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Case reports

2000 Volume 19, Issue no. 3

Joe, aged 50, had worked for the same insurance company for many years and was well thought of as a salesman. His work required extensive driving in a company car and entertaining clients. He was divorced with grown up children. He had always been a heavy drinker but was thought of as a person who could "hold his drink".

His son became worried about his father when he noticed that he was starting to have blackouts. The son encouraged him to see their doctor but the father repeatedly denied any alcohol problem and declined to seek help. The son then spoke to a family friend in Joe's firm who reported that Joe had been seen drinking heavily during the working day and that the quality of his work had been affected. The son became so concerned that he went to see Joe's manager at work who was also aware of the problem and had on several occasions spoken to Joe about his lunchtime drinking. The manager then confronted Joe and suggested that he should seek help for the problem from his doctor. Again Joe denied that he had any problem.

Finally it was decided that in an effort to make him see reason, Joe should be confronted in the doctor's surgery with the family and the manager present. He was inveigled to the surgery one morning on the pretext that the doctor wished to purchase some insurance. When Joe arrived he was confronted with a chronological list of incidents which identified him as having an alcohol problem. Even then he continued to deny the addiction. Because he smelt of alcohol the doctor offered to breathalyse him and this gave a reading of 120 mg/dl. Joe still denied he had a problem and claimed that he could stop drinking whenever he wanted. The manager then removed the keys of his company car from him but allowed him to continue his employment with a desk job at head office. Eventually Joe accepted rehabilitation and managed to remain sober for some considerable time although ultimately he relapsed.

Comment
Salespeople who travel and entertain extensively without supervision are a high risk group. Although many people at work had known of Joe's drinking problem for many years they had done nothing effective to address the issue.

Denial is a frequent feature of such cases. The denial was maintained despite severe symptoms and even when challenged with a powerful confrontation.

The manager was right to remove the company car keys from Joe. Had he not done so in view of his knowledge he could have been an accessory to any offence of driving a car under the influence committed by Joe.

Mike McCann
Consultant in Occupational Medicine

2000 Volume 19, Issue no. 1

John aged 67 had been an active man but was now being considered for admission to part three accomodation because he had become unable to walk, doubly incontinent and generally 'rambling'. Social Services, Mental Health Services, the Housing Department and his General Practitioner were all involved with his case discussion. The community mental health nurse noted several empty whisky bottles scattered around the house. Questioning of John's partner revealed that John had regularly drunk a bottle of whisky a day for the last two years. The community alcohol nurse specialist was consulted and suggested that John's physical and mental state should not be assessed until he had undergone detoxification.

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last modified: 20th May 2001