I cannot bear my wife’s alcoholism any longer. If I stay I’ll perish. But if I leave her I’ll be in the financial pits. And strangely, I still love her!  I’ve been to an Al-Anon meeting but it’s not enough. Most of my friends tell me to leave her, and my family tells me to stick it out. What do I do?

Note: I first wrote this answer as a way to talk about ways to approach tough dilemmas, but since that time it has grown into a forum for partners of alcoholics and addicts.

Please feel free to tell your own story.  I encourage you to respond to other postings with a few words of appreciation, support and ideas.  Please do not give direct advice.

Updates are welcome too!

Thank you.

Answer:

You have a mighty dilemma. My first suggestion would be to treat with skepticism any advice to take choice 1 over choice 2. In the end, only you can decide.  And only you will know just how much sadness and anxiety is going to be inherent with either option.

Try viewing your dilemma as four-pronged: Choice 1 would be that you decide to leave your wife and that you do so in the most careful, strategic manner, doing the most that you can to ensure this unfolds as becoming the right choice. Choice 2 would be that you leave in a way that magnifies the potential for a negative outcome, say by being mean, impulsive or passive, neglecting the care of your self, your social network, financial interests and so on. Choices 3 and 4 would be the most attentive, well-equipped approach to staying with her, vs. the approach that would leave you the most hurt.

In other words, the way in which you select a choice and then follow through on it what is important, and it is where you can make nitty-gritty choices on a day-to-day basis. The working out of those specifics might be where your attention is going to be productive.

There is another general rule in making a wrenching decision. Make the mistake you can correct. That is, whichever course is more reversible might be considered first. In your case, it is much easier to recover from the mistake of waiting a bit more, than to recover after discovering that divorce was a mistake. Naturally, this is a general guideline only.

One more thing. Loneliness and anxiety, among other troubles, are almost universally difficult for partners of alcoholics.  Reaching out is good.  More reaching out is better.  Al-Anon is not for everyone in your situation, but those who do find it helpful would probably say that it’s the repeated attendance that makes it work.

My doctor has advised me start taking an antidepressant. She tells me they are not addictive but I don’t understand how they can’t be. If you rely on a drug to be happy, isn’t that a form of dependence?

Answer:

You may choose to go without a medication for any number of reasons, but this should not be one of them. I hope that some points here can lay the concern to rest.

A minority of those who take an antidepressant do take it indefinitely, but this is always a free choice, usually for one who has had recurrent or chronic depression. For most others, it is taken for roughly eight to twelve months. This way, the chances of remaining depression-free are better. I advise people that they can use this window of time while on medication to improve the odds even further. By learning a bit about your own risk factors and in putting some self-care habits in place, you can assure yourself that you are coming out with a higher level of emotional resilience and a smaller chance you will need medication ever again.

Now we’ll get a little technical. The drugs that are addictive have several characteristics that set them fully apart from the antidepressants:

1.  The tolerance effect. This is when you must gradually take more of the same drug to experience the same results. As addiction becomes severe, say with narcotics or alcohol, it is no longer taken for pleasure, but simply to avoid pain.
2.  Craving. I myself crave coffee in the morning. As much as anyone might appreciate the effect of an antidepressant, “craving” is not a word used to describe the motivation in taking it.
3.  Loss of control. Most of us are familiar with how an addict might take a desired substance in spite of efforts not to. Getting off the wagon is as easy as falling. Those on antidepressants are able to stop when they choose, and do not continue if it goes against their better judgment.
4.  Addictive chemicals (at times behaviors too, such as gambling) induce a euphoric effect of some kind. Antidepressants on the other hand do not. They have no street value.
5.  Several other features might be included depending on who you ask, such as denial, secrecy, accelerating use despite mounting consequences and reorganizing one’s life to facilitate continued access to the drug.

Here is where confusion comes in: It is true that most of the antidepressants have one thing in common with addictive drugs – the withdrawal effect. If you stop “cold turkey” you are likely to experience unpleasant physical consequences. With some of the other substances, occasionally with alcohol for instance, this can be lethal. Among the antidepressants, Paxil (paroxetine) and Effexor (venlafaxine) are noted for the potential withdrawal effects. These occur in part because the chemical is eliminated from the body quickly, while the other drugs take longer, making for a sort of a natural tapering effect. The withdrawal can be highly uncomfortable – nausea, dizziness, agitation and many other unpleasant symptoms. Another consequence of going off any of the antidepressants too quickly is that you are at higher risk for relapsing into depression.

All of this is avoidable however if you follow this advice: If you choose to take an antidepressant, it should be in your system for a long-enough period of time, and you must taper off the medication gradually, in a planned way. Your prescriber should give you the uncomplicated specifics. The process simply needs due attention, not undue fear.