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Norman M.
Norman M., Principal psychotherapist in private practice. Newspaper contributor, over 2000 satisfied clients on JA
Category: Mental Health
Satisfied Customers: 2568
Experience:  ADHP(NC), DEHP(NC), ECP, UKCP Registered.
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Please help if you can. I have a 23 year old son who is an

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Please help if you can. I have a 23 year old son who is an alcoholic and dual dx. The trou ble is that no one seems to be able to help him adequately. There is bipolar illness on his father's side and unipolar illness on my side. His father abandoned him as a child and has little contact except through an occasional very mean and hurtful email.
My son has mostly been dxed with MDD and substance-induced mood disorder. One psychiatrist thought he had early bipolar disorder. If he is not drinking, we start to see his personality improve, although he remains dysfunctional, cannot find a job and cannot complete any school courses. He has been in multiple 28 day programs, a sober step-down program (3 mos of this the past year) but he does not follow through with AA.
Current psych meds are Abilify, Lexapro, campral prn Trazadone plus milk thistle, NAC, vits. He did poorly on a trial of topamax and depakote, with raised ammonia levels and extreme lethargy.
His father has never been dxed but we think he is bipolar II. He also has hemochromatosis. He stayed up late, slept much of the day, was functionally depressed to the point of losing jobs and not functioning, spent money on credit he didn't have, had delusions of grandeur, felt himself to be a genius, and still tries unsuccessfully to make a living as a piano teacher, with a falsified website. We have been told he is delusional and he has a narcissistic personality. I am divorced from him. He is not alcoholic, but has a half-brother who is, along with being bipolar, a sister who is dysfunctionally bipolar, and another half-brother who was a drug addict and is now labelled bipolar.
My son in testing was labelled as probably having narcissism, avoidant and dependent disorders.
My son stops his meds and goes on severe drinking binges. He has fatty liver and hepatomegaly. His brain MRI recently was normal. He is severely depressed and non-functional. The meds have calmed his irritability, but don't seem to do much else. He is in trouble with the law for being violent when drinking.
We have done everything we know of and he won't stop. We are pulling all financial support from him now unless he goes on Vivitrol, which has been near to impossible to get anyone to prescribe around here.
If you have any thoughts on diagnosis, I would be most grateful. My son acts like his father--very dependent on others, doesn't support himself financially, expects to be taken care of, feels the world is against him, narcissistic, but cares about others, especially the downtrodden, at times.
My son denies he is suicidal but he acts as though he is by drinking 1.75 L bottles of vodka, several over consecutive days. We do not know where he is getting the money except that he has stolen from us.
Thank you. I am desperate for help. His psychiatric help doesn't seem to be working. He is in IOP now, but has not seen the psychiatrist yet and he keeps missing due to relapses.
Many thanks.

Hello and thanks for visiting JA

I´m really sorry to hear about what you have been going through.

I have several suggestions for you.

First off, your son needs to be confronted with your feelings about his behavior, and made to understand that while you care for him, his behavior is unacceptable and will not be tolerated, at least by you. We can stick as many psychiatric labels on him as we like, but the fact is that he is simply acting like a spoiled child.

He also needs to understand that that any continuation of this disruptive and anti social behavior will have consequences. They need to be spelled out to him very clearly, with clear emphasis on the fact that they will apply immediately. Missing a psych appointment means sanctions! You might, as well as withdrawing all financial support from him, advise him that if he ever steals from you again, you will involve the police, and ultimately, if he does not clean his act up, he can leave.

Remember, he is an adult and responsible for his own choices. That said, until he finds out that the world owes him nothing, and accepts that it owes him nothing, not all the drugs in the pharmacy will sort him out. They might help his behaviour a little, but it is grass roots change that is required here.

We humans only indulge in behaviour that brings reward of some kind. Only when that reward (whatever it might be) disappears, or the consequences of our behaviour promise to be unpleasant do we consider changing what we do. Right now, he has no reason to change - he gets away with whatever he wants, so why should he change? It is time to give him some reasons to alter his behavior!

Here is the clue to sorting things out. When you are faced with non-co-operation – give him choices, and make sure he understands the consequences of his choice – and always follow through. If you don’t he will continue to take treat you the way he is doing just now.

Ask him too, what he is prepared to do to change his behaviour in future – tell him to research what might help him, what professional help he might get, and even consider a ‘contract’ between you. In other words, involve him in his own change, with a prospect of a small reward for success and dire consequences for failure.

However, don’t get angry, stay cool and in control, matter of fact and stick to the facts. Avoid drama.

There are difficult choices to be made ' if you take you take too firm a line, you may alienate him completely, and if you are too soft, nothing will change. Try to find a middle way.

Finally, I feel sure you would benefit from some supporting therapy for yourself.

I’m going to suggest that you would benefit greatly from a course of Cognitive Behavioral Therapy. It is a form of therapy that addresses problems in a direct and targeted way and is brief compared with most other therapies.

CBT is based on the fact that what we think in any given situation generates beliefs about, and reactions to that situation, and also cause the behaviour and feelings which flow from those beliefs and reactions.

These ‘automatic thoughts’ are so fast that generally, we are unaware that we have even had them. We call them ANTS (automatic negative thoughts) for short.

If the pattern of thinking we use, or our beliefs about our situation are even slightly distorted,

the resulting emotions and actions that flow from them can be extremely negative and unhelpful. The object of CBT is to identify these ‘automatic thoughts’ then to re-adjust our thoughts and beliefs so that they are entirely realistic and correspond to the realities of our lives, and that therefore, the resulting emotions, feelings and actions we have will be more useful and helpful.

Cognitive therapists do not usually interpret or seek for unconscious motivations but bring cognitions and beliefs into the current focus of attention and through guided discovery encourage clients to gently re-evaluate their thinking.

Therapy is not seen as something “done to” the client. CBT is not about trying to prove a client wrong and the therapist right, or getting into unhelpful debates. Through collaboration, questioning and re-evaluating their views, clients come to see for themselves that there are alternatives and that they can change.

Clients try things out in between therapy sessions, putting what has been learned into practice, learning how therapy translates into real life improvement.

Please visit this website for much more detailed information on CBT:

One final word – you have not failed him. He is an adult and is responsible for himself, and has been for the last few years. Please, therefore, do NOT be hard on yourself.

Best wishes,


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