Self-Medicating: When the Cure IS the Disease

Self-medicating with alcohol is common in BP
Clarita / Morguefile

I self-medicated with alcohol for more than 30 years and became addicted to prescription painkillers for about 10 years in a foolish attempt to gain enough control so that I could manage to keep working. The self-medication became the only way, over time, that I could manage to sleep or remain in control enough to function.
~from Will3481​

Those diagnosed with bipolar disorder, as well as the families and friends of these individuals, face many struggles and challenges.

The road to stability may be riddled with complications and setbacks. Of these factors, one of the biggest hurdles is often substance abuse.

At the 1996 U.S. Psychiatric & Mental Health Congress, Kathleen Brady, M.D., Ph.D., an associate professor of psychiatry at the Medical University of South Carolina, reported that "substance abuse occurs in 30% to 60% of patients with bipolar disorder and is more likely to coexist with bipolar illness than with any other Axis I psychiatric disorder". Dr. Brady went on to add that "2% to 4% of alcoholics and up to 30% of cocaine abusers meet the diagnostic criteria for bipolar disorder."

Agnes B. Hatfield, Ph.D., approached the statistics from the other side stating that "as much as 50 percent of the mentally ill population also has a substance abuse problem." And in her article "Dual Diagnosis: Adolescents with Co-occurring Brain Disorders and Substance Abuse Disorders," Brenda Souto states that "the combination of mental illness and substance abuse is so common that many clinicians now expect to find it."

The term "self-medication," then, is defined as "the process by which some individuals may abuse substances in attempting to use them to relieve other problems such as anxiety, pain, sleeplessness or other symptoms of bipolar disorder."

In my past, before being diagnosed with bipolar disorder, I tried everything available to alter my mood - cocaine, crystal meth, ecstasy, LSD, mushrooms, pot, crack, alcohol.

~from Rebekah

Obviously this is a very serious and widespread issue, but why? What makes those with bipolar disorder turn to alcohol or street drugs? Research and theories about this abound, but for the most part it is generally believed that a biological or physiological cause may be the root. There is an "underlying vulnerability of the individual that precipitates both mental illness and substance abuse," said Dr. Hatfield.

Dr. Brady further adds to this by outlining several symptoms unique to those with both bipolar disorder and a history of substance abuse:

  • Over 90% show dysphoria during manic phases.
  • Half have other comorbid serious mental disorders.
  • Patients have a slower time course to recovery.
  • More lifetime hospitalizations occur.
  • Patients have an earlier age of illness onset.

In other words, these individuals have a difficult struggle with bipolar disorder and they are more likely to try a drug in the first place. The continuation of drug use possibly stems from the discovery of short-term release from symptoms of mania or depression beginning the cycle of substance abuse. The unfortunate reality is that the relief of symptoms via self-medication is short lived. An individual struggling with dual diagnosis offers this perspective: "Self-medicating treats the symptoms, not the underlying illness.

The more we use a substance other than doctor supervised medication the worse our symptoms become and we often find ourselves in a hole which is very difficult to climb out of" (SoberDykes, 2000).

I went through years of drinking and using illegal drugs. When I would get so disgusted with myself, I'd try to stop. At that time I'd be interested in seeing a therapist and pdoc. With the meds I'm on now, I have no desire to get so loaded I can't breathe. BUT I have found I smoke more pot that I ever did. It helps calm me down when I get too manicky.
~from ​Askrop

For those struggling with a dual diagnosis, there are most certainly many challenges to treatment.

First and foremost, even identifying both conditions presents problems. Dr. Brady points out that "acute intoxications as well as withdrawal states can mimic affective illness."

Furthermore, Dr. Hatfield notes that "mental health services are not well prepared to deal with patients having both afflictions ... the individual may be bounced back and forth between services for mental illness and those for substance abuse, or they may be refused treatment by each of them."

As research continues and more health care practitioners gain better knowledge of the complicated issues surrounding dual diagnosis, the options and prognosis will continue to improve. However, as stated by the SoberDykes Hope Page, "We are responsible for educating ourselves and finding the treatment program which fits our needs. If we wait for 'the system' to take care of us we are setting ourselves up for failure. Our recovery is OUR responsibility and no one else's."

Brady, K. & Goldberg, J. (1996). Substance Abuse and Bipolar Disorder. [No longer online.]
Hatfield, A. B. (1996). Dual Diagnosis: Substance Abuse And Mental Illness.
SoberDykes Hope Page. (2000). "Dual Diagnosis."
Souto, B. (1996). "Dual Diagnosis: Adolescents with Co-occurring Brain Disorders and Substance Abuse Disorders."

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