Beyond Blue

Beyond Blue

Depression and Addiction: A Very Bad Combo

posted by Beyond Blue | 11:00am Thursday October 4, 2007

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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Wisdum

posted October 4, 2007 at 12:10 pm


Re -But there is no question that the most common destructive behavior affecting depressed patients, baring suicide, is alcohol or any substance abuse.
** Perhaps “Self-destructive” behavior would be more correct. The deeper I get into words (or Word) and that’s all we are, and worse yet, it is the mis-conception of words that is causing all this de-pression. Somehow a lot of our words have been turned around 180% to mean the exact opposite of what they reallly mean. Consecrate – means against the sacred, it should be pro-secrate or com-secrate (duh!) Pro-hibited means- for to have- it should be con-hibited. Who in the Hell did that ? Worse yet, Webster re-writes the meaning in his current dictionary, to reflect the current meaning. My PHD Brother-in–law tells me “That’s the evolution of words” and my response “That’s BS! That would mean that yes, could evolve into no, and no evolve into yes !” (Dam!, If he wasn’t right) BEWARE!Backward masking, the Devil’s language. For me de-pression is not a bad thing, it’s a good thing, what makes it bad is is the futility of it in our lives and futility is re-pressing,sup-pressing and op-pressing (or is that pro-pressing ?) Be happy, do happy, Love happy … Focus, focus,focus!
Oh yeah ! Conception means- against ception (although I have no idea what the Hell a ception is !) I know what septic is, and a septic system is, and a con-seption is, but that is all a bunch of crap and I am against it!
LUV 2 ALL
Wisdum



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Brian

posted October 4, 2007 at 12:27 pm


Might it be helpful for addicts or people suffering from depression to begin to see their destructive behavior is a result of destructive/negative thought, and focus first on eliminating the fearful thoughts? I just read a book entitled Fearproof Your Life (by Joseph Bailey, Author of The Serenity Principle which addresses addiction) that really opened my eyes as to the root causes of fear which can exacerbate depression, addiction, and even create an addiction to the fear itself. This book was eye-opening for me and helpful to no end in becoming aware of how to begin to create change in how I perceive and live my life. I stumbled upon this book at http://www.fearproofyourlife.com



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Larry Parker

posted October 4, 2007 at 12:35 pm


I have no doubt in my mind I was self-medicating my (masked) bipolar disorder with alcohol for years.
I was drinking like a fish despite the fact that a. my father was and is an alcoholic, a fate I deep down didn’t want to repeat; and b. I never even LIKED drinking — I don’t like bars, and it was never fun for me. I’m not even that crazy about the taste (my drink of choice was a Long Island iced tea — with all the liquors mixed together and cancelling each other out). It was almost like (yes) taking socially accepted medicine, albeit far too much of it — unlike, say, lithium.
After a dear friend staged an intervention and I quit cold turkey (thank G-d!), I had a romance turned engagement turned marriage to distract me for a couple of years.
Then the disease itself broke through. And loyal BB readers know everything that happened after that …
(Sigh.)



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Lee Silber

posted October 4, 2007 at 1:50 pm


Please tell me what are the best organic vitamins,minerals, herbs, organic nutrients you have for chemical imbalances in the brain,aswellas the most advantsed brain chemical machines-science has discovered in controling brain chemistry and negative behaviour.



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Nancy

posted October 4, 2007 at 1:54 pm


Hey Therese – good post – I agree with the concept that mixing alcohol and/or drugs to depression is the next worst action in self-destruction baring suicide. For me, it would be a form of suicide; a slow death. That’s how I felt 15 years ago. Dead. In the Big Book of AA, there is a chaper entitled, “How It Works”. There is a line that refers to mental illness, “There are those, too, who suffer from grave emotional and mental disorders, but many of them do recover if they have the capacity to be honest”. It then goes on to expand on the work required with the honesty and willingness. I came to learn through the steps that underneath each difficulty was the root of fear, as Brian mentioned finding in another source of help for himself. We expect Doctors to fix us, but for me, I have/had to do my part, which is first and foremost to abstain from alcohol. I don’t get into semantics over words and scrutinizing them. It keeps the focus off the true issue; how much am I willing to do to help my Doctor help me. I remember many years ago, the first time I was put on an anti-depressant, in the old days, prior to the SSRI’s. I remember asking him if I could have a drink with the medication. Not knowing that I loved alcohol way too much – and neither did I at that time, his reply was that I could have an occasional drink. My brain interpreted that as, “You may drink as much and as often as you like. In fact, it will help the process.” That’s not how non-alcholics think. I didn’t know that back then. I was clueless. Was it any wonder that I eventually wound up in patient in a hospital? Thanks for reinforcing one of many reasons why I don’t want to drink today.



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Cindy

posted October 4, 2007 at 4:49 pm


Hello Dear Readers:
I have seen first hand how Bi-Polar mixed with alcohol/drugs can destroy families. As I’m writing this, the tears are rolling down my cheeks. I have seen the family I love fall apart at the seams. My brother is the one with the illness. He is 52 yrs. old and is living with my 80+ year old parents. He lives in their basement like a hermit…is on meds some of the time…..refuses to work…..lacks motivation to even take a walk and is sucking the life out of my parents. My mother can’t say “no” to him and my father is so depressed, he just sits at McDonald’s during the day and drinks coffee. I absolutely hate my brother’s actions, (not my brother)as he’s “chosen” to stay ill and refuses steady treatment. I am 200 miles away from them, which is sometimes a God send……however, I worry constantly about them and “hate” to go visit. It makes my depression plumit (sp). Thanks for listening….I don’t expect anyone to say or do anything, I just need to vent to folks who know my pain.
I would take physical pain any day over mental illness!!!!!!!



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lapatosu

posted October 4, 2007 at 7:25 pm


My therapist and psychaitrist never accepted a diagnosis of alcoholic, interestingly enough, though I did go to my share of AA meetings. They pointed out that my drinking was just another way of commiting suicide. It helped me get a handle on what was happening in my life.



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Shirley

posted October 4, 2007 at 8:30 pm


I’m not an alcoholic or drug addict (never used either) but I have a boundary issue. I go to therapy and groups and I’m still allowing myself to be hurt by a family member who likes to take advantage of others and it is a learned behavior — to survive. I can’t afford to do this anymore, and yet, I still find myself “helping this person when I have little or no resources myself. What’s up with that?
Any comments regarding this syndrome?
Thanks.



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peg

posted October 4, 2007 at 10:03 pm


Hi
I can definitely relate to this post as I believe I am an addictive personality in many ways and moderately depressed.
I fight all of this alone. Why I won’t trust someone to help me with this, I don’t know. The Recovery program would add that I don’t want to be average, but special. I don’t really want to do the work that is involved in moving forward. Yet.
I did finally order a book by Dr. Julian Taber (now retired) called, In the Shadow of Chance (from the Nevada gaming commission’s website), and it has also shed light on the different types of gambling (pathological or problem). I was highlighting relevant stuff like crazy as I read it.
Beating myself up is not the answer. Getting to the point of being in enough pain, probably is. Also, reading this blog is extremely helpful.



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Gigi

posted October 8, 2007 at 11:55 am


Reading these comments makes me feel less alone….I always think other families, at least most families are normal….our family has mental illnesses, addictions, depressions, you name it we got it.
it makes me feel less alone to know we are not alone…recently my sister who lived with my family drove herself to a hotel and committed suicide…i cannot get over it..i think of it constantly. i keep running it over in my mind how could i have helped..i know i guess i could not have done anything differently. this was about hr 10th and final time. her adult children would not have a thing to do with her, not even a phone call or a card on birthdays etc. i never realized how much this hurt her. i agree with whoever said it….give me physical pain any day over mental pain….it never lets up. Only thing that helps me is God…i stay very close to him and ask for his help constantly. we still have “it” in our family. it didnt end with my sister…..our whole family has “it” in one way or another. May God Bless everyone who is dealing with these devils.



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Roni

posted October 8, 2007 at 1:04 pm


Dear Gigi, I don’t know where you live, but I highly reccommend a grief recovery/ survivors of suicide group or program. They are available everywhere and tho may be held in a church basement are not all religion based, reality based. Helps to know it’s more common than we think, I had an ex who also killed himself. The thing you need to search for is forgiveness, FOR YOURSELF. You are not in charge,God is, and he loves all his children. When he calls them home, it matters not HOW they get there, just THAT they get there. Her pain and her suffering is gone.



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Alex J

posted October 9, 2007 at 1:30 pm


I believe I am manic in many ways, and have been depressed many times in my life. I am also a addict of many things, and for this I am very thankful for these articals.
I know I have chronic alcoholism, and was a member of AA and NA for years. This artical explains in many ways why I have gone back and started drinking again.
It started about 10 months ago when I had a job location change in my life. For the first few months things were ok, but due to the isolated area I lived in no AA nor NA meetings were close enough to go to on a daily basis, (which I did for years). The phone calls to my friends in the program dwindled to nothing in this time, and within 4 months I started feeling sorry for myself, and went back.
Even now I am having addiction issues where I drink (binge) for 2-3 weeks 24 hours a day, go throught DT’s and I still go back because I lack support groups.
My vehicle is not a new one and can not travel the distance needed for daily meetings, and I have spiraled out of control. Nor is the local area meetings any help for they are all card signed parolled people who could care less if they stay sober.
Anyway I wanted to thank you for this artical, and I shall do my best with the information gathered. If anyone reads this and would like to contact me about any of these problems, feel free to email me at Uiiath@yahoo.com
Thank you
Alex J



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Larry Parker

posted October 9, 2007 at 2:31 pm


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!



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Gigi

posted October 15, 2007 at 2:07 pm


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



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Madelyn Griffith-Haynie, MCC

posted October 20, 2007 at 10:33 am


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



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Amy

posted October 23, 2007 at 7:36 am


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



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Madelyn Griffith-Haynie, MCC

posted October 25, 2007 at 3:59 pm


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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