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Alcoholism, Prescription Drugs, And A Sedentary Lifestyle
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An almost totally reclusive, overweight 66 year old woman who has never suffered a serious physical illness, taking prescription drugs (for the past 40 years) for panic attacks, drinking a bottle of vodka a day, and rarely moving from a lying position on the sofa. How long do you think that can continue before it has serious repercussions upon her physical health?
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Other aspects, around the subject: -
Those who drink on a daily basis do develop alcohol tolerance, that is to say the dosage required to achieve a set (desired) level of drunkenness steadily increases from the point at which they take up drink. Like a supermarket opening up extra checkouts, the liver produces more enzyme to break down the ethanol (this being a fascinating example of DNA responding directly to the outside environment). So, despite the bottle a day (which would likely render infrequent drinkers, like me, legless) they are probably no more than comfortably sozzled.
The liver is one of the few organs capable of regenerating itself, after damage, so it is feasible that long lived drunks never actually damaged their liver at a rate exceeding their body's ability to repair (which may be a heritable trait, varying widely between individuals).
The people with real problems are the binge drinkers, I gather. The absence of daily intoxicant signal means that their liver cells do not invest in the extra enzyme production (waste of resources), so they do not build up tolerance. They get drunker, for any specified dose than the daily drinker would but this also means the peak blood alcohol concentration their body experiences is way higher than the high tolerance drinker's liver ever suffers.*
So, the binge drinker's liver takes a large amount of damage and it is down to whether or not it can rebuild, in five days' abstinence, what was lost in the previous drinking bout. The real problem is the amount of damage it can sustain before symptoms provoke a visit to the GP, by which time some of the cumulative damage may have become irreversible.
* The "unit" of alcohol was based around the statistical average amount of alcohol that the liver can break down per hour. Hence, at one pint per hour it is two units forward and one unit back, per hour. 5 units up, after 5 hours. If a bottle of spirits is 20 units but they are evenly spaced across ~16 hours, then they're, at most, only 4 units up, by bedtime.
A necknominate victim would be 19 units up - and probably comatose - an hour after downing a bottle in one go.
Those who drink on a daily basis do develop alcohol tolerance, that is to say the dosage required to achieve a set (desired) level of drunkenness steadily increases from the point at which they take up drink. Like a supermarket opening up extra checkouts, the liver produces more enzyme to break down the ethanol (this being a fascinating example of DNA responding directly to the outside environment). So, despite the bottle a day (which would likely render infrequent drinkers, like me, legless) they are probably no more than comfortably sozzled.
The liver is one of the few organs capable of regenerating itself, after damage, so it is feasible that long lived drunks never actually damaged their liver at a rate exceeding their body's ability to repair (which may be a heritable trait, varying widely between individuals).
The people with real problems are the binge drinkers, I gather. The absence of daily intoxicant signal means that their liver cells do not invest in the extra enzyme production (waste of resources), so they do not build up tolerance. They get drunker, for any specified dose than the daily drinker would but this also means the peak blood alcohol concentration their body experiences is way higher than the high tolerance drinker's liver ever suffers.*
So, the binge drinker's liver takes a large amount of damage and it is down to whether or not it can rebuild, in five days' abstinence, what was lost in the previous drinking bout. The real problem is the amount of damage it can sustain before symptoms provoke a visit to the GP, by which time some of the cumulative damage may have become irreversible.
* The "unit" of alcohol was based around the statistical average amount of alcohol that the liver can break down per hour. Hence, at one pint per hour it is two units forward and one unit back, per hour. 5 units up, after 5 hours. If a bottle of spirits is 20 units but they are evenly spaced across ~16 hours, then they're, at most, only 4 units up, by bedtime.
A necknominate victim would be 19 units up - and probably comatose - an hour after downing a bottle in one go.
Her OH is probably fatalistic by now, too. It's not exactly a healthy lifestyle - we all agree on that. She sounds to have just given up. She very much needs her medication reviewing and checking IMO. I can't understand why her doctors are doing nothing. A lot of us (me included) drink too much - but we eat well, walk dogs and are busy and engaged with life. (Actually, I'm feeling sorry for myself at the moment, sore throat, temp and sneezles- : ((. )
I think she's inviting blood clots by the sedentary lifestyle itself. I'm 66 and (sore throat apart) was dressed to the nines and out at a dinner dance on Sat. - after a 4hr. workout in a choir workshop - I was k*nack*ered, by the way and had to go to bed for an hour in-between. Is there anything that can get her up and even into the garden?
It sounds (horribly) like terminal depression and a sort of wish-fulfilment, that's why I think the medics need to be involved, maybe she needs sectioning? Good luck to all involved.
Length of life? Inviting an early death, but could be next week or a couple of years. Sqad would probably have some scientific measure.
I think she's inviting blood clots by the sedentary lifestyle itself. I'm 66 and (sore throat apart) was dressed to the nines and out at a dinner dance on Sat. - after a 4hr. workout in a choir workshop - I was k*nack*ered, by the way and had to go to bed for an hour in-between. Is there anything that can get her up and even into the garden?
It sounds (horribly) like terminal depression and a sort of wish-fulfilment, that's why I think the medics need to be involved, maybe she needs sectioning? Good luck to all involved.
Length of life? Inviting an early death, but could be next week or a couple of years. Sqad would probably have some scientific measure.
@baths
I don't understand how naomi was able to dismiss depression, from the outside, short of directly asking her friend and her friend replying, with no dissembling, in the negative sense.
Social withdrawal is one aspect of depression but, by itself, it isn't a problem. Little different from becoming a hermit. Obviously, her spouse would not see this as a trivial change in personality.
Meanwhile, a better write-up on prognoses here
http://
Lengthy and thourough; if in a hurry, read the first and last sections.
I don't understand how naomi was able to dismiss depression, from the outside, short of directly asking her friend and her friend replying, with no dissembling, in the negative sense.
Social withdrawal is one aspect of depression but, by itself, it isn't a problem. Little different from becoming a hermit. Obviously, her spouse would not see this as a trivial change in personality.
Meanwhile, a better write-up on prognoses here
http://
Lengthy and thourough; if in a hurry, read the first and last sections.
Hypognosis, // I don't understand how naomi was able to dismiss depression//
This is what I wrote here over two years ago when the only thing I could link to the change in her was her newly discovered obsession with Facebook. At that time I knew she liked a drink, but I had no idea of the extent of her habit. Until fairly recently when her ever-loyal husband, at the end of his tether, finally confessed to me the appalling life he is living with her, that has been kept a closely guarded secret.
//I’ve been doing a bit of research, and it would appear so. An enthusiastic ’Facebooker’ with lots of Facebook ‘friends’, seems to have become completely disinterested in interacting with the real world. She is wealthy, physically healthy, has a lovely family of grown-up children and little grandchildren, and really doesn’t have a worry in the world, but she does nothing much except sit all day with rubbish television, and the laptop. Housework is neglected, she doesn’t cook, or shop, and all her hobbies (she’s a clever lady) have been abandoned. She’s always had problems with ‘anxiety’, and has taken medication for years to combat it, but whilst she was sociable and enjoyed parties, theatre, etc., she is now isolating herself from society completely. She rarely leaves the house, and won’t have visitors – even family. She has gone from a fun, bright, sociable lady to one who seems to wallow in gloom, in the past, in criticism of everything, in self-pity, and more recently, has been in a state of considerable distress because someone on Facebook (who she doesn’t know) has ‘unfriended’ her for being critical. Her husband, who is out at work all day, is in despair. I speak to her on the phone and by email every day, and she seems ok – but she’s not. Every suggestion is dismissed – there’s always an excuse for not trying something – and her problems are always someone else’s fault. Her doctor offered counselling – she went twice and said the counsellor was stupid. She’s very ‘touchy’, so I hesitate to suggest to her that she forget Facebook for a while to see how she gets on without it – she’d never consider that it could, at least, be part of her problem. Has anyone else experienced anything like this – and if so, do you have any answers? We are at our wits end really. //
Her husband has now retired, and when I wrote that she hadn't been referred for psychiatric assessment - her doctor was simply writing the usual prescriptions to deal with the panic attacks - which, since the anxiety has never abated, clearly have never worked. She has always been quite self-obsessed and quite selfish, and if it suits her, shamelessly unsupportive of those around her, using her panic attacks as an excuse to avoid what she doesn't want to do. Since then she has been referred for psychiatric assessment and her drugs changed - something she is not at all happy about so that is currently being reassessed. Her psychiatrist has said that he thinks she's suffering from Social Phobia, but she lies to him so accurate diagnosis is difficult to attain. She has the curious ability to exhibit normal behaviour when she wants to. Speaking to her on the phone, one would never know that anything is wrong. However, her husband says she can be slumped on the sofa in what, to all intents and purposes, appears to be a drunken stupour, but if the doctor rings she immediately presents herself to him in a coherent and intelligent manner. I simply do not know what the answer is. I don't think there is one. I think she genuinely mentally ill and is simply going to continue down this path of self-destruction - and there's not a thing anyone can do about it. Hopeless.
This is what I wrote here over two years ago when the only thing I could link to the change in her was her newly discovered obsession with Facebook. At that time I knew she liked a drink, but I had no idea of the extent of her habit. Until fairly recently when her ever-loyal husband, at the end of his tether, finally confessed to me the appalling life he is living with her, that has been kept a closely guarded secret.
//I’ve been doing a bit of research, and it would appear so. An enthusiastic ’Facebooker’ with lots of Facebook ‘friends’, seems to have become completely disinterested in interacting with the real world. She is wealthy, physically healthy, has a lovely family of grown-up children and little grandchildren, and really doesn’t have a worry in the world, but she does nothing much except sit all day with rubbish television, and the laptop. Housework is neglected, she doesn’t cook, or shop, and all her hobbies (she’s a clever lady) have been abandoned. She’s always had problems with ‘anxiety’, and has taken medication for years to combat it, but whilst she was sociable and enjoyed parties, theatre, etc., she is now isolating herself from society completely. She rarely leaves the house, and won’t have visitors – even family. She has gone from a fun, bright, sociable lady to one who seems to wallow in gloom, in the past, in criticism of everything, in self-pity, and more recently, has been in a state of considerable distress because someone on Facebook (who she doesn’t know) has ‘unfriended’ her for being critical. Her husband, who is out at work all day, is in despair. I speak to her on the phone and by email every day, and she seems ok – but she’s not. Every suggestion is dismissed – there’s always an excuse for not trying something – and her problems are always someone else’s fault. Her doctor offered counselling – she went twice and said the counsellor was stupid. She’s very ‘touchy’, so I hesitate to suggest to her that she forget Facebook for a while to see how she gets on without it – she’d never consider that it could, at least, be part of her problem. Has anyone else experienced anything like this – and if so, do you have any answers? We are at our wits end really. //
Her husband has now retired, and when I wrote that she hadn't been referred for psychiatric assessment - her doctor was simply writing the usual prescriptions to deal with the panic attacks - which, since the anxiety has never abated, clearly have never worked. She has always been quite self-obsessed and quite selfish, and if it suits her, shamelessly unsupportive of those around her, using her panic attacks as an excuse to avoid what she doesn't want to do. Since then she has been referred for psychiatric assessment and her drugs changed - something she is not at all happy about so that is currently being reassessed. Her psychiatrist has said that he thinks she's suffering from Social Phobia, but she lies to him so accurate diagnosis is difficult to attain. She has the curious ability to exhibit normal behaviour when she wants to. Speaking to her on the phone, one would never know that anything is wrong. However, her husband says she can be slumped on the sofa in what, to all intents and purposes, appears to be a drunken stupour, but if the doctor rings she immediately presents herself to him in a coherent and intelligent manner. I simply do not know what the answer is. I don't think there is one. I think she genuinely mentally ill and is simply going to continue down this path of self-destruction - and there's not a thing anyone can do about it. Hopeless.
Cloverjo, He's done that - and in very low moments when he's been in the depths of despair he has considered leaving her. I've talked to her and tried to reason with her incessantly, but to no avail. I once asked her what she would do if he died. 'Nothing', was her reply. She'd order everything she needs online and just carry on as she is. She's doing what she wants to do so she doesn't care.
Ummmm, he's tried standing up to her, but that just creates arguments which he can no longer deal with. She could moan for England - and it's always his fault! She takes personal responsibility for nothing whatsoever. He is mentally exhausted so basically he just goes along with it all now. Since he retired he has started going out though. He sees the children regularly - and us - and he has joined a couple of clubs where he pursues his hobbies and interests, and if we're going to the theatre he often joins us. If he didn't I think he'd go crazy. The sad thing is, he has always doted on her and done everything for her. He loves her still.
Ummmm, he's tried standing up to her, but that just creates arguments which he can no longer deal with. She could moan for England - and it's always his fault! She takes personal responsibility for nothing whatsoever. He is mentally exhausted so basically he just goes along with it all now. Since he retired he has started going out though. He sees the children regularly - and us - and he has joined a couple of clubs where he pursues his hobbies and interests, and if we're going to the theatre he often joins us. If he didn't I think he'd go crazy. The sad thing is, he has always doted on her and done everything for her. He loves her still.
Clinically I have come across a similar thing a this couple of times over around 20 years of practice which makes it unusual but not rare. Both people were retired from the NHS and both had been intelligent busy strong minded efficient practitioners. Both were fit and healthy on retirement with no evidence of physical or psychological illness. On retirement, both seemed to let the “old persona” go. One took to their bed where they would watch TV, eat junk food and drink wine; the other stopped doing all housework and let their self care go. This person would spend a lot of their time reading and doing puzzles. Neither were married, both had groups of friends and neighbours who were concerned about them. Both were seen by the same very good consultant geriatrician and a psychiatrist, no evidence of organic or psychological disease was found, no depression, no dementia. the bed bound one ended up being sectioned into care because they started to soil the bed and would not allow any cleaning up so it became a public health issue, the other continued in their chosen life with some support which they paid for. This person allowed enough cleaning to stay within the law but continued to live their own chosen life. I have used “they and their” throughout in order to conceal gender, although both people will be long dead by now.
Given that the behaviour definitely is at one end of the “normal” spectrum, and in the absence of organic change, it could be argued that there was some kind of a mental health issue but what it was or how to help, we never discovered.
Given that the behaviour definitely is at one end of the “normal” spectrum, and in the absence of organic change, it could be argued that there was some kind of a mental health issue but what it was or how to help, we never discovered.
@naomi
Thanks for the background info and explanation. Some behaviours, there, inconsistent with depression.
I know how easy it is to "put on a mask" (of normality) but this is an immense strain and, after a day at work, I'd be shattered and I'd need hours on the sofa just to regain enough energy to make myself an evening meal. Had there been an external observer, my behaviour would have appeared just as mysteriously 'switchable' as hers is.
Keeping up appearances so as to not have people in your face, trying - unhelpfully - to help. Also, trying to avoid torpedoing one's own career advancement (I have to laugh at that now, as I must have stuck out a mile and wasn't allowed to progress, at all).
---------
On another tack. How would you react if it was the same behavioural symptoms but, instead of Facebook, it was a computer game? Would we be discussing aspects of addiction, at this point?
Stimulus/reward behaviour loop. Drug addicts let responsibilities to themselves and others slide too, don't they? She's trying to escape something, is my best guess.
Thanks for the background info and explanation. Some behaviours, there, inconsistent with depression.
I know how easy it is to "put on a mask" (of normality) but this is an immense strain and, after a day at work, I'd be shattered and I'd need hours on the sofa just to regain enough energy to make myself an evening meal. Had there been an external observer, my behaviour would have appeared just as mysteriously 'switchable' as hers is.
Keeping up appearances so as to not have people in your face, trying - unhelpfully - to help. Also, trying to avoid torpedoing one's own career advancement (I have to laugh at that now, as I must have stuck out a mile and wasn't allowed to progress, at all).
---------
On another tack. How would you react if it was the same behavioural symptoms but, instead of Facebook, it was a computer game? Would we be discussing aspects of addiction, at this point?
Stimulus/reward behaviour loop. Drug addicts let responsibilities to themselves and others slide too, don't they? She's trying to escape something, is my best guess.
Ummmm, she's always been lazy. The only thing she was never lazy with was herself. She's spent fortunes on expensive make-up and clothes, although little of it is used these days. She did cook because she liked cooking but she never did much cleaning - he did that at weekends. He couldn't get a cleaner to come in - she wouldn't allow that.
Hypognosis, //She's trying to escape something, is my best guess.//
I think you're right. I think she's trying to escape herself. There is much in her past that I think she is ashamed of - neglecting her ailing mother whilst giving everyone around her the impression that she was dutifully - if grudgingly - doing everything for her. She never stopped complaining about her mum needing help - help that she pretended she was giving, but wasn't. Her parents told me that their daughter didn't care about them, and that they relied upon her husband, or us, when they needed shopping, transport, etc. Additionally, failing consistently to support those close to her - even her husband and children - at distressing times in their lives. She didn't arrive at her mother in law's funeral! I think she is in denial - which is why everything is always someone else's fault. She blames her alcoholism on her parents, insisting that they too were alcoholics. They weren't - far from it - but she's convinced herself they were so has given herself a reason to continue hugging the bottle. I kind of think that she thinks if she has as little contact with people as possible, nothing will be asked or expected of her, and she's achieved that. None of us ask or expect anything of her. It's not depression - but it is complex. I really think she's mentally ill and beyond help. It breaks my heart to think of her ending up in an institution, but unless she dies first, that outcome wouldn't surprise me in the least.
Woofgang, //it could be argued that there was some kind of a mental health issue but what it was or how to help, we never discovered.//
I guess we're in a similar situation.
Hypognosis, //She's trying to escape something, is my best guess.//
I think you're right. I think she's trying to escape herself. There is much in her past that I think she is ashamed of - neglecting her ailing mother whilst giving everyone around her the impression that she was dutifully - if grudgingly - doing everything for her. She never stopped complaining about her mum needing help - help that she pretended she was giving, but wasn't. Her parents told me that their daughter didn't care about them, and that they relied upon her husband, or us, when they needed shopping, transport, etc. Additionally, failing consistently to support those close to her - even her husband and children - at distressing times in their lives. She didn't arrive at her mother in law's funeral! I think she is in denial - which is why everything is always someone else's fault. She blames her alcoholism on her parents, insisting that they too were alcoholics. They weren't - far from it - but she's convinced herself they were so has given herself a reason to continue hugging the bottle. I kind of think that she thinks if she has as little contact with people as possible, nothing will be asked or expected of her, and she's achieved that. None of us ask or expect anything of her. It's not depression - but it is complex. I really think she's mentally ill and beyond help. It breaks my heart to think of her ending up in an institution, but unless she dies first, that outcome wouldn't surprise me in the least.
Woofgang, //it could be argued that there was some kind of a mental health issue but what it was or how to help, we never discovered.//
I guess we're in a similar situation.
Woof...I didn't mean it to sound like that. If you have an underlying problem the internet and alcohol makes it easier to indulge in the hermit lifestyle. Years ago boredom would encourage people to do stuff but now you can speak to people all over the world from the comfort of your sofa 24 hours a day.
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