My friend Tom is an alcoholic. His intense grey-blue eyes, hair-trigger temper, desperate wit, betray his Kerry ancestry. Tall, dignified yet self-deprecating, Tom is moderate in most things, except booze. Just recently I helped him through a detox at my home without medically qualified supervision. It probably saved his life. But addiction specialists want to ban such do-it-yourself detoxes. Tom’s home detox, according to experts in alcoholism treatment, might have killed him, and, they say, won’t help him stay off the booze.

I first saw Tom totally smashed at the age of 16, on rum and blackcurrant after an office-party binge. As he got older, he learnt to “hold” his drink. He worked in the City, thriving on liquid lunches. He drank on his train commute and had a weakness for nightcaps. He spent weekends with congenial cronies in the local golf-club bar. His capacity crept up on him. Now, in his early sixties, Tom has been drinking two 75-centilitre bottles of scotch a day diluted in tea. Recently (and yet again) he decided to stop, and invited my help.

According to new government figures, around 12m people in the UK drink hazardously – over the recommended guidelines of two to three units a day for women and three to four units a day for men, the equivalent of two to three small glasses of wine a day. Over 800,000 people (four times the estimate 10 years ago) are hospitalised in the UK annually because of alcohol-related illnesses and accidents, at a cost of £2.7 billion. Around 600,000 underage Britons are estimated to be drinking alcohol recklessly and illegally. Pressure groups, like the Alcohol Health Alliance, blame the government’s liberal drink policies, especially the availability of alcohol 24/7 from many supermarkets.

Yet immediate access to alcoholism treatment is available for only five in every hundred alcoholics (one in a hundred in the northeast). And there’s no dedicated budget for alcoholism. Contrast that with the UK’s 300,000 drug users, whose treatment access is virtually 100%, with a budget this year of £600m. This access mismatch, in the view of specialists and GPs, reflects the perception that alcoholism is largely the responsibility of those afflicted. As a result, according to a survey conducted by Mori and a London teaching hospital, a third of Britain’s GPs are encouraging alcoholics to detox by themselves at home without professional help. Professor Ian Gilmore, president of the Royal College of Physicians, warns of the dangers of unsupervised detoxes. “It’s hazardous, and things can go badly wrong,” he says. “In any case, detox is just the first step on a long rehab journey requiring professional help.” Colin Drummond, professor of addiction psychiatry at the Maudsley hospital, south London, echoes that warning: “A detoxed person is like a car without wheels; it’s the weeks and months of follow-up counselling and talk therapy that matter. And self-detox is dangerous.”

So what are the dangers? There are no hard figures for detox deaths. They melt into the 20,000-plus alcohol-related fatalities in the UK each year: deaths caused by everything from liver failure to road accidents, from brain seizures to suicides. The detox hazards lurk within a set of arcane percentage stats. According to data provided to The Sunday Times Magazine by Professor Drummond, about 20% of patients with high alcohol consumption will have epileptic fits, or seizures, on a detox withdrawal. This proportion is considerably higher in people, like Tom, with many previous detoxes as well as severe alcohol dependence. Of those who have seizures during detox, about 3% progress to a prolonged epileptic state lasting 20 minutes or more. This in turn carries a mortality rate of 20%. About 5% of patients in alcohol withdrawal also develop delirium tremens, which can be fatal in about 35% of cases if untreated. A further claimed danger involves brain damage due to a lack of thiamine, vitamin B1, during detox. “Hence it’s dangerous,” says Professor Drummond, “to expect a severely alcohol-dependent patient to self-administer, or an untrained relative or friend to oversee, withdrawal drugs without medical supervision.”

As Tom’s “untrained friend”, without medical supervision, I knew none of these percentages when I agreed to assist his home detox. And yet, in the absence of a baseline number of annual detoxes of all kinds, the statistics are not helpful. And excessive alcohol consumption being dangerous in any case, the dangers of an unsupervised detox must be contrasted with the dangers of no detox at all.

In fact, Tom’s history of attempts to combat alcoholism has been a rake’s progress of professionally supervised detoxes, including a three-month spell 18 years ago at the exclusive Farm Place rehab clinic in Surrey; an NHS outpatient rehab nine years ago at his local primary care service; and an enforced inpatient hospital detox after he suffered a stomach haemorrhage last year.

Private treatment is no longer an option for Tom, and he refuses to apply for treatment at his local NHS addiction unit. “Last time, it took the unit a year to get me to the point of a detox. Endless prevaricating interviews. Once I missed an interview because I was ill, and I was pushed to the bottom of the waiting list. When they finally got round to it, it involved a male nurse coming once a day for 20 minutes to monitor the drugs. Otherwise, I was completely alone for the whole week it took. And I had to put up with this chap doing amateur psychoanalysis on me. I told him to piss off.”

Tom’s determination to try his own home detox this summer was prompted as much by financial pressures as by immediate concern for his health. For 12 years now, ever since his wife died, leaving him and their four grown-up children (two still at college), it’s been a downward spiral. Ten years ago he was made redundant. He downsized from a five-bedroom detached house to ever-smaller properties, drawing down his pension till there was hardly anything left. Finally, alone in a one-bedroom flat, he had reached a stage where he could not afford to drink and pay his rent.

In August, Tom’s GP agreed to prescribe him 100 5-milligram Librium capsules (scientific name chlordiazepoxide), to do a self-detox. Librium is the preferred antidote for the effects of alcohol withdrawal, which can include delirium tremens (or “the shakes”), vomiting, hallucinations, sweats, insomnia, incontinence, seizures or fits, and serious brain damage. The effects of unchecked alcoholism, however, include well-known consequences: cirrhosis and cancer of the liver and pancreas (which can develop “silently”), hepatitis, arteriosclerosis, heart disease, depression, memory loss, blackouts, and a host of psychological and social problems.

During detox, chlordiazepoxide acts on the brain to produce a calming effect. It enhances the effects of a natural chemical known as Gaba. A supplement of vitamin B1 (thiamine) is crucial, since a rapid loss of essential vitamins during both heavy drinking and detoxing can cause brain damage known as Wernicke-Korsakoff syndrome.

When Tom told me about his detox plan, he said: “I’m worried that I might have a fit and nobody would find me.” So I offered to assist, unaware of what I was getting into. Tom’s flat being small, we decided to do it at my home in Northamptonshire. A psychiatric nurse friend warned me: “It takes a week. Two days in is the worst. Sometimes they don’t know who they are or where they are. If they grab you during a seizure they can break your arm.”

How could I keep watch on Tom day and night for a week? I called on my friend Mark, a physically strong carpenter, who agreed to give up a week of his holidays to join me. Our cleaning lady, Midge, who usually comes twice a week, volunteered to come in every day to help on the domestic front.

I called Tom’s GP. He had known Tom for 30 years and seemed confident that he would come through okay without a seizure. “It’s unlikely if he’s taking sufficient of the pills I gave him.” Then he said: “If he has a fit, call 999.”

When I arrived at Tom’s home in Colchester, he had obviously been drinking heavily (by the time he took his last drink the next day, I would estimate he had drunk three 75cl bottles of scotch in 24 hours). While I drove him the 100 miles to my house, he talked disjointedly about his drinking history. He had married his teenage sweetheart when they were both barely 21. He worked his way up the insurance industry to the managing directorship of a City company by the age of 40. Drinking was a natural part of his business lifestyle. “I made a number of white-knuckled attempts to stop drinking in my forties, to no avail,” he said.

In 1990, with Bupa insurance, he booked into Farm Place private clinic (a residential detox in the UK can cost hundreds of pounds a day; Tom was at Farm Place for 90 days). I visited him there and took part in group-therapy sessions. I remember him weeping as we walked around the grounds: “They break you down. They want you to accept your vulnerability.”

He joined Alcoholics Anonymous for a couple of years. Like many, he grew disillusioned with the organisation’s “higher power” aspects and its tendency to form ruling cliques. “There are all these old guys who have been going for years. They find it hard to involve the new ones.”

He stayed off the drink for seven years. But in the sixth, his wife died of ovarian cancer, aged 51. Tom said: “I felt that I couldn’t properly grieve unless I started drinking again.” For a decade now he had been consuming more and more each year, with occasional periods on the wagon. Two years ago he told me in a moment of candour: “Fact is, I don’t want to give up.” But in July this year he realised that giving up was a matter of life and death.

When we arrived at my house, I left Tom in the car for a minute to fetch Midge and Mark. In the meantime, Tom staggered out of the car and fell backwards on the driveway with a wallop. His head was bleeding and he had cut his wrist badly. Tom’s bedroom was on the first floor. Mark and I had to carry him bodily up the stairs and he kept falling backwards. Then he peed in his pants. How were we going to help him detox when he was incontinent and immobile? I told Mark that Tom should surely be in hospital. “No way,” he said. “Give him a chance. He’s just completely sozzled after a final binge.”

In Mark, I had somebody not only physically strong, but patient and level-headed. I was enraged with Tom and wanted to castigate him, but Mark was talking soothingly – to both of us.

The plan was to start the first dose of Librium at 10am the following day, two hours after Tom’s last drink. Before starting medication, he would need to keep drinking periodically to avoid severe withdrawal symptoms. I had a sheet with a five-day “reducing regimen” that I got off the internet. It’s essential to bring down the intake of Librium each day, apparently, to avoid a secondary addiction – to the drug itself.

The regimen allows for four doses per day at four-hourly intervals. If Tom took 100mg through the first 24 hours, he would be allowed 80 on day two, 60 on day three, 50 on day four, 25 on day five, and lesser amounts on days six and seven. He would also need two thiamine tablets a day. I made brief notes.

Day 1: Mark and I took turns checking on Tom through the early hours. He wanted the radio on all night (“I’ve got to have noise all the time”) and he chain-smoked. Tom told me he hadn’t slept for longer than an hour at a time, day or night, for several years. He has a tendency when dozing to flick ash anywhere. I’m worried about him setting his bed on fire. Mark arranged to have a bucket of water handy. At 3am, Tom started retching but brought up nothing.

At 4.30 he complained of seeing double (“Not surprising,” laughed Mark). At 7 he retched drily again. He took his last drink at 8 and I took away his almost empty bottle. At 10 I gave him his first four Librium capsules, 20mg, and he fell into a deep sleep. Another 20mg dose at 2pm, along with tea, and he fell asleep again. By 5 he was awake and feeling “jittery”: 10 more milligrams. At 7 he said he was hungry (he hadn’t eaten for 36 hours at least). He was shaking uncontrollably and couldn’t hold a beaker of water: 30mg to settle him.

At 8 he eats some fish and mash. A large black moth flies through the window and he is scared out of his wits. The slightest noise or movement terrifies him. He’s still seeing double. 10.30: another 10mg. How will he get through the night? By midnight he is complaining of acute stomach pains and nausea. He takes an antacid capsule. “I’m terrified,” he says, “of drowning in my vomit if I sleep.” A final dose of 25mg. I tell him Mark and I will watch out for him all night. He has had 110mg of Librium, which means a reduction to 80 tomorrow.

I had decided to give up alcohol during Tom’s detox, in sympathy. When Mark and I take a break to eat, I open a bottle of claret and drink more than half of it. My own weakness gives me a small indication of what Tom is going through.

Day 2: Mark and I take turns to check on Tom: 3.40am, 4.30, 5.20. He sleeps till 6.30am. I bring him tea and 20mg of Librium. He is lucid, sober, but has the shakes. Mark and I walk him to the toilet and he nearly falls down several times.

I fetch a Zimmer frame used by my late mother-in-law after a hip operation. At first he rejects it (“I’m not using that bloody thing!”). Mark makes a game of it, and Tom relents when he sees how much it improves his mobility. Midge cleans his room and changes the sheets. She brings a bowl of warm water, soap and a towel. She helps him to wash his face, arms and feet. I’m moved at the sight of Midge on her knees washing Tom’s feet. He is, after all, a complete stranger to her. Tom says he hasn’t had a bath for many months because he can’t climb out.

At lunchtime he eats a small steak pie and mash. He talks about the death of his wife, and how he started drinking again at a New Year party a year after her death – the nostalgia of the moment, the champagne toasts, Auld Lang Syne! He’s talking so much that Mark suspects he has a stash of hidden whisky. When Tom falls asleep, we search. He is clean.

Mark and Tom and I talk about our parents, our childhoods, disappointments, sibling rivalries, incidents of perceived injustice. Tom admits he was a sensitive child routinely bullied by his mother. Down in the kitchen, Midge talks about her life and childhood. Strange how this detox has become an unscheduled sharing of memories, life experiences. I can’t imagine a “qualified” supervisor stimulating such candid, free-ranging exchanges. Throughout the day, Tom takes 80mg in total. But when I look in on him after midnight he is wide awake, shaking uncontrollably. I give him an extra Librium, bringing his second-day dosage to 90mg.

Day 3: When I check at 5.30am, Tom is snoring loudly. Before a dose of 15mg, he has some breakfast. He talks volubly about his drinking career, while puffing hard on one cigarette after another. He is getting through 60-plus a day. When I open the window wider he gets bolshie, assuming I’m exasperated with his smoking (which I am). He says angrily: “I told you – if I couldn’t smoke, I wouldn’t have come here!” A dark mood has come over Tom. At noon, Midge comes again. While she changes the sheets, Mark and I get a bath ready. Once in, he is enjoying it, but shaking badly. He panics trying to get out, but Mark calms him, working out an easy way: the way he went in. We help him downstairs for the first time and he watches TV before having lunch in the kitchen. He complains he has lost control over urinating. He is shaking, and dying for a cigarette. As he goes upstairs, unsteadily, Mark and I behind him, he starts a breathless, convoluted anecdote. I say: “Tom, save it till you get to the top.” He erupts angrily: “I can talk and walk at the same time.”

Mark tells me that when Tom got to his room, he searched frantically for his mobile, determined to call a taxi to go back to Colchester: “I’m not having John bullying me.” Mark’s humour and reassurance came to the rescue.

Day 4: Tom’s Librium dosage is coming down fast, heading for the 40mg mark. He is eating well and gets up for two hours at lunch. But he is still incontinent with urine. We persuade him to accept a large plastic bottle for when he gets caught short. I see on the internet that incontinence can be a side effect of Librium. Mark tells me that Tom opened up about his anger when they were alone together. Coming off the booze, said Tom, is “like being jilted by the love of one’s life”.

Day 5: Tom sleeps till 9am. Mark thinks he is making up for months of lost sleep. Tom is reluctant to take his first Librium dose. He is on target for 25mg. His shakes have diminished, and so has his tendency to jump whenever he hears a noise or sudden movement. For the first time he shaves. But he still can’t control his urine. Midge has been dealing with the laundry.

Day 6: We are spending more time talking with Tom while he smokes and drinks endless mugs of low-octane tea. Librium: 15mg today. Tom says, as if he has just climbed Everest: “Six days without a drop of scotch!” Tomorrow he goes home; I’m worried about how he’ll cope without our companionship and regular meals.

Midge’s last day. She goes up to say goodbye to Tom. Comes down half an hour later, flushed.

“I told him off, ” she says. “Told him he has a lovely family and should think of them and stop drinking.” Mark and I have spent an entire week avoiding the slightest vocalised hint of reproof towards Tom. When he comes down for supper he doesn’t mention it. Nor do we.

The following day, I took Tom back to Colchester. We talked about his positive plans, which included his determination to take an internet distance-learning course in teaching English as a foreign language. He will not discuss going into a rehab programme. His attitude, for a long time, has been that he knows all about it and there is nothing they can tell him that he doesn’t already know. Tom’s son and I had talked about the family giving him more support. When we arrived at the flat, his eldest son and daughter were there to greet him. They had cleaned up the place and got food in.

He waved down to me from the window, looking cheerful; but I knew that his struggles had only just begun. For my part, I felt that I needed to put the experience into context with the help of experts. Tom had approved my decision to write about our week, but he wanted his true identity to be withdrawn.

It seemed clear to me that a successful home detox needs two and possibly three helpers. A relative or friend such as myself, and one strong and dedicated other person. Midge’s daily stint of an hour or two was essential for us – keeping the kitchen, Tom, his room, and his bedding, clean, especially since incontinence can be an issue. A daily visit from a qualified detox nurse, the norm for NHS home detoxes, was surely no substitute for what we had provided for Tom. All the same, the research I had done, on what to expect and how to handle the Librium, had been crucial, and Tom’s GP could have done more to inform me about the dosages and the reducing regimen.

The following week, I visited some of Britain’s alcohol-addiction experts to talk through “best detox practice”, including Colin Drummond of the Maudsley and Ian Gilmore of the Royal College of Physicians. They are intransigently against the amateur home detox, yet agree that NHS alcohol-addiction resources are woefully inadequate. I could not persuade them that my “team” in Northants had been better than an NHS home-visit detox, or none at all.

I visited George Best’s doctor, Professor Roger Williams, a veteran liver-transplant surgeon of the old school, and an ardent campaigner for more resources for treatment of alcoholism. Williams said: “As far as I’m concerned, intervention is best. In other words, a good bollocking at the right moment is worth six months of psychology.” Midge would have agreed; but Williams failed to convince me.

All the medically qualified experts I spoke to, whatever their views, advised me to talk to the most skilled detox practitioner in the country. “Nurse” Lynn Owens, as she likes to be called, works at Liverpool Primary Care Trust. She has a PhD in best practice for detoxing, and a string of other degrees relevant to addiction management. Owens tells me that she got into alcohol addiction treatment by working as a nurse in intensive care: “I realised that most of the patients, whatever their primary illness – road accident, stroke, liver, kidney disease – had an underlying problem: alcohol. But we’d just patch them up and send them off without addressing the drink problem.”

She has established a routine whereby patients are “unobtrusively” assessed on all the wards, but especially in A&E, for the possibility of a drinking problem and offered treatment. “I take the view that the patient is in charge of their own return to health: they know their bodies and their own lives. All we can do is offer what skills we have to support them.” She tells her patients that many do get better spontaneously, without counselling: 20%, she claims, and that gradually cutting down to zero drinking is also an option rather than a crash detox.

Her main concern, she says, is that we have become a drinking culture – for which government, retailers and the media are all to blame, whether it’s seeing the sensational side of binge-drinking or the availability of drink. “The trouble is, many alcohol-related diseases creep up without symptoms.”

She tells me the story of a young solicitor aged 26, “a lovely guy”, who came to her unit wanting to cut down. “He was drinking two bottles of champagne every evening. We tried to get him down to one bottle a day. After six weeks we noticed that the whites of his eyes were yellow. Two weeks later, he was dead with cirrhosis of the liver.”

Often, she went on, it is the more intelligent and educated people who refuse help. “We had a woman patient in her early forties, a high-profile person in the community, let’s say. She was having an alcoholic-induced psychotic episode. She refused to speak to me or get involved in an addiction programme. When she got out, I received threats warning me not to blab. She thought it would destroy her career.”

On the crucial issue – would she advocate unsupervised home detoxes – she says: “No, it can be medically dangerous.” She concedes this much: “Given the lack of resources, I would never criticise a GP for encouraging patients and their families to go this route.”

Talking with Owens and the other experts, I suspected that their reluctance to advocate GP-managed, home-based detoxes reflected anxieties for the budgets and interests of the institutions they represent.

I ended my inquiry by talking to a number of self-professed alcoholics and GPs. Most poured scorn on what they regarded as “scaremongering” by the experts. One GP admitted that he encouraged one of his patients to detox at home once a year: “He knows, and I know, that he’ll start drinking again a few weeks or months later; but at least he’s giving his liver a rest.” By the same token, the alcoholics I spoke to insisted that they were much more comfortable with allowing their GPs to help them than going to a clinic run by people they didn’t know. In Tom’s case, it was obvious that he went to his GP not because of lack of alternative resources in Colchester, but because he felt more comfortable with him.

If GPs have anything to do with it, the practice of home self-detoxes looks set to continue and expand. In the meantime, the National Institute for Health and Clinical Excellence (Nice) has embarked on its own study of best practice in alcohol treatment. If the experts have an influential voice in its recommendations, GPs could be banned from or restricted in prescribing Librium for use in home detoxing.

I can only hope that Nice will also consult patients and their GPs. There remains the problem of follow-up programmes such as AA post-detox. I did not get the impression that GPs have the time or even the will to encourage their alcoholic patients to seek counselling. But then many of their patients have tried it and become disillusioned. The fact is, however, that detox on its own is not sufficient to give up drinking.

As for Tom, at the time of writing, he is still off the booze.

But it is early days. He has many problems, especially debts, and he feels irritable and depressed.

But he has applied to that course for teaching English as a foreign language, and his family are determined to be more involved with him.

Would I support Tom again through his dark night of the detox? It was a difficult week that left me exhausted, depressed and in some ways disillusioned. The hardest thing was the impression that people, some of them close to me, were not just sceptical, but angry with me for doing it. People like Tom, it is widely felt – even by members of the medical profession – don’t deserve consideration or help. They are authors, it is believed, of their own misfortunes. But yes, I would do it again; provided that I had Mark and Midge with me.

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