To ask for a medical perspective on alcoholism

[StartingOver2020]

KidsDad is drinking himself to death.

I greatly appreciate the support I’ve had on another thread about the challenge for me and kid. Separately I’d be very grateful for some information about the medical side.

He had many years of sobriety before a lockdown triggered mental breakdown and alcoholic relapse. Before this his damaged liver, varices and Barrett’s oesophagus, which were being regularly monitored, had been doing well.

I’ve not known him as a drinker although I initially had contact with Alanon family groups many years ago in relation to someone else so I have this as a support network and source of wisdom.

GP advised several weeks ago that to stop drinking suddenly could be fatal. He’s drinking up to 2 large bottles of vodka per day, definitely more than 1. I haven’t seen him face to face for over 3 weeks but I get the impression it’s crept up from about 1 large bottle to at least 3 half bottles. I imagine at these quantities the precise amount is academic.

I severely reduced contact between KidsDad and kid then stopped it altogether partly because I feared kid might witness a sudden fatal haemorrhage - is this letting my imagination run wild? Sadly contact isn’t appropriate for any number of reasons, for the time being.

There seems no immediate prospect of inpatient detox.

Are you asking about prognosis, how long before he kills himself?

Yes, sudden stopping when you've been consuming that much alcohol can be fatal. That's why my brother had to be under medical supervision to detox.

Is that what you're asking?

Thank you, sorry for asking a question then vanishing.

It may be too much to hope for but I’m hoping someone working in a healthcare/detox/rehab type setting might give me some medical information.

I understand about withdrawal seizures but for example how would a nurse or doctor assess someone’s mental state ie signs of wet brain, and capacity. What might be the impact on the things I mentioned liver etc and possibility of survival with what sort of long term consequences.

If he really thinks he will die without detox is there any sense in him switching from alcohol to his prescribed diazepam which he’s not taking as already having breathing problems.

Are medical detoxes accessible or is it a complete lottery now because of Covid?

As he says he wants to detox and has been through a phone assessment which is recommending he has residential detox and his life is definitely in danger is it really likely that there is an expectation that he will wait for a place in ‘months not weeks’ as his recovery caseworker told me a 3 weeks ago.

My fil drank himself to death. He was hospitalised for months before he died, he was on an alcohol drip.
He had several haemmorages before he died, over the space of around 2 years. In and out of hospital.

OK my mum is 80, alcoholic, and has been in and out of hospital for the last 50 years (she's actually been in twice in the last two weeks, it really is very boring having to explain to poor well-meaning hospital staff that it's not "a fall" or "D&V" it's a bottle of whisky and 3 litres of cheap cider a day that causes the vomiting blood and the loss of balance) so never underestimate the unreliability of the unreliable.

The difficulty with wet-brain is that unless symptoms are really obvious, most MH professionals don't have the time to get into it. My mum is spot on with the capacity assessments but absolutely conviced that the woman in the flat downstairs (who is an NHS dispensing chemist) is in fact a drug dealer with addicts coming and going at all hours of the day and night. You'd need to know that, to know that....IYSWIM.

The physical damage she has caused herself is enormous, but most of it is not directly alcohol-based: it's things like falls and self-neglect over a period of time.
Mum had a care package from Social Services put in place from her last hospitalisation, most of which she has since disengaged from - which she can, she has capacity.

If you want to DM me for a moan, be my guest - but please protect yourself and kid as well x

@AcrossthePond55 I've had similar, I stayed with him for 9 days for the detox but ultimately it failed as as soon as I was gone he started drinking again. At least for now. I was too terrified he was about to die to stop pestering paramedics or his GP for medical detox. Drinking escalated during lockdown.

Hope you had a better outcome.

Has he already had a detox before?

[quote Frownette]@AcrossthePond55 I've had similar, I stayed with him for 9 days for the detox but ultimately it failed as as soon as I was gone he started drinking again. At least for now. I was too terrified he was about to die to stop pestering paramedics or his GP for medical detox. Drinking escalated during lockdown.

Hope you had a better outcome.[/quote]
We did. It's a long and hellish story but the end result is that my brother has now been sober for 5 years.

What might be the impact on the things I mentioned liver etc and possibility of survival with what sort of long term consequences.

That would be individual to the patient. There's no way to 'guess' or generalize these things. One person might sail through with no permanent damage, another might have life altering complications.

What is your specific concern? That he'll go 'cold turkey' or that he's using the wait for treatment to continue his drinking? It might help posters to know exactly what you're worried about and to frame their answers to your specific questions/needs.

There's no real 'wait' for treatment where I am (in the US) you just find a facility, pay, and get admitted. If you're saying that the NHS has told him that he'll have to wait for medical detox for 3 months, that's horrible. I know my brother was prescribed diazepam to try home detox but it didn't 'stick', he started drinking again. The only thing that worked for him was an in-patient medical detox followed by in-patient treatment (groups, counseling, therapy, meds).

It's more than just 'detoxing'. The alcoholic has to work on themselves to find the root causes of the drinking in the first place.

I understand about withdrawal seizures but for example how would a nurse or doctor assess someone’s mental state ie signs of wet brain, and capacity.

There's an assessment with different questions to ask to assess mental capacity, but capacity can change. When he is drunk he might not have capacity, but when he is sober he might do. Drinking 3 bottles of vodka a day isn't a good decision, but if he is deemed to have mental capacity then that's ultimately his choice to make.

These replies are so helpful, especially the questions I don't have an immediate answer to. Deeply thought provoking.

To do the right thing for kid and me I need support to walk away from the drinking situation and the drama surrounding it. I cannot help him and I can only damage myself.

It might be hard to do or it might feel so right that it's not hard. I certainly feel very sad about how things have worked out.

By the way he went through detox and over a year of rehab before we met. His sister and brother have been through all this before.

One slip for 36 hours in 15 years of sobriety, until this.

@StartingOver2020

These replies are so helpful, especially the questions I don't have an immediate answer to. Deeply thought provoking.

To do the right thing for kid and me I need support to walk away from the drinking situation and the drama surrounding it. I cannot help him and I can only damage myself.

It might be hard to do or it might feel so right that it's not hard. I certainly feel very sad about how things have worked out.

Contact your local chapter of Al-Anon or go online to their website. It's specifically for the families of alcoholics. I think you'll find them a great source of knowledge and support. It's people who have been there, done that, got the t-shirt, and wore it to shreds.

Something can feel completely right and still be the hardest thing you've ever done. It was that way for me with my brother. It nearly broke me to block him.

And feeling sad is perfectly normal. Part of letting go is going through the '4 stages of grief'.

Remember:
You didn't cause it
You can't control it
You can't cure it

My partner died of alcoholism age 34, he first found out his liver scores were slightly high in 2010. we split up shortly after & he met someone who was an alcoholic who managed to get snowed in with him during the bad winter & got him in to drinking 24/7. I noticed a difference to him when we got back together in 2011, he was drinking a lot more, never had a day when he didn't drink, he got arrested for drink driving. He carried on drinking, he would have his first can as he woke up in a morning, he was drinking about 10 cans a day plus sharing a couple of bottles of wine on Friday & Saturday nights with me. The only time he didn't drink was when he had his supervised access with his children, he still managed to play snooker professionally, he also used coke occasionally. We split up in 2012 & he went to live with his mum, she tried to stop him drinking but he carried on in secret, we got back together in 2013 & he was persuaded to requalify as a professional player, the only way he could play was if he was drinking, he had neat Vodka in a water bottle, somehow he managed to qualify, he played in a couple of tournaments still drinking, I managed to persuade him to speak to alcohol services, he tried for a couple if weeks before he was back to normal. He was arrested for threatening behaviour & missed playing in a big tournament. He broke his arm in 2014 drunken arm wrestling & never played again, in the September he started swelling up, I dragged him to the doctors who referred him to see a liver specialist, he had cirrhosis of the liver, she wanted to admit him for detox but he refused, a month later he had over 7 litres of ascites drained from his stomach, he was yellow, couldn't stop shaking & was drinking 15 cans of cider & half a bottle of vodka a day. He was admitted to hospital in January 2015 with liver & kidney failure, 4 days later he was in intensive care after a massive alcoholic seizure & died 3 days later from his lungs filling up with blood which basically caused him to drown, it was horrific to watch. An alcoholic will only stop drinking if they want to, they will lie, cheat & steal to get what they want, you can't fix them, believe me nobody tried harder than me.

So he had a detox before? But when was it I'm not clear from your posts. I previously worked for an alcohol charity. It was very very difficult for people to get a detox of they'd had one recently or within a few years. They are very expensive and unfortunately if the individual can't show they can maintain it then it's less likely he will get one. However if it was a while ago and he had a good history or not drinking this works to his advantage a bit.

Also I'm so sorry you're going through this my uncle was an alcoholic he died a few years ago in his 50s. My grandparents, his parents are still alive and had to go through that. In all honesty they haven't been the s as me since and in particular my grandma has taken a huge health it. Let alone the years of in and out of treatment and the drama, the job losses, the financial issues. So I understand on a personal level how awful it is.

@StartingOver2020

These replies are so helpful, especially the questions I don't have an immediate answer to. Deeply thought provoking.

To do the right thing for kid and me I need support to walk away from the drinking situation and the drama surrounding it. I cannot help him and I can only damage myself.

It might be hard to do or it might feel so right that it's not hard. I certainly feel very sad about how things have worked out.

You're clearly in a really tough spot and it's not your responsibility - so you know what the best course foward is - either decision is right. Medical advice is likely to suggest the option where he faces tragedy down the line, rather than giving him the best chance overall.

Forgive me if this is patronising, but I've been there and there are some things you can do to help him - perhaps doing this will make it a little less hard to leave if you need to, or make it easier to cope if you stay in touch. Sorry if you know this, I'm just saying it in case.

Firstly, rehab doesn't work (on it's own), no one has a cure (if he's waiting for one it's like waiting for a wizard) and he'll have to psychologically "quit" himself while he's still drinking... 3 months wait for rehab is kind of short notice to make the psychological change needed. I'm speaking from experience (1 litre of Whiskey a day). Hope is the enemy of acceptance and acceptance is key.

If you haven't already, look up "Euphoric recall" - doesn't matter what caused him to drink or to relapse, won't ever matter how bad or great his life is or becomes - he just needs to understand that his brain once made a connection between alcohol and feeling good / less bad / coping and it just assumes that connection is correct (the brain keeps a positive connection for up to 20 years in the face of repeated contradicting evidence...thus relapses are common). If he really meditates on this enough he will notice when it's kicking in and can overwrite it...3 months is a good amount of practice and then deal with the physical / habit side. The good news is it's absolutely possible to undo this.

If you do block contact make it about something else - guilt may give him a temporary attempt to quit but it's bound to fail. "Will power" is like trying to arm wrestle yourself. Also make sure your decision is forever - you can't be half in, or have any chance of changing things for either of your sakes - he has to quit because he's indifferent to alcohol for change to be permanant... solutions like antabuse just reinforce euphoric recall (denial equates to value)

He may die either way (sorry to be so blunt) - the fact adds no weight to a cold turkey or rehab decision, the gamble is the same. All I'll say is physical withdrawal without psychological freedom isn't sustainable (it helps with confidence...but it's a failure in advance).

He also needs a hobby that involves adrenaline and achievement - video games are excellent for this.

Last comment is that I've been there and back (over 6 years sober now from a very similar situation) - I can definately say he can quit and not have cravings or regret it...life still sucks of course, but that becomes a good thing in it's own way.

Good luck to both of you!

Though I know you’re asking the questions with the best of intentions, no one on here can give you a specific prognosis.
Capacity is time and decision specific.

It would be dangerous for him to stop drinking straight away.

Inpatient detoxes certainly do exist and he should be eligible for one but they normally need a few months of doing the groundwork in the community before you’re eligible - the evidence is that many people relapse after an inpatient detox. It’s not a lightning rod.
Diazepam can be used to manage a community detox.
Either way, it needs to come from him.

Gosh op what a hard place to be in.

A very dear friend of mine hit rock bottom 2 years ago, very highly functioning alcoholic but was diagnosed with almost everything your ex has after emergency hospital admission with vomiting blood (varices?). Rehab was lengthy but was completed as an outpatient.

He 'graduated' after a year, but the need for a drink never left him.

Unfortunately, heartbreakingly, he had a massive brain haemorrhage recently which took his life.

If I was in your shoes, and knowing that this is an incredibly likely risk with his prior diagnosis, I would continue to restrict contact. Firstly because he's in no fit state to look after them, but also because if (and when) things go wrong you need to protect your kids from being there.

This is not your fault or your responsibility op. He needs to go back to his gp/consultant urgently, but it is not your place to handhold him through it. You must find strength to protect your dc and support them when the inevitable comes. I'm sorry.

I need to hear these stories and perspectives. They are helping me move forward even though they are opening the floodgates of my sadness. Some replies and reactions:

“nobody tried harder than me” 😢

Previous detox must have been 15+ years ago

He’s 59.

It is awful.

I can’t tell if he’s accepted the reality of his situation but I am coming to an acceptance of mine. He may die.

You’re right, prognosis is unclear and not necessarily relevant to my decisions.I guess I’m trying to understand the range of medical possibilities (I feel better if I have an intellectual understanding of a medical situation - it was a help to me to understand NEWS scoring when my father was dying). The diazepam he has is a long term prescription. He’s been assessed as needing residential detox.

Yes, a catastrophic event is possible and the detox/rehab experience he had before is no predictor of whether he could achieve stable recovery again. As far as I possibly can I must prevent kid from a having the traumatic experience of witnessing KidsDad having a medical emergency.

He has been a good man, as imperfect as we all are, may he and all beings be free from suffering and the causes of suffering.🍁

Just reread “neat vodka in a water bottle” that was a boundary crossed for me when KidsDad had one of these on a visit to us. He was too far gone to realise his deceptions had become transparent.

My DH (I left him a few months ago) is drinking huge amounts daily and we all worry about him dying and have accepted it may happen but equally we know the body has an amazing capacity to carry on. We all worry when we receive a call from an unknown number.
I am sorry you are having to deal with this. I am thankful our child is too small to fully realise what is happening.
DH also uses Diazepam to 'self detox' but never lasts more than a few hours wth no drink, he too needs a medical detox but is in denial that he has an issue.
I very much feel stuck in limbo but recognise I have to carry on and try and build a happy healthy life, something which I hope you can do too.

@StartingOver2020 I slept on this one because I don't want it to sound preachy or patronising, but I'm also going to put a thumb on the scales on behalf of kid. If you like, for the kid I was once, whose voice went unheard because the people who were expected to be looking after her, wee too busy firefighting mum's ongoing issues.

I know that's not you, I know you're protecting kid as hard as you can, but I don't know from what you've said whether there are other people who would be down as his next of kin or his support network, or whether this is likely to devolve upon you. What I would say from my own experience is that you need to be incredibly careful not to become carer-by-default. You can't do it all. But if there is no one else around, you will be expected to. The agencies involved with the ongoing care and support of alcoholics are on their knees, they're overstretched, understaffed, and under-resourced. All of that understood. You still don't have to pick up the slack. Your primary care is for kid and I know you know that, I can see that in what you've said, but sometimes other agencies will put pressure on you to "do your bit" and it is right and proper to say no. Don't be guilted into any more than you're comfortable with.

You sound like a lovely caring person and I wish you all joy and strength in the future.

Perhaps I can enlist the children's bit of social services to prod the adult bit. You are 100% on target Cattermole

I can see that in what you've said, but sometimes other agencies will put pressure on you to "do your bit"

This is absolutely true. I was put under enormous pressure and 'guilt tripped' by the facility where my brother was to take responsibility for him when they wanted to discharge him after 48 hours. They tried 6 ways to Sunday to get me to agree. Some of their suggestions were ridiculous. They tried to make me feel like a horrible person.

I stood firm in my 'no'. I knew it was the right thing for him, and for me. And I was right. I forced them to do their job and provide my brother with the services our taxes were paying for. These agencies don't always have the best interests of their client at the forefront, they're trying to 'close a case' to save money. Don't let them use you to do that.