What Can Be Done Legally For My Son?
QUESTION:
Dear Dr. Heller,
My son was diagnosed with a Learning Disability at age 7, has been developmentally delayed all of his life (we adopted him at 11 mos. and he couldn't sit up on his own) and was diagnosed with ADD in High School.
He's extremely bright, especially in Math, Computers, Electronics and Art., but school was always difficult for him because of his poor organizational skills. He quit High School in Feb. of his Senior year, and finished at a technical school. During these years he began to experiment with alcohol, drugs, and self mutilation, but little known to me. His father asked me for a divorce when he was about 12. He, his two older sisters and I received therapy and counseling and he was put on Dexedrine and other drugs for depression and ADD during those years.
At age 19 he went into the Navy. They really wanted him because he had such high test scores. When he told them he had ADD and was LD he was told to go off his Dexedrine for 6 months and they'd take him, which he did. The day after he finished courses for his High School diploma, he went to basic training. At first he did well, the structure was good for him. But as time progressed he began spending those paychecks and a big bonus given to him for extended duty and special training. In less than a year, he got so drunk one night he was put in the hospital and sent to their alcohol/drug rehab. facility for a month.
The night he got out he went out and drank with a friend he met in the facility and later tried to commit suicide (slitting his wrists). He was diagnosed with BPD and discharged. He came home and for a month tried to deal with his past, met up with some Navy friends at another base a few hours away, went to live with them, and 4 days later, started drinking, slit his wrists, and ended up in another Naval Hospital for 2-3 weeks. He was released to me, and we sought help through our local Mental Health Facility. For over 2 years he's been seeing a social worker and Psychiatrist, has been in and out of Hospital Emergency Rooms, Psychiatric Units, and a State Hospital and through their alcohol/drug rehab. program once due to his continued drinking episodes, depression, problems sleeping and just basically trouble functioning.
He has had four different jobs, and different Drs. have tried him on different medications that didn't seem to be helping. He was in a State Hospital for over 4 months and was taking Prozac and Depakote and gained over 60lbs. He was on a waiting list for one of their programs, but when he proved to be too high functioning, was released. He has lived on and off with me, and his married sister, and it's been very stressful on all of us. We been reading "Walking on Eggshells" and I have been to Al-Anon and received counseling myself. His intentions for improving are always there, and he's made good strides.
But a week after his hospital release this time, he went down town, ended up drinking too many beers. He realized he needed to get home and in the process, as he was leaving the bar, heard someone threatening to shoot someone, went to his truck and drove around the corner to look for a policeman to get help. He honked and waved, got the policeman's attention and in the process, sideswiped a parked car on Main St. and was immediately stopped, and arrested with his first DUI. (His father, who lives in another state now, was an Alcohol Programs Manager for a Highway Safety Research Center on Campus and he's always been aware of the seriousness of drinking and driving and would go home with a friend or sleep in his truck before driving in the past.) I brought him home from the police station, and about an hour later, he made another suicide attempt, went to the Emergency Room, and back to the State Hospital. They released him a week later and said he didn't qualify for their rehab. because it had been less that a year.
The next day I took him with me to a conference where you were speaking, and he felt for the first time, he'd heard a Dr. speak that cared. We're reading your book, and Website. He was inspired to go back to his Dr. and he did put him on Tegretol. He feels better and has continued to feel better, is losing weight, is starting DBT/Alcohol classes through the Adult Day Program and is job hunting. We got your email answer about treating both ADD and BPD but his Dr. won't treat his ADD so we're working on trying to find someone who will, because it really interferes with his productivity and motivation. Everyone who knows him, has seen a big difference in him. We've given his Dr. information from your Website, but he's not as receptive as we'd like, especially about the epilepsy, so we're looking for someone else.
We were very impressed with your presentation and your book and how much you seem to really care about your patients. Other people I talked to from the conference were also very impressed. We hired a lawyer who seems very interested in his DUI case and trying to help him. We told him about his BPD and his past. A local judge came to a Mental Health Conference I attended and talked to us about how too many people are in jail that are mentally ill and how the court system is trying to learn more about how to help them.
My question to you is: Somewhere on your Website I saw where you mentioned that you had represented BPD's in court. My son goes to court May 2 for his DUI. Is there any thing that his lawyer should know that might help him defend him in court? We've given him information from your book on BPD and I'll give him the info. you sent about how his ADD should be treated. He would like to get it reduced to reckless driving and present to the judge that he, on impulse, went looking for a policeman having been drinking, and that he just wasn't thinking about what he was doing. This DUI/followed by a suicide attempt, happened a week before he met you, and got his medication changed to Tegretol, and hopefully he'll mention that too.
ANSWER:
It’s impossible to predict any individual judge, however in general this is what I’ve encountered:
If an individual has a mental illness that is either untreated or inadequately treated, the judge will often put the individual on probation as long as they are adequately treated. In other words to give the individual a chance with the correct medication.
In my experience, there’s no question Tegretol is a superior medication for an individual like your son. Recent articles in the medical literature show that those with attention deficit disorder who take Ritalin are at a LOWER RISK of substance abuse than those who have the disorder and don’t get treated. While I can understand the concern about prescribing the medication, he’s at high risk of incarceration, death, or of hurting someone else in a motor vehicle accident if he’s untreated. In my opinion, the benefits outweigh the risks because the risk of his abusing the Ritalin is likely significantly less than the risks of his uncontrolled impulsive behavior. There was an article in the American Journal of Psychiatry a few years ago with cocaine abusers that showed a reduction in abuse when treated with Ritalin. Dr. Cowdry’s landmark Feb 1988 NIMH study published in the Archives of General Psychiatry showed that "patients taking carbamazepine (Tegretol) had a marked decrease in the severity of behavioral dyscontrol." As you stated, these behaviors occurred before he was placed on Tegretol.
There’s also a study on the use of Ritalin in patients with Cluster B personality disorders - including the BPD - who also had bulimia. Ritalin reduced their bulimic behavior. {Methylphenidate treatment for bulimia nervosa associated with a cluster B personality disorder. Int J Eat Disorders 1999 Mar (Menninger Clinic)}
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