Posted by: dopaminedialogue | 02/16/2010

The battle of the bulging liver

The deep levels of denial exhibited by people with the disease of addiction are extremely baffling to witness. I give the following example to highlight the toll that the use of substances takes on the brain, disabling a person’s ability to think and behave rationally.

A female patient in her late 40s checked into inpatient treatment. She was forced to seek treatment because her employer gave her an ultimatum: seek help or lose your job (by the way, most people are forced into treatment due to some sort of consequence, whether they willingly walk in the door of the treatment center or not, they would most likely rather be at home using but decided if they did that, the consequences would be too painful – so treatment is their only option to avoid that pain). She had worked hard for many years to climb the ladder in her field and it was excruciating for her to think of losing her job. Upon arrival, everyone around her noticed that she had a huge stomach — which was disproportionately sized when compared to her otherwise petite frame. Many assumed instantly that she was pregnant because her belly was tight and round like the belly of a pregnant woman (never mind that she was in her late 40s). Repeatedly she was asked, “when is your baby due?” by fellow patients in treatment. “I’m not pregnant,” she replied again and again, ever astonished that anyone would think such a thing and then have the gall to ask as well.

After the completion of her medical exam, it was clear what the problem was. Drinking almost 1 gallon of liquor per day takes a toll on the liver over time. The reason her  belly looked like it was carrying a baby inside of it was because fluid and toxins had built up so much inside that it had caused her stomach to protrude and be very round and hard.

Consider this:  She actually had no idea that her stomach appeared larger than normal. Why? Over time, the neurochemical imbalances, malnutrition, and the slow disease process all lead to a “broken” brain. The brain is so hell-bent on continuing the drive to use that it overlooks what is quite obvious. Another word for all of this: DENIAL.

Fortunately for her, her denial was challenged regularly — as each new patient that arrived on a daily basis inevitably asked, “so when’s your baby due?”

Even so, the denial hung on for dear life throughout her time in treatment. Her regular medical exams led the physicians to believe that she would eventually need a liver transplant. Long-term inpatient treatment for alcoholism was recommended due to the dire nature of her medical problems. Long-term treatment would be like insurance on her life, after all, longer term treatment is more likely to lead to longer-term sobriety. The extended time without use would also give her brain precious time it needed to heal – and this would likely help her to think and behave much more rationally.

All she could think about was returning to work and saving her job. When the recommendation that she complete another 4 weeks of treatment was explained, she refused, even after considering the very serious nature of her medical problems. Time and time again, treatment staff tried to convince her to put her recovery first and time and time again she refused.

Finally, her employer – who had learned of the seriousness of her situation – stepped in and let her know that she was in no condition to return to work any time soon because of her medical problems. Even with this news, she still put up a fight — but finally — at the last minute — she broke down and agreed to continue with treatment. It probably saved her life.

In case you are wondering, I ran into her about 2 years later – ironically, on her job. She was still sober – waiting on the transplant list, but otherwise doing well. She thanked me for working so hard to get her the help that she so desperately needed – but so desperately fought to avoid.

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