Dear Dr Duffy,

Where do I begin? First, a little background: I am a 23 year-old female. I have been married for 4 years to a man that is 20 years older than I. We have had two children age 3 and a newborn. We plan to have more children. They are a wonderful family.

For several years I have felt frustrated and disappointed with life, although I realize that I am extremely fortunate and very blessed. There is an emptiness inside that seems to echo louder with time and yet I cannot put a finger on what is eating away at me.

 Earlier attempts at communicating with my husband regarding these issues have left me feeling weak, unimportant and angry. He doesn’t seem to hear me in anything that I say, so anymore I don’t say anything other than superficial conversing. While I am constantly surrounded by my immediate family I feel extremely alone.

 I have never been a morning person, however, I sleep in as long as my children will allow me and I dread the new day for the tireless effort that will be required. I love the evenings because the day is finally over and sleep offers one slight reprieve of the emptiness. Even simple tasks seem dreadfully difficult.

 I work at home but I avoid my duties and responsibilities as long as possible. The house is often in disarray and I can’t get my work done. It seems that most things that I start I cannot finish.

 One of the only things that gets me through the day is the thought of alcohol at the end of the day, after the boys are in bed. I can easily drink 20-30 ounces of wine in an evening and be able to function quite well.

My biggest regret is that I am breastfeeding, and while I try to time things in the evening so that he doesn’t nurse until the early morning hours, occasionally he wakes up before then and needs to feed. Each morning I resolve to stop drinking but the strong desire to slip into oblivion at the end of the day is too much to resist, and so the cycle continues.

 I used to create fantasy stories that I would live out in detail in order to escape the reality of this life. In a way I used it to cope with reality, and have always enjoyed the stories. However, since I have married and have children I have little to no time to engage in my fantasy worlds.

 When I do things I enjoy my husband gets angry because I am neglecting my other duties and shoots down the small enjoyment I had, so I am back to simply mulling through life and feeling miserable.

 I don’t feel that I can trust my husband with my inner feelings. I feel myself withdrawing from him. I avoid physical intimacy and have a strong desire (sometimes an uncontrollable urge) to pull back from his advances. Why do I avoid him; what is wrong with me?

•  How can I engage in life with joy and enthusiasm?
•  How can I rekindle my relationship with my husband?
•  How can I stop drinking and find something else to take its place?

 I do not want to live like this… and I pray that the Lord will help me through. If you have any suggestions, I would be very grateful.

 -Alone and desperate

Answer From Dr. Duffy 

Dear Alone,

 There are a number of things about your letter that I would like to respond to.

 First I believe you may be depressed. This could be postpartum depression or may have been present before as some of your comments suggest. Here are some things you said that make me concerned about depression.

• “Emptiness inside”
• “I used to create fantasy stories that I would live out in detail in order to escape the reality of this life”
• “The house is often in disarray and I can’t get my work done.”
• “It seems that most things that I start I cannot finish”
• “…sleep in as long as my children will allow me”
• “I dread the new day for the tireless effort that will be required”
• “I love the evenings because the day is finally over and sleep offers one slight reprieve of the emptiness.”
• “Even simple tasks seem dreadfully difficult.”

 Of course I cannot make this diagnosis over the internet, I encourage you to be evaluated by a mental health professional. You may need an antidepressant but it will not help much if you continue with the alcohol.

  Second: Your relationship with your husband. Although you start off saying what a wonderful family you have, you quickly talk about how unsatisfying your marriage is. It is certainly not the situation where you should have more children.

 My suggestion is that you tell your husband that you are very unhappy and the situation must be taken seriously or it most likely will get worse. Be honest about your feelings and worries. Couple therapy may be necessary. If he refuses to go you need to find a professional to talk to for yourself. This will help you to figure out what to do next and help you to answer your final questions.

 Third: Your alcohol intake. It sounds like you have a serious problem because you cannot stop despite multiple attempts and worries about breastfeeding. Many experts feel 2 drinks will not hurt the infant but anything over that may. (you are way over this limit!)

 The other issue is alcohol makes depression worse!  It is hard to know what comes first the alcohol or the depression. My suggestion would be to get some help to stop drinking first. This can be done through many programs and AA. You must do this and it sounds as if you cannot do it alone.

 Please get some help, for your own sake and for the sake of your children, and your marriage. I am truly concerned about you, and send you my best.

Alcohol Use and Abuse:

It is not always easy to recognize when alcohol is becoming a problem for someone we love. First we do not want to see it and second the person is usually trying to hide it. Here are some clues to look for. Intoxication is usually easy to see. The signs of chronic use are more difficult to detect. Remember alcohol can become a problem for all ages. Older adults who live alone may be at high risk, as are adolescents. Here are some things to look for.

Sure Signs of Alcohol Intoxication

• Odor on the breath
• Difficulty focusing: glazed appearance of the eyes
• Irritability
• Excessive laughter
• Loud rapid, talking
• Sleepyness or stuporous in the later stages
• Inflammation in whites of eyes; pupils unlikely to be dilated

Changes Seen in Ongoing Alcohol Abuse

• Change in usual behavior
• Secrecy
• Decrease interest in appearance and hygiene.
• Decrease function in work or school
• Missing or tardiness at work or school. This often happens after time off.
• Increase in accidents
• Irritability
• Flushed skin
• Loss of memory (blackouts)
• Alcohol becomes the focus of activities.
• Loss of friends or different friends and associates
• Trouble in relationships, becoming secretive
• Forgetfulness in conversation
• Depression
• Physical illness, bruises

Marijuana Use and Abuse

Marijuana users are difficult to recognize unless the person is under the influence of the drug at the time. Casual users may show none of the general symptoms. Marijuana does have a distinct odor and may be the same color or a bit greener than tobacco.

Signs of the Influence of Marijuana

• Marijuana has a distinct odor, once you smell it you will recognize it. It smells similar to burnt rope on clothing or breath.
• Persons who are under the influence “high” tend to drive slowly, often below the speed limit.
• Persons under the influence tend to overestimate time intervals.

Signs of the Abuse of Marijuana

• Use or possession of paraphernalia including roach clip, packs of rolling papers, pipes or bongs.
• Financial difficulties (with long term use)
• Loss of interest in other activities with increased use
• Loss of motivation
• Increased sleep or time lying around
• Loss of job
• Loss of relationships except with other users
• Despondency, I don’t care attitude.

To learn to deal with someone under the influence of substances check out my book,

Behavioral First Aid: Managing Emotions During Emergencies