My first presentation in a series was titled "Leave or Stay??" The presentation included the 12 Stages of Alcoholism and was focused on alcoholism in general. For this posting, I'm focusing only on end-stage alcoholism. I can’t post the entire presentation – but – below is the Cliff Notes version:
So – leave or stay? That is the question. No one can really answer that question except the non-alcoholic faced with the dilemma of having to make a choice. I’m big on making sure I am thoroughly familiar with an issue before I make decisions – especially life altering ones. Knowing what to expect is the best place to start.
We all know that alcoholism is a pain in the patutti. But when the alcoholic becomes “end-stage” the difficulties become compounded by about a 100 times – or at least it seems so to the other people in the alcoholic’s household.
You can expect the alcoholic do display some of the traits below:
1. Loss of interest in family, friends, hobbies and anything outside of being drunk.
2. Loss of memory – mostly short-term, but can also affect long-term. There will be confusion between which day starts and which day ends.
3. Reversed or erratic sleeping cycle. The alcoholic will spend more and more daytime hours sleeping and may be up and roaming the house during the night.
4. Personal hygiene becomes non-existent or selective and very difficult. Usually showing requires the insistence of an outside party. Assistance while in the shower is often necessary. Shaving is problematic if the alcoholic doesn’t use an electric razor.
5. Inabilities for blood to clot making even the simplest scratch require immediate attention. Nosebleeds increase in frequencies and intensity.
6. Falls easily and has difficulty getting up even when assisted by another person. Since there is a loss of muscle mass, there is no strength to hold onto to the person attempting to help.
7. Loss of bladder and bowel control. The alcoholic will frequently urinate without even realizing that he is doing so. Bowel movements will become diarrhea-like and often the alcoholic will not be able to hold it until he gets to the toilet. A diaper may be necessary -- but it may be difficult to get the alcoholic to agree. Protective pads must be used on all the alcoholic’s favorite furniture places and in the bed.
8. Vomiting gradually increases to a daily occurrence.
9. Makes unreasonable demands of the caretaker and/or the family and will become hostile when he doesn’t have his demands met. Or, after the caretaker and family do everything possible to meet the demand – the alcoholic doesn’t remember ever making the demand.
10. Easily irritated, angered and may possibly morph a quiet peaceful person into a violent rage-filled bully.
11. Loss of appetite. Although he may say he’s hungry, he will only eat a few bites of food at any sitting. Then he may pick at various foods throughout the day. Or he may stop eating altogether.
12. Loss of appropriate social behavior and inhabitation. Anything goes. Everything is acceptable in the alcoholic’s mind. There are no morals and no shame.
13. He may become insistent that there is something wrong with him – cancer – bird flu – plague – anything that is not alcohol related. And he will either be very insistent upon seeing a doctor or will refuse and just keep complaining.
If you think you might stay, you must know that dealing with all the above issues is time-consuming and stressful. Cleanliness will be of the upmost importance for you and your family. The alcoholic will leave in his disheveled, filthy wake, the possibly of exposing everyone to salmonella and other bacterial infections. Here are some things to consider:
1. Use latex gloves and protective masks when handling any of the articles of clothing or bedding whether or not they contain excrement.
2. When cleaning the alcoholic’s bathroom, use a solution of 1 part bleach to 2 parts water. Clean the toilet daily, but also clean the floor and walls behind the toilet.
3. Put waterproof pads between the sheets and mattress.
4. The alcoholic’s laundry must be done separate from the family laundry. The alcoholic’s laundry must be done at least every other day.
5. Keep a very small trash can by his bed. Use a plastic can liner – doubled. He can use this if he needs to vomit and can’t get to the bathroom. Empty and clean each day using the bleach mixture.
6. Don’t allow him to handle any food. Prepare his meals. If he eats during the night, prepare food and snacks that he can eat while you’re sleeping. There’s no point in designating breakfast from dinner. He can’t make that leap – so just fix what you know he will like.
7. There is a “point of no return” where taking the alcohol away is just as dangerous as the drinking itself. So if the alcoholic cannot get to the store to buy his booze, you will need to decide on whether to buy it or not to buy it. Either choice is encouraging his death and puts the caretaker in a moral dilemma. Please see my post “To Buy or Not to Buy” posted in December 2010.
Now that you know a bit about what to expect and some of what may be required to keep him at home, here are your options:
1. Kick him out and he will die possibly within weeks of his exit.
2. Keep him in your house where you can provide a safe place for his deterioration. His life expectancy is probably ranging in months rather than years, although I’ve heard of alcoholics hanging on as long as two years in an end-stage state.
Those are really the only two options. The reasons WHY you leave or stay are really not as important as what you do after you make the decision.
If your decision is to take care of the alcoholic, you must also take care of yourself. Establish your own support system. Al-Anon is great, but often their tenements conflict with what you find you must do. But, there is a sense of acknowledgment of your pain and conflict. They will not judge. They will not advise.
I’ve found that developing my own support system works best for me. I have a friend (who has had issues with drugs and alcohol), my family, a mental health counselor, a medical doctor, a selective on-line Al-Anon group, and last – but certainly not least – all the readers of this blog. I consider these people collectively as my support group.
For tips on how to maintain your sanity in this journey, please read the page “What the Non-Alcoholic Can Do.”
In a nut shell – this was my presentation. It is certainly a shortened version. I provided a handout for my attendees. It really only contains information that can be found on the blog with the exception of the recipes of the food I served. But if you want a copy, just e-mail me your information and I will send one along. Information sent to me will be considered confidential and will not be used for any purpose other than to send the handout.
Also… if you wish to be added to my mailing list… send me a request in an e-mail and I’ll happily include you.
