How To Refrain From Alchol And Bring Aggression Down?

Posted on Mon, 26 May 2014

Question: Hi Sir,
My father is about 54 years old and taking alcohol for almost 30 years. Currently he has no server problem and is a very good person at sometimes. Even I arrange for 1-2 pegs of whisky for him daily night. But sometimes he is taking some branded liqour (like rum) outside and after that his behavior is getting very aggressive. He sought loudly without thinking about neighborhoods if asked why took drink outside. Currently he is taking medicine like Trapez, Zupion SR and Frext 50 mg. Could you please advise what kind of medicine can be used to help him refrain from alchol and bring his aggression down. He is not willing to take any medicine which may help him to avoid alcohol. Is there any medcine that can be used without his knowledge with food and all? Please advise!

Answered by Dr. Sunil Gupta (22 minutes later)

Brief Answer:
Medication without information not usually advised

Detailed Answer:
Hi XXXX

I read your query in detail and do understand your concern regarding your father. I am a consulting psychiatrist and will try to address your issue in the best possible way.

From what you have mentioned, your father seems to be dependent on alcohol. His becoming aggressive is part of the dependence syndrome of alcohol. You have mentioned that he is taking medicines Trapex, Zupion and Frext, but you haven't mentioned for what symptoms were this medications prescribed and by whom (psychiatrist or general practitioner).

There can be multiple treatment options for alcohol. Anti-craving drugs like acamprosate, topiramate and naltrexone do help but such medications generally are useful only if the patient is motivated to quit. Aversive drugs like disulfiram can cause severe and sometimes lethal reaction if alcohol is taken after taking the drug, hence is not recommended to be given without informing the patient.

In your father's case, the best way out is trying to motivate him when he is sober. Your making drinks for your father too is not going to help. You will have to gradually try to show him the direction. If he is already seeing a psychiatrist, you can ask the psychiatrist to discuss the issue with your father. This process will take time but if successful will give you better and long lasting results.

Hope I have answered your query. If you have any further questions I will be happy to help.

Best wishes,

Dr. Sunil Gupta

Above answer was peer-reviewed by : Dr. Vaishalee Punj

Follow up: Dr. Sunil Gupta (1 hour later)

Thanks Dr XXXXXXX for your kind advise. Here are few more details asked by you.

1. Medicine given by Consultant Psychiatrist

2. I approached with same problem of addiction to Psychiatrist and those medicines were prescribed then. Zupion for quitting smoke (which he didn't yet), and Trapez 1 for his Insomnia (taking almost everyday even with alcohol) and Frext I think for depression.

3. I understand your concern regarding alcohol quitting drugs, but is there anyway to control his aggression? Same doctor gave Serenace 5 drops to control aggression with another medicine (could not read the name yet) to control side effect of Serenace 5. But didn't try any of them as of now.

Is it possible to give Sizodon (as it is Aversive) to control his aggression, if yes at what extent?

Or you can suggest me any alternate medicine! Ultimate goal is to reduce his alcohol dependency (without making him angry) in some extent otherwise its becoming tough to have a healthy family life.

Thanks in advance!
XXXX

Answered by Dr. Sunil Gupta (6 hours later)

Brief Answer:
Details in answer below

Detailed Answer:
Dear XXXX

Thanks for replying and giving further information. Your father was prescribed serenace (haloperidol) which is an anti-psychotic. The other drug most probably would have been trihexyphenydil which is usually given for the extrapyramidal side effects of haloperidol.

First, regarding the medications. Zupion is Bupropion which is used for quitting tobacco/smoking. It is also an effective anti-depressant. You can discuss with your psychiatrist regarding increasing its dose as your father is still smoking. It will also help control his anger if his depression comes down. More importantly like alcohol it is important to motivate him for quitting smoking.

I would also advise cause regarding using trapex (lorazepam) for long term. Using it with alcohol increases the risk of side effects and also in long term, there is a high chance of becoming dependent even on lorazepam. Discuss regarding the same too.

Coming to your most important concern regarding controlling aggression. Your father's aggression occurs only in intoxicated state, as you have mentioned. So, the best management will be to help him quit drinking. Haloperidol (serenace) and Sizodon (Risperidone) are both anti-psychotics. We use them sometimes to control aggression. If you have to chose between the two, I would suggest you opt for Risperidone (due to side effect profile of both drugs). Low dosage of the drug will be recommended to start with (you will have to get a prescription from your psychiatrist for the same).

I would also recommend to start some anti-craving drug like topiramate or baclofen. It might just help in reducing the craving for alcohol. You can discuss with your psychiatrist regarding the same. In the end, I will again reiterate. Try motivating him for quitting alcohol.

Hope I have answered your query. If you do not have any clarifications, you can close the discussion and rate the answer. Wishing your father good health.

Dr. Sunil Gupta

Above answer was peer-reviewed by : Dr. Yogesh D

Follow up: Dr. Sunil Gupta (5 hours later)

Thanks Dr. XXXXXXX I am completely satisfied with your answer!

Answered by Dr. Sunil Gupta (9 minutes later)

Brief Answer:
Thanks for the appreciation.

Detailed Answer:
Dear XXXX

Thank you for your feedback. Its the appreciation from people like you which motivates me to work on improving myself consistently and continuously in the filed of Psychiatry.

In case of any future queries you can ask me directly on the following link:
http://doctor.healthcaremagic.com/doctors/dr-sunil-gupta/67657

I will glad to help you at any time ahead. You can now rate the answer and close the discussion.

Best wishes.

Dr. Sunil Gupta

Above answer was peer-reviewed by : Dr. Prasad

Follow up: Dr. Sunil Gupta (23 minutes later)

Dr. XXXXXXX

One last thing, as per your suggestion I am planning to start Baclofen along with Risperidone for my father. In that I case I am planning to withdraw Trapx and go with Zupion.

Hence the combination I am planning will be Zupion, Baclofen and Risperidone.

Zupion SR 1 tab he taking after dinner.

Could you please advise the timing and dosages for Balcofen and Risperidone.

I'll be highly obliged to you!

Thanks Sir,
XXXX

Answered by Dr. Sunil Gupta (32 minutes later)

Brief Answer:
See below for details

Detailed Answer:
Dear XXXX

Thanks for following up. Although I will mention the dosage of the drugs, I will still recommend that you consult a psychiatrist in person for the same.

Bupropion is usually recommended on the morning. The starting dose is 150 mg/day which can be increased to 300 mg/day if there is no response. The dose of baclofen ranges from 20-80 mg/day taken once or twice a day. It is to be started a low dose and gradually the dose is increased. Risperidone is started at 1 mg/day dose given preferably at night. Dose has to adjusted accordingly according to side effects and response to the medications.

I will again reiterate that you discuss these with the consulting psychiatrist in person first before going ahead with them.

I hope I was able to answer your query. Best wishes.

Dr. Sunil Gupta

Note: In case of any other concern or query related to prevention, evaluation, diagnosis, treatment, or the recovery of persons with the any type of addiction or substance use, follow up with our Addiction Medicine Specialist. Click here to book a consultation now.

Above answer was peer-reviewed by : Dr. Prasad