I concur, Mrrzy, fascinating on more levels than one ...

remember the patient who lost his temper and stormed out of a community meeting, which one is supposed not to do?
He is in serious trouble now.
I'm not going to say what substance he was 'using' but
suffice to say you're not supposed to use it, or other substances that compare to it.
He had been secretly doing so for weeks, right under our noses.
I'm not even going to specify if the substance is generally illicit or if it is legal past a certain age or whatever.
The point is, he is an in-patient resident living in close quarters with several dozens of other patients, and his actions affected us all, however indirectly.

Having avoided 'substance use' in general for the whole of my life, there is a lot about which I am ignorant.
I was just aware that this patient, always needy and dependent on interacting with others, was presenting in a way that was increasingly conflicted and complex.
With a change to his prescribed meds --
something that happens quite often in a clinic like this one --
he went through a downright euphoric period, and in fact he was insufferable for a while,
because he wanted the whole civilized world to know that he felt like life was worth living again, aargh, which is anything but considerate of fellow patients who may really still be struggling.

Then, with the improvement in his feelings and well-being, came the moments when he could no longer avoid looking at the really tough issues which were his excuse to abuse substances in the first place. And so, he took the path of least resistance, for weeks as I say, covering it up the whole time. And the way he presented, while hiding it, was a different presentation. His volatile temper got worse instead of better. However, instead of demanding attention and being needy, he became wary and guarded, holding people at arm's length or further. This is a troubling combination even to someone like me who does not know what to suspect.

Of course the patient population includes other recovering abusers of substances, and no one had been watching this patient MORE carefully than they had. One of them caught him out, not because he was obviously in an altered state, but because they caught him carrying a certain implement, and: "Is that a ***** ?"   Sooooooo busted.

Eventually these others will sort things out, but right now they are royally pissed-off with this patient, now that they can look back on the last few weeks and recall all the times they socialized with him and what he said, and how he said it, instead of coming clean.

This patient has not been discharged on the spot. He turned himself in, for one thing, after being caught out by his fellow patient. Other mitigating factors. This does not mean that he won't be asked to leave -- just, that it won't happen now if it does happen. First his case will go through a couple of weeks of reevaluation, for which there is a definite protocol and procedure. So whether he continues or whether he receives an administrative discharge, he will have the benefit of sustained, cooperative, care and attention from a whole integrated team of different specialists.

In my months here, I have witnessed this reevaluation process for two previous patients, both of whom were allowed to continue their treatment following the process; it was a wholly positive experience for both of these;
and for one of those earlier patients, whose parents had sort of dragged him here after years of having psychiatrists controlling him with addictive prescription meds, the reevaluation -- following a really scary "discompensation" incident -- was truly a turning point; now he is grateful for the attention that he received when his need was greatest, and he continues his treatment on an entirely different footing: not against his will, as when he was first admitted, but voluntarily and with gratitude and appreciation. That is a beautiful thing to watch, as unnerving as the incident was that was the catalyst for the breakthrough.
Time will tell, with this third patient, how things work out; and meanwhile the patient community is helping each other get to grips with the disturbance and the drama.

Although I am hanging in there, and my treatment is going well and I am working hard and productively at it, I'm starting to think carefully about life after treatment. Which I guess means that I feel safe enough to do so without doing it as an escape or an avoidance of reality. And only time will tell how that, too, works out.