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Chaos in Action
Transcript of Chaos in Action
My name is Ryan, and I am an alcoholic. I have a disease. I have an obsessive compulsion to consume something to which I am allergic. Every single day I think about alcohol, sometimes fantasizing about drinking, sometimes simply being grateful I didn’t drink the day before. But though the thoughts of alcohol are always there, every morning I remind myself that just for today, minute by minute, I can stay away from what would kill me. I have this one chance, this one life to live. As a friend told me, “Life is not a dress rehearsal.” So now, in sobriety, I put on the show.
- March 2012
19.9 million US adults struggle with alcohol abuse or dependence (American Psychological Association [APA], 2012; United States Census Bureau, 2012)
"People with alcoholism — technically known as alcohol dependence — have lost reliable control of their alcohol use." (APA, 2012, para. 3)
6.2 million US adults struggle with Bipolar II Disorder (National Institute of Mental Health, 2005)
25-50% of individuals with Bipolar Disorder will attempt or complete suicide within their lifetime (Jamison, 2000)
Hypomania is the seeming joy of an "exquisitely alert nervous system" (Jamison, 1995, p. 3)
Jamison also eloquently captures the depressive side of Bipolar Disorder:
My mind had turned on me: it mocked me for my vapid enthusiasms; it laughed at all of my foolish plans; it no longer found anything interesting or enjoyable or worthwhile. It was incapable of concentrated thought and turned time and again to the subject of death: I was going to die, what difference did anything make? (p. 38)
Hi darlins. You folks are the most amazing people I’ve met in this world, and for the pleasure of your company I thank ya. I don’t know anymore how to do this. Everything strikes me as simultaneously humorous and depressing and, well, the depressing has, I guess, won over. You all know why I love you so there’s no reason to put it out here – you’re the five people in this world who have made me believe it can be a better place, perhaps even a place where fuckers as fucked in the head as me can feel free and maybe happy. I saw you all this summer – it was my summer of goodbyes. I had great times with people I adore, and if nature somehow allows my brain to continue on, I will never forget y’all: the loves of my life. I don’t think there’s anything anyone could have done, so don’t be all girly and silly.
Just love, luvs. Love it all.
October 31, 2006
This paper is an examination of co-occurring Bipolar II Disorder & Alcoholism
It is a research & experiential paper structured around my narrative
Its purpose is to emphasize for clinicians the magnitude of this comorbid condition
It presents research and personal experience with psychopharmaceuticals used to treat Bipolar II Disorder and alcoholism
It highlights the importance of a dual-diagnosis approach to treatment
The diagnosis of bipolar disorder is often preceded by a diagnosis of unipolar depression and is treated with psychopharmaceuticals as such (Takeshima & Oka, 2013)
Sonne & Brady (2002) found that of 500 bipolar patients, 48% were not diagnosed before having seen at least five mental health professionals and that 35% of them had coped with the disorder for an average of 10 years before being diagnosed and treated
I saw over a dozen therapists and psychiatrists before I was diagnosed with Bipolar II Disorder in 2007, three years after I began seeking help
Two studies by Frye & Salloum (2006) and Sonne & Brady (2002) found that 2.4 to 2.9 million people diagnosed with Bipolar II Disorder have a co-occurring condition of alcoholism
Alcohol destabilizes the medications taken for Bipolar II Disorder and when an uncontrollable cycle occurs, alcohol consumption becomes more likely (C. L. Schuster, personal communication, November 22, 2013)
Haley, Peters, Kinderman, McCraken, & Morriss (2009) wrote consideration of patients' previous history of Bipolar Disorder phases is key to helping patients alter her or his alcohol use
Farren & McElroy (2008) wrote that Bipolar II patients experience more severe struggles with alcoholism, have longer inpatient stays, and have a poorer prognosis than non-alcoholic individuals who have Bipolar II Disorder
Farrent & McElroy (2010) presented a self-medication hypothesis that must be considered
The self-medication hypothesis suggests that alcoholism is a complication of Bipolar II Disorder rather than a cause of it
This has particular importance in treatment, where identification and treatment of Bipolar Disorder in the earlier years of a person’s life could help prevent the development of alcohol abuse and dependence (Preisig, Fenton, Stevens, & Merikangas, 2001).
While writing this paper I came to wonder what my life might have been like had I been diagnosed when I first sat in a therapist's chair in 2004
I can’t help being bipolar any more than I can help being Southern, being Native American, being gay. “One is what one is” – I want to wrap a ribbon around those words. Bipolar disorder along with anxiety disorder is difficult to treat, one along with the other. My doctor has made this clear on a number of occasions, so I have relied on alcohol to try to calm nerves that biology renders seemingly uncalmable. It’s an interesting but scary thing to have no recourse for a mental state of being.
Numerous psychopharmaceuticals available for treatment of this comorbid condition, but they must be carefully monitored by a psychiatrist - many people do not have this access as it is unfortunately considered a luxury by our society
Medication must be carefully monitored as though they are effective treatment for controlling the presentation of Bipolar II Disorder and discourage alcohol consumption, they are dangerous when they clash with an individuals unique body chemistry
In conclusion, I strongly suggest, if not demand, that dual-diagnosis is necessary for treatment of those of us with this condition. The importance of treating both a patient’s bipolar disorder and her or his alcohol consumption cannot be overstated and is highly possible
Numerous psychopharmaceuticals are available for treatment of this comorbid condition, but they must be carefully monitored by a psychiatrist - many people do not have access to this "luxury"
Medication must be carefully monitored, as though they are effective treatment for controlling the presentation of Bipolar II Disorder and discourage alcohol consumption, they are dangerous when they clash with an individual's unique body chemistry
In conclusion, I strongly suggest that dual-diagnosis is necessary for treatment of those of us with this condition. The importance of treating both a patient’s Bipolar Disorder and her or his alcohol consumption cannot be overstated and is highly possible
American Psychological Association (2012). Understanding alcohol use disorders & their treatment. Retrieved from http://
Farren, C. K., & McElroy, S. (2008). Treatment response of bipolar and unipolar alcoholics to an inpatient dual diagnosis
Journal Of Affective Disorders, 106
Farren, C. K., & McElroy, S. (2010). Predictive factors for relapse after an integrated inpatient treatment programme for
unipolar depressed and bipolar alcoholics.
Alcohol And Alcoholism, 45
Frye, M. A., & Salloum, I. M. (2006). Bipolar disorder and comorbid alcoholism: Prevalence rate and treatment
Bipolar Disorders, 8
(6), 677-685. USUS: American Psychological Association.
Healey, C., Peters, S., Kinderman, P., McCracken, C., & Morriss, R. (2009). Reasons for
substance use in dual diagnosis bipolar disorder and substance use disorders: A qualitative study.
Journal Of Affective
Jamison, K. R. (1995). An unquiet mind: A memoir of moods and madness. New York, NY: Alfred A. Knopf, Inc.
Jamison, K. (2000). Suicide and bipolar disorder.
Journal Of Clinical Psychiatry, 61
(Suppl 9), 47-51.
National Institute of Mental Health (2005). Bipolar disorder among adults. Retrieved from http://www.nimh.nih.gov/
Preisig, M., Fenton, B. T., Stevens, D. E., & Merikangas, K. R. (2001). Familial relationship between mood disorders and
alcoholism. Comprehensive Psychiatry, 42(2), 87-95.
Sonne, S. C., & Brady, K. T. (2002). Bipolar Disorder and Alcoholism.
Alcohol Research & Health, 26
United States Census Bureau (2012). State & county quickfacts. Retrieved from http://quickfacts.census.gov/qfd/
Takeshima, M. & Oka, T. (2013). Association between the so-called “activation
syndrome” and bipolar II disorder, a relate disorder, and bipolar suggestive features in outpatients with depression.
Journal of Affective Disorders, 151, 196-202.