Geriatric Alcoholism: A Story About Denial
Let’s start off with full disclosure: I am a psychotherapist and have worked in addiction and mental health settings for a couple of decades. I am no stranger to identifying and naming alcoholism when I see it, which does not exactly make me popular at cocktail parties or family gatherings. Sometimes, however, being able to see compared to being able to act upon what I see is a tricky matter, requiring diplomatic skill beyond my typically blunt approach. Case in point: when your partner’s parent is an alcoholic.
My father-in-law has been showing symptoms of alcoholism for 30 years. His first DWI was back in the 1980s, and now, at age 82, his alcoholism is quite progressed. He has severe gout and cardiac complications from his drinking and has been hospitalized three times in the last year for alcohol-related accidents or other complications. He stopped driving and no longer has a car, but neighbors or friends bring him alcohol when he calls them and asks. His most recent hospitalization occurred after a neighbor delivered a quart bottle of vodka. Consumed in a 48-hour period, my father-in-law fell and hurt his knee. He was able to crawl to his recliner, where he spent the next 48 hours, drifting in and out of consciousness, in pain from his injured knee, unable to remember to use his medic alert, and profoundly drunk. When his home health aide arrived Monday morning, she found him conscious, in his chair, sitting in his own excrement. She called 911 and family members and off he went to begin his fourth hospitalization this year.
Denial in the Family
My mother-in-law died of leukemia almost two years ago. She was a classic enabler, angry and saddened by the lack of a relationship she had with her husband after all the years of marriage, but unable or unwilling to leave. She finally departed by dying, leaving him alone. He had been an angry, abusive drunk for years, and alone without her, he was lonely, bored, and felt terribly guilty about having wasted so much of their marriage being unpleasant. These emotions add up to a recipe for more drinking, drinking to forget and drinking to flirt with a passive effort at suicide. My father-in-law is clearly depressed and addicted to alcohol.
His care is managed by his sons who live near him, adult men in their 50s. Unable to see their father as depressed, they ignore what may well be life-threatening symptoms, and seek treatment for his knee, since that is what hurts after his recent fall. They seek specialty care for his hand, which is swollen from the gout. They have never once sought treatment for depression or alcoholism for him. No one has connected the dots regarding his own abusive alcoholic father, and suggested psychotherapy to work through his own childhood traumas. While I understand that I might be quick to make such suggestions given my background and training, his family members have avoided “rocking the boat” regarding his behavior, his passive suicidality, his years of emotional and verbal abuse aimed at their mother, and now his rapidly declining health, all in service of avoiding his wrath when his drinking is mentioned. The disease process of addiction has enveloped the family to such a degree that they cannot discuss the “elephant in the room” despite its ever-increasing size. The result is a vicious cycle of hospitalizations, which become detoxifications and periods of abstinence for my father-in-law, and thus he gains some physical strength. The family has him discharged and sent back home, to live alone, where he inevitably repeats the process and returns to the hospital.
Denial in the Medical Profession
No one in the family—and especially none of the immediate relatives involved in his care—has communicated any of this to his professional caregivers. The primary care doctors, home health aide, physical therapists and specialists he has seen over the last few years have neither explored treatment for his alcoholism nor for his depression. I believe that had his depression been treated after his wife’s death, these hospitalizations might have been prevented. Had his alcoholism been addressed, perhaps he could have enjoyed a slightly better quality of life even now, despite old age and infirmity. The hospital stays are terribly stressful for him and for the family, and the circumstances under which each admission occurs are increasingly unpleasant. If sitting for two days soiling yourself is not a serious indicator that you need help, I don’t know what is.
I have asked repeatedly about his blood-alcohol levels upon admission—those tests have not been requested and no one in the family will do so. Each time he is physically stable again, he is discharged and sent home to an environment that has created repeated medical emergencies. To call this a dysfunctional pattern is a whopper of an understatement.
The doctors play along with the family’s denial, focusing on a knee injury that occurred decades ago instead of addressing the conditions that result in hospital visits. Whether they are aware but unable or unwilling to address the mental health issues is not clear to me; I am “out of the loop” and can only ask questions and raise issues for my husband to bring to the professionals’ attention when he is able to do so.
Take Home Messages
While my father-in-law’s situation is a single case, and I don’t want to generalize too broadly from it, I do think that there may be lessons to be learned, and a value in considering the issues for geriatric patients suffering from addiction and depression. Most importantly, the take home message I wish to shout from the rooftops is that treatment is available and it helps. The suffering is needless. Both depression and alcoholism are medical conditions that respond to treatment. While an 80-year-old with advanced alcoholism may not recover to the same degree as a 30-year-old, quality of life is important at every age. It is possible to make things better.
The single most important intervention is to refuse to join in the denial. Ask doctors about depression and anxiety. Ask your parents or parents-in-law about their feelings of loneliness or guilt. Ask the doctors about medications for these conditions, or self help meetings that other seniors attend. Talk about everything that’s wrong, not just physical aches and pains. Believe that things can get better, and act upon that belief. Your enthusiasm and hope may be contagious.