In the initial days of the lockdown, Dr G Prasad Rao, director, Asha Hospital in Banjara Hills, Hyderabad, was woken up at midnight for an emergency. The caller, a patient of Dr Rao, was hallucinating. "She told me, ‘I am throwing up and my office colleagues are chasing me. I called the police but they asked me to seek a doctor’s help.'” The lady, who suffered from alcohol abuse, had to be rushed to the emergency ward of the hospital, and had been going through what doctors call alcohol withdrawal syndrome.
The push
With alcohol not being available in the coronavirus lockdown, symptoms vary from mild to severe, depending on the person's alcohol dependence.
“Those consuming more than a quarter of alcohol six days in a week, when suddenly stopped, can go into a clinical syndrome called Alcohol Withdrawal Syndrome. Depending on the severity, they might have seizures or go into delirium, thus needing hospitalisation and acute care. They may have chronic alcohol dependency syndrome with nutritional problems,” says Dr Rao.
However, he says that even a social drinker consuming alcohol on three days or less in a week, could suffer from withdrawal symptoms. The symptoms show up within three weeks. The most severe ones show symptoms in 2 to 96 hours, and others any time between one and four weeks.
Dialling in
Every day, Dr Rao, who has been doing video calls over the last seven and a half years, gets around 45 people dialling in -- up from 10 am. Callers have different mental health issues; 15-20 % of these are related to alcohol dependence and addiction. Often, the dependence is linked to anxiety and panic disorders, depression, bi-polar and personality disorders, even schizophrenia. “Among these, more than 5% need immediate attention.”
A team of psychologists and doctors at Hope Trust — a Hyderabad-based de-addiction centre and rehabilitation clinic — are busy conducting therapy sessions on Skype and Zoom for people without medical complications, such as stress management, addictions, anxiety, parental and relationship issues.
The centre’s existing online services surged by 15 calls (for different mental health issues) every day. “This lockdown period is stressful for the family,” says Rahul Luther of Hope Trust. “We do get calls for admission but we are avoiding new admissions and instead, are referring them to psychiatric clinics,” he adds. Sometimes even the family members call to share their anxieties.
“When it has to be medically managed, the blood pressure needs to be constantly monitored and maybe medication also given,” he says, so it’s important to take it seriously.
Dr Ankineedu Prasad, a telecounselling doctor at Hope Trust has been in the de-addiction field since 2004. “It has been 15 years since I have been sober and hence understand the mental state of the callers,” he says.
A telecounselling call (two weekly sessions for at least three weeks) lasts for 40 minutes, and doctors empathetically give an insight into alcoholism to the callers and explain what they are feeling is normal and natural. “We tell them their anger, frequent arguments, irritability, and stress are common issues arising due to alcohol withdrawal syndrome. We help manage their lifestyle, diet and sleep patterns and also to cope with anger, stress, and negative emotions so that their inter personal communication improves. ”
Poor network connectivity, no clear feedback from callers, multiple extended sessions due to a lack of time and non-co-operation from family members are a few limitations of telecounselling. The family members are also counselled on stress management, managing home environments during the lockdown period, and improving communication skills with the person.
One main benefit is to be able to continue the therapy sessions without skipping them. In the lockdown period, this is a relief, for family members and the person.
Factoring in
Rahul says that identifying addiction is difficult over a video or audio call though -- both the person and family can go into denial. “We also have reports of domestic violence increasing during lockdown. When a person addicted to alcohol does not get his substance, there will be huge irritability and a part of withdrawal can create aggressive behaviour, but it is actually the addict’s cry for help,” he says, having been through this himself. He suggests that partners and well-wishers gently suggest online therapy to tackle symptoms like insomnia, rather than accusing the person of a dependency.
The common physical symptoms of withdrawal include headache, gastric issues, non-cardiac chest pain, sleeplessness, restlessness, irritability, body aches and lower back ache.
Will the withdrawal symptoms last? “It depends on the severity. Mild withdrawal symptoms do not last long but after withdrawal of lockdown, if the substance is available, 99% will go back to it. Management of withdrawal symptoms is only the first step towards treatment,” replies Rahul.
