The Adaptable Caregiver
I have fond memories of a patient of mine whose son was the epitome of the “ultimate” caregiver: relentless, resourceful, and resilient with unconditional care for his father. He had approached me asking for assistance to stop his father from overconsuming alcohol. He had done extensive research about alcohol dependence, and often expressed frustration at the “passive” nature of local community services.
Whenever his father was picked up by passers-by for drunkenness and hospitalised for physical health ailments related to chronic alcohol use, he would stay by his side day and night. But he was not entirely successful because he was recalcitrant and over-controlling towards his father’s alcohol use. He would be apologetic towards the harassed nurses. He was desperately grasping for any opportunities to get his father into rehabilitation, and would attempt to “stop” his father from asking for discharge. However, he was also very deferent towards his parent. He would back down when his father scowled and refused any interventions. He was clearly burnt out, caught in a vicious cycle of his father’s cycle of addiction. He was frequently angry at his younger sibling and mother’s nonchalance and enabling behaviour — they would buy the beers just to avoid confrontation with their father. Thus, he felt like he is the only one doing something about his father’s addiction. He felt the need to frequently “rescue” his father and as such, was not able to hold down a full-time job, as his work day was constantly interrupted.
I could tell the son had mellowed when I caught sight of him in the wards many years later. He is more measured in his conversation and calm in demeanour now, even though his father’s health has declined much more over the years due to liver cirrhosis and a heart problem. His father is still drinking, but only a permitted amount that his son had scheduled for him with a reward system in place. That is, father would be able to drink if he had kept to scheduled activities such as showering, taking his medication, and sitting out in the day area. Today, the son has found a full-time job and has a support network — he is in touch with Al-Anon and Caregiver Alliance.
This situation showed me that caring for someone with an addiction is never a straightforward and simple task. It calls for commitment, wisdom, perseverance, knowledge, a need to stay connected and to take time for self-care. The carer must remain updated with current care standards and stay connected with the helping services.
Various factors can lead to the development of addiction. These include childhood adversities such as bullying; sexual abuse; a hostile home environment (constant lack of warmth with a chaotic and harsh upbringing); familial (parents or caregivers with addiction and mental health problems); and societal issues (like recreational drugs or gambling). Someone caring for a person with addiction may question and doubt the reality of the problem, and sometimes the carer will wonder if the family had contributed to the problem or failed the person. Considering the taxing and unpredictable nature of addiction, the carer can feel burnt-out and demoralised. Consequently, the emotional burden from the caregiver can exacerbate or even get projected onto the person with addiction, worsening their sense of shame.
The carer must acknowledge that they play a supportive role to enable a positive change in the user, and not be overly controlling. The carer should practise self-care and learn to accept the vacillating nature of addition and remain dedicated to the user throughout the recovery process — both during sobriety and in times of relapses.
There is never a one-size-fits-all and fail-safe plan, but the human spirit is resilient and adaptable. Kudos to all caregivers.
The contributor is a Consultant at the Department of Psychological Medicine, National University Hospital (NUHS), and an Assistant Professor at Yong Loo Lin School of Medicine, National University of Singapore.
