The Bipolar Alcohol and Drug Abuse Double Whammy: The Conversation Continues

John McManamy Health Guide
  • Following up on our conversation on the condition known as dual diagnosis and co-occurring disorder, Anonymous writes:

     

    I had my first drink at 10 years old. I felt such relief. There was childhood abuse, neglect, abandonment, so when I discovered alcohol it gave me the strength to escape the troubles at home. ...

     

    Anonymous was responding to my post from last week, The Cruel Double Whammy: Bipolar and Alcohol or Drug Abuse. Alcohol and drug abuse is the major complicating feature of bipolar, turning a challenging but manageable condition into an impossible hell.

     

    Anonymous experienced a very troubled teen-hood that included run-ins with the law and an attempt at suicide. She (I’m making at educated guess at gender) left home at 14 and quit school at 16. She was put into her first treatment program at age 18, but it was just about the alcohol. No one mentioned other issues.

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    At age 35, she was jailed for a year as a result of her fourth DUI. Part of her sentence was a treatment program, which she says was excellent, but again there was no mention of any other issues. She did manage to successfully remain sober for the next nine years, but something wasn’t right: a roller-coaster of three jobs, three moves, and three relationships. 

     

    Over the course of her life, with alcohol in the mix, she has been through 33 jobs, 22 moves, and 12 relationships, not to mention busted friendships and all the rest.

     

    Eight months ago, she experienced a deep depression and sought help. The “other issues” finally came up, and she was diagnosed with bipolar, PTSD, and ADHD. At last, after all these years, she knows what she is up against. She is prepared to rise to the challenge, but a lingering question remains. “Why,” she asks, “was none of this looked at?”

     

    All the signs were there at age 18, as with other programs she has been through over the years. Why, then, did no one even suggest to her that alcohol could be just one of many reasons why her life was not going right? Granted, she acknowledges, she may have not been ready do deal with all her issues at age 18, but eight years ago on release from jail - surely, by then, she says, she was ready to begin her exploration.

     

    Anonymous, I have no ready answer to your extremely poignant and profound question, one that I can restate in one word: Why?

     

    But I do have a theory, if you will permit me to explain: You are age 44, which means you had the misfortune to grow up in the age of biological psychiatry. The age started off with great promise. After years of Freud and other silliness, the recognition dawned that mental illness had a biological component to it. It wasn’t just all in our heads. We couldn’t just snap out of it. Once we identified the biological causes and effects, we could come up with effective treatments equivalent to insulin for diabetes and antibiotics for infectious diseases.

     

    Indeed, psychiatry assured us, that golden age was already upon us. We had the drugs to treat specific conditions - depression, bipolar, anxiety, ADHD, and schizophrenia - and even better drugs were on the horizon. This encouraged a highly simplistic way of diagnosing and treating mental illness. Essentially, psychiatry turned into a dating service of matching illness to medication.

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    Find the right pill and all your problems will go away. But what if you came from a broken home? What if you were poor? What if you lived in an abusive relationship?

     

    In their enthusiasm, psychiatrists forgot how to listen, to probe, to search for what was really going on in our lives. Talking therapists resisted the trend, but economics worked against them. Talking therapy is time-consuming and expensive. Soon, the entire healthcare system was organized around biological psychiatry.

     

    Later on, the realization dawned that these diagnostic labels were at best rough guides. Not only that, the meds that were supposed treat these illnesses were highly problematic. But by then, it was too late. The insurance companies were calling the shots.  

     

    Alcohol and drug abuse - from a treatment angle - was not in the biological psychiatry mainstream. After all, there was no magic pill. But the same fatal mindset persisted: treat the illness and all your problems will go away. Find a way to stop drinking or using drugs (just say no?) and your life will instantly improve.

     

    So the clinicians working the alcohol and drug side of the street didn’t want to know about your life, either. Not only that, they weren’t talking to the rest of the clinical world, and vice-versa.

     

    Meanwhile, geneticists and brain scientists were revealing a world infinitely more complex than the one first imagined by biological psychiatry, but one that completely validates your question, “Why?” It comes down to this: our behavior makes absolutely no sense without investigating everything - literally everything.

     

    According to Robert Sapolsky, of Stanford, in an online lecture on human behavior, first, we ask - what does the behavior look like? Then we need to ask what went on in that organism a half-second before that behavior occurred to cause it to occur (this is the world of neurons). Then we keep pushing back - to sensory stimulation, to hormone levels in the blood through to early development and even fetal life, on and on.

     

    We know that mental illness treatment needs to be headed in this direction, but we’re a long way from even making the first step. But the good news, Anonymous, is that you are already asking these questions. The other good news is that others who have walked in your shoes are asking similar questions. Unlike biological psychiatry, there are no easy answers, but your explorations will lead to your own personal life-changing realizations.

     

    Be encouraged ...

Published On: March 04, 2012