Rrecovery is an interesting term in mental health. The idealized version for people with mental illness is to quickly return to their “normal” level of functioning shortly after starting treatment with their general practitioner, psychologist, or psychiatrist. Unfortunately, payback isn’t always clear cut, and people are often unsure what they’ll lose along the way.
Peter is a client 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, nine-year-old Maya and seven-year-old James. Peter had been referred to my clinic by his GP for help with his alcohol and cocaine use, and his bad mood. This had caused significant marital problems and a recent police charge of driving under the influence and the loss of his license for three months.
Despite drinking heavily for the past seven years, Peter showed up for treatment because his employer told him to fix his drinking problem or he would lose his job. Like many men I see at the clinic, Peter had been referred several times before, but only at the risk of losing his job did he keep his appointment.
Peter begins by saying, “I don’t think it’s that bad. It’s just the job and the wife that seem concerned about my drinking.” I guess Peter is downplaying his problems to make himself look better than he really is. I do not directly challenge him, but choose to continue the session. I have been taught that building rapport is one of the most important parts of the first session. You can’t treat people if they don’t come back.
During the assessment, Peter tells me that he is drinking two bottles of wine a night and attributes this to financial stressors, arguments with his wife, and difficulty connecting with his children. His drinking only became a problem after the birth of his child. At the time, Amara was a stay-at-home mom and he was working overtime to make ends meet. Drinking was the starting point for several arguments with his wife, which led to Peter going out with his friends more, which turned into weekly cocaine binge.
Peter is now sleeping in the living room and is vague about the reasons for this. I ask her if Amara is thinking about splitting up and she denies it saying, “I don’t think so. We have been married too long. I make a mental note to consider a family meeting at a later stage of treatment. He admits that the distance between his children and himself makes him sad and constantly apologizes for being hungover or forgetting sports activities.
At the end of the evaluation, I recommend a hospital detox as a circuit breaker and the opportunity to start craving treatment for his alcohol dependence. Peter is initially hesitant, but then agrees when I advise him that his employer would look favorably on this course of action, and allows his wife and children to meet him sober. He comes in the next week and his withdrawals are managed with some diazepam and thiamin. Peter agrees to take naltrexone (anti-craving medication) to help him stay sober. To my relief, Peter is aiming to abstain from alcohol altogether in the coming months, as he finds controlled drinking too risky for him.
This detoxification causes some concern when neither his wife nor his children nor his friends visit him during his hospital stay. Sadly, this isn’t uncommon, but for a man going through his first cleanse, there tends to be more fanfare. Peter gives them excuses which they then question when his wife emails me saying she has a restraining order against her. He also alludes to domestic violence. Ultimately, Amara says that Peter cannot return to the family home and will instead live with his parents. When this information is presented to Peter, he tells me that he already knew about it, but that he hoped this detox would put him back in good hands with Amara.
In the last week of his detox, I notice that Peter has some signs of depression and I recommend antidepressants to him, which he refuses saying, “I think that’s too many pills.” We discuss therapy to help him stay sober and interpersonal problems involving his wife and children. Peter worries that therapy will make his symptoms worse, since it involves reliving old wounds. He agrees to weekly group therapy as a commitment and other outpatient appointments when he is discharged into the care of his parents.
Detoxification is the first step on a difficult journey to recovery. The next few months are difficult for Peter. While he participates in weekly group therapy, he relapses through both the restraining order and divorce court proceedings. On his third detox admission, Peter decides to try mirtazapine to help with sleep deprivation, fleeting suicidal thoughts, and moodiness. Fortunately, he has been 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 upon discharge.
The following months are more positive. Peter is able to stay sober longer and this helps at work and at home. He gets a promotion at work and moves into a small apartment with a spare room for his children to visit. Eventually the restraining order is lifted and he is able to have a healthier relationship with his ex-wife. Two years have passed and Amara has found a new partner which causes Peter some discomfort, especially when his children comment on how well he treats them. Peter has been less successful romantically and finds dating apps constantly frustrating.
I recently saw Peter, who has been sober for a year and his depressive symptoms are stable on medication. We talk about the challenges he has overcome on his road to recovery. Peter tells me how lonely he feels and explains that a good number of his friends were his ex-wife’s and that he has been struggling to build his own support groups. He has parents, children, and a good job, but he hasn’t made any friends over the years. We make some plans to work on 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 general rule of thumb is that the sooner you enter some type of treatment, the better the results. With Peter’s case, we’ve seen substance abuse, detoxification, depression, divorce, and relapse. But I hope people know that while recovery may be long and bumpy, it’s still a worthwhile pursuit.
Dr. Xavier Mulenga is a Sydney-based addiction psychiatrist.
The patient examples are not real people and are amalgamations of situations often seen by psychiatrists.
