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.