To expect some help with bipolar, alcoholic DSS

[Notnamed]

I have posted this in 'alcohol support' but no one around to advise. Be gentle, crisis at this end, posting for traffic.

NC'd

DP is enroute (3 hours away) to try and help his son.

DSS is 33, diagnosed 18 months ago with bipolar and is an alcoholic.
This time DSS has drank for 10 days (stopped his BP med's to be able to do so)
Has been out of contact ( couple of days at a time) for the last 10 days.
Has talked about killing himself.
Has injuries because he has fallen.
On Friday he took himself to A&E, they gave him med's for the withdrawal from alcohol. He continued to drink Saturday and again talked of killing himself.
We called 111 and they sent an ambulance, escalated to an emergency because he had head injuries. They took him to hospital, he refused to go inside and went home.
He messaged this morning to say he was hallucinating through withdrawal.

His DM and DB are there now but can't control his violence. DP is on his way.
None of his family can continue to miss work to stay with him long term while he sobers. No assessments can be made because he is drunk.

This happens every two to three weeks, same cycle.

DSS has moved out from his wife and DC's. Lives alone, will lose his job, his flat and will be homeless?
His DM today was shocked to find his flat is a disgrace, burned carpets, 20 empty bottles of vodka, same for beer and cider.

This can't carry on. He has been in units for MH but signs himself out. His family don't know what to do next.

We have read information and understand 'enabling' and know about AA ( which he goes to sometimes or so he tells us, though so many lies. We know that he has to want to be sober and that we can't do it for him.

He lies, he is expectant about money, he is horrid to this he loves. His DF and DM are decent professional people. His DM has had alcohol issues herself.

He is losing everything.

Sorry for the ramblings. We are at a loss and scared for his safety.

No sure what happens next.

My late partner was a Bipolar alcoholic, its horrific what happens to them, it's a vicious circle, the bipolar feeds the alcoholism that feeds the bipolar. He ended up in hospital so many times I lost count, there doesn't seem to be any kind of service that treats the whole person, just someone for the alcoholism & someone for the bipolar, nobody ever treats them both together. It's an awful thing to say, but unless he gets treatment for both conditions, one of them could end up being fatal. If he has damaged his liver through drinking, the drugs he should take for the bipolar will also be harming his liver, plus the alcohol will cancel the effect of the drugs. The best treatment is for him to be sectioned & detoxed under controlled conditions as he may have withdrawal seizures & may need his bipolar drugs changing as he withdraws. Going to A & E doesn't help as unless they ask for help, all they will do is patch him up & send him on his way, I spent many nights sat there with my partner begging for help but until he asked for it himself they did nothing & by the time he asked for help, he was dying & it was too late. You can speak to Al-anon for support for yourself, your husband & any siblings, but unless he is prepared to ask for help himself, there is nothing you can do.

Poor sod - an unholy and untreatable mix of bipolar and alcoholism

Or, as BarbarianMum say some: There's very little help available if he wants it, and nothing at all if he doesnt.

Has he been through detox/rehab? I’ve commissioned these services, your local authority pays for these services, most areas have emergency detox beds with then straight access to rehab placements, speak to your local alcohol treatment service

I think he has been through a detox programme and he had a stable time after that supported by AA.
He has been in a residential placement through a charity. He told them he was ok and went home.

He had binges after that, one where A&E refused him but suggested he may be bipolar. He's clung to this and uses it to excuse his behaviour ( shame on him).
He lies. I'm not convinced about the bipolar even, why would he suddenly be bipolar? Is this caused by drinking? Can you fake a bipolar diagnosis? Oh I feel so crap even saying that and my apologies to all of those with genuine MH issues. Never trust an addict comes to mind.

It seems a downward spiral. He's lost two teaching jobs, he has left his family home ( which is good really unfair on his DW having to manage him), doesn't see his DC's, will lose this job, has slept with people he shouldn't ....it goes on and on.

DP has phoned just now. Hospital are doing CT scans. They will keep him in to sober him up and the MH Assessment team will assess once he is sober enough. I'm still not convinced he will stay though. I don't think there is anything to stop him getting up and leaving.

The real difficulty in trying to treat chronic alcoholism is that the law does not allow treatment to be forced upon individuals who have capacity. Even if a person is incapacitated due to withdrawal and is in a hospital as soon as the acute withdrawal phase passes with treatment and capacity is regained they often self discharge. I do mental health liaison and see lots of chronic alcoholics who have a dual diagnosis of a serious mental illness and alcoholism. Whilst someone is drunk it's not possible to be certain how mentally ill they are. We see people time and time again who are admitted for a detox but won't engage with aftercare services. People return to dire social circumstances and soon return to drinking.

Soul destroying for you too dottycart. Thank you for your work.

Detox beds/rehab that is commissioned. I've googled in his area, it comes up with something like 'addicts4you' who will provide advice on beds. Don't even know if this is real or whether it is trying to sell private placements.
How do we find out the correct information? Do we expect that the hospital will help? Do we need to source a next step ourselves. Can the NHS provide this or do we need to pay for a service. We have little idea of how to get support.

Read some Al anon literature on the website it's really helpful.
Hopefully he will hit rock bottom soon, remember everytime you intervene in that natural process all you do is prolong it.

It will be really hard to diagnose Bipolar whilst he is drinking, he needs to dry out and be assessed in hospital but would need to agree to this unfortunately. The days where people were detained for alcoholism are long gone, mostly because often they got out and started drinking again.
I would join Al anon if I were in this position to get some support, knowing that you need to distance yourself is one thing, doing it is quite another.

If he’s threatening to kill himself then you could get him sectioned for his safety.

Is he I’ll enough to be sectioned? A friend was recently sectioned when she was found ‘acting oddly in a Tesco car park’ and was kept in for 3 months. I imagine he needs to dry out as well, so he has complex needs. Sounds a nightmare, op. Hugs and sympathy.

You can't get someone sectioned.
People are not sectioned for threatening to kill themselves.
You can ask for an assessment, but from what the OP says he is unlikely to meet the criteria to be sectioned.

People tend to detox as an emergency when they end up in an A&E with withdrawal symptoms severe enough to require a general hospital admission following seizures or gastric bleeding. This will give immediate access to a physical detox when hopefully they will be seen by either mental health or alcohol team to plan follow up. Detox arranged by substance misuse services is planned and involves a more controlled withdrawal, there is a move to home detox where people are visited at home and withdrawn. Access to NHS funded inpatient detox beds is really hard to get and normally requires planning and waiting lists but will offer counselling etc as well as a physical detox. There are drugs which can be prescribed long term to reduce cravings.
If he really wants to get off alcohol and ends up back home tonight I would try and persuade him to contact his local substance misuse team.
Regarding the bipolar, this diagnosis would be made by mental health services not a GP but unlikely to be diagnosed unless sober for many weeks.

Op is he taking medication for bipolar?
It does not sound as if he is psychotic. So he knows what he is doing. So until he decides to stop drinking, there is nothing anyone can do. Even if you could force him to dry out, the chances are that as soon as he was able to, he would start drinking again anyway.

An intoxicated alcoholic would not typically be detained under the MHA, the mental capacity act would be an adequate legal framework.

Thanks everyone. DP arrived back at 4.00am. DSS has been kept in hospital. Still very rude with those trying to help him. DP is so ashamed of him.
Ambulance crew said he is the worst case drunk they have seen.

He's been put on a medical assessment ward under observation as there is blood when he is sick. He is sharing with some older ill men. DP has warned him about his behaviour ( 'this could be your ill grandpa' were his words)... not likely to make a difference to a drunk tho!

Hospital said they would use security to try and stop him leaving though he hasn't put up any more resistance. He's alone now in his home city. His family are all back here. He has no phone (he's smashed it), no money and no keys to his flat.
No contact from the hospital overnight, so we are taking that as news that he is still there.

He'll be assessed once sober and then we may know more.

Thank you for your time, for sharing your expertise and experiences. We all feel very numb. DP has gone to work, I'm on my way...both having delayed early meetings. DP's EXW has gone home but will return today to the hospital. No sure I would TBH!

Just some added to answer your questions.

He is on medication for bipolar, supposedly diagnosed a year to eighteen months ago. He stopped taking the meds to be able to drink, as far as we know at the start of this episode nearly two weeks ago, though it could be intermittent stopping whenever he drinks, we don't know.

He has had support before and was taking a drug (antiabuse?). He told us that he was only able to take this for 6 months at a time as it is too damaging to the body. His 6 months were up. He did attend very regularly AA and had a mentor. This stopped when he moved. He says he goes to AA, if he does it is intermittent, we're not sure that is even true.

He did spend a month, about 5 years ago in some sort of unit and in a charity based residential two years ago. He talks about ' but I was 5 years sober' but that isn't true, there isn't enough time for that to have happened.

Both of the residential stays he checked out of. The first he says he convinced them he was fine, the second he said his DW said she couldn't manage any longer without him at home..but again we don't know if that is true.

Find your nearest Al anon meeting. They saved me, the whole family can get support there x

I think I phrased it wrong...you are right youd never get over it, but if it coincides with you detaching yourself, that would be so hard to bear.
I know how we felt when my son disappeared...

You cant stop him drinking- alchohol is his no 1 priorty ....please get your DH and you if you can to an al-anon meeting - they really helped him/us understand there was nothing we could do

no phone calls
no moving him close
no keeping an eye out
no talking - no anything will stop him drinking... you cannot take that on yourselves
MIL stopped drinking once hospitalised with fits/splitting her head open 3 times and being basically kept in a coma for her body to detox.. (obviously thats not exactly what it was but sort of)
she had lost her licence had punched ambulance men and nurses etc (shes a tiny old lady but still....) over the frequent admissions when found passed out...
DH was running back and forward (we are 3hrs drive away)but it is not sustainable.... and actually made no diference at all..

she hs been sober a while following teh extensive hospital stay and has had some support in teh community but she wont access much of whats there and has capcity so cant make her...

your BIL may be judged to not have capacity??????
either way nothing you/dh can do can make him change.....its crap but make your boundarioes... DH stopped talking to her if drunk on teh phone but it was hard journey to make...

He stopped taking his meds so he can drink. So he knows what he is doing. He is choosing to drink alcohol and live the life he is.