Facing a tough decision

Discussion in 'Parent Emeritus' started by AHF, Dec 25, 2011.

  1. AHF

    AHF Member

    Hi folks. Last time I posted, I think Peter Pan had been kicked out of one step-down program and was heading off to another, basically a sober house with a lot of added features (costing $$) for dual diagnosis guys. Terrific program. But he has been home for Xmas and it is clear that he is worse than when he went in. Part of this is a depression that resists everything thrown at it. Part is a personality disorder. Part is an addictive personality, not tied up with substances or alcohol (though it could turn into that) but with poker. After the first month, we agreed to pay for the second month reluctantly, but we had faith in the program. After the second month, they indicated he was ready to move to the second "phase" of the program, so we did the same. The evidence we were given of his functioning at a higher level was that he was getting up in the morning, participating in groups, and doing his chores. But in terms of his mood or attitude, there's zero change--still withdrawn, sullen, sleeping or staring at his computer, hostile toward family, claiming to be suicidal, refusing any responsibility for the course of his life. This second phase is meant to be a transitional phase, where the guys start a volunteer job and get themselves set up with schooling and/or with interviews for a paying job; then they move to "phase 3" and actually start living the lives they've set up. Well, Peter Pan has done none of that and is no way ready for phase 3, which is also where the costs of keeping in the program become (finally) reasonable. I don't see where he CAN be ready for phase 3 by the time classes start in late January. I suspect that the folks in the program--not because they're greedy, but because they want to think of themselves as doing some good--would be happy for us to pay another month--starting January 4--in Phase 2. But we've given it 3 months already, and if we burn the $$ like this, we'll have nothing left by the time he's actually ready for help. At the same time, he's on a very delicate cocktail of medications that he surely would not self-administer properly, and he really isn't functioning. So here's my gut instinct, which I would just like to share with folks on this forum in case you have any other ideas or cautions: I think I should tell the program people now that we don't see Peter Pan taking advantage of their excellent program and we don't think we should keep putting money into it. That would mean he's out of the program as of Jan. 4. Home is not an option, so I ask them whether they think he's safe to be discharged to a homeless shelter or whether they prefer to send him to the hospital. This gives them some time to talk through what, if anything, they think they can offer this stubborn young depressive; and it shows Peter Pan that we are serious, that his actions are having a consequence, without having it all come crashing down on the day when the next month's bill comes due. The hard part would come, of course, when they let him go, if they let him go to the street. But the alternative seems destined to suck down all our funds while Peter Pan treads water psychologically or even slowly drowns. Any thoughts or ideas? I am trying, for once, to think this through carefully ahead of time.
  2. Nancy

    Nancy Well-Known Member Staff Member

    Tough decision. If you don't think the program is working there's no sense in pouring more money into it. I think what you suggested telling the program director is reasonable and lets them know taking him home is not an option. I don't think they would admit him to the hospital unless you have awesome insurance or he is an acrtive threat to himself or someone else. So that leaves a homeless shelter or a sliding scale sober house where he could file for housing assistance and possibly pay the rent himself.

    You might ask the sober house he is in now if they will keep him until he gets a job and can start paying his own way.

  3. AHF

    AHF Member

    Oh, sure, they will keep him. But the cost is much, much higher than a regular sober house. And I would support his being in a regular sober house, but that's my point--I don't want to drop this bombshell on the day the next payment is due, because he will just go into victim mode and they will be faced with putting a completely dysfunctional young man on the street or tossing him into the hospital (which may well simply toss him back out). It is AWFUL having a poker-addict difficult child--he ups the ante, gauges his odds, bets on my compassion for him.
  4. Elsieshaye

    Elsieshaye Member

    I think your plan is a sound one. You can't do more for him than he is willing to do for himself at this point, and honestly he sounds like he's just marking time and not working on things. It's very hard, and I'm sorry that things came to this point, but I don't see what else you can do.
  5. susiestar

    susiestar Roll With It

    It is not a fun or easy situation, is it? I am sorry it has come to this. I think you are right to give him a week or so notice that you are not paying another dime for a program he isn't committed to. in my opinion at this point it is time to get firm, even hardened, and cut off all $$ and support other than maybe a pay as you go phone and emotional support. ANY $$ you give him goes to his addiction. He clearly hasn't hit bottom or committed to the program. he is doing the program to keep you off his back so he can gamble as he likes. No matter what it is you give him, a place to sleep, food, clothes, it just means he doesn't have to spend that amt of $$ on necessities and can spend it on poker.

    He is 22. He is NOT a child or teen no matter what he wants to be. If he wants someone to baby him, then let hm go find a rich girlfriend to care for him. Until such a fairy godmother, or I guess a Wendy is more in line for Peter Pan, comes along, he NEEDS to live with his problems, not have you support him and enable his addiction.

    I would continue to pay for medications IF and ONLY IF he could prove compliance. Maybe having him take them in front of someone at a sober house, etc....

    It is a tough problem and the answers are not easy. It si easy for me to type that you should NOT give him anything, but at least a million times harder to do it.

    He will likely threaten suicide if/when you stop paying for the program or giving him whatever you are now giving him. Make SURE you call the hospital and tell them he is a danger to himself if he utters those words. DON"t let him get away with-o the psychiatric exam even if you have to keep calling each time he says it. Even fi the ambulance leaves with-o him and he then starts telling you he will hurt himself, don't give in and do call 911 again.

    Most of all, listen to your instincts. They are telling you that Peter Pan is not sincere about getting hlp. Until he is, you are tossing away your $$. It is time to make this Peter Pan's problem, NOT yours.
  6. DammitJanet

    DammitJanet Well-Known Member Staff Member

    I have to say this is something I dont have a ton of experience with but my gut instinct is to say that it is time to cut the money off. He isnt even attempting to try to help himself. I wouldnt say this if he was making even small attempts but he isnt. I wish there was something like a methadone clinic where he could go to have his medications administered. That would be ideal if he would use it. Of course, that would also mean he would have to be in one area. But at sometime he is going to have to grow up enough to become responsible for himself. This just might be the time he has to do it. I dont know what medications he is on but there may be a way that he can have them in long acting forms. I know some come in shots that can be given in weekly forms.

    I dont know. Just throwing out some ideas.
  7. AHF

    AHF Member

    Yeah, the medications part of this decision is really tough. He is currently on a last-resort antidepressant, with the next step being ECT. I wonder if any of your difficult children on this forum have gone through ECT? I've thought of bringing it up with the psychiatrist associated with his program when we speak--which we surely will--this week.
  8. DammitJanet

    DammitJanet Well-Known Member Staff Member

    I havent but I have heard of a new treatment that isnt quite as severe as the ECT that we all think about. I cant remember the name but the next time I see the commercial I will come back and post it.
  9. rejectedmom

    rejectedmom New Member

    Janet are you thinking EMDR? We did EMDR (brain wave entrainment) and bio-feedback with our difficult child#2 It was expensive and didn't help.
  10. AHF

    AHF Member

    Yes, we've had one very expensive shrink try to tempt us with TMS, so I read up on it and learned the it is useless too. The only therapy shown to have better results than placebo is ECT, scary as that is.
  11. susiestar

    susiestar Roll With It

    There was someone here a couple of years ago who tried the newer version of ECT (NOT the primitive stuff used decades ago) on her adult difficult child. The difficult child was greatly helped in the short term with the severe depression and suicidal ideation, or so the poster reported. I cannot remember the name as this person wasn't here for very long. I do NOT know if they had long term good results, but the results after the first 2 sessions of ECT seemed promising.

    Have they tried using more than one medication for depression? Wiz did not pull out of his depression until he was on THREE antidepressants. yes, THREE. Strattera was for adhd but is also an a/d. He was on luvox (psychiatrist called it prozac on steroids as it is closely related to prozac but much stronger) and the 2 medications had good results but Wiz still wasn't sleeping. then the psychiatrist added trazodone and not only did Wiz sleep, he really started to emerge from the depression. After a year on it he even stopped wearing all black clothing all the time - which was a HUGE change for him.

    I know at one point I was on a combo of medications for depression that would not go away also. I think it was topomax and something else but I can't remember because I had 2 kids on medications at the time and it was 6 or 7 yrs ago. But maybe using different types of antidepressants together might help?
  12. DaisyFace

    DaisyFace Love me...Love me not

    I know someone personally who went through ECT. She reported that it helped GREATLY - at first.

    Years later, she still struggles with severe depression...
  13. AHF

    AHF Member

    Peter Pan has been on at least a dozen antidepressants, frequently mixed with cocktails of other drugs for bipolar, psychosis, you name it. No help from any of them. And now the story has taken a new and more urgent spin: The folks at the program don't think he should continue there past the first week of January unless there's a radical change. Bringing him back there this afternoon, I tried to get it through his head that he was closing down his options, and no, I was not going to come in and rescue him. Don't think he heard me. Strange how hard of hearing they can get. I did put it back to the treatment team that THEY need to decide if he is safe to discharge to the streets; they were trying to tell me I should take him to a private-pay psychiatric facility, which a) we have tried and almost gone broke doing, and b) didn't help. So either they let him go or they send him to the public hospital. He is 22. It does not have to be my responsibility. right? (Please tell me right!)
  14. DDD

    DDD Well-Known Member

    I wish I had something relevant to contribute to your thread. Sadly, I don't. I did want to post however to say that I understand the poker addiction. Our difficult child#1 who has had ongoing problems with substance abuse (and Traumatic Brain Injury (TBI) issues) got WAY too hyped about poker a couple of years ago. I never mentioned here on the Board. Fortunately the interest has ebbed but for awhile he "knew" all the high stakes poker people on television and...sigh...was going to three places in our small community to compete on poker nights. They are sanctioned somehow and he expected that he would have enough recorded points to go compete in Orlando. Then...who knows why...when he was close to that "goal" he decided not to continue in the local competitions. I didn't understand it then. I don't understand it now. I "think" that poker became a substitute addiction as he was weaning off drug use. It's hard to know with our complex difficult children. Just wanted you to know that you are not alone in that boat.

    Sorry I have no advice on the overall picture. I know that my husband and I are still working daily because our future funds went for the support of the difficult child's. It does get to a point where it is scarey and I hope you can avoid that stage. Hugs. DDD
  15. DammitJanet

    DammitJanet Well-Known Member Staff Member

    I dont know why you feel that TMS is useless because it sounds pretty good to me. I would have to try it and fail miserably before I would try ECT. I think you are definitely being put in a really difficult position due to a young man who is refusing to take control of any part of his life and I think he is capable of doing so if he wanted to do so. As you said, he will figure out how to play the odds. Maybe you need to call his bluff at this time. He may show you that he is more capable than he is letting on. After all when push really comes to shove people do have to figure out something even if it is a homeless shelter and food banks. That will get old too and that may lead him to look for a job. Never know.
  16. Elsieshaye

    Elsieshaye Member

    No, it does not have to be your responsibility. He needs to take that for himself.