As long as he receives alcohol, the patient remains in bed and receives only liquid diet. In cases of considerable digestive disturbance, capsicum is freely used, but we have seldom found it necessary.
All receive preliminary catharsis, but no attempt is made at prolonged elimination in that way.
For about a month tonic treatment with strychnine nitrate is used in doses of 1-20 to 1-40 gr. three times a day. Any other medication depends entirely upon the physical condition of the patient as revealed on examination. Only under the most exceptional circumstances are drugs given in alcoholic vehicle.
In morphine or cocaine users, the reduction is usually made more gradually, requiring a week to ten days. Generally, we find a patient comfortable with one-half the drug he has been accustomed to taking. In some cases we find it best to reduce the quantity to about one-half grain, and then abruptly cease.
Under this plan, diarrhea, cramps, restlessness, and insomnia are much less marked. We regard the free use of the prolonged warm bath as more advantageous to those addicted to drugs than to alcohol. Generally, it is the only measure that seems to offer relief. We particularly do not use hypodermic medication in any drug users.
Heroin users, who seemingly are more numerous, receive their drug only once in twenty-four hours. The withdrawal of the drug does not cause the discomfort that the withdrawal of morphine causes. Vague sensations of discomfort, some perspiration, and insomnia are met with in such cases.
No users of cocaine only have been met with, but in mixed forms this drug is at once withdrawn.
The removal of alcohol or drugs is the easiest part of the work. Under the regular discipline of the institution, and the absence of temptation, the great majority of patients get along without any trouble because of abstinence. But there is the future to fear. The patient must go out into the world again, and engage in the daily struggle for his livelihood. One must aim to put him in such condition that he may be able to resist the temptations that will surround him on every hand. Our work, then, is to build up and re-educate, to strive to form a new character, to encourage a habit of sobriety, instead of drunkenness, to teach the man to work, to occupy himself, to obtain for him a new outlook on life, and to teach him his duty to himself, to his family, and to his neighbor. Here is where our difficulty begins. Nearly every inebriate has a firm belief in his ability to abstain from alcohol or drugs at any time and under any condition, because he thinks he is not really responsible for the condition into which he has fallen, and that, had not certain things happened, he would not have been drinking.
He is insistent in iterating and reiterating that he has now made up his mind to stop drinking, and that is all that is necessary. Though admitting that, for five, ten, or fifteen years, he has been going steadily downward, he has full confidence in himself, and he believes injustice is being done him when his parole is refused and he learns that he is expected to remain until he has strength to resist temptation.
In this upbuilding of body and character the following are essential: regularity of habits, discipline, work, food, and recreation, together with the personal influence of the physician and those coming into close and personal contact with the patient.