Dual Diagnosis: Bipolar Disorder and Addiction
An accurate dual diagnosis and comprehensive treatment plan finally help a woman who turned to drugs after being abandoned and sexually abused as a child.
Celeste doesn’t remember what came first––the drugs or the mood swings. She was a teenager when she started using, falling right into her mom’s footsteps, and everything was in upheaval then. Her father had been a stockbroker whose friends were all Wall Street guys. They worked hard, but they partied harder, and booze and cocaine were always around the penthouse. Celeste’s mother Sandy partied with the best of them until she crashed into violent fits of rage or spiraled into deep depressions, accusing her father of cheating (he was), which usually precipitated her being sent away for a while. Celeste eventually grew to understand that her father was periodically having her mother committed, though she knew to never ask questions.
When she was 13, one of the younger men at her dad’s parties invited her into her own bedroom to use cocaine. He was handsome and convincing. What happened next became a part of the deep dark territory Celeste never questioned, never looked at or examined, but the cocaine became something she sought out––it helped her feel invincible, to forget.
By 19, Celeste was a party pro herself; she had her own scene but could still easily move in and out of her father’s Wall Street world. She lit up a room like a Roman candle. She was electric night. Nothing got her down … until the party stopped. The coke ran out. By now, her mother was permanently hospitalized and when her father would lose patience with Celeste, he’d accuse her of being just like her mother––crazy. Am I crazy? She asked herself as she lay curled on the sandstone tiles of the en suite bathroom, skinny and bruised, unable to pick herself up for hours, days.
It would be another five years of destructive behavior, and two more years in and out of rehab, before Celeste got her answer. She wasn’t crazy. She had a chemical dependency to a stimulant drug, and a brain disease––bipolar 1 disorder. Bipolar had been genetic; she’d inherited it from her mother, and the conditions under which she had been raised, chaotic, uncertain and, at times, traumatic.
Dual-Diagnosis and Bipolar Prevalence
Dual-diagnosis refers to a person who has a mental disorder diagnosis and a substance use disorder, such as alcoholism or a drug problem. A person with bipolar disorder has about a 60 percent chance of having a substance use disorder. Many people with bipolar disorder find a way to cope from the discomfort of changing mood states––mania, hypomania, mixed states and depression––by using illicit drugs, prescription drugs and/or alcohol to self-medicate, but it may also be that the use of substances brings about complicated mood states or encourages an underlying genetic tendency for a mood disorder to express itself.
In the past, mental health practitioners believed that individuals’ substance abuse problems needed to be treated before getting to their underlying mood disorders. Today, however, we have a different understanding. Mental health and addiction healthcare workers understand that these issues need to be approached concurrently, and that in fact, one will likely not be handled successfully while the other is neglected. An individual is unlikely to get and remain sober as long as his or her bipolar disorder remains untreated and vice versa.
For Celeste, a team of practitioners evaluated her full story and came to understand how her genetic history mixed with details of her upbringing––lack of supervision or appropriate caregiving, exposure to drugs and alcohol, and sexual abuse at the hands of her father’s friends––created a perfect storm for both substance abuse and the mood tempests she would be left to deal with on her own. She used cocaine to feel on top of the world as much as to escape from terrible secrets and the dark moods these traumas had left her with. Celeste’s recovery would need an integrative approach––methods to help her come to terms with a tragic past; skills and strategies for dealing with mood changes; and a recovery program she could take accountability for.
Not all people who experience dual diagnosis with bipolar disorder have gone through the kind of abandonment and pain that Celeste has, but nearly everyone has experienced difficulties either precipitating their disorder or brought on as a result of it. Part of recovery is learning how to integrate these experiences and move past them as emotionally whole adults. The best substance abuse recovery programs alongside positive, forward thinking treatments for bipolar disorder offer just that.