Dan Mushens examines the challenges recovery workers face in dealing with people who are in denial about their addiction problems
What is often referred to as alcoholism, is now more frequently described as alcohol dependency. Once this illness takes hold of someone, devastation is likely to follow with every part of a person’s life affected. I’ve heard it likened to a volcano consistently spewing molten lava for years; engulfing the surrounding villages and changing the landscape forever.
For those who can’t escape the lava - exposed to the effects of alcohol abuse and malnutrition for a sustained period - it’s possible that a medical diagnosis may escalate from alcohol dependency to alcohol related brain damage (ARBD).
Working for an ARBD specific supported living service in Glasgow, I’ve been fortunate to have met so many interesting service users. Their stories are unique; their recoveries are each at different stages and I find their understanding of their situation can often be placed into three distinct categories.
Some, despite having cognitive deficits, are able to comprehend the destruction that their previous alcohol abuse has initiated. They live with the consequences of failed marriages; alienation from loved ones and various health related concerns but now choose to live a life of sobriety and measure their abstinence in years.
The second group of people are the majority. They are the people who have wonderful insight, crave above all else to live a life of sobriety but find relapse a common feature on their road to recovery.
The final third are the people I describe as being in denial – those who have no desire to stop drinking alcohol and actively continue to do so despite the dangers being apparent - to others if not themselves.
The cases of two people enter my mind when I consider different approaches of intervening to help them modify their behaviour. James is in his mid sixties, divorced from his wife and estranged from all his family. He has many ARBD related deficits as well as scarring on his liver.
After a recent hospitalisation, the prognosis from a doctor wasn’t too optimistic. In spite of these red flags, he still chooses to consume twelve cans of lager daily stating he could stop if he really wanted to...but he doesn’t want to. And it’s true, he could indeed stop. He has done in recent years when he spent twenty-four alcohol free months in our supported accommodation service. James says he doesn’t have an issue with alcohol.
Then there’s Angela. Angela is a private and petite lady who apparently drank heavily for decades with her husband who sadly passed away several years ago. Living in a sheltered housing complex and drinking a bottle of rum daily, Angela’s short term-memory continues to deteriorate and confabulation is apparent in most conversations. Contact with her children is infrequent and although once a regular worshiper in a local church for most of her life, she hasn’t been able to attend since 2014 and generally only leaves her flat to visit the shop.
Angela appears to have the odd moment of lucidity and self-awareness but she doesn’t feel as if alcohol has caused her any harm. Even with much encouragement on offer, Angela hasn’t been able to attend multiple healthcare appointments due to her reduced
mobility. Planned breast, cervical and bowel screenings have come and gone, with visits to the dentist, optician and osteopath also dismissed.
It’s commonly said that reaching rock bottom is needed before any meaningful and sustained behaviour change is likely to take place, yet James and Angela have both been there. As a service, we also try to educate and raise an awareness of a person’s given situation in the hope that something strikes a chord and they realise that recovery can happen should they allow it do so.
In the absence of a magic wand, it could be argued that occasionally we need to accept our professional roles have their limitations, despite our best efforts.
We each have our own degree of agency and our personal responsibilities should be promoted then respected. Maybe promoting the benefits of healthier lifestyle choices is sometimes as good as it gets.
Dan Mushens is a recovery practitioner for Scottish mental health charity Penumbra and can be found on twitter @danielmushens where he regularly tweets on the subject of ARBD. James and Angela are pseudonyms.
