Bipolar and the Self-Medication Issue

Patient Expert

This is the third installment in our series on the bipolar-drug/alcohol abuse double-whammy that goes by the two names of dual diagnosis and co-occurring disorder. The starting point was the issue of self-medication, in effect using drugs or alcohol to "treat" the mood disorder. As Miss T in a comment describes it:

I do take meds and they do help, but alcohol really helps, at least for awhile. Then you have to have it again to feel better.

But there is a catch. As Tabby puts it in a comment:

Self medication does not "improve" or truly assist the mental illness... it just fools one into thinking it does and well, I've been, personally, fooled.

The upside, as Tabby says in another comment, is that  substances of abuse are easy to obtain and use. No telling your life story to a therapist, no doctor visits, no fiddling with doses and dealing with side effects. While the stuff is working, "it washes away your trauma, your drama, or chaos (or it tricks you into thinking so)."

Then, of course, the stuff wears off and there you are with your illness. Still the same bipolar brain you're living in. Then the craving starts, and next thing you are living in a brain with two illnesses. As Tabby acknowledges, all these years later:

I no longer drink but that is not to say, I do not desire nor crave.There are times when I literally wake in the night desperately wanting a drink ...

But the intense psychic torment our illness puts us through - a pain so excruciating that contemplating the unthinkable is perfectly rational to us - leads us to seek escape, even for a few fleeting moments, at any cost. Say Tabby:

When you are living with and struggling with the mental and emotional pain that mental illness does inflict, some folks will find whatever means necessary.

Another reader,  TY, didn't start out self-medicating. It was only after the docs couldn't find the right mix of meds to even her out that she began her own chemistry experiments. She was raising two kids, one with early-onset bipolar. She suffered through depression and panic attacks. Her emotions were raw, the pain was unbearable. Then she found pain-killers and alcohol. Soon, she needed more.

How can we say TY made the wrong choice? Yes, it was a choice with a predictably bad outcome, but wrong? In her state of distress?

I recently finished reading Robert Sapolsky's classic book on stress, "Why Zebras Don't Get Ulcers." Dr Sapolskly explores the effects of stress on every organ system in the body, from every conceivable source. The theme that comes through loud and clear in his book is that when the body is in crisis - be it from a heart attack or depression or being attacked by a lion - every resource in the body is diverted from long-term projects (such as storing fat) to handling the immediate situation.

Dr Sapolsky asks us to imagine a personal cash flow crunch. We deal with the emergency at hand by moving our investments from our long-term accounts (where we may have invested in our retirement). The final reckoning may well come later. In the meantime, we have a Code Red that demands our immediate attention.

Let's pick up where Dr Sapolsky leaves off. This is speculation, mind you: We are in a severe emotional crisis. The body responds as it would to any extremely stressful situation, shifting from long-term mode to short-term mode. In this case, this would involve the brain churning out all manner of thoughts - crazy thoughts in normal situations, entirely rational thoughts in states of crisis.

These are not just random thoughts that we can easily ignore. These are highly compelling thoughts, ones that have us locked in a vice. If you haven't eaten in four days, your brain is telling you that you need to eat right now, this very instant, everything else be damned.

Never mind that you are diabetic and the only food available is a triple-layer double fudge chocolate marshmallow cake. You eat the cake, anyway. All of it.

"Just say no," simply doesn't cut it.

So here we are, dealing with an emotional crisis, our brains in strict short-term mode, demanding an instant resolution. No negotiating, no if-ands-or-buts. There is the solution - the bottle on the shelf, the pills in the drawer.

What to do? What to do? That's the question I will leave you with.

Previous posts:

The Cruel Double Whammy: Bipolar and Alcohol or Drug Abuse

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