Invisible segment...

There is a large gaping hole in the world of alcoholism. Most people, who are not alcoholics, do not understand that not every alcoholic is savable. Oh… I can just hear my e-mail box filling up with that statement!

I am certainly not trying to be disrespectful. I personally believe most alcoholics have the ability to achieve and maintain sobriety. I also believe that some alcoholics say they don’t want it when they really do. Their brains are just too saturated at that moment to realize that sobriety is what they want. Once the brain dries out, they see that a better life is available to them.

That being said… there is a large segment of alcoholics that are beyond saving. They are end-stage and it’s called end-stage for a reason. They’ve reached the end. The end of being accepted into treatment centers; the end of the medical community being interested in helping them; the end of the family’s patience for the situation; the end of their overall health being able to sustain the stress of detox; and/or the end of the possibility for a sane and productive life.

These end-stage alcoholics have usually been through detox and rehab more times than you can count with both hands. Each time they have returned to what they covet the most – alcohol. And each time their health deteriorates even more. They eventually reach a point where detoxing is more dangerous than the drinking. This group of people do not want sobriety. Even when in a sober state of mind, they will openly state that they prefer drunkenness over sobriety. This is where they veer off and become invisible to the world.

No one wants to admit that someone – anyone – can’t be helped. We all like living in the fantasy world where every illness is cured, every bump and bruise gets a kiss and is made all better. But this isn’t Fantasyland and not everyone gets cured or gets the message. We don’t cure every case of cancer. Why would addictions be any different? Not every case is curable.

Unfortunately, there is no guidebook for what to do when an alcoholic is not curable. No one knows what to do with an end-stage alcoholic who needs medical treatment that may include a stay in the hospital, but has a high death risk if allowed to go into withdrawal. I’m sure there may be a drug that would help them get through to discharge without putting them into a detoxing state. I don’t know of any, but I’m not a pharmacologist. I do know that the one thing that will prevent withdrawal is more alcohol. Even small amounts may be enough. Yesterday I wrote about a hospital providing alcohol to an end-stage alcoholic.

As Riley sits across from me and says there must be a way to get this woman some help – I’m not sure what he means by HELP. He doesn’t (even in a sober mind) believe that anyone should be forced into detox without their consent. So maybe the help he was referring to was actually met with the doses of vodka.

Twice I have heard of a hospital emergency room providing (or allowing) the patient to have alcohol. I don’t know if it is a good thing or not. In my mind, it is a contradiction between bad and even worse. Doctors do take an oath to “first do no harm.” Maybe taking away the alcohol constitutes MORE harm in certain cases. I understand that. And I also understand that taking away the alcohol may mean probable death in certain cases.

I suppose that each alcoholic that enters an ER should be taken on its own merits instead of putting them all into one savable category. It makes sense to me that each alcoholic should be evaluated and treated in the manner that would most likely aid in the recovery of whatever injury brought them to the ER in the first place. In other words, treat them for the bump on the head, or the broken arm, or the cut hand. But automatically insisting on detox is not always in the best interest of the alcoholic. Of course, it never hurts to ask or even to gently prod. But threats of refusal of service should never been an option.

I have taken Riley to the hospital many times with calamities as a result of his inebriation. Each time the scenario plays out the same. The admitting and triage nurses are gentle and sometimes even playful with Riley. They examine his boo-boo and take his vitals and say a doctor will be with him shortly. Several times during the process he will state that he does not want to detox or go to rehab. The doctor comes in and examines him while asking lots of questions about his drinking.

After the examination, the doctor will take me aside and tell me that I need to get Riley to detox. As if it was totally my decision. The doctor will come across as lecturing me as to what must be done – as though I should have done it long ago. I will then be informed that there are no facilities at the hospital to accommodate the detoxing process. (Well – I know that’s not exactly true – all hospitals have ICU’s and that’s the safest place for a detox to happen. But I don’t say that to the doc.) And then – as though everything is hunky dory – I’m informed that they will try to find a facility for Riley. I smile and nod, because to do anything else – to provide any other information – will certainly fall on deaf ears. A few hours after the lecture, the doctor will reappear and tell me that they were unable to find a center that would accept Riley. The mortality risk and relapse risk was way too high. They treat him for whatever and he is discharged.

It’s disturbing to me that the family is almost always admonished for the condition of the alcoholic. It seems they are just expected to keep the alcoholic from getting to the point of being end-stage. Once the alcoholic is at end-stage the family is forced to make decisions as to what is best not just for the alcoholic, but for the entire family. In my opinion the family is more savable than the end-stage alcoholic and if that means the alcoholic goes back home and continues on the path of self-destruction – well so be it.

Personally, I won’t take the detox road again. If I have anything to say about it, I will do anything I can to keep Riley out of detox and let him finish the task he has set before himself. Riley knows my point of view. Everyone knows my point of view and I’m not winning any popularity contests with my attitude. That’s fine with me. Riley has made a choice. I am simply respecting his choice.

The patient described in my last post was in extremely frail health. She was anemic and so weak she could not stand on her own. She did not know any of the why, where, or even who of the questions that are always asked to determine whether or not the alcoholic is cognizant of the present. The stress of detox would almost certainly end in death. The general consensus seems to be to get the alcoholic to detox and that will be the answer. It isn't always the answer and sometimes shouldn’t even be a question.

Our society needs to stop ignoring the fact that not everyone can fit into the round hole that we have been almost “brainwashed” to believe. Everyone is different. Every alcoholic is different. It’s time to acknowledge that fact.