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Sunday, May 19, 2013
Addiction and Substance Abuse
How will hubby`s alcoholism affect his health
My husband is a 54 yo alcoholic. He got sober in 1989 and remained sober till 2001. Since then, his alcoholism has progressed steadily to where I feel he is end stage alcoholic. In any event, three years ago he was diagnosed with alcoholic liver disease by biopsy, had severe microvesicular and macrovesicular steatosis, and some pericelluar fibrosis. He continues to drink between 18 and 30 beers per day. Last year, he was hospitalized due to alcohol induced rhabdomyolysis, but it did not progress to kidney failure. He went to rehab and remained sober for almost 4 months, before relapsing for two straight months (drinking sunup to sundown every single day). He again went to rehab, and remained sober for almost 4 months again. During that time, he was diagnosed with diabetes. He has since relapsed again, two straight months of at least 18 beers per day, maybe one meal a day and no hydration other than beer (no water, nothing). He takes glipizide for his diabetes almost every day, even though he is drunk. He also was diagnosed last April with mild concentric left ventricular hypertrophy. Two months ago he had a ct scan of his liver, which still only showed the fatty infiltration, but no fibrosis. Dr. said his liver has improved (which I don`t get since he continues to drink). I am hoping you can just let me know what I can expect if he continues on with this steady drinking in light of his health issues, ie., how does his alcoholism/alcohol consumption affect his left ventricular hypertrophy, how does it affect his diabetes, etc.? Thank you in advance for answering my question.
Thank you for your thoughtful and thorough letter. It certainly sounds as if there has been a lot of heartache over the years from the alcoholism ... but also some successful remissions. As many people say in meetings, "where there is life there is hope", even though it can seem not to be the case when you are immersed in the relapses.
Regarding the medical issues that you ask about, they can all clearly be resultant from alcoholism, can all be worsened by alcoholism, and can be fatal (the liver disease, left ventricular hypertorphy, type 2 diabetes). However, it is almost impossible to predict a time course. Some patients progress quite quickly with worsening liver function and some progress quite slowly. There is some evidence that those who progress quickly are those with strong family histories for not only alcoholism but also for alcoholic liver cirrhosis. Your description of the CT scan indicating "less damage" than before is a common one ... the CT scan is a VERY insensitive and non-specific measure of liver disease compared with a liver biopsy. Suffice it to say that remissions are the only way to address any of the damage, although vitamin therapy and better nutrition during a relapse may slow damage a bit.
I constantly try to re-enforce to patients that the physical body tends to be the last thing "to go", and that they absorb physical damage 10-20 years after they have been routinely absorbing and causing damage in their self respect, self image, close love reationships, social relationships, etc. I also try to always follow this information with the statement that they CAN do better if they commit to making change now and pursuing sobriety at least for today. Hope this helps.
Ted Parran, MD
Associate Professor of General Medical Sciences
School of Medicine
Case Western Reserve University