Depression with Alcohol Misuse

Depression with  Alcohol Misuse

History

depression III

A consultant overwhelmed by workload and domestic pressures of a young family at home turned to alcohol to help him sleep. The quality of sleep was poor and became increasingly fatigued and anxious. He was not eating properly and was irritable with everybody at work. He was unable to interact properly, resulting in a complaint to management about behaviour whilst on call. He was challenged about his behaviour and he admitted alcohol misuse.

Assessment and Advice

He was advised to self-refer to the Practitioner Health Programme and was also referred to occupational health for advice about his fitness for work. He was advised not to do clinical work pending the occupational health assessment.

He was seen urgently and when the work-related issues were discussed. He found relief in just being able to talk to someone as he had felt very isolated. He felt totally exhausted and unable to manage any longer. He was relieved when he was advised that he was unfit for work. It was agreed that he would go home immediately and would make a GP appointment.  He was advised to stop drinking and to follow the treatment regime from PHP. This comprised cognitive behavioural therapy to address his anxiety and a review of his use of alcohol.

An action plan involved a discussion with management about workload and on call duties. His department was understaffed but new staffing appointments were in the pipeline. On a return to work, he was advised he should initially avoid on-call work for three months and his job plan was reviewed to reduce overload. A return on this basis was felt to be more beneficial to both individual and department than remaining absent. A safety net identifying warning signs of relapse and specified actions was agreed with the consultant and senior colleagues.

Follow up

He did well on a more normal working pattern and was able to start back on a less onerous on-call following recruitment of new colleagues.  He continued to be supported by occupational health for several months before being discharged with open access for review if necessary.

Had not understood purpose of occupational health and therefore had not recognised potential support available during previous months,  when he had been struggling at work. He had now learnt new coping strategies following cognitive behavioural therapy and occupational health interventions.