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"I Think She's Addicted to Prescription Medication"

After her ovarian cancer surgery, Abby went on pain killers and never got off. Joe thinks she's addicted. Can this marriage be saved?

The Couple

Abby: 48, office manager
Joe: 50, construction worker, part-time event planner
Married: 25 years
Kids: Ashley, 21, and Rose, 19

The Counselor

Robin Newman, Huntington, New York

The Background

Ever since she had cancer surgery, Abby has been moody and suspicious. Joe thinks Abby's behavior is related to the pain meds she's been taking. Abby says Joe is totally unsympathetic.

Joe: Abby had ovarian cancer and she says she's still in pain and needs her pills. I'm not so sure. Her doctor told her to cut back on her drugs, but then I caught her looking through my gym bag for an old prescription of mine. I'm no expert, but I think she's out of control. If she's not addicted now, she will be soon unless she gets a handle on this.

Abby: Seriously, do I look like a drug addict? Joe doesn't get it. Two years ago I had a malignant tumor in my ovary. It was a terrifying experience. I was in a lot of pain after the hysterectomy, so my doctor gave me Vicodin. It helps but I'm still not pain-free. The doctor thinks there might have been some nerve damage during the surgery. That's why I still take the pills. But I don't take that many and I don't feel high, so there's no way I'm addicted. Besides, the doctor wouldn't have prescribed this medication if it wasn't safe. Joe makes it sound like I'm shooting heroin.

I was able to go back to work six weeks after my surgery, but with the after effects of the operation, chemo, and radiation, I still don't feel great. The pain pills really help me cope and carry on with my life. So when the doctor told me it was time to taper off them and refused to renew my prescription, I panicked.

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Then I remembered that Joe had taken painkillers when he tore his ACL recently. I scrounged around in his gym bag and discovered a half-used bottle of Vicodin. When I finished those, a woman I work with said she could get them for me.

Joe: Abby claims she's taking "only a few pills." Try ten a day — and the recommended dose is six a day, max. I can't believe she started buying prescription drugs on the black market. We're not that kind of people, or at least I didn't think we were.

Abby: Oh please, that's an awful thing to say. It's not like I'm a criminal or something. I'm grateful that my friend at work realized I was suffering and wanted to help. I wish I could get that kind of empathy from Joe.

Joe: Look, I can't imagine the hell that Abby's been through. When I first heard the news about the cancer, I broke down. Considering what she's dealing with, I feel like a jerk complaining. But living with her is not easy. She has these wild personality swings. I married a sweet, happy woman, but now there are times when she's a raging bitch.

Abby takes everything I do the wrong way: If I sit down on the couch and turn on a baseball game when I get home, she thinks it means I don't want to spend time with her even though she used to love to watch games with me. She also has this totally irrational idea that I'm having an affair with my boss. Maybe she's worried I'm cheating because she and I never have sex anymore, but that's Abby's choice, not mine. It's not like I have the time or energy to have an affair — I'm physically exhausted! I leave before 6 a.m. for the construction site. Then at 4 p.m. I go to my second job at an event-planning company and start setting up tents, tables, and chairs. Instead of accusing me of being unfaithful to her, Abby should be thanking me for what I'm doing to put our daughters through college, and for all the extra grocery shopping, cleaning, and cooking I do when she's not feeling well.

Abby: Why is he surprised that I get nasty sometimes? I'm stressed because I'm so afraid that the cancer will come back. I admit that I have zero interest in sex these days. It's just not on my radar anymore. Joe and I have definitely been arguing a lot — mostly about his boss, Nancy. She calls his cell at all hours and often asks him to work late. Joe is charming and I'm used to women flirting with him, but Nancy really bugs me. I just don't trust her. When I say that, Joe calls me crazy. He does help out when I'm feeling really terrible, but I can tell he doesn't want to be with me because when he comes home, he walks into the den, turns on the baseball game, and zones out. I might as well be invisible.

Joe: I never know who I'm going to meet when I get home — the nice Abby or the one who snaps and snarls. Obviously the pills are a huge problem. The other night I found Abby passed out on the floor in the den and she couldn't remember how she got there. That scared the hell out of me.

Abby: I think I was just really tired. It was getting late and Joe still wasn't home, so I poured myself a glass of wine and turned on the TV. The next morning, Joe told me I'd blacked out and gave me an ultimatum: Stop the medication or he'd move out. He also insisted we get counseling.

Joe: She's really in denial. I told her I wouldn't tell our daughters about the Vicodin problem, but unless she gets help now, I will. I really love Abby but I'll move out — for her sake if not mine.

Abby: I'm glad we're getting counseling. I love Joe and I hate the fighting. Maybe talking to a therapist will help him understand that I'm under a lot of stress. And if taking a pill makes me feel better, then don't I deserve that?

The Counselor: After Abby and Joe told me their story, I didn't mince words. I told Abby, "Your husband is right. Your mood swings, anxiety, and volatility are classic signs of addiction. If you want to save your marriage — and your life — you need to begin a detox program immediately."

Like many people, Abby believed that pain medications such as Vicodin, Percocet, and OxyContin aren't dangerous because they're prescribed by a doctor. In fact, these drugs are highly addictive. Most abusers start taking them for legitimate medical reasons, which morphs into a psychological addiction — they feel they can't cope without the drugs. And as the body develops a tolerance, they need to take even more pills to achieve the same effect.

Abby really loved Joe and was prepared to do anything to keep him. As a first step I convinced her to see a psychiatrist, who was licensed to dispense a drug called suboxone, which blocks the receptors in the brain that crave the painkiller. The psychiatrist agreed it would help Abby. He also prescribed an antidepressant. Over the course of several months she was able to stop the Vicodin completely and cut back to one suboxone a day, with the goal of eventually stopping entirely.

As Abby began to take fewer pain pills — and to feel less depressed — she could see more clearly that Joe wasn't doing anything wrong. I encouraged them both to talk more openly about their feelings, so they could better understand what the other was going through and resolve their conflicts more peacefully. I also suggested that they join a support group for couples who have been affected by cancer.

When Abby told me she thought her husband was falling out of love with her, I suggested that her concern might be linked to her hysterectomy. "When you feel like less of a woman, it ramps up your anxiety," I said. "Are you afraid he'll leave you?" Abby burst into tears and admitted she was. When Joe heard this, he assured her it wasn't true and made more of an effort to be affectionate and to let her know that she's always beautiful to him. In turn, she makes sure he knows how grateful she is that he's working two jobs and helping out so much around the house.

We spent time during each session discussing how difficult it is for couples to live under the shadow of serious illness. Although Abby is currently cancer-free, every survivor knows the disease can return. The antidepressant helped her out of the dark place she'd settled into, but she also needed to learn other ways to keep her mood stable. "When life is filled with unknowns," I said, "it's critical to stay in the moment. When you're feeling hopeless, remind yourself, 'Today I'm alive.' Or 'Today I have the energy to do the things I love to do.' Count your blessings because it will build your confidence and make you feel happier."

Finally, we talked about why they weren't having sex. I wasn't surprised that Abby's desire had vanished, since having a hysterectomy throws your body into menopause. I advised her to speak with her gynecologist about the problem. We also discussed the importance of staying physically connected — giving each other back rubs, walking hand in hand, snuggling on the couch — which could help Abby get in the mood. Sure enough, after a while, their sex life returned. "That old saying, use it or lose it, seems to be right," Abby said. "Having sex really does make you want to have more sex."

Although they ended weekly sessions after a year, Abby regularly checks in with me by phone. She still isn't happy about Joe's crazy work schedule, but they both acknowledge it's essential until their daughters get out of college. Abby finds it easier to manage her feelings now that she's off the pills, and Joe has been making an extra effort to reconnect with her when he gets home. She's still taking one suboxone daily, a typical maintenance dose that many people stay on for as long as three years. "I finally feel normal," she told me. "I have my life back."