Your Dying Spouse 153 - Self-Medicating

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What do you do, as a caregiver, when you realize that your terminally ill husband or wife is self-medicating?

Self-medicating can take many forms; what they have in common is that they address the combination of physical pain and discomfort along with the emotion burden that dying places on the soul - the fear, disconnection, and loneliness.

Understanding where it's coming from is the first step in dealing with the issue...and as a caregiver, you have to find a way to deal with it. You can't turn away.

The process usually begins when a patient feels that he or she is being 'let down' by medicine, that the prescribed treatments either aren't effective enough, or cause side effects that are hard to tolerate.

"I now how I feel...I can do a better job."

Well, no. Unless one's well-trained and well-educated, and can work with an almost superhuman detachment from oneself, one can't. I mean, would you take out your own appendix? That's an extreme example, but not completely hyperbolic, because self-medication can and sometimes is fatal (consider Prince and heath Ledger).

There's also a sense of entitlement, as in, "I don't have long, and I deserve to feel better in my last days."

Sure, you deserve to feel better. But as Mick Jagger said, You Can't Always Get What You Want, and sometimes, to continue to function as part of a family and part of a community, you simply have to bear the pain, and face the sadness.

Self-medicating can take many forms, such as -

• Finding a tame doctor who'll over-prescribe pain meds (harder now, but still possible)
• Alcohol
• Marijuana use
• Street drugs
• Shopping (especially online)

I separated out marijuana from 'street drugs' because there is some social tolerance for it, and therefore often more reluctance in confronting someone who's using it to self-medicate.

What should you, as a caregiver do, when you realize that self-medication is happening on your watch, so to speak?

First, talk to a counselor to get your own bearings.You should be doing this anyway, if possible; caregiving takes an enormous toll.

Next, try to determine the extent of the problem...and stay involved. There are some levels of self-medication that aren't worth a confrontation. If your husband goes to the house of the old hippie dude down the street to share a marijuana cigarette or two once or twice a week, you may find that it's simply better to keep your own counsel, and keep an eye on the situation, especially if death is close.

Creating an emotional rift at the end of days can make for damage that's hard to repair.

Likewise, shopping. If you can afford the 'feel-better' purchases, you may choose to let it go.

But sometimes, it's past tolerating, and you have to take action. Prepare for it.

Talk to your spouse's medical care team. Don't make it about 'you'; but do make them aware of what's happening.

Talk to your pastor. You'll need prayer, and all the spiritual support you can get, because I promise you this...

When you confront, it's going to be ugly.

Your spouse is going to get defensive, guaranteed, and when he or she realizes that you've called in outside parties, feelings of being ambushed will arise.

Be firm in your commitment to the health of your relationship. Don't make it a power-play; someone who's dying is losing influence steadily, and raming this as a matter of exerting control will make things really horrible, and can kill the good times you may have left.

Be supportive in every way you can. If your husband or wife is having problems with medication dosage or effects, listen attentively, and if possible, go with them on doctor visits to lend your support. Make the system work.

Don't take the abuse that may be hurled your way personally.  While part of it is personal, and intended to hurt, a larger part comes from feelings of guilt and shame. Your spouse may, on being confronted, say that he or she hates you; but the amount of self-hatred is even greater.

Don't expect a quick 'healing' if you have to confront. Bad habits can be hard to break, and quitting cold-turkey can cause some pretty nasty physical and psychological problems. It's going to take time to mend.

And it will take time to mend your relationship. From both sides; you'll have to be watchful, and untrusting for awhile, and that builds distance. Your spouse will feel, at best, 'on probation', and something less than an equal partner in your marriage.

Finally, pray...a lot.

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