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: 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.