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Dual Diagnosis: Relapse and Recovery

Six weeks ago I relapsed from my addiction recovery and, subsequently, from my Bipolar Disorder recovery. The two are so intertwined that a distinction can barely be made by me or my mental health team. When I use substances I also quit taking my medications.  When I quit taking my medications I am more likely to use substances to control growing symptoms. 

The first question everyone asked was: “Why?”  What led to picking up again?  The hope is to identify the reasons and prevent future relapse.  However, with all my self-analysis I couldn’t give them an answer except “I felt like I was missing out.”  In retrospect, the harsh reality is “I saw others using drugs to escape and I desperately wanted to escape too.” 

Today I can see reality and see that, despite the best medicines and mental health team, I have spent 3 decades using drugs of one kind or another to deal with life on life’s terms and sometimes---not always or even mostly—I miss the escapism.  Drugs weren’t the only way I escaped: an active fantasy life and “letting” myself become hypomanic were my other forms of escape from the day to day challenges and pains of life. 

So, I sit here today and wonder what could have been done: 1) I have to minimize or eliminate people in my life who use escapism to deal with life, 2) I have to accept the discomfort and pain when it comes and work through it and 3) I have to reach out to others (very difficult for me) when I feel weak or my thinking is compromised by life. 

What I am doing now?  Refocusing on the success I had for many months.  A lapse/relapse doesn’t constitute starting over.  I was very depressed at first because I believed that to be the case.  It is not.  Your successes are still yours, your coping tools are still there and your support system is still intact.  If you lack tools or support, it is imperative that you get to treatment/therapy/self-help meetings and build your toolbox.  Remember that others have so much wisdom to give and it is totally free at self-help meetings.  Similarly, build yourself up with people who will support you.  They can be found on your mental health team (if not, think about changing providers, but most MH Professionals will go above and beyond to help you), in self-help meetings, and amongst your friends and family (simply asking “Can I come to you with issues of recovery?” goes a long way). 

I am also “sitting in” the discomfort of my shame and disappointment in myself.  NOT beating myself up, but letting myself see the disappointment I have and burn it into my brain.  Both my disappointment and that of my supporters is a powerful incentive to stay on track.  It’s painful to see my boyfriend suddenly not trusting me again.  There are long awkward silences and questions that I want to get defensive about, but realize they are the consequences of my relapse.  I have to own these moments too.  

I have a sponsor now.  I attend more self-help meetings and really listen, knowing my best thinking got me where I am.  Most of all, I have hope:  hope that I CAN deal with life as it comes without picking up or stopping my psychiatric medications.  Hope that I never have to use escapism to deal with trials again.  I thank my supporters for this hope…My higher Power, Calvin, Anne, Marianne, Ken, Ms. Langley, Dr Smith and many more people who shall remain nameless but very much a part of my support network.  If you are struggling, reach out.  If you know someone who struggles, be their support person! 


Thanks for husband is bipolar and recently relapsed after the recent unexpected death of his mother. I suspect he was using before this however and the death just exacerbated things. I am exhausted from all the lies and drama. Lying about using and lying about taking his meds. I love him but I'm fed up.

When the Brintellix caved in and I ended up full of fear, anxiety and suicidal depression a few weeks ago, I drank. I drank for about 9 days, about a bottle of wine a night, until I went to sleep. I looked forward to it. It was a crutch. I am not that remorseful, but I am afraid I'll do it again, because I have intense emotions I'd like to escape. I have also found local AA to be abusive. Hear me out: I've been going to this one place for ten years and this is my first relapse. It's interesting how AA members can speak about a divorce or a lost job leading to thirst for alcohol, but if you mention meds or depression, the whole room either becomes MD's or 'God' 'Higher Power' types who claim mental illness is a myth and to stop taking the meds." Or, the room becomes a "Mental Health Meeting," Where everyone who is on meds needs to put in their two cents. This is actually called Crosstalk and it is not supposed to happen at AA. But at my group, unfortunately, it does. AA is not supposed to take any position on outside issues, but by letting their members run wild and run roughshod over dually diagnosed people, sometimes the solution is to find another meeting, be selective in what you share, and try not to take personally the fact that some AA's are socially aversive to anyone who has ever shared about mental illness or medications ever. This has been my experience. It could have been worse. Now I'm looking into DBT, reading the big book alone, and trying to find another meeting. I'm also writing a few letters suggesting that we put it to group conscience in the business meeting to read in our preamble "Not being doctors, we refrain from giving medical advice," after the part about "crosstalk is discouraged." Now, I'm trying to recover from that relapse. I'm bipolar also, on a lot of medications and alcohol in the amount that I drink is NOT part of a good recovery plan for me.

I'm assuming what you're explaining is true and probably my husband misses escaping life's issues wherever things got difficult.
Now with a family I think he never really learned how to cope with life without drugs.
Now that he's finally been diagnosed it's still really complicated.
He's also recently suffered a death in the family and although things seemed to be on a downward spiral it push him completely over.
Even with him taking his meds, I think he just WANTS to stop the pain so badly that no amount of medication will stop him from relapsing.
He's in a center that deals with dual diagnosis and they've diagnosed him with Schizophrenia AND bipolar.
So a double barrel of complications.
I'm conflicted about when he comes back because I can't forget how horrible it all became with stealing and lying and using drugs and the fighting.
I love him but it feels like I've got to take both the good and the extremely bad and I can't live like that again.
He's an amazing father and loves our son to distraction. They have an amazing bond.
He's a good husband when he's doing okay.
It's just that things are too often NOT okay with him and that's when everything gets screwed up.

I wish it was easy to make a decision but he's both wonderful and good and then a lying, stealing bastard.

There has to be a big change from his side to ALSO deal with life and not just try to avoid it.
Therapy is REALLY important in my opinion.
Sadly it's REALLY expensive and I don't have the money being a family with only one income and somehow finding the money for therapy as well seems impossible.
Feel like I'm at a dead end with no space to make a U-Turn.

I am bipolar and often psychotic . Your article was excellent,you show great insight into your problems and know how to go about tackling them. There are no triggers for my disorder, either when a mood swing will come (frequently)nor do I have a toolbox for psychosis. But, like you, I have insight and that, I think, is the most powerful tool there is. Good luck to you Liz.

very informative and helpful ! Thank you for sharing. I (and maybe a lot of people) who can very much relate to this hope to read more enlightening and educating information concerning DUAL DIAGNOSIS. My daughter's currently diagnosed with such. God bless.
and more power to you!

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