addiction psychiatry

“I just like to get high”

I recently had a conversation with a family member of an addict and he related this story. His family member had been an addict for several years and over the course of that time had been in an out of several treatment programs at a cost of many thousands of dollars. Each treatment failure was an emotional and financial setback for the family but the addict seemed never to share their pain. Finally after another relapse the family member sat the addict down and asked him, “why after all these years are you still doing drugs despite all that we have done to try to help you?” The addict simply answered, “Because I just like to get high”. the family member looked at him, shook his head and said, “If you just told me that to begin with I would have saved a lot of money!”

I like to exercise. I run, I bike, I play tennis and golf , and I do yoga. i like to read. I even like work.

An addict likes to get high. An alcoholic likes to drink.

Clearly there is a significant difference between my likes and theirs.

To say that you get are an addict simply because you like to get high is as simplistically immature and moronic as you can get. Every addict and alcoholic has a “real” answer to the question “why?”. A legitimate answer to that question is ,or at least should be, the answer that every well designed, well run treatment program strives for. Until an addict is willing to look for that answer then every family that is willing to bear the cost of treatment is really just wasting their money like the family above. One of the unifying aspects of many addicts is that they lack insight. They also often lack maturity and an understanding of the consequences of their actions. Under those circumstances situations like the one described above are common place and a huge source frustration for the family. Consider this before you send a loved one to treatment and send them to a program that can help them find the answer to the question “why?” when they are ready.

“A doctor told me I was bipolar once, but….”

“I didn’t believe him and I didn’t want to be bipolar, so I ignored him”

In the meantime this person continued to be an addict and many years later he is just starting his rehab. better late than never but imagine if he had just accepted the diagnosis years ago.

While I will be the first to admit that MANY doctors are often wrong about their diagnoses, especially when it comes to psychiatric diagnoses, but they are usually wrong when they MISS the diagnosis of bipolar disorder.

So, as a rule, if a doctor tells you that you are bipolar–then you probably ARE.

Approximately 80 percent of bipolar patients are chronic substance abusers and so it is never a walk too far out on a limb to suspect that an addict is bipolar. there is no harm in treating a patient who is presumed to be bipolar with medications that are indicated for this disorder. However the corollary is not true. Treating a patient who is indeed bipolar with medications indicated for patients who are not can be catastrophic. In that situation a patients risk of sucidality increases exponentially.

How do you know if you are Bipolar. It is actually quite simple. Look for these 5 simple signs. First, remember that your genes don’t fall far from the tree. If you have a family member (parent, grandparent, sibling) with bipolar disorder or substance abuse then you are 10 times more likely to be bipolar. Second, if your symptoms of depression, anxiety or substance abuse start before the age of 21 or if your depression is seasonal or if you had postpartum depression then you are more likely to be bipolar. Third, if you took an antidepressant and it made you anxious or game you insomnia then you might be bipolar. Third, if you ever experienced mania then you are bipolar. Lastly, if you have what are know as associated symptoms then you are more likely bipolar. Associated symptoms are behaviors that people exhibit that make “normal’ people nervous. Things like high risk behavior, multiple marriages, jobs, legal issues, etc.

Being bipolar is only a bad thing if it goes undiagnosed and untreated. Bipolar patients are patient who have trouble lives and live in disturbed worlds and that trickles over to the lives of those that they touch. Don’t avoid treatment symply because of the condition. That won’t make it go away. Face it head on. Get the right treatment. take your life back

Why can’t doctors get it right?

Data from as far back as 2002 tells us that one out of every three patients diagnosed with depression actually suffer from bipolar depression. The problem lies not so much in the misdiagnosis of these patients but in their mistreatment. When patients are treated with the wrong drug at the wrong time the consequences can be catastrophic. When patients who are bipolar are treated with drugs that are intended to be used in unipolar major depressive disorder because they are mistakenly diagnosed they are at significantly increased risk of suicide. Bipolar patients exposed to unipolar drugs often experience treatment emergent mania. This mania is characterized by symptoms which may include increased energy, increased anxiety, euphoria, poor judgment, insomnia, agitation, and thoughts of suicide. In the United States we have not significantly decreased the incidence of suicide in the past decade. There are approximately 60,000 suicides each year. The major risk factors for suicide include overwhelming hopelessness and the energy to commit the act. Therefore when we energize a hopeless patient by accelerating them into treatment emergent mania with the wrong drug at the wrong time it becomes very clear how we are putting our patients at risk.

A significant number of chronic substance abusers suffer form bipolar disorder. Unfortunately these patients largely go undiagnosed and mistreated. the average bipolar patient has symptoms for 10 years before an accurate diagnosis is made and along that journey they have seen on the average of 4 physicians before the proper diagnosis is made. Just today I such a patient. A young man who has suffered with drug addiction for 10 years. He has suffered the loss of his marriage, his job, and legal issues partly because he was mistreated for many of those years. If he had been properly diagnosed and treated for his bipolar disorder perhaps he would have gained control of his life years sooner.

We have an obligation as physicians to train ourselves to better recognize and treat bipolar patients. Given the information above our patients can’t survive if we don’t.

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