Summary
A reader describes a brother’s escalating substance use and suicidal threats, alongside the family’s exhaustion and uncertainty about obtaining help. They ask how relatives can respond when someone refuses treatment.
The response recognizes the pain addiction and mental illness can cause throughout a family, while discussing the tension between treatment and an adult’s individual rights.
It emphasizes rehabilitation, family psychotherapy, and clearer boundaries around ongoing support, presenting these as difficult decisions that require help rather than a simple solution.
Question
Reader · Identity withheldFor months my brother has been talking about death and asking painful questions like, “why can’t you just let me go and forget about me?” He has been abusing his pain medication and drinking heavily, often mixing the two. Just last week, he threatened to kill himself. I called 911 because he was completely out of control, and he still is.
At the emergency room, I told them everything: how he’s been using drugs, drinking until he passes out, and becoming completely unresponsive. Still, nothing has changed. He continues to spiral.
What hurts even more is that my family cannot seem to take a stand and force him to get help even though his behavior is draining all of us. We are becoming depressed. We cannot even go to work without worrying that he might hurt himself while we are gone.
This law needs to change. When someone is in a mental health crisis and refuses help, the family should have the legal right to step in, especially when their actions are affecting everyone around them. People who are stable should not have to carry the emotional burden of someone else's illness without support.
I am suffering from severe anxiety because of this and it is exhausting. How is it that we cannot smoke a cigarette in public anymore, but we have no protection from people who are mentally ill, abusing drugs, or pushing others into crisis? The system is completely broken.
Answer
Allan Schwartz, Ph.D.Your comment is very passionate and the reasons are clear. It is very painful to see a person being destroyed as a result of addiction, mental illness or both. It is equally frustrating to experience the impact of this on your self and the witness how the family is being affected.
Having admitted this to you we must also be mindful of the saying, “be careful of what you wish for, it could come true.” There was a time, prior to the 1960’s, when the mentally ill were warehoused in huge state mental institutions. Most of them languished there until their deaths, ignored, raped, abused and abandoned. Thankfully, with the advent of new medications, people could be treated in the community where they receive medication, psychotherapy and support services. The days when people could be locked away and deprived of their rights is over.
Please remember, in the former Soviet Union, those who dissented with the government were put into their mental institutions and medicated into passivity. We do not want that here.
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The situation with your brother is somewhat different because he is addicted to pain medications and probably other drugs as well. So, he is numbed out and you and the family feel all the pain. Though I never like saying this because it is so difficult to do, he must be confronted with going to rehab or losing all contact with the family including financial, room and board and emotional support. The entire family needs psychotherapeutic help in doing this.
I have been told that this strategy risks suicide. My response is, maybe, but the addict is on a definite suicidal course anyway. In fact, the risk is that he will take others in the family with him due to stress. The choice is up to him and the choice is up to the family to stop suffering and allowing him to feel the pain.
Best of luck.
