For those who have followed this blog you know that the fundamental question that every addict or alcoholic must answer is “why”. Why do I use? Why am I in this position in my life and how do I get back on track? Why can’t I stop? Why do I keep subjecting myself and my loved ones to this drama and trauma?
The answer for many is Bipolar Disorder. And while Bipolar disorder may be the buzz word of the new millennium leading to an over diagnosis in some circles; it is clearly under diagnosed in the substance abuse population. Which leads to another “why”. Why am I Bipolar?
For most the answer lies in their family tree. Today I saw a client with an addiction who presented to her first day of treatment significantly depressed. she had never before sough out treatment but her family knew she needed help and she finally agreed. On the surface it seemed as though she just suffered from a straight forward Major Depressive Episode. And who could blame her–given what her addiction a=had done to her life and the lives of her family along with the stressor of a bad marriage. But underneath the surface there was more to the story. Her Father was an alcoholic. She had 2 Brothers and a Sister who were alcoholics. Another Sister who suffered from Major Depressive Disorder for many years. And while never seeking treatment herself she had suffered with mood swings for many years.
When her psychological testing was complete the proof was in black and white. but long before she answered the first question on the questionnaire it was blatantly obvious that only one diagnosis would be made: Bipolar Disorder. Her Father has pasted away and her 2 brothers and 2 sisters don’t know yet, but they are Bipolar as well. The familial concordance of Bipolar disorder is astronomical and there is little chance of avoiding it. Knowing that allows us to reach out to family members sooner and be more vigilant of their own symptoms of mood before their lives are turned upside down.
“He’s a chip off the old block”. “Like father like son”. Sound familiar? Two phases often used when we are proud of our children and looking to take a little credit for their virtues. However, when it comes to addiction and the psychiatric pathology that goes along with it, this is where the problem often lies.
When addiction rears its ugly head in a family, particularly when it is associated with a psychiatric illness or diagnosis, it is almost never the index case within the family. When you take a close at the family tree of the addict and pay particular attention to substance abuse history and psychiatric history you will more often than not see that the origins of the current problem lies in the genes of the individual. Let’s look at two particular problems, bipolar disorder and ADD. If a parent is bipolar then their offspring is six times more likely to be bipolar and if the parent has ADD then their children are ten times more likely to be ADD than those children who come from “normal” parents.
Think about your own experiences have had the opportunity to know the parents and watch the children grow up just like them. This is why many kids have no real chance to escape their pathology and that they are doomed from the outset to repeat the sins of their parents.
We must keep this in mind when creating a treatment plan for any person who has entered rehab. It is why in our program we spend a significant amount of time looking at the family. We look at the dynamics and the family history and use that to create a family treatment plan that best addresses everyone’s needs. It also helps us in recognizing the true dual diagnoses that a client is dealing with which we believe assists in treatment success.
Why is it that parents PRETEND to have their child’s best interest at heart when they discuss their reluctance to start the child on medication for their ADD or ADHD? Knowledge is power and unfortunately for many parents with ADD children they would have to be classified as “weak”. Parents look to all sorts of sources of information from Chiropractors to alternative medicine specialists to herbalists to anyone who shares a common opinion about how an ADD child should be cared for. The problem is that they have the process backwards. You don’t formulate an opinion based on a lack of knowledge and then seek out people who share your thoughts. Instead you should thoroughly research all the information available and then rely on credible experts in the field to guide you and your child through the best treatment options available.
A family recently told me that they would not start their 9 year old son on medication for his ADHD because the medication would eventually lead to him becoming an addict. When asked where they obtained this information about the link between ADHD medications and addiction I was told that it was from a book written by a chiropractor. A CHIROPRACTOR!! To the best of my knowledge Chiropractors are not trained in the treatment of mood disorders and if they were they are not licensed to prescribe medication. So is it any surprise that they would object to medication. The problem with that thinking is that they couldn’t be farther from the truth and they are creating a situation where rather than helping a child they are instead setting that child up for a life time of problems. This is what happens when you try to extend your influence outside the realm of your qualifications.
The truth is simply this: every piece of reputable medical literature in the recent past tells us completely opposite what the Chiropractor had to say. Early intervention with medication in the ADD or ADHD brain helps to prevent addiction while late intervention makes a child more susceptible to addiction. the brain is an organ in many ways similar to other organs in that if you allow it to go untreated irreparable damage will occur. Everyone thinks that they can control their brain. That is true if you need to scratch your head. It is not true if you want to control the deeper centers of your brain that are responsible for behavioral disorders like ADD and ADHD. Only medications in combination with behavioral therapy and ADHD coaching have been shown to fix that.
Finally, let me share a thought with you on dosing. Once a decision has been made to start medication that medication must be given at the appropriate dose. The appropriate dose is defined as that dose at which the behavioral problem has been completely better. It not fair to a child to let them taste what it feels like to be “normal” for a couple hours rather than a whole day. If you had pneumonia you would never tell the doctor to give you enough antibiotic to make you some better. You want to be totally better. The same principle applies to ADD treatment. Take the right does of medicine to get completely better. Less medication is not a good thing if it doesn’t work. Use the right dose.
People for whatever reason easily develop opinions about the field of medicine. Leave in the hands of the fight experts and just be a parent. This will lead to what parents really should care the most about; the best outcome for their child.
It seems so much easier. I never have any trouble try to get patients take antibiotics or medicine for their blood pressure or diabetes. Patients almost never turn down pain meds–especially addicts. Clearly addicts have the hardest time saying no when it comes to drugs that in any way resemble those chemicals which live in the same neighborhood as their substance of choice. But tell an addict that you are going to give them a drug to treat their anxiety or depression or bipolar disorder (unless of course it is a Benzo) and you have a whole new fight on your hands.
It is not just addicts that have an aversion to psychiatric or psychotropic medications. Everyday, not some days, everyday; I have a conversation with someone who is reluctant to take a medication to treat their psychiatric symptoms. People believe that they can control their own thoughts. That they have control over their emotions. That unlike their pancreas or kidney or liver they actually have control over their brains. That is simply not true.
As a patient imagine how many times you have woken up and said that this will be a day when you will not feel depressed or you will not have a panic attack. And yet it happens anyway. The centers of your brain responsible for emotion (depression, anxiety, fear, happiness, etc)lie in your limbic system; miles from from your prefrontal cortex. It is the prefrontal cortex that you do have control over. It is there that you can scratch your head or memorize a poem. It is a whole different world in the limbic system however, and you have no more control over that region of your brain than any other organ in your body. Medications allow us to change the dynamics of the limbic system in a way that we can’t otherwise do consciously. And they can do it quickly. When combined with psychotherapy they can do it more thoroughly than any other treatment modality.
Perhaps most importantly, when you say no to medicine you may be guaranteeing that you will stay on a path or psychiatric illness with no hope of recovery. Recent studies show that when untreated, illnesses such as depression can cause irreversible anatomical, hormonal, endocrinological, and physiological changes to the brain and the adrenal gland. These changes not only attenuate recovery but also promote increased incidence of heart disease, diabetes, and stroke.
Today the United States leads the world in very few areas. One area where we are miles ahead of the rest of the world is psycho-social illness. The numerous reasons for this will be a topic for another day. One thing is clear. If we want to change this dubious distinction then we must stop saying “no” to the right drugs! Take your medicine!