Douglas T. on the Multifactorial Disease of Chemical Dependency

I want to again deal with the disease of alcoholism and drug addiction. We used the term yesterday, if you prefer, chemical dependency. And hopefully those of you who were here yesterday appreciated that this is a disease. And I feel that we have established the fact, basically, that this is a disease that is not primarily dependent upon dosage or volume or the type of drug or the duration of the drug. That, indeed, this is a disease. And the symptom, the primary symptom of the disease, which we have established is that it is a disease that is not primarily dependent upon dosage or volume or the type of drug or the duration of the drug. And that we're going to discuss in the next subsequent lecture the primary symptom of this disease that many of you have is inappropriate, irrational, irresponsible, compulsive lack of control drug taking. And that was the basic message that I was establishing yesterday. That you have a disease. And that, indeed, in having it, you have a disease. this disease it isn't a question of lack of willpower it isn't a question of evilness or sin or a bad habit or you being dumb or you being crazy but that you have a disease with a symptom of inappropriate irresponsible lack of control compulsive drug-taking and that the description of the disease that you have which we established yesterday was that it was a multifactorial disease that it was a disease unique in this country but nevertheless a disease different to be sure than any disease that you're used to but in this new frontier of medicine and we of the new professionals have established that this indeed is a disease. Dr. I'm going to stop now and I'll be right back. Dr. Well I think that we're talking about more than just a disease and not any of these things and as we talked last night this isn't a primary psychiatric symptom it is a disease entity unto itself that is part physical and that we sort of talk of as the medical aspect it's the medical component but then it's part emotional or psychological and that is the psychiatric component and the disease part physical is part emotional. Dr. It partly relates to your job, your community, your church, and your family and we call that the social, spiritual, cultural. So this is a multifactorial or three kind of a disease part medical, part psychiatric and part social, spiritual, cultural. That it's chronic and it's progressive not so much progressive when you don't drink you're alcoholics where your primary problem is alcoholism but it's also a disease that is children, adults, children, kids, everyone's children. Dr. That's right. Dr. Yes. Dr. Yes. alcohol not so progressive when you don't drink or take drugs but progressive in terms of sensitivity to the chemical that you take so that if you start up again after 20 years you're 20 years more sensitive so it is chronic progressive multifactorial and relapsing and recurrent it's relapsing and recurrent in the nature that tuberculosis is relapsing and recurrent it's relapsing and recurrent like diabetes when it's not under control is relapsing and recurrent or even some of the malignancies like Hodgkin's disease but most important this is a family disease it's to that issue to that particular component or characteristic of this disease that I want to address myself this morning and as the years have gone by the vulnerable and in many ways the most sensitive family member is the spouse and so I coined the term spousalic and I want to talk of the disease of spousalic now immediately as the years have gone on this has raised some hackles and some spouses and I can hear them now saying look Dr. Talbot I'm not sick I'm not involved I don't have the disease if he would just stop drinking then there wouldn't be any problem or is the husband who recently came to me said if you have a problem of drinking it's only taking out water and taking out the unwashed liquid from the bathtub, literally you will experience the flavor of the تھ Спасибо神 anys將 Cultivationazioneộc행 came to me said if she would just stop taking those damn Valiums then we wouldn't have any difficulty. But it isn't true. It isn't true. All of the evidence and the data and as we move into this new profession and we move into this new field we have realized that the spouse is just as ill as the alcoholic. And that's why very frankly when we talk about the alcoholic we say no program is going to work unless you've got a spouse and spouse program. And we talk about our spouse and spouse program because the spouse is ill and if you show me an alcoholic and you say the spouse isn't affected then I say love's gone. Love's gone. Because if love and caring and concerning your significant spouse if he's an alcoholic or a drug addict or if she is afflicted with a disease of chemical dependency then the spouse is ill. And so are the children. And so we need to indeed talk of this as a family disease. And one of the data that's now available from our work both in Baltimore where I was associated with the University of Maryland and I also lectured at Johns Hopkins. We did a great deal of work and one of the interesting things that we did was to look at patients who were very ill and very very sick. They had a great deal of work and one of the interesting things that we did was to look at patients who were very ill and very very sick. sick with heart disease and then we went into the home we went and and personally became involved with the family and when we went into the homes and personally became involved with the family we found that if the patient had severe heart disease one member of the family was affected one member was affected emotionally or one member of the family was affected psychologically and that that effect was discernible measurable we could test we could find it and if the patient on the other hand had cancer there were two members of the family who again were psychologically situationally emotionally involved not so with alcoholism and drug addiction not so with this disease of chemical dependency that figure rose to be three to five and the most significant disease to involve significantly involved family members was alcoholism and drug addiction and that involved the parents it involved the spouse and it involved the children and while I am going to spend the majority of this morning talking to you about spousalic because they are the ones significant in diagnosis significant in treatment and rehabilitation and recovery I need to spend a moment to talk to you about the children one of the myths and the tragic myth the greatest tragedy of the 20th century of course to me is that alcoholism and drug addiction isn't thought of as a disease by the majority of people including nurses and doctors and we talked about that last night it's thought of in this myth this intellectual and verbal garbage down here as far as I'm concerned and I can get very very emotionally involved very angry about this and we talked about it and I'm not going to talk about it for a long time. I'm going to talk about it for a long time. this last night but what I'm most impressed with secondly is this statement all dr. tall that my children are too young to know that bad that is sad when I was at central Decab I did a group called alτόt they were five to nine years old young 그런데 ich hatte einmal eine Torben ich war fünf bis sechs jahres alt ز freshly bedacht zum innen anbabi noch но儿 ein beklein per l'願い von finden sie uns darüber folgee cllenze ist es Danke viel ages mehr mein leidens was auf dieser Stelle ihm zu heißen ein They were five to nine years old Les des wieain Beine und diese rein manfolgen mit einem and I sat there and I'm very sorry all these lights and the cameras were not there I would have given anything for that I sat on the floor and was quiet that's very difficult for me and I sat on the floor and I was quiet and I listened for one hour and a half to nine five year olds and the nine-year-olds discussed two things what you do when mother is so drunk that you're ashamed to bring anybody home from school and secondly what do you do when daddy asks you to go to the icebox and the icebox and the icebox and the icebox and the icebox and the icebox and the icebox and get him another can of beer and you're afraid he's going to hurt himself if you ever in your life wanted to hear a beautiful characterization of alcohol and drug addiction I wish you'd heard that it was the exquisite description of the disease the pain and the anguish and the loneliness and the depression and the guilt and the anger and the pathos I hate to say it's a bad thing darling but I don't know why this bunny says I am child I'm a grand parent I've released my daughter into everything she can I don't have to wod when I can I can't لبنن Keys bring on my daughter's Конечно there's a little Creation in there it was all that every bit that was laid out in five-year-old six-year-old timmy year old and eightth year old talks and never never again never would you say four or five year old two or two doesn't know anything 21 annual talk from Valium and Librium and one from alcohol that they were ashamed to bring their friends home or the eight-year-old who talked about daddy hurting himself when him daddy said go get me another can of beer son. And so it was also when an associate of mine in Baltimore who is an excellent addictionologist and a very close friend of mine told me this tale of some nine years after his recovery. Nine years after his recovery he had a daughter who was 14 years old. Now she had stopped drinking when she was five. The scene was all sitting around in the living room in a house. Where you could look down the hall of the house and see the bedroom. And they were sitting around and watching Red Skelton. Again doing Freddy the Freeloader. You know Red Skelton is a funny comic. Funny and I laughed at it. And he was doing Freddy the Freeloader and talking about getting drunk and everybody was laughing. And he looked down the hall and the door opened. And he said. And there was a 14-year-old girl in a long white nightshirt with the tears streaming down her cheeks. And he thought she was sick that he was hurt. She thought that it was really a problem. And he stood up and she ran down and jumped in his arms and threw her arms around him and said. Daddy drunk men aren't funny are they? She said. And he ran down his arms and threw her arms around him. And she looked at him and said. Daddy what's the matter? And he looked at her and she said. Daddy what's the matter? Daddy what's the matter? Daddy what's the matter? And she looked at him. And he looked at her. And she said. in New York, and she had written a description of a young lady, a girl teenager at school. It's worthwhile. It's worthwhile in just briefly reading this to you. It's worthwhile for you to listen about the influence, the impact, the effect that alcohol has on a young growing daughter. Oh, I wish that clock would move. Will 2.30 never come? I have to stop worrying because today everything's to be okay. She said it would. She said today we'll visit Uncle Jim. Hurry home from school and we'll be there at the three o'clock bus. Don't worry. Everything will be all right today. I hope so. Oh, I really hope so. Hurry, clock, hurry. The sooner I get there, the sooner I know. So long, kids. See you tomorrow. Can't you walk with us today? No, I've got to go home fast. My mother and I are going out. Oh, my stomach hurts. I wish I wasn't so nervous. Maybe if I stopped running it would help. Besides, what's a few minutes? It's a lot, though. It could mean a lot. The sooner I get there, the sooner I'll know. Please, God, please make it all right today. Just this once, okay, please? I'll be good. I'll try harder in school. You love me, don't you? Listen to her guilt. If you will make it okay today, I'll get a good mark on my test. Please, God, I'll be good. I'll be great. Ouch, my side hurts from running. I've got to slow down. I know in a few minutes anyway. I'll know how it is at home. If I don't stop on a crack, everything will be okay. Step on a crack, break your mother's back. Step on a crack, break your mother's back. Maybe if I walk on the left side of the street, it will help. If I step over every crack with my left foot, maybe if I walk on the left side and step over every crack, it'll be okay when I get home. Hey, God. Do you hear me? Hey, God, I'm going to retry. I'll be good. I promise I won't lose my temper anymore with her. Please, please, please let it be okay. Just this once, let me be proud. Let me tell you I want to win with my mommy and when we're going to have a great time today. I'll hold my books in my right hand. That's closer to my heart. No, that's not enough. I'll keep my hand on my heart, and then God will see I'm really trying. Step on your crack, break your mother's. Not me. Not today. I wouldn't step on a crack. Everything's going to be okay. I'm so ashamed. I'm so ashamed. Why can't I be like other kids? Why can't I go home and smell something good, cooking, and find mom smiling, and she would say, did you have a nice day, dear? Boy, do I hate that expression she gets on her face. That dumb, stupid expression. I hate it. I hate her when she's like that. But today, today's different. I'm going to love her. Today is different. A little more, and I'll be there. Please, God, we made a deal. Please, okay, let her be my real mother today. Let me look and see that everything's okay. I promise I'll be good. I'll do everything. Please, God. Just once. She's not at the door. She's not at the door. Hey, mom. Hey, mom. Hey, mom, I'm home. You ready? God, you promised me you said it would be okay today. Mom, mom, please, not today. Don't let it happen today. It's too quiet. She's not answering. Oh, no. Mom, get up. Oh, mom, you promised. You said today would be different. You said today we'd visit Uncle Jim. You promised you wouldn't drink today. You promised, Mom. God promised. Tomorrow. We'll go tomorrow, and I promise I won't drink anything. You go home from school. Get the bus tomorrow. Tomorrow will be different. Gilson taped that, actually, from a young girl, and I guess I just need to see her. I don't know. I don't know. I don't know. I don't know. I don't know. I don't know. I don't know. I don't know. I don't know. I don't know. I'm難 expects You can't say that. Don't live in the myth that your disease does not affect the children. Don't live in the fantasy world, and don't live with the fairy tale that your child is too young to know. Five years old, four years old, six years old, my friend's daughter nine years later remembered. And this is the issue that... you need to think about. Let me ask you one very pertinent question. And I ask this to every alcoholic and every drug addict in this room. Does your child have a drug problem? If you do, they do. I want to turn from the children to the disease of spousalics. And this work that I'm going to present you was done predominantly with doctors' wives, physicians, and dentists. But there's no reason to suppose that the study is any different in length. A careful study was done of 100 wives, predominantly. There were two husbands. And we looked and characterized these wives and husbands in a detailed study that we did at Baltimore. I wasn't as sensitive then to the problem. And I need to share with you, that the term spousalic did not come from a doctor's wife. It came out of my experience with a businessman whom you would call a businessman and I would call a businessman. He was an affluent or upper middle class individual who worked for the Spice Company in Baltimore. And I got him into treatment. And he did well. But I had extreme extremely difficult time getting his wife into treatment. She was Mrs. Baltimore. She was Mrs. Baltimore Symphony, Baltimore Junior League, Baltimore Director of the Zoo, Baltimore Opera Company. She was always too busy. They had no children. And every time I tried to get her into treatment or get her to see, she wouldn't even come for an interview. And in those years, I wasn't that sensitive. I wasn't that acute. And so I treated him. And he did beautifully. He got into Alcoholics Anonymous. He came to see me for counseling. And I thought he was doing well. I thought he won't answer abuse for a while and then thought it wise to stop that. And I was pleased with his recovery, with his progress. And he, time slipped by me. And I wasn't as sensitive to the disease as spousalics and family disease. And I kept saying, you know, I really wish Jane would come and see me. And I'd say, Ed, I want Jane here. And he would say, well, I'll get her here next time we visit. Or he'd say to me, well, you know, she has a board of directors meeting. And so the time went on. And pretty soon he came to me and he said, Dr. Talbot, I'm going to have my birthday and get my blue chip. And, you know, being a typical physician and having gotten my M deity, I puffed myself up and said, well, you know, us gods are great. And we really have come down from the pinnacle and solved another problem. And I went in the mirror and I said, congratulations, Doug, you've done a great job. And generally worked on my humility. And so Ed said, I want to go to a birthday party. And I said, I want to take Jane now to the Chesapeake, which is a fancy Baltimore restaurant. And I said, well, that sounds fine. You're going to have ginger ale, Ed? And he said, yes, no champagne for us this time. And I thought, fine. And he said, go out and celebrate. Go out and have a good time. Go out and you deserve it. You've worked hard. You know, you've really been into this business of recovery. And I'm proud of you. And his appointment with me was the following week. And he didn't show up. And that was very unusual. He was always prompt. He was an executive with McCormick Spice People. And being on time was unusual. Ed was part of his nature, was a characteristic of his. And I got very concerned about this. And, you know, he didn't show up and I said, hey, there must be a problem. And I called. And Jane answered and said, that slob is drunk again. And the way she said it, the anger in her voice, with this relapsing recurrent chronic disease, made me immediately happy. know she was down here. I said, James, whatever happens, you bring him to see me tomorrow. And I said, I'm not going to put up with this coming alone or a taxi cab or anything else. You bring him if you have to come in an ambulance. And she brought him, and the story, of course, was classical. They went to the Chesapeake. They ordered dinner. They had a beautiful dinner. And halfway through dinner, she turned to him and she said, Ed, I am proud of you. You have done beautifully. I think this is just great, the way you've handled this. And I bought you a present. And she handed him a beautiful red box done in velvet with silver ribbons with the most beautiful bow on it. And he opened it up, and it was an ambassador 12-year-old Scotch. And, of course, he drank it, and they got drunk. And, of course, then... Then I realized what we were talking about. Because when I brought her back, she finally said to me, I've hated every minute of his abstinence and his not drinking. I've hated it. That's what she finally was able to admit to me. She was the surrogate lawyer, surrogate head of the family, surrogate treasurer. She was taking care of the money, all of the household thing. She always wanted all of that authority. She had it now. Secondly, they had no children. She wanted a child. What better way to have a baby. You know, Shakespeare said it, mewing and puking in your arms. You know. What better way to diaper a baby than to take care of your slob husband who's drunk. And then the third thing is是 And then the third thing is she hated this last year's 5 angst against child abortionuk, you know. And then the third thing is she hated this last year's 5 angst against child abortionuk, you know. this last year because she wasn't Joan of Arc. You see, a year and a half ago, every time she went out, all of her neighbors came up and said, Jane, you're the most wonderful woman in the world to put up with that slob that you're married to. What a great lot of guts and courage. What a marvelous person you are to put up with that drunk. And she missed the Joan of Arc, she missed being the surrogate head of the household, the lawyer, the business manager, and the treasurer, and she indeed had a baby, and she indeed did hate his sobriety and recovery. And so I termed then some five years ago the disease of spousalics, and indeed she did have the disease. Basically what we have found out is that there are three stages that the spouse goes through. If the spouse gets no treatment. I used to call them early, middle, and late. I've changed that. I call them stage one and stage two and stage three because often the spouse, normally our data refers to women, but this occurs for the husbands just as well, they tend to fluctuate back and forth between stages. They can get off at any place they want, but they tend to fluctuate back and forth. They usually start out, and if you want to call this the first stage or the early stage, that's okay. And the characteristics we found in our girls were that first of all, and I say girls, the wives, but again we had some men, but it applies both to the husband and the wife. First of all, they are the keeper of the conspiracy of silence. So, for those of you who are not aware, I'm not going to go into too much detail about the conspiracy of silence, but for those of you, incidentally, who are talking about videotapes, my wife says I can't write, and she's right, but you know, we're taught not to write in medical school because we don't want you to read what we put down on prescriptions or we couldn't charge you. So that we try to write badly. The keeper of the conspiracy of silence, and often then she rationalizes his drinking at this stage. Oh, come on. This is the Madison Avenue group. Everybody drinks. Look, his partners drink more than he does. No, there's no problem. I don't know why you even think there's a problem. There's no problem at all. And she becomes very angry and defends him. If you say anything about his drinking. Oh, now listen, don't you talk about my husband. How about your husband? I saw him drunk last Saturday night. Oh, she becomes angry and defends him. And we have used the term here, which I've starred, that she at this point is a solicitous caretaker. She is a solicitous caretaker. She is calling up the boss. I want to tell you, I'm very sorry, Mr. Jones, but, Mr. Smith, but my husband is sick today. Um, you know, he's... He's gone to the dentist. You know, we have some dentists in the group, so they'll appreciate the fact that one of our employees came to us because his wife was in stage one, and she called the boss and said he had gone to the dentist. The boss sent him to us because he told her that her husband must be a crocodile, that that was the 76th tooth that he'd had pulled, according to her. And, uh, you know, there was no way that he could be having... And, uh, you know, there was no way that he could be having... And, uh, you know, there was no way that he could be having... She had forgotten how many times she had called him. She goes ahead and assumes more and more responsibility. She begins to pay the insurance. Uh, she begins to take care of the business. And the solicitous caretaker is also now into hiding. You know, hiding liquor. And, uh, this is not the alcoholic hiding the liquor, as you heard. This is the white who is now hiding the liquor, hiding the keys, hiding the guns. And, uh, she is also very, very solicitous of his diet. Special diets. She's making appointments with the doctors, saying, You really got to go and see the doctor, George. You really need to do... Hey, now look now, children. Be quiet tonight. Daddy's coming home. We don't want to upset Daddy. You know, next time. Now, let's be quiet and not upset daddy. Or, you know, if it's the husband, let's do the dishes tonight. Mother's too upset. Again, even maintaining that conspiracy of silence with the children. Not saying mother's zonked out on liberium or valium. No, mother's just too upset. Again, the feeling, the guilt, and the fear begins to creep in to play what I call the doormat role. Never confronting him. Never really saying, look, I can't handle this. Or, this is screwing up our lives. Or never saying anything to his boss or the kids. Basically saying, look, I can't do anything about this. A feeling of hopelessness and despair. And when we really looked at this, the things that we were impressed with was the, from a psychological standpoint, was number one, the tremendous amount of guilt that was present in the spouse. And also the fear. My God, the world is really going to pot. And I very well may end up with a... A dead husband. No income. No house. And tremendous fear and guilt feeding into this kind of behavior. Now, very quickly, they move into what I call stage two. Or, if you want to call that, the middle stage. I don't quite like the use of middle, early, and late, as I say. Because, you know, I don't like the use of middle, early, and late. Because of the shifting back and forth that we found. But at this point, the spouse begins to isolate herself. I'm sorry, Mary. I can't be part of the club anymore. I can't make those meetings anymore. Oh, no, no, I can't join you anymore for CARD. No, listen, I'm sorry, Minister. I have to drop out of the church work. I can't do that. Oh, as far as the bandmothers are concerned, I have to resign from that. No, no, I can't be part of the Girl Scouts anymore. She, in turn, will begin to isolate herself. And, in turn, she becomes unreliable. She begins to start breaking appointments. You can't count on her for doing the things that she used to do. She is unreliable unto herself. And one of the things that's very important to us, and this is, I put down sloppy, poor personal hygiene. And I might add that my family therapists are so sharp. I've got two, and I'm prejudiced, but I'm also objective. I think I've got two of the best family therapists in this country. In the disease of chemical dependency. They are so sharp that they can look at a spouse in her disease of spousalics and tell where the alcoholic is whether he's early, middle, or late in the disease. But when I ask a spouse to come in and see me and I've got an appointment for her to come in or from him to come in and at if I ask the spouse to please be there at 11 o'clock and she walks in, I want to look at her hair, I want to look at her fingernails, I want to see what kind of addressed is they asked to come in with arm in the air, of a dress she has on how dirty it is what is her personal hygiene because there is neglect going on in the in this stage in stage two or the middle stage and one of the things that i missed in atlanta was what i did in in baltimore i never saw a spouse if i could help it in my office i always went to the home because i wanted to get into the home to look at the kitchen to look at the living room i always excused myself to go into the bathroom so i could look in the bedroom see what kind of uh i also went to excuse myself to go to the bathroom so i could look in the medicine cabinet any any good addict always does that you know i see the good response from my fellow addict we never went to the bathroom without cracking the medicine okay the neglect of the children and of the housewife and of the housewife and of the housewife and of the housewife and of the housewife that has already started and goes with her unreliability and unpredictability and at this point the spouse will begin to develop a number of physical complaints diarrhea headaches aches pains nausea vomiting lots of physical complaints themselves and right after this and this i want to to again sort of stop and to start to think about the things that we've been doing for a long time and i want to say that i'm not going to stop now i'm not going to stop now like i started this as the role as the solicitous caretaker now she changes she's no longer the solicitous caretaker she is now the arrogant controller there is no room left for sympathy or empathy you see the tragedy is that she's had no education in the middle of here attitudinally she's lost in the swamp and the morass a feeling that this is a bad habit if he had more guts or willpower if he wasn't so dumb or crazy or if he wasn't just an evil sinful person that he'd quit why doesn't he quit he's got to quit we're going to lose everything and he don't he doesn't love me he doesn't love the children if he was a better father and a better husband he loved us more he'd quit the world and that he'd quit and he'd continue to do whatever they wanted to but the world doesn't know everything about him it doesn't know what made him what he's doing he just knows goodness gracious lord what the child of the gods does he tell that to his aunt and to night andee two things he says all these friends hate hands you know one man has caused death and they say stop stop stop listen now the authorities say you're a misfit Librium and all those bills and if it keeps up I'm going to call the boss. The arrogant controller and two other things are happening now. One is the family fights have started. Lots of family fights. And the other thing is that she has become a workaholic herself. She'll do anything to avoid personal, emotional, verbal, communicative contact. I'm too busy. I can't get involved. I've got to get away. And indeed this is what happened. And again as one looked at this what we were principally impressed with was the anxiety that she had and the anger. The two predominant conspirators. Remember we talked of the conspirators in the alcoholic and the drug addict and the chemical dependency. The conspirators were guilt, anger, anxiety, and depression. And the conspirators always hear the hallowed footsteps of the assassin which is loneliness. And so the conspirators and the assassin began to creep up on the spouse as she too developed the disease of spousology. And we're now ready to pass into the third stage. I'm going to put the third stage up here so that you can see it a little bit more clearly. And this is stage three, or the late stage. And how often we have seen this. First of all, the impressive thing to us in this stage was the true grief. And it's very interesting because as time went on, and I appreciated the disease of spousology, I also appreciated the fact that there was real true grief. And I spent some time with Kubler-Ross, looking at her data, her work, her publishers. And Kubler-Ross is a marvelous Chicago psychiatrist who has done the work on the dying patients. She took a number of patients who were terminal. There was no question they were going to die. They knew it, the family knew it, the doctors knew it, and Kubler-Ross studied them. And she found out that when patients were dying, they went through a series of stages. They first denied it. I am really not going to die from this cancer. And then they went through an exaggerated sense of isolation. My God, I'm totally alone. First, I haven't got the problem. Then an exaggerated sense of isolation. Then tremendous anger. Hey, God, you ran off and left me. Why did you leave me? God, you didn't leave me. God, anger at a doctor. What do you mean I got cancer of the lung? And then bargaining. Hey, let's let the world remain. Now let's sit down and maybe I could get chemotherapy. Maybe I could get, you know, maybe we could cut my lung out. And then deep depression. You know, I am going to die. And then finally acceptance. And deep depression. You know, I am going to die. And then finally acceptance. And deep depression. You know, I am going to die. And then finally acceptance. Those six steps, the denial, the exaggerated sense of isolation, the anger, the bargaining, the depression, and the final acceptance is exactly what the spouse-olic does. Because the spouse-olic's loved one, the alcoholic at this point has died. The body may still be there, but the alcoholic has died. The body may still be there, but the alcoholic has died. There is no communication left. There is no physical contact, no sexual relationships left. There is true, honest-to-God, Kubler-Ross death grief. And it is true death grief that that patient, that spouse-olic, that spouse ill with the disease, that they, that they, that they, that they, that they, that they have to go through. Now, there are many visits to the doctor. The physical complaints have blown now wide open. And there are many prescriptions. Or there are many OTCs. We'll be talking about OTCs in subsequent lectures when we're talking about relapse. Over-the-counter drugs. The self-medication. But the spouse at this time is having lots of symptoms. There's frantic church activity, or no church. It's one or the other. There's no church at all or church all the time. It's frantic church activity. And there is geographical separation or legal separation. In other words, they go out and I'll get an apartment by myself, or they're beginning to talk about a lawyer. They're talking about—very often, of course, what we found was the geographical separation was going back home to mother and dad, going back home to the parents. The spouse with the spouse-olic returns to the parents. And again, you know, you stop and think now, and that's a great idea. But again, I want to say that, you know, there's no such thing as a and when I say this, it gets me into a lot of moral issues. I don't want to get into moral issues. I'm talking about our hard data. And our hard data showed that in many cases, the spouse became involved with extramarital affairs. And very frankly, I can say that the assassin did arise. That the assassin followed the conspirators because I found the assassin loneliness. The lonely wife, the lonely hurting, the lonely angry, the lonely depressed and anxious and guilt-ridden and grief-stricken wife will reach out. And depending on a large number of factors, will reach out in an extramarital affair. And the family structure is now gone. And sitting over here, of course, are all now, when you look at the ceiling, are all four of the conspirators. The guilt, the anger, the fear, and the depression. The four conspirators are all there, of course, with the assassin, which is the lonely wife. I think there are two points to make. And no matter how many times, I make these points, they can't hear them. The spouses with the disease often can't hear them. The first point is that the spouse can get off at any stage. But that's not the point that I'm most interested in making. What I'm most interested in doing, and it's to star it with five stars, is that there is a time lag. Now listen, and hear me, you alcoholics, you drug addicts, and chemical dependent people. There is a time lag of nine to twelve months. And what I'm saying is, your spouse gets sicker nine to twelve months after you do, and your spouse gets weller. I don't know that that's a good English word, but it gets better. I sort of feel like Churchill. If I said it, it's got to be okay. I'm back with a humility problem. The point is that your spouse is going to lag behind you in recovery. And that lag is going to be more pronounced, is going to be longer, and is going to have more impact and influence on you, the addict, unless she gets treatment. I can't emphasize that too much. Because I hear, time and time again, and in the subsequent lectures, when we're talking about relapse, that's going to come up. You haven't, you know, the spouse hasn't heard it. The spouse is somewhere in here, and the alcoholic is well on the road to recovery. Is making substantial, is practicing good AA. Is practicing good sobriety. Has got some serenity. And that nine to twelve months lag, and she's back here still. Uh, in stage three, or stage two, or shifting back and forth. And if you don't hear that time lag, it represents a substantial problem to you. I'm sensitive to the clock, and the times run out again on me. Times my enemy, because I would, I really do like to talk with you. I like to hear from you. I like to communicate with you, and I like to share with you. And so I'm very sensitive to the clock, and I'm very sensitive, and very, very fond of discussing the disease of spouse-alic. Because as the last, in the last ten years, I've learned that spouses hurt. And those assassins and that conspirator is no more gentle with the spouse than they are with the drug addicts. And the pain, and the hurt, and the loneliness, the grief, and the anger, and the depression, and the anxiety is just as severe. And yet, I need to say that whenever I talk about this, I like to think about Jerome, Kopti Jerome, who in the last century wrote The Passing of the Third Room. And in that, the stranger speaks, and he says, the love of the young for the young, that's the beginning of life. But the love of the young for the young, that's the beginning of life. But the love of the old for and with the love of the old, that's the beginning of things larger. For that is love that has weathered the storms of life. And that's what we're talking about. The fact that I look around the room today, and I see some spouses here, some significant others, be they parents and children. And for you alcoholics and you addicts, uh, for us chemically dependent people, the fact that our spouses and our children are here means that they care, and that they have weathered the storms of life. And this is the exciting thing about the disease you have, if you can hear that word, in your pain and in your hurt, be you a spouse or be you a chemically dependent alcoholic or addict. The exciting thing about this disease, about this disease that you have, is that in your recovery, having weathered the storms, you're going to have a whole new life of communication, of closeness, of togetherness, and of love that was necessary and was a product of recovery. Because unlike any other disease of this kind, it's survival, your survival, your living, your being able to exist and recover and get well, depends in many, many ways upon your developing communication, understanding, togetherness, and true love with your spouse. For the spouse is critical for your recovery. And she, like you, has to realize that this is a disease, that she is ill with the disease of spousalics, but it's a very treatable disease, and with the proper treatment, there is recovery, and an incredible, beautiful rainbow of serene sobriety at the end of the pilgrimage. This completes the audio portion of this cassette.