MindfulMan

By working them both I don't necessarily exactly concurrently. I was about 45 days over when my psychiatrist saw me and resumed medical treatment. The Mood Disorder clinic had basically said that the first step in my treatment was detox and inpatient. Had they not dealt with the bipolar disorder at that time immediately after inpatient and had I not continued into dual diagnosis outpatient treatment I'm not sure I would have remained sober. Both needed treatment. I started drinking and drugging heavily in 2005 when I went off my psych meds. Yin and yang.

Definitely agree that psych meds have unpredictable effects when you throw uncontrolled alcohol and street drugs into the mix...often being used in an attempt to self-medicate. Bipolar disorder and substance abuse have a huge comorbidity.

soberlicious

This is actually a common practice, and it's big business.

Well I'm sure there are numbers all over, but I just read an estimate that about 45% of those Dx with Bipolar Disorder also have AUD. That leaves just over half who don't. So there's that.

In any event, I'm glad you quit drinking. That is number one, if you are to effectively address anything else.

MindfulMan

Yep, that's a huge comorbidity, especially when you contrast that with the rates of alcoholism in the general population. That 45% for lifelong comorbid alcohol use disorder seems fairly standard across a number of epidemiological studies, but the average jumps to around 60% for ALL substance abuse disorders, not just alcohol. There is also a bit of a cause-and-effect thing going on, as people with relatively mild BPII can progress to BPI as substance use escalates, and the cycling of BPD can also speed up. Generally the more rapid the cycling the more severe the effect of the disease.

Stopping substances is indeed important, but it's only half the picture when dealing with bipolar disorder and many other mental illnesses. Dual diagnosis is seems to be often undertreated by many recovery programs, no matter what the stripe, method, or philosophy.

I have gotten sober by simply not using after some pretty brutal self-detoxes. When I have been unmedicated or otherwise untreated, I invariably went back to substances, and this seems to be a pattern with substance and comorbid mental illness, definitely including bipolar disorder. One without the other wouldn't work for me, despite pretty much taking the position that alcohol and drugs are off the table, for life.

I have encountered 12 Step "big book thumpers" (thankfully none at SR, at least not overtly) who view psych meds as meaning you are NOT sober, that people who do meetings and step work and follow the Big Book should need nothing else to address any mental health issues if they remain sober. I find that the reliance solely on a Big Plan without addressing mental health issues as equally important as sobriety to be similarly irresponsible, even dangerous. Untreated mental illness can, and often does, lead right back to the DOC.

Bipolar disorder responds extremely well to medication, but also has a notoriously poor rate of long term medication compliance. People like hypomania, and will often go "off their meds" to chase it. The LAST thing that population needs is to have another reason to stop taking their medication. Also, like the kindling effect of alcohol, mania seems to worsen every time it occurs, and cycling shortens. Of course there is overdiagnosis and overmedication, but there is also a lifelong pattern in many bipolar disorder patients of leveling out the moods with meds, feeling better, thinking "I got this" and going off the meds, and ending up back in the hospital.

Addiction is a highly complex state with a nearly infinite amounts of individual variations. It does not lend itself to a one-size-fits-all treatment method.

zerothehero

Great conversation. MM's mention of detox reminds me of my earlier assertion that the industry needs to change, and the influence of RR/AVRT strategies could help. When someone needs supervised detox due to risk of medical complications (heavy alcohol or benzo use, for example), they find themselves in the system and are thus most often steered toward the very methods RR is against. Thus, my point that RR could help those who stumble (or catch a ride by ambulance or police car or parole officer) into the system.

About dual diagnoses: I was drunk and miserable, and I risked home detox because of my job. All I knew at the time was I was sick and tired of being sick and tired. And I was miserable.

It didn't even occur to me until about a month of sobriety that I may have had a co-occurring disorder, and the anxiety I experienced may have been due to detoxing after decades of drinking and drugging, or probably equally true, drinking and drugging was fueled by anxiety in the first place. Regardless, in retrospect, I met criteria for PTSD, probably a major depressive episode, maybe adjustment disorder, and perhaps an anxiety disorder - who knows? I've read up and now I don't think I no longer meet criteria for any of the above.

And I didn't use medications or seek help of any kind. Maybe I should have, but I didn't. Pride. Job. Fear. Cussedness.

But my point is that even without psych meds or even just therapy, there was no way I was going to be able to effectively self-treat or receive effective professional treatment until I was clean and sober. Once I was sober long enough to level out and begin to understand my symptoms without alcohol and other drugs - only then could I start making progress - mostly via meditation and mindfulness - toward emotional stability.

And that required commitment to permanent abstinence, plus another 18 months or so before I could truthfully say I had recovered from substance use and mental illness (if we must call it that).

MindfulMan

My GP insisted on a psych consult and referred me to a dual diagnosis clinic. I already knew I had Bipolar 2 disorder, but had not taken meds for years.

Rehab was 12 Step based, but my counselor was not, she was of the “whatever works” school. She also leads both the Dual Diagnosis and LGBT special groups, both of which I attended.

Other than Step 1, I didn’t really take to 12 Step. At the time of my intake I was indeed powerless. This realization lead me to just take it off the table. The only true power I had over alcohol and drugs were to not use them.

I do wish that other recovery methods were gone into in more detail. They were meantioned but not practiced or encouraged.

Gottalife

That could be a good thing, though it might better if limited to an adequate presentation of what is involved to provide enough information to choose a path. It would be confusing and ineffective to spend a rehab stint dabbling in a number of different options.

Economics would have a bearing on this too. An earlier post drew attention to long term membership expectations of one method, and indicated a preference for a different approach where one could pop along until the problem was solved and then get on with life, never having to return.

My guess is you can do that now if you are willing to pay. Join a recovery group led by someone trained in that method. Stay as long as seems necessary and as long as you pay. In that lies the major obstacle of individualized recovery option being presented in rehabs etc. someone has to be paid to do it, someone has to be trained.

The easy option for the rehab is to take advantage of freely provided presentations which happen to be a part of that groups recovery program anyway. They have no financial driver, pay and go is not practiced. No one has to pay, but many pay it back by being there for the next person. It seems to work quite well.

I don’t know if it is a spiritual law, or an economic one, but nothing for nothing seems to be the general rule. One way or another, if you wish to utilise external help, a price has to be paid.

MindfulMan

I am doing individual therapy for continued sobriety, but more importantly to deal with some underlying life issues and old traumas. have done outpatient (12 Step) and inpatient rehab (dual diagnosis and cognitive based), attended some SMART meetings, am in the care of a psychiatrist. I have no need for a “recovery group,” paid or otherwise. I have sober friends that utilize a variety of methods and groups, including none.

I don’t agree that 12 Step only is a good model for rehab. It would have made my inpatient stay far easier, particularly near the close, if I hadn’t had to keep trying the 12 Step approach as it was the only thing available at that facility. I gave it a go, tried to get a sponsor and work the steps...did not take. I don’t agree with exchanging the helplessness of addiction for some imagined higher power for me. I felt that 12 Step was keeping addiction close instead of allowing me to move on and do other things with my life without constant meetings, dwelling on it, etc.

I have noticed that people insist that the method that got and kept them sober is the only viable one, and that includes big book thumpers, medical solutions, and abstinence promoters.

I also don’t feel the need to buy into and stick with one approach. Parts of most sobriety programs have value.

Gottalife

I didn’t say 12 step only is good for rehab. I said it is free. Just a question of economics. Smart meetings? Is that not a group people following a method of recovery i.e a recovery group. Why doesn’t someone from that organisation, yourself perhaps, volunteer to take it into and institution or rehab.? There are, I have heard, quite a few non 12 step rehabs these days. Maybe take you ideas into one of them?

I am open to all methods. Whatever works. My preference is that folks with a drinking problem keep AA as a last resort. It seems to work better that way. The only reason I ended up there was that nothing else had worked.

I understand your experience with the steps. Really, you had trouble with step one in how it identifies your problem, and you didn’t like step two which identifies the AA solution. The best thing to do at that point is exactly what you did, go and find another solution. Everyone is perfectly free to try that.

Wholesome

AA is supposed to be free, yet people are paying through the teeth to go learn it in rehabs.

Morning Glory

12 steps are off topic for this forum.

Please follow the forum rules.

Dropsie

Mindful,

My father was an early diagnosis of BP and was treated with lithium for more than 50 years.

He also drank heavily his entire life.

His BP stayed under control provided he took his meds.

I dont know the impact that drinking may have had, but there was no outward sign of mood swings as long as he took his medicine.

Just as info, everyone has their own experience and most folks dont take lithium anymore for other reasons.

Always like your posts.

Dropsie

MG,

isnt it kind of artificial to ban the mention of the thing that has two letters??

i totally get the sentiment, but hard to have a discussion.

Morning Glory

It is necessary Dropsie.
This is an AVRT forum and it has nothing to do with the 12 steps.
The Alcoholism forum is open to discussions that include both topics.

MindfulMan

I think the idea is to focus on the positives of an abstinence based recovery program rather than bash the negatives of 12 Step.

AAPJ

Agree. I am someone who is active in a 12 step program. But to me it's more important that a person finds a recovery path that works for them.

Someone in a business forum once said that too many people are more interested in being right vs. finding the right answer. I think this is true in the recovery community as well.