As a recovering alcoholic with bipolar disorder, I’m always looking for information on how the two are related, which illness is responsible for what behavior, and how their treatments might collaborate or clash.
One of the best overviews I’ve read on the relationships between addiction and mental illness is written by J. Raymond DePaulo, Jr. a professor of psychiatry and Director of the Affective Disorders Clinic at the Johns Hopkins University School of Medicine, where I was evaluated in March of 2006. Following is an excerpt from chapter 10 of his book, "Understanding Depression," on destructive behaviors.
Nothing makes the job of a psychiatrist treating depression and manic depression harder than alcohol and drugs. The most difficult treatment situations that I have ever seen patients and families confront, since I started my training in psychiatry twenty-seven years ago, occur when the patients’ illnesses are complicated by what we call addictive behaviors. While I have seen many successful outcomes, none were easy to achieve.Let me be precise about what I mean by the word behavior. Depression and manic depression are diseases, not behaviors. They are, however, associated with certain types of behaviors. We’d say that seeking help is a good behavior and that the most destructive behavior of all associated with depressive illness is suicide. Alcohol abuse and dependence, drug dependence, anorexia nervosa, pathological gambling, and repetitive self-injury are all negative behaviors. That is, they are activities defined in terms of their goals or their consequences. Addictive behavior, we would say, is "abnormally" driven.
Depressive illness sometimes seems to make some people more prone to destructive behaviors; at the same time destructive behaviors generally tend to make depression and manic depression worse. …There’s a greater risk of abusing alcohol or drugs by people who have depression of moderate severity than for patients whose depression is quite severe. People with illness of moderate severity, after all, can still move around. As a result, they still have enough strength and initiative to seek out a number of “remedies” that actually make their depression worse and more difficult to treat. To compound the situation further, the remedies can become very big problems in their own right.
A number of such depressive-related destructive behaviors, when combined with depressive illness, can wreak havoc. Some of this behavior probably would never have occurred if the person hadn’t been depressed at the time. But many patterns of behavior as they relate to depression and to mania are common and do involve choices, at least when they start. While they are linked to the illness, they are not integral to it. That is to say, only the patient can stop them.
The affected person makes this difficult decision and if things go well—he or she gets support like from Alcoholics Anonymous (AA), and treatment—the person becomes sober and is well at least "one day at a time." By taking responsibility for his or her own recovery, the individual with depression can level the playing field. That leaves only the depression demon to face down, which is hard enough. Ironically, the most severe depressions can actually stop someone’s drinking because he or she lacks the energy or the drive for anything. That’s one of the few positive things in the relationship between depression and alcohol. Unfortunately, the effect is often temporary since many of these people often go back to drinking when they recover. As I said, there are also many different kinds of destructive behaviors that can come into play and make treating the depression difficult: smoking, gambling, anorexia or bulimia nervosa.
But there is no question that the most common destructive behavior affecting depressed patients, baring suicide, is alcohol or any substance abuse.
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Alex:
Even rural areas have county departments of health and/or social services.
IMHO, I would say you might want to make an appointment and ask if you can be admitted into a dual-diagnosis program (to treat bipolar disorder and addiction SIMULTANEOUSLY).
Some of these programs are inpatient (and thus probably out of your area), so I don't want to minimize the potential financial cost to you if you are living paycheck-to-paycheck in your rural area and can't afford time off (let alone co-pays for what health insurance doesn't cover and travel costs).
But it sounds like you're in crisis, and so (again, IMHO) you may want to think about such serious interventions.
We will be pulling for you! Please post back on BB!
Roni, thank you for your suggestion and the thought that my sister
is with our Lord makes me less sad....you hear so much that people
who commit suicide are not going to heaven but I believe they are sick and are not responsible. I guess the guilt is what i need to deal with as since she lived in my house with me and i was talking to her the night before (she was high as a kite she took pills) and I forced myself to stay up later that night to talk with her and still I did
not detect suicidal thoughts from her...Yes it is the guilt of that bothering me still.
Gigi
Understanding "comordbid" disorders - kissing cousins to the one you have and occuring in tandem for many - often lends help and provides explanations that help. In this case, I recommend colleague Wendy Richardson's excellent book, The Link Between ADD and Addiction. (no personal involvement here - it's available at on Amazon or major bookstores).
I am an ADD professional (and ADD Poster Girl) and many in our dx. population struggle with diagnostic bi-polar as well. Others have mood swings so severe that even good doctors sometimes misdiagnose them.
In my experience, although not always appearing to diagnostic levels, many behaviors from a "sister" diagnosis will be observable, and interventions and strategies that work for one will quite often work for the other. In any case, the more information you have about what you are dealing with, the easier it is to cope.
I also want to add my voice to Ms. Borchand's excellent post about how an extremely difficut disorder becomes so much worse in the presence of substance abuse - even substance USE in many cases. As heartbreaking as it is to be the observer, it is so much worse for the sufferer searching for relief (in many of the wrong places). Gigi (and others) - I can tell you first hand that the love you shared made a difference.
Try not to take responsibility for the degree of another's pain, or for the mental confusion that sometimes leads others to believe that suicide is a solution. It may also help to know that many who actually go through with suicide are no longer sending signals for help - so there may not have been any expression of suicidal thoughts for you to detect, Gigi.
As an ordained minister, I promise you that God loves all of His children, and none more than the Prodigals. He would never reject your sister, Gigi. Concentrate on your own grief, knowing that she is now receiving the very BEST of care and is out of pain.
For anyone contemplating suicide, God can help you here as well - and sometimes better - so add prayers for the courage to keep working with yourself to everything else you are doing. You CAN have a life worth living - and you can lead others out of their pain once you get to that place. It's extremely healing, and SO worth living for.
Love and Light,
Madelyn Griffith-Haynie, Master Certified Coach
Boy howdy: did god put me on this web page today. You see, my family is going thru this with my sister and has been for 2 years, she went off the deep end last week and is now in a court ordered inpatient which thank god they put her back on her bipolar meds (i to am a recovering addict and bipolar) sixteen years now!! This is breaking my heart because she is out of control. Her husband of 13 years has ask for a divorce and she moved to a new place in which the doors opened up to her and she worked the program for awhile and then she closed the doors. She is suppose to go before the judge tom. wend. to see if she can get out. I hate to say this but i hope they keep her there for a while more. I guess out of my own selfesness. At least when she is in a rehab (5) times or detox (10) i know she is looked after an the next phone call is not going to be the one. My husband and I are thinking of going to get her and bring her to our home to see if it will help. I REALLY don't know if i am strong enough. Yet i do see my counseler ever 2 weeks, and my scy. is informed every other day. Thank you all for being here today for me. I really needed to open this web site up today. Amy
NO, Amy - although it may be an emotional relief to know that your sister is in the hospital and out of harm's way, it is not a "selfish" thought at all. Wanting her to receive the care she needs to stabilize is ALL love - don't you doubt it! (I know I don't have to tell YOU how tough it is to manage bipolar disorder - or that the most important first step is neurochemical balance.)
You are probably NOT strong enough to take responsibility for her life - leave that on God's broad shoulders. Staying in recovery for 16 years certainly sounds strong enough to me, however, to speak your truth lovingly and to presence what is worth keeping alive in your sister (congratulations to YOU, by the way!).
In my experience, setting loving but firm boundaries while you provide support helps stop the emotional "spinning" of the one in crises - so if you take her to your house, don't be afraid to set (and monitor) some ground rules designed to keep your household in balance. Whenever we do that we are affirming that the one in pain IS capable of self-control - a gift beyond measure - and we are not adding the guilt of what they do to OUR lives to their already very full plates.
I believe Ms. Borchard has an article in this section entitled "YOU are not your [disorder]" - worth reading and saying to your sister as many times as it takes for her to hear it.
I pray for your continued strength and a successful recovery for your sister - and I have no doubt that landing on this page was NO accident. Keep coming back.
Rev. Madelyn Griffith-Haynie, Master Certified Coach
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