Drug abuse and bi-polar

by Mary

Hi Ben,

My 23 year old son has dug himself into a deep hole. He was diagnosed with bi-polar after the classic manic symptoms of excessive spending, thought broadcasting, paranoia, auditory hallucinations...For several years before this diagnosis, he was getting into increasingly stronger illegal drugs. He overdosed on heroin and now has a traumatic brain injury on top of everything else. He is stable on meds when he doesn't abuse drugs, but once he is out of rehab, he is back using again. I love my son but his self-destructive behavior is terrifying and exhausting. Is there a recommended approach where drug abuse coexists with bi-polar?

Ben's Answer:

There is a close connection between substance abuse and the manifestation of Bipolar Disorder. In many cases, drug use precedes the development of the disorder (and is its main cause). Once the condition gets rolling, it becomes an ongoing cycle of instability. Sometimes when the drug abuse stops, the condition may clear; but for others, the improvements may be less apparent, or may take a much longer period of sobriety and recovery.

The latest findings are now suggesting that the psychiatric drugs themselves set up a long term dependence and actual worsening of the condition over time; but for someone who can't stay away from drug abuse, the medication may offer a more stable alternative.

I really feel for you in this situation. It's a very helpless feeling to watch your child spin out of control and refuse help.

I know of no "good" method of treating serious drug abuse, combined with Bipolar AND head injury - when the person is in a self-destructive pattern of behavior. The standard care out there seems to be traditional rehab facilities, and dual-diagnosis (drug and psych) programs that address the addiction as well as the Bipolar illness.

Bottom line is, nobody can force a person to accept help unless they come to the realization that they actually want and need help. It's better to set some boundaries, be steady with your love and compassion, but don't sacrifice all your energy, time, money or peace of mind trying to save him, or you will only hurt yourself in the process and wont do him any good. Your prayers would be more effective.

If he could connect and stay with a therapist that he liked and trusted, it would probably serve him better than most other methods that he tries but doesn't stick with.

I have seen people come back from extreme drug abuse and Bipolar illness, and still recover their sanity eventually. Don't lose hope.

I wish you all the best,
Ben Schwarcz, MFT
Santa Rosa Psychotherapist

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Aug 22, 2010
Thoughtful and perceptive response
by: Anonymous

Thank you for your kind response. I always fear I am missing the simple cure-all for my son's problems. Your answer reassures me that I can't make it happen for him. He needs to change. He is in his 3rd rehab this year and may be paying attention this time. Do you have any associates you recommend for comparable therapy in Minneapolis? Too bad we are 2000+ miles away from you. Again, I really appreciate your response to our family's problems. All the best - Mary

Ben's Response:
You're welcome Mary. I'm sorry but I don't know of anyone to recommend in Minnesota. I wish you the best.

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