Sunday, November 30, 2008

What happened on Wednesday - part two, Community Addictions Unit assessment

Have no doubt, the services that deal with addicts of various stripe are stretched and could probably hoover up a whole pot of further funding.

What this means for the patient, service user or (shudder) customer of these services is simply that there's a fair amount of waiting around to be done.

After my counselling on Wednesday I went home waisted (as I do far too readily and far too often) a couple of hours on the Guardian's Comment is Free website and then headed back out for my first appointment with a doctor at the Community Addictions Unit.

And there I sat. The appointment was at high noon and the letter confirming it had told me to expect it to take around an hour. I left in the end at 2.45.

Not that I minded. I avoid going out of the house, partly through anxiety and fear and partly because I know if I do I will sooner rather than later end up in the pub. Sitting in a dingy NHS corridor is at least harmless. It also humbles and shames me: I see others struggling with far harder problems than I have and who are in a plainly evident far worse state in terms of physical or mental health. I sometimes feel a fraud: you should be able to pull yourself together I tell myself as I watch people collect their methadone scrips and read the posters about open wounds and the safest way to inject and clean works using water from a toilet.

The doctor was Asian and quietly spoken and patient. He ran through a long list of questions - asking about my history of drinking (I started pretty early in my teens, developed into a heavy binger and from there to pretty constant and addicted drinking from my late 20s onwards, it's been a problem for 20 years now), use of other drugs, family relationships, mental and physical health, my suicide attempts, where I am now and what I hope to get from the process.

It was all rather cathartic, it's nice to be able to speak openly and honestly to a sympathetic ear. He told me the options: basically in patient or outpatient detox using diazepam. I told him I'd prefer an outpatient detox because that's what I've experienced before and I'm nervous about being admitted to hospital.

In reality, I know this is unlikely to get the thumbs up. There is a risk of fitting during detox and with my girlfriend at work I'll be on my own during the day. I must admit I dread hospitalisation - there surely aren't many people who look forward to spending time in hospital - and the attendant group therapy: I find it very hard to open up to a therapist in one-on-one situations, competing for air in a group is something I'll find incredibly hard. But, perhaps that's something that has to be got through and will induce the sort of cathartic breakdown into real tears that will help cleanse me.

I raised the idea with the doctor that I was a self-medicator; that I find my thoughts very hard to control, and that drink really is the best way I've found to do this. He nodded, but it's early days in the process and the first aim is to get me off the booze, that's the only aim really, the rest may well be down to me. He certainly accepted the fact that I'm currently depressed and said he would write to my GPs to ask them to raise the dose of my antidepressants. "It could be prolonging your problems with alcohol," he said.

I wasn't able to provide a urine sample but had two sets of blood tests down - all I heard was renal and liver function. Despite everything, I think I'm probably in relatively good physical health and I hope there's nothing serious hidden under my irritable skin.

My blood pressure was taken and is apparently good, my pulse was 74 I think, which is a bit high but there's a certain amount of stress in having needles stuck in your arms and I should imagine that would account for that.

I left feeling lighter still. Something's moving at least. It'll be slow I know, the doctor told me to expect another appointment in three weeks and asked me to think more about the treatment options and also to think about reasons why I've relapsed three times before after detox.

(If you are reading this thinking, "You feckless waster of NHS resources that could go to people that are really ill and who chooses the path of addiction," I have every sympathy with your view. All I can say is the hatred and opprobrium of others merely confirms my own opinion of myself (although I doubt anyone could hate me as much as I hate myself), and that I really don't want to be like this anymore and I will try as hard as I can. I want desperately to be a useful person.)

I left at 2.45, knowing I was going to go straight to the C. As I've said, I've avoided the place of late, it's been getting me down, it's the only pub I use where I have people to speak to but they too have their problems and that tends to be what we talk about. As it happened I bumped into my best mate from the all-day-drinking gang, he'd just left the C and was on his way to one of the social/working men's/sporting clubs in the area.

I didn't want to go. The last time I went there was bad. My girlfriend was working away as she often does. While she's here I do much better, I desperately want not to upset her so my drinking stays relatively stable. With her gone the brakes come off. I'd gone out to watch football that time and ended up spending 12 hours on the pop, I'm sure I got mouthy and obnoxious in the club and couldn't remember much after arriving and certainly couldn't recall getting home. That was Jack Daniels. I rarely drink spirits, almost never in fact, I drink pints far too quickly - I drink everything far too quickly and even when I've been dry I've chugged through pint after pint of soft drinks when I go out, it's all to do with nerves I think - so spirits vanish even faster.

As it happened I did fine. Four pints, relatively slowly, after downing the first two.

Again, it was a sobering experience. Most of the pubs I use are filled with habitual drinkers and the club was no different, I see faces not so much damaged as completely wrecked by alcohol. People on the margins and with troubles, often unemployed and with money troubles who spend all day drinking and desperately staring at the horse racing on the screens waiting for a much-needed winner.

A man came in with a terrible facial wound - his left eye was hugely swollen with an open wound beneath it. He said he'd had a plate put in.

"I haven't had a pint since Monday," he said, "so don't look at me I've got the ******* shakes."

The barman offered him a straw.

The place stank of weed after a while. No-one inside was smoking, but it was drifting in strong and unmistakable from somewhere.

I'm angry with myself for trying to score some weed through my mate - which was easily arranged. I've been without for maybe two weeks and I should have accepted that that's a good thing. But, when I'm in my cups I do crave it. I was weak and stupid.

Onwards and upwards nevertheless.

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