Cecilia Ford Ph.DCecilia Ford, who has been a psychologist in private practice in New York City since 1987, has addressed emotional issues for us in many articles over the years. This week she counsels a woman who is sure that her husband is addicted to pain medication and is nerving herself to confront him.

 

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Dear Dr. Ford:

I am concerned that my husband has become addicted to pain medication that he mixes with alcohol. He is 50 and had a back injury at work that required prolonged physical therapy and eventual permanent disability from his job. He has more than one pain doctor, and has become both secretive about his medications and very nasty when I ask him what he is taking. We have two teenage sons, who are drifting away from a relationship with their father. They tell me that he acts weird at their school games and that he seems “out of it” during the day. I rely on him to be there for the children, since I am not at home during the day. They can both drive now, so at least I don’t have to worry about an accident with my husband behind the wheel.

I work as an administrator with a long commute.  I get up and out of the house by 6 a.m. and drive two hours to and from work five days a week. I get home at 7:30, make dinner, and try to connect with my children and get the house cleaned a bit; then I fall asleep and start all over again. I have to work—for insurance benefits for the entire family and because we need the money, since my husband’s disability checks do not help much. 

Our community is small, and everyone knows everyone’s business. My fear that my husband has an addiction problem has not been as bad as my fear of shame in the community, but I know that I have just been a coward. Now that I am determined to deal with this big problem, I don’t know where to start. There is a psychiatric hospital in a small city 60 miles away. There may be AA programs here, but I have been too ashamed to ask. But, for the sake of my sons and the safety of others who could be harmed if he were driving with pills and/or drinking, I need to do something. And my husband will never forgive me. But that is something I will have to live with.

Barbara

 

Dr. Ford Responds:

Dear Barbara:

It sounds as if you already have made up your mind that you have to do something about your husband’s addiction problem, which is a major step in the process. So often we close our eyes, minimize, or outright deny substance abuse among our family members because it is such a painful issue and there are no easy solutions. But you have realized that the consequences of not acting will be worse than whatever hardships confrontation may bring.

Prescription drug abuse has grown substantially in the past decade. According to Dr. Nora D. Volkow, a neuroscientist who leads the National Institute on Drug Abuse, hospitalizations due to it increased fivefold, in the decade between 2001 and 2011, and overdose deaths increased fourfold in this time period. Like many people who become addicted to these drugs, your husband began using them to treat pain and had access to them with a doctor’s prescription. For some people, whose brain responses can be shown on scans to be physically different from others’, these drugs can be powerfully and quickly addictive.  As you yourself have witnessed, it is not too difficult to fool other doctors into writing duplicate prescriptions. When alcohol is added to the mix, the effects are potentiated.

As Dr. Volkov’s and many others’ research has proven, addiction is “all about the dopamine.” In other words, it is entirely a physical, not a moral or psychological, problem, though many people feel shame and anguish over their “lack of willpower.” Addiction and alcoholism are medical illnesses with physiological roots. Unfortunately, they are usually progressive, and without intervention, your husband and your family are in danger.

Almost every community has some form of help available, though it seems as if  your husband needs to start by going to rehab in order to withdraw safely from the medications. Your medical insurance should cover at least the minimum 28-day initial stay, and some places have “financial aid” available. Begin your research by consulting with a doctor, who may refer you to an addiction specialist or counselor. Secondly, you can call an AA hotline. They have resources on the Web and 24-hour call-in centers where you can get information. Once these sources have helped you make plans about what to do, you will need to confront your husband. For many people, this is the hardest part, and families often opt to do it as a team, sometimes even bringing friends and others to add support to the effort. You may want to consider using the help of a professional interventionist who can guide you through the process and be present when you do it. Often, the professional will also take the patient directly from this intervention to rehab that day.

Despite your shame, you may be surprised to know how many people in your small community are touched by this issue. Ever since Betty Ford bravely came forward with her admission of drinking and drug addiction in the 1970s, there has been much wider acceptance of the idea that this can happen to anyone. Since you live in such a small community, chances are that people will find out about this, if they don’t suspect already. Perhaps you should be open about what you’re doing. In that way, you can “control the narrative”: Instead of rumors, your friends and neighbors will hear the truth, directly, from you. A second benefit—not to be minimized—is that you will be an example of courage in the face of a great challenge. You will be an even finer role model than you are already for your sons, your husband, and your community.

Dr. Cecilia Ford