One of the saddest things about addictions is that the people who fall victim to them often have so very little insight into their disease. More often than not they are in denial about the fact that they have a problem, and find a thousand little ways to justify their behavior. It is very rare to meet an addict in the throes of his addiction who has insight into his problem. They usually need to hit rock bottom, or have sobriety inflicted upon them by outside forces, before they realize what a mess they're really in.
For instance, a man in his 40s who I admitted to our unit this past week. He came in for chest and neck pain. His bloodwork revealed that his liver enzymes were elevated. When he arrived to the floor from the ER, I immediately noticed a faint tinge of orange to his skin... one that can only be attributed to jaundice, or to a very bad spray tan. With no documented history of hepatitis, I suspected that he might have a drinking problem. During the admission assessment, I asked him about drug and alcohol use. He said, "I like rum." I asked, "and about how much rum do you drink, on average?" He shrugged, and replied, "about half a bottle per day." I nodded, wrote it down, and continued with the rest of the questions.
A short while later I left the room and spoke to the physician about whether or not he wanted to put him on a Serax taper, or at least write an order for a sedative as needed for the symptoms of withdrawal this man was likely to experience. Further investigation revealed that the man's last drink had been the evening of the day before. Delerium tremens usually sets in within 72 hours after the last drink, and withdrawal symptoms and warning signs can begin long before that. The doctor ordered an "as needed" dose of Ativan. I then explained to the patient what the doctor had ordered and why. He said, "Well that's certainly not going to be a problem" and scoffed at the idea. I said, "okay, but if you do happen to start feeling anxious, or if you notice trembling, sweating, or anything unusual, you let us know right away so that we can help you be more comfortable". He dismissed me as though I were crazy. His denial had him completely blinded to the very real danger he was in. The DT's can be deadly. But he wasn't ready.
I met this man's extreme opposite a few months ago. An older gentleman in his 60s checked himself into the ER because he decided to quit drinking cold turkey (he drank about a liter of vodka DAILY) and started to experience withdrawal symptoms at home. He came to our hospital when he developed pain in his chest, afraid he was having a heart attack. When completing the admission assessment, the questions begin with health history, immediately followed by the questions regarding drugs, alcohol and tobacco. I hadn't yet gotten to the part about substance abuse.
When I asked him, "do you have any other health problems we need to know about?" he replied, "Yes, I'm an alcoholic. I realized tonight that I can't safely do this on my own, and I'm hoping that when I'm cleared medically I can get into a rehab program." I'm sure that my face did not betray what I felt, because I've gotten pretty good at maintaining a neutral, calm demeanor when faced with shocking, horrifying, disgusting, embarrassing, or humorous things (I've seen a lot of teeny wee-wees in my days as a nurse), but I was stunned. It is so rare to meet someone caught in the mires of their addiction who can admit that they're an addict, admit that they can't quit on their own, and recognize their addiction as a HEALTH PROBLEM, not just a social problem. It was beautiful. I left the room with a real sense of hope for that man's recovery.
Today, I think about that sixty-something man who faced himself, and I bow my head in humble gratitude for the people in my life who have survived their own addictions and come out the other side to be some of the most self-reflective and content people I know. I breathe a sigh of relief knowing that my own days of vice, cravings, and discontent are so long behind me... 8 years now, it's hard to believe. And I offer a little prayer of hope for the addicts out there who haven't yet let themselves see the truth.
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