Substance Abuse & Bipolar Disorder

Substance abuse occurs in 30-60% of patients with bipolar disorder & is more likely to co-exist with bipolar illness than with any other Axis I psychiatric disorder. Citing data from the Epidemiologic Catchment Area (ECA) Study, Kathleen Brady MD, PhD, an associate professor of psychiatry at the Medical University of South Carolina, noted that alcohol & other drug abuse are not only common among bipolar patients, but may contribute significantly to treatment resistance & poor outcome. Dr. Brady reports that 2-4% of alcoholics & up to 30% of cocaine abusers meet the diagnostic criteria for bipolar disorder, placing them at significantly higher risk for bipolar illness when compared to the general population. When one also considers the bipolar spectrum disorders (e.g., cyclothymia, hyperthymia & hypomania), the prevalence rates among substance-abusing patients are even higher. Diagnostic Challenges

Please read the rest of this article here (http://open-mind.org/News/DA/6.htm)

Hi I love to have any info on this...so if anyone has any holla back please!

Shelby-
Thanks so much. I'd like to read the rest of the article but the link didn't work. Where can I find it?

If you do a google search on: Kathleen Brady MD, PhD or Epidemiologic Catchment Area; you will come up with articles. If you need any help finding some please give me a holler and I will help!!

Patti

This makes sense to me because they are self-medicating both the depressive and the manic states.

guess i need to get in on this...cause we self-medicate our bp and other illnesses, like ADD, anxiety, etc.

great article, i am gonna cut and paste the info to my bipolar support group thread. thanks

so here is a question for discusion...why do u suppose bipolar people self medicate with illegal drugs? and why is cocaine the number one use? are the drugs in the pharmacy really not worth the trouble and side effects...or are there really no good bipolar drugs out there?

so here is a question for discusion...why do u suppose bipolar people self medicate with illegal drugs? and why is cocaine the number one use? are the drugs in the pharmacy really not worth the trouble and side effects...or are there really no good bipolar drugs out there?

I have a couple theories regarding bipolar medications and self-medication.

My daughter is bipolar. It took me 4 years to convince someone that was the problem. Including my daughter... Everyone kept saying she was depressed, they wouldnt listen to the fact that she might stay up for two-to-three days rearranging her bedroom. Then to get her to be convinced that she needed the medication, that was another battle.

For her the medications work great, provided she takes them. She does not like the side effects and still struggles with them but she knows she feels better in general if she is on the meds. The side effects are not that bad, but she thinks there should be a miracle cure. If she doesnt take them for three days in a row, we start all over.

Part of the problem is that it is so dificult to get mental health care, and its virtually impossible to get inpatient treatment for mental health if the person is at all functional. Doctors tend to treat most bipolar as depression, and do not treat the entire mental health package. People who are bipolar tend to like the hypomanic states, where they are energetic and feeling good but not completely out of control (manic). My daughter says if she was only in a hypomanic state all the time she would never take medication. Cocaine mimics the feeling of the hypomania, and it feels good and familiar, and it give the person some feeling of control of their bipolar condition.

Same with alcohol, it tends to combat the extreme mania since its a depressant. Helps them feel a little more even. Same with marijuana.

I'm not a doctor, but I have a BSN with a minor in pschology, not to mention the family (hands on) experience. I have been there...

Me too I've been there and I'm still there. I have Bipolar II, I have experienced many many cycles and hypomania and drug addiction.

It's important to find out if your bipolar is secondary to your addiction, or if it's the other way around. Many people have bipolar symptoms from using street drugs and may even begin an onset of the disorder. If you have substance abuse due to bipolar disorder and you are trying to get symptom relief, it doesn't matter which drug you choose if it masks relieving your symptoms then thats what you will use. It's not a very wise choice I have found for myself.

I used marijuana for a lot of years to relieve my bipolar symptoms and I truly believed that it was helping my symptoms. I'm really not sure to this day if it helped more than my medications or not back then, but now I know that for me I am doing much better without any street drugs and just my prescribed medications.

It took doctors many many years to properly diagnose my bipolar disorder. When I was a child I was diagnosed with depression/manic depression but was left untreated properly but I don't think the medications are at fault, I know now that it takes a long time sometimes for the doctors to make a proper diagnosis. Partly because bipolar is so hard to understand and partly because there are several types of bipolar disorder. It takes years to diagnose the type of illness you have (they mostly see it over a period of cycles in your life). Once a diagnosis is properly made then it takes trying different medications to see if they relieve the symptoms. Everyone has a different chemical body make up so no two people will get the same symptom relief from the same medications. It took years to find the proper combination of medications to relieve my symptoms. A huge factor was once I got into my mid teens I tried marijuana and it seemed to relieve most of my symptoms so any medication they prescribed was off balance just from that once I stopped trying to self medicate years and a lot of suffering later when I used only my prescribed medications they were able to be work properly.

I was addicted to a couple different drugs. My bipolar disorder is genetic and my addiction is also genetic. Both diseases/disorders run in my family most times it is pure H*ll to live with. There is never a time when things just go alright for a long period my med.'s always have be to watched and adjusted if needed but I do what I have to, in order to get by.

Finding out if you are first and addict or first bipolar is important so the prescribing physician will have proper knowledge of you condition in order to properly treat it (believe me it's in your best interest to be truthful).

There is a web site www.About.com (http://www.About.com) type in bipolar disorder upper right hand corner, you will see it has a lot of good up to date information on the disorder. It even explains the brain chemical that is not properly functioning and why in bipolar disorder. Also if you are like me and have dual diagnosis (bipolar & have substance abuse) it explains about that as well. I really like the part that lists personality markers in bipolar people. People wrote down symptoms and things that mark their bipolar traits. It's very interesting to me. I can identify with a lot of them. Hope you can check it out.

I think that people with bipolar disorder who use cocaine may find that it numbs a part of the brain which may bring short term relief but I am willing to bet it causes more problems than it's worth. Cocaine of course was orginally used in this country as an anaesthestic so maybe that is why some people find relief using it. The long term effects of using cocaine will be detrimental if you have bipolar disorder I promise you that.

Certain drugs will cause an onset of bipolar disorder (if you weren't previously) like for example Meth., it is almost an epidemic in this country today and will cause many different psychotic and psychiatric disorders even and especially after ceasing to use it. I know people who've never regained their minds again after using it.

I would stick with the prescription medication for bipolar-I, & bipolar-II for sure or any mind illness. The medications have come a long way and for me it's the only relief I have found to truly work *I'm a high functioning bipolar disorder patient* some aren't as fortunate.

Hope that helps:)

Lots of good info here. What i want to know is what makes a pt with bp start smoking weed again after 6 months clean. Not even 2 hours out and its so frustrating.....

My xwife is dully but a good person .Do they offer any help in prison?Her drug combo caused her some long prison time.She needs help and I'm afraid that's not given.what if anything do they do with this problem.

My xwife is dully but a good person .Do they offer any help in prison?Her drug combo caused her some long prison time.She needs help and I'm afraid that's not given.what if anything do they do with this problem.







Has anyone found that a bipolar diagnosis is taken into consideration during sentencing? For Example, a lesser sentence, treatment while in prison, etc?

If there is a prior diagnosis you may be able to have it used to obtain a lessor sentence. Who is defending her? the DA or a private attorney?

My son was looking at 12-15 years on drug charges. His attorney kept talking with the SA They were aware of his Bipolar since he had been in Mental Health Court twice. He was placed in Mental Heath Court due to each time we tried to Baker Act him, our lovely police department would arrest him instead. So when we show up at court on his arraingnment for Domestic Battery (which was BS!) we explained to the Judge what had happened... Judge places him in MHC and orders him into therapy & take meds.
Anyway... his private attorney made it a point to bring up his issues with the State in each conversation & each email with them. He was prepared to hire a Forensic Psychiatrist, had me get all my son's old medical records ready showing he suffered prior to his drug use & criminal behaviors in the event they had to go to trial. The state eventually made a deal with my son, he plea's guilty, to 3 charges instead of 4, 2 of them at a lesser crime & they will give him 3 years with credit for time served.
I wasn't thrilled since my son was being charged with trafficking drugs when he never did actually "traffic" them. He was the one who introduced the Under Cover to the dealers and he was set up by an informant whom he knew .. that asked him if he knew where he could "cop some pills". My son said yeah.. then the ball started rolling & rolled for over a month. My son went with them to his friends (as per the under cover's request) to get these pills. My son didn't know what was going on. He didn't make anything off the deals, he wasn't even in the same room (or house) when they were done. Once the undercover even had my son call the guy to meet him at our house, in our driveway.. jerko son still insn't catching on... the 2 meet in my driveway & my son didn't even go outside yet was still charged with trafficking on that one :angry:
After reading on this site, I figured out why they did that too.. my house has a school on the block in front of me & one on the block behind me..they didn't
add that to my son's charge though, maybe because he was in the house :confused: Long story short.. yes, his attorney was going to show during sentencing that my son is an addict who is Bipolar and self medicates. He should have been charged only with possession since when he was actually arrested, they found 13 roxies and 4 needles on him... When the State came back with the 3 years, his attorney said to take it because if he fought it and even got it lowered to possession, he would get more time because he was already on probation for possession...and that one could have gotten him 3 years alone.

He is not getting treatment while in prison. They placed him in a work camp where there is no drug counseling.. go figure that one...

Does anyone know if it does any good to write to the DA or Judge from the arraingment to inform them of their condition? My partner was jailed (county of Los Angeles CRDF) and was in her "manic" mode. She is under out patient care, but when this arrest happened, they sited her for violation of a restraining order and are ignoring the fact I have documentation to stand by her illness. Would this help or hurt?:angry:They are giving her only 1/2 of her meds in jail.

Make you concerns PUBLIC--THIS IS A COPY OF MY LETTER
xxxxxxxxxxxxxxx February 1, 2010
Independent Advocate


Michael Bien
Rosen, Bien & Galvan, LLP
Coleman & Armstrong Monitors
315 Montgomery Street, Tenth Floor
San Francisco, CA94104
Phone: 415-433-6830


Prison Law Office
General Delivery
San Quentin, CA 94964


RE: xxxxxxxxxxxxxxx. Termination of psychotropic medications prior to the parole of a substantially disabled prisoner.

Is CDCR failing to provide substantially disabled prisoners with reoccurring mental illness such as Schizophrenia, and Bi polar disorder, the medication support and psychiatric services needed to access a successful completion of Parole and is this failure to provide access to the supports and services needed by the substantially disabled mentally ill parolee a form of premeditated recidivism (http://www.google.com/search?hl=en&rlz=1T4GGIC_enUS317US317&ei=PEVoS-7KBYH-sQO5udnyBA&sa=X&oi=spell&resnum=0&ct=result&cd=1&ved=0CBMQBSgA&q=recidivism&spell=1) by CDCR?


Gentlemen,
I am an independent advocate in the county of Butte . I volunteer my time in the Butte County Court System to advocate for dual diagnosed addicts, and repeat offenders
I have known xxxxxxxxxxxxxxx for three years. He has a long history of mental illness and drug addiction. I have advocated for xxxxxxxxxxxxxxx on several occasions and he is both a client and a personal friend. To the best of my knowledge xxxxxxxxxxxxxxx has been diagnosed at Duel Vocational Institute as a Paranoid Schizophrenic and released on 1-15-2007 and diagnosed as having Bi Polar Disorder at Tehachapi State Prison and released on 12-21-2009 . Both Prisons release xxxxxxxxxxxxxxx with terminated Psychotropic medications 6-12 weeks prior to release.

Interviews with xxxxxxxxxxxxxxx family members and Parole Social worker indicate the termination of psychotropic medication prior to release was an on going experience for xxxxxxxxxxxxxxx The parole social worker expressed indifference to the termination of psychotropic medications prior to release by stating
“ What do you expect me to do about this?” when I brought it to his attention on 1-12-2010 regarding xxxxxxxxxxxxxxx terminated psychotropic medication, and then delusional belief that he was running from a warrant.

xxxxxxxxxxxxxxx suffers from both auditory hallucinations that he explains as “command voices” and delusional thinking, which he explains, as “believing.” Butte County Court records www.buttecourt.ca.gov/case (http://www.buttecourt.ca.gov/case) information indicate xxxxxxxxxxxxxxx has been arrested 9 times between 1994 and 2008 for resisting arrest, by Mr. Branches own admission he is psychotic at the point of arrest. xxxxxxxxxxxxxxx explains his history of resisting police offers and high-speed chases as responding to “command voices.” At the time of these actions, he “believes” that God is protecting him and will keep him safe. He won’t be shot because officers are “afraid” to shoot him. The bullets cannot pierce his skin because “God is protecting him.” He expresses much fascination by the “red dot” on his chest placed by the officer’s guns. He told me in detail of repeated stories of accidents and near death experiences where God kept him “safe.” xxxxxxxxxxxxxxx has been repeatedly arrested by teams over a dozen officers armed with riffles, dogs and/or helicopters. No attempt is made to 51/50 him. He is often left a PAL for up to 5 months without psychotropic medication before he is arrested for the commission of a crime.

In jail interviews with xxxxxxxxxxxxxxx xxxxxxxxxxxxxxx states that he commits crimes to be arrested, as he needs to “lock xxxxxxxxxxxxxxx up for a long time.” He has to “stop xxxxxxxxxxxxxxx” In these jail interviews, xxxxxxxxxxxxxxx is unable to connect his need to “stop xxxxxxxxxxxxxxx” with xxxxxxxxxxxxxxx need to be stabilized on psychotropic medication. Psychiatric evaluations and Psychotropic medications are not started until he is transported to prison often some 30 days later. Interviews with family members and my own personal experience indicate xxxxxxxxxxxxxxx is only stable while in prison, only receives psychotropic medications while in prison, and only believes he has mental illness while in prison. xxxxxxxxxxxxxxx is released from prison believing his substantial reoccurring disability, like his psychotropic medication, have been terminated upon release.

In 2006 xxxxxxxxxxxxxxx also was determined to suffer from a brain abnormality that causes blood vessel ruptures. As a result, he suffers from migraine headaches with vomiting, which occur almost daily. While in prison his Migraines are treated with morphine, the morphine was terminated upon from Duel Vocational Institute upon release on 1-15-2007 Between the dates of January 16, and February 6, 2008, xxxxxxxxxxxxxxx met with parole three times in an attempt to get his medication prescriptions in place. Twice between these same dates, he asked me to help him find a “psych doctor.” as parole was either unable, or unwilling, to assist him, xxxxxxxxxxxxxxx was repeatedly told by parole that he would be returning to prison with in 30 days., Consequently, xxxxxxxxxxxxxxx relapsed while withdrawing from CDCR prescribed morphine, ran from parole on 2-11-2008 and was arrested on 6-18-2008 and returned to prison for violating Drug Court and resisting arrest. On 12-21-2009 xxxxxxxxxxxxxxx was released from Tehachapi State Prison once again, with terminated psychotropic medications and indications racing thoughts, paranoia and delusions. He quickly derailed and ran again on 1-12-2010 30 less than 30 days after his release from prison.

xxxxxxxxxxxxxxx is one, substantially disabled parolee, who has had his psychotropic medications terminated prior to release, by two different California State prisons, in a very short period of time. My concern is whether CDCR is side stepping it’s obligation to serve this population of substantially disabled parolees by terminating psychotropic medications prior to release Your assistance in the investigation of this matter is greatly appreciated please feel free to forward my concern to a more appropriate respondent. Thank you,

Sincerely,




xxxxxxxxxxxxxxx
Independent Advocate
County of Butte




CC CDCR
CC CDRR OOO
CC BOPH
CC CCDP

CC ACLU
CC DRC

CC SAN FRANCISCO CHRONICLE
CC LA TIMES
CC CHICO NEWS AND REVIEWS

The above letter was delivered to the DA within the 48 window prior to arraignment. All 5 charges:
Possession
Possession- syringe
UTI
Resisting arrest
Driving on a suspended

Were dropped-lack of capacity to do the crime
I am now waiting the results of the Parole hearing

Naghten Rule:

A test applied to determine whether a person accused of a crime was sane at the time of its commission and, therefore, criminally responsible for the wrongdoing.
The M'Naghten rule is a test for criminal insanity. Under the M'Naghten rule, a criminal defendant is not guilty by reason of insanity if, at the time of the alleged criminal act, the defendant was so deranged that she did not know the nature or quality of her actions or, if she knew the nature and quality of her actions, she was so deranged that she did not know that what she was doing was wrong.
The M'Naghten rule on criminal insanity is named for Daniel M'Naghten, who, in 1843, tried to kill England's prime minister Sir Robert Peel. M'Naghten thought Peel wanted to kill him, so he tried to shoot Peel but instead shot and killed Peel's secretary, Edward Drummond. Medical experts testified that M'Naghten was psychotic, and M'Naghten was found not guilty by reason of insanity.
The public chafed at the verdict, and the House of Lords in Parliament ordered the Lords of Justice of the Queen's Bench to fashion a strict definition of criminal insanity. The Lords of Justice complied and declared that insanity was a defense to criminal charges only if
at the time of the committing of the act, the party accused was labouring under such a defect of reason, from a disease of the mind, as not to know the nature and quality of the act he was doing; or, if he did know it, that he did not know he was doing what was wrong. (Queen v. M'Naghten, 8 Eng. Rep. 718 [1843])
The aim of the M'Naghten rule was to limit the Insanity Defense (http://legal-dictionary.thefreedictionary.com/Insanity+Defense) to cognitive insanity, a basic inability to distinguish right from wrong. Other tests formulated by legislatures and courts since M'Naghten have supplemented the M'Naghten rule with another form of insanity called volitional insanity. Volitional insanity is experienced by mentally healthy persons who, although they know what they are doing is wrong, are so mentally unbalanced at the time of the criminal act that they are unable to conform their actions to the law.
The M'Naghten rule was adopted in most jurisdictions in the United States, but legislatures and courts eventually modified and expanded the definition. The definition of criminal insanity now varies from jurisdiction to jurisdiction, but most of them have been influenced by the M'Naghten rule.
Many jurisdictions reject volitional insanity but retain cognitive insanity with a minor variation on the M'Naghten definition. Under the M'Naghten rule, a person was legally insane if she was so deranged that she did not know what she was doing. Under many current statutes, a person is legally insane if she is so deranged that she lacks substantial capacity to appreciate the criminality of her conduct.
The difference between the two definitions is largely theoretical. In theory, the latter definition is more lenient because it requires only that a person lack substantial capacity to appreciate her conduct.

Parole hearing gave him 90 day program