Mrs Bellamy came in a month or two ago. She was feeling a bit below par. Lost appetite, heartburn, bit of upper abdominal pain. We talked about lifestyle, and being a bit of a bonne-viveuse she admitted to at least a half a bottle of wine a day. For years.
Apparently the whole "units" thing had passed her by completely. When we sat down and added them up she came in at around fifty a week. Or around four times the recommended level. That said she had none of the hallmarks of dependence. She felt no need for an "eye opener" first thing, didn't find herself worrying where her next drink was coming from, had never been embarrased or discommoded in any way by her drinking.
Still it sounded likely her symptoms and alcohol had some connection. We agreed she would do some bloods and come back for the results. Meantime she agreed to look at her drinking.
Sure enough her liver function was very distorted. The enzyme most commonly implicated in long term alcohol use was significantly raised. (Normal values are up to around 45, hers chimed in at around 500.) She was also very slightly chemically jaundiced with a bilirubin just outside the normal range though there was no observable yellowing of her skin or eyes.
Knowing all of this she stopped drinking. Just like that. No weaning off. No drugs to cover withdawal. And no withdrawal symptoms at all.
Within a month her bloods were improving. Bilirubin back to normal. Enzyme level around 150. Symptoms all abolished. After another month her blood picture returned to normal. She has been dry now for 4 months and has a clean bill of health. She's very pleased. She now knows all about units, and might even go back to the odd glass of wine on occasions, but overall it looks like she is determied to stay well and not to go back to her past habits. We are often sceptical when patients tell us this, but I an inclined to believe Lillian. She has never presented as though she were dependent and very rapidly took the right steps to look after her health once the problem had been identified.
I can think of at least a dozen other similar cases where I have not been able to persuade them to curtail their drinking, and have sat here powerless to do more than chart and react to their inevitable decline, but once in a while someone like Lillian comes along and shows that there is an alternative.