Bipolar and addictions (Dual Diagnosis)

According to www.dualdiagnosis.org, 56% of people with bipolar disorder suffer(ed) from addiction to drugs or alcohol at some point. According to www.drugabuse.gov, the rate for general population (in America) is 8.9 percent.

Obviously there is something about bipolar disorder that correlates with high addiction rate. While I am not a medical professional or addiction counsellor, I will hazard a guess that bipolar makes you predisposed to addiction, not the other way round. There are some drugs that can trigger a bipolar episode (in particular marijuana and LSD), but they do not create bipolar disorder in a mentally healthy person. They may only make it manifest earlier.

There are a few obvious reasons why bipolars tend to become addicts. One of them is self-medication. I used to self-medicate my depression with alcohol for years – it seemed to be the only way to make the black dog go away for a few hours. I knew that alcohol is a depressant and on some subconscious level I probably realised that I am making things worse for myself long term, but at those times the only thing that counted was quick relief which the bottle provided. The same scenario happened daily: I’d be terribly depressed, I’d get drunk, depression would be replaced by euphoria, I would do some really stupid things, go to sleep, get up in the morning and scream “F–K!!!” (I never blacked out; I always remembered what I did the day before, and it was always terrible and make me more depressed.) Repeat. Repeat.

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Book vs life

One of the readers of “Bipolar For Beginners” has been chatting with me online the other day, then she mentioned she was having a glass of whisky as we spoke.

My automatic reaction was “don’t do it!”. Alcohol stops correct processing of medication by the brain, and in conjunction with Depakote/Depakine it wrecks your liver real bad. Unfortunately, alcohol is also something people enjoy. In fact, even while I was on Depakote, my doctor told me it would be fine for me to have one beer per day. It’s just that at the time I weighed over 100 kg, and so one beer was hardly going to make a noticeable effect, so once I finished my pint all I wanted was another one.

Another piece of advice which is easy to dispense but not so much to follow: “Avoid stress”. We can do certain things to limit the amount of stress. We can look for a less stressful job, avoid watching or reading things that we find triggered. But let’s say your brother contracts a deadly illness. How exactly are you going to avoid stressing over it? Or – an example from real life – your parents constantly smoke weed, and you live with them. Your friends smoke too. How easy is it going to be for you to avoid using yourself?

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Bad doctor

In the 3.5 years that passed since my diagnosis I have worked with about ten psychiatrists. All of them were psychiatrists-in-training, because that’s how hospitals roll in the Netherlands. Some of them were good. Some of them weren’t.

The worst doctor that I had a “pleasure” of working with had a habit of rolling his eyes when I asked questions. He also didn’t bother listening to what I said, much less remembering it after, dismissed suggestions I came up with and generally treated me appallingly. When I told him I wanted to see another doctor, he responded by saying he didn’t see the need for that. Meaning, he was a judge in the case where he was the accused, and unsurprisingly found himself not guilty. It took a letter to his supervisor, where I detailed all the wrongdoings, mistakes and omissions, to get him off my back and give me a doctor that — shock horror — actually listened to me and worked with me, rather than against me.

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Mood charting

The image above is an example of my mood chart. Click the thumbnail below for full size version.

Foto 13-03-15 12 44 01

Mood charting is important for us bipolars for a few reasons. First and foremost, it allows us to identify patterns to our moods — we can look into the past and make comparisons, and once we gathered data for a few years, we may be able to predict mood swings before they happen. (For instance, I always get unwell in the early spring.) Second, it provides us with material we can present to our psychiatrist or therapist, which is especially useful when we change doctors. And perhaps most importantly it gives us hard proof that no matter how we feel right now, this too shall pass. Continue reading