I need to tell the whole story: Alcohol, depression and hidden truths

Hester Wilson

27/12/2018 11:03:50 AM

Dr Hester Wilson reflects on the mental health issues that often accompany problems with alcohol, and how people can hide them.

Secrets nearly killed one of Dr Hester Wilson’s patients.
Secrets nearly killed one of Dr Hester Wilson’s patients.

When David* walked into my surgery six months ago, he sat down and didn’t say anything for several long moments. It felt like the room was suddenly quieter and I sensed something important was about to happen.  
Then it did happen.
‘Doc, I need to tell you the whole story,’ David said. He started crying. ‘I haven’t told you the truth, I’m so sorry, I’m so ashamed.’
I’ve seen David occasionally in the past for routine business – coughs, colds, his kids’ illnesses. But, a couple of months earlier, he’d come to see me at the urging of his wife.
When I asked him what was happening, David said that he was fine and had only come to get his wife off his back. He did admit that he felt he needed a bit of a ‘tonic’, something to pick him up, as he was often stressed and tired.

It was a challenge to find out exactly what he meant.
David is a proud 40-year-old man. It was hard for him to talk openly about what was happening, but he did agree to tests – blood, liver function, blood pressure and a physical exam – which were all normal.
I wondered if something else was at play, but he reported low scores on the Depression, Anxiety and Stress Scale (DASS). He was a non-smoker and reported drinking small quantities of alcohol on occasion.
David left and I watched him go, wondering.
Not long afterwards, I saw his wife, and the story she told was somewhat different. David wasn’t sleeping, he was often irritable, he drank daily. She was very worried about him.
‘I love him dearly,’ she said. ‘I know he’s really struggling. He’s just down all the time.’
She then explained that David’s father was an alcoholic and had committed suicide at 40. David’s age.
As GPs, it’s not uncommon for us to come to know our patients through different sources of truth; it’s a skill we develop, learning and holding this conflicting information until the right time while supporting families with members who are unwell and not able to seek help themselves.

When I saw David in tears six months ago I felt a strong surge of compassion. As he started to tell me a truth he found terrible and shameful – that he simply wasn’t coping – I listened. Then I thanked him for sharing his story.
‘This is really important that you’ve spoken,’ I said. ‘I understand this is very hard for you and I’m here to help. It’s okay to tell me anything. But I can tell you that what you’re feeling will get better with help.’

David talked and wept and talked and wept. The truth unspooled from him.
He wasn’t just a social drinker. It was two bottles of wine a day, every day. He’d been feeling very depressed. Fleeting thoughts of suicide kept returning. The thoughts troubled him greatly – especially given his father’s experience. It had been going on for months and months. He has tried his best to hide it, to keep the show going. But no longer.
This time, David’s DASS showed high levels of stress, anxiety and depression. This time, a deeper truth was revealed.

I saw David often following that hard, important consultation, sometimes alone and sometimes with his wife. The changes came fast after that.
David started undertaking an alcohol detoxification program and went to the pharmacy for diazepam to help his withdrawal. He started seeing a counsellor. And he stopped drinking completely.
We talked about medication for his low mood, but agreed to put that on hold while he changed his drinking.
Without the alcohol, his mood slowly improved.
When I saw David most recently, he told me he felt he was managing better.
Then he told me he missed his father.
‘He was a troubled man, but I miss him,’ he said. ‘It’s hard to explain, but it felt like I had become him and that really scared me. He was so unwell, and I realise that the terrible place I found myself in was where he lived all the time.’
David shook his head.
‘He didn’t get help,’ he said. ‘I can’t help but think how different things would have been if he had. I felt so caught and the alcohol I used to relieve the pain just kept me there in that place.
‘I can really understand how people don’t seek help. I’m horrified that killing myself seemed like a reasonable option. But the shame of the situation felt so debilitating and so hopeless.’
David’s secret truth is a common one. Shame and helplessness are emotions I see often in people with issues related to alcohol.
It would be easy for the unkind to label David a liar, a patient who is resistant to treatment. But that would be to totally miss the levels of denial that he built to try and protect himself from emotional pain.
But, sadly, doing this didn’t protect David from his grief. Alcohol gave temporary relief, but seriously worsened his depression and even endangered his life.
Now that David has quit alcohol, sought counselling and, crucially, dared to share the secret that was killing him, he has improved. It is as if a large stone has been lifted from him, and his wife has her husband back.
David’s case is one of those I cherish. It is a gift to be part of the journeys and struggles of our patients and their families as we see them over the years. And it is a privilege to be able to help.
* Not his real name.

alcohol alcohol misuse depression and anxiety

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Dr Marie Hong Shieh   20/11/2018 6:52:52 AM

Thank you! Beautifully written and told and so true. Reminds me to keep hope and keep asking and listening and keep caring.

Dr A Sultan   6/01/2019 11:28:26 AM

Many thanks for your great and helpful article above. I face this challenge regularly in my rural practice. We both agree that detox and stop drinking after such a "confession" is the key to any any real recovery from alcoholism.
I got a burning question to ask, however. In your experience, what options available and how effective are they to stay well and not relapsing for such cases? I'm talking about a long period of abstinence without struggle or calm recovery and ease of life.

Dr Jane Louise Tierney   5/03/2019 1:02:22 PM

Something I have certainly encountered as a GP. Do you find that benzodiazepines are very oftn required to aid withdrawal symptoms?

Hester Wilson   8/03/2019 9:51:23 AM

Thanks Jane. Diazepam has a specific role in pts at risk of complications ie seizures, DTs. In this case, better in a supervised environment - medical input or detox facility
Pts at low risk of complicated withdrawal can manage in GP or outpatient setting. Sometimes it’s better to consider inpt option for people at low risk for detox but maybe unsuccessful trying at home
Gen outpt option in GP setting is 5-7 days. Daily staged supply thru pharmacy – 21 tabs – fax script & talk to pharmacist before
At most
day 1;10mg diazepam QID
day 2; 10mg diazepam TDS
day3; 10mg diazepam BD
day 4; 5mg diazepam BD
day5; 5mg diazepam nocte
I often use less. Some with lower dependence get very anxious and lower doses can work for them. I’ll suggest people see how they go and may not need to take full dose, and let pharmacy know so less is dispensed
Don't use more than 7 days, don’t give script to take away, don’t consider if person not in position to stop drinking. Start anti-craving agents day 3