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Serious Mental Illness & Addiction—Help!

Mental Illness

Allies' member chris has been told it would be immoral to ask her son, alcohol-dependent and experiencing psychotic symptoms, to leave the house.

"I have a question about substance abuse and mental illness. My son is an alcoholic and is in psychosis. He has been this way for a number of years and has been to numerous programs and is always back in the house almost immediately. I am told kicking him out in any way would be unethical and immoral. His psychosis and substance abuse issues are completely co-mingled. Would you have any advice on the mentally ill and substance abuse?"

As the respondent already mentioned, the rates of co-morbidity of both substance use disorder and mental illness are very high. When you say psychosis, it suggests to me that your son perhaps has a serious mental illness, the definition of which has evolved, but that basically includes disorders that produce psychotic symptoms, such as schizophrenia and schizoaffective disorder, and severe forms of other disorders, such as major depression and bipolar disorder (

These disorders can definitely complicate treatment and recovery. In an ideal situation, your son would be treated in an integrated program with an integrated team (psychiatrist, psychologist, substance abuse therapist—or some derivative of these three roles—along with a case manager/social worker to help with aftercare planning). Team members would meet regularly to go over your son’s care and progress.

The reality, however, is that this rarely happens. Busy clinics have limited psychiatric care and sitting in case meetings is poorly reimbursed. In the programs I’ve evaluated over my 24 years doing this work, I can count on one hand the times psychiatry of any sort was in a case meeting. And if they were present, it was because the program was a mental health program first and had grant monies to pay for the time spent in team meetings. With psychiatry in the room, the conversation narrows to include medications and therapeutic attendance. How substance abuse can complicate the behavior a psychiatrist is trying to treat is hard to disentangle. It takes people who are dually trained and experienced. Psychiatrists are in very short supply, even more so in busy public or insurance-based clinics. The chances are rather good that your son has not received much truly integrated dual-diagnosis programming.

Your son goes to a treatment program and then immediately returns to your home. Does he follow up with community-based treatment? Is he followed by a psychiatrist? There is much on this site about allowing your Loved One to live in your home. Your home is a reward, a huge reward, that gets awarded when a Loved One is trying to get and stay healthy by working a program of recovery. See the topic "home as a reward" to review our ideas on how to address having your Loved One live with you.

If your son is so seriously mentally ill that his problems with daily living make it impossible for him to live independently, then it would be worth talking to the Department of Mental Health. I had a parent who recently looked into this for her son. Here are her notes from the conversation she had. I specifically suggested she ask about DPH assigning her son a case manager, which is someone that helps the Loved One navigate the mental health system.

I recently talked to a supervisor at the Department of Mental Health for our local counties (MA), and here's what I found out.

1) Fill out the application available online.

2) Application is assigned an eligibility specialist.

3) Criteria reviewed, and while this is general and not absolute, sounds like we need to meet this criteria:

– have a diagnosis that fits the criteria for eligibility

– involved in outpatient mental health, currently or previously

– must have had inpatient psychiatric stay, currently or previously

4) If we fit all criteria, application goes to a Needs and Meet department to do a formal in-person assessment.

5) If accepted, meet with team and recommendations are made with referrals for service. If denied, recommendations are made to applicant.

6) Typically a 90-day period for the application to be processed.

The person I spoke to stated that addiction does not qualify for mental health. If the court-ordered counseling is for addiction, then it does not count for outpatient mental health. If symptoms are related to addiction, as opposed to mental health, then criteria are not met. I specifically asked about being assigned a case manager, and that has its own qualifications to meet.

The DPH system has supportive homes and a larger system of care than for those with substance problems. Let us know if you are able to tackle this and what you learn from trying.

Our best wishes for you and your son.



In your comments, please show respect for each other and do not give advice. Please consider that your choice of words has the power to reduce stigma and change opinions (ie, "person struggling with substance use" vs. "addict", "use" vs. "abuse"...)

  1. Dear Chris, thank you for sharing your struggles, heartache, and redemption. Just reading this has centered many of us. We run in so many different directions trying to catch the tiger by the tail and save our loved one. You bring home the grace at the core of our purpose for being here, Just Love him. I pray that you can continue to heal and grow in that Love.

  2. Thank you for your response. I was so worried about my son and prayed deeply for what to do. The room filled with light and the answer came….Just Love Him. A week later he took his life. He was in so much pain. In 13 years of going everywhere for help. I had never heard that before….I will remember in his honor with gratitude………..Just Love Him.

    1. Chris, I am very sorry for your loss. I can not imagine the pain you are going through. I am not sure saying “your son is at peace now” is the right thing to say, but it comes from my heart. I really do believe your son was suffering and could not fight against his illnesses or the system any longer.
      Your words posted above about praying for guidance, brought tears to my eyes. You loved your son, that is all you could do. God Bless You

    2. Dear Chris,

      I am deeply moved by your story. Not only the brutal struggle alongside your son, which I know too well myself. But in the final days – the inspiration to “Just love him.” Wow. I feel it was direction from a loving-force that oversees the end as much as the beginning, in ways greater than we can comprehend. In my personal belief, that is Who and What restored your son’s peace and welcomed him home. What powerful direction, how loving for you both.

      I don’t have the right words to comfort you as you part ways with your precious son, except to say I believe it’s only for now. What an honor you are to his life and his struggle, as you continue to “just love him” until you see him again on the other side.

      All any of us truly have is today. I am in awe of your strength and love. May you find peace, strength and comfort in the days ahead.



      1. Thank you – ….It was such a good message, so many who have demons to stuggle with have such a hard time feeling the love. It is so healing to remember to give it. Again thank you

    3. Dear chris,

      Wishing his soul all the peace he was seeking, and wishing you and the rest of the family as much peace as is possible. It’s hard to go wrong when you’re cultivating Love around you. So glad you found some light and guidance in the midst of such a harrowing time. I am sure your son felt —and took with him— the unencumbered Love you were sending his way. All of our best wishes,


    4. Chris, thank you for sharing these last moments about your son. The clear message you received about love is so important to hear. Thank you for reminding us. May both you and your son now rest. Dominique