Family and Caregiver Schizophrenia Discussion Forum

Insight into illness gained, but relapsed on street drugs

I had a remarkable conversation with my 26 year old son who has been diagnosed with schizophrenia for 5 years and has struggled with mental illness since childhood. He shared with me how lonely it is to have schizophrenia and he has no one to talk to about his hallucinations. He feels schizophrenia is a life ruining disease, without the possibility of getting married or having a family. He also shared with me he thinks he has had schizophrenia for years before it was formally diagnosed. I told him I think that is highly likely in hindsight. But I also shared with him that recent research shows that with early treatment schizophrenia can be managed.
This was the first time he ever said the word “schizophrenia.” He had significant anosognosia until he was on court ordered abilify maintaina and it seemed to rewire his brain gave him empathy and insight he has lacked his whole life. The interesting thing is abilify pills did not have same effect; the pill form fixed positive symptoms but no impact on insight or empathy. This conversation touched my heart in ways that are indescribable.

The second part of the conversation broke my heart. He admitted he had relapsed and was back on street drugs. I am heartbroken. Long story short he moved out in January for first time in his life first to drug rehab, then to halfway house. He identified as an addict as it was preferable in his mind to having a serious mental illness. Yet it got him to therapy, he stayed compliant on his antipsychotics and learned many skills to be independent. He went out and about, he had friends. This is after a year of paranoid psychosis, trapped in his own world, where he never left the house, except occasionally with his parents. Then violence and a involuntary commitment in May 2019.

His drug use did not start until his late teen early adult years mostly pot. Then we moved south to the coast and he got into cocaine and heroin. I know relapse is common, but he was doing so well. He was consistently taking his antipsychotics which is going on 18 months now. He held job as construction helper for 5 months which is longest employment since his diagnosis. He willing went to therapy and intensive outpatient therapy. He has grown such much this past year that this news of relapse is so sad. To top it all off when he reached out for help his insurance denied inpatient treatment as they said his drug use was not life threatening as he was only using cocaine, not immently life threatening drugs like heroin or fentanyl. The system is crazy. The intake coordinator told him what he had to say to get his admission paid for. So he is in inpatient rehab, but he lost his housing as he used illicit substances. The next chapter begins…who knows what is next? At least he is safe for the moment.

Thanks for listening. Sorry for the long-winded story I have so many thoughts and worries going through my mind.

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So sad… i pray he finds his way. This life is just horrible, to have such a disease. then drugs on top of it. Surprisingly my son has never turned to hard drugs. Just marijuana. which makes his schizophrenia worse. He is non compliant for meds. Drinks, smokes pot to self medicate. There’s just no answers . Since your son found the right medication. he will be ok.

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He does have a lot of insight and maturity at times, so maybe he’ll come to see that drugs are not the answer. Like anything delusional (I think substance abuse is a form of delusion – the delusion being that it’s going to make life better) you probably can’t argue him out of it. He has to see it for himself.

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@Elsa I am so sorry for this struggle. :blue_heart:On here I usually talk about my spouse, who has SZA, but your son sounds a lot like my brother. My brother is diagnosed with Borderline Personality disorder, and has issues with street drugs.
For what it’s worth, sometimes help is help. If your son identifies that he needs help with addiction, that is a big step, even while you know he also needs help with for his MI. The overlap between MI and drug use/abuse is widely acknowledged, and any recovery program/ support person worth their salt will tell you that you can’t treat one without also treating the other. But we also have to let the person heal their own way. It cannot be forced. (Lessons my brother has taught myself and my mother.)

You are so right to focus on how he is safe, for now. The system is incredibly messed up… sometimes it feels like the only “road to recovery” available in our society is the one that has been systematically lined with traps for failure. Try to celebrate the small successes, and avoid thinking about “if only he would do x, y, z…”

Please feel free to message me if you want to talk or vent or get things off your mind! I can’t promise good advice, but I have a sympathetic ear and a little experience. It’s so hard to have co-morbid conditions, but it’s sadly not unusual.

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Laughingsteps I appreciate your response. I agree help is help and the fact he initiated the help is a huge positive step. Co-morbidity is double whammy. Now I have to worry about 2 different types of relapse. The good news is they both used to happen at the same time. This is the first time he has been on his antipsychotic medication consistently and relapsed on street drugs.

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Caregiver1, thank you for taking the time to respond. I am grateful for improved insight and glimpses of maturity. I am hopeful that will make a difference going forward. There is never a dull moment in this journey of life with my youngest son!

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Shallcro, thanks for reminding me that finding the right medication for his schizophrenia is huge. Some times it’s hard to see the big picture in the midst of crisis.

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So sorry, my 24 yo son diagnosed at around 15, abused all sorts of drugs without my knowledge. He saw friends die from heroin so he stopped the hard stuff but I’m sure it did not help his mind. He insists on using pot daily and has managed to live independently for 5 years.its sad that they can’t see that every mind altering substance whether it’s nicotine, cannabis, take up space on brain receptors that could be targeted by anti psychotics. Sadly now my son thinks antipsychotics are bad and he has tardive dyskenisia so he gone off them without telling his dr so now I wait for the sky to fall

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Anosognosia (aka lack of insight) is such a strange and bizarre ‘reality’, truly. Not to in any way trivialize the value of the other struggles you and your loved one are going through, the addiction, the housing issues… but I have to get it out there that I found myself thinking “Wow. How nice simple insight would be [for my sz partner and us both]) and I wondered to myself how many aspects of our life and our relationship would change, and in what kind of significant ways, if he simply KNEW and was willing to seek any kind of treatment at all. How many of our day to day struggles could be washed away clean? Having been together more than ten years, there are actually entire years we have shared that I feel are lost to what I call his ‘constant crisis years’ that he seems to have no recollection of at all. Wether it’s legitimately part of the disease or just good old fashioned deny deny deny! no accountability! with a healthy dash of gaslighting, who the hell knows. Because if he acknowledged the damages he’d also have to acknowledge that he has a problem? Well, anyway, I’d be so grateful for something seemingly as small as insight yet I dream could have such huge potential for ‘progress’! It sounds like there have been so many groundbreaking positives for you guys since he gained insight (which has become very obvious to me has little or nothing at all to do with wether somebody is or is not on meds. Empathy, maybe. But not that funny little thing called insight! Just a matter of… what? Self reflection? Ability for introspection? The answer is somewhere… I just know it!) Good to hear your loved one has found it!
You also reminded me of a time long ago that an old friend came to me saying he had gotten involved in street drugs, namely cocaine, and asked if I’d help him get into a rehab. He desperately wanted to quit but knew there was no way he could do it by himself without being physically restricted any and all access. Me being me and never saying no to somebody in need, agreed to take him to the closest center. When we got there, he was denied on intake, as cocaine is not considered physically addictive and doesn’t put somebody in imminent danger of death by overdose, such as opioids like you said. (Apparently these people had never heard of a heart attack.) Luckily, the facility wasn’t to capacity (which I guess is rare. Sometimes people have to wait weeks to get a bed) and the coordinator tipped us off with an elbow nudge and a wink telling us if I brought him back in drunk, and he declared that he was in fact a daily drinker (as alcohol IS physically addictive and sudden withdrawal without proper meds and monitoring can actively shut down kidneys and liver) that they could accept him. So…guess what. Yup. That’s exactly what we did! Half a bottle of Jim Beam later and he was inpatient, insurance covered for a whole thirty days. He’s been clean of all drugs since. (Note. Ironically, he did after that become a maintenance alcoholic. He to this day drinks most every day.) Yes, the system is messy and just a touch counterintuitive!

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@Sandy1234

It’s so hard to be in limbo waiting for the next shoe to fall. It’s frustrating when our kids use substances that cannot be good for their brain, but I often found my found my son sought comfort in illegal drugs when he refused antipsychotics. I am hoping now that he will be able to conquer his addiction, now that he is willingly taking antipsychotics that work for him.
Is there anything your son can take for tardive dyskinesia, I think there are some medications on market to treat td. Best of luck. Encourage son to keep seeing his MD even if he won’t take medication…maturity can help so don’t give up hope!

I often think. If only my son knew he had schizophrenia it would help. I feel its useless to talk to him about it.

The 5 years my son was unaware he had schizophrenia were hell. He fired therapists, psychiatrist…anyone who did not agree with him. He was unmedicated until court ordered. Our lives were turned upside down.

But here are some things I did that helped in long run. I talked with him about anything related to mental illness that he would acknowledge ie… Anxiety, depression. Talking openly about what he thought his struggles were helped us to connect and maintain decent relationship. I never mentioned schizophrenia, psychosis, hallucinations or delusions until he used those words first.
When he said bizarre things or was lost in delusions I would focus on emotion I thought delusion evoked. It must be frightening when you see people at the grocery store that want to murder you
I feel blessed my son developed insight, I was not sure he ever would. The book “I’m not sick, I don’t need help” by Xavier Anador was a tremendous resource when insight was lacking. The communication skills described in this book help even with insight, but are focused on how to get someone who does not believe they are ill to accept help, medication, treatment…

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I agree. I urge caregivers where they can to avoid labels and pathology. They often impede rather than further recovery.

My brother ‘accepts’ and ‘acknowledges’ his bipolar disorder and alcoholism, and it’s been a spectacularly potent obstacle to treatment. He uses them as a fatalistic excuse that he has a tough life that’s not his fault, and thus escapes all responsibility. He’s genetically cursed, and proclaims he is so special that even the most skilled doctors wouldn’t know what to make of him. And he must consume large quantities of alcohol (his words, not mine) to counteract his disorder, and admits he’s an alcoholic too, but he has no choice in the matter. I like to say he’s stuck at step one of the twelve step program.

It’s far more important to accept treatment than admit to any specific disease. One of Dr. Amador’s early points in his book is the definition of insanity is trying the same thing over and over again and expecting different results. Don’t make yourself crazy by insisting that an unwilling potential patient know or accept their illness. While it can be useful later on in recovery, it’s not essential or even important initially.

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