Prof. Dr. Ulrich Zimmermann, ©kbo-Isar-Amper-Klinikum

A glass of wine for lunch, a beer in the evening – alcohol is an integral part of many culinary cultures. But what happens, when alcohol consumption gets out of hand?
This is an interview with Prof. Dr. Ulrich Zimmermann who directs the Clinic for Addiction Medicine and Psychotherapy of the kbo-Isar-Amper Clinic München Ost where most German patients suffering from alcoholism are treated.

Clinic Compass: Depression, schizophrenia, dementia: alcoholism is accompanied by different psychological disorders. At which stage of disease are the patients considered as hopeless cases?

Prof. Dr. Ulrich Zimmermann: Sometimes you do get the impression that hope is lost, but this is often wrong. This is mainly due to the surrounding circumstances. It is a downwards spiral between drinking, psychological side effects and life circumstances. When someone has been homeless for a longer period of time, it gets very difficult because then, outpatient treatment does not work anymore. In severe cases, an in-patient stay does not make any sense. You cannot keep the patients in a hospital or a rehab facility the whole time. You are often wrong when saying: „They just don’t want it. He has been there twenty times already. Now he comes back here and wants to become abstinent. That’s a likely story!” There are many cases where patients suddenly snap out of their disease. At first, they are laughed at but they pull through. Then, it depends on the surrounding circumstances whether it is too late or if someone can still successfully overcome the disease.

Clinic Compass: Alcohol is accepted in many cultures. How many people suffering from alcoholism with behavioral or other disorders are there in Germany?

Prof. Dr. Ulrich Zimmermann: There are 2.5 million patients with alcohol dependency and loss of control or other side effects. Another 3 million people can be added where alcohol consumption has already caused physical damage or problems in the social environment.

Clinic Compass: Is including psychotherapy in the treatment of addicted patients a modern treatment method?

Prof. Dr. Ulrich Zimmermann: The treatment of alcohol dependency functions on different levels. Psychotherapy is always part of it. Especially for doctors, there is often the idea to detoxify the patient and then send them to another location for therapy. In my opinion, this basic idea is wrong. It is important for us as doctors to support the patient with psychotherapy from the beginning. Motivation for change should not be a requirement for medical action. It has to be the aim. Do you know what percentage of patients with alcohol dependency ever visit a specialized detoxification center?

Clinic Compass: A few percent?

Prof. Dr. Ulrich Zimmermann: „Four percent of the 2.5 million patients suffering from alcoholism go to a clinic for treatment. The rest never gets any addiction-related treatment. If you go to the emergency department as a patient suffering from addiction, you will be patronized. “Are you aware of your level of breath alcohol? You do know why you fell, don’t you? Why are you drinking so much?“ Alcohol addicts are not stupid, they know that the accident has something to do with their drinking patterns. They also know that they will hear a lot of accusations. That is why they don’t like going to the hospital.

In Germany, more alcohol is consumed than in most countries in the world. People drink particularly much during street festivals like the Cologne Carnival. Picture: Michael Gallner

Clinic Compass: An orthopedist or an anesthetist can check the result of their work immediately. This is not the case for physicians specialized in addiction medicine. Is your job rewarding?

Prof. Dr. Ulrich Zimmermann: Yes, definitely. The prejudice that in psychiatry, you cannot make a difference anyways, is not true at all. Some patients come onto the ward in a terrible condition: arrested by the polive, delusional, self-endangered and after a few weeks they can live independently again on an outpatient basis. We can check the results of our work, too. We notice relatively quickly when it goes wrong, because the patient comes back.

Prof. Dr. Ulrich Zimmermann is a specialist for Psychiatry and Psychotherapy and directs the Clinic for Addiction Medicine of the Munich Isar-Amper Clinic as Chief Physician. Before, he worked at the Clinic and Polyclinic for Psychiatry and Psychotherapy at the University hospital Carl Gustav Carus of the Technical University Dresden.