Which comes first . . . the chicken or the egg?

[Kathy813]

Or in difficult child's case, is she a substance abuser because she is mentally ill or is she mentally ill because she is a substance abuser?

Here's an update to my last update . . .

After we found out that difficult child forged a check when we were out of town to buy alcohol, we told her that she had to leave or we would press charges. She supposedly had a job lined up so we paid for one month's rent for her to rent a room in a house. She got kicked out 2 weeks later after she got into a fight with the people that owned the house.

During that time we were dealing with husband's mom having a massive stroke and dying a few days later. We couldn't deal with finding difficult child a place to live at the same time so we let her come back "temporarily" and go to husband's home town with us for the funeral. She acted well while we were there but as soon as we got back she took a credit card out of my wallet and went to a gas station and bought cigarettes and beer. We told her to leave on the spot.

She said she had nowhere to go so she lived in her car for a couple of days and kept coming back and parking in our driveway. Finally, she started texting me that she had no one and nowhere to go and that she had "taken something." I made her text exactly what she had taken so she couldn't change her story later (as in the past) and she said she had taken 20 Celexa.

We took her to the emergency room where she did change her story to taking 8 Celexa. The triage nurse was awesome and called her on her behavior and told her that she was 26 and it was time to start taking care of her own problems and that her parents were going to get tired of the drama and stop reacting. She took difficult child off to another room and told us that we should go home. She said it was time for difficult child to have to face the consequences of her actions and that this would continue the rest of her life unless she hit bottom. She said that difficult child would be held and then taken to a psychiatric hospital and a social worker would work with her from there.

They kept difficult child for three days and I talked with the social worker while she was there. She said that the doctor thought that difficult child's problems were more substance abuse than mental health. He recommended a residential treatment center. Of course, difficult child has no insurance so that is a big problem.

She ended up going to the community health center where she gets her medications and they have a 30 day inpatient treatment center for substance abuse recovery and which is followed by an outpatient program. Since she has had no income for the past year, she will only have to pay $700 instead of the usual $7000. Of course, we will be the ones that have to pay the $700.

She supposed to go in Monday morning. She is already working an angle about being allowed to come back here after the 30 days. She is currently staying with a friend's mom that has taken her in before but the woman made it clear that it was only up until a bed opened at the treatment center. We told her that we would be willing to support her recovery and perhaps help with expenses for a half-way house but that we would not let her come back here to fall back to her old ways.

We'll see if she really goes in on Monday. But it has me thinking whether it was substance abuse all along that really was the problem. Or is it a combination of bipolar/borderline and substance abuse? If it’s the second case, it makes me wonder what the chances are of a real recovery and for difficult child having any semblance of a normal life.

It is so sad.

 

[InsaneCdn]

Yes, it is a chicken-and-egg question. Partly because... it cuts both ways. More likely, if you really could go back to the beginning, there would be an underlying mental health issue, that lead into the substance abuse. BUT... substance abuse makes mental health issues worse. And worsening mental health... leads to more substance abuse.

Somehow, you have to solve both problems. Makes sense to start with substance abuse... but without solving the other, you might not get to the bottom of it.

At least, it was that way for my bro... depression first, then drug and alcohol abuse. But he had to get help for the addictions first, before he could go back and address the depression.

 

[Hound dog]

Sad, yes.

I guess the only way to figure out which came first is to know exactly when the drug use came into play vs when her symptoms of "mental" issues appeared. Addiction mimicks mental illness symptom wise to a scary degree. I say "scary" because if they're being medicated for "mental" issues and it's addiction......then how much are you feeding into the addiction and making it worse? It's awful but the vast majority of addicts have figured out to play the mental health system to fund their addiction. If the medications they get they don't want, they simply sell them for the ones they do want. BFF did this for years.

If rehab is not her idea, I'd keep that 700.00 in my pocket. Or go out and buy something nice for myself with it. Because if she's not hit bottom, and it doesn't sound like she has quite yet, you're just throwing it away. I know that hoovers to hear, but it's just the simple truth.

Hugs

 

[keista]

Very sad, and I'm very sorry you have to deal with it.

in my opinion Mental illness always precedes addiction. What makes the whole situation even sadder and more difficult is that the preceding mental illness does not necessarily have to be severe to cause severe addiction. Even a "mild depression" if not identified and treated can result in "off the charts" addiction.

Once addiction has set in, that's the first thing that needs to be addressed, but if the underlying illness is not addressed simultaneously or soon after, prognosis is not good. The best example of this is the "dry drunk". A person may stop drinking but not much else has changed - personality, behavior, etc. That's the mental illness. The 12 step programs are successful because they touch on the deeper issues. they don't necessarily look to identify mental illness, but the program does have therapeutic strategies in place to deal with such symptoms.

I'm certainly open to the possibility of "stand alone" addiction, but have personally never seen it. Even socially acceptable addictions - coffee, cigarettes, food - have a mental health based cause. It may not necessarily be a true illness, but certainly a deficit of some sort - loneliness, low self esteem, emotional desire/loss.

 

[toughlovin]

I don't know if it really matters which came first. Certainly there are people much more prone to addiction than others and it may be that normal every day feelings and issues for those people lead to addiction. Addicts deal with difficult feelings by using drugs or alcohol and we all at some time or another have difficult situations and feelings.

But I think many who have underlying mental health issues start using drugs or alcohol to in a sense self medicate and the substance use becomes a problem in and of itself and they may not recognize or deal with the mental health problem.

Ultimately I think both mental health and substance abuse need to be treated, hopefully in some kind of dual treatment.... although I do think a person needs to be sober to deal with the mental health issues... clearly you can't really do that while using.

We are in that situation right now with my son. He was recently hospitalized because he was suicidal. They started looking at his mental health issues and actually have a program that deals with some of his personality disorder issues which was helfpul. He wants help with this piece because he is realizing he has problems in his relationships and life due to these issues. He was discharged from inpatient and went and used drugs, and the program basically strongly suggested he get readmitted and he is still there. They also have told him he needs to be sober for 30 days and the strong recommendation is for residential substance abuse tx. I think he still thinks he can be sober on his own (which I think is a fallacy that would lead him to using) but is willing to go to residential tx if that is the way to get the mental health treatment.

So in his case his desire for the mental health treatment may help lead him to substance abuse treatment. That is my current hope and it is very clear to me he needs both. He needs substance abuse tx because he has to learn ways to deal with his issues and problems other than by using substances.... and he also needs mental health treatment (and medications) because he needs to get at the issues driving him so strongly to need something to help him cope.

I don't think either treatment alone will help him long term.

It is complicated.

I think you are taking the right stand about what happens after residential. I strongly support you in not having her come back to your home. That won't be good for her or for you.

TL

 

[Nomad]

I'm so sorry.
I switched jobs very recently, but was working with substance abuse/abusers before that for six months and did notice that in the GREAT majority of the cases, there were other things going on like depression, bipolar illness and/or personality disorder (s). I would say in about 99% of the cases.

As long as she is using, it will be more difficult to treat any under lying illnesses.

We provided therapy and things like depression were addressed along with addiction. It did seem to make some inroads.

I hope and pray she does both the inpatient and the outpatient programs.

Special prayers for your family.

Surely, this has had to be very hard for you and your hubby. Remember the Serenity Prayer. It comes from a place of truth and empowerment.

 

[DammitJanet]

I would say that most times the mental illness comes before the fall. I believe most people who are able to socially use drugs recreationally and then just stop at any time, aren't using them to self medicate anything. That should make obvious sense...lol. You only need to medicate if you have an illness.

 

[DDD]

I had hoped that no news was good news, Kathy. Sorry to hear that the rollercoaster ride continues. I tend o think that the mental health issues make our difficult children more vulnerable and therefore self medication is more likely to occur. No matter which theory is accurate it is a heck of a way to live for the entire family. I'm sorry that you and husband have lived through so many years of chaos. It just tries the soul. Sending hugs. DDD

 

[Nancy]

Kathy I wondered the samee thing. Our difficult child was a major difficult child long before the took her first drink. The drugs have now become the focus of why she acts out. I hate those texts asking to come home and saying they have no place else to go. It tugs at your heartstrings. I hope she goes into treatment Monday and that she is successful. You know from my story that treatment is difficult and they are very resistant. It's a start and there is reason to hope, but a halfway house is where she needs to go after treatment. Hard as it was to do, making her go to a sober house was the best thing.

I'm sorry this is happening. Haven't we lived like this too many years already? Why do they want to continue living like this. I can't make sense out of it.

Nancy

 

[BusynMember]

I think people with depression and other mental illness and certainly personality disorders are far more prone to using drugs. However, it's all intertwined because nobody can get better while they use drugs or are addicted to drugs.

 

[toughlovin]

I have been thinking about this. I think there are a lot of factors... I don't think it is always cooccuring mental illness. Sometimes it is major trauma in ones life. I think (and this is just my own opinion and not based on anything but that) that most people who are addicts become so because they learn that using drugs or alchol helps them cope with life and drowns out their problems. Obviously it is not a good or healthy coping skill but that is what it is. I don't think an addict can just stop using and be better with no other supports. They need to also deal with whatever thing they are tyring to cope with... so that may be mental illness, it may be some sort of trauma, it may be somethingn else.

 

[Nancy]

And that TL is my biggest complaint about treatment centers. Unless you deal with the underlying factors you can't get well. It's not just about drinking or using drugs, it's about why you did that in the first place.

Nancy

 

[toughlovin]

Yes I agree... and that is what is making me hopeful right now..... we are looking at dual diagnosis programs and looking at a follow up outpatient program to deal with the mental health issues... it has become crystal clear to me unless my son deals with those issues he will not stop using, at least not for long.

I know a woman who is inspiring to me. She at one time was a pretty hard core heroin addict. I first met her fairly early in her recovery.....lots of background which I won't go into but she has been sober now for 5 years. She is working hard though now on all of her issues and trauma history. i have a huge amount of respect for her. She gives me hope that it can be done.

TL

 

[Star*]

I was told - the substance abuse is not necessarily because of mental illness, but mentally ill people are more easily LED into it because of their low self esteem, wanting to find a "family" to fit in with, sadly - being on government funded programs with a constant source of money - and dealers know this too.

I think people who have addictive personalities and genetically born from alcoholic parents are more likely to become alcoholics and will have a harder fight to stay sober. But as far as drugs? I don't buy mentally ill having a greater factor/cause with that. If that were so - I think there would be more DOWNS kids and Aspergers kids, and the like on heroin - see where I'm going wtih that? (no offense to anyone) Just my opinion.

I think it all boils down to self -esteem issues and dealing with layers of history, pain and stuffing emotions too painful to deal with OR not really knowing HOW to handle anger for years and turning it inwards to rage or depression and thinking drugs will calm you down or pick you up. (self-medicating) That's not mental illness.

 

[InsaneCdn]

Star - its well known that ADHD kids who are not diagnosed, or not properly or successfully medicated, will self medicate, and the drugs of choice are... caffeine, nicotine, alcohol, marajuana, and cocaine.

Now, ADHD is NOT a mental illness. But... for these kids, it definitely comes first.

There are a handful of drugs that can capture even a easy child - crack and meth being two of them - where once can be enough to get addicted. So... which comes first depends on the person, and on the drug... like most things, nothing is simple!