Friday, November 24, 2006

My brother got hooked on crystal meth

Yesterday I met with the psychiatrist from the mental health team that's been overseeing his case for the last few months. Despite the fact that the symptoms of psychosis persist, he informed me that he would retain the "substance-induced" diagnosis, because it can take up to a year for meth-induced psychosis to resolve. Without a psychiatric diagnosis, my brother has access to little in the way of resources, save for traditional drug treatment, which might be helpful if he could actually engage in treatment, but he can’t. He’s so far been dismissed from three treatment centres in two months... He's waiting for admission to a fourth—this one with a better handle on meth-users’ special problems. Better handle is probably a stretch, though, because people with meth-induced psychosis really need to be in a residential psychiatric facility for 5-9 months before their brain chemistry will balance out enough to make drug rehab worthwhile. This is not available. They don't lock people up anymore. We’ve moved on to community-based care, but he’s not eligible for that, because he doesn’t have a psychiatric diagnosis. All his participation is voluntary, so the fact that he can’t keep track of anything for even five minutes is a problem. He was dismissed from one recovery house because he failed to take his meds. He failed to take his meds because he couldn’t remember to take them. Treatment centres and psych wards have released him without notifying us, which is about equivalent to dropping a six year-old child off on the street to fend for himself. This is how it goes: no case manager overseeing his treatment, no communication with the family because of privacy laws, and no resources of the type that he actually 1) needs, and 2) of which he can avail himself.

I have experience working with the mentally ill and with addicts in recovery and I've never seen anything like this, never seen anyone this vulnerable, this lost, this resistant to help. And it's not just resistance—he can't ever see that it's help. He raves. He spins like a top. If there's a way back, I haven't been able to see it for him. He wants to die. He talks about it often—how it would be easier than the life he's now living. Eighteen months ago he was as normal as you or I.

This is the problem with crystal meth: its captives are so rapidly and so profoundly undone. They move quickly beyond reach, away from everything that knows them. It doesn't happen to all of them, but this is why many of them will die.

So the psychiatrist listens to me tell him that my brother was a successful small business owner for fifteen years, that he’s shared custody and care of his 13 year-old son up until the point when the drugs took over, that he does not have a long-term drug habit, that he in fact developed this one after nine months of ADD meds, which he was unable to regulate his use of and so quit taking, that he’s been unable to comply with treatment, that he only recently started taking his meds, that he's still disorganized, still hearing voices. The doctor leafs through his file and asks about his arrest last summer for uttering threats on the phone to his ex-girlfriend, convinced she was part the conspiracy against him. I explain that he now has a bail supervisor and that drug rehab has been mandated by the court, which is good, because he’s not really anti-social, and the criminal justice stuff has so far moved him to compliance (when he can remember appointments). I don’t bother tell him about how they held him in pre-trial for a week, and how glad I was—because it was like catching a moth in a glass before he beat himself to death on the porch light—how I urged them to hold him until he could go to treatment, to not release him, how they released him anyway, and he got high, of course, because the lizard brain wants its succor and it is driving.

I thought he was going to die. My beautiful, intelligent, talented brother had grown barely visible inside the arrogant and volatile shell of a person he'd become. When he stayed at the house, I had trouble sleeping, worried that he would decide I—his nemesis—was the person behind all his misery. I was the one who called 911 when he threatened to kill himself. I was the one who called the police when he grew menacing. He’d never been violent in his life, but this drug made him hostile and unpredictable. The cats were afraid of him, and so was I.

I have been angry at him. I've been tired, disgusted, aloof, furious, terrified and despairing. I've shut him out. I've thought it might be easier if he did die.

Today the psychiatrist advised me to contact his bail supervisor, to ask him to call the mental health team and request that my brother's file be transferred to the forensic psychiatric centre. It's not residential treatment, he said, but my brother would get real case management there. They'd give him more support, more structure, and would actually keep tabs on him, supervise his meds, his rehab, his re-integration into work and community and life.

I had this guy, his bail supervisor, on the phone as my mom took my brother in to his scheduled meeting with him. Although the man had just told me he didn’t have the authority to request the transfer, that my brother wasn’t in the right funding group for that intervention—maybe it’s because I speak the language, maybe I convinced him that my brother is a good candidate for rehab, is worth the extra effort, because my brother came home and informed me that he was getting referred to the forensic psych centre. He was happy about it. He’s been taking his meds for about ten days, too, and he’s coming back to us. Incrementaly, the symptoms resolve, and he’s mostly himself now. He can feel us again—that we’re not just interfering in his life, making things hard for him, but that we're trying to help. He's still volatile, but he recovers from anger quickly. He’s remarkably cooperative. His communication skills are excellent. He’s almost three months clean.

Today, for the first time since this ordeal—his year-long descent into psychosis—began, I allowed myself to hope. I just went downstairs to find him spreading a sheet of tin-foil on the floor at 2am, but nevertheless—I have hope. Today I began to believe he would survive.

4 comments:

TenaciousK said...

I'm so sorry about your brother. De-institutionalization was such an important movement - people languished for years locked up in mental hospitals, when they could have easily led far more satisfying lives in less restrictive settings. These days, though, it's usually just an excuse to avoid providing costly treatment in situations where less restrictive care is insufficient.

The drug court program in the states is a good example of a program that works - impressive outcome data, and the ability to maintain a high enough degree of monitoring (and real, correctional teeth to ensure program compliance) that less restrictive care is possible.

With the notable exception of inhalant use, meth is the most efficient substance to employ if your goal is to turn your brain into high-tension cobwebs. Many people are able to recover, though few don't show the scars. For some, there are residual psychotic symptoms (mild) that are persistent.

There's a philosophy people use to justify withholding treatment in the states - the idea that, because a person engaged voluntarily in the acts that resulted in their compromised state, the most appropriate social response is to abdicate responsibility for their well-being. But we were all young and immortal once, and the same people who refuse to adequately fund drug treatment continue to smoke, eat at McDonalds, drive at high speeds etc. with little concern about how the impact of their health-related irresponsibility will be spread among a larger group of people, somewhere.

I've been waiting a long time for the social pendulum to shift back towards providing rational care for people with both psychiatric and substance-related disorders - when rational prevention efforts (addressing underlying social causes, not ridiculous takes on "just say no"), and treatment outcomes were assessed by issues like quality of life, rather than checkboxes and inane symptom checklists (and in which dropouts and exculsions were counted as treatment failures - part of the problem in your brother's case, undoubtedly). But I'm very glad to hear that he is going to be able to access at least a level of supportive supervision and monitoring to enhance the probability of his engaging successfully in treatment.

Public attention on social issues like drug treatment has been pre-empted by national crises like war and terrorism, but the human cost continues to accumulate, untabulated, and usually unnoticed.

Good luck, Dawn. Thanks for sharing your painful experience on this important issue. And good luck to your brother. That he wants treatment and feels positive about an event like being transferred to a forensic psychiatric unit probably speaks more powerfully about the hopefulness of his prognosis than any reassurance his correctional or treatment providers could provide.

august said...

Dawn,

Watching people in your family come undone is one of the most horrifying things there is. It must be much worse when the person is a sibling, for lots of reasons, not least because of the ways siblings can (or could) be so much help in figuring out/dealing with the rest of the family.

I've been told that one of the most important variables in recovery is that a person have someone close to them who allows him to feel loved. There must be a way of saying it so it doesn't sound so trite, but there it is. The loved will recover.

Dawn Coyote said...

TK: well, the appearance of wanting treatment may have been misleading. I had to ask him to leave this morning.

august: what I've observed in my own years in recovery is that people have to believe they deserve to get better. I do think it's that they need to feel loved, but with a subtle and significant difference from the way you've stated it: it's not that they need someone who can make them feel loved, they have to be able to feel loved.

Lots to catch up on here. Probably tonight.

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