I’m Religious About CRAFT but He’s Not Improving
ccomtl2014 has been artfully following the CRAFT principles and yet, her Loved One is not showing signs of improvement. Engaging in extreme behavior, barely ever sleeping, misusing his ADHD medication, lying and now, stealing… Is it all on the addiction or could her partner suffer from an underlying, untreated condition?
“First off, I have to say the free group and this whole website, I can't say how lost I would be without this site. I had read Beyond Addiction by Foote and the gang, and Get Your Loved One Sober by Meyers in 2016 or so, but the exercises on the website and the chance to have personalized feedback brought my understanding to a whole new level.
So the situation continues to spiral out of control, and it almost seems to me like this is what he wants? Re: strange being awake from Friday to Monday (without any stimulant use that I can see, he simply does not take his night meds and rides the ADHD hyper focus)… he just plays video games and needs "alone time"…I suspect this is also when he uses, since all he has 7 days a week during the day is alone time. I have no proof though, just my instinct, and I think what little money he can scrounge up maybe he has marijuana for weekends only. Anyway, some natural consequences of this habit finally happened…..” Read ccomtl2014’s comments (there are several) here.
Dear ccomtl2014, your comments paint a detailed, and worrying picture. Your "whole new level" of CRAFT (thanks so much for the kudos!) is inspiring to the entire team. We are deeply moved by your steadfast efforts to help your Loved One. You have been applying CRAFT to a T (or as best as any of us could), yet you are not seeing signs of improvement in your Loved One. It feels like he's been spiraling downward, rather consistently.
CRAFT can work miracles, yet has its own weak spots
We have given your situation careful consideration and it has taken us some time to put this post together. We also wanted to speak with an experienced counselor to get a view of what may be going on with your partner. We asked Dr. John Fitzgerald, who regularly intervenes as a guest expert for us, to weigh in.
Dr. Fitzgerald emphasizes the need for a good psychiatric evaluation
“My summary answer is that he needs a good psychiatric evaluation, because it seems like he may have a spectrum mood disorder (Bipolar II). If he can go for four days without sleep (off drugs), that suggests hypomania. He has other indicators that point towards mood disorder: depression, lack of motivation, significant sleep problems, being intelligent, abusing substances, lack of self-care (not being able to cook for himself) and self-isolation (no phone). I would want to know his age, family history of mood disorders (were mom or dad bipolar?), when the symptoms first began showing up, and what happens when he takes a selective serotonin reuptake inhibitor (SSRI) like Lexapro, Prozac or Zoloft[1] (usually makes people with mood disorders worse — can lead to manic episodes). Has he ever gone without sleep for 7 or more days? In this case, we’d be looking at Bipolar I disorder.
Here is a great resource on the topic: https://psycheducation.org/ (check out the many great pages on this site).
Your partner is clearly stuck, feels shame, and may also suffer from insecure attachment, adverse childhood events (ACE), and trauma, which would all complicate the clinical picture even more…"
When addiction is masking other, undiagnosed problems
Dr. Fitzgerald continues: "… I have never really given much thought to how in some cases — perhaps like this — CRAFT needs to be practiced with the understanding that addiction is an adaptive response to underlying (unidentified and untreated) drivers. When a concerned significant other (CSO, aka the family member) starts using the tools without appreciating that the person engaging in addiction does so because no one has ever accurately diagnosed their underlying problem(s), I can see where things get worse for both parties. There is an assumption built into CRAFT that the "primary problem" is addiction, when in fact it most often is an adaptive response to something else. When that "something else" goes untreated, outcomes will not be good.
Also, it's important to note that even when a CSO gets their loved one to attend addiction treatment, we know that often clinicians who work in the addiction field are ill-trained to assess attachment, trauma and, in particular, spectrum mood disorders. So, a person can do fairly well in addiction treatment with all the supports, and actually look better than they are because the mood stuff takes a break. But once home, the mood cycles come back, the CSO blames continued problems on relapse and addiction, and the cycle continues. It's a complex and tricky subject. We need to continue to provide people the tools to see deeper into the nature of their suffering.”
Could this also be misuse of psychological medications?
I have seen the effects of misusing ADHD medications. It provokes over-focusing and obsessive behavior. The person sleeps very irregularly, and only after days of staying up. They appear highly disorganized, irritable, even psychotic. In the situation I am thinking about, the young man worked on miniature military formations for days on end. You'll find this young man's story in Module 2, Video segment 3.
I started digging into the Vyvanse misuse, and some people on chats report that this new ADHD drug can have unintended psychological side effects. When misusing it, one crushes and snorts the drug, thereby getting more of the drug immediately, despite its being long-acting. He may also be withdrawing from the drug, as he would be running out quickly.
He could be feeling the effects of withdrawing from his antidepressant medication. These withdrawals can be quite serious, especially if he didn’t carefully titrate the dose down over an extended period of time. The psycho-pharmacological effects of misuse or withdrawal can differ in different individuals, but there is no doubt they can be severe and could look like what your partner is going through.
By now, several days have gone by and your situation may have changed. Getting your Loved One a good psychiatric evaluation is not going to be easy. Module 8 lays out how to engage your partner.
I wonder if the inpatient center he attended can help more. Yes, ideally he needs to show some initiative and call the center, but that is very hard to do when you’re running scared in the basement. Can you call the most senior person you can reach at the center and get them to be more helpful? They could initiate a zoom call with him as an aftercare follow-up. Really, they should be in regular touch with him. Especially if they were the ones to prescribe the drugs, they have an ethical responsibility to follow up with the patient to see how the first period is going. Of course, ideally, he makes the call, but he has so decompensated[2] that he most likely can’t.
You describe the way his behavior has been rapidly evolving over the last weeks. He is now stealing a little money to buy alcohol. Before this goes further, can you:
1) Talk to the clinic;
2) Call the local crisis help-line for guidance and for possible mental health treatments and retreats.
In Western Massachusetts for example, you call: 413-733-6661. I searched “crisis mental health call center,” along with my location, to find this number. They are open 24/7. You can call them if you can’t find anything specific to your area.
3) Sit down with him to gently express how much you love him and how much this situation worries you.
Script it out if it can help you stay calm and focused on the message you are trying to get across.
Put the debit card receipts for beer in front of him, along with coffee, cake and ice cream if possible (you come in peace).
Here are some sample statements that you can work from:
“I love you and I admire you. Things are bad right now. I don't know what else I can do to help you. I can't live this way much longer. Please tell me what your plans are for the next couple weeks.”
“I am very worried. I have the number of the psychiatrist who prescribed you the drugs and he is willing to talk to you.”
“Here is what I got back from a site that is helping me cope with my end of things…”
Only try this last option if you think it can help. If he is more likely to get upset because you shared about what he has been struggling with, don’t even go there.
Avoid the common traps: No matter what else is at work, substance misuse is a surefire source of nastiness
You have made many great observations about how you're engaging or withdrawing, and how he takes it (usually, badly). He's familiar with CRAFT principles, and doesn't appreciate your withdrawing when you do so. It feels to both of you like the "ultimate big chill" because when you step away, you aren't being warm. He takes it very personally.
I just want to take this opportunity to point out that substance addiction is one of the best predictors of not-nice behavior. As we've pointed out earlier in this post, there may also be undiagnosed mood or mental disorders at play that are exacerbating everything. But please remember that — as long as he is using/withdrawing more or less constantly — everything he says is infused with the ever-bitter communications cocktail that so often accompanies SUD: denial + blaming + accusations + paranoia + manipulation, etc.
When you're being addressed like that, it's OK to acknowledge that you hear him (maybe a bit of reflective listening) but it's almost never useful or productive to actually respond with your own thoughts/concerns at that point. Disengage as swiftly as you see fit when the tone is so ugly.
Also, as much as he makes you feel like everything you're doing or attempting to do for him is wrong, YOU.ARE.STILL.THE.REWARD.
We salute you and your "militant level self-care"
It's music to our ears to hear that you are taking your self-care so seriously.
Is there a way for you to extend, or multiply, your outings? When he's making your life unbearable, can you make a point of taking an extra walk at that moment? Can you take your laptop and find another place to work (A friend's place? A safe public place? Your car?) Covid is making this extra complicated and your health concerns must be taken into consideration, but it could make more of an impression if you were to take more frequent and/or longer breathers.
When he complains you're punishing him, try to put it back on yourself and point to your needs, which he clearly isn't able to focus on right now:
"I need to take some time for myself…" or "I need to take a breather" or "I'm going to take a walk and decompress for a while"
I also wanted to make sure that your own support system is as strong as it can be? Aside from the guidance and support you receive through Allies, could you maybe add in some one-on-one counseling or a regular full-body massage (etc.) We worry about your own health, despite all that you're doing to compensate for the stress.
ccomtl2014, I feel both for your partner and for you. He sounds caught and you are left having to figure everything out for him. We hope this helps you gain additional clarity. We want you to know that you are not alone. We are here to support you.
Thank you for writing in, please keep us in the loop!
Not long after reading your advice at my last post, I started emailing the counselor to move the conversations towarding me asking for a break. Couples counselling was getting more and more heated and only escalated him and increased the focus on me as the SOB and how come I’m not in “the hot seat”. The couples counselor is actually extremely gentle with him, there really is no hot seat. He has been in a sort of outpatient group for people who are actively using for months (they need to be abstinent two weeks before they are accepted into intensive group, he declined their 10 day rehab to jump start sobriety and enter the intensive program). He feels like he has heard it all before and that since he is going to this group, we should all “stop shitting on him”. My “shitting on him” was pretty much having only two boundaries, the rages directed at me (stomp around I don’t care just keep it to your space) and don’t put dishes in the sink with food in them (arthritis, I have a dishwasher so that I don’t need to wash the dishes, it’s an old dishwasher though you have to rinse the plate).
The two weeks before I asked him to leave, the rages were getting worse and closer to what it was like before rehab. Before rehab things were bad but he had remorse and pockets of insight, I do not see those anymore. Screaming so much his face was red punching the couch and saying that he felt if he couldn’t let it out at me (screaming) he would jump out a window. Finally I had quietly thrown out a moldy pan that he had not cleaned, I was quiet about it and figured he wouldn’t notice (we have lots of pans). When he did notice, he slammed doors and cupboards all around the apartment and stomped around loudly. I ignored it and stayed in my bedroom (he moved himself to the couch a year ago, said he is so debilitated he can’t make it to the bed). I was doing my physiotherapy on the wall, this is close to the door but I have been doing it like this for years as it’s the only spot with enough wall. He never comes into the bedroom, he knows I do my physio there. I had finished my physio not 2 minutes before and was working, he came into the room slamming the door open so hard that if I had been there, it would have been an emergency room visit for sure. He went around looking for something slamming all the doors of the chests and closet while giving me a glare. I screamed at one of the bangs and started to cry. He wordlessly gave me one last look and slammed the door shut again. He didn’t actually get anything in the room.
Hours later after the slamming had stopped for some time, I calmly told him I could have been behind that door and it would have been accidental but it would have been an injury all the same. I told him he can’t slam things in my space like that. He freaked out and continually came into my room to yell at me that he has a complex about being abusive because of how I speak to him, etc, etc. He had zero remorse or concern about the door, he was angry that I do my physio there. He kept coming in to yell at me in and out for at least an hour. This time I actually felt unsafe. Around this time I also found out that my health was declining and needed to do high dose steroid treatment, the side effect of steroids that high is extreme panic attacks and anxiety. I had the therapist mediate a conversation about him needing to stay with his parents for a month (or anywhere else he could think of, up to him). He knows one of the side effects of strong steroids for me is that my adrenal glands don’t work. This means in a crisis they can’t produce stress hormone we need, so when I get a cold or if there is a really really severe yelling situation I quite simply just pass out cold. This was part of my rationale that we can’t live together right now, I made the initial request 30 days.
He showed not much insight in the conversation. Afterwards it was horrible, the guilt was intense and on another level, he kept saying over and over again “if this is for me it won’t make me feel better” and made me keep saying this is for my needs, he knows its very hard for me to verbalize a need like that. He refused to call his parents because I wanted this not him. It was awful. He feels punished abandoned and that my boundaries are too “black and white”. I asked him what not black and white would look like in this specific situation as a solution for the anger given the new medication situation. His answer was that my version was: “you got angry you need to leave” vs he would have wanted: “he’s in pain”.
It’s been a month, he continues to use and declines going to rehab. I got the counselor he liked a lot from rehab to give him a call to reach out. My loved one appreciated the call but felt he can do things on his own. He goes to the zoom meeting once a week for the program, but he feels its nothing new or helpful. We only spoke once, I mostly listened and reflectively listened but it was bad and showed me where his mind is at…everything is being done to him by me, it’s unfair to ask of someone depressed, the problem is me and my lack of compassion and black and white boundaries. He feels couples counselor is out to get him, and it’s all because of how I word things. At home he would put the dirty dishes in the sink with food still in them. At his parents house he puts the dishes in the dishwasher, and has done so after being asked only once. At home he said he was so depressed it was “physically impossible”. He knows since he has gone to his parents that his mom checks in on me, she has relayed to him that certain medical tests revealed new scary problems but it was radio silence on his part. He has made it clear the silence is anger, I told him I’ll respect his space. But eventually I need to have a second chat with him.
I tried once during our one talk to see if there was any salvagable solution in terms of coming home. He keeps delaying any talk of what a solution would look like, I said I cannot continue at home with the dynamics as they are in respect to the angry outburts as I am more medically fragile than I was before. He insists he only will need to work on that when he is home, he doesn’t feel he can do anything about it while he is not at home. Couples counselor doesn’t feel any further sessions would benefit and says we cannot continue. The 30 days are almost up now.
I recently got him the message that my treatments were renewed for another 30 days, so I think he knows a conversation is coming. I would be afriad to have him home now, he is way angrier at me than he ever has been. He still is upset that when he is angry about something, that his raging becomes the issue at hand and that his point about what he was mad about is lost. This is strange because I do set boundaries about what I won’t accept in terms of being shrieked at, but after he has calmed, I always circle back to his original point so he can feel heard. He says it doesn’t count because of the way I do it.
I don’t have the couples counselor to help me mediate this next conversation. I need to make this not living together arrangement permanent I feel, at least for now. How can I say this in a way that would be least harmful for him I wonder. This is a new low in his mindset I have not seen before, usually when things are bad like this he comes around and has insight and remorse for a day or two. The stimulants have been going strong for 9 months now, he doesn’t even get high off them anymore. I see shifts in his demeanor I haven’t seen before, and perceptions far more openly distorted than I’ve seen before too…Feels like my heart was ripped out of my chest. I am genuinely surprised that he did not go to rehab after I asked him to leave, but I supposed I shouldn’t be. He just used to come around in terms of insight and willingness after big crises events, it’s how he went to rehab in the first place.
It must be hard to find your Loved One impossible to reach, when you have experienced him differently. After completing treatment at the start of the pandemic, he had hope, insight, even bounce. There isn’t a shred of this optimism in your descriptions of him now. It’s as though life with your partner is negotiated behind a huge, invisible wall that separates the house. It sounds so painful and stressful.
Your efforts to connect with your partner have been met with anger, to the point you have felt unsafe. Nice job, by the way, having your couples therapist mediate the first 30 days of separation.
Your partner did finally leave your home and went to his parents for the agreed upon 30 days. You note that he behaves better with them, cleaning up after himself and perhaps fewer outbursts?
Read my full response to ccomtl2014 here: https://alliesinrecovery.net/discussion_blog-how-do-i-let-him-know-he-cant-come-back-yet
Back again seeing some feedback. First off, despite things not getting better at home, this website has been a huge help for my own wellbeing. The Wednesday group with Kayla Solomon as well has been a big game changer for me, in terms of me becoming OK, despite my partner steadily declining.
There was a question after my last post of whether there was him abusing stimulants vs maybe more to the mental health diagnoses (more than depression/adhd). So it turns out he has been abusing the stimulants pretty continuously, so he is in a use/withdraw cycle that lasts most of the week, each week of the month. He can only get it at the pharmacy once a week and cannot access earlier, he uses it all within a day or two and is in withdrawal the rest. The other piece is when he is in withdrawal, he neglects everything including taking his antidepressants. So he takes his antidepressants a few days a week, and the one he is on has actual withdrawal symptoms as well. He likes the antidepressants and finds they help, but everything just drops away with the stimulant withdrawal. I find the stimulant withdrawal makes him particularly emotionally volatile. In between he sells whatever he can to get weed or alcohol now as well, he is pretty much out of things to sell that is his own. He also ends up frequently out of cigarettes, which adds to the whole high meltdown on his end. he will run out of smokes and become really doubly mean, and refer to himself as in a “crushing crippling depression” but then get smokes and immediately be walking around bubbly and in a super mood, bright affect, engaged in video games etc. Still we went with, let’s get some of that depression treated. He won’t call the psychiatrist or accept any of the other options that were offered, even with pretty heavy assistance to get barriers out of the way. There was one week that because of a pharmacy error and he couldn’t abuse stimulants, saw a huge difference in his affect/mood…. I’m pretty sure this is nowhere near where the organic depression lands.
His rehab team reached out many times but he didn’t call back, he spoke to his counselor on the phone once but it never went further. It’s a small apartment and so I was able to hear him kind of yelling, it seemed tense. We have back to couples counselling for 6 months and he continues to pretty much lie, shift blame to me and victimize himself, and refocuses anything that is being addressed as a “communication issue” with me. He has a good rapport with her, she saw us for a year before he went to rehab, and she does work in addictions. She has been trying to see what small steps he can take to help with the depression, he will say “I don’t know” or “yeah I should do that” and then is quite passive and talks about how can he do any of what she is suggesting when he is so depressed. I enable recovery as much as I can and have the list of many choices of really great recovery options ready and willing to do most of the footwork, but he would still need to actually consent and he won’t. Recently she mentioned that our living situation is becoming something that is maybe protecting him from facing an impact of his substance issue, and I agree and I have been worried about that for a while.
I have had 2 planned conversations, I pretty much used some of the lines you mentioned for me to use before. Tried to be collaborative as possible but he shrugs and will not engage so I back away. The list is easily accessible so he can see it without pressure, told him say the word we can make it happen. With expressed wishes/dips he tends to be affronted if I suggest getting help for any aspect of this (even depression), *or* he will shrug. I would say, is there something we can do together to head off this spiral (coming with ice cream and showing peace), his response is “I have crippling depression how dare you not support me”. If I ever use an “I feel… (scared, worried, sad)…” he will get enraged at how dare I make it about me when he is in so much pain.
Even with the positive communication, reinforcement of any small bit of behavior that we could want to encourage, still try to withdraw best as I can depending on how volatile he becomes… it is still high confrontation on his part, or the victim but I can’t help it I am so horribly depressed. I have left him suffer on the couch, but after a full year he is in lots of ways comfortable with his ability to be very high for 2-3 days, then cut the withdrawal with weed, and sleep on the couch and not be bothered by any sort of consequence other than my withdrawing. The struggle still feels very external, like I’m the SOB that is the problem. I frequently admit to my part as well and wanting to own my side of the street.
I pulled back far, far as I could go, while also mentioning that I know he often feels this is punishment and a message he is “bad”. But I do not think he is bad, and I definitely would never want to punish, I see his struggle. Even so, I can’t be around this anymore, and he wouldn’t want me to hang around when he is high anyway, cause I’d just be upset and we’d fight so this is better for both of us. He is very nice at first when he is just starting to feel the high on stimulants, so I am sure not to reinforce.
The weird thing lately is he will see an expression on my face and decide what it means and be extremely upset/angry at it, it happens when I am sick. He will see me and even if I say “hey you look sad you ok?” he will decide my face means I am surprised he is sad, then freaks out and say HOW COULD YOU NOT SEE I AM SAD HOW DARE YOU THIS IS HARD FOR ME and can’t be de-escalated. I am able to get away after he has yelled for a bit (can’t get a word in early on) but these are happening a lot. He will also be mad if I have no facial expression too basically and how could I be so callous.
Is it time? I feel like if he had to live with his parents he’d consider rehab real quick. I can’t tell his psychiatrist about the meds because I am afraid my safety re: for his reaction, and with covid I have nowhere to go for safety plan. My last planned conversation was your original one that you gave me a year ago, that I want to continue living together but I can’t go on like this and I am out of ideas. He continued same and it’s been a few weeks.If I framed it as a not break-up but we can’t live together as things are? If there are other options to try I am still open to it.
Thanks again for this space. Sorry if this is a bit hard to follow, exhausted at the end of the day and just trying to get everything out.
I’ve been better in terms of being at my wits end, with Kayla’s group I’m much less on my emotional edge. Work is tiring but keeps my mind occupied and it is nice to be able to help. I can’t hide that my autoimmune disease (lupus) is progressing, but it’s not like he sees the triggering stuff per se, but I am sure he is picking up on it. But despite being much better emotionally, I still feel as is the situation is getting unmanageable…
Thank you, once again, for such a clear, detailed account of the last several months in your home with your partner. Your use of CRAFT skills is textbook.
Our team so appreciates, and feels warmed by, how seriously you have endeavored to learn, understand, embody and apply CRAFT.
A couple thoughts:
Your partner, whose communications and behaviors you describe with understandable frustration, is the same man who came home from a 30-day program just under a year ago, filled with joy and excitement, ready to start his aftercare work and a new, bright life with you and for himself. This is a reminder of the type of dramatic letdowns families on this site experience. And of course, if it’s an emotional rollercoaster for the family, how can it not be for the Loved One as well.
I am encouraged, however, that the problem appears to be drugs and not more serious mental illness. Your partner is misusing his A.D.D. medication and has started to drink again.
Read my full response to ccomtl2014 here: https://alliesinrecovery.net/discussion_blog-i-think-im-ready-to-ask-him-to-leave
I even know LEAP pretty well, I love Dr. Xavier Amador’s work (was so excited to see his work cited on this site!!!)… although my partner is extremely insightful into his mental health diagnoses… recognizes what is wrong and what helps, says himself he feels the medication helps, and the coping mechanisms that work well for him he chose himself. He understands the interplay between it all… still the idea behind LEAP informs a lot of how I speak often. Still he takes neutral as being mean (and I am pretty sure I am pulling off neutral, I stay away when I feel like I can’t and exercise or something before I interact).
He used my card again to buy beer and lied. I was setting up the living room for an important work zoom call, I fixed the couch cushions and found the beer (it was pretty obvious didn’t have to search or anything). He found me and is convinced I am snooping because he always gets caught (he really doesn’t hide things super well…). I withdrew but there will need to be a limit setting about no touching my card. I wish you could get card without tap function, but I tried without luck.
Dr Xavier Amador developed an approach for those close to the person with serious mental illness. His work has helped countless people to navigate a relationship in which someone lives and may cycle through episodes of illness, sometimes brought on by playing with or stopping medication.
Thank you for writing back ccomtl2014. Your observations of your partner, given your expertise, provide for a rich description of what has been going on. I still wonder about the Vyvance being misused, or, as you suggest, another stimulant drug.
How do you feel about sitting down to a tea party with your partner and having that “what’s the plan, Stan?” talk. Really, how does he see the next two weeks now that he has started slipping a little on beer? How are you supposed to behave?
Plan B might be to wait for those prescriptions to run out. Perhaps you let the psychiatrist know there are problems, and his medications are likely a part of it. You would ask the psychiatrist to see your husband rather than automatically renewing any prescriptions. At least this gets him in front of someone, hopefully soon.
Finally, if pulling away from your husband and leaving him alone as a consequence of his use, causes too much discord, stop. There are other small ways of allowing consequences.
We are here.
Thanks so much again for such a detailed response. Answering the questions too really helped me to reason it out.
Re: psych eval: before I discovered how deep the drug use was, I dragged him to get help for depressive and anxiety symptoms, coupled with untreated ADHD. I work primarily with severe mood and psychotic disorders, so I had some connections in the system. He has been evaluated by 3 psychiatrists, one in town where we live (who treats him now), one in a hospital ER, and the other at the rehab. The consensus was depression, anxiety, ADHD combo. The ADHD adds a layer to difficulty treating depression and anxiety, which is why the vyvanse was a game changer for his depression. There is definitely attachment trauma though as another layer. The rehab I picked for him was one that specializes in mental health comorbidities.
I’ve never really sensed a hypomanic flavor from him, or even the dreaded “mixed state” (manic and depressed state combined). They still explored bipolar I/II though, especially with the hard time sleeping. But he responds very well to antidepressants and there have never been any other hypomanic or classically manic symptoms before. Before toying with his medications, his insomnia would only keep him up for one night max. The ADHD had always made falling asleep difficult, so they prescribed trazodone and a bit of remeron to help. The ability to stay up for days on end has only been seen in context of abruptly stopping his trazodone/remeron. He is on a moderately high dose of trazodone and the side effect of abruptly stopping is inability to sleep, same with remeron. He can only pull all nighters when he skips his meds.
Regarding the mood I had seen it be quite stable with proper dose of vyvanse, celexa, and then the trazodone/remeron combo for sleep. I saw his mood dip low again once he started taking trazodone remeron only a few days a week (stop-start pattern is bad news if you’ve been on it for a long time) and then once he started taking celexa very sporadically. All 3 of these medications have rather notorious withdrawal type symptoms if you don’t wean down properly, and he is start-stopping each week. That is when I saw the extreme self-neglect behaviors kick in. Withdrawal symptoms for all 3 medications also cause extreme lack of appetite.
I do wonder if he has access to stimulants or other substances though. I don’t give him money but it’s not hard to get a credit card and hide it. His explanation on why he stays awake of the entire weekend is it gives him “alone time”. This explanation has always made my spidey senses tingle, since he is already alone mostly all the time.
I wish he was ill enough for a court-ordered psych evaluation in an ER, but even if I managed to pull off a court-ordered psych eval in an ER… they would say stop screwing around with your meds before we make changes, and send him on his way.
I feel validated by your response about the rehab part. I have reached out multiple times. He will definitely freeze over before he calls the counselor, the counselor even said you need to make changes before you contact me again. I am stuck because this is the clinical coordinator. Of course, my partner could be lying, his lying runs deep. Either way they won’t answer my emails though. The case was transferred back to his psychiatrist, who he just won’t call…
I feel so at a loss. I agree the mood component is strong part of this. He’s had the evaluation and has psychiatrist following up… I arranged it years ago. But he just won’t call her, and no-one would make any medication changes until he stops fooling with his meds, since we don’t know where his depression organically lands. He won’t go to the local crisis center either, I tried this too. He won’t do the mood hygiene we know keeps you well, exercise, routine… His mood was quite stable until he started fiddling with his medication in order to stay up on the weekends, that is when the depressive symptoms really resurfaced. He is aware of the withdrawal symptoms and the effects of start-stopping those medications too.
Am I making the wrong move by withdrawing? He has a habit of hiding his drug use from me by framing it like I am misunderstanding the situation and the only problem is depression… that is how it went on unrecognized by me for so long. Since the mood symptoms really geared up only once he started fiddling with his medications to stay up late and game (or other stuff)… do I react to these nights as if he is using and withdraw?