Substance abuse

MaryRH

My DH was diagnosed with EO Alzheimer's in 2020, caused by peripheral vascular disease, over 50 years of cigarette smoking and numerous years of alcoholism. Right now he is very capable of caring for himself and other than being moody, forgetting and misplacing things he does okay.    

My concern is he has been a chronic marijuana smoker for many years and now seems to have developed a psychological dependence on it. When he runs out he is angry, verbally abusive and has gone on drinking binges; the last binge was October 2021. He does not listen to me when I tell him that smoking anything is not good for him, his vascular surgeon also directed him to stop smoking. I would like him to go into an extended stay substance abuse rehabilitation facility to see if his EOA is possibly being pushed by the marijuana. If anyone has ideas who I should speak with on his care team to try to get him help I would appreciate it.

I have become very depressed living with him and try to direct my sadness and pain in other more positive ways, but it is so hard. My beloved mother had Alzheimer's and passed in 2003 so I know what may come. Thank you for reading this. 

Hoot619

If he doesn't want to go for treatment and is forced in to it I don't think it will help. I've known others that were forced in to treatment and most went right back to it.  They went in for their job, wife or stay of jail.  They have to want it to work! Hoot

M1

welcome to the forum Mary.  My fear would be that if he truly already has a diagnosis of EO AD, he won't benefit from any substance abuse rehab.  Certainly worth discussing with his team, but I'd be doubtful of benefit.   Your best bet may be that as he worsens, he no longer has ability to obtain marijuana, cigarettes, or alcohol.  I take it he's still driving?  Has he had a driving assessment?  I realize this will be a volatile subject (it is regardless), but ultimately removing his access may be your salvation.  I'm sure others will chime in.

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dayn2nite2

If he's diagnosed, it's too late for substance abuse treatment.  Best you can hope for is a supervised detox and probably placement in a facility where he can't get his substance(s) of choice.

Treatment is lost on someone with Alzheimer's.  They don't have the cognitive ability to understand and don't have the ability to process what damage the substance abuse has done to their bodies and relationships.

harshedbuzz

Mary RH-

Hi and welcome. I am glad you found us though very sorry for the reason you are here.

Yours is a unique set of circumstances. The intersection of dementia and substance use/abuse is never an easy place to be. Under ideal circumstances, the treatment of the latter requires a tenacity and commitment that is undermined by some of the earliest manifestations of the former (specifically the apathy and losses in short term memory, empathy and executive function) in the context of a terminal diagnosis. Rehab requires a person to learn new ways of thinking, being able to recognize when to reframe a thought IRL and make different choices. 

I have lived this with my dad and was told by the director is the lone substance dependence facility that specifically treats seniors that they are rarely ever successful in treating addiction after there has been a cognitive shift related to one of the dementias. He suggested we not even try. If you were to attempt this, you would first want to make sure that the person was safely detoxed if needed (dad was detoxed from alcohol while in the hospital).

The options are looking the PWD down in their own home and enduring their abuse when denied their substances of choice once they have been safely taken off it. This is not a pleasant prospect for either party. The caregiver- in the role of drug and/or alcohol police will be verbally abused at best. My dad could get quite aggressive when denied his wine in the early and middle stages of dementia. The other option is having your LO join a care community-- probably MCF if you can find one willing to take on a 70-year-old with a history of substance abuse and potential behaviors-- where alcohol is not served. 

We chose the former and it was difficult. Part of that difficulty was dementia overlaid on an already difficult personality/mental health issues. This was complicated by dad's suspicions and anosognosia (a condition in which a PWD cannot appreciate that they aren't as capable as they once were- they truly believe they're fine).

Has your DH been diagnosed by a neurologist or memory center? If not, you might want to look into that.

I am sort of confused by his diagnosis as you explain it. Dementia is an umbrella term for several different conditions related to loss of cognition and IADLs/ADLs. Vascular disease is typically associated with vascular dementia. Alzheimer's disease is a kind of dementia caused by physiological changes to the brain that result in shrinkage, plaques and tangles. Often vascular dementia progresses in a short of series of plateaus followed by a sharp decline whereas Alzheimer's is more of a steady slope decline. Every person's dementia journey is unique, but in general PWD VD tend to have a shorter disease course than those with Alz who can live 15+ years after their diagnosis.

Complicating this is the fact that a PWD can have more than one kind of dementia. My one aunt had a slowly progressing VD for 12 years when her geriatric doc diagnosed Alzheimer's as well when the rate of her progression changed dramatically. My dad who clearly had symptoms as early as 2005 but wasn't diagnosed until 2016 had a mixed dementia diagnosis of Alz and Wernicke-Korsakoff's which is an alcohol-related dementia. He was something of the poster child for an early and accurate diagnosis as the WKS is somewhat treatable- especially in the earlier stages. It's a Thiamine deficiency and when treated with IV supplementation dad's cognition and clarity improved a great deal. His short term memory was still badly impaired which rendered him unable to do the work of recovery. Had it been recognized and treated sooner, he might have had a better quality of life until the Alz hit the later stages. 

In your shoes, I would suggest getting your DH in to see a geriatric psychiatrist. This was the best thing we did for my dad. He was on a low dose cocktail of medications which relieved his anxiety and dialed back the aggression which allowed him to stay home for a long time. He also prescribed Wellbutrin which seemed to lessen dad's urge to drink and slowed his consumption dramatically. Wellbutrin is sometimes used for smoking cessation and to manage disordered eating, so it kind of makes sense. 

Specific to marijuana use, have you been up front with his doctors about this? I know there are some folks who actually have medical marijuana cards and gummies for their PWD to treat some of the worst symptoms of anxiety, weight loss and poor sleep. 

That said, my advice to you would be to see a certified elder law attorney to set up the documents needed to prepare for care in the future. Specifically, you might need to prepare for Medicaid and for someone else to be your POA if needed as your DH can no longer be trusted in that role. My mom also took advantage of the meeting to explore divorce as an option. Their marriage had been pretty miserable as a result of dad's personality overlaid by the dementia for which they refused to have him medically evaluated and she wanted out. She ultimately stayed, in part because if was better for her financially and him in terms of insurance and because she didn't want to burden me with his care. Plus, I don't know that she fully trusted me to do the right thing.

HB

rlpete

Mary, 

I can't add much more to the good information in HB's post but I would second the suggestion of gummies if your DH would take them. My wife lives with mixed dementia. She occasionally gets very bad spells of anxiety sometimes bordering on a panic attack. We have used prescription drugs at times to help but also gummies. Her doctor said the studies are mixed on them but if they help then keep using them. We have found the right amount for her such that they don't leave her feeling "high" but enough to take the edge off her anxiety. 

Good luck.     

mommyandme (m&m)

This may not be helpful at all but if smoking is your concern, maybe he could switch to edible marijuana.  I’m thinking if the THC calms some of his behaviors maybe it’s not the worst thing.  My observations are that marijuana can be a more peaceful influence compared to alcohol.  

I’m with many that a rehab isn’t going to help. I doubt he will be able to participate in the exercises deemed necessary for recovery, especially since he’ll most likely be resistant and might possibly be detrimental to others in the program.  Since he’s an adult he can walk away at any time. No one wants a patient with dementia walking away at all, especially in unfamiliar surroundings.  If he’s quite difficult to handle they will probably kick him out for the safety of others there.

Dealing with an addicted LO is very difficult on its own, then add in dementia!   I’m so very sorry for your pain and heartaches. Glad you came to share with us. Keep coming back. 

easy23

We got my husband to stop drinking by placing him in a MCF for five weeks. During this time his dementia got so much better that we brought him home. He hasn't had a drink in two years. Memory care was an expensive solution, but it worked.

Rescue mom

I have close family with dementia who, doctors said, were functional alcoholics. They and rehab people said rehab and/or therapy is no help, because of dementia. (As others have said).

Wellbutrin did decrease the urge to drink, and medical marijuana (not smoked, but gummies and oils) were advised for calming, and did work for calming. The person doesn’t get “high” as we used to think of, but their anxiety is less and they slept better.

mommyandme (m&m)

easy23,

That’s really awesome! 

harshedbuzz

easy23 wrote:

We got my husband to stop drinking by placing him in a MCF for five weeks. During this time his dementia got so much better that we brought him home. He hasn't had a drink in two years. Memory care was an expensive solution, but it worked.

Alas, that did not work for us. Dad spent 7 weeks in a SNF/rehab after a hospitalization and it did not diminish his urge for alcohol. 

We also found watering down drinks or swapping at non-alcohol versions unsuccessful strategies. Dad's brain was damaged, not his palate. He wasn't sure what state he was in, but he could tell the difference between a Kendall Jackson Chardonnay and a Bin 65.

HB