Central  South  Dakota  Medical News
The Clinical View
by Phillip Hoffsten,M.D.
07 April 2004

BUT WHAT CAN YOU DO?

     The lady had come to the clinic because of abdominal discomfort.  She described the pain as a dull aching sensation seeming to be over the entire abdomen.  If one pushed on one part of the lady’s abdomen or another there was no local tenderness.  She indicated that her bowel habit was normal and not a problem, that her urine passed without a problem and that there was no bleeding from any site.  She did not have any fever, her pain did not seem to be started or stopped by anything that she was aware of.  The pain seemed to come on in the evening lasting until bedtime and then gone when she woke up in the morning.  It didn’t seem to interfere with her sleep.  Basic blood tests were unremarkable.  Liver tests were normal.  She said that rather than get involved in more expensive and time-consuming examinations, she would rather try a medication to see if it would improve the problem.  A medication was provided and she checked back in about 2 weeks stating that the medication didn’t really seem to help very much.

     Further questioning and eventually some x-rays were simply not helpful in finding a disease to explain her abdominal pain.  Her dietary history was taken and inquiry was made about her use of alcoholic beverages.  She indicated that she didn’t drink at all but that her husband did.  Her voice and inflections at that point made it very clear that she didn’t approve of his drinking.  She volunteered that he drank at one of the local bars often coming home late, obviously influenced by his alcohol consumption.  He was not physically violent or abusive.  She did volunteer that he said some terrible things to her when he would come home like that.  Then in an offhand way, she said that her stomach often hurt much worse when that happened.

     She was 33 years old with children, 12, 10, and 6 years of age.  Her husband was a gainfully employed computer programer with a higher than average income.  He enjoyed his work and had fun with his children and then she again threw in an offhanded remark that he didn’t seem to enjoy her.  She said that she couldn’t remember the last time that they were intimate.  And then came the title of this column, “But what can you do?”  At this point, it became obvious that her abdominal pain did not represent ulcers, or gallstones, or cancer or colitis or any other medical structural organic disease.  Her story is played out in too many homes where either the husband or the wife seeking medical attention for headaches, abdominal pain, itching, aching, fatigue, etc.  The problem is not a medical entity but rather has to do with a disturbed relationship.

     In order to help this lady, there needed to be some ground rules and definitions provided.  The first definition was to help her understand what addictive behavior was.  When asked if her husband was an alcoholic, she indicated that she didn’t think he was an alcoholic.  She said that he dressed well, he was clean, he played with the children wonderfully, he provided for the home, and he had lots of friends.  Her picture of an alcoholic was some poor, unshaven soul in tattered clothes lying in the gutter with no home and no job.  So, there needed to be a first definition.

     Definition #1:  Addiction or addictive behavior is an activity that a person can’t stop or won’t stop that adversely affects their health, their social relationships, or their occupation.

 This definition doesn’t require that all three areas be affected.  Her husband was gainfully employed and at 35 years of age seemed to be very healthy taking no medications and not having seen a doctor in 10 years.  But indeed his drinking behavior was severely adversely affecting his marriage.  After further discussion, she seemed to understand this point.  Whether you called her husband an alcoholic or addicted to alcohol or simply participating in an addictive behavior really didn’t seem to matter.  Whatever it was that he was doing, wasn’t working.

     Then we had to talk about rules.

Rule # 1:  You cannot stop another person’s addictive behavior.  Go to Rule # 2.

Rule # 2:  You can reinforce another person’s addictive behavior by facilitating that behavior or by continuing to deny that person the gratification they seek.  Go to Rule # 3.

Rule # 3:  Re-read rule #1.

To make a long story short on further discussion, this lady acknowledged that she had told her husband that she didn’t want to have anything to do with him if he was going to be drinking.  She acknowledged that she had behaved in a cold and righteous way regarding his drinking.  I asked if that behavior seemed to be helping the problem and when she said, “No”, I pointed out Rule # 4.

Rule # 4:  “When what you are doing doesn’t work, do anything else.  But don’t keep doing what you are doing because you have already shown that doesn’t work.”

     Nothing is ever as simple as it seems and this lady’s story is not as simple as this column would make it out to be.  But the rules above are universal.  She was referred to a counselor and how this will all work out is yet to be known.  At some point, her husband’s participation and understanding of the problem will be helpful.  To deal with problems this complex is very scary and takes a great deal of courage.  It requires the ability to recognize that the issue isn’t cancer of the stomach but rather a sick relationship.  It then requires a willingness to change behaviors to heal a relationship.

     As a last note:  Alcohol is not the only addictive behavior problem.  Addictive behavior can be physical abuse, verbal abuse, various drugs, workaholism, foodaholics, or a host of other destructive behaviors.