Expert: Beverley Glazer - 11/9/2009

Question
My 46-yr old brother is an addict with mental health issues. In addition to being in denial about his addiction issues (alcohol is his current drug of choice), he is either incapable of seeing or also chooses to deny that he has mental health issues. He literally has the mind of a 14-yr old and can't handle the responsibility of adult life. The mental health issues have been going on for yr's and due to a lack of treatment are getting worse. He's on disability welfare (his mental state is his disability) but cannot live even on this higher than normal rate of welfare. It was getting very heartbreaking for my Mom to watch him choose alcohol & cigarettes over food and so now for the last 3+ yr's she's been taking him on a big grocery shop 1/mo so that he sustains himself on more than a pot of white rice/day. Both she & I suffer from chronic illnesses, so supporting him in both physical & emotional senses is difficult for us both. I have chosen to pull away as I still try to work as much as I can to earn a living. My 63 yr old mother is getting close to the end of her rope and clearly this cannnot go on (it may only be 1/mo, but being with him and talking to him is very draining, and seeing the way he lives [in squalor] is hard to watch). Re: the alcoholism, everyone says to stop enabling him and give the tough love: let him hit rock bottom. We really believe that he does not have the 'where-withall' to make better choices; his mental health issues started with a personality disorder and ADD/HD, but now include schizophrenia (he halucinates) and dillusion. I've called the Schizophreniac Society and they've said that until he can admit he has a problem, there really isn't anything we can do. I've also called VCH re: assisted living kinds of situations and the waiting lists are ridiculous and he would only qualify if he's on medication. He talks about suicide and has even talked about actions that involve harming others. We don't feel that going to Al-Anon is really going to help us given the combined mental health issue, and hearing that there really isn't anything we can do if he can't admit he has a problem doesn't leave us with much direction. Even our family Dr. who is the one who got him onto disability welfare doesn't feel that anything further can be done with or for him if he's not willing to want to change/see that he has the problems he has. We don't enjoy being with him but also feel very sorry for him as he has no friends and has never had a relationship. Can you offer any advice as to the approach we should be taking?

Answer
Hi Liz

This is a real problem for both you and your mom. Unfortunately unless someone wants to get help you cannot push them into it.

There are a few things however, that both you and your mom can do. The first one is that you must  stop enabling him. I know that you know that, and you're afraid that he will fall lower, but it doesn't have to be that way. When you enable someone, you're giving them permission not to change. This is somewhat different then tough love. Here is some information on enabling that may help you, but keep bringing him food.

Http://www.untwist-your-thinking.com/enabling-behavior.html

The hallucinations and delusions may not be based on schizophrenia. They may be due to drinking and/or drug use.

But since he talks of suicide and actions that involve harming others, you now may be able to mandate him into treatment. Tell his family doctor and ask him for a referral to a psychiatrist for a psychiatric assessment.

It may also be necessary for him to go into detox or a rehab before the assessment, but don't feel sorry for him. At this point in time he is not capable of having friends or being in a relationship. He has to get help first.

Now, since he's a threat to himself and others, you and your mom are in a good position to have the medical and mental health care that he needs. Not easy I know, but at least now he will get help.

I hope that this information is helpful,

Thank you for asking AllExperts

Wishing you the best

Beverly Glazer
http://www.untwist-your-thinking.com