A wife on what it's like to live with an alcoholic

by North & South / 15 September, 2018
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What's your poison?

A wife on the long, slow, heartbreaking damage a partner’s daily drink or two, or four, can do… 

I don’t know how many steps it was from our TV room to the fridge in the garage, but some sounds can travel quite a long hallway. And I heard it so often – that tiny, gritty sound of a metal cap coming off a wine bottle.

I once met a woman who had written a book about how she left her alcoholic husband after years of waiting and hoping he would change. Back then, I was in the early days of wrestling with the same situation. The blurb on the back of her book said, “To me the sound of a metal bottle cap unscrewing against a glass bottle is the worst sound in the world. To my husband it is heaven.”

As author Cherry Parker talked about heart-sinking moments of discovering hidden supplies and her despair over failing to diminish his longing for a drink… all the time I was thinking, “Me too, me too. This is me, too.”

Some people living with alcoholics have a truly terrible time. For them, booze can bring anger and violence. Angry scenes can lead to rage, punches, bruises and bloodshed and – at the lesser end of the scale – door-slamming, shouting and nights spent on the sofa. When stories about the downsides of drink hit the headlines, it’s the noisy, horrific effects we see. And yet, the quiet, constant consumption of copious amounts of “sav” and “beersies” in our homes and at everyday family parties is also doing deep damage in our society. 

It’s done damage in my house. Maybe it’s happening in yours and you just don’t know it yet. 

My husband John used to be one of the legions of quiet drinkers out there who go unnoticed. There’s never any news about people like him; it’s only the loud, angry ones who get the headlines. John wasn’t vomiting in the street or hitting anyone. He never went out boozing alone or with rowdy mates. There was no need, as he had plenty at home. Courier vans were always dropping off another carton of wine at the door.

He was what is called a high-functioning alcoholic. He succeeded for years in a very demanding job involving lots of travel, where drinking in hotel bars after work was just what everyone did. When at home, he’d have a Scotch (or three) before dinner. Then wine with dinner. And a late-night one or two as well. And because he’d start pouring at 5pm or so, I’d have a few, too. But there was a difference. I could stop. His cut-off switch slowly became unreliable and then failed to exist at all.

And so my worrying began. I began cutting tiny nicks on wine bottle labels so I could check by how much the level was sinking when I wasn’t looking. I began to find stray bottles and half-full glasses in odd, secret places. I harped on about how we needed to have more AFDs (alcohol-free days) or should drink only at weekends. Funny how weekends could start on Thursday nights and run through to Mondays.

For years, I tried talking to him about counselling and he did once go and stay at a retreat centre. After a week of fasting and talking and being talked to and having massages, he came home very sober. But only for a while.

He wasn’t oblivious to his problem and knew he needed to slow down. Eventually, after years of my nagging, he swore off his beloved Scotch. But that just opened the door for yet more wine. Then there was a time I became aware he was slipping vodka into his breakfast orange juice. That wasn’t good.

There was a time when I knew I no longer wanted to travel with him because he wasn’t interested in seeing things or going places, just in where the nearest wine shop was. That wasn’t good.

There was a time when, on a family weekend away, one of our grown kids saw him standing in the kitchen of our rental apartment at 10am, swigging sauvignon blanc straight from the bottle. That wasn’t good.

But mostly he seemed all right, stayed upright and contained. We’d have lunch with friends and go to family parties. With a glass in his hand, he was okay. I’d always drive home.

The thing is, he remained polite, made no fuss. A shy man, he was often anxious but hid it well. We had quiet arguments as opposed to raging rows. There were lots of fun times. But even early in our marriage, going to a party meant he first had to bolster his confidence with a drink or two before we left home. Then the parties were, of course, booze-fuelled.

Many people drank too much then. Many drink too much now.

And many people’s marriages do not survive the stress it brings. Perhaps I should have left, walked away and carved a free, new path for me. But despite the shame and worry, I never did. I’m a stoic and hopeful sort of person. And I still cared for him. Instead, I coaxed and threatened and fumed and argued and sometimes cried. Withdrawal became my refuge.

We already lived pretty separate lives because his job took him away so much. I had my own busy life. I mixed with friends he didn’t really want to meet and had interests he knew little about, and so I took the route of simply doing my own thing and hoping he would eventually come right.

All his working life he had regular check-ups. Sometimes, after blood tests, his doctors would mention his “fatty liver” and tell him to “ease up” on the alcohol. As is well known, the liver is famously good at coming right if you treat it well. And he would, for a few days. But as far as I knew, no one ever told him he might be heading for cirrhosis, which is irreversible. But then, he probably never told the docs how much he was drinking.

After he retired, John had time to drink more. His physical shape gradually changed as he developed a ruddy face and a pot belly. Have you noticed how many older blokes begin to look like that?

Then last year, he began to look really ill. His energy flagged. He was sleeping every afternoon and developed swollen ankles. He had so much fluid on board that one of his legs began to leak. While his stomach was bloated, the rest of him was getting thinner. He ate almost nothing. His skin was yellowish-grey. His mental state was slow and dull. Once, out in the car (with me driving, as usual), we passed a police car ablaze with flashing lights and he hazily asked, “What is that?”

Even then, he was telling me that he needed his wine because it “settled his stomach”.

He made an appointment with his GP. And this time, I went too. It triggered the start of much medical testing to check out heart, lungs, everything. The results all pinpointed the liver. Now he can’t drink again. Ever.

Cirrhosis makes the liver go hard and shrunken. It’s caused by scarring that leads to reduced blood flow. The liver’s like a big red sponge and if the blood can’t filter through it as usual, then the rest of our systems go downhill.

Livers do a lot for us. Among other things, they store fat, sugar, vitamins and minerals as reserve energy sources, detoxify chemicals, metabolise drugs, secrete bile, make blood-clotting proteins and regulate the amount of blood in the body.

As this crisis came upon us, I realised I knew next to nothing about the liver – and couldn’t find much online about cirrhosis.

I went to see John’s specialist gastroenterologist, Dr Ali Jafer, to find out more. Jafer sees many patients whose alcohol abuse has brought on cirrhosis. But there are no simple explanations as to why some people can drink for years without apparent liver damage while others go downhill, because alcohol’s effects differ so much from person to person.

“It has to do with the bulk and size of the liver, the amount we drink, its concentration, and the pattern of how we drink it – whether in slow and gradual amounts or in weekend binges,” he says. “All those are quite variable factors.

“Then there are possible other insults to the liver. Do you have a fatty liver as well? Do you have hepatitis B or C? Hepatitis B is quite prevalent in Southeast Asian and Polynesian people, so there are other factors involved. Really, to try to calculate the burden of alcohol on the liver specifically and the body generally, based on the amount we consume, is false. We are never going to achieve it.”

Warning patients about their alcohol intake can be difficult. “I have to be diplomatic in how I tell people to stop drinking. People get offended and may not believe me when I say that alcohol might be their problem. Quite a few of them don’t come back. They can see it as a blasphemy for me to say it, because they may not be drinking a lot – but in reality how much is a lot and how much is a little? That’s the most important question. We don’t know the amount that will poison you because there are no good studies.”

Ministry of Health guidelines recommend no more than 15 standard drinks a week for men, and 10 for women. “But where did that come from?” says Jafer. “Who did the studies? And in which population?”

We don’t think of India as a drinking nation, says Jafer, but it’s the largest producer of whisky in the world. “It all gets consumed locally. Billions and billions of litres. So how many alcoholics are there in India? I bet you no one knows.”

A Baghdad-born specialist who’s been working in New Zealand since 1994, Jafer has a keen eye for alcohol’s global effects. Mention Muslim prohibitions and he laughs. “Iraqis drink arak [an anise-flavoured spirit]. It’s embedded in our psyche. The ancient Egyptians had beer. Alcohol consumption probably started when civilisation began.”

And it’s not just humans who like it. As a little boy, Jafer used to watch how nightingales would peck at ripe figs to inject a little saliva, and then return a few days later when the juice had fermented to “drink, get pissed and start singing”. 

My John had been drinking for decades before his cirrhosis became obvious. The trouble is, early on it’s largely undetectable. That’s a shame because our livers are so essential. Those big, red, glossy organs, vital for our immune systems and metabolic functions, are tucked under the right side of the rib cage, extending from about the fifth rib down to the lower edge.

As you read this, about 13% of your blood is filtering through your liver while it screens, sorts, stores and works in many ways to keep your system in good nick. If scarring makes it go sclerotic (or hard) it seriously messes with the good functioning of your body. 

We might take more care if we could see what a bad liver looks like, says Jafer. “A healthy liver feels smooth and soft. A sclerotic one feels quite firm, almost like an over-cooked piece of eye fillet.”

Once cirrhosis takes hold, the liver becomes studded with nodules and its usual maroon colour turns a light yellowish brown. But because we’re blithely unaware, it’s out of sight, out of mind.

“People can look normal, feel normal, blood-test normal and have ultrasounds and CT scans that look normal and still have cirrhosis,” says Jafer. “They might go to their GP and say, ‘I drink too much, can you check me out?’ But a blood test isn’t going to be enough. To tell someone who’s been having four drinks a day for 20 years that their blood test is normal and there’s nothing happening, is wrong. There’s always something happening. The problem is you cannot see it.”

A biopsy can reveal the truth, but they’re not done early in a drinker’s life. “It’s very invasive, very uncomfortable; you’re stabbing someone in the liver. At a routine check-up, we don’t say, ‘Well, you’ve been drinking for five years now so we’ll do a liver biopsy just in case.’”

It’s only in advanced stages that telltale symptoms show up. They may include fatigue, jaundice, loss of appetite, shortness of breath, confusion, itching and a certain body shape – a swollen abdomen accompanied by skinny arms and legs. 

Jafer would love to be able to design a study where people of different sizes, genders and backgrounds were recruited to drink the same amount of alcohol each week and undergo a biopsy every five years to see what would happen. But it won’t happen.

“No ethical committee in their right mind would approve a study like that. There are certain questions we will never have the answers to, simply because we cannot experiment that way.”

It’s hard to establish how many New Zealand deaths a year are caused by liver disease related to alcohol. According to alcohol.org.nz, between 600 and 800 people die annually from causes related to booze, though that includes fatal injuries, falls, drownings, vehicle crashes and fires. But there are many other downsides to too much drinking. Few of us know how alcohol is implicated in various cancers and how it can affect heart, nerves, brain, spinal cord and pancreas.

John’s condition has stabilised, but having cirrhosis is no fun. In his 70s now, it’s too late for a transplant. So he must put up with it. All those years of “having a quiet drink” have damaged his liver so badly that even a small amount of alcohol would now be lethal.

He’s not had a drop in a year, ever since Jafer told him this: “You must now regard a glass of wine as a glass of cyanide. You can never have a drink again.” So, there is none in our house. I was told I must not drink around him either, because even the smell of it might tempt him to take a sip or two. Our fridge now contains only juice, milk, water and soda. He still misses his wine but is staying staunch and managing (just) to get through family occasions and Christmas without a sip of anything lethal.

When he got the bad news, he stopped cold turkey, just like he’d done years before when he gave up cigarettes. “I always thought I’d stop drinking that way too,” he told me recently. “I just didn’t do it early enough.” 

One day, I stood in the laundry and poured the last of our supplies down the sink. We had a cupboard full of leftovers. And out it went, glug, glug. Gin, vodka, brandy, and ancient bottles of various liqueurs. No more Bailey’s or Kahlua. Bye-bye Limoncello. There was a great crash of glass hitting the bottom of the recycle bin.

As I did that, I wondered about how much alcohol might have affected my own health. I was hit with breast cancer a few years ago, and research says my own liking for wine might have helped cause that as well.

John is far from his old self. He has only about 10% of normal liver function. He feels cold even when it’s hot, sleeps a lot, has little energy, gets breathless with even slight exertion and does little but nap, read, potter in the house and watch the news on TV. He is indifferent to social life, rarely goes out. There is little joy within our four walls. That’s odd when you think how drinks are marketed as a natural part of having good times. We see drinking as an upper, not a downer. As Jafer says, we rarely stop to measure how it wrecks so many lives: “The effects on work and income and society are immeasurable.”

So here we are, awash in an ocean of booze. There are few barbecues without wine, weddings without bubbles, car-race finishes without sprays of Champagne, or roofs raised without the builders getting stuck into a beer.

Why the complacency? “Drinkers like it,” says Jafer. “They think they benefit from it. They say it’s not like smoking because there are no secondary drinkers, but in fact there are. Families get affected, people get ruined, businesses get lost because of alcohol. It is a drug. You’d think seeing we’ve used it for 6000 years, we’d know more about why people get addicted. But actually we don’t.”

After all this, you might think I’m right off wine now, but I have an occasional glass when out with friends. Jafer does too, though he’s careful not to exceed two glasses over dinner. 

Abolishing alcohol is never going to happen, he says. “To be honest, we don’t need to. It’s an enjoyable drink in small quantities and we are social animals, but the thing we really all have to be blamed for is that we’ve never studied it well. We have no idea what it’s doing to society overall and that’s what we need to work on.”

As someone affected by “secondary drinking”, I try not to dwell on how much I’m to blame for the state John got into. How complicit was I? I’ve beaten myself up for years over concepts like “enabling” and “co-dependence”. Should I have yelled more, begged more, raged more? If I had, would it have helped?

The other big downer about too much alcohol is how it takes an emotional toll on everyone around the drinker. I’m still feeling a churn of relief, sadness and guilt. I’m relieved because at least I no longer have to worry about John’s drinking, sad his life has come to this, and guilty over somehow not managing to fix things.

But then I think back to an Al-Anon meeting I once went to, where someone looked at me with kind eyes and offered good advice. (Al-Anon is a group that supports the families of alcoholics.) She said I needed to be aware of the Three Cs – which means realising you didn’t – Cause your loved one’s addiction, can’t Change it and can’t Cure it.

We can do as much as we can for friends and family who might be at risk. But the most important thing, for all of us, is to take care of our livers – and ourselves. 

How are we being harmed?

A 2015 New Zealand Medical Journal article estimated that 802 deaths of people up to 80 years of age were attributable to alcohol in 2007. Because our drinking patterns haven’t changed, the ongoing annual toll is likely to be similar.

“Forty per cent of that is caused by injury, both intentional and unintentional, including a substantial number of suicides,” says the article’s lead author, Jennie Connor, professor of epidemiology at Otago University. The other 60% (generally later in life) involves chronic conditions such as cancers, digestive and respiratory disorders and cardiovascular disease – “and that’s a huge burden on everyone”.

Connor says the New Zealand guideline for safe drinking is no more than an average of 15 drinks a week for men and 10 for women. “But those are small, hotel-sized drinks. In reality, two standard drinks for women equate to one big glass.”

And on any one day, a man shouldn’t have more than five drinks – a woman no more than four.

Convincing us that we should curb consumption is no easy task for researchers, especially as some statistics don’t look too alarming. “Australia has a similar drinking guideline and it estimated that your chance of dying of drink over a lifetime – if you drink at the guideline level – would be 1%.

“Of course, people say, well that’s not much. But it’s quite high risk for a commodity that’s being sold to us.”

Connor says it’s well accepted across society that having a little alcohol is harmless and even beneficial. “But the evidence for that is in fact weak.”

Women at special risk

While it’s usually men who suffer from too much drinking long-term, women need to be careful too. “Small females can be affected much faster than larger-framed males,” says Auckland-based specialist gastroenterologist Dr Ali Jafer, who is appalled by how the rise of sweet, intoxicating RTDs (ready-to-drink beverages) has made drinking easier and more appealing to teenagers.

“They’ve been an absolute disaster. It has normalised alcohol for young people. People jump up and down about synthetic marijuana, but RTDs are no different. I’ve never tasted one in my life, but I know how much kids are drinking them because you see them in the emergency department.”

Jafer has also seen people in their 40s receive liver transplants because their own has been wrecked by alcohol. “I’ve looked after women with cirrhosis in their mid-30s – but remember, it depends on how much you’ve had and how early you started. If a girl starts drinking at 15, then 10 years might be enough to cause permanent liver damage.”      

The book referenced in this story, Living with an Alcoholic Husband: A true account of living with and without a husband addicted to alcohol, by Cherry Parker, is available as a paperback and Kindle edition on Amazon.

This article was first published in the September 2018 issue of North & South.

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