Question: I have a relative that is probably a hoarder. He has so much stuff that there are rooms I can’t even get into because the stuff is piled from floor to ceiling. I have tried for years to get him to work through some of the junk (because most of it is junk) but he just can’t seem to make any real progress on it. He always has a reason why everything has some value to him or why he might need it again in the future. It seems crazy but he actually starts to get pretty upset if I press the issue so invariably I just leave it alone and nothing really gets done. The place is obviously a fire hazard and to me the air is very stuffy and musty, although he says he doesn’t notice this. I worry he is going to get some sort of lung disease from the dust and bad air. I know that he has a real problem here and I don’t think he will ever be able to solve this on his own. I have keys to his house and I know his schedule and so what I am thinking about doing is going in when I know he’ll be gone for the day and renting a Uhaul and just pulling out a few literal truck loads of useless junk and taking it to the dump. I know he’ll be upset after but at least it will make a little room in the house and after he sees this maybe he’ll be inspired to keep the progress going. I guess I am not sure if I should do this or not. I am ready to give a little tough love here, but I don’t want to do something that is harmful or mean spirited. Should I make him take this help that he doesn’t want – for his own good?

Iona Health Says...:

As a concerned relative of someone who is unable to detach from his belongings or change his immediate environment, I would not advise you to do anything underhanded like taking his belongings out of his home without his consent, permission, or stated desire. To execute this type of plan would require that you placed your will over his will. Will this weaken or strengthen an already strained relationship? Do you think your relative would consider this a violation in trust? I think your relative’s problems are deeper than can be solved by a trip to U-Haul and cleaning out his home.

Compulsive hoarding has often been linked to Obsessive Compulsive Disorder (OCD) but recent research as shown it to be an independent condition which has often been linked to other psychological disorders; such as major depression, generalized anxiety, social phobia, post-trauma stress disorder (PTSD), attention deficit disorder (ADD), dementia, and grooming disorders (skin-picking, hair plucking, nail biting). Standard and traditional treatment has seen hoarding as a component of OCD and treating it as such. However, there is a difference between compulsive hoarding and OCD. Results from treating hoarding as a component of OCD has produced mixed results. Treatment is complicated and made complex as hoarders are often disorganized, in denial, and forgetful when taking scheduled medications.

The problem with getting hoarders to treatment is that they do not see anything wrong with holding on to their possessions and do not consider it a psychiatric disorder. The argument could be made that they overly attached to material objects which may be seen as more reliable objects than the people in their lives. Something to consider when considering any type of intervention…

Standard interventions for hoarding include, but are not limited to, Cognitive Behavioral Therapy (CBT), medication (Seroxat or Paxil, Prozac, and Effexor), intervention, and self help groups. A combination of CBT and medication appears to be the most effective treatment for compulsive hoarding. Some sources for more information about hoarding can be found at these websites:

• http://www.compulsive-hoarding.org/OCD.html
• http://www.compulsive-hoarding.org/Diagnosis.html
• http://www.compulsive-hoarding.org/Treatment-options.html
• http://psychiatry.ucsd.edu/OCD_hoarding.html
• http://www.ocfoundation.org/hoarding/types.aspx

A friend recommended a book which offers a greaat resource and recovery program for compulsive hoarders. Buried in Treasures: Help for Compulsive Acquiring, Saving, and Hoarding by David F. Tolin, Randy O. Frost, and Gail Steketee. I would encourage you to investigate this resource as it has been highly recommended and can be found on Amazon.com.

From a careful review of professional literature, most people are shown to not fully understand the phenomenon of hoarding as laymen or professionals. I would highly recommend that you support your relative by supporting him in seeking a professional assessment for hoarding or any other associated psychological concerns by a qualified mental health professional. As importantly, I would attempt to identify and utilize professionals or programs which can give evidence to their success in treating hoarders.

My sincere wish is that your relative obtains the help needed to overcome the hoarding and stop the suffering or distress for all involved. If I can be of further service to you, please do not hesitate to contact me.

Respectfully,

John W. O’Neal, Ed.S, MSW, MA, LPC, NCC

Question: I have been a heavy drinker for about 25 years. I drink 10 or 12 beers a day. I don’t get drunk and I know what the alcohol does to me and how it affects me. I am probably what you would call a functional alcoholic and at this stage in my life I am not interested in stopping. Lately I have been having a lot of anxiety and I went to my doctor to get some medication for it. He said that it could be the alcohol that was making me anxious and that he didn’t want to prescribe me anything until I tried quitting the drinking first to see if that made the anxiety go away. I do not wish to quit drinking and I have been drinking for long enough that I know what it does to me and what it does not do to me. Alcohol actually makes me feel less anxious and it’s pretty much the only thing I’ve got now to deal with the anxiety since he would not give me any medications. I do not wish to go against medical advice, if it is sound, but it simply makes no sense to me. Is it possible that alcohol would not make me anxious for 24 years and then all of a sudden it would start to make me feel anxious now? It just seems crazy to me.

Iona Health Says...:

Although you have gone against medical advice, I do honor your right to choose whether to continue drinking at your own possible high risk. However, you have describe three of the clear symptoms of alcoholism:

1. increased tolerance as evidenced by you inability to become intoxicated after drinking 10 or 12 beers per day,
2. little or no motivation for sobriety or recovery, and
3. withdrawal symptoms as indicated by recent incidents of anxiety.

I will admit that I may be limited in my feedback because I do not have information concerning what triggers your anxiety, when your anxiety manifests itself, or the length of time which anxiety has troubled you.

Most people, who have been drinking for a long time or drinking frequently, will often experience some form of withdrawal symptoms. Withdrawal can begin when the body is craving more alcohol than is being consumed. Mild to moderate psychological withdrawal symptoms include: anxiety, irritability or easily excited, emotional volatility or rapid emotional changes, and depression. For more information about this, go to websites: http://www.umm.edu/altmed/articles/alcoholism-000002.htm, http://alcoholism.about.com/cs/withdraw/a/aa030307a.htm. Did your doctor discuss alcohol withdrawal symptoms, their psychological and physical symptoms, and the dangers of severe withdrawal symptoms, such as hallucinations, delirium tremens, agitation, fever, convulsions, and blackouts. So to answer your question, the medical research in alcohol withdrawal symptoms has indicated that anxiety is one of the mild symptoms of alcohol withdrawal. Yes, anxiety can appear as a withdrawal symptom after 24 years of self-reported untroubled drinking.

Since you have gone against medical advice and have made it clear that you are not motivated to stop drinking, I would recommend that you look at your progression by getting more information about alcoholism, its physical and psychological consequences, and alcohol withdrawal symptoms. A positive first step towards this goal would be to identify what symptoms could be expected from progressive alcoholism by taking an inventory, such as, the Alcohol Withdrawal Symptoms Quiz.

The Alcohol Withdrawal Symptoms Quiz indicates reveals if your symptoms are mild, moderate, or severe. It is completely confidential and your answers are not recorded. After you answer the 20 questions, you will be provided an assessment of the severity level of the withdrawal symptoms that you may be experiencing. You can find this quiz at this website:

http://alcoholism.about.com/od/tests/a/Alcohol-Withdrawal-Symptoms-Quiz.htm

You sound like you made the decision to continue drinking on your own. Would it be possible for you to ask people close to you as to whether they think you should stop drinking or not? Use the people who care about you or you pay for advice from, to help you make important life changing decisions. Although you did use good judgment to seek medical advice from a physician, it would be excellent if you would talk to an addiction specialist and have a professional assessment with recommendations. Alcoholism is being treated more often on an outpatient basis. Please do not rule out treatment while your symptoms reportedly are mild to moderate.

I wish you every success in the future. Best of luck to you, your decision-making ability, and willingness to accept outside support.

John W. O’Neal, Ed.S, LPC,NCC