Doctors with drink problems: letting go of denial

It is five years since my husband died. He was an alcoholic. He was a very talented man, a brilliant clinician, articulate, funny, intuitive, creative, kind. Watching him slowly kill himself was a terrible kind of torture. Living with his illness was also a terrible kind of torture. By the time he died the whole family was ill.  

I have talked to several people with alcoholic partners and, although the specifics are different, the fundamental dynamics are always the same. I found them one day in a booklet provided by my local Al Anon group. Al Anon is the family and friends equivalent of Alcoholics Anonymous (AA).  The booklet is called ‘Alcoholism: A merry go round named denial.’

Addiction, I learnt, is all about denial. It was years and years before I came to accept that my husband was an alcoholic. When I met him our group of friends were all quite heavy drinkers, a legacy from medical school, and he didn’t stand out as drinking any more than anyone else. But when most of us started to moderate our drinking, when children came along and feeling tired all the time lost its appeal, he continued. He was what they call “a top-up drinker,” he was never rolling drunk, was never violent, didn’t crash the car, and rarely slurred his words. As a result nobody outside the family, other than the few close friends I told, knew that he had a drinking problem.  That made the denial easier. 

He would go for days never being entirely sober. He would become sour and stupid when he was drunk, regularly spoiling family meals and outings, and embarrassing our daughters in front of their friends. Our younger daughter simply stopped asking friends round and withdrew to her bedroom when her father was drunk. Our elder daughter became more and more angry, infuriated by every sour or stupid remark. Alcohol wrecked our family life. And as time went on, it all became worse and worse. 

I became increasingly lonely, stressed, and desperate. I was covering up for him. I was mediating between him and our children. I was trying to manage mealtimes in a way that didn’t end in conflict. I was trying to spot the signs he was drunk so that I didn’t end up committing to meals out where I would look across the table and suddenly realise my husband was not there, a drunk stranger was there. I was controlling and arguing and blaming and withdrawing. I became someone I did not like at all. 

One time I was at a retreat, talking to a man whose parents were both alcoholics. He was a long-time attender at Al Anon. I was telling him about my day to day life, not complaining, just reporting how it was, and he said, 

“That sounds hard.” 

I looked at him, surprised and confused. 

“That sounds hard,” he said again, “on you.” 

This was the first time that anyone had succeeded in turning the attention away from my alcoholic husband and on to me. It was very disorienting. Focusing—as I did every day—on the other person, I had never for a moment taken a good look at myself. Now I could suddenly see what a mess I was in. 

So it was that I came to the 12 step world of Al Anon and associated groups, and I was lucky to have two good friends who supported and counselled me. It was a revelation. I discovered that my constant vigilance and covering up and smoothing over earned me the title of “enabler”—I was one of the means by which my husband continued drinking. By covering up I was protecting him from the consequences of his drinking; by remonstrating with him I was giving him somewhere to put his energy, on defending against me, which meant he was not putting it where it needed to be—on himself and his drinking; by focusing on fixing him instead of fixing myself I was going slowly mad because, in reality, there was absolutely nothing I could do to fix him. Only he could do that. 

At the first meeting of Al Anon that I went to, I heard these three fundamental tenets about alcoholism: 

“You didn’t cause it, you can’t control it, and you can’t cure it.”   

The beliefs that underlay what I had been doing, of course, were the complete opposite of these. 

Once I really understood these three things I started to let go of the denial and face up to the stark reality of our lives, of my life; of the misery and frustration, the constant cycle of hope and disappointment, the loneliness and the shame, the ever diminishing size of our lives, and of my complete powerlessness to do anything about it. It took time and it was painful and I needed to remind myself of the facts again and again. But as time went on I was able to start to focusing on what I actually could take care of—myself and my children.  

My experience of mainstream medical services was that they were subject to the same denial and ignorance as we were. When my husband was admitted to hospital with pneumonia, he actually told the excellent registrar that he drank a lot and had suddenly stopped. Nevertheless nobody told us that this DIY detox was almost certainly the cause of the pneumonia, and nobody scanned his liver. When he became jaundiced shortly afterwards, he managed to convince his GP that it was a side effect of the antibiotics. By the time somebody did scan his liver he was in full blown de-compensation. He was bright yellow with liver failure, he was in renal failure, and his liver was the size of a walnut.  I remember saying to the registrar that I thought liver disease caused hepatomegaly. “At first it does,” was his grim response. 

My experience of psychological services for alcohol was that my husband was well cared for but the family was not. There was mention of support for the family by his psychiatrist (there is good evidence that treatment is more effective when partners are involved) but it never materialised. When he was admitted to rehab we went to see him on the “family day.“ The family counsellor was off sick and instead we had one of the regular addiction counsellors, who clearly had no understanding at all of the dynamics of an alcoholic family. I remember meeting another wife of a doctor there, who was on her knees with it all. The counsellor just nodded and smiled.  Although most of us visitors had travelled for several hours to get there, and faced similar return journeys, there was no lunch for us. We were sent off on foot to the nearest pub, two miles away. When my husband was admitted to hospital with acute alcoholic hepatitis and renal failure and expected to die, I was in pieces and I tried to get support from the rehab unit. I was told that because my husband was now in hospital and therefore no longer technically a resident they would not permit me to attend the family session.  

When I talked to his psychiatrist, the focus was always on him, and that focus was primarily on the drinking. The job was to stop the drinking, and once it had stopped the job was to keep it that way. 

But when you’re close to an alcoholic you know that the drinking is just a symptom of the problem, not the problem itself. Like all alcoholics, my husband drank because he didn’t like how he felt when he was sober and alcohol made him feel better. He had everything to live for, his work as a doctor, his family, home, interests, financial security, retirement, but there was a deep unhappiness in him that only alcohol relieved. Stopping drinking is just the first step in recovery. Once that happens, the real work can start. The 12 step community knows this. They also know that if you’re going to address the problem, you have to include the family, because they are part of the problem.  They know that the alcoholic can twist anyone around their little finger, and that they are consummate liars, not least to themselves; they know that you, the partner, are as mad as the alcoholic; they know what you do and they know what you need. The relief in finding these people who knew and who understood was extraordinary. 

The 12 steps sadly could not save my husband, and whatever the services had done I suspect it wouldn’t have changed the outcome. But the 12 steps did save me. Five years down the line I am relatively sane. I have raged, I have grieved, I have accepted, I have learnt, and I have changed. 

The author of this piece has withheld her name, in the spirit of anonymity that is central to AA and Al Anon, but is happy to respond to anyone who wishes to make personal contact. She is also a doctor and a consultant in her specialty.