Thanks for all advice and helpful suggestions.
And thanks, @Hawaii_Jake, for emphasizing this in my OP: he is rejecting all care.
I can’t get therapy for him. I can’t force him to get help. He is an adult. He refuses every kind of counsel and treatment from any professional or institutional source. I can’t control what he does or where he goes.
Once before, he came back on condition of getting treatment, and then he put on such a performance for the admitting nurse that she decided he was okay and sent him home.
I have been seeing a therapist and talking to two trained counselors who came with my late husband’s hospice enrollment (even though he never came home to hospice care). I attend Al-Anon meetings regularly. And I have given him shelter and support for years, and money.
It’s time for me to stop that; it hasn’t helped, only prolonged things. So we are now in the “tough love” phase, and it is horrible.
I think his mind is so damaged by various substances that he doesn’t grasp much of reality at all. Instead I have become the enemy for not rescuing him. The past nine years that he squandered under my roof apparently count for nothing.
He actually did get picked up by the cops the other night, and wound up in the county psych ER. For a moment I had a breath of hope, because they had him in a medical environment. But he apparently fought his way out and is literally on the street. He wants me to take him back in, and I just cannot do that again, so he is sending me terrible messages.
So my question is really about what has helped you, because I can’t help him. I do not possess the power or the means to give him what he needs. But the cost to me of seeing him like this and enduring his reciminations is great.