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When It’s Both: Your Child has a Drug Addiction and Bipolar Disorder

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The Partnership welcomes back author and Intervene blogger Ginnah Howard!  We’re also excited to be giving away two free copies of her novel Night Navigation – new in paperback – see below for details.

What if, in addition to having a substance abuse problem, your son or daughter also has a mental illness such as bipolar disorder? Your child’s behavior is erratic, temper explosive, judgment impaired. It’s hard to know which roller coaster you’re riding. Is it drugs or manic depression?

If the answer is “both,” then the whole dilemma of when to hang on and when to let go has become even more complicated, especially if a history of suicide is in the family footnotes. This is the dilemma which my novel, Night Navigation, explores, a story inspired by my own family’s experience of riding that roller coaster for many years.

According to the National Alliance on Mental Illness, Sixty-one percent of individuals with bipolar illness also have a substance abuse disorder. Bipolar, or manic depression, is a medical illness that causes extreme shifts in mood, energy and functioning. Most people usually require lifelong treatment. While medication may be a key element in successful treatment, psychotherapy, support and education about the illness are also essential components in the treatment process. Though the exact causes of bipolar disorder are not known, most scientists believe bipolar illness is caused by multiple factors that interact with each other to produce a chemical imbalance affecting certain sections of the brain.

Bipolar disorder often runs in families and studies suggest there is a genetic component. A stressful environment or negative life events may interact with biological vulnerabilities to produce the disorder. This is why when people debate the whole nature/nurture cause-and-effect question, I always say “both” to that as well. Many families have generational histories of co-occurring mental illness and substance abuse, even though neither is fully recognized as such until way down the line.

For those parents who have concerns that their son or daughter may have a co-occurring mental illness, the National Alliance on Mental Illness website is an excellent source for information: www.nami.org

Editor’s Note: WIN a copy of Night Navigation by Ginnah Howard.
HOW TO ENTER: Leave a comment responding to Ginnah’s post with a valid email address and two winners will be chosen at random at the end of this giveaway.  Enter as many times as you want!  This giveaway ends next Tuesday July 6 @ 5PM EST.  US only. Good luck!

** Giveaway has ended **

30 Responses to this article

  1. Avatar of Aria Dual Diagnosis Sullivan
    Aria Dual Diagnosis Sullivan / October 25, 2011 at 2:35 pm

    As someone who did not really know about dual diagnosis or its treatments before now, thank you so much for posting. I think it’s important for people to know about this: too often people with a substance abuse problem are dismissed as people who made bad choices. While this may be true on some level, it’s important to know that there is often something else going on that we may be unaware of. This post has helped me to be a little less judgmental. Thanks for posting!

  2. Ginnah Howard / September 25, 2010 at 11:12 pm

    Patti,

    I am happy to hear that you are finding the Famiy-to-Family Program so helpful. I will pass your evaluation on to my NAMI group here in Otsego County, New York State. I very much appreciate you getting back to me with your positive feedback. Just more proof of what a good thing blogging on this Intervene site is in terms of sharing valuable information.

    Ginnah

  3. Patti Herndon / September 24, 2010 at 4:47 pm

    Ginna,

    I have started the NAMI Family to Family program in my area, Dallas. Tomorrow is our second meeting. The facilitators are incredible. The quality of the study materials are way beyond expectation. The class is very well attended with a wonderful and diverse collection of family members devoted to their challenged loved one-many of those affected loved ones struggling with a substance use disorder in addition to their mental health challenge.

    I have no doubt that this (no cost) 12 week class is going to serve my goals in advocacy, my family and my spirit. Thank you for being the catalyst in this opportunity to learn more and more.

    Addiction is the journey. Recovery is the destination.

  4. Avatar of Dawn Higley
    Dawn Higley / September 10, 2010 at 12:51 am

    Hi Ginnah, It’s Dawn (Piambino) Higley – I was very happy to see your brochure in our local library! 4 mothers in our area have started a monthly autism support group. I am not sure if you are aware that I deal with Autism/OCD and stress/anxiety, as well as suicidal threats with our oldest.

    If you wouldn’t mind contacting me privately, I would love to share more with you.

    Congratulations on your accomplishments! :)

    Dawn

  5. Ginnah Howard / August 9, 2010 at 6:45 pm

    Patti,

    I’m happy to hear you’ve been able to contact a Family-to-Family program in your area. I hope when they get back to you, that works out. I’d be interested to hear what you think of the course once you complete it if it does turn out to be something you are able to do. I think others who read these Intervene blogs would like to hear your evaluation as well.

    Ginnah

  6. Ginnah Howard / August 9, 2010 at 6:40 pm

    Cheri,

    I have been through times like you’ve described in your comment, so I know how difficult and frightening it can be. Regarding an intervention, I do not have the expertise to advise you on that, but here is the contact information for the National Alliance on Mental Illness in Pennsylvania. I suggest you give them a call to see if they may be able to help in some way:

    State Organization: NAMI Pennsylvania
    Address: 2149 North 2nd Street
    Harrisburg, PA 17110-1005

    Primary Phone: (717)238-1514
    Alternate Phone: (800)223-0500
    Fax: (717)238-4390
    Email Address: jdesrosiers@nami-pa.org
    Website: namipa.nami.org

    Ginnah

  7. Avatar of Cheri
    Cheri / August 9, 2010 at 12:42 am

    Need some help…I have a 19 year old cousin who we believe is on drugs along w/drinking and we believe she has mental issues..Living in Pa we can not commit her and she feels there is nothing wrong w/her.
    We have called the Crisis center in our area and they cant do anything unless she harms herself or someone else. I agree this is totally wrong.
    Today she was found walking on railroad tracks w/berries covered all over her body and she was wearing a hooded jacket. It was 85 here today…
    Can someone please Help…..
    Should we get a big family intervetion and confront her??

  8. Patti Herndon / August 6, 2010 at 10:06 pm

    Ginnah,

    Just in case you end up visiting your post again…I wanted to thank you. I found a NAMI “Family to Family” training in my area, facilitated by the information/link you provided here on Intervene.

    I sent an inquiry to NAMI about the course scheduling. I’m looking forward to a response to my inquiry and I am eager to learn more about the course.

    I experience a surge of renewed inspiration through new opportunities to expand on my support role skill set. Thanks for being that catalyst!

    Best wishes,

    Patti

    Addiction is the journey. Recovery is the destination.

  9. Patti Herndon / August 6, 2010 at 1:42 am

    What a great resource for families, Ginnah. Your adding this info. is serendipitous. I had recent communication with a parent that was experiencing difficulty with being able to match the available CRAFT (Community Reinforcement and Family Training) course with their schedule and area.

    NAMI’s “Family to Family” training would be a great option in these kinds of situations. Having a menu of options designed for family-centered assistance maximizes the odds for families who are seeking help in developing a healthy strategy -one that will grow and preserve a sense of hope and provide opportunity to build on coping skills tailored for each family system. That’s two really good resources for families to investigate.

    Awesome! Thanks for the info. and the links!

    Addiction is the journey. Recovery is the destination.

  10. Ginnah Howard / August 5, 2010 at 12:29 pm

    And thank you, Patti. You have shared so much valuable information in your posts. Your mention of the “bloomng of family resources” made me think it might be helpful to include a description of the NAMI Family-to-Family course:

    The NAMI Family-to-Family Education Program is a free, 12-week course for family caregivers of individuals with severe mental illnesses.

    • The course is taught by trained family members
    • All instruction and course materials are free to class participants
    • Over 115,000 family members have graduated from this national program

    A tribute video containing moving testimonials about the Family-to-Family program from family members and course instructors can be found by going to Family-to-Family at http://www.nami.org

    What does the course include?

    • Current information about schizophrenia, major depression, bipolar disorder (manic depression), panic disorder, obsessive-compulsive disorder, borderline personality disorder, and co-occurring brain disorders and addictive disorders
    • Up-to-date information about medications, side effects, and strategies for medication adherence
    • Current research related to the biology of brain disorders and the evidence-based, most effective treatments to promote recovery
    • Gaining empathy by understanding the subjective, lived experience of a person with mental illness
    • Learning in special workshops for problem solving, listening, and communication techniques
    • Acquiring strategies for handling crises and relapse
    • Focusing on care for the caregiver: coping with worry, stress, and emotional overload
    • Guidance on locating appropriate supports and services within the community
    • Information on advocacy initiatives designed to improve and expand services

    How can I find a course in my area?

    Family-to-Family classes are offered in hundreds of communities across the country, in two Canadian provinces, Puerto Rico, and Mexico.
    View the current Family-to-Family course schedule on http://www.nami.org

    P.S. Note that the course includes information on co-occurring substance abuse as well.

  11. Patti Herndon / August 3, 2010 at 8:08 pm

    And…I wish I could have heard yours’ and the other speakers presentations at that conference. I can just imagine the incredible energy that resulted in that commingling of spirit!

  12. Patti Herndon / August 3, 2010 at 8:00 pm

    I always love finding your posts on Intervene. Your written perspective consistently brings together relevant education about co-occurring disorder delivered in a hope-inspiring message that targets the head and heart in tandem. That’s a powerful, change-making combination.

    For so long, I struggled as a parent with the process/development of cultivating a consistent sense of hope in the aftermath of my son’s battle with major depressive disorder. I think a big part of my lack of progress in that so-very-critical-to-recovery part of the journey was due to the lack of family-centered education, training and encouragement. Since then, those kinds of resources for families have begun to bloom, more and more, as clinical advances infuse the field of recovery, and the monumental barrier to treatment seeking known as stigma is slowly, but surely, being knocked down.

    When folks, like you, share with others your acquired wisdom and obvious passion to connect for the purpose of facilitating recovery through education, training and hope; It supercharges the sense that families can look forward to a time when addiction and other mental health conditions need not destroy the lives of our loved ones and our family systems. We are getting there…

    I’m a more recent member of NAMI and I really look forward to accessing the link you provided.

    Thank you, Ginnah…Please keep sharing on Intervene…As often as you have opportunity to ;0)

    Addiction is the journey. Recovery is the destination.

  13. Ginnah Howard / August 2, 2010 at 7:28 pm

    Patti Herndon,

    So much good information about dual diagnosis and treatment in your comments. I appreciate you adding it to the post. I was a speaker at the NAMI Pennsylvania State Conference last week. The high point for me was listening to the recovery stories of many people who have co-occurring mental illness and substance abuse disorders. These people were articulate, confident, and full of hope. Their progress was inspiring to the rest of us that were part of the session. Many of the people who shared have participated in one or more of NAMI’s trainings: Peer to Peer, Peer Specialists, and NAMI Connection which all help build support skills. More information about these programs can be found at http://www.nami.org

  14. Patti Herndon / July 31, 2010 at 8:38 pm

    The article, below, might be of some help in expanding upon this extremely relevant post on co-occuring addiction and bipolar, though the article does not concentrate its focus on bipolar disorder specifically, but, mental health issues and addiction in general. It provides good information on statistics of co-occurring disorders and offers some brain science information that is very interesting.

    Great post, Ginnah! Thank you so much for posting on this subject.

    The Challenges of Dual Diagnosis
    By Hugh C. McBride
    Addiction and mental illness share a number of traits: Both are oft-misunderstood disorders that some misguided individuals continue to insist are actually “character flaws” that can be overcome by will power alone; both have biological bases and emotional aspects; and, left untreated, both can ruin lives.

    Another similarity is that both conditions often occur in the same person.

    Known in medical parlance as a “dual diagnosis,” the co-occurrence of mental illness and addiction can present significant challenges to recovering patients as well as to the health care and rehabilitation professionals with whom they are working.

    In the “Co-occurring Disorders” section of its website, the nonprofit advocacy group Mental Health America expresses the challenges of dual diagnosis in stark terms:

    “For people struggling with co-occurring mental health and substance abuse disorders, physical safety and overall health risks are greater; the impairment of life skills is greater; and the chances for successful treatment are much less – all of which contribute to stigma.”
    As the National Alliance of Mental Illness (NAMI) puts it, “having a simultaneous mental illness and a substance abuse disorder frequently leads to overall poorer functioning and a greater chance of relapse.”

    THE PREVALENCE OF DUAL DIAGNOSIS
    NAMI, which notes that there is little conclusive data on the prevalence of dual diagnosis, cites the following statistics from reports in the Journal of the American Medical Association:

    •About 50 percent of people with severe mental disorders are also affected by substance abuse issues.
    •Twenty-nine percent of all people who are diagnosed with a mental illness also abuse either alcohol or another drug.
    •Thirty-seven percent of alcohol abusers and 53 percent of drug abusers also have at least one serious mental illness.
    According to Dr. Andrew Chambers, who led a 2007 study on the brain’s role in dual diagnosis, between 20 to 50 percent of all individuals who suffer from anxiety or depression also have some type of addiction, as do 40 to 80 percent of those diagnosed with antisocial personality disorder, bipolar disorder, or schizophrenia. Chambers noted this data in a Dec. 2, 2007 American Psychological Association press release that announced the results of his research.

    THE SEARCH FOR EXPLANATIONS
    Though health professionals have long noted the prevalence of dual diagnosis, relatively little research has been conducted into a biological explanation for an individual’s predisposition to develop two such potentially debilitating disorders. Many experts believed – and continue to theorize – that addiction follows mental disorders as a result of afflicted individuals attempting to “self-medicate” their psychic pain away.

    However, Chambers and his team may have gained some significant insights into the physical roots of this complex condition.

    Chambers’ research addressed developmental changes in an area of the brain called the amygdala, which is associated with emotions such as fear and anxiety. According to the APA release, his study found that rats whose amygdalas had been surgically damaged during their infancy grew up to be “abnormally under-responsive” to certain stimuli, but were hypersensitive to the effects of cocaine.

    In humans, Chambers said in the release, a similar effect could result from brain damage prompted by as-yet-unknown causes. “Early emotional trauma, paired with a certain genetic background, may alter the early development of neural networks intrinsic to the amygdala, resulting in a cascade of brain effects and functional changes that present in adulthood as a dual-diagnosis disorder,” he said.

    “Brain conditions may alter addiction vulnerability independently of drug history,” Chambers added, noting that this may also explain why some dual diagnosis patients do not respond as well as expected to certain psychiatric medications.

    THE IMPACT ON TREATMENT
    According to Dual Recovery Anonymous, a nonprofessional support group based upon the Twelve Step principles of recovery, the following are among the obstacles that can impede the effective treatment of dual-diagnosis patients:

    •The symptoms of a person’s mental illness may be masked by the effects of his abuse of alcohol or other drugs.
    •Abuse of – and withdrawal from – alcohol and other drugs can present “false symptoms” that incorrectly suggest the presence of a specific psychiatric disorder.
    •A person’s untreated chemical dependency can contribute to a re-occurrence of her mental illness.
    •A person’s untreated mental illness can slow his recovery from his addiction, and can cause him to relapse.
    Until the mid-1980s, the primary method for dealing with dual-diagnosis patients involved “parallel treatment,” in which the two conditions with which the patient was afflicted were treated simultaneously but separately by two distinct health care teams. Over the previous two decades, though, an integrated approach has become the norm, with a unified team addressing all of the patient’s needs.

    The integrated treatment model has earned widespread approval, with the National Institute on Mental Health advocating that patients “receive consistent treatment, with no division between mental health or substance abuse assistance. The approach, philosophy and recommendations are seamless, and the need to consult with separate teams and programs is eliminated.”

    Addiction is the journey. Recovery is the destination.

  15. Ginnah Howard / July 13, 2010 at 3:14 pm

    Barbara,

    Yes, as you say “it’s a long road,” but nine months is a real gain. I read somewhere that eight times of going through relapse and rehab treatment is the standard. Though Night Navigation does not end “happily-ever-after,” there is some light by those last pages. And in my own life, the member of my family who has a dual diagnosis has had a long period of recovery. May this continue!!!!

    Ginnah

  16. Barbara / July 11, 2010 at 5:28 pm

    Ginnah, a friend read your book and gave me a copy knowing I’d relate.

    I had to put it down halfway through because I related too well and was not ready for it. Thank you for writing it and bringing attention to this dual diagnosis. Its doubly frustrating. My son is only 19 so we have a long road ahead of us. He managed 9 months of sobriety and then started using (heroin) again and so his meds are messed up now and …well you know the story.

    Thanks, I will finish reading your book :)

  17. Ginnah Howard / July 6, 2010 at 10:30 pm

    Bobby,

    Professionals in both the mental health and substance abuse fields appear to believe that treatment should be integrated, that staff should be cross-trained, with funding no longer be given in separate strands. It’s difficult enough for someone with a dual diagnosis to connect with one treament team, much less to be expected to go to two separate clinics. Plus rehabs for dual diagnosis need to be geared toward instilling trust, not based on confrontation of the old models because it’s likely the person with a co-occurring disorder will find the program too stressful and respond by leaving. Unfortunately the bureaucracy has not caught up in terms intergrating funding. But from my research, it does appear progress is being made.

    Ginnah

  18. Bobby / July 6, 2010 at 7:28 pm

    Addiction and mental illness often go hand and hand although this fact is not widely recognized. They each still have to be treated as individual problems. Addiction needs to be addressed by addiction experts and bi-polar symptoms need to be treated by mental health experts. Getting into recovery is the first step for the person suffering from mental illness to becoming stable enough to decide on a course of action. Thank you for the information. I am sure it will help many people who are dealing with a similar situation.

  19. Ginnah Howard / July 6, 2010 at 1:22 am

    Mary,

    I am sorry to hear of your many years of so much pain and suffering, and now to also have failing health as well. Of course there is no easy answer, but again I can say that one of the things that helped me most was regular attendance at both NAMI and Al-Anon support groups. I made some gains at learning to detach. As many of the other people in these blogs have said, it is so important to find ways to take care of yourself, to spend time doing things that bring you calm and pleasure. Because sometimes anxious thoughts would keep going over and over in my mind, I found listening to audiobooks was an excellent way to stop obsessing.

    You are likely to find support groups in your area on these two sites if you haven’t already given these a try: http://www.alanon.org.za and http://www.nami.org

    Ginnah

  20. Avatar of Mary
    Mary / July 3, 2010 at 6:27 am

    What a blessing to see this blog. I have battled the unknown for the last 38 years of my life. My first and ex-husband was an undiagnosed bipolar manic personality with borderline manipulative personality. He was abusive, emotionally, mentally, verbally, and physically. I called him a Dr. Jeckel and Mr. Hyde. Unfortunately, I did not get out of the relationship before my precious identical twin sons were born. It took me going to nursing school to discover the problem. Now, my most fearful nightmare has come to past. My sons are showing the same traits, and personality characters of their father. For twenty years the youngest son has used alcohol and dope, and I just discovered this a year ago. I can not tell you how this has affected me. I have done everything I can to help. But no one warns you of the depth they can will go, even to lies they tell about you, and the monies and things they steal from you. He gave up his only daughter, he can not keep a job, and he has a dual diagnose of both bipolar, and alcoholism. I don’t know how much more emotional loss I can endure. My health is declining, as I am recovering from a heart attack from a year ago with complications. I am seeing more of this heartbreaking disease in society with the use of dope, and alcohol, I and would like to know how I can help myself, my family, and others. I have not had a relationship with the other son for the past 5 years, and now it is going on a year and half for the other. I know I am grieving, because it is like a death with no closure.
    Mary

  21. Ginnah Howard / July 2, 2010 at 12:44 pm

    Amber,

    So sad to have your child become a stranger along with the anxious concerns for his well-being. Plus having to manage your own bipolar disorder. Two groups that I found helpful during those rough years were Alanon and NAMI. Both have excellent websites and perhaps support groups in your area. If you are reaching out by reading Intervene, probably you already know about them. It was such a help to be able to talk with other parents who truly understood.

    Ginnah

  22. Ginnah Howard / July 2, 2010 at 12:34 pm

    Susan,

    How fortunate you and your daughter have found a doctor who listens and is able to connect. And what is even more important that your daughter is able to hear his wisdom. This is such a critical part of recovery. My own experience has been that it’s a long process: two steps forward, one step back, but it sounds like both of you have already made some real gains.

    Ginnah

  23. Avatar of Amber
    Amber / July 1, 2010 at 4:27 pm

    my boy and both have bpd, and my boy has adhd and sensory processing disorder. He’s a handful, always has been. He’s been receiving treatment for his mental illnesses since elementary school. We’ve caught him huffing, smoking pot, and smoking. But since he’s almost 16, his psychiatrist won’t divulge the results of his ua’s…or share any information about his case with us. I live with a stranger…a distant, aggressive, remote young man who is nothing like the wonderful loving outgoing child I knew 5 years ago. I miss that boy desperately. I fear that he’s lost to me…

  24. Susan Lea / July 1, 2010 at 4:08 pm

    Our family doctor told my daughter she needs to address the underlying causes of her anxiety disorder. Until she does that, her battle against opiates will fail. I think he was very wise and my daughter feels someone finally understands and is on her side in this struggle.

  25. Ginnah Howard / July 1, 2010 at 2:26 pm

    Teri,

    I cried when I read about your daughter. When my younger son died in 1995, the most comforting thing someone said to me was, “You will never get over this.” Finally someone who “got” it. Of course time has been a healing factor, but that room of grief is always there, the door ajar. Reading your story takes me into that room and that feels right, exactly where I needed to go at that moment.

    Ginnah

  26. Ginnah Howard / July 1, 2010 at 4:56 am

    Heather,

    It sounds like you’ve already gained real insight into your situation. When I first began looking for treatment for a family member ten years ago, many rehabs did not deal with co-occurring disorders (dual diagnosis). Recently when I was researching for the novel I’m currently working, I found that many of the centers now include dual diagnosis treatment. Real progress. An excellent site for locating the right program for your daughter is http://www.samhsa.gov. It describes the basics of hundreds of programs in every state and usually provides you with the web links.

    Ginnah

  27. Ginnah Howard / July 1, 2010 at 4:45 am

    VJ,

    I commend you for having the psychiatric assessment. It sounds like, for now, “watchful waiting” is the wise course. It is hoped that the assessment it accurate: so much less complicated if you and your family do not have to deal with mental illness, in addition to concerns about substance abuse.

    Ginnah

  28. Avatar of Teri
    Teri / June 30, 2010 at 11:39 pm

    We fought these demons with our daughter for 27 years. She was diagnosed with ADHD, Bi-Polar, Narcissist and Borderline Personalities as well as Oppositional Defiant Disorder. She was also an alcoholic and crack cocaine addict. We tried everything we could to help her…to no avail.

    My oldest brother also has Bi-Polar disorder. We were told that there is a genetic component.

    The doctors always told us that she was self medicating…

    She had two beautiful children, whom we had custody of since they were babies.

    Our daughter died June 27, 2009 of an “accidental” drug overdose.

  29. Avatar of Heather
    Heather / June 30, 2010 at 10:01 am

    Thank you for your post! I was totally engrossed in reading this information. My ex-husband is bi-polar and addicted to alcohol. My daughter is following the same path with addiction, and I suspect she is also bi-polar.

    I am an over analytical person. I am constantly trying to assign her behavior to either the drugs or mental illness. I am starting to realize now that it doesn’t matter which behavior is attributed to which illness.

    I am also starting to realize that one illenss can not be helped without the treatment of both. I am starting to expolore treatment centers (hopefully I can get her to go to one) and will definately inquire as to whether they have mental illness treatment to coinside with addiction treatment!

    Thanks again for getting me on a roll!

  30. VJ / June 29, 2010 at 3:17 pm

    Thank you for your post.

    I did all I could to have my son properly assessed but no one could find any mental disorders. And other than alcoholism nothing on either side of our family tree indicates any mental illness.

    A psychiatrist told be that if there is no mental illness or other specific trauma in my child then there is nothing he can do. That is not what a parent wants to hear.

    I look forward to your next post.

    vjforrecovery@aol.com

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