Dual Diagnosis

“Population-based studies have documented that among all patients with major psychiatric disorders, those with bipolar disorder have the highest prevalence of comorbid substance abuse and dependence” (Tohen, et. al 1998, Pg. 133).

My substance abuse came long before my diagnosis of Bipolar I.  As children living in fear of their Father, my brother taught me at a very young age to use drugs and alcohol to overcome the pain and shame of living in a violent and abusive family.  Only later in life did I learn to self-medicate my Bipolar symptoms (and often exacerbate them) with drugs and alcohol.

In the past decade I have courageously faced these lifelong habits and coping mechanisms, peeled off the band-aids and felt the pain that “Lil Liz” could not understand or verbalize.  It has not been an easy road, but it is one that others had dared to tread before me.  The well-worn path included famous politicians, NFL stars and famous actors and artists of every imaginable genre.  These brave men and women fought so I could enjoy dual diagnosis recovery today; more often they were simply fighting for their lives when our feet walked down the same road.

So, what if you have just received a Substance Abuse diagnosis and are living with Bipolar Disorder (or vice versa)?  Firstly, there is hope!  In about a year to 18 months of abstinence from drugs, our brain’s pleasure and reasoning centers heal.  We feel hopeful again, we receive joy from the little things that drugs and alcohol may have obliterated during active use and we begin to feel connected again?.  The bad news is, we cannot get the instant gratification or feel these results over night.

There are things we can do, though.  Below is a (far from comprehensive) list of things that helped me:

Make sure you have a strong, Dual Diagnosis Mental Health Team.  Mine consists of a Psychiatrist to manage my medications with me, a Therapist or SA Counselor to discuss my barriers and challenges and a Treatment Group (I do Intensive Outpatient and Narcotics Anonymous Meetings) with whom there is accountability and, potentially, sober socialization.  You may need Vocational Training and/or Case Management as well (especially if you are living with career or legal consequences).

•(“Traditional, separate services for individuals with dual disorders are ineffective, in that integrated treatment programs, which combine mental health and substance abuse interventions, offer more promise” [Drake & Mueser, 2001, Pg. 105].)

Treat both disorders as needing DAILY maintenance.  Just like any health issue, both Bipolar Disorder and recovery from Substance Abuse requires daily attention.  I start my day by taking my medications for Bipolar I, checking my mood (daily mood charts are helpful to you and your Psychiatrist), meditating and planning for what I will do if I have triggers or cravings to use (e.g. will I be around people, places or things that expose me to use—parties, for example) and what will I do if I get a craving (e.g. call my Therapist or a sober friend or sponsor…)?

Know your relapse warnings.  For me, I have come to recognize that if I start neglecting my health by overeating, skipping exercise or simply ignoring my hygiene it can send me tail-spinning into an “I don’t care” state.  For example, if I eat half a pie and pick up a pack of cigarettes—for me—I’m on my way to skipping my psych meds and the potential for substance relapse becomes very high.  Your therapist and treatment group work will reveal your individual triggers.

Be willing to put the same effort into your sobriety that you put into getting high.  New people; sober ones in recovery, new places; the importance of finding and reclaiming positive hobbies and activities cannot be overstated and new things are all part of a sober, healthy life.  In addition to NA, I find activity partners on Meet-Ups, at Smart Recovery (non religious and online) meetings, through Craigslist (use caution) and through community sources (Church, fellowships, etc).

Finally, face the reasons you picked up substances in the first place.  Was it to manage your symptoms?  Work with your Psychiatrist to manage them now.  Were you, like me, running from your feelings? Therapists and groups can be very helpful at dealing with latent feelings—good and bad.  Whatever the cause for picking up drugs or alcohol, find something healthy and positive to fill that void.  Reward yourself for successes…a piece of hard candy for working out to an international trip on your year anniversary of sobriety or anything in between; whatever keeps you motivated!  

Liz Wilson


1.Tohen, M.,  Greenfield, S. F., Weiss, R. D., Zarate, C. A.  & Vagge, L. M.  (1998, Vol. 6, No. 3, Pg. 103). The Effect of Comorbid Substance Use Disorders on the Course of Bipolar Disorder: A Review, Harvard Review of Psychiatry. 

2.Drake, R. E. & Mueser, K. T.  (2001, Vol 6, No. 1, Pg. 105). Psychosocial Approaches to Dual Diagnosis. Schizophrenia Bulletin. 


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