“Recovery” will be different for each patient battling their addiction, but it’s always worth pursuing Xavier Mulenga

Recovery is an interesting term in mental health. The idealized version for people with mental illness is a rapid return to their “normal” level of functioning soon after treatment by their primary care physician, psychologist, or psychiatrist begins. Unfortunately, recovery is not always clear cut and people are often unsure of what they will lose along the way.

Peter is a customer that often comes to mind.

He is a 39-year-old man who works as an accountant in a small business. He has been married to Amara for 10 years and they have two children, 9-year-old Maya and 7-year-old James. Peter had been referred to my clinic by his GP because of his alcohol and cocaine use and bad mood. This had led to significant marital problems and a recent police charge of drunk driving and losing his driver’s license for three months.

Despite drinking heavily for the past seven years, Peter presented for treatment because his employer told him to get his drinking problem under control or he would lose his job. Like many men I see at the clinic, Peter has been referred several times, but only kept his appointment at the risk of losing his job.

Peter begins by saying, “I don’t think I’m that bad. It’s just work and the wife that seem concerned about my drinking.” I assume Peter is downplaying his problems to appear better than he really is. I do not challenge him directly, but choose to continue the session. I was taught that building relationships is one of the more important parts of the first session. You can’t treat people if they don’t return.

During the investigation, Peter tells me that he drinks two bottles of wine every night and attributes this to financial pressures, arguments with his wife, and difficulties in relating with his children. His drinking only became a problem after the birth of his son. At the time, Amara was a housewife and was working overtime to make ends meet. The drinking was the starting point of several arguments with his wife that led Peter to start dating his friends more, which escalated into weekly cocaine binges.

Peter is now sleeping in the living room and is unsure of the reasons for this. I ask him if Amara is considering a breakup and he says no: “I don’t think so. We’ve been married too long.” I make a mental note to consider a family reunion later in treatment. He admits that he is saddened by the distance between his children and himself and constantly apologizes when he has a hangover or forgets sports activities.

At the end of the review, I recommend a hospital detox as a break and a chance to start anti-craving treatment for his alcohol addiction. Peter is reluctant at first, but later agrees when I tell him that his employer would look favorably on this course of action and allow his wife and children to get to know him soberly. He will be admitted in the next week and his withdrawal symptoms will be treated with some diazepam and thiamine. Peter agrees to take naltrexone (anti-craving drug) to stay sober. To my relief, Peter is aiming to give up alcohol completely in the coming months as controlled drinking is too risky for him.

This detox raises some concerns when neither his wife nor children nor friends visit him during the hospitalization. This isn’t uncommon, unfortunately, but for a man undergoing his first detox, there tends to be more fanfare. Peter apologizes for this, which is later questioned when his wife emails me saying she has a restraining order on him. She also alludes to domestic violence. Ultimately, Amara says that Peter cannot return to the family home and will live with his parents instead. When this information is presented to Peter, he tells me that he already knew, but was hoping that this detox would put him back in Amara’s favor.

In the last week of his detox I observe that Peter is showing signs of depression and I recommend antidepressants which he refuses saying “I think these are too many pills”. We discuss therapy to help stay sober and interpersonal issues affecting his wife and children. Peter worries the therapy will make his symptoms worse as old wounds need to be re-warmed. He agrees to weekly group therapy as a compromise and more outpatient appointments when he is released into his parents’ care.

Detox is the first step on a difficult road to recovery. The next few months will be difficult for Peter. While attending weekly group therapy, he relapses during the court proceedings of both the restraining order and divorce. On his third rehab admission, Peter decides to test mirtazapine to ease his poor sleep, fleeting suicidal thoughts, and bad mood. Fortunately, he was able to improve his relationship with his children and they visit him in the hospital, accompanied by his parents. He agrees to start individual therapy after discharge.

The following months are more positive. Peter can stay sober longer and that helps at work and at home. He gets promoted from work and moves into a small apartment with a spare room for his children to visit. Eventually, the restraining order is lifted and he can have a healthier relationship with his ex-wife. Two years have passed and Amara has found a new partner, which makes Peter a bit uneasy, especially when his children say how well he treats them. Peter has been less successful romantically and constantly finds dating apps frustrating.

I recently checked on Peter who has been sober for a year and his depressive symptoms are stable on medication. We talk about the challenges he overcame on his road to recovery. Peter tells me how lonely he is and explains that many of his friends were his ex-wife’s and he struggled to set up his own support groups. He has his parents, children and a good job, but has not cultivated any friendships over the years. We are making some plans to work towards this in future sessions.

When Peter leaves my clinic I can’t help but think that he is one of the loneliest people I know.

Recovery is rarely linear or orderly. The rule of thumb is that the sooner you start treatment, the better the results. In Peter’s case, we saw substance abuse, withdrawal, depression, divorce, and relapse. But I hope people know that while recovery can be long and up and down, it’s still a worthwhile endeavor.

dr Xavier Mulenga is a Sydney-based addiction psychiatrist

Patient examples are not real people and are aggregations of situations that psychiatrists often see

In Australia, the crisis support service is Lifeline 13 11 14. If you or someone you know has been affected by sexual assault, family or domestic violence, call 1800RESPECT on 1800 737 732 or visit www.1800RESPECT.org.au. In an emergency, call 000. International helplines can be found at www.befrienders.org

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