to a meeting,” they’re told. Thing is, if they wanted to attend a 12-step program or simply abstain from alcohol they’d have done it by now.

But it doesn’t have to be that way – and shouldn’t. C’s thoughtful questions about what to expect and how to prepare for that visit are often the beginning of a successful health partnership.

Here are some guidelines to help promote a positive experience:

* Identify which of your current doctors are most willing to consider an alternative treatment proposed by you. For example, some patients tell us they are able to work most effectively with their Ob-Gyn because of the long-term, trusting relationship already established.

 * Consult a DO, or Doctor of Osteopathy. These fully licensed physicians often embrace a more holistic approach to healing than traditional MDs.

* Many patients have reported success with a mental health practitioner. Doctors of psychiatry are usually more familiar with anti-craving medications or new treatment strategies than their counterparts. Their medical training requires specialization in the prevention, diagnosis, and treatment of addictive disorders.

* If you feel more comfortable with a new physician, look for an addiction specialists in your local Yellow Pages or search online. Look into one of the web based resources such as 4therapy.com, the US Substance Abuse Locator, or – if your goal is controlled drinking – Moderation Management. Instructions on how to use these resources are located in our online community’s FAQ.

* Prepare your doc! Download the May 2003 Lancet study if you’re interested in using Topamax. Print out information (for providers, not consumers) from Vivitrol and Campral’s website. If you plan to follow the My Way Out program, print out the articles from Newsweek Magazine, Wall Street Journal, and wired.com in which it is featured. Bundle the info together in an envelope and drop it off at your doctor’s office at least one week prior to your visit. Include a note on the outside stating your doctor wishes to read the material before your appointment.

* Become knowledgeable about tests you may be administered to assess your drinking problem. Popular screening surveys include:

The Cage Questionnaire in which a “yes” response to two of the four questions indicates a problem:

C: Have you ever felt you needed to CUT DOWN on your drinking?
A: Have people ANNOYED you by criticizing your drinking?
G: Have you ever felt GUILTY about drinking?
E: Have you ever felt you needed a drink first thing in the morning (EYE OPENER) to steady your nerves or to get rid of a hangover?

(Our medical director, Dr. Linda Garcia, MD, also asks patients if they’ve received a DUI.)

The Short Alcohol Dependence Data (SADD) Questionnaire, a more sensitive diagnostic test than CAGE, which is available online here. It helps doctors distinguish between early alcohol dependence and heavy alcohol use.

The Alcohol Use Disorders Identification Test (AUDIT), developed by the World Health Organization. It has been validated by several countries and is recognized internationally. You’ll find it here.

The Michigan Alcohol Screening Test (MAST), a tool used widely by courts to determine sentencing for those convicted of driving under the influence or other alcohol related offenses. It’s available online, as well.

A number of other survey instruments are listed by the National Institute on Alcohol Abuse and Alcoholism here.

* Understand and prepare for your medical exam, which may include:

  • A physical examination in which the doctor palpates or taps various parts of your body and listens to sounds your body produces. Vital signs such as blood pressure, heart rate, respiratory rate, and temperature will probably be taken.
  • A complete health assessment including information about your general and mental health, lifestyle, alcohol use, and family history of alcohol use and/or problems
  • A gamma-glutamyltransferase (GGT) blood chemistry test to evaluate liver function. Your blood may screened for anemia and electrolyte disturbances, such as low potassium, magnesium and calcium levels.
  • A carbohydrate deficient transferrin (CDT), a blood test some physicians feel is more sensitive than a GGT in identifying and monitoring problem drinkers
  • Signs of medical complications due to alcohol consumption, such as abdominal pain, heart problems, alcohol withdrawal or cirrhosis. Additional test may be ordered.
  • A referral for individual counseling to be undertaken in conjunction with therapy
  • A short-term prescription for a benzodiazepine such as Valium or Ativan to help manage alcohol withdrawal symptoms, if necessary. The physician should first screen for the presence of other medications to avoid interactions such as over-sedation

* When you meet with your doctor, be as truthful as you can about your alcohol consumption and medical history. Don’t withhold any information about medications you’re taking. If you are uncomfortable with what may appear on your chart, first ask your physician if you may talk off the record, but don’t consider it a guarantee that information won’t be noted.

* Assure the physician you’re committed to tackling your alcohol dependence within the context of a comprehensive program and you understand you will not be “cured” by a pill. Let him/her know that you intend to follow up. And do so.

* Tell your doctor about your plans to proactively seek support, whether at local 12-step meetings or an Internet-based forum. Point him/her to the MWO website if you plan to follow this program. Leave a copy of the book, or email us at provider@mywayout.org ahead of time and we’ll provide a complimentary copy.

* Ask questions. Prepare them ahead of time and refer to them at the end of your exam to make sure everything has been answered sufficiently

* If the physician refuses to honor your request for medication or medical services, insist on a referral to someone s/he believes will help you. Be vigilant and honest about your desire to find a provider. Let him/her know you plan to move forward regardless and that if you leave the visit without support your choices about how to proceed will be limited. It it the physician’s responsibility to help you–do not forget this!

* Do not be aggressive, but do not be meek. Remember that this change will benefit your health, your family, your relationships, your future. Prepare yourself mentally for this appointment beforehand. Meditate on it. “Visualize” your confidence and presentation and see yourself leaving the clinic with whatever it is you need to succeed.

We often don’t hear from the many patients who quietly seek help and leave their doctors’ offices filled with a renewed sense of hope and joy. It happens every day and it can happen for you. If not, you must simply resolve to keep trying until you get the help you need for this serious and progressive condition.

You’ve made the decision to get help, so don’t let anything – or anyone – get in your way. You’ve lived with this problem long enough.

It’s time to get better.

One Response to “Finding a doctor who’ll help”

  1. imagine Says:
    October 15th, 2006 at 5:20 pm

    Thank you for this very useful information!

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