Signs of Addiction or Illness?

[Daughter_of_a_Nurse]

My mother has been a recovering addict on and off for nearly 25 to 30 years.  About 5 years ago, my brother passed away at the age of 22.  My mom has been on a downward whirl wind ever since.  Her dr gave her Atavin which she has been taking for years now (Im not sure of the dosage).  She also injured her back and was given Oxycontin, (again, I'm not sure of the dosage).  She has been taking both meds for years.  

About a year ago, she was diagnosed with Graves disease and hyperthyroidism.  She had the iodine radioactive treatment and was placed on other meds.  She was also placed on a blood pressure medication.

My mom is 54 years old.  She says that she is not taking ANYTHING now and hasn't for a couple of months. However, her speech is slow and slurred, she has confusion and short term memory lapses, she gets dazed, she has little to no appetite, she sleeps all the time, has difficulty staying on tasks, even in conversation.

I am not sure if these signs are caused from abusing medications or from not taking the medications.

She is a nurse and due to these symptoms she can't keep a job and she has agreed not to practice until we get this under control.  Unfortunately, she does not have any insurance  and therefore I can't get her into see a dr.  Plus she is worried that she will lose her nursing license and therefore has been trying to fight the addiction herself. (which she says she has).  

I don't know what I should do.  She finally got a job working in a kitchen, 4 hrs a day and this gives her some structure and support, which is what she needs, however she is about 1 1/2 hours away from me and I can't check on her like I feel I need to.

I don't know what to do?  With no insurance and her living out of town, I just don't know what to do.  

Could these signs be from not taking the medications for the Graves and hyperthyroidism or is it more likely that she is using again?

[Daughter_of_a_Nurse]

Thank you so much, all of you, for your support and advice.  I just saw my mom for the first time in months, due to the fact that she lives a couple of hours away from me and we work opposite schedules.  I was horrified at what I saw.  She behaved like she had been heavily sedated, (similar to someone who had just had shock treatment).  Her movements, speech, reaction, responses, everything was in slow motion.  Her face is very withdrawn.  I tried everything to get her to let me take her to the hospital or to just stay with me for a little while, but she refused because she said she finally got a job after months of trying and she can't lose it,  She went from being a charge nurse in a nursing home to working as a cook.  

I am going up to see her this weekend, but I am just trying to do some research before I do.  I need to know what our options are, what I need to be looking for, am I seeing things (well, I know that's not the case anymore), but most importantly I needed to know if the signs she is showing could be from the Graves or Hyperthyroidism and/or from not taking the medications for it.

Thank you for your time and assistance.

[J T Junig, MD PhD]

There are a number of possible causes of your mother's problems, including depression, dementia (depression can cause something called 'pseudodementia' in the elderly, but your mother isn't really that old), addiction... strokes, other brain diseases...

As for addiction, your mother is a person taking opiates and benzos (which work at the same place and in the same way as alcohol), and she is a health professional who treats her own addiction-- which is another way of saying that she is not treated... and so the issue isn't 'using again'-- it seems more that she is using the whole time.  Addicts can have their 'appetite' filled by the prescription of a doc or multiple docs, particularly if the patient isn't being completely hones about her symptoms and/or history.

You are in a tough spot.  Not so much from the lack of insurance perspective-- that doesn't help, but many insurers at least in my area don't pay for residential treatment anyway.  She may need hospitalization though if she is abusing the ativan, as that can have fatal withdrawal.  As a nurse, she probably knows that there are resources out there in most areas--- I can't speak to your area for certain, but there are usually county resources, state-funded programs, and even free community clinics for the uninsured.  The money issue is often used by the active addict to rationalize avoiding treatment.

You will not have a great deal of power over the use of another;  you can at least make sure that all of her treatment providers know your observations and know her history of addiction.  You can also make sure that she can't find her car keys (by taking them), and maybe do a 'clean-out' of the drugs in her house.  All of this risks getting her angry at you, but sometimes it just has to be done.

Finally, consider contacting the county human resources dept in her area to see if they have people to do 'wellness checks' on people in their homes.  She may need help and not want help-- and in that case sometimes the child must become the parent.  

JJ