An astounding development is the explosion in the numbers of substance abusers being diagnosed with Bipolar. I teach a class in Substance Abuse at Georgia State. Typically, this course draws persons in recovery. In the early 1990s, most were recovering alcoholics. Now, with the current prescription drug epidemic (think oxycontin), the recovering addicts tend to be people addicted to some type of opioid drug. Invariably, my recovering students offer details about their Bipolar II disorders. For those students working in treatment centers and who are assigned the task of passing out the meds, they marvel at the numbers on the atypical antipsychotic, Seroquel.
Since the early 1970s when the genetic case for alcoholism found research support, it has been known that alcoholics are more likely to score high on the MacAndrew scale of the Minnesota Multiphasic Personality Inventory. The MacAndrew scale measures an upbeat, risk-taking, extroverted personality. Persons with high scores on the MacAndrew scale endorse such statements as “I like to talk with strangers on buses.” In the early 1970s, Kammeier, Hoffman, and Loper took advantage of the fact that at the University of Minnesota the entire freshman class took the MMPI. Kammeier et al. followed up on the high scorers on the MacAndrew scale. Not surprisingly, those who were the high MacAndrew scale scorers were more likely to be drinking heavily at age 40 than the low scorers. Thus, traits of enthusiasm, high energy levels, and extroversion describe a lot of alcoholics. Anyone who has ever been to an AA meeting knows this to be true. Most of them like to laugh and most of them have a sense of humor. They are an adventurous lot. But, guess what, that means they will meet criteria for Bipolar II disorder.
For those of us who were in the field during the 1970 and 1980s, medicating substance abusers is really hard to grasp. In the 70s and 80s, and indeed for those in AA since its inception in 1935, many substance abusers would have met criteria for Bipolar II if the diagnosis had existed. They all recovered from alcoholism and drug addiction in AA without any drugs at all (except for the coffee). Their lives became dramatically better, once they found sobriety. They did not require any pharmaceutical interventions; they just went to meetings. But, now, with the modern take on treatment and the new diagnosis of Bipolar II, they will receive a prescription for lithium, which destroys kidneys; an anticonvulsant, which is toxic to the liver; or for an atypical antipsychotic, which shrinks the brain cortex. Modern treatments have made things considerably worse. Ironically, the street drugs were arguably less toxic than modern medical treatments. Alcohol takes a good twenty years to destroy the brain. According to animal work cited by Ho et al. (2011), Seroquel only takes 2 years to reduce cortex volume. Heroin does not really do much to the organ systems of the body, (although you can easily die of an overdose). In contrast, the antipsychotics and antidepressants increase risk for weight gain, Type 2 diabetes, osteoporosis, and movement disorders.
For recovering substance abusers, who will attend a least a couple of AA meetings, taking psychotropic meds creates dissonance. At the AA meetings, recovering people are told to abstain from mood and mind altering chemicals. In Twelve Step treatment programs of the past, an importuning addict asking for a chemical to relieve his/her distress would be told to go to a meeting. Lining up for drugs just is not part of the Twelve Step recovery program. Most people who are familiar with AA are struck by what a positive philosophy the program offers. Rather than self-focus (a recipe for depression), the program stresses gratitude and service to others. Indeed, the AA philosophy is remarkably similar to the treatment for depression designed by Giovanni Fava.
Presently, recovery centers are hiring psychiatrists with traditional pharmacotherapy training. They are passing out the meds. But, again the meds are antithetical to the articles of faith of the Twelve Step program. Because they are Twelve Steppers, many recovering individuals might be looking for help which truly is free from mood and mind altering chemicals. Perhaps Twelve Step treatment programs might offer a home for psychiatrists who wish to discontinue dependence on the prescription pad. Here psychiatrists might be able to practice without violating the Hippocratic oath: First, do no harm.
Fava, G. A. & Tomba, E. (2009). Increasing psychological well-being and resilience by psychotherapeutic methods. Journal of Personality, 77, 1903-1934.
Kammeier, M.L., Hoffman, H., & Loper, R. G. (1973). Personality characteristics of alcoholics as college freshman and at time of treatment. Quarterly Journal of Studies on Alcohol, 34, 390-399.