Letters to The Editor The Effect of Liquor Store Strike Upon Psychiatric Hospital Admissions for Alcoholism Dear Sir: A study was undertaken to investigate any possible effect of the 61-day strike in 1975 of the employees of the Newfoundland and Labrador Government liquor stores upon the number of alcoholic admissions to Waterford Hospital, the principal psychiatric facility of the Province. The stores closed after the usual working hours on April 25th and re-opened on June 27th at the usual time. During this period, liquor could be legally purchased for consumption in bars, although toward the end of the strike the supply in some of the bars, was exhausted. However, beer to take out was sold six days per week in the . privately owned beer stores. It was decided to compare the number of Waterford Hospital admissions during the strike to the number of admissions in the 61-day period before and to the 61-day period after the strike. The 20 admissions during the strike are identical to the 20 admissions before the strike and comparable to the 17 admissions after the strike (x 2=.24,NS). This evidence would appear to indicate that the liquor strike had no effect upon admissions for alcoholism. Such findings are understandable in view of the fact that the Province was certainly not without other sources of alcoholic beverages and also the well-documented failure of "Prohibition" in the United States to eradicate drinking and alcoholism. It is noteworthy that during the first six days after the strike, there were no admissions for alcoholism, but during the following 12 days,
there were 10 admissions r-r- 59 percent of admissions during this 61-day period. Perhaps these observations could be accounted for by alcoholics who exhibited abstinence or relative abstinence restricted to the period of the strike. Possibly their first six days of resumed drinking were not sufficient to produce behavioural or somatic abnormality requiring hospitalization, but the overall effect of abstinence followed by indulgence produced a rebound phenomenon similar to the "alcoholism deprivation effect" (I) experimentally produced in animals whose alcohol intake exceeds that during the' predeprivation period. However, since the observations and inferences contained in this paragraph were made after the inspection of the data, they must be regarded as merely generating hypotheses for future research A.Ede.M.D. Dept. of Psychiatry James Paton Memorial Hospital Gander, Newfoudland D. 1. Templer, Ph.D. Louisville, Kentucky, USA Reference I. Sinclair, J.D., Senter, R.J.: Increased pre-
ference for ethanol in rats following alcohol deprivation. Psychonomic Science 8: I I, 1967.
Electroconvulsive Therapy (ECT)
Dear Sir: While working at a state mental hospital I have seen many patients who present in a markedly depressed state with a history of multiple hospitalizations for depression, many of whom are not suitable for intensive psychotherapy and show no favourable response to chemotherapy. Characteristically these refractory patients have received extensive electroconvulsive therapy in 501
the past and often demand additional treatments. I have been impressed that their insistence for this additional therapy represents a type of dependence not unlike drug dependence. I use the term dependence as I do not equate this phenomenon with physiologic addiction. My aversion to the use of ECT in these patients left me with a therapeutic dilemma
502
CANADIAN PSYCHIATRIC ASSOCIATION JOURNAL
which resulted in my decision to try placebo electroconvulsive therapy. The patient chosen for this trial was of the type previously described with an apparent ECT dependence. The procedure was in every way identical to the usual ECT procedure except that no current was used and therefore no seizures resulted. I was indeed surprised that the patient who had been severely depressed on admission responded dramatically to the placebo treatment. She described her treatment as having cleared her mind of many problems. Interestingly enough she also reported a post-treatment headache with accompanying confusion. Additional placebo treatments were given which resulted in further affective improvement and she was soon stable enough for discharge after only a brief hospitalization. I realize that previous studies have shown a much more therapeutic effect from actual ECT
Vol. 21, No.7
than from the placebo, and do not wish to suggest that most responses are due to a placebo effect nor that a placebo effect contributes significantly to most responses. I do, however, wish to point out the occurrence of ECT dependence as a possible sequela to the electroconvulsive modality of allopathic psychiatric treatment. It seems that this is an overlooked phenomenon and that patients who exhibit this type of dependence might respond to placebo ECT. I am fully aware that what I have described is not scientifically documented and that a carefully planned study would be necessary to validate my observations. J. Gary Carter, M.D. University of Virginia, Medical Center, Charlottesville, Virginia
INTERNATIONAL
HEALTH WORK PSYCHIATRISTS are needed for Community Mental Health Programmes in Jamaica. A NURSE INSTRUCTOR is required to teach Psychiatry and General Nursing Subjects at a School of Nursing in Ghana, West Africa. Two year contracts are standard. Salary generally equals a local worker's in a similar job. CUSO pays for life insurance, health and travel expenses. Detailed job descriptions are available through CUSO: CUSO Health - 150 151 Slater Street Ottawa, Ontario KIP 5H5
there were 10 admissions r-r- 59 percent of admissions during this 61-day period. Perhaps these observations could be accounted for by alcoholics who exhibited abstinence or relative abstinence restricted to the period of the strike. Possibly their first six days of resumed drinking were not sufficient to produce behavioural or somatic abnormality requiring hospitalization, but the overall effect of abstinence followed by indulgence produced a rebound phenomenon similar to the "alcoholism deprivation effect" (I) experimentally produced in animals whose alcohol intake exceeds that during the' predeprivation period. However, since the observations and inferences contained in this paragraph were made after the inspection of the data, they must be regarded as merely generating hypotheses for future research A.Ede.M.D. Dept. of Psychiatry James Paton Memorial Hospital Gander, Newfoudland D. 1. Templer, Ph.D. Louisville, Kentucky, USA Reference I. Sinclair, J.D., Senter, R.J.: Increased pre-
ference for ethanol in rats following alcohol deprivation. Psychonomic Science 8: I I, 1967.
Electroconvulsive Therapy (ECT)
Dear Sir: While working at a state mental hospital I have seen many patients who present in a markedly depressed state with a history of multiple hospitalizations for depression, many of whom are not suitable for intensive psychotherapy and show no favourable response to chemotherapy. Characteristically these refractory patients have received extensive electroconvulsive therapy in 501
the past and often demand additional treatments. I have been impressed that their insistence for this additional therapy represents a type of dependence not unlike drug dependence. I use the term dependence as I do not equate this phenomenon with physiologic addiction. My aversion to the use of ECT in these patients left me with a therapeutic dilemma
502
CANADIAN PSYCHIATRIC ASSOCIATION JOURNAL
which resulted in my decision to try placebo electroconvulsive therapy. The patient chosen for this trial was of the type previously described with an apparent ECT dependence. The procedure was in every way identical to the usual ECT procedure except that no current was used and therefore no seizures resulted. I was indeed surprised that the patient who had been severely depressed on admission responded dramatically to the placebo treatment. She described her treatment as having cleared her mind of many problems. Interestingly enough she also reported a post-treatment headache with accompanying confusion. Additional placebo treatments were given which resulted in further affective improvement and she was soon stable enough for discharge after only a brief hospitalization. I realize that previous studies have shown a much more therapeutic effect from actual ECT
Vol. 21, No.7
than from the placebo, and do not wish to suggest that most responses are due to a placebo effect nor that a placebo effect contributes significantly to most responses. I do, however, wish to point out the occurrence of ECT dependence as a possible sequela to the electroconvulsive modality of allopathic psychiatric treatment. It seems that this is an overlooked phenomenon and that patients who exhibit this type of dependence might respond to placebo ECT. I am fully aware that what I have described is not scientifically documented and that a carefully planned study would be necessary to validate my observations. J. Gary Carter, M.D. University of Virginia, Medical Center, Charlottesville, Virginia
INTERNATIONAL
HEALTH WORK PSYCHIATRISTS are needed for Community Mental Health Programmes in Jamaica. A NURSE INSTRUCTOR is required to teach Psychiatry and General Nursing Subjects at a School of Nursing in Ghana, West Africa. Two year contracts are standard. Salary generally equals a local worker's in a similar job. CUSO pays for life insurance, health and travel expenses. Detailed job descriptions are available through CUSO: CUSO Health - 150 151 Slater Street Ottawa, Ontario KIP 5H5
