As we all know, the holiday season brings joy to some and anxiety to others. It is therefore not unexpected that at this time of year there is an increased feeling of loneliness for those who are alone, a heightened sense of hopelessness for those who have depression and an increased challenge by the temptations of the season for those who are faced with the disease of addiction. “Tis' the season to be jolly. Fa la la la la, la la la la.” Really? So during a time when we are faced with the senseless deaths of fellow citizens for minor crimes and the rising up of voices, which reminds us of the disparity that existed between the discriminatory penalties imposed for crack cocaine versus powder cocaine, I thought I would share a few stories.
As a physician who has spent many holidays working in Emergency Departments treating those who come to the hospital for care as a place of last resort, it is clear that we as a society need not only to open our hearts and our wallets but our minds to ameliorate the suffering. It is time to embrace mental health and substance use/abuse as illnesses no different than diabetes, high blood pressure or heart disease. But until we are willing to accept that our neighbors, co-workers, friends and family members are equally affected by this illness, community resistance to establishing local treatment centers for addictive diseases will persist.
Treatment does make a difference, but it is not a one size fits all, as illustrated by two patients who live inside of me, especially at this time of year. Both patients were in their mid-seventies when I met them as a young physician several decades ago.
I will refer to the first patient as “Joy”, as that is what she truly was. Joy had been coming to see me for alcohol dependency for a few years, and she was able to remain abstinent from drinking except for the time between Thanksgiving and New Year’s - the time when families gather to eat, drink and be merry. Joy needed some help to stay sober, a little more encouragement from her family and maybe a different approach than just an increase in her counseling visits during the holiday season. Otherwise the pattern of this delightful and spunky woman “falling off the wagon” during the holiday season, resulting in this joyful person becoming joyless, was bound to continue.
So one day she asked me about the medication called Antabuse, which forces alcohol to be metabolized by an alternate pathway. If one drinks while on Antabuse the alternative metabolism creates toxic byproducts that can make one very ill, resulting in low blood pressure, fainting, nausea, vomiting and even passing out - too dangerous to risk in an elderly woman with other medical illnesses. But she insisted she wanted to try it. So I prescribed an extremely low dose (really a sub-therapeutic dose) and was pleased that she never questioned why I had her break the tablets into multiple small pieces. Yes, I lied, or maybe just exaggerated, about the potentially catastrophic consequences if she took even the smallest sip of alcohol. I think she knew I was fibbing a tad, but she never asked. “Now remember, you need to also stay away from the rum cake,” I would tell her with a smile.
So off Joy would go with her prescription for a sub-therapeutic dose of medication to last her from Thanksgiving to New Year's; and she lived on without ever again taking another drink!
The second patient I will refer to as “Happy” because that is just what he was - an extremely warm and positive man who also struggled to stay sober over the holidays. As a younger man, he was able to just say, “No” when offered a drink at his family’s multiple holiday events. He came from a “large family of partiers” as he would refer to his relatives; who never believed anyone could have a problem from just a few highballs. So despite Uncle Happy’s persistent refusals to drink, they never gave up hope! At the prior year’s Christmas Eve event, he succumbed to the pressure of constantly be handed a drink.
When I saw him shortly thereafter, he had gone on a three week “bender” and needed hospitalization for dehydration. Over the ensuing ten months, he always kept his medical appointments and remained sober, but had lost some of his happiness, replaced by guilt and embarrassment. Just as he was starting to let go of these negative feelings, the holiday season was again upon us. What to do? “How about you make sure the first thing you do is make yourself a drink as soon as you walk in the door. Put some tonic water and ice in a glass and be sure to add either a lemon or a lime. Or maybe grab a martini glass, fill it with water and drop in a few olives. That way everyone will see you have a drink and your empty hands won’t be empty.” A big smile came across his face, as he responded, “And I could even take a sip if I wanted to.”
So during this holiday season I hope everyone can find Joy and be Happy just like my two special patients. “Tis' the season to be jolly. Fa la la la la, la la la la.” As a special holiday gift to bring some additional pleasure, my book Addiction on Trial, is now on sale through January 8th and the ebook is just 99 cents! And a special thanks to the many folks and organizations that have been supportive of my literary endeavors over this past year.
Happy Holidays and Healthy New Year 🙂
