Many of you have heard my dilemma with dh who has been abusing alcohol for a while and then becomes angry and aggressive with me. I doubled his Celexa about 1 month ago and, in general, this has helped with most of his aggressive behaviors except when the alcohol is involved. He is still drinking wayyyy too much (not every night, but most) - he drank 6 glasses of wine tonight and is currently out on the couch. I have learned not to challenge him on his drinking to avoid the rages, but, I have to really use a lot of self control to "let it go" when he's sucked down so much wine. So, to my question:
Should I go back to his doctor now and ask him to add an anti-psychotic meds now AND have him explain very candidly with dh how alcohol and his drugs DO NOT MIX WELL and could be dangerous? DH is also obsessing about his lost guns again. These doctors are so reluctant to level with the AD patient and so when we the spouse tries to tell them they shouldn't do something because... they think we are lying.
I'd greatly appreciate your views on this issue as it is becoming so burdensome and I worry about his behavior escalating.
I found that my husband would pay attention to the doctor when he wouldn't listen to me. Even if you have to write a note to the doctor beforehand telling him of your concerns, at least you've put the onus on the doctor, and if nothing else, you will know that you have done everything you can. Some have written on this site that they have the nurse give the note to the doctor to read before he comes in to see the patient.
mothert--from what you have described, the Celexa (even at double dose) isn't doing the trick. Seroquel is from a different drug family and may really help a lot. So I don't see the downside to asking the doctor for a more effective drug combination (well, maybe added expense is a negative, but surely would be worth it if it works). My hb was put on Celexa at dx and his neuro added an antipsychotic shortly after that. It has been 6 years taking both simultaneously. And yes, there were some side effects of the anti psychotics (initial weight gain, but then lost it) from Seroquel. He is now on Zyprexa and Amantadine and they really help. BTW, I just heard yesterday that the anti psychotics cause the pacing behavior--don't know if that's true, but if so, even then it's worth it.
Thanks, MarilynMD, for your insight. He seems to be manageable, but the cost is I have to walk on eggshells all the time and watch him drink lots of alcohol. I'm sure that is not good for his AD. I watch his cognitive abilities disappear very quickly after he begins drinking each day and he will ask me the same question over and over again within minutes of the last; I find it takes all of my self control to not get angry with him which will escalate things into something pretty ugly. I want to remove all the alcohol from the house, but I want the doctor to make it clear to him that this is what has to be done and to put it in writing so that I have something to show him each time he gets agitated that his wine bottle is no longer there. If I do this on my own, I'd better just leave town for a while because he will have a nuclear meltdown. I know I'm being a wimp about this, but having experienced his rages before, I really don't want to have to experience another if I can avoid it.
Believe me, I understand you wanting to avoid rages. I know you want him to stop drinking, but it will take a while for any new drug to get into his system and make him more manageable. Consequently, I don't think from day 1, regardless what the doctor says or puts in writing, he will say "OK, I won't drink because of the new medication." What I would ask the doctor is--what are the consequences of him being on an anti psychotic drug first, and then slowly tapering off the drinking? These drugs can be effective but need time to get there. I believe that's why, in a previous post, I asked if he could be put somewhere to detox. I'm no expert on alcohol, but it seems there might be a physical dependence on it as well as a psychological one. An addiction, if you will. Reminds me a little of Carosi's efforts to stop her husband from smoking--addiction and dementia are a difficult mix.
mothert, I strongly agree with Marilyn, if your husband is a true alcoholic, removing the alcohol from the from the house will only make him more combative. I believe that detox needs to come first. He may not even remember (long term) what the doctor advises. The upside to detox is that most inpatient hospitals can address the behaviors along with the alcoholism. Then he can come home to an alcohol free home, on the proper meds. Arms around, Susan*
My story does not deal with alcohol, but has to do with written orders from a dr and spouses reaction to same. Remember we are dealing with broken reason buttons, brains that no longer absorb info or process same. I thought I was so clever getting a script from dr re no driving. What a joke. DH didn't care who wrote what! He was going to drive! Don't count on a note from the dr making anything better. Wont happen.
Mothert- if nothing else works, tell him that I am an experienced alzheimer caregiver, and it is the caregiver that should be drinking the wine,,,not the patient... My motto is "If you can't beat them, join them..Perhaps after he sees you drunk, he will soon notice that no one is caring for him.... (can I blame caregiver demential for this stupid solution??)
I have now changed my apprpoach regarding DH's smoking and the related deterioration. Originally the probl;em was presented to me as a medical issueand I tried every way possible to dealwith helping him quit; limiting his supply. Upping meds to deal withy thge added agitation and flashes of anger when he was limited--or out. When it finally got to the point wherewe could notspend anymore on them, he'd get some in other ways. Friends, acquaintnces,and strangers give them; he sold somethings; took money from my purse. He started leaving the house to get them fom neighbors. I couldn't stop any of it and was making myself crazy trying. Finally, I realized my approach was wrong. This is nolonger a medical issue--it is a BEHAVIORAL problem--and I started treating it as such. WE spend nothing on smokes. He gets them--right now a sister is supplying him. I don't touc h them, don't ration, don't call when he's out. When he has a TIA I verify that he isn't hurt; encourage a sholrt rest and then encourageim to try to get up, even coach a bit. If he can't get up on his own, I call for help to get him up. I have now begun to treat the related bad behaviors the same way. His neuro-psych Dr. has stated that he is a danger to himself, but until something serious enough to land him in the hospital long enough, I can't get him Placed--only by waiting list without a medical crisis.
The bottom line for me is that I can Care foir him and do everything to provide for him, but I cannot Control him. Once I redirected my efforts to what I can do I've found my role much easier. We do the best we can.
I really don't think my dh is a bona fide alcoholic, I think it is more like Carol describes - a behavioral thing AND he truly forgets how many glasses he has had. Some nights he totally moderates himself, as he did tonight, and only has 2 glasses of wine; I'm not sure why, but some days he doesn't over indulge. I can only imagine how hurt he would be if I placed him in a detox place; he wouldn't understand at all.
Tomorrow I will email his doctor and ask for an appointment for me alone to discuss this situation with him. I'm sure if we put him on Seroquel or another like it, the drinking will have to be stopped entirely and if he gets too out of control, then I will have to take stronger measures. Whenever he's given me grief in the past about driving, I got out the letter from the doctor and that took the wind out of his sails, so I think it will probably work with this as well. We'll see how this works out before I do anything drastic.
Change of subject - tonight his best friend of 75 years called and asked him to go on a 2 week cruise with him in January. Oh, Lord, if only he could do that I would be dancing on tables. I could tell the thought of going somewhere without me totally scarred him. His friend is also a caregiver to his wife and I was surprised that he even asked Herb to go - I guess he doesn't really believe that his friend is as bad off as he is. He'd sure find out fast enough.
Speaking of the wine - I haven't been indulging at all with dh as it only encourages him to drink more. So, the other night I went to get a haircut and my hairdresser asks me if I want anything to drink. I ask if she has wine and she says yes and brings me a big, cold glass of chardonnay. I told her she had no idea how much that glass of wine meant to me. Life's little treasured moments. I really enjoyed that stolen moment with my coveted glass of wine.
MotherT, I had boxes of wine (cheapo) out in the pantry. I would fill a half-bottle carafe with about 2/3 wine and 1/3 water and put it in the fridge to chill. Later it became half and half. The deal was that when the carafe was empty that was the end of the wine. He became very comfortable with that.