Friday, January 10, 2014

Drunken Danse Macabre: A Tale of Two Departed Alcoholics

John
A chronic alcoholic, a phone call, the police, and devastating news: the formula of tragedy. Found dead in his apartment at forty-seven years of age, John’s death was not a surprise. His lifelong alcohol and drug induced pseudo-nirvana had ended. Any hope for a spiritual awakening, possibility of treatment, or stint into sober recovery disappeared with his body on the coroner’s table. Because of the condition of his body when it was discovered, the requisite autopsy was performed. Confirmation from his postmortem revealed what his family and friends suspected: death from hepatic cirrhosis. John’s last deadly dance with alcohol culminated in bloody vomit, an alcohol level of .39, and a lone body of man on a bed putrefied by alcohol and drugs.

The son of a friend, John’s descent began in his adolescence when he first became infatuated with intoxication. His joyride was not just about getting high but getting wasted. Devoid of inertia or brakes, John’s escalating behavioral and legal entanglements left his parents few choices. Outpatient counseling was ineffective in reducing his ardor for mind altering substances. The last straw, an admission to a reputable treatment program, only seemed to instill the temperate life was not for him. It also introduced him to better connections for more exhilarating highs.

As he progressed through adulthood, the pace of his imbibing intensified, producing a litany of repercussions. Alcohol fueled accidents, jail terms, financial ruin, and deteriorating health bounced off his impenetrable armor. These warning signs were either summarily dismissed or denied. Avenues providing him with additional treatment options were fiercely rejected.

It would be easy to dismiss John as a pathetic drunk, habitual druggie, or low-life derelict. Despite his propensity for getting obliterated, he was well liked by those who knew him and valued by his employer. Even the cops in the small town where he lived would sometimes transport him home from the local tavern when he "overindulged". His kind and helpful demeanor made it easy to overlook his obvious "problems".

The denouement of John’s alcoholism was a silent heartbreak whose recourse hardened his family’s Achilles heel. Throughout their ordeal his family tried to hold onto his fundamental decency, hoping he might bottom out and come to his senses. No one ever believes Dr. Jekyll will permanently become Mr. Hyde. Insurmountable odds ultimately eroded their suspension of disbelief.

While Al-Anon provided them tools to counter the insidiousness of codependency, it could not completely eliminate the stinging scourges incurred by John’s progression into addiction. Fortified by John’s inability to become straight, the family resolved not to be dragged down by enabling the disruptive chaos of his plight. To insulate themselves from the wake of alcohol’s sequelae, they practiced detachment. This meant they no longer implored, berated, condemned, or punished him. They let go of having any control over the circumstances he created. There were no more interventions, rescues, bailouts, or financing of his predicaments. He alone faced all the consequences of his actions.

Needless to say, sometimes they would not see or speak to him for years. During the last year of his life John had phoned them sporadically, attempting through his profound alcoholic haze, to reestablish communication. Knowing his addiction was in its final stage, they patiently listened to his incoherent ramblings. There was nothing more to say or do. Their stoic acceptance of his addictive apocalypse validated it was only a matter of time before an ominous call could be expected. Weeks later when the toll of his death knell sounded, years of rehearsed requiems gave them the strength to gracefully handle his interment. If there was a silver lining in this sad tale, it would be that his family expected this communiqué ten years earlier.

Nick
Addiction-backed expiration creates an eerie déjà vu among its survivors. John’s waltz with morbid addiction awakened memories of my friend Clare's ex-husband Nick, another departed habituate. A co-member of the dead-at-forty-seven club, Nick’s alcoholic bungee jump occurred twenty years earlier under similar conditions.

Born in the same small northern Minnesota town where John died, Nick’s journey with addiction also began as a teenager testing his penchant for intoxication. Everyone admired Nick’s charm, humor, verbal acumen, and intellect. Conversant as a renaissance man, his breadth of knowledge captivated anyone in earshot. He didn't fit the stereotype of an alcoholic. Acts of immoderate consumption spaced months apart made it seem that he had nothing more than a recreational problem. His drug of choice was beer. Yes, beer.

When Clare first met Nick he had been in recovery eleven months following an arrest for his first DUI. Motivated by "hitting bottom", he voiced being bone-tired of enduring the guilt, humiliation, and utter despair inflicted by alcohol. Genuinely contrite after this brief incarceration, a spiritual awakening inspired him to pledge no further recurrences. His humility and dedication to recovery overrode any reservations Clare had about being in a relationship with him.

Cautioned by his family and friends of his struggles, Clare disregarded their forebodings. She focused on supporting his sobriety by not becoming his unwitting alibi. For awhile it seemed to work. Armed with a false sense of confidence, Clare was certain she could leap the hurdles before her. So she leapt by getting married. Little did Clare know she would be hurdling over her own anger, frustration, and exasperation.

Initially Nick maintained sobriety by following his version of the AA program. Living with a binge alcoholic, Clare attempted to balance the hope of sustained abstinence with the hard reality of the chemical’s allure. There had been a couple of lapses but Nick rebounded with a mea culpa desire to stay sober. Recommitting to the AA principles, his "birthday clock" reset as did an expectancy of continued abstinence. But there was a problem with Nick’s "program"-he was following his own abridged interpretation of AA. Multiple rationalizations for this, including no connection to a sponsor, reinforced delusions of self-control. To admit being powerless over alcohol contradicted his entrenched autocratic ideology. This lone ranger regimen quickly sabotaged his fragile recovery and propelled Clare into Al Anon.

As time advanced, further slips became all-out benders. Frightening pathological symptoms emerged. Descending into the torment of addiction, antagonism erupted toward anyone or anything interfering with his drunken "danse macabre". He became fluent in the language of denial and blame. A cynical defiant stance intertwined with shameful despondency. Emotionally labile, one never knew which Nick you were addressing. Legal skirmishes became frequent events without fear of consequences. When not drinking he was recovering from drinking. Five rehab admissions ostensibly punctuated his inebriant bouts with dry drunk moratoriums. Dreams of Nick ever living a life in recovery vanished like the contents of his cherished bottle of beer
.
The journey of final stage addiction subjects those in its cross hairs to abject anxiety and dread. Worry for the addict, their safety, and for potential victims caught in their wake can be a consuming obsession. What would be compassionate and merciful in a healthy relationship is almost always enabling and detrimental when dealing with a terminal addict. Any rationale used to rescue them from their free fall serves only to prolong the pandemonium. Defying reason and logic, their decline is an unremitting vortex of spiritual, emotional, and physical ruination. Horrific is too inadequate of a word to describe the powerlessness of witnessing the addict’s depravation
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The decision to end their relationship after seven years was the result of an epiphany. Worn down by her numerous attempts to salvage their relationship, Clare suddenly realized that Nick did not have a problem with alcohol. She had the problem with Nick’s alcohol. Nick never got past the first step in AA. Clare finally surrendered. Nick’s life was no longer in her hands. Divorce gave her the detachment to release him to his karma, whatever that was to be. She relocated to another state to protect herself from the ongoing drama. Geographical distance allowed her to emotionally move on. The healing began as she refrained from indulging in the shamed-based dialogues and unrealistic expectations driving her misery. As her life progressed, his life ebbed.

Predictably, when Clare's marriage with Nick dissolved, the legal system became his primary codependent. It was the eighties and addiction recovery was still in its infancy. Though Mothers against Drunk Driving had campaigned to show the human and financial cost of driving under the influence, the courts faltered enforcing tougher sanctions for habitual offenders. Astonishingly, Nick skated through his DUI court appearances with light jail sentences, court ordered rehab, and probation.
His adroit handling of recidivism’s revolving door masked his steep decline and chronic medical problems. Once proud of his honed body builder frame, alcohol induced diabetes ravaged his physique while beer-swilling marathons decimated his brain. Mr. Hyde completely forgot who Dr. Jekyll was. "Gravely disabled" was the operative phrase to characterize his level of functioning. Family and friends finally distanced themselves from him, seeking protection from his destructive spiral.

Grim reports from distant relatives described his rapid deterioration. Psychologically Clare prepared an obituary, waiting for his corpse to catch up to the funeral. Like John’s family, she awaited "the call".
Nick’s final days were spent in a small town in Idaho working pick up construction. Ironically, alcoholism had little effect on his strong Midwestern work ethic. The day Nick died was actually one of the few days he called in sick. He was discovered dead in a trailer house by a supervisor suspecting something dire about his absence. When 911 could not revive his depleted body or battered spirit, a coroner rendered the final verdict. Clare never learned of the exact reason for his demise, nor did she ask. Suicide by addiction is not recognized as a cause of death unless the patient leaves a note.
Notification of Nick’s death elicited an empty sadness tinged by relief. Grateful his suffering had ended quietly, Clare was also thankful his exit did not include additional victims. The last vestige of her sorrow was grieving for the future with him which never actualized. Making an appearance at Nick’s memorial was unnecessary-Clare had mourned his passing years ago.

An alcoholic, a phone call, the coroner, and grievous news: the conclusion to the throes of chemical dependency. John and Nick’s alcoholic folie a deux exemplifies the rule rather than the exception. The American Society for Addiction Medicine has classified addiction as a chronic brain disease, not an implication of poorly controlled will power or moral failing. This is their epitaph. 

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