Dear Dr. Roach: After treatment for prostate cancer (with brachytherapy) at age 69, my husband started self-medicating for pain with alcohol. His drug of choice is straight vodka in what I feel to be staggering quantities.
Although we鈥檝e had many conversations about the effects from long-term use and with numerous attempts to stop drinking, he refuses any type of rehab, saying he won鈥檛 waste money on something that won鈥檛 work.
He is not violent or abusive. He has periodic checkups at the Veterans Affairs hospital relative to the prostate cancer, but is not frank or honest with his doctor about his alcohol consumption.
Having read a great deal about living with an alcoholic, I realize I have no control or power over his drinking. I also realize I鈥檒l be the one left to deal with the effects when they become so severe he can no longer deal with them, most likely in the form of mental deterioration or liver disease.
Although he displays symptoms of alcoholism, at this point none, to my untrained eye, appear to be severe or debilitating. What signs/symptoms must I watch for to know what to do and when to do it?
I realize this is a multifaceted question, but I feel powerless and helpless since he鈥檚 a grown man and I cannot force him to pursue treatment.
Anon.
I understand why you are in a difficult situation, and I hope I can help, though it is very hard.
The first thoughts I have are about the prostate cancer and its treatment. It isn鈥檛 normal that he should have so much pain after brachytherapy (the placement of radioactive material in the prostate to slow tumour growth), and there certainly are better treatments for chronic pain than alcohol. That鈥檚 a question for his urologist, general physician or a pain specialist.
I also am concerned about a mental- health disorder, especially depression, which he may be using alcohol as a self-treatment for. Unfortunately, alcohol is a very poor antidepressant as well. Many people, but especially men, have difficulty accepting the possibility of depression, which certainly worsens pain symptoms. As his wife, you can support his getting better treatment for his pain and depression, if appropriate. One resource is at samhsa.gov.
Before I answer your question about the medical issues he is facing from alcohol abuse, I want to support you, in that you are neither responsible for nor able to cure his drinking problem. Your husband has to want to stop drinking in order to stop drinking. Many partners of people with alcohol abuse feel tremendous guilt. It鈥檚 not your fault.
The organs that can be affected by alcohol are many, but the most important are the liver, heart, bone marrow and brain. Liver disease comes on slowly, and not every drinker will get cirrhosis, the endpoint of alcoholic liver disease.
Signs of severe liver disease include a large, swollen abdomen (even if the extremities are thin), yellow colour of the eyes and tremor. Heart failure from alcohol causes shortness of breath and fluid retention.
Bone marrow disease causes easy bruising, bleeding and anemia. But the brain is the most profoundly affected, and the list of possible symptoms is very large.
Ataxia (a particular type of unsteady walking), poor memory and many personality changes are common.
In order to help your husband, it is important for you to take care of yourself. Al-Anon provides support to people who have loved ones who are struggling with alcoholism. More information can be found on its website at al-anon.org.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to [email protected].
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