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My sister is a desperate alcoholic in a medical family; help!

Dear Stanton:

My sister, aged 45 has liver disease. She is actually dying. Her drinking has been an ongoing problem for 15 years and has now become life threatening. She is covered with sores from unhealing bug bites, has a swollen stomach, and actually in malnourishsed.

Our family consists of our father (a psychiatrist), with a drinking problem that developed when he reached his 60's, 3 siblings with controlled alcoholic tendencies, 6 other physicians (immediate family), and 4 nurses (immediate family)! (Immediate meaning a sibling or spouse and there is a bunch of us educated Catholics!

My sister has been in treatment centers 4 times over the last 10 years and has always relapsed. She has three children, the last will leave for college next fall.

My question: When she has been treated in the past, she was NOT treated for depression which is an obvious problem. Nor was her shyness and boredom (as an intelligent person) addressed.

I recently heard of an antabuse implant used when the patient is in danger of dying and has the resourses. SHE has the resourses.

At this stage, her life is in danger and she actually needs detox before any steps can be taken.

We have tried many times before to help and all have given up but now it appears her demise is inevitable if dire step are not taken. (Her husband has been an enabler for all the 26 years of their marriage but now he has heart disease!

Please help me help her. Their insurance is tops and they have the resourses to do what is necessary to at least prolong her life.

We are desperate and our dad is unresponsive.

K.B.

Dear K.B.:

I can't solve your sister's problems from here. Indeed, I might not be able to solve them from there. But let me make some observations that perhaps can help you.

1. You say her depression, shyness, and boredom have not been treated. That's a lot of things to deal with. Indeed, I don't think even medicine has claimed to have a cure for boredom. But these are real problems that drive people to drink excessively—despondence, nothing to do, a fear of putting oneself forward. Perhaps your sister is intimidated by your exceptionally talented family, and feels there is little that she can do. You don't list the activities, interests, and enterprises in which your sister is involved. How does she spend her days? If the answer (as I suspect) is that she has little to do, and that she indicates no motivation to do anything, this is where to attack her problem.
2. You mention that her last child is leaving home. People often point to the empty-nest syndrome as a danger point in life. But, more often, it is a relief for people. Sometimes, teens are not the best company at home. When that stress is removed, and with the free time and freedom of mind to pursue new options, this can be a time for your sister to reorient her life.
3. It is good and important that you want to help your sister. You have asked about medical options for her, such as implanted antabuse. I know nothing about that. Can you implant something permanently in a person that makes them wretch as they approach a drink? I do think of Kitty Dukakis, who poured down nail polish remover and other toxic chemicals as she desperately tried to get drunk, substances that people ordinarily find repugnant to drink. Your family is remarkably involved in medicine. You sister has been treated (I assume at the best medical facilities) several times. My mind doesn't move in the direction of more and better treatments. If you and your sister can't reorient her existence, her ways of filling her time, her view of herself in her world, then I don't think more medical treatment is the answer—unless, of course (and this is rare) this is the purpose of the treatment, or a serious adjunct to it.
4. Your portray yourself at odds with your father and your brother-in-law in this question. This is, of course, strange, especially since your father is a physician. What did they think when your sister was in treatment the previous four times? In other words, do they also think, "Well, when things get bad, we'll send her to a hospital," even though medicine hasn't been able to treat what she's got. Perhaps this is the denial that needs to be dealt with—the need for the family to get out of its comfortable assumptions and to get involved in a real way, including admitting the problem and the pain. What about the children, including the youngest one leaving for college? Are they likewise as complacent about their mother's condition? I don't favor interventions—meaning groups ganging up on vulnerable individuals. But it it critical to get at least some of your family besides you unified in their sense that there's a problem, that change is immediately required, and that your sister needs "a life" with interests, involvement, satisfaction, opportunities for self-esteem, and time away from the bottle and the situations that encourage her to drink.
5. What is the difficulty in doing this in your family? That is the problem you must face, the object of your therapy, so to speak. There is a rule in therapy—help the one you're with. You have come to me for help, not your sister. Let me point out that you never actually ask me a question in your letter, even at the point where you write "My question:". Perhaps this means that you have very good insights about what you need to do, and therefore you don't have any questions. Perhaps it means that you haven't thought about the steps you should take (other than seeking a medical input) and therefore you haven't formulated a question. Perhaps you don't like to ask questions. Please think of five real questions, then try to answer them. My hopes and wishes are with you.

With best wishes,

Stanton