Mental Illness and drug addiction

Parent Cafe
1

<p>Sorry for the not so happy holiday topic, but I really could use some help. I am a long time member of CC and have created a new user name for this unpleasant topic. My hope is that the oh so smart members here can give me some direction.</p>

<p>I know this will be hard to follow as I want to keep it as short as possible and will be leaving details out. I could write a very long book about all my brother has done! My brother (I will call him Steve,) is in his mid 50’s and have been divorced for over 10 years. He has 3 children in their 20’s that have not had much contact with their father since each was in college. They will see him during family events, but do not contacted him. Steve has been under a psychiatrist care for 25+ years. At some point he was given ativan to deal with anxiety, I believe. Over the course of time he divorced and dealt with some depression. The psychiatrist he was seeing was one that the family felt just feed him meds and did not really help with the real issues. Steve has had some really tough times and has lost almost all of his friends and has torn the family up. He was always needing money and help to the point my parents really have little left.</p>

<p>I decided I needed to help my parents by taking over as much of his care as I could. Steve has no insurance and had a low paying job up to a few weeks ago. After abusing his ativan, his current psychiatrist refused to give him any more. This doctor has been trying to get him off of ativan since Steve began using him about 1 1/2 years ago. The problem we ran into is Steve went off of the meds cold turkey and was having withdrawal symptoms. I took him to the ER as he said he was having chest pains and he was admitted overnight for observation. I was hoping to get him into the state hospital for evaluation, but he refused to go. Once the hospital knew he was medically stable, he was released. His psychiatrist changed him to an antipsychotic medication which of course my brother didn’t like as all he want is ativan. All he can think about is getting ahold of more ativan, but no one would give it to him. He calls me 10 times a day and repeats the same things over and over again.</p>

<p>Last week Steve agreed that maybe he would go to the state hospital. I took him to a different ER as they seem to be able to get a bed quicker than the other hospital. He was evaluated and agreed to a 72 hour hold. A bed would be available the next day, so he stayed in the ER over night. The next afternoon he was transferred to the state hospital detox unit. The mental health evaluator felt he had come off the ativan too fast and needed to learn how to cope without the medication. He had been having panic attacks several times a day, so along with the withdrawal, and the mental illness it was hard to tell what was really wrong with him.</p>

<p>Somehow or another Steve was able to convince the hospital psychiatrist at the state hospital that he was better than all the other patients, so they let him go home after only 20 hours there! He was ok for a couple of days, but then he started calling me every few hours wanting me to take him to a mini medical facility to get ativan since his doctor would not. Some of the calls were for me to call his doctor and convince him that Steve needed ativan. Of course I did not call the doctor as he had told me he would never give Steve ativan again.</p>

<p>One of Steve’s big problems is he talks and talks to anyone and everyone. He tells the same stories to anyone that won’t walk away from him. At his job there has been several complaints from customers that he will not quit talking and let them out of the store. Steve will follow people out to their cars and continue talking. He likes to tell jokes, but many are inappropriate. His boss has been very kind to let him continue to work. People think he is eccentric, not mental ill. </p>

<p>Last night Steve called me at 4 in the morning. He said the same things he has been saying for weeks- “I” let him go off the ativan too quickly and he “needs” to go off slowly. In other words, he wants more ativan. It wasn’t really until 3 weeks ago that I realize he was a drug addict. So now on top of the metal illness, he is an addict.</p>

<p>Steve really needs a residental treatment facility where some one can monitor his medicals and help him through this period of no ativan, panic attacks and maybe get decent care. There is no money to be had to send him to a facility and he has no insurance. His children do not want to contribute at all, and part of me understands. Last time we he had a bad spell, I found several treatment places that were more like group homes in the mountains or on a farm. One of Steve’s issues is he is very lonely; much of which he cause by turning all his friends away. He has “borrowed” thousands and thousands of dollars from old friends over the last 10 years as well as from the family. No one has seen a penny of that money.</p>

<p>I do not know where to go to get help for Steve. I can not even seem to be able to get him on medicaid because he make more that $250 a month. That might not be an issue as I am assuming he is not getting his job back; he had not worked during the last 3 weeks. Steve feels he is better than the other indigent patients and is too good for the public and state facilities. I know the state mental hospitals are horrible; every doctor we have spoken to has agreed. </p>

<p>Where can a person go to get good treatment without money and insurance? How can I best find someone to help us get him some sore of public assistance? Steve has drained the family emotionally, physically, and monetarily. We can not do this anymore; it is taking a toll on everyone. I hate being angry at him as I know he is sick; but when he calls non stop and just shows up at my door, I can not help myself.</p>

2

<p>Does your brother have a primary care doctor? Does the psychiatrist have any suggestions or recommendations? I realize that these doctors can’t discuss private medical issues without the patient’s permission, but they can listen to your concerns and make suggestions without getting into specifics.</p>

<p>Does your area have a local management agency that oversees care of mental health, dd, and substance abuse consumers? They can provide basic treatment (therapy and meds.) depending on their budget. While you can call and ask for guidance, it would have to be your brother to actually call to ask for help.</p>

<p>Is your brother at risk for harming himself or others?</p>

<p>Just some initial thoughts.</p>

3

<p>I looked up this particular drug and it seems to have a variety of legitimate uses but it looks like it has the potential for abuse in making one high. It appears that this can also be used as a date rape drug.</p>

<p>The psychiatrist’s job is mainly in dealing with medication. Psychologists are typically used for counseling as they are less expensive since they aren’t medical doctors.</p>

<p>Public mental health resources aren’t very good here as you’ve found out. Families try to do the best that they can but it is often a very draining process. The only thing that I can suggest would be to contact a social worker, perhaps at a local hospital.</p>

4

<p>The psychiatrist, which my husband pays for, is so mad at my brother for abusing the meds that all he has suggested is to get him in the state hospital. My brother allows his doctor to speak to me, as well as at each ER visit.</p>

<p>A big issue with my brother is he doesn’t see himself as having a mental illness or an addiction problem. Because he will not seek out services for himself, I have to do it for him. I know this will sound terrible, but unfortunately, he is not a harm to himself or others at the moment. If he was, the hospital would have kept him longer.</p>

<p>He needs to be in a 12 step program, but he is not willing to go on his own. That is why if I could get him into a residential program, he might stay, but only if the other residents aren’t crazy!!</p>

5

<p>Is he in denial? He’s been under psychiatric care for 25 years, but doesn’t have a mental illness? I don’t mean any harm by asking that question, but how does he justify treatment?</p>

6

<p>Denial is putting it mildly, and I find no harm in you asking! I think he started going to a psychiatrist for a minor issue and he got sicker as time when on. I always knew he had depression because of the divorce, but over the last 8 years or so, it was obvious he had other problems. I thought he might have been bipolar before I became involved with helping him, although it looks more like schizophrenia to me. I have no mental health training so I can only go by what I read. His psychiatrist will just tell me he has personality problem and he wants him on antipsychotic drugs. </p>

<p>Besides calling me all hours of the day and night, he has also called his current psychiatrist as well as the one he used long term previously. The current doc I believe does not want to treat Steve any more, it is that bad.</p>

<p>The doctor at the state hospital was able to get him an appointment with our county mental health office, but I believe it is with a social worker. He needs an MD that can treat him with the correct meds. I can not go with him to this appointment, so I don’t know if anything will be accomplished, but we will see.</p>

7

<p>A personality problem is not a diagnosis and doesn’t justify meds. It’s difficult to proceed without an established diagnosis so I would continue to ask questions.</p>

<p>What does your brother feel is the purpose for the meeting at Mental Health?</p>

<p>Initial contact is usually with a social worker, followed by an evaluation by clinicians. Then they should make a recommendation to a psychologist and/or
psychiatrist. I would collect as much documentation as possible before this meeting including a journal and medical histories to provide as much background as possible. Be prepared to give frank answers to their questions.
Is there anyone else that can go to this appointment with your brother to provide moral support? </p>

<p>I think this meeting is a step in the right direction. Good luck.</p>

8

<p>“I thought he might have been bipolar before I became involved with helping him, although it looks more like schizophrenia to me. I have no mental health training so I can only go by what I read. His psychiatrist will just tell me he has personality problem and he wants him on antipsychotic drugs.”</p>

<p>Antipsychotic drugs, in low doses, can be used to treat anxiety so his psychiatrist may have suggested an antipsychotic instead of ativan to treat the anxiety without the potential for addiction.</p>

<p>Schizophrenia frequently shows itself via hallucinations and delusions (delusions are when you believe the hallucinations are real). I don’t think that you’ve mentioned these as a problem.</p>

9

<p>Actually, for those with Bipolar, extreme manic episodes can sometimes lead to psychotic symptoms such as hallucinations and delusions.
Have you seen anything like this?
From what I have read, it sounds like an undiagnosed anxiety disorder complicated by depression after divorce.</p>

<p>I was reading over the original post, OP, and I would say that your brother was allowed to leave the hospital because he voluntarily committed himself for the 72 hours. He can change his mind and ask to leave. If he has participated in treatment and seems stable, then they can’t hold him without justification.</p>

10

<p>The mental health professionals I know speak fondly of the support organizations for the family of mentally ill. Others who have gone through “it” might be helpful. So many places have eliminated behavioural health facilities. Places that take those without insurance have to make room for others all the time. I hope you can contact an advocate that knows the ropes.</p>

11

<p>“The mental health professionals I know speak fondly of the support organizations for the family of mentally ill.” </p>

<p>Yes; You need a contact at NAMI so you can get support and know what can and cannot be done. A lot probably depends on what state your in, but there are no easy answers. NAMI is everywhere.</p>

<p>[NAMI:</a> National Alliance on Mental Illness](<a href=“http://www.nami.org/]NAMI:”>http://www.nami.org/)</p>

<p>Disclaimer: It has recently come to my attention that they may get some of their financial support from the pharmaceutical industry.</p>

12

<p>“Actually, for those with Bipolar, extreme manic episodes can sometimes lead to psychotic symptoms such as hallucinations and delusions.”</p>

<p>Psychosis can be seen in those with depression and bipolar too (DSM-IV-TR).</p>

13

<p>That’s it-- NAMI.</p>

14

<p>I do want to say, OP, please don’t apologize for the “not so happy holiday topic”. Life is messy, but it is life and it doesn’t stop for the holidays. Good thoughts are with you as you help your brother.</p>

15

<p>I have nothing to say that will help … I just want to tell you that you will be in my prayers. I also have a brother who is mentally ill, and he is also in his 50’s. It is EXTREMELY difficult to be the sibling of an adult who has a mental illness. We muddle through, and I can’t say we are entirely successful … but we are managing. I hope that some of the advice here is helpful for you. My best to you and your brother.</p>

16

<p>I don’t know how to help either. NAMI is a good resource in that it can direct you to those who have the information that can give you some options. Since things are very state specific in the way they work, you do need to know what options you have in your area. </p>

<p>It’s always such a problem when we have loved ones who are making wrong choices, and though they are mentally impaired to some degree for some reason, they are not sufficiently impaired that they are not prevented from making these harmful choices.</p>

17

<p>I have looked into NAMI in the past, and they are on my to do list. I feel torn the last week as my kids are home and I want to spend time with them, but I have my brother calling and 2 ER visits. My stress level is up and I find myself snapping at the kids when they really are not the problem. The last two days, Steve has taken to just showing up at my house, interrupting our family time, as well as overstaying his welcome. My kids have no tolerance for him as he babbles non stop and they think he is weird. Today when he showed up I lied and told him he had to leave as we were getting ready to go out for the evening. He walked away mumbling something and I did feel bad, but I can not do this 24 hours a day. He is very lonely and likes to be around people; since he hasn’t been working the last 2 weeks, it has been worst. My parents refer to him as my new best friend! </p>

<p>I truly believe if my brother were on the correct medication and great support, he could function better. He is smart, but has never been driven to succeed. I think if he was a child of the 90’s he would have been diagnosed as ADD when he was younger. That doesn’t mean he wouldn’t have the psychotic episodes he has, but maybe he would have the skills to handle them. </p>

<p>The sad thing is my brother can name every medication he has ever been on as well as the generic name and dosage. When he was in the ER the last time, the intake nurse ask me if he was bipolar or schizophrenic. You only have to speak to him for a few minutes to know he is off. When he is in a high, he can seem almost normal, but he still babbles. Usually he will talk about things from 30-40 years ago; things that are always someones fault. Either our parents were horrible parents, his ex wife was at fault for the divorce, or more recently it was my fault he went off of his medication cold turkey. He never will take responsibility for his own actions, never did anything the psychiatrist wanted him to do to better his life, always wants everyone to clean up his mistakes; you get the picture.</p>

<p>My parents will not go to counseling for themselves to help them deal with this. They are older and I believe embarrass that their son is this way. Steve has them convinced they were horrible parents and they are at fault for all his failures. It upsets me to see my parents so depressed over this; my mother said my dad did not sleep the other night when Steve went to the ER as he was crying. Do you know what it is like to know your 80 year old father is lying in bed at night crying?</p>

18

<p>“I have looked into NAMI in the past, and they are on my to do list”</p>

<p>For your families sake, move this up on your list. It is no panacea, but it is at least as helpful as posting here.</p>

19

<p>I am so sorry for your family and your sibling. I feel I could replace “Steve” with other names of clients I have known. Several are now living with their parents, and draining them of money and energy. The anti-anxiety drugs (Atavan, Xanax,etc) seem to satisfy the people involved, even tho their doses are constant and far beyond the intended PRN uses of these meds. I find these patients resistant to SSRIs or even small doses of antipsychotics, eg Seroquel, which would at least help them manage the sleep and manic symptoms. (They complain of side effects from day 1.) I also find they hunt for psychiatrists that give them what they want, and move on to others when the psychiatrists refuse to increase their anxiety meds without other interventions. I don’t find these people interested in psychotherapy. I’ve seen families spend small fortunes on rehab programs that prove of little value.</p>

<p>NAMI and NA are useful. I don’t think the OP is in denial of the problem, but needs more help in being assertive. The brother may be headed for disability, but this is a 2 year project. </p>

<p>For further info, e-mail me privately. Meanwhile, I do sympathize…</p>

20

<p>I have no more answers than any of the others, but I do have a sibling with mental illness, so I know the difficult road you are travelling.</p>

<p>I only want to say this:

I just want to encourage you to not feel guilty for protecting your own psyche and your own family at times. We feel guilty if we are not “there” for them. But when we are “there,” we cannot really help for the various reasons you have outlined. I cannot imagine the extra level of difficulty when there is substance abuse/addiction complicating matters, as you have (I do not experience this aspect). </p>

<p>Try to allow yourself the freedom to limit the disruption to yourself and your family, in whatever small ways you can. I know that doing this exacerbates feelings of guilt, but just know that you have this right.</p>

<p>Best to you.</p>