what i've learned from a co-occurring disorder


10 things i've learned from having a co-occurring disorder -- a dual diagnosis


  1. I learned the hard way that bipolar is not compatible with alcohol. They're a bad combination because the co-occurring disorder -- the substance abuse -- seriously hinders the work required for maintaining mental illness health. It also hinders your ability to have accurate insight; it blocks your ability to perceive and fully understand that you have an illness and a problem that needs treatment.

  2. I found it can be so easy and tempting to self-medicate. I thought I was just helping my psychiatric meds, just helping my sleep, just helping to dampen my rising hypomanias --- I thought I had good reasons to have a few drinks each night. I learned too late that alcohol abuse gets slowly and steadily worse -- and is far too much to handle without professional help.

  3. Using alcohol to get sleep when you have bipolar -- in my experience, the substance abuse masks and hides what you need to know about your mental illness, and you don't see the things that you need to tell your doctor about. I was taking my meds -- but my hypomanias were getting stronger, and I was getting less and less sleep. These were important developments in my bipolar, that my doctor needed to know about, but I didn't even realize them, because I self-medicated to fall asleep. I never saw the initial signs. I was unintentionally masking the facts that I needed to know. This led to my rock bottom.

  4. In my experience, abusing alcohol destroys the very hope you need. It's hard to believe in a better future when you're stuck in a downward spiral of inertia and inaction lets time slip away and that breeds self-hatred, shame, and self-pity.

  5. I learned that alcohol -- or any substance -- is a false substitute for taking the little steps of daily action that build real hope. Instead of building support teams, I stayed secret. Instead of seeking inclusion, I stayed isolated from friends. Self-medicating with alcohol each night, to fall asleep, did nothing to help that. I spent nights thinking and wishing, or distracting myself with movies and sports and TV, but I didn't take any actual action. That just accelerated my trip towards rock bottom.

  6. It's hard to break bad habits and form new habits -- especially about addictive things -- especially about alcohol, which is so inexorably intertwined with our society and culture. Alcohol is everywhere in our society and culture, and it is considered socially acceptable. It’s everywhere in our media. It’s known and seen by every kid. I used this cultural acceptance to excuse my escalating self-medication abuse -- wasn't I just doing what everyone else does to unwind? Aren’t I showing how cultured I am by having this craft beer or this glass of wine? This prevented me from realizing the growing addiction. And it prevented me from realizing I had bad habits around alcohol that I needed to fully break.

  7. In my experience, there does come a time when action -- the little steps of recovery each day, ending the old habits, practicing the new habits -- when these action steps will lift the fog from substance abuse, leaving your mind and body ready to begin the work of creating hope for yourself. And the work of creating a concretely better life, too. In my experience, the feelings of joy and contentment that come from taking action steps, and being present in life with my loved ones — those are much nicer feelings, and much more real, than the false ones I used to get from fancy beer or wine.

  8. My experience is that recovery from a co-occurring disorder requires a medicine, but it is not a prescribed medicine from a doctor. Rather, the medicine is doing the work of recovery. In my experience, you need two medicines for co-occurring disorders -- the meds from your psychiatrist, for your mental illness -- and the medicine of daily steps, to maintain sobriety and substance abuse recovery. Both have been essential for me in my recovery these six years.

  9. In my experience, the elements of 12-step programs work very well -- but you have to do the work, every day. You have to take action -- including doing the suggestions of your support teams and your doctor, as well as your trusted peers in your 12-step world. These are just some of the daily action steps. But they do build traction; they give you a chance at staying sober, and they help you build and strengthen your hope.

  10. Apparently, recovery in a co-occurring diagnosis situation can be very difficult. Long odds. Likely relapses. I have not had this experience, but I have had setbacks. Life events have occurred, and sometimes I lose a little bit of focus, and take a bit less action, from time to time. If you take a step backwards, or if you relapse, be patient with yourself, and forgive yourself, and start taking action right away again. This is about improvement, not turning in a perfect record. I've learned that part of hope, and part of trusting yourself, is letting yourself, without judgment, get back on your feet after a setback, whether it's big or small. Just start doing the small steps of daily action again, to get that traction that builds hope.