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Sounds like the real problem is addiction. The rest is just symptoms.
I don't do as much counseling as I used to, and I no longer try to help them all because they need it, or even because they want it. I tend to help the ones who will do the work. It isn't fun telling someone that you aren't going to watch them kill themselves, but I have seen enough people do it, and I am not going to hold your hand for that. I can't make someone live, and I won't watch them die. How fun is that?
In your case, it would be pretty easy to have the guy declared a danger to himself and others, and possibly have him committed. Or you can offer him the choice in very clear terms and let him walk away if he wants. Just be very clear that You cannot save him unless he takes steps to save himself, and understand that none of this is your doing.
If there is some kind of agency you can pawn him off to, where he can be incarcerated and receive forced treatment, I expect that would be the only thing that might get him healed of his wounds, which again are only a symptom. As a doctor of the body, you are IMO fighting a lost cause.
You didn't cause this, you can't cure it, and you didn't create it. None of this is your doing. This guy isn't even clear enough to make his own choices. If you truly want to help him, you have to put him where he will receive enforced detox and care, knowing that the end result may still be the same.
Again, if people come to me for help, it is going to be on my terms. From experience, I know that this is the only way it will work. I don't tell people to go to hell, I just tell them I am not holding their hands while they walk to the gate. I tell them it is a clear choice of Life or Death, Good or Evil. I invite them to choose life in very clear terms.
FWIW, I have never refused help to someone who tries, even if they fail. But you have to try. It doesn't always seem fair or right, but there it is.
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