May 14, 2007

• Self-Medication for Bipolar Disorder

  Over half of the people who have bipolar disorder also have substance addictions.  Over half of alcoholics have bipolar disorder.  Those statements are derived from numerous governmental and professional mental health and substance abuse sources that mention percentages from as low as 60% to as high as 75%.  I think that the true figures could well be higher.

  I know quite a few addicts who would be surprised to learn that they are bipolar.  I also know some people who know that they are bipolar but are in deep denial about their drug addictions.  The statistical situation becomes even more absurd when you dispense with the medical euphemism, “chemical dependency,” and acknowledge the fact that an addiction to a legally prescribed drug is neurochemically indistinguishable from dependence on an illicit drug.

  The terms, “comorbidity” and “dual diagnosis” are used to label the coexistence of addiction or substance abuse with mental illness.  Some of us just call it Double Trouble.  I had been attending AA and NA meetings for a year or two when I attended my first meeting of Double Trouble in Recovery.  It quickly became my favorite 12-step group because there is more self-awareness among the members and less of the hypocritical bullshit I have found among some people in AA and NA.

  The higher level of self-awareness makes sense when you realize that virtually everyone in Double Trouble has been in psychotherapy of some sort.  That’s what therapy ideally is supposed to do for us:  make us more aware of our selves, our motivations, feelings, etc.  Additionally, there is a tendency in other 12-step groups to ascribe the addict’s problems in life to, “character defects,” or to whichever addiction is that organization’s target.   DTR starts out by acknowledging that everyone there is mentally ill.  That works for me, and would work in every 12-step organization there is.  It is an error to view addiction, whether to sex, “love,” gambling, meth or alcohol, as anything but a health issue.

  But, to get back to self-medication, it is an issue across the board in those disorders that used to be called neuroses, as well as those that were formerly termed psychoses.  Current psych jargon runs more to words like conduct disorder, dissociative state, etc., but one common thread that ties the whole mess together is the tendency of crazy people to tinker with their neurotransmitters in an attempt to attain better living through chemistry.  Some vivid examples of how that can work out include Ted Bundy and Jeffrey Dahmer who always got drunk before stalking their victims.

  It is fairly widely accepted that virtually nobody enjoys being depressed.  A drug-savvy bipolar being on a downswing is likely to turn to something that increases dopamine in the brain, such as cocaine, meth, X, or Prozac.  One with less savvy or fewer drug connections might just drink alcohol.  The drinker accelerates and accentuates the depression immediately, while the rebound effect of the other drugs would worsen the depression somewhat later on.

  The other side of bipolar disorder, the mania, isn’t so simple to nail down.  A relatively recent change in diagnostic criteria recognizes a “Type II” bipolar patient who is hypomanic, mostly depressed, whose upswings can easily be mistaken for what I laughingly call “normal.”  My kind of bipolar is was hypomanic.  I used to welcome the manic swings.  Lots of other people do, too.  It feels ever so much better to be manic than to be depressed.

  The problems come afterward, when we have time to reflect on our manic behavior.  Some of that reflecting gets done in jail cells, hospital beds, divorce courts, unemployment lines….  Veterans of manic-depressive mood swings eventually learn to fear the mania as much as they dread the depression.  The tendency is often to run to drugs as soon as one realizes that things are getting, “too good.”

  I hear it all the time at NA meetings:  someone says they’re feeling so good that it is scary.  I see those same words in blogs, too.  Why would anyone fear feeling good?  That’s obvious.  It is because they have been through the cycles before and they know that after the high comes the low, after being ten feet tall and bullet proof for a while, they always get shot down.  So, some of them take action as soon as they start feeling good.  They shoot themselves down.

  It doesn’t have to be that way.  With detoxification, adequate nutrition, healthful exercise and psychotherapy, especially if one has a strong support group as well as clarity of intent and personal motivation, most of us can level out our neurochemistry.  If for some reason that doesn’t do it, there are whole new families of pharmeceuticals that are less damaging than alcohol, meth and the other old standbys.

  

  • 2:50 pm
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