Q: My 35 years old brother-in-law has alcoholism, though not on a regular basis. He got married 9 years back to my sister and started drinking alcohol heavily after the second year of marriage. After drinking he starts abusing his wife and all relatives in filthy language and making false and rubbish statements/ accusations. This bout lasts for about one week to ten days. After that he becomes normal and leaves drinking. Such episodes keep on coming in every 4 to 10 months (infrequently). During such bouts he recalls all the sundry incidents in the past and keeps reciting them telling whoever is present. This way he tries to justify all his abnormal behaviour. After the passage of the bout, he apologizes to all of us and requests us to unify with his wife and children. For the last 9 years this has happened at least 25 times. We had taken him to psychiatrist for treatment of alcoholism. Assuming that he is a normal person doing such things deliberately, we took the case with police and women's help groups many times. But there has been no improvement. His strange behaviour still continues. This is causing a lot of hardship to his family and us (as close relatives). Please suggest.

A:Alcoholism can make one psychotic in 12 different ways! So it's not a deliberate act. This understanding is important for all of you, as it's hard in itself to put up with his angry filthy outbursts! I am sure there are other reasons why this behaviour continues. Psychiatrist can help you with medication and therapy to address the unconscious reasons behind his act.

I would talk to the psychiatrist about Vivitrol intra muscular injection that is given once a month. This helps with compliance (assuming that he is not taking his oral meds regularly).

Is he attending self-help groups like AA? Is his wife and children going to Al anon? (Family of alcoholics meet for support and to cope).

I recommend that he be placed on valproic acid if his liver is fine for anger issues and also send him to anger management groups. It is also his paranoia that needs to be addressed so a cocktail of Thorazine, valproic acid,along with Disulfiram and Naltrexone or Thorazine, valproic acid vivitrol injections will be of great help.

Talk to the psychiatrist. Try to get family counselling and battered woman support groups for his wife and family.