I think that at some point, it becomes clear. I think it just happens on its own--at least that's what I'm expecting will happen for me. Whether you consciously weigh up all the pros and cons or not, I think the decision about the next step becomes clear in its own time.
I can relate a lot to your sitch. Like you, this is my second time around. Like you, my H plays around with his medication. When he comes off his ADs, he becomes verbally aggressive. He keeps promising that he'll stay on but then decides to come off without telling me and becomes very angry with the world and especially with me.
Good luck!
Me: 51 H: 52 T: 23 yrs M: 19 yrs S18, D16, S14 (special needs) PA: 2003/2004 Piecing: 2004 on Suspect H had EA: 8/2012-12/2012