Question: My sister is allowing her brother in law to stay with herself, her husband and her two young children. This man was arrested for resisting arrest and assaulting police officers while hallucinating. He was a heavy drug user (marijuana) and was not his medications for schizophrenia. If he continues to use marijuana (he does) will hes medications work? If they do not work are her children possibly in danger?

Jennifer Liles Says...:

I can't answer whether this gentleman is dangerous any more accurately than this: Every human being is dangerous in some circumstances. Mental health issues, including schizophrenia, do not typically make people with them more dangerous with people without them. However, some people who use drugs become more dangerous, either because of the effect of the drugs or because of the effect of the cultures they sometimes engage with to obtain drugs.

I am not a psychiatrist, and I do not know the man in question, so I can't state for certain how his medications and marijuana use might interact. I have seen people for whom that was a very bad idea, and others for whom it posed little problem. In general, mixing drugs without discussing it with your physician is a bad idea. 

People with schizophrenia can be dangerous when off their medications, if their delusions and hallucinations lead them to paranoia and fear. It is pretty common for police officers to mishandle mental health situations, so I cannot speak as to whether this man's arrest for assaulting a police officer is a good example of his 'violent tendencies'.

That said, the best predictor of future actions is past actions. If this man has been violent to family members in the past,he may very well be dangerous to them in the future. Your sister may have thought all of this through and has a good understanding of setting boundaries and dealing with mental health crises with him, or she may not.

If your sister feels unsafe, then she might want to have a discussion with her husband regarding alternative arrangements for her brother in law. She might also want to have a plan in place in case of a mental health emergency. 

I strongly suggest that you and she contact NAMI (National Alliance on Mental Health) on their national help line at  1 (800) 950-NAMI (6264) to find a local chapter for assistance and perspective on this situation. If you can find an organization teaching Mental Health First Aid in your area, that is also a good resource. 

Your sister has taken on some major responsibilities, between her children and her disabled brother in law. If you can offer her support and respite from her caretaking tasks, that will probably be a tremendous help to her. 

Good luck and I hope things go well for everyone involved. 

Question: What is the best way for a person that has agoraphobia and who is also an alcoholic to learn to stop drinking. I have tried online 12 steps meetings but they are not really helping.

Jill Edwards Says...:

I wish I could talk to you direct, but I will deal with the situation in broad terms and hope that some of it may be helpful.

In your position, it would seem important to stop drinking in stages, to reduce slowly, or at least to get some medication to help if you are going to stop suddenly.

You should work to change your situation in small steps, which feel manageable for you.

You need to do more activities in your house. You can choose any activities which you like. If at present you do not know what you like, then do exercises, but do them regularly, some in the morning and some in the evening.

If the weather is nice, I suggest that you sit by the door and get yourself used to this transition environment. Then progress slowly increasing the distance from the house by 10's of steps. Be sober when you are doing this.

Fundamentally, you need to experience the things that you fear, but in small manageable amounts. Together with this, you need to accept that if you want a life, if you want to live in the way you would like, then you will have to accept some of the pain of making the transition.

If there are psychological events, which have set up your situation, perhaps you can find on-line or telephone counselling that can help. That position applies to your drinking and your agoraphobia.

So spend as much time as you can thinking about what you would like to do in life. Picture what you want and proceed in small steps, accepting the fear and the pain as you go.

You may find the book. "Get out of your mind and into your life, the new acceptance and commitment therapy" useful. It is by Stephen Hayes and Spencer Smith. You can get it from Amazon.

My best wishes!

Question: If I have a dual diagnosis of alcoholism and depression. And both are documented by my doctor. And I go to AA 7 days a week and take Paxil. Can I be fired by my employer for being hungover at work? I am really trying to overcome my diseases but I threw up in the parking lot of my workplace. It just happened. Many of my coworkers witnessed this. And I was called into my bosses office that morning and fired. I told my boss I had a disease and I was getting treatment but he was disrespectful about the idea that alcoholism is a disease. Do I have any rights under the law for protection from harassment or firing because I have a disease? I feel like no one would fire a person that had cancer and had chemo and thrown up! I wish people could understand that ALCOHOLISM IS A DISEASE!

Jennifer Liles Says...:

Your question is more a legal one than a mental health one, and I don't know what state you live in so I can't be precise in my answer -- but yes, unfortunately in most states you can be fired for any reason.  I would definitely consult a lawyer if you think this is not the case where you are.

Even in states that are not 'right to work' states, any behavior that interferes with your ability to do your job can lead to firing. You may feel that you work 'well enough' when you are hungover, but your boss may have had a different belief. 

Alcoholism is a disease. It is a treatable disease, and the treatment is highly successful. Like other diseases such as diabetes and heart disease that have a lifestyle component, you have to change your behavior to get better. I'm sure you are aware of this and are doing everything you can.

My favorite definition of addiction is W.A.R.T: With Addiction Repeated Troubles. These troubles can include things like losing jobs and relationships, having physical symptoms such as hangovers and trembling hands and ulcers and liver damage, having legal issues related to the substance, etc. You are aware that you have a problem, and that is a great first step. 

I am glad you are going to AA and taking your Paxil. I worry that your Paxil may be being undermined, however, if you are still drinking. You might want to talk to your psychiatrist or GP about this and ask about one of the new drugs out there that can help you quit drinking, so that you can get the full benefit of your anti-depressant.

When I worked in substance abuse, one of the cues that told us that someone would benefit from residential treatment was when despite working hard on quitting (as you say you are, and I believe you are or you wouldn't be reaching out) they cannot stay sober on their own. I am not saying for sure that you need residential addiction treatment, but it is definitely something to consider at this point. 

One important point I would like to bring up that you might already know is that alcohol is a depressant. When you drink, you actually make your depressive symptoms worse, even though it might not feel like it when you first start drinking. 

In addition to the Paxil and the AA, if you can do it you would probably get a lot out of therapy. Be sure to do a bit of 'shopping' and pick a therapist you feel you can work with. Someone who has worked with people who have both addiction and depression is a good choice. 

Keep working hard like you are doing now, and eventually you will beat this disease. The only way it wins is if you stop trying. Good luck to you!

Question: I realize that in general alcohol is not good for mental health, but does it relate specifically in any way to depersonalization? If I drink socially will it make my symptoms worse? If I get drunk occasionally will that be a big problem or make things very much worse? I currently do not drink at all but I would like to be able to go out with my friends to clubs. I am trying to have a ‘normal life’ even with my problems and this seems like it might be a normal part for a person my age (22).

Jennifer Liles Says...:

One of the primary effects of alcohol is to lower inhibitions, so if you are looking for a 'quick fix' to feel less self-conscious, it would do the trick. However (and this is a huge however), most addictions start when someone uses a substance or behavior to solve a particular problem (such as feeling self-conscious). 

Gradually the original problem (which is often a problem that can be fixed relatively easily by changing behavior or thinking or both) becomes a secondary problem, and the substance or behavior (such as alcohol or gambling) becomes the problem.

I don't recommend starting to drink to solve a problem that appears to be self-consciousness and perhaps some social anxiety. It is absolutely okay to go out to clubs with your friends, announce to the bartender that you are designated driver, and get free or reduced price sodas all night.

Another factor to consider is your family history. If you have any blood relatives, especially first degree (mother, father, brother, sister) who are addicted to any substances, you have a greatly increased chance of developing addiction from social drinking.

For some people it is 'normal' to drink regularly in their twenties. Many of these folk, however, in their thirties, forties, and fifties have difficulties with relationships, jobs, and other issues in their lives because instead of learning how to cope, they drank. Many 'normal' people don't drink at all or drink very little.

Some ideas for mingling socially when you're feeling self-conscious:

• Have an 'anchor friend' with you who knows you well and can be relied on to reassure you
• Spend time before social events 'rehearsing' simple social events in your head and imagining them going well.
• Reminding yourself that no matter how interesting and attractive that person you just met is, he or she probably has insecurities of his or her own.
• Remembering that people who listen well are perceived to be intelligent, kind and interesting. Your side of the conversation can be (mostly) questions about the other person.
• You can't hear well enough to talk at most clubs.

And as an FYI: The best dance partner I ever had was the absolute worst dancer I ever met – absolutely no rhythm, but incredible enthusiasm. He was so much fun I forgot that we looked like idiots dancing together. It has been twenty years and I still remember him fondly.

Adding a substance to a problem very rarely improves the situation. It can help give you respite from the situation, but so can good conversation, meditation, baths, a good book, music, dancing, and a multitude of other ways to spend time.

Here's another thought: some people are naturally introverted and find the club scene a bit overwhelming. These are still social people, but their idea of fun is small groups, conversations, and interactions. If this describes you, there's nothing wrong with you. We live in a society that values extroversion, but over half of the population is introverted.

You didn't describe your 'symptoms' here, so I can't speak as to whether alcohol would 'cure' them. Be assured that being self-conscious and nervous about social outings to some degree is normal. All too often we decide we don't like parts of our personality and describe those parts as 'symptoms' instead of 'important bits of who I am'.

You are okay just as you are. You are not broken. You do not need to be fixed. If you are unhappy with aspects of your life and your behavior, you can work on those, but those are not 'you'. If you are already feeling somewhat 'out of control' in your life, drinking won't help that, not in the long run. Working on accepting yourself and improving those bits you want better, on the other hand, can work wonders.

Good luck, and I hope your next outing with your friends is a wonderful one.

Question: How would you explain a total personality change after addiction? Let me explain. My brother was the sweetest guy you’d ever want to meet. Then he got into drinking in his teens and drugs in his twenties. He hit rock bottom by the time he was 25 and went into rehab. Now he is 27 and he is still clean. However, it’s not a happy ending. Something happened to him when he was using drugs. He became an A-hole, for lack of a better way to describe it. Where he used to be sweet and considerate he became callous and selfish. We all thought it was the drugs but now that he has stopped the drugs his personality has not reverted. He is still a jerk and this is so hard to take. It is really a noticeable personality shift. It is like he is a different person. As I understand it this is not really a normal thing to have happen from drinking and drugs. Do you think he probably has a psychiatric condition that is still undiagnosed?

Jennifer Liles Says...:

It sounds like you're grieving for the kid your brother used to be and wondering (and hoping!) that the sweet kid comes back – and that is your real question. Is it possible that he has an undiagnosed mental health condition? Absolutely, yes. 

It's also possible that there is something that happened to him (that you may or may not be aware of him) that fundamentally changed him.  It's possible he's still (secretly) using drugs or drinking, or has switched to a non-chemical addiction (such as gambling, or sex) and is still displaying addictive behavior.  

None of that is really the point though. The point is that the person he is now is not the person he was then, and you want to know whether the sweet kid is still in there. 

I honestly don't know, without knowing more about you, and him, and the situation, whether that sweet kid is still there. Is it possible to talk to him about this? Perhaps just honestly saying “I remember when we were kids, (this thing) happened, but now things are like (this). Why is that?”

Do you or any other friend or family member have some sort of influence over him to convince him to get an assessment? Have you ever noticed symptoms above and beyond 'being a jerk' that might be depression or anxiety or trauma? 

Some other questions for you: Can you avoid him when he's 'being a jerk' or are you stuck with him? Are you ever afraid of him? Can he sometimes be talked into mellowing out and being 'halfway decent'? 

I might start by picking a time when he appears to be in a pretty good mood, and let him (gently) know how you feel, including your worry that maybe he's depressed or has something else going on. If he's receptive, offer to go with him to get assessed, or to help him in some other way he might tell you he need. If he gets rude or acts like 'a jerk', it might be time to assess how much you want him in your life, and distance yourself.

The first couple of years of recovery from an addiction can be very stressful times. It's possible he's still experiencing significant cravings, has guilt and shame from his addiction and/or things he did while actively using, or still has some brain chemistry issues going on.

It sounds like you're coming from a place of love and concern, even though you also sound frustrated and annoyed. I don't know if you have the power to change the road he's on, but I think that if you speak to him from that place of love and concern, you'll feel better about yourself, and possibly be able to find a new path that accepts your brother (oddly, sometimes when people feel accepted, the 'jerk' stuff starts to go away). 

I can't promise he will change or seek help. But you're asking good questions, from a good place. He's lucky to have you in his life regardless of how he's acting. 

Question: My insurance company is giving me the run around, while attempting to get into inpatient dual-diagnosis rehab. They are not responding to the different facility who are attempting to get claims approved. Today I'm finally picking up my referral from an in-network psyc dr. for in patient rehab. What key elements need to occur for insurance companies to have no choice but to authorize treatment?

Dr. David Sack Says...:

There are several factors related to meeting "medical necessity" for treatment:

1. The amount/frequency of Drug/Alcohol  use and/or the need for a medically monitored detox
2. Recent failure of treatment at a lower level of care (for example, outpatient treatment)
3. The presence of a co occurring disorder such as diagnosed clinical depression or anxiety
4. Medical problems and medication history
5. Legal issues related to use
6. Family or work problems related to use
7. Employment that combined with substance abuse puts self or others in jeopardy, for example Nurse or Pilot. 

Not all of these examples are required however your assessment must demonstrate the severity of your problem in order to meet the insurance companies criteria for residential treatment. 

Question: I don't know what to do. Work is becoming very unbearable. I am becoming angry, depressed and feel cornered. I am a recovery alcoholic. I have a sponsor, attend meetings, work steps, and practice principles in my life. I have a wife and kids I am responsible for. Right now I am hurting so much I feel like cutting, not suicide, just to hurt in a different way. I have been direct with my coworkers and I am not getting any support and I am being left being the only one working long hours sometimes all night. I know changing jobs is an idea, but right now I have a major project due Monday morning and I am responsible to that client to get it done. I feel really taken advantage of. Everyone else is at home with their families and I am left working, not spending time with mine. My boss seems to praise those around me who do just enough to show face and get paid and I don't get that pat on the back. Honestly I really don't want it. It would be nicer if e everyone else was doing their part and we worked as a team. Right now I am the team. Today I have really wrestled with anger, hurt, depression and I have had many moments where I am almost at a breaking point of just walking away from my job. I don't know what to do. I do suffer from major depression and I am bipolar. Unfortunately I don't really get any mania, just depression. I do see professional help for it, but I keep having these moments, where this is too much for me and I it is all too unbearable. I am almost broken to a point where I am scared and confused.

David Shannon Says...:

When you wrote this, you were experiencing a particularly stressful and discouraging time at work.  But it sounds as though this is an ongoing issue for you on that job.  Have you discussed how you feel with your supervisors?  Would they be open to having that kind of talk with you?  It would probably be important to figure out a way to do it, that did not sound like just complaining.  Perhaps you could stress how important it is you to be a team player, and ask for clarification about your role on the team.  And you might mention that getting a little recognition for your contributions could boost your morale and have a positive effect on your performance and productivity.  Does your supervisor know you have depression?  Have you discussed that and how it affects your job?  You are in a particular job in a particular situation, with particular people involved.  If you have not already been doing this, I would discuss this with your therapist, asking for specific help to plan a strategy for dealing with this.

Do you and your therapist talk about your thinking, particularly self-talk that might be negative, inaccurate, and counter-productive?  Our thoughts have a direct  affect on how we feel.  Some would even say that thoughts are what cause specific feelings.  Developing awareness of that, and learning how to intervene to change those thoughts, is a pretty crucial skill for handling your depression.  Most therapists these days do use cognitive behavior therapy, since it is one of relatively few methods that have proven effective with a variety of conditions and diagnoses.

Have you talked about cutting with your therapist?  As you seem to understand, causing yourself physical pain can be a way of distracting yourself from emotional and mental pain.  It is a coping mechanism that may work for you, to a point.  It is one way to *externalize* the pain, rather than having it stuck inside your mind and weighing down your heart.  I always feel badly that it requires injuring and perhaps scarring yourself, however.  I am a *kink aware* therapist.  There are probably ways that you could experience physical pain, other than cutting.  There might even be someone you could trust and feel safe enough with, who would agree to give you pain in a negotiated, consensual, non-injurious way.  A lot of people would not feel comfortable doing that, but somebody might.  The key of course is the trust and safety part, and it could be hard to find someone like that.  I realize this is a somewhat radical idea, though with the recent popularity of "50 Shades of Grey", it might not be as foreign a concept to some, as it previously would have.   Cutting on yourself is a pretty radical solution too, if you think about it.

I hope that things have already gotten better for you at work, since when you wrote.  But if it seems like that is never going to happen, no matter what you try, then you may indeed need to start searching for a new job.  Change can be difficult, but staying put in an unhealthy situation may be worse.  Good luck!

Question: My 54 year old brother falls asleep in his Lazy Boy most nights after drinking too much in front of the TV. He has been a drinker for a long time so this is not new. Lately has started sleeping with a loaded handgun right next to the chair. He says people are looking for him but he won’t say who or why. He is a nice guy and he is on a disability pension and pretty much keeps to himself so I can’t imagine who would want to hurt him. I am scared he is going to accidently hurt someone else but he won’t listen to me anymore and he has been acting really weird the last 2 months or so. He is not himself and I think there is something seriously wrong but I don’t know what to do? He is paranoid and armed and drunk. Someone is going to get hurt. What do I do?

Jill Edwards Says...:

My 54 year old brother falls asleep in his Lazy Boy most nights after drinking too much in front of the TV. He has been a drinker for a long time so this is not new. Lately has started sleeping with a loaded handgun right next to the chair. He says people are looking for him but he won’t say who or why. He is a nice guy and he is on a disability pension and pretty much keeps to himself so I can’t imagine who would want to hurt him. I am scared he is going to accidently hurt someone else but he won’t listen to me anymore and he has been acting really weird the last 2 months or so. He is not himself and I think there is something seriously wrong but I don’t know what to do? He is paranoid and armed and drunk. Someone is going to get hurt. What do I do?

I am assuming that you and your brother live in the same house, so this is an immediate problem for you. Drinking for a long time can affect mental health, or poor mental health may encourage someone to drink. It would seem that your brother suffers from drinking a lot and having some degree of confusion which has led to this fear. I would like to be sure that he is not involved secretly in taking any drugs as well, as this might increase his fears and his risks. Like you I am a little concerned about the weird behaviour of the last 2 weeks. When you say he wont listen to you, I assume that you have told him that you dont like the gun being around and he wont listen to that.

It is a difficult decision to make, in terms of action, as strong action on your part might make him more scared and more dangerous and a bigger risk to you. I think it might be useful to talk to people who know him, also other family members, and get some advice from them, see if you can get to know more of what is going on. It would be proper to consult a local doctor, preferably one who has seen him before. You also have the option to consult the local mental health professionals, and if all else fails, you may need in the end to talk to the police.

It is a judgement call as to how much you can let him know that you are concerned because of accidents that happen with guns, if you notice that he gets angry, or markedly more paranoid, then you may have to leave this to the professionals. You also do not tell me if there are other people in the house, who are also at risk. This is an important aspect.

My advice is to think this over and talk to someone who knows him and together to reach a decision as to how to deal with this situation. I think the doctor will be helpful. You can make an appointment yourself to talk to the doctor.

My best wishes to you.

Yours sincerely

Jill Edwards

Question: My insurance company is giving me the run around. While attempting to get into inpatient duel diagnosis rehab. They are not responding to the different facility who are attempting to get claims approved. Today i'm finally picking up my referral from an in network psyc dr. for in-patient rehap. What key elements need to accure for insurance company's to have no choice but to authorized treatment

Jim LaPierre Says...:

It sounds like your insurance company is hoping that if they delay long enough that you will cease your efforts.

I urge you to be dilligent and to call them yourself - verify what information they need and fax it to them. Make follow up phone calls and stay on top of them. Get the name of each person you speak to and keep working your way up the ladder of supervisors if you're not getting response. 

What you have now should be more than sufficient but your insurer may require more info - again, in my experience this is all a stalling tactic. 

Stay on top of them and good luck to youi!

Question: My brother has schizophrenia. He is 22 and I am 16. My parents know I smoke weed. They say if I smoke weed I am more likely going to get the same disease as my brother. I am not sure if they are full of it or not. They are always trying to scare me away from weed and drinking and stuff. But the idea of getting schizophrenia actually does scare the crap out of me. If I smoke weed am I in more danger? I have already smoked like 500 times. Is there any point in stopping now after I have already smoked so much?

David Shannon Says...:

Your parents are not full of it.  They have reason to be concerned.  It is not clear cut that your marijuana (cannabis) use will cause you to develop schizophrenia, although the fact that your brother is diagnosed with it does increase the risk.  It may already have caused other changes in your brain, however.

I have worked with a lot with people who have schizophrenia.  But I am not an expert on the causal relationship between marijuana use and development of schizophrenia or other psychotic conditions. When in doubt, I check Wikipedia first:

http://en.wikipedia.org/wiki/Marijuana#Long-term_effects

"... effects [of cannibis use] on intelligence, memory, respiratory functions and the possible relationship of cannabis use to mental disorders such as schizophrenia, psychosis, depersonalization disorder and depression are still under discussion."

"A 35-year study published August 2012 ... provides objective evidence that, at least for adolescents, marijuana is harmful to the brain. It was found that the persistent, dependent use of marijuana before age 18 showed lasting harm to a person's intelligence, attention and memory. Quitting cannabis did not appear to reverse the loss."

http://en.wikipedia.org/wiki/Schizophrenia#Environment

"The greatest risk for developing schizophrenia is having a first-degree relative [such as a brother] with the disease (risk is 6.5%)"

"Evidence supports a link between earlier onset of psychotic illness and cannabis use ... the more often cannabis is abused, the more likely a person is to develop a psychotic illness, with frequent use being correlated with twice the risk of psychosis and schizophrenia. Whether cannabis use is a contributory cause of schizophrenia, rather than a behavior that does not actually cause the disease, remains controversial."

You haven't done yourself any favors by using marijuana so much at a young age.  Changes to your intelligence, attention, and memory may be subtle enough that you don't notice them.  But they still might affect things over the course of your life.

Although the question of whether marijuana use causes schizophrenia, or makes it show up earlier, is still being debated, if we take the 6.5% likelihood of developing it because your brother already has it, and the suggested correlation that lots of marijuana use can double the chances, then you might have a 13% chance of developing the disease.  That may or may not seem like a big risk to you.  But add to that the mental effects that are apparently better documented, and you can imagine why your parents would be concerned.

Should you be as concerned?  Probably.  You have to take the possibilities seriously.  On the other hand, there are a whole lot of marijuana users out there, and they are not all walking zombies, with schizophrenia, paranoia and other psychoses, due to that use.  But they may not have started as young as you, or smoked it nearly as much.  You are still young enough that continued heavy use might cause more of the negative mental effects.  That might be reason enough to cut way back, if not quit completely.  If you do want to quit or cut back, and find you are unable to do so, you may need professional help to overcome your addictive habit.

You've still got most of your life ahead of you, with many wonderful things to experience.  Try to consider that when making decisions like this.  Good luck and best wishes!