The Clinique du Château de Garches takes in sick people having difficulties with alcohol and has developed a specific program for them.

Schematically the problem faced by the person suffering from alcoholism is triple:

• severance from alcohol;
• evaluation of the psychic situation of the patient which often includes depressive elements;
• setting up a procedure which allows the patient to remain abstinent, in deed, it is not so difficult to stop drinking, but how not to start again?

Severance:

Severance is made without great difficulty, according to a well established therapeutic protocol.

Severance necessitates treatment by means of medication, with the concerted support of the different intervening parties.

Hospitalisation of the alcoholic-addict in a specialised centre is a response to very specific indications; different from those of the out-patient severance, with a precise health objective, and this is part of a therapeutic project defined as of admission, by a contract made between the patient, the doctor and the healthcare team.

In conclusion, setting up medical treatment together with a psycho-therapy seems today to be the best guarantee for success of the severance in terms of tolerance and long term abstinence.

Indications for the hospitalisation of the alcohol-dependent subject:

• Hospitalisation is warmly recommended when the patient finds himself once again in difficulty after the failure of one or several attempts at severance as an out-patient.
• Hospitalisation enables the patient to be place in a situation of rupture from the home environment, which is often pathogenic.
• Hospitalisation enables the search of the existence of a comorbid psychiatric pathology, which is very frequent (depressive troubles, anxiety disorders, personality disturbances, various addictions …) and which is a concern requiring specialised care, but also the need to search for the existence of a under-lying somatic pathology or one that is a consequence of the alcoholic-dependence of the subject.
• Hospitalisation of the subject is finally preferable in the case of antecedent comital crises or severance accidents such as delirium tremens upon previous attempts

The main objective of the severance treatment of the hospitalised alcoholic-dependent subject is to avoid severance accidents, to give the subject pharmacological and psychotherapeutic assistance, in the face of a serious pathology which has become chronic, often punctuated by relapses, serious somatic complications when this illness is not treated, and repercussions which may be dramatic in the subject’s socio-professional and personal spheres.

The therapeutic alliance, represented on the health contract between the doctor and the patient, is the central axis around which is organised not only the treatment in the acute phase but also the long term severance of the alcohol dependent patient.

The hospitalisation process (setting up the therapeutic project) is the following:

• The patient is admitted into our establishment following what we call a « pre-admission » consultation during which the motivations of the subject and his adhesion to the health project are evaluated.
• He may also be referred by a « correspondent » doctor who know the patient well
• A health contract is drawn up with the patient, the doctor and the health team (protection of a fragile subject by not allowing the person to leave the establishment, handing in the car keys …).
• Constantly information about alcoholic illness and therapeutic education groups are proposed to the patient during his hospitalisation but also to the family circle on the subject of the alcohol-dependent.
• The patient benefits from daily individual interviews with a specialist doctor (7 psychiatrists for 44 patients).
• Medicinal help is of course systematically proposed in order to ensure the patient’s comfort upon severance and to avoid moreover complications and severance accidents

The objective of hospitalisation is:

Severance to begin with, but also the preparation for the return to a normal life

Preparation for coming out is based upon:

• The daily interviews that the patient has with his psychiatrist doctor,
• The 3 weekly meetings (Tuesday, Wednesday and Thursday at 2.30pm and 4.30pm) attended by hospitalised patients and also those who were hospitalised and who, after discharge, come once or twice a week looking for help to remain abstinent.  These meetings are animated by Brigitte and Marie-France;
• The possibility the families have to meet the doctor (with the patient’s agreement) or Isabelle (Thursday at 6pm) which brings support to the alcohol sufferer’s spouses and friends

During hospitalisation a psychological assessment is made; which may lead to special treatments, such as anti-depressors.