Is it the end?

Sometimes I’m asked if a spouse is at end-stage or how to tell if a spouse is at end-stage. One of my most popular posts is a definition of end-stage alcoholism. You can find it here:

End-Stage Definition

An end-stage alcoholic has usually
been through detox and/or rehab several or many times only to return to drinking almost immediately after being released. Most likely they have other health difficulties such as cirrhosis or pancreatitis or a combination of issues. The most common theme is that they simply do not want or cannot stop drinking. If they try to stop on their own they will have tremors and will probably go into DTs which can be life-threatening without medical assistance.

The best way to determine if an alcoholic is end-stage is by observation. Extreme yellowing of the eyes and soft tissues of the face is one of the first physical signs. Vomiting blood; explosive bloody diarrhea; lack of appetite; swelling in the belly; inability to walk; loss of the ability to “be in the moment”; and, hallucinations are all signs that the end may be approaching.

Just because someone is end-stage does not mean death is imminent. End-stage can last years or it can last days. It just depends on the severity of the health issues. Sometimes if the alcoholic can get into a medical detox program, they can recover from many of the health problems. For example, the liver can regenerate cells and become functional again. However, if a return to drinking occurs, the process just repeats itself over and over again – hence The Immortal Alcoholic.

I don’t want to mislead anyone. The long-term consequences of the biological damage will remain. Dead brain cells will always be dead brain cells. Brain atrophy (shrinkage of the brain) can continue to progress at a more severe rate than most people of the same age with dementia. Once the damage is done to any of the organs, it is done and although functioning may improve greatly during abstinence, once that bottle hits the lips everything will go back to that pre-detox status very quickly.

The next question asked is what to do if you believe you are dealing with an end-stage alcoholic. There’s really not much that can be done except prepare yourself for the various scenarios. What will you do if your alcoholic dies? Are you dependent in some way on his income? Housing? Or any other basic living needs? If so, have a plan for what you will do when that support ceases. If he goes to the hospital, detoxes and lives, knowing that the likelihood is that he will return to drinking, what will your plan be on how to handling that situation? It’s hard to think of all the various routes until actually faced with them, but there is a need to try to imagine and have a plan. My motto is hope for the best, but plan for the worst.

Don’t forget about the legal stuff – get a medical power of attorney and a general one if the alcoholic will consent. Try to find out what the alcoholic would like as far as services are concerned. You must consider that this is just like any other terminal illness and handle the legal issues as such.

That being said, there are some things you can choose to do if you suspect end-stage is fast approaching. First off, do NOT take away the alcohol. At this point removing the alcohol should only be done in a medically safe environment. It is possible to gradually reduce the amount of intake if you have control of all alcohol access. It can take quite a while, but it will be less traumatic to the alcoholic and can eventually lead to him being alcohol free.

You can try to get the alcoholic medical help, but most doctors want to treat people who WANT to live and alcoholics often do not make good patients. However, getting a full CBC blood test with INR can give you a good idea of life expectancy using either the Child-Pugh or MELD scores. You can find more specific information concerning these two tests in The Workbook for Caregivers of End-Stage Alcoholics available only on this site.

There really is no definitive program for what to do when you discover you are living with an end-stage alcoholic. So I leave you with these suggestions: Be knowledgeable; Make a plan or several plans; Hope for the best and plan for the worst.