Addiction/Alcoholism in Caregivers and the Catastrophically Injured

Frey, Brand Consultant for Landor Associates, conducted focus groups with professional caregivers. Among their findings, they identified five phases of an "injury resolution process." Certain emotional states are associated with each phase.

• Medical Stability: Patient is in hospital/ICU. Associated feelings are shock, denial, anger, hope, confusion, grief, fear, guilt.
• Intensive Rehab: Patient is in hospital/ACU/Rehab Center. Added emotions of fear, disappointment, grief, mistrust, frustration.
• Discharge: Patient is released from hospital/rehab center to home, institution, specialized care center. Emotions are marked by increased sense of dependency, loss, fear, renewed confusion.
• Second Stage Rehab: Patient is home with in-home visits and/or outpatient rehab at rehab center or specialized care center. Common emotions include depression, anger, anxiety.
• Ongoing Care: Patient is at home, or in specialized care center/living arrangement. Recurring depression, frustration, and anxiety are common emotions.

It is noteworthy that the feelings associated with the injury resolution process mirror, to a degree, the feelings associated with developing alcoholism/chemical dependency, particularly those associated with middle to late stage alcoholism and addiction.

The occurrence of alcoholism/chemical dependency may increase when the injured person's primary caregivers are family member(s). This is due to increased stress on everyone involved, as well as decreased medical supervision. Certainly, combining substance abuse with physical disability and its attendant emotional problems makes it more difficult to provide effective medical treatment and rehabilitation.

Some people are more susceptible to the use/misuse of alcohol and other drugs. Much depends upon environment, previous use patterns, family history, or predisposition.

Given a previous pattern of use, socially or recreationally, it is possible that the caregiver as well as the injured person will increase use of alcohol/other drugs during the Medical Stability and Intensive Rehab phases. It might become a coping behavior—to relax at night, to numb uncomfortable feelings, etc.

As the patient enters the Discharge phase, or as the caregiver undertakes the task of ongoing care, the use/misuse pattern may intensify or escalate. With discharge begins the realization of the long-term life changes for both the caregiver and the injured person.

During the Medical Stability and Intensive Rehab phases, the injured person may be susceptible to a developing need or tolerance for pain medications (opiates), as well as sedatives. Use might continue into Discharge if medications continue to be readily prescribed and available.

This stage presents the greatest risk for developing chemical dependency. Once the injured person is home, drug use is less easily monitored and alcohol is more accessible. There could be a tendency to medicate pain, anxiety, or stress with increased alcohol and/or other drug use. This could lead to an increased tolerance, which would then contribute to recurrent use. As tolerance increases, withdrawal symptoms also tend to increase.