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Thursday, 20 June 2013

Dual Diagnosis

Last night I told my son, like any mother of any child would do, "It really isn't nice to spit in the kitchen sink. I want you to go to the toilet or get a tissue". Normal. Reasonable. Understandable. From this comment and request came resistance, explanation, argument, hostility and an onslaught of verbal abuse which lasted 45-60 minutes! The things my son said to me was hurtful, spiteful, disgusting and uncalled for. I do not even want to remember them long enough to write them down.

My daughters sat in one of their bedrooms behind a closed door, together, the older one reading aloud to the younger one trying to block out the noise of his horrible shouting voice. I sat in my room, with my fingers in my ears, trying not to hear. I started to think, "I keep blaming the drugs for everything, maybe there is more to this than just drugs? This is not normal".

He stayed up all night and dosed on the sofa this morning while his sisters and I began our day, had our breakfast and carried on as if everything were normal. His reason for not sleeping last night was because he had a 10 am appointment with the social worker in his office in town. Knowing this and planning his night of no sleep in order to allow him to get somewhere in the morning did not mean he was acting responsibly. He still dozed a little too much and I had to spend my time trying to wake him and urge him to get ready for his appointment. When  I finally got him awake, I had to urge him to get ready. When he was ready it was past 10:00 am and I dropped him off in front of the Social Services Office.

Upon his return home, I ask my son how it went. My son tells me that the social worker thinks he is making good progress. The fact that he has made it out of the house and to an appointment is a great step and sign of his improvement! I had to ask the following question: "Did you tell the social worker how you stayed up all night and how I had to wake you up still, tell you to get ready and take you to your appointment?" No, my son did not. So to the social worker it appears that my son had a night's sleep, got up on his own accord to get ready for his appointment and walked out the door and headed off to his appointment like a responsible adult. Not quite what happened, but if that was what happened, than fair enough, my son would have made an improvement.

Even more amusing or disappointing, depending on your viewpoint, is that my son said that the social worker says that if he does the group sessions at the drug and alcohol clinic he has finished his recovery! Seriously??? The boy still orders benzos on the internet and self medicates, he still smokes weed, he still drinks he still takes codeine and he is nearly finished with his recovery??? I think not Mr Social Worker and the last time I checked you not an expert in drug rehabilitation!

What do these sort of comments do? They belittle our situation. They make me look like the "bad guy" or the "unreasonable one" and my son thinks, "see the social worker is praising me, why aren't you?". I would love Mr Social Worker to live with my son for just one week and see what his opinion would be after that week! This is reinforcing, in my son's mind, that I have too high of expectations.

Then it was Methadone time. Shortly thereafter the police officer came out to talk to me and then my son about the situation at home and the increasing issues with uncontrollable anger.

I could have had my son arrested today, but I did not. I could have had him arrested for his violent outbursts when he damaged my property. I said no, but next time I will. She talked to me for a long time. She took a lot of details for their "domestic violence" report. She kept telling me that he is not contributing as an adult and is an adult and is misbehaving and so I have every right to put him out. She then talked to my son and reiterated all that to him. She said that even though family relationships can become stressful there is no excuse for his behaviour and he needs to control his behaviour. Since he is not contributing to the household he is a guest in my house and needs to behave. And she said he will be removed from the house or arrested the next time they are called out.

My son was calm, but not surprisingly so, he just had his methadone. I expected him to be nervous or angry.

She told my son that she is not saying the arguments are always his fault because there are of course other factors, but the way he reacts is up to him and him only. And from all the things the police officer said, what he took away from it was that because she said there are other factors involved in arguments, he started to go on to me about how people keep saying it is not all up to him and that I also need to start making changes and be more reasonable and control my anger and other people need to stoke provoking him....OK, clearly him and I are not hearing the same message!

The support worker/counsellor I saw earlier this week (who was the one who made the call to the police) mentioned about wanting to try to pursue the mental health avenue and said that my son should be assessed and perhaps there is need for a dual diagnosis in his case. I will see her again next week and I think this is something that needs to be pushed and maybe even demanded. I feel that some behaviours have changed with the drug usage but were there before, namely the anxiety and depression. Also it is hard to say whether or not the rages would have happened without the drugs or not. There are the incidences like last night and with most of our arguments which get out of hand for hours, his reaction is not quite "normal". By the way, I never liked the term "normal" but sometimes it is the only word that seems to work. My son is also very obsessive about some things, which is often the trigger for arguments. Not to mention that his obsessive behaviours have also made it very difficult to leave the house when others are ready and waiting because he is not. These are all mental health issues on some level and we are not even taking into account the psychological impact that his emotionally, and sometimes physically, abusive relationship with his father has had! So yes, a THOROUGH mental health assessment would definitely be in order! But it is not that easy, especially as soon as you mention any substance use/misuse the mental health professionals wash their hands of you.

This excerpt from the following Wikipedia article sounds very much sounds like my son's own form of self medication:  Khantizan proposes that substances are not randomly chosen, but are specifically selected for their effects. For example, using stimulants such as nicotine or amphetamines can be used to combat the sedation that can be caused by higher doses of certain types of (usually typical) antipsychotic medication.[29] Conversely, some people taking medications with a stimulant effect such as the SNRI antidepressants Effexor (venlafaxine) or Wellbutrin (bupropion) may seek out benzodiazepines or opioid narcotics to counter the anxiety and insomnia that such medications sometimes evoke.

Full article:

Lets hope this counsellor will be successful in asking for a full mental health assessment, but if she is, I hope we don't have to wait weeks before he gets an appointment!